Exam 1 Material
Chapter 1: Responsible, Assertive, Caring Communication in Nursing
Multiple Choice
1. Which statement describes the affective aspect of learning effective communication strategies?
a. “The nurse should use clear, direct statements using objective words.”
b. “The nurse uses body language that is congruent with the verbal message.”
c. “The nurse believes that positive communication strategies build confidence.”
d. “The nurse practices assertive and responsible communication strategies.”
ANS: C
Learning involves three domains: the cognitive aspects (understanding and meaning), affective aspects (feelings, values, and
attitudes), and psychomotor aspects (physical capability).Learning basic communication skills involves the cognitive domain;
building confidence through a belief in the value and impact of positive communication is the affective domain; and putting skills
into action is the psychomotor domain.
2. The nurse manager asks the staff nurse to work an extra shift. Which response by the staff nurse is assertive and based on rational
beliefs?
a. “I don’t want you upset, so I will work extra.”
b. “Why do I always have to cover extra shifts?”
c. “I am not able to work an extra shift.”
d. “If you can’t find anyone else, I will do it.”
ANS: C
The staff nurse may turn down even a reasonable request; an assertive response avoids irrational beliefs. Irrational beliefs occur as
a result of being anxious about assertiveness or focusing on possible negative outcomes.
3. A nurse manager offers a staff nurse a choice between working 8- or 12-hour shifts. Which statement, if made by the staff nurse,
is nonassertive and may result in a frustrated response from the nurse manager?
a. “I want to decide the shifts for all of the other staff nurses.”
b. “Do whatever you want. It doesn’t really matter to me.”
c. “Thank you for offering me a choice. I prefer 12-hour shifts.”
d. “You will never be able to give me what I really want to work.”
ANS: B
A statement that allows others to make decisions for a person is an example of a nonassertive style of communication; the
response of others to a nonassertive statement may include disrespect, guilt, anger, or frustration. Statements that make choices
for others or that are accusations are examples of aggressive styles of communication; the response of others to an aggressive
statement may include hurt, defensiveness, or humiliation. A statement that allows making one’s own decisions is an example of
assertive style of communication; the response of others to an assertive statement may include mutual respect.
4. The nurse is providing care to a patient who was admitted with heart failure. The patient has not been following the prescribed
diet or taking the prescribed medications. Which type of communication approach is most important for the nurse to use with this
patient to facilitate a change in self-care behavior?
a. Authoritative, honest, and outright communication
b. Assertive, responsible, and caring communication
c. Aggressive, sympathetic, and realistic communication
d. Positive, expert, and focused communication
ANS: B
Communication must be technically responsible, assertive, and caring to facilitate a change in behavior.
5. Which are examples of a nurse who is communicating responsibly? (Select all that apply)
a. The nurse uses profanity to respond to a client who is intoxicated and verbally abusive.
b. The nurse helps a client talk to family members about discontinuing chemotherapy.
c. The nurse uses interpersonal strategies to help a client develop methods of coping.
d. The nurse provides a client’s health information to a close relative who is visiting.
e. The nurse listens carefully to the client’s concern about inadequate pain relief.
ANS: B, C, E
, A nurse who communicates responsibly will perform the role of a client advocate, will consider the world of the client and the
client’s family, and will naturally focus on the nursing process and problem-solving process. The nurse is responsible for
maintaining the professional conduct of the relationship. Examples of unprofessional conduct would include breaching client
confidentiality or verbally abusing a client.
6. According to Swanson’s theory, there are five caring processes, one of which is “being with.” Which of the responses by the nurse
portrays an understanding of the concept of “being with” a client?
a. The nurse charting in the room to spend more time with the client
b. The nurse wearing locator badge so you can quickly respond any time patient would call front desk and ask to page you
c. The nurse requesting one-on-one nurse staffing
d. The nurse being emotionally present to the client
ANS: D
Caring is an essential ingredient in life and must characterize the nurse–client relationship…. Consider Swanson’s five caring
processes (Swanson, 1993):1) Maintaining belief—sustaining faith in the capacity of others to transition and have meaningful
lives2) Knowing—striving to understand events as they have meaning in the life of the other3) Being with—being emotionally
present to the other4) Doing for—doing for others what they would do for themselves if possible5) Enabling—facilitating the
capacity of others to care for themselves and family members (Tonges and Ray, 2011, p. 375)
7. According to Swanson’s theory, there are five caring processes, one of which is “knowing.” What are the other four?
a. Communication, assertiveness, responsibility, and caring
b. Maintaining belief, being with, doing for, and enabling
c. Understanding, action, information, and comfort
d. Maintaining belief, being with, enabling, and supporting
ANS: B
Caring is an essential ingredient in life and must characterize the nurse–client relationship…. Consider Swanson’s five caring
processes (Swanson, 1993):1) Maintaining belief—sustaining faith in the capacity of others to transition and have meaningful
lives2) Knowing—striving to understand events as they have meaning in the life of the other3) Being with—being emotionally
present to the other4) Doing for—doing for others what they would do for themselves if possible5) Enabling—facilitating the
capacity of others to care for themselves and family members (Tonges and Ray, 2011, p. 375)
8. The charge nurse informs a staff nurse that it is her turn to float to another unit. Which response by the staff nurse is aggressive?
