Health Assessment Exam 1

Assessment

Assessment is the collection of subjective and objective data about a patient's health.

Subjective data

Subjective data consist of information provided by the affected individual.

Objective data

Objective data include information obtained by the health care provider through physical assessment, the patient's record, and laboratory studies.

The database

The database is the totality of information available about the patient. The purpose of assessment is to make a judgment or diagnosis.

Diagnostic reasoning

Diagnostic reasoning is the process of analyzing health data and drawing conclusions to identify diagnoses.

Diagnostic reasoning has which four major components?

Diagnostic reasoning has which four major components?

(1) Attending to initially available cues, which are pieces of information, signs, symptoms, or laboratory data;

(2) Formulating diagnostic hypotheses, which are tentative explanations for a cue or a set of cues and can serve as a basis for further investigation;

(3) Gathering data relative to the tentative hypotheses;

(4) evaluating each hypothesis with the new data collected, which leads to a final diagnosis.

The nursing process includes which six phases?

The nursing process includes which six phases?

(1) assessment,

(2) diagnosis,

(3) outcome identification,

(4) planning,

(5) implementation, and

(6) evaluation.

It is a dynamic, interactive process in which practitioners move back and forth within the steps.

The novice nurse

The novice nurse has no experience with specific patient populations and uses rules to guide performance.

The experienced nurse

The experienced nurse understands a patient situation as a whole rather than as a list of tasks, attends to an assessment data pattern, and acts without consciously labeling it.

Critical thinking

Critical thinking is the multidimensional thinking process needed for sound diagnostic reasoning and clinical judgment. Seventeen critical thinking skills have been identified, including setting priorities.

First-level priority problems

First-level priority problems are emergent, life-threatening, and immediate, such as establishing an airway or supporting breathing.

Second-level priority problems

Second-level priority problems are next in urgency. They require prompt intervention to prevent deterioration, and may include a mental status change or acute pain.

Third-level priority problems

Third-level priority problems are important to the patient's health, but can be addressed after more urgent problems. Examples include lack of knowledge or family coping.

Evidence-based practice

Evidence-based practice is a systematic approach to practice that uses the best evidence, the clinician's experience, and the patient's preferences and values to make decisions about care and treatment.

Every examiner needs to collect four kinds of databases based on the situation. What are the four kinds of databases?

Every examiner needs to collect four kinds of databases based on the situation. What are the four kinds of databases?

(1) A complete (or total health) database includes a complete health history and a full physical examination.

(2) A focused (or problem-centered) database is used for a limited or short-term problem. It is smaller in scope and more targeted than the complete database.

(3) A follow-up database evaluates the status of any identified problem at regular intervals to follow up on short-term or chronic health problems.

(4) An emergency database calls for rapid collection of data, which commonly occurs while performing lifesaving measures.

The biomedical model

The biomedical model of Western medicine views health as the absence of disease. It focuses on collecting data on biophysical signs and symptoms and on curing disease.

The holistic health model

The holistic health model assesses the whole person because it views the mind, body, and spirit as interdependent and functioning as a whole within the environment. Health depends on all these factors working together.

The concept of health also includes health promotion and disease prevention.

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Health assessment also should consider what two other factors?

Health assessment also should consider what two other factors?

(1) The usual and expected developmental tasks for each age group

(2) the cultural beliefs and practices of different people. Obtaining a heritage assessment helps gather data that are accurate and meaningful and can guide culturally sensitive and appropriate care.

According to the biomedical model, a narrow definition of health is:

A) an optimal functioning of mind, body, and spirit within the environment.

B) the absence of disease.

C) the response of the whole person to actual or potential problems.

D) prevention of disease.

According to the biomedical model, a narrow definition of health is:

A) an optimal functioning of mind, body, and spirit within the environment.

Feedback: INCORRECT

Nursing has an expanded concept of health; holistic health includes the mind, body, and spirit as interdependent and functioning as a whole within the environment.

B) the absence of disease.

Feedback: CORRECT

From a biomedical perspective, health is defined as the absence of disease or elimination of symptoms and signs of disease.

C) the response of the whole person to actual or potential problems.

Feedback: INCORRECT

Nursing diagnoses are clinical judgments about a person's response to an actual or potential health state.

D) prevention of disease.

Feedback: INCORRECT

Health promotion and disease prevention are important aspects of nursing's concept of health.

What type of data base is most appropriate when a rapid collection of data is required and often compiled concurrently with life-saving measures?

A) Episodic

B) Follow-up

C) Emergency

D) Complete

What type of data base is most appropriate when a rapid collection of data is required and often compiled concurrently with life-saving measures?

A) Episodic

Feedback: INCORRECT

An episodic database is for a limited or short-term problem; this database concerns mainly one problem, one cue complex, or one body system.

