Collab. NCLEX
When performing collaborative health care, what must the nurse implement?
1. Assume a leadership role in directing the healthcare team.
2. Rely on the expertise of other healthcare team members.
3. Be physically present for the implementation of all aspects of the care plan.
4.Delegate decision-making authority to each healthcare provider.
2. Rely on the expertise of other healthcare team members.
x In collaboration, each member of the team, including the client, participates in sharing ideas and reaching consensus on the best plan of care. The team is generally led by the healthcare professional most skilled in the client’s specific areas of need. Once the plan is established, it may be implemented by any member of the team or a designate at an appropriate time or place. It is not necessarily delegated by the nurse.x
A client is scheduled for a lumbar puncture to rule out bacterial meningitis. She tells the nurse that she is fearful of becoming paralyzed from the needle being placed into her spinal column. Which of the following responses should the nurse make?
1. "Let's not focus on the negative. Let's focus on getting better."
2. "Why are you feeling so anxious about this procedure?"
3. "The needle is inserted below the third lumbar vertebrae, well below the point at which the spinal cord ends."
4. "Your doctor is very skilled in this procedure. Everything will be alright."
3. "The needle is inserted below the third lumbar vertebrae, well below the point at which the spinal cord ends."
x This is a therapeutic response that provides information that specifically addresses the client's concerns and helps to decrease anxiety and fears
What does the SOLER technique for active listening entail?
Squarely face the person,
Open your body position,
Lean toward the person
Eye contact (if appropriate)
Relax
The primary care physician has recommended to the nurse that the client be discharged to a rehabilitation center for further care. The nurse discusses the recommendation with the family and client, who decides that this is not what they want to do. What is the nurse’s next action?
1. Tell the family that this is the physician’s order.
2. Notify the case manager that the family is noncompliant.
3. Discuss available acceptable options with the family.
4.Notify the physician about the family’s decision.
3. Discuss available acceptable options with the family.
x The family and client are a part of the collaborative team. If the family does not favor a recommendation, the nurse explores other options open to the client, such as home health care, and then communicates the client’s wishes to the team. It is not appropriate to tell the family that this is the doctor’s order because clients have a voice in care decisions. The case manager can be notified to help the nurse present other options, but not that the family is noncompliant. The physician may be notified of the need for other options as part of the team.
A nurse is caring for a client who has Type 1 diabetes mellitus and is to receive hemodialysis. The client says. "I don't even know why I'm doing this. There is no cure." Which of the following statements should the nurse make?
1. It sounds as though you have given up
2. Dialysis will help you live longer
3. You shouldn't complain. You are fortunate to have this option available to you.
4. Let's talk about what you are going to do after dialysis today
1. It sounds as though you have given up
x The nurse is using the therapeutic communication technique of restatement to encourage the expression of feelings
What are some important aspects of verbal communication?
Pace & intonation, simplicity, clarity, brevity, timing, relevance, adaptability, credibility, humor (if appropriate)
The home health nurse has made a visit to a client who is receiving several therapies by health team members in the home for arthritis and postoperative care. Upon return to the home health office, what does the nurse plan to do?
1. Communicate the client’s status to the rest of the team.
2. Review the cases on the schedule for the next day.
3. Report to the manager the findings of the home visit.
4.Call the client to reinforce teaching that was introduced that day.
1. Communicate the client’s status to the rest of the team.
x The client is receiving several therapies, so the nurse would communicate with team members regarding the client’s current status and progress in collaboration. Reviewing the cases for the next day may or may not be necessary. It is not necessary to report to the manager unless there is a system problem. Calling the client is probably not necessary because the nurse would evaluate client understanding of teaching before leaving the home.
A nurse is caring for a 13-year-old female client who is admitted for an emergency appendectomy. While the nurse is providing the preoperative teaching, the client asks, "Will I have a large scar from the surgery?" Which of the following responses should the nurse make?
1. "It will be small enough that it won't show when you're wearing a bathing suit"
2. "That isn't our biggest concern right now. You will be fine."
3. "You should be happy. You won't be in pain for much longer."
4. "What is your favorite class in school?"
1. "It will be small enough that it won't show when you're wearing a bathing suit"
x This is a therapeutic response because the nurse is providing information specific to the client's concern. The nurse recognizes that body-image is an important issue for adolescents. This response allays fears that the client might be having.
What are the components of SBAR communication?
Situation
Background
Assessment
Recommendation
A 73-year-old client is in the hospital for pneumonia for the third time in six months. During the nursing history, the nurse discovers that the client has few financial resources, lives alone, and has not received needed immunizations. To provide excellence in care, what should the nurse prioritize?
1.Request consultations with other disciplines.
2.Recommend that the client remains in the hospital until well.
3. Request an order from the physician for long-term care.
4.Tell the client of the need to move to long-term care.
1.Request consultations with other disciplines.
x
Many older adults choose to remain in their own homes to care for themselves. In today’s world, the nurse recognizes that, with the proper resources, this is a possibility. The nurse might request a social worker and a nutritionist to help the client with home care resources, and might also ask the physician for the appropriate immunizations. Considering the cost of health care, the client can recuperate at home with the appropriate resources.
The client may not want or need long-term care and should be consulted prior to making that decision. The nurse might discuss the advantages of long-term care with the client, but would not tell the client to move to it.x
An emergency department nurse takes a telephone call from a client who states, "I have just taken 100 amitriptyline tablets to kill myself." The client is crying and says, "I want to die. I have no reason to live." Which of the following responses should the nurse make?
1. Please stay on the phone with me so we can talk about your feelings
2. Why do you think you have no reason to leave
3. How do you feel about what you have just done?
4. This is a nontherapeutic response because the nurse is falsely reassuring the client and this can cause the client to stop sharing his feelings
1. Please stay on the phone with me so we can talk about your feelings
x. This is a therapeutic response because the nurse has given the client opportunity to share his feelings. The nurse is also encouraging the client to stay on the phone so that emergency personnel can get to the client's home.
What are some consequences of effective communication?
Promote client safety, improved health outcomes, allows for collaboration, avoids cultural misunderstandings, helps establish therapeutic relationship