a. “I had such a bad experience last time. Please send another nurse instead of me.”
b. “I will miss working with you today, but I understand that it is my turn to float.”
c. “I will not survive on the other unit. The staff are always too busy to help me.”
d. “I will float, but you’ll be sorry. You cannot handle emergencies without me.”
ANS: D
An aggressive response is forceful and confrontational; the person using an aggressive approach will place his or her needs first
and respect for others is lacking. A nonassertive response is apologetic; the person frequently puts himself or herself down. An
assertive response is clear, direct, confident, and honest.
9. A client has high blood pressure and needs to learn about a low-sodium diet. Which question if asked by the client would be an
indirect request for information?
a. “How should I prepare food without adding salt?”
b. “What will I do to make food taste better?”
c. “What diet changes are needed to control my blood pressure?”
d. “What foods should I avoid that are high in sodium?”
ANS: B
Indirect requests for information are not obvious, and the meaning must be interpreted by the nurse. “What will I do to make food
taste better?” is an indirect request for information; the nurse must interpret this question as a request for information about a low-
sodium diet. The other questions are direct requests for information on a low-sodium diet.
10. The nurse plans to delegate a client’s personal hygiene to a nursing assistant. Which statement if made by the nurse to the nursing
assistant is assertive?
, a. “Would you mind helping the client with a bath when you have time? If not, I will skip my lunch and do it myself.”
b. “You never get your work done and are always on the phone. You need to help the client right now with a bath, or I will write
you up.”
c. “The client needs help with bathing. I want you to assist the client now, and you can go to lunch when you are finished.”
d. “I have important work to complete this morning. You will assist the client with a bath. Do not take a break until you have
finished.”
ANS: C
An assertive statement is clear, direct, and respectful; the nurse should use assertive rights, avoid irrational beliefs, and use the
Describe Express Specify Consequence script to formulate an assertive response. Describe: “The client needs help with bathing.”
Express and Specify: “I want you to assist the client now.” Consequence: “You can go to lunch when you are finished.” The other
statements are nonassertive or aggressive: “Would you mind helping the client with a bath when you have time? If not, I will skip
my lunch and do it myself.” is nonassertive, hesitant, and apologetic. “You never get your work done and are always on the
phone. You need to help the client right now with a bath, or I will write you up.” is aggressive, blaming, and negative. “I have
important work to complete this morning. You will assist the client with a bath. Do not take a break until you have finished.” is
aggressive, sarcastic, uncaring, and superior.
11. A hospital nurse is concerned about the demands of providing safe care to clients who are seriously ill. The nurse manager should
suggest which intervention to effectively help the nurse balance the demanding work in the hospital setting?
a. Delegate more tasks to the unlicensed nursing personnel on the unit.
b. Request a transfer to another nursing care unit with patients who are stable.
c. Write down stories in a journal about how caring makes a difference for patients.
d. Use an assertive communication style for every patient–nurse interaction.
ANS: C
Caring is the moral ideal that guides nurses through the caregiving process. Although there is satisfaction in being technologically
competent, that satisfaction is not as lasting as the satisfaction derived from meaningful moments of connection with clients,
family, and colleagues.
12. Which nonverbal action(s) would be consistent with an assertive style of communication? (Select all that apply)
a. Relaxed posture
b. Established eye contact
c. Hands placed on hips
d. Distant, soft voice
e. Mask-like facial expression
ANS: A, B
Assertive styles of communication that are nonverbal include a relaxed stance and eyes that are warm, in contact, and frank.
Aggressive styles of communication that are nonverbal include expressionless, cold, narrowed, or staring eyes and hands placed
on hips. A weak, distant, soft voice is a nonassertive style of nonverbal communication.
Chapter 2: The Client-Nurse Relationship: A Helping Relationship
Multiple Choice
1. The nurse cares for a patient who has just been diagnosed with lung cancer. Which statement by the nurse is therapeutic?
a. “You sound really frightened about your diagnosis of cancer.”
b. “You will get better because the treatment will be started this week.”
c. “I think you should take a vacation and try to forget about the cancer.”
d. “An apple a day will keep the doctor away.”