B) Follow-up

Feedback: INCORRECT

A follow-up database is used to follow-up short-term or chronic health problems; the statuses of identified problems are evaluated at regular and appropriate intervals.

C) Emergency

Feedback: CORRECT

An emergency database is rapid collection of the data often obtained concurrently with lifesaving measures.

D) Complete

Feedback: INCORRECT

A complete database includes a complete health history and a full physical examination; it describes the current and past health state and forms a baseline against which all future changes can be measured.

A medical diagnosis is used to evaluate:

A) a person's state of health.

B) the response of the whole person to actual or potential health problems.

C) a person's culture.

D) the cause of disease.

A medical diagnosis is used to evaluate:

A) a person's state of health.

Feedback: INCORRECT

Nursing diagnoses are clinical judgments about a person's response to an actual or potential health state.

B) the response of the whole person to actual or potential health problems.

Feedback: INCORRECT

Nursing diagnoses are used to evaluate the response of the whole person to actual or potential health problems.

C) a person's culture.

Feedback: INCORRECT

Holistic model of health care is used in nursing, and culture is an important factor to consider in a nursing assessment.

D) the cause of disease.

Feedback: CORRECT

Medical diagnoses are used to evaluate the etiology (cause) of disease.

An example of subjective data is:

A) decreased range of motion.

B) crepitation in the left knee joint.

C) left knee has been swollen and hot for the past 3 days.

D) arthritis.

An example of subjective data is:

A) decreased range of motion.

Feedback: INCORRECT

Objective data is gathered by what the health professional observes by inspecting, percussing, palpating, and auscultating during the physical examination. Range of motion is assessed by inspection.

B) crepitation in the left knee joint.

Feedback: INCORRECT

Objective data is gathered by what the health professional observes by inspecting, percussing, palpating, and auscultating during the physical examination. Crepitation is assessed by palpating.

C) left knee has been swollen and hot for the past 3 days.

Feedback: CORRECT

Subjective data is what the person says about himself or herself during history taking.

D) arthritis.

Feedback: INCORRECT

Arthritis is a medical diagnosis.

What type of database is most appropriate for an individual who is admitted to a long-term care facility?

A) Episodic

B) Follow-up

C) Emergency

D) Complete

What type of database is most appropriate for an individual who is admitted to a long-term care facility?

A) Episodic

Feedback: INCORRECT

An episodic database is for a limited or short-term problem; this database concerns mainly one problem, one cue complex, or one body system.

B) Follow-up

Feedback: INCORRECT

A follow-up database is used to follow up short-term or chronic health problems; the statuses of identified problems are evaluated at regular and appropriate intervals.

C) Emergency

Feedback: INCORRECT

An emergency database is rapid collection of the data often obtained concurrently with lifesaving measures.

D) Complete

Feedback: CORRECT

A complete database includes a complete health history and a full physical examination; it describes the current and past health state and forms a baseline against which all future changes can be measured.

Which of the following is considered an example of objective data?

A) Alert and oriented

B) Dizziness

C) An earache

D) A sore throat

Which of the following is considered an example of objective data?

A) Alert and oriented

Feedback: CORRECT

Objective data is what the health professional observes; level of consciousness and orientation are observations.

B) Dizziness

Feedback: INCORRECT

Subjective data is what the person says about himself or herself during history taking.

C) An earache

Feedback: INCORRECT

Subjective data is what the person says about himself or herself during history taking.

D) A sore throat

Feedback: INCORRECT

Subjective data is what the person says about himself or herself during history taking.

An example of objective data is:

A) complaints of left knee pain.

B) crepitation in the left knee joint.

C) left knee has been swollen and hot for the past 3 days.

D) report of impaired mobility from left knee pain as evidenced by an inability to walk, swelling, and pain on passive range of motion.

An example of objective data is:

A) complaints of left knee pain.

Feedback: INCORRECT

Subjective data is what the person says about himself or herself during history taking.

B) crepitation in the left knee joint.

Feedback: CORRECT

Objective data is what the health professional observes by inspecting, percussing, palpating, and auscultating during the physical examination. Crepitation is assessed by palpation.

C) left knee has been swollen and hot for the past 3 days.

Feedback: INCORRECT

Subjective data is what the person says about himself or herself during history taking.

D) report of impaired mobility from left knee pain as evidenced by an inability to walk, swelling, and pain on passive range of motion.

Feedback: INCORRECT

Subjective data is what the person says about himself or herself during history taking.

A nursing diagnosis is best described as:

A) a determination of the etiology of disease.

B) a pattern of coping.

C) an individual's perception of health.

D) a concise statement of actual or potential health concerns or level of wellness.

