Chapter 01
1. 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? [Multiple Choice]
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.DIF: Application REF: p. 6 TOP: Integrated Process: Communication and Documentation MSC:
Physiological Integrity: Basic Care and Comfort
2. According to Swanson’s theory, there are five caring processes, one of which is “knowing.” What are the other
four? [Multiple Choice]
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)DIF: Knowledge/Comprehension REF: p. 6 TOP: Integrated Process:
CaringMSC: Safe and Effective Care Environment: Management of Care
3. 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? [Multiple Choice]
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.DIF: Analysis REF: p. 8 TOP: Integrated Process: Communication and Documentation MSC: Safe and
Effective Care Environment: Management of Care
4. 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? [Multiple Choice]
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.DIF: Analysis REF: p. 7 TOP:
Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management
of Care
5. 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? [Multiple Choice]
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.DIF: Application REF: p. 13 TOP: Integrated Process: CaringMSC:
Safe and Effective Care Environment: Management of Care
,6. Which are examples of a nurse who is communicating responsibly? (Select all that apply.) [Multiple Response]
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.DIF: Application REF: pp. 11-12
TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity
7. 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? [Multiple Choice]
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.DIF: Analysis REF: p. 6 TOP: Integrated Process: Communication and
Documentation MSC: Safe and Effective Care Environment: Management of Care
, 8. Which nonverbal action(s) would be consistent with an assertive style of communication? (Select all that
apply.) [Multiple Response]
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.DIF: Comprehension REF: pp. 11-12 TOP: Integrated Process: Communication and Documentation
MSC: Psychosocial Integrity
9. Which statement describes the affective aspect of learning effective communication strategies? [Multiple Choice]
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.DIF: Comprehension REF: p. 13
TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity
10. 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? [Multiple Choice]
a. Authoritative, honest, and outright communication
b. Assertive, responsible, and caring communication ✔
c. Aggressive, sympathetic, and realistic communication
1. 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? [Multiple Choice]
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.DIF: Application REF: p. 6 TOP: Integrated Process: Communication and Documentation MSC:
Physiological Integrity: Basic Care and Comfort
2. According to Swanson’s theory, there are five caring processes, one of which is “knowing.” What are the other
four? [Multiple Choice]
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)DIF: Knowledge/Comprehension REF: p. 6 TOP: Integrated Process:
CaringMSC: Safe and Effective Care Environment: Management of Care
3. 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? [Multiple Choice]
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.DIF: Analysis REF: p. 8 TOP: Integrated Process: Communication and Documentation MSC: Safe and
Effective Care Environment: Management of Care
4. 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? [Multiple Choice]
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.DIF: Analysis REF: p. 7 TOP:
Integrated Process: Communication and Documentation MSC: Safe and Effective Care Environment: Management
of Care
5. 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? [Multiple Choice]
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.DIF: Application REF: p. 13 TOP: Integrated Process: CaringMSC:
Safe and Effective Care Environment: Management of Care
,6. Which are examples of a nurse who is communicating responsibly? (Select all that apply.) [Multiple Response]
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.DIF: Application REF: pp. 11-12
TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity
7. 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? [Multiple Choice]
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.DIF: Analysis REF: p. 6 TOP: Integrated Process: Communication and
Documentation MSC: Safe and Effective Care Environment: Management of Care
, 8. Which nonverbal action(s) would be consistent with an assertive style of communication? (Select all that
apply.) [Multiple Response]
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.DIF: Comprehension REF: pp. 11-12 TOP: Integrated Process: Communication and Documentation
MSC: Psychosocial Integrity
9. Which statement describes the affective aspect of learning effective communication strategies? [Multiple Choice]
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.DIF: Comprehension REF: p. 13
TOP: Integrated Process: Communication and Documentation MSC: Psychosocial Integrity
10. 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? [Multiple Choice]
a. Authoritative, honest, and outright communication
b. Assertive, responsible, and caring communication ✔
c. Aggressive, sympathetic, and realistic communication