ANS: A
Reflecting helps the patient to clarify feelings and is a therapeutic communication technique. Reassuring (i.e., “you will be okay”)
negates fears and feelings of the patient. Getting advice (i.e., declaration to the patient of what the nurse thinks) negates the worth
Chapter 1: Responsible, Assertive, Caring Communication in Nursing
Multiple Choice
1. Which statement describes the affective aspect of learning effective communication strategies?
a. “The nurse should use clear, direct statements using objective words.”
b. “The nurse uses body language that is congruent with the verbal message.”
c. “The nurse believes that positive communication strategies build confidence.”
d. “The nurse practices assertive and responsible communication strategies.”
ANS: C
Learning involves three domains: the cognitive aspects (understanding and meaning), affective aspects (feelings, values, and
attitudes), and psychomotor aspects (physical capability).Learning basic communication skills involves the cognitive domain;
building confidence through a belief in the value and impact of positive communication is the affective domain; and putting skills
into action is the psychomotor domain.
2. The nurse manager asks the staff nurse to work an extra shift. Which response by the staff nurse is assertive and based on rational
beliefs?
a. “I don’t want you upset, so I will work extra.”
b. “Why do I always have to cover extra shifts?”
c. “I am not able to work an extra shift.”
d. “If you can’t find anyone else, I will do it.”
ANS: C
The staff nurse may turn down even a reasonable request; an assertive response avoids irrational beliefs. Irrational beliefs occur as
a result of being anxious about assertiveness or focusing on possible negative outcomes.
3. A nurse manager offers a staff nurse a choice between working 8- or 12-hour shifts. Which statement, if made by the staff nurse,
is nonassertive and may result in a frustrated response from the nurse manager?
a. “I want to decide the shifts for all of the other staff nurses.”
b. “Do whatever you want. It doesn’t really matter to me.”
c. “Thank you for offering me a choice. I prefer 12-hour shifts.”
d. “You will never be able to give me what I really want to work.”
ANS: B
A statement that allows others to make decisions for a person is an example of a nonassertive style of communication; the
response of others to a nonassertive statement may include disrespect, guilt, anger, or frustration. Statements that make choices
for others or that are accusations are examples of aggressive styles of communication; the response of others to an aggressive
statement may include hurt, defensiveness, or humiliation. A statement that allows making one’s own decisions is an example of
assertive style of communication; the response of others to an assertive statement may include mutual respect.
4. The nurse is providing care to a patient who was admitted with heart failure. The patient has not been following the prescribed
diet or taking the prescribed medications. Which type of communication approach is most important for the nurse to use with this
patient to facilitate a change in self-care behavior?
a. Authoritative, honest, and outright communication
b. Assertive, responsible, and caring communication
c. Aggressive, sympathetic, and realistic communication
d. Positive, expert, and focused communication
ANS: B
Communication must be technically responsible, assertive, and caring to facilitate a change in behavior.
5. Which are examples of a nurse who is communicating responsibly? (Select all that apply)
a. The nurse uses profanity to respond to a client who is intoxicated and verbally abusive.
b. The nurse helps a client talk to family members about discontinuing chemotherapy.
c. The nurse uses interpersonal strategies to help a client develop methods of coping.
d. The nurse provides a client’s health information to a close relative who is visiting.
e. The nurse listens carefully to the client’s concern about inadequate pain relief.
ANS: B, C, E
, A nurse who communicates responsibly will perform the role of a client advocate, will consider the world of the client and the
client’s family, and will naturally focus on the nursing process and problem-solving process. The nurse is responsible for
maintaining the professional conduct of the relationship. Examples of unprofessional conduct would include breaching client
confidentiality or verbally abusing a client.
6. According to Swanson’s theory, there are five caring processes, one of which is “being with.” Which of the responses by the nurse
portrays an understanding of the concept of “being with” a client?
a. The nurse charting in the room to spend more time with the client
b. The nurse wearing locator badge so you can quickly respond any time patient would call front desk and ask to page you
c. The nurse requesting one-on-one nurse staffing
d. The nurse being emotionally present to the client
ANS: D
Caring is an essential ingredient in life and must characterize the nurse–client relationship…. Consider Swanson’s five caring
processes (Swanson, 1993):1) Maintaining belief—sustaining faith in the capacity of others to transition and have meaningful
lives2) Knowing—striving to understand events as they have meaning in the life of the other3) Being with—being emotionally
present to the other4) Doing for—doing for others what they would do for themselves if possible5) Enabling—facilitating the
capacity of others to care for themselves and family members (Tonges and Ray, 2011, p. 375)
7. According to Swanson’s theory, there are five caring processes, one of which is “knowing.” What are the other four?
a. Communication, assertiveness, responsibility, and caring
b. Maintaining belief, being with, doing for, and enabling
c. Understanding, action, information, and comfort
d. Maintaining belief, being with, enabling, and supporting
ANS: B
Caring is an essential ingredient in life and must characterize the nurse–client relationship…. Consider Swanson’s five caring
processes (Swanson, 1993):1) Maintaining belief—sustaining faith in the capacity of others to transition and have meaningful
lives2) Knowing—striving to understand events as they have meaning in the life of the other3) Being with—being emotionally
present to the other4) Doing for—doing for others what they would do for themselves if possible5) Enabling—facilitating the
capacity of others to care for themselves and family members (Tonges and Ray, 2011, p. 375)
8. The charge nurse informs a staff nurse that it is her turn to float to another unit. Which response by the staff nurse is aggressive?