A nursing diagnosis is best described as:

A) a determination of the etiology of disease.

Feedback: INCORRECT

Medical diagnoses determine the etiology (or cause) of disease.

B) a pattern of coping.

Feedback: INCORRECT

Coping patterns would include methods to relieve stress.

C) an individual's perception of health.

Feedback: INCORRECT

Health perception is how the person describes and defines personal health.

D) a concise statement of actual or potential health concerns or level of wellness.

Feedback: CORRECT

Nursing diagnoses are clinical judgments about a person's response to an actual or potential health state.

A complete data base is:

A) used to rapidly collect data and is often compiled concurrently with life-saving measures.

B) used for a limited or short-term problem usually consisting of one problem, one cue complex, or one body system.

C) used to evaluate cause and etiology of disease.

D) used to perform a thorough or comprehensive health history and physical examination.

A complete data base is:

A) used to rapidly collect data and is often compiled concurrently with life-saving measures.

Feedback: INCORRECT

An emergency database is rapid collection of the data often obtained concurrently with lifesaving measures.

B) used for a limited or short-term problem usually consisting of one problem, one cue complex, or one body system.

Feedback: INCORRECT

An episodic database is for a limited or short-term problem; this database concerns mainly one problem, one cue complex, or one body system.

C) used to evaluate cause and etiology of disease.

Feedback: INCORRECT

Medical diagnoses are used to evaluate the cause or etiology of disease.

D) used to perform a thorough or comprehensive health history and physical examination.

Feedback: CORRECT

A complete database includes a complete health history and a full physical examination; it describes the current and past health state and forms a baseline against which all future changes can be measured.

A patient admitted to the hospital with asthma has the following problems identified based on an admission health history and physical assessment. Which problem is a first-level priority?

A) Ineffective self-health management

B) Risk for infection

C) Impaired gas exchange

D) Readiness for enhanced spiritual well-being

A patient admitted to the hospital with asthma has the following problems identified based on an admission health history and physical assessment. Which problem is a first-level priority?

A) Ineffective self-health management

Feedback: INCORRECT

Third-level priority problems are those that are import to the patient's health but can be addressed after more urgent health problems are addressed. Ineffective self-health management is an example of a third-level priority.

B) Risk for infection

Feedback: INCORRECT

Second-level priority problems are those that are next in urgency; those requiring prompt intervention to forestall further deterioration. Risk for infection is an example of a second-level priority.

C) Impaired gas exchange

Feedback: CORRECT

First-level priority problems are those that are emergent, life threatening, and immediate. Impaired gas exchange is an emergent and immediate problem.

D) Readiness for enhanced spiritual well-being

Feedback: INCORRECT

Third-level priority problems are those that are import to the patient's health but can be addressed after more urgent health problems are addressed. Wellness diagnoses are third-level priority problems.

In the United States, about __ in __ people are immigrants.

In the United States, about one in eight people are immigrants.

___ in every ___ residents belongs to a group other than single-race, non-Hispanic White.

One in every three residents belongs to a group other than single-race, non-Hispanic White.

Of the emerging majority in the US, _____ are the largest population.

Of the emerging majority in the US, Hispanics are the largest population.

The second largest population is _____ followed by ____, _____, _____, _____, and _____.

The second largest population is Asians followed by Blacks, American Indians, Alaska natives, Native Hawaiians, and other Pacific islanders.

Many new immigrants have little understanding of the modern health care system and medical and nursing practices and interventions. Many also speak and understand little or no English.

...

The National Standards for Culturally and Linguistically Appropriate Services in Health Care state that health care organizations should ensure that patients receive effective, understandable, and respectful care in a manner compatible with their cultural health beliefs and practices and their preferred language.

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When people with limited English proficiency seek health care, services cannot be denied to them.

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The most common non-English languages spoken at home are Spanish, Chinese, French, German, and Tagalog.

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Cultural care

Cultural care is professional health care that is culturally sensitive, appropriate, and competent. To develop cultural care, you must have knowledge of your personal heritage and the heritage of the nursing profession, the health care system, and the patient.

Heritage consistency

Heritage consistency is the degree to which a person's lifestyle reflects his or her traditional heritage. A person can possess values that are consistent with the norms of the traditional culture or that are modern (or acculturated to the norms of the dominant society). Heritage consistency includes determination of a person's cultural, ethnic, and religious background and socialization experiences.

Culture has which four characteristics?

Culture has the following four characteristics:

(1) it is learned from birth through language acquisition and socialization.

(2) it is shared by all members of the same cultural group.

(3) it is adapted to specific conditions related to environmental and technical factors.

(4) it is dynamic and ever changing.

Ethnicity

Ethnicity pertains to membership in a social group that claims to possess a common geographic origin, migratory status, religion, race, language, shared values, traditions or symbols, and food preferences. One's cultural background is a fundamental component of one's ethnic background.

Religion

Religion is the belief in a divine or superhuman power or powers to be obeyed and worshipped as the creator or ruler of the universe.

Spirituality

Spirituality is borne out of each person's unique life experience and his or her personal effort to find purpose and meaning in life. Spirituality may be used to find meaning and purpose for illnesses.

Socialization

Socialization is the process of being raised within a culture and acquiring the characteristics of the group. Education is a form of socialization.

You assess factors related to heritage to determine the depth to which you and the patient identify with a traditional heritage, that is, the cultural beliefs and practices of the family, extended family, and an ethnoreligious community.

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Before you can understand the role that beliefs and values play in a person's life, you must understand culturally dominant values and personal values.

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Cultural conflicts

Cultural conflicts between nurses and patients from diverse backgrounds are related to different time and relationship perceptions. For example, in some cultures, the past may influence health practices. When making decisions about health, patients may rely on relationships with others, and their behavior may depend on the opinion of others.

In a multicultural country, you must accept that differences exist and be open to the importance of these practices to the patient.

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The meaning of health and illness is determined, in part, by the way members of a person's culture define them. The perceived causes of illness and symptoms can be culturally based and may be viewed as biomedical (or scientific), naturalistic (or holistic), or magicoreligious. All cultures have their preferred lay or popular healers, recognized symptoms of disease, acceptable sick-role behaviors, and treatments. Patients may seek help from biomedical health professionals as well as traditional healers. You must be aware of traditional folk practices and assess them.

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In times of illness, religion and spirituality may be a source of comfort for patients and their significant others. Religion and spiritual leaders may strongly influence the perception of health, illness, and practices.

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Religious beliefs may influence the person's:

Religious beliefs may influence the person's:

(1) Explanation of the cause of illness

(2) Perception of its severity

(3) And choice of healers.

Each person responds differently to the same stimuli, regardless of the primary culture and value system. You should guard against stereotyping individuals. You should also understand culture-bound syndromes, which may have no equivalent from a biomedical perspective.

...

Each culture has its own healers who usually:

A) speak at least two languages.

B) own and operate specialty community clinics.

C) cost less than traditional or biomedical providers.

D) recommend folk practices that are dangerous.

ach culture has its own healers who usually:

A) speak at least two languages.

Feedback: INCORRECT

Most healers speak the person's native tongue.

B) own and operate specialty community clinics.

Feedback: INCORRECT

Most healers make house calls.

C) cost less than traditional or biomedical providers.

Feedback: CORRECT

Most healers cost significantly less than healers practicing in the biomedical or scientific health care system.

D) recommend folk practices that are dangerous.

Feedback: INCORRECT

Most of health practices used by folk healers are not dangerous and are usually harmless.

While evaluating the health history, the nurse determines that the patient subscribes to the hot/cold theory of health. Which of the following will most likely describe this patient's view of wellness?

A) Good is hot.

B) Evil is hot.

C) The humors must be balanced.

D) The phlegm will be replaced with dryness.

While evaluating the health history, the nurse determines that the patient subscribes to the hot/cold theory of health. Which of the following will most likely describe this patient's view of wellness?

A) Good is hot.

Feedback: INCORRECT

Beverages, foods, herbs, medicines, and diseases are classified as hot or cold according to their perceived effects on the body, not on their physical characteristics.

B) Evil is hot.

Feedback: INCORRECT

Beverages, foods, herbs, medicines, and diseases are classified as hot or cold according to their perceived effects on the body, not on their physical characteristics.

C) The humors must be balanced.

Feedback: CORRECT

The hot/cold theory of health is based on humoral theory; the treatment of disease is based on the balance of the humors.

D) The phlegm will be replaced with dryness.

Feedback: INCORRECT

The four humors of the body include the blood, phlegm, black bile, and yellow bile; the humors regulate basic bodily functions and are described in terms of temperature, dryness, and moisture. The treatment of disease consists of adding or subtracting cold, heat, dryness, or wetness to restore the balance of the humors.

Before determining whether cultural practices are helpful, harmful, or neutral, nurses must first understand:

A) the logic of the traditional belief systems.

B) the beliefs of the patients family.

C) their personal belief models.

D) the risk of disease in the patients ethnic group.

Before determining whether cultural practices are helpful, harmful, or neutral, nurses must first understand:

A) the logic of the traditional belief systems.

B) the beliefs of the patients family.

C) their personal belief models.

D) the risk of disease in the patients ethnic group.

On the basis of median age:

A) the non-Hispanic white population tends to be younger.

B) the Hispanic population tends to be older.

C) the Asian population tends to be younger.

D) minorities tend to be older than non-Hispanic white populations.