a. “I had such a bad experience last time. Please send another nurse instead of me.”
b. “I will miss working with you today, but I understand that it is my turn to float.”
c. “I will not survive on the other unit. The staff are always too busy to help me.”
d. “I will float, but you’ll be sorry. You cannot handle emergencies without me.”
ANS: D
An aggressive response is forceful and confrontational; the person using an aggressive approach will place his or her needs first
and respect for others is lacking. A nonassertive response is apologetic; the person frequently puts himself or herself down. An
assertive response is clear, direct, confident, and honest.
9. A client has high blood pressure and needs to learn about a low-sodium diet. Which question if asked by the client would be an
indirect request for information?
a. “How should I prepare food without adding salt?”
b. “What will I do to make food taste better?”
c. “What diet changes are needed to control my blood pressure?”
d. “What foods should I avoid that are high in sodium?”
ANS: B
Indirect requests for information are not obvious, and the meaning must be interpreted by the nurse. “What will I do to make food
taste better?” is an indirect request for information; the nurse must interpret this question as a request for information about a low-
sodium diet. The other questions are direct requests for information on a low-sodium diet.
10. The nurse plans to delegate a client’s personal hygiene to a nursing assistant. Which statement if made by the nurse to the nursing
assistant is assertive?
, a. “Would you mind helping the client with a bath when you have time? If not, I will skip my lunch and do it myself.”
b. “You never get your work done and are always on the phone. You need to help the client right now with a bath, or I will write
you up.”
c. “The client needs help with bathing. I want you to assist the client now, and you can go to lunch when you are finished.”
d. “I have important work to complete this morning. You will assist the client with a bath. Do not take a break until you have
finished.”
ANS: C
An assertive statement is clear, direct, and respectful; the nurse should use assertive rights, avoid irrational beliefs, and use the
Describe Express Specify Consequence script to formulate an assertive response. Describe: “The client needs help with bathing.”
Express and Specify: “I want you to assist the client now.” Consequence: “You can go to lunch when you are finished.” The other
statements are nonassertive or aggressive: “Would you mind helping the client with a bath when you have time? If not, I will skip
my lunch and do it myself.” is nonassertive, hesitant, and apologetic. “You never get your work done and are always on the
phone. You need to help the client right now with a bath, or I will write you up.” is aggressive, blaming, and negative. “I have
important work to complete this morning. You will assist the client with a bath. Do not take a break until you have finished.” is
aggressive, sarcastic, uncaring, and superior.
11. A hospital nurse is concerned about the demands of providing safe care to clients who are seriously ill. The nurse manager should
suggest which intervention to effectively help the nurse balance the demanding work in the hospital setting?
a. Delegate more tasks to the unlicensed nursing personnel on the unit.
b. Request a transfer to another nursing care unit with patients who are stable.
c. Write down stories in a journal about how caring makes a difference for patients.
d. Use an assertive communication style for every patient–nurse interaction.
ANS: C
Caring is the moral ideal that guides nurses through the caregiving process. Although there is satisfaction in being technologically
competent, that satisfaction is not as lasting as the satisfaction derived from meaningful moments of connection with clients,
family, and colleagues.
12. Which nonverbal action(s) would be consistent with an assertive style of communication? (Select all that apply)
a. Relaxed posture
b. Established eye contact
c. Hands placed on hips
d. Distant, soft voice
e. Mask-like facial expression
ANS: A, B
Assertive styles of communication that are nonverbal include a relaxed stance and eyes that are warm, in contact, and frank.
Aggressive styles of communication that are nonverbal include expressionless, cold, narrowed, or staring eyes and hands placed
on hips. A weak, distant, soft voice is a nonassertive style of nonverbal communication.
Chapter 2: The Client-Nurse Relationship: A Helping Relationship
Multiple Choice
1. The nurse cares for a patient who has just been diagnosed with lung cancer. Which statement by the nurse is therapeutic?
a. “You sound really frightened about your diagnosis of cancer.”
b. “You will get better because the treatment will be started this week.”
c. “I think you should take a vacation and try to forget about the cancer.”
d. “An apple a day will keep the doctor away.”
ANS: A
Reflecting helps the patient to clarify feelings and is a therapeutic communication technique. Reassuring (i.e., “you will be okay”)
negates fears and feelings of the patient. Getting advice (i.e., declaration to the patient of what the nurse thinks) negates the worth