On the basis of median age:

A) the non-Hispanic white population tends to be younger.

Feedback: INCORRECT

The non-Hispanic, single-race white population was older than the population as a whole; the respective median ages were 40.8 and 36.6 years.

B) the Hispanic population tends to be older.

Feedback: INCORRECT

The Hispanic population was much younger, with a median age of 27.6 years, and about one-third of the Hispanic population was younger than 18 years old.

C) the Asian population tends to be younger.

Feedback: CORRECT

The Asian population was younger with a median age of 35.4 years, and about 26% of the Asian population was younger than 18 years old.

D) minorities tend to be older than non-Hispanic white populations.

Feedback: INCORRECT

Minorities tend to be younger than non-Hispanic white populations.

Spirituality is defined as:

A) participating in religious services on a regular basis.

B) a personal effort to find meaning and purpose in life.

C) the process of being raised within a culture.

D) a social group that claims to possess variable traits.

Spirituality is defined as:

A) participating in religious services on a regular basis.

Feedback: INCORRECT

Religion refers to an organized system of beliefs concerning the cause, nature, and purpose of the universe.

B) a personal effort to find meaning and purpose in life.

Feedback: CORRECT

Spirituality is a personal effort to find purpose and meaning in life.

C) the process of being raised within a culture.

Feedback: INCORRECT

Socialization is the process of being raised within a culture and acquiring the characteristics of that group.

D) a social group that claims to possess variable traits.

Feedback: INCORRECT

Ethnicity pertains to a social group within the social system that claims to possess variable traits.

Which of the following is true regarding language barriers and health care?

A) There are laws addressing language barriers and health care.

B) Limited English proficiency is associated with a higher quality of care.

C) English proficiency is associated with a lower quality of care.

D) Patients with language barriers have a decreased risk of nonadherence to medication regimens.

Which of the following is true regarding language barriers and health care?

A) There are laws addressing language barriers and health care.

Feedback: CORRECT

Title VI of the Civil Rights Act of 1964 provides people with limited English proficiency access to health care; these individuals cannot be denied health care services.

B) Limited English proficiency is associated with a higher quality of care.

Feedback: INCORRECT

Limited English proficiency is associated with a lower quality of care.

C) English proficiency is associated with a lower quality of care.

Feedback: INCORRECT

English proficiency is associated with a higher quality of care.

D) Patients with language barriers have a decreased risk of nonadherence to medication regimens.

Feedback: INCORRECT

Patients with language barriers have an increased risk of nonadherence to medication regimens.

What is the yin/yang theory of health?

A) Health exists when all aspects of the person are in perfect balance.

B) Health exists when physical, psychologic, spiritual, and social needs are met.

C) Health exists in the absence of illness.

D) Health exists when there is optimal functioning.

What is the yin/yang theory of health?

A) Health exists when all aspects of the person are in perfect balance.

Feedback: CORRECT

In the yin/yang theory, health is believed to exist when all aspects of the person are in perfect balance.

B) Health exists when physical, psychologic, spiritual, and social needs are met.

Feedback: INCORRECT

In the hot/cold theory, health consists of a positive state of total well-being, including physical, psychologic, spiritual, and social aspects of the person.

C) Health exists in the absence of illness.

Feedback: INCORRECT

The biomedical model of Western tradition views health as the absence of disease.

D) Health exists when there is optimal functioning.

Feedback: INCORRECT

In the biomedical or scientific theory, high-level wellness (or health) exists with optimal functioning of the human body.

Which theory has been expanded in an attempt to study the degree to which a person's lifestyle reflects his or her traditional heritage?

A) Behavior theory

B) Heritage consistency

C) Congruence mechanism

D) Socialization experience

Which theory has been expanded in an attempt to study the degree to which a person's lifestyle reflects his or her traditional heritage?

A) Behavior theory

Feedback: INCORRECT

Behavior theory or behaviorism is a learning theory.

B) Heritage consistency

Feedback: CORRECT

Heritage consistency theory has been expanded in an attempt to study the degree to which a person's lifestyle reflects his or her traditional heritage.

C) Congruence mechanism

Feedback: INCORRECT

Carl Rogers described the concepts of congruence and incongruence as important ideas in his theory of personality and human development.

D) Socialization experience

Feedback: INCORRECT

Socialization is the process of being raised within a culture and acquiring the characteristics of that group.

What symptom is greatly influenced by a person's cultural heritage?

A) hearing loss

B) pain

C) breast lump

D) food intolerance

What symptom is greatly influenced by a person's cultural heritage?

A) hearing loss

Feedback: INCORRECT

Hearing loss is more common in whites than in blacks.

B) pain

Feedback: CORRECT

Pain is a very private, subjective experience that is greatly influenced by cultural heritage. Expectations, manifestations, and management of pain are all embedded in a cultural context.

C) breast lump

Feedback: INCORRECT

The incidence of breast cancer varies with different cultural groups.

D) food intolerance

Feedback: INCORRECT

Food intolerance varies with different cultural groups. For example, lactose intolerance is common in African Americans, American Indians, and Asian Americans.

When considering cultural competence, there are discrete areas that the nurse must develop knowledge of to understand the health care needs of others. These discrete areas include understanding of: (Select all that apply.)

A) his or her own heritage.

B) cultural and ethnic values.

C) the heritage of the nursing profession.

D) the heritage of the patient.

E) the heritage of the health care system.

When considering cultural competence, there are discrete areas that the nurse must develop knowledge of to understand the health care needs of others. These discrete areas include understanding of: (Select all that apply.)

A) his or her own heritage.

B) cultural and ethnic values.

C) the heritage of the nursing profession.

D) the heritage of the patient.

E) the heritage of the health care system.

Feedback:

A discrete area of knowledge for cultural competence is understanding of ones own heritage, the heritage of the nursing profession, the heritage of the patient, and the heritage of the health care system.

Empathy

Empathy means viewing the world from the other person's inner frame of reference while remaining yourself.

A health interview

A health interview is a structured interaction between you and the patient. The rules governing this interaction should be clearly outlined and agreed on by you and the patient at the start of the interview. Your mutual goal is the patient's optimal health.

Communication

Communication carries you and the patient through the interview. Communication is the exchange of information so that each person clearly understands the other.

A two-person interaction usually has two roles: sender and receiver. When exchanging information, both individuals engage in verbal and nonverbal communication. Internal and external factors can affect communication.

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Internal factors

Internal factors are what you bring to the interview.

Three internal factors promote good communication:

Three internal factors promote good communication:

(1) liking others,

(2) expressing empathy, and

(3) having the ability to listen.

External factors

External factors relate mainly to the physical setting.

You can foster good communication with which external factors?

You can foster good communication with certain external factors, such as by ensuring privacy, preventing interruptions, creating a conducive environment, and documenting responses without interfering with the conversation.

The interview has three phases:

The interview has three phases:

(1) introduction,

(2) working phase,

(3) closing.

During the first phase of an interview

During the first phase, introduce the interview.

During the working phase of an interview

During the working phase, gather data. Start with open-ended questions, which ask for narrative information. Then use closed questions, which ask for specific information in short, one- or two-word answers.

During the closing phase of an interview

During the closing, signal that the interview is ending, which gives the patient one last chance to share concerns or express himself or herself. Also briefly summarize what you learned during the interview.

You can use different types of verbal responses to assist the narrative and help gather data. Each response plays a role in the interview process, but practice is needed to use them effectively and move among them smoothly.

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Through facilitation, silence, reflection, empathy, and clarification, you react to the facts or feelings the patient has communicated. Your response focuses on the patient's frame of reference.

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Through confrontation, interpretation, explanation, and summary, your response focuses on your own frame of reference, thoughts, and feelings.

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10 traps of interviewing

10 traps of interviewing. These nonproductive verbal messages include:

(1) Providing false assurance or reassurance,

(2) Giving unwanted advice,

(3) Using authority,

(4) Using avoidance language,

(5) Engaging in distancing,

(6) Using professional jargon,

(7) Using leading or biased questions,

(8) Talking too much,

(9) Interrupting,

(10) And using "why" questions.

Nonverbal modes of communication

Nonverbal modes of communication include:

- Physical appearance,

- Posture,

- Gestures,

- Facial expression,

- Eye contact,

- Voice, and

- Touch.

Nonverbal communications convey messages from the sender to the receiver. Work to develop the ability to read patients' nonverbal behaviors and to monitor your own nonverbal communication.

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Modify communication techniques based on each patient's developmental stage, including parents, infants, young children, adolescents, and older adults.

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Learn to communicate effectively with patients who have special needs, such as those with a hearing impairment, acute illness, or intoxication and those who are sexually aggressive, angry, anxious, violent, or in tears.

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When a patient comes from a different culture, modify your approach as needed. Behaviors that one culture views positively may have different, possibly negative, connotations in another culture.

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For a patient with limited English proficiency, use a bilingual team member or a trained medical interpreter whenever possible. Avoid using a family member or close friend as an interpreter because this violates the patient's confidentiality.

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Facilitation

Facilitation These responses encourage the patient to say more, to continue with the story ("mm-hmm, go on, continue, uh-huh"). Also called general leads, these responses show the person you are interested and will listen further. Simply maintaining eye contact, shifting forward in your seat with increased attention, nodding "Yes," or using your hand to gesture, "Yes, go on, I'm with you," encourage the person to continue talking.

Silence

Silence is golden after open-ended questions. Your silent attentiveness communicates that the patient has time to think, to organize what he or she wishes to say without interruption from you.

Reflection

Reflection. This response echoes the patient's words. Reflection is repeating part of what the person has just said.

Clarification

Clarification. Use this when the person's word choice is ambiguous or confusing (e.g., "Tell me what you mean by 'tired blood.' "). Clarification also is used to summarize the person's words, simplify the words to make them clearer, and then ask if you are on the right track. You are asking for agreement, and the person can then confirm or deny your understanding.

Confrontation

Confrontation. These responses now include your own thoughts and feelings. Use this only when merited by the situation. If you use it too often, you take over at the patient's expense. In the case of confrontation, you have observed a certain action, feeling, or statement and you now focus the person's attention on it. You give your honest feedback about what you see or feel.

Interpretation

Interpretation. This statement is not based on direct observation as with confrontation, but it is based on your inference or conclusion. It links events, makes associations, or implies cause: "It seems that every time you feel the stomach pain, you have had some kind of stress in your life." Interpretation also ascribes feelings and helps the person understand his or her own feelings in relation to the verbal message.

Explanation

Explanation. With these statements, you inform the person. You share factual and objective information. This may be for orientation to the agency setting: "Your dinner comes at 5:30 PM." Or, it may be to explain cause: "The reason you cannot eat or drink before your blood test is that the food will change the test results."

When preparing the physical setting for an interview, the interviewer should:

A) set the room temperature between 64 and 66° F.

B) reduce noise by turning the volume on the television or radio down.

C) conduct the interview at eye level and at a distance of 4 to 5 feet.

D) stand next to the patient to convey a professional demeanor.

When preparing the physical setting for an interview, the interviewer should:

A) set the room temperature between 64 and 66° F.

Feedback: INCORRECT

The room temperature should be set at a comfortable level; a temperature between 64 and 66° F is too cool.

B) reduce noise by turning the volume on the television or radio down.

Feedback: INCORRECT

Turn off the television or radio and any unnecessary equipment to reduce noise.

C) conduct the interview at eye level and at a distance of 4 to 5 feet.

Feedback: CORRECT

Both the interviewer and the patient should be at eye level at a distance of 4 to 5 feet.

D) stand next to the patient to convey a professional demeanor.

Feedback: INCORRECT

The interviewer and patient should be comfortably seated; standing communicates haste and assumes superiority.

Parents or caretakers accompany children to the health care setting. Starting at ___ years of age, the interviewer asks the child directly about his or her presenting symptoms.

A) 5

B) 7

C) 9

D) 11

Parents or caretakers accompany children to the health care setting. Starting at ___ years of age, the interviewer asks the child directly about his or her presenting symptoms.

A) 5

Feedback: INCORRECT

Refer to feedback in option B.

B) 7

Feedback: CORRECT

School-age children (starting at age 7) have the verbal ability to add important data to the history. The nurse should interview the parent and child together, but when a presenting symptom or sign exists, the nurse should ask the child about it first, then gather data from the parent.

C) 9

Feedback: INCORRECT

Refer to feedback in option B.

D) 11

Feedback: INCORRECT

Refer to feedback in option B.

Which of the following statements, if made by the interviewer, would be an appropriate response?

A) "I know just how you feel."

B) "If I were you, I would have the surgery."

C) "Why did you wait so long to make an appointment?"

D) "Tell me what you mean by 'bad blood'."

Which of the following statements, if made by the interviewer, would be an appropriate response?

A) "I know just how you feel."

Feedback: INCORRECT

This response is an inappropriate communication technique referred to as false reassurance.

B) "If I were you, I would have the surgery."

Feedback: INCORRECT

This response is an inappropriate communication technique referred to as giving unwanted advice.

C) "Why did you wait so long to make an appointment?"

Feedback: INCORRECT

This response is an inappropriate communication technique referred to as using "Why" questions.

D) "Tell me what you mean by 'bad blood'."

Feedback: CORRECT

This response is an appropriate communication technique referred to as seeking further clarification.

While discussing the treatment plan, the nurse infers that the patient is uncomfortable asking the physician for a different treatment because of fear of the physician's reaction. In this situation, the nurse's verbal interpretation:

A) affects the nurse-physician relationship.

B) impedes further discussion.

C) helps the patient understand personal feelings in relation to his or her verbal message.

D) helps the nurse understand his or her own feelings in relation to the patient's verbal message.

While discussing the treatment plan, the nurse infers that the patient is uncomfortable asking the physician for a different treatment because of fear of the physician's reaction. In this situation, the nurse's verbal interpretation:

A) affects the nurse-physician relationship.

Feedback: INCORRECT

The nurse-physician relationship is not the barrier to communication in this situation

B) impedes further discussion.

Feedback: INCORRECT

The interpretation by the nurse will improve communication.

C) helps the patient understand personal feelings in relation to his or her verbal message.

Feedback: CORRECT

Patients may experience barriers to communication with a health care provider seen as an authority figure. The patient may not share personal feelings if fear is experienced. In this situation, the nurse identified the patient's personal feelings in relation to the patient's verbal message.

D) helps the nurse understand his or her own feelings in relation to the patient's verbal message.

Feedback: INCORRECT

The nurse's feelings are not the barrier to communication in this situation.

The use of euphemisms to avoid reality or to hide feelings is known as:

A) distancing language.

B) sympathetic language.

C) avoidance language.

D) ethnocentric language.

The use of euphemisms to avoid reality or to hide feelings is known as:

A) distancing language.

Feedback: INCORRECT

Distancing is the use of impersonal speech to put space between a threat and the self.

B) sympathetic language.

Feedback: INCORRECT

Empathy means viewing the world from the other person's inner frame of reference. Empathy is therapeutic; sympathy is nontherapeutic.

C) avoidance language.

Feedback: CORRECT

Euphemisms are used to avoid reality or to hide feelings. Using direct language is the best way to deal with frightening topics instead of using avoidance language.

D) ethnocentric language.

Feedback: INCORRECT

Ethnocentrism is the belief that one's ethnic or cultural group is more important or superior.

When addressing a toddler during the interview, the health care provider should:

A) ask the child, before the caretaker, about symptoms.

B) use nonverbal communication.

C) use short, simple, concrete sentences.

D) use detailed explanations.

When addressing a toddler during the interview, the health care provider should:

A) ask the child, before the caretaker, about symptoms.

Feedback: INCORRECT

For a younger child such as a toddler, the parent will provide all or most of the history.

B) use nonverbal communication.

Feedback: INCORRECT

Nonverbal communication is the primary communication method for infants.

C) use short, simple, concrete sentences.

Feedback: CORRECT

A toddler's communication is direct, concrete, literal, and set in the present. The health care provider should use short, simple sentences with concrete explanations.

D) use detailed explanations.

Feedback: INCORRECT

Detailed explanations would be more appropriate for a school-age child, adolescent, or adult.

Nonverbal communication is the primary form of communication for which group of individuals?

A) Infants

B) Preschoolers

C) Adolescents

D) Older adults

Nonverbal communication is the primary form of communication for which group of individuals?

A) Infants

Feedback: CORRECT

Nonverbal communication is the primary form of communication method for infants.

B) Preschoolers

Feedback: INCORRECT

Preschooler's communication is direct, concrete, literal, and set in the present.

C) Adolescents

Feedback: INCORRECT

Adolescents should be treated with respect; the nurse should use open, honest, professional communication.

D) Older adults

Feedback: INCORRECT

Older adults may need special considerations related to physical limitations (e.g., adjusted pace to avoid fatigue, impaired hearing).

Viewing the world from another person's inner frame of reference is called:

A) reflection.

B) empathy.

C) clarification.

D) sympathy.

Viewing the world from another person's inner frame of reference is called:

A) reflection.

Feedback: INCORRECT

Reflection is repeating part of what the person has just said.

B) empathy.

Feedback: CORRECT

Empathy means viewing the world from the other person's inner frame of reference.

C) clarification.

Feedback: INCORRECT

Clarification is used to summarize the person's words or to simplify the words to make them clearer.

D) sympathy.

Feedback: INCORRECT

Sympathy is a social affinity in which one person stands with another person, closely understanding his or her feelings.

An example of an open-ended question or statement is:

A) "Tell me about your pain."

B) "On a scale of 1 to 10, how would you rate your pain?"

C) "I can see that you are quite uncomfortable."

D) "You are upset about the level of pain, right?"

An example of an open-ended question or statement is:

A) "Tell me about your pain."

Feedback: CORRECT

Open-ended questions and statements ask for narrative information; they state the topic to be discussed, but only in general terms. This type of question encourages the person to respond in paragraphs and to give a spontaneous account in any order chosen.

B) "On a scale of 1 to 10, how would you rate your pain?"

Feedback: INCORRECT

This is a closed or direct question. Closed or direct questions and statements ask for specific information. This type of question or statement will elicit a short, one- or two-word answer, a yes or no response, or a forced choice.

C) "I can see that you are quite uncomfortable."

Feedback: INCORRECT

This is a closed or direct statement. Refer to feedback in Option B.

D) "You are upset about the level of pain, right?"

Feedback: INCORRECT

This is a closed or direct statement. Refer to feedback in Option B.