Chapter 15: Therapeutic Communication

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1. Which of the following is the best general definition of communication as it applies to the paramedic?

a. Asking the patient direct and simple yes or no questions
b. Explaining steps of an assessment or treatment to the patient
c. Receiving the patient's location and chief complaint from dispatch
d. Sending a message to the patient and receiving feedback

d

2. Asking the patient her chief complaint is which step in the communication model?

a. Decoding the message
b. Encoding the message
c. Interfering with the message
d. Misinterpreting the message

b

3. Your patient is a 55-year-old single male who has recently lost his job. He has substernal chest pain radiating to his jaw and left arm. He is anxious and is refusing transport. Which of the following is the best example of internal interference to the communication model?

a. The patient is complaining of the pain from your partner's attempts at IV access.
b. The patient is concerned that he cannot afford the hospital bill.
c. The patient is distracted by the loud noise of a nearby construction site.
d. The patient is hesitant to discuss his medical history in front of bystanders.

b

4. The first call of your shift was a pediatric cardiac arrest. You dropped off the child at the hospital after achieving return of spontaneous circulation. You have been running calls nonstop since. As hard as you try, you have not been able to shake the image of the child's mom running down the driveway with the limp child in her arms. What component of the communication model are you experiencing?

a. External decoding
b. External interference
c. Internal encoding

d

5. This is at least the fifth time your unit has responded to the same homeless shelter to treat a man with a productive cough who is intentionally coughing on other residents. You know him well and suspect he wants a shower and meal at the hospital. Which of your partner's individual attributes is being expressed when says, 'I can't believe we are transporting this freak again?'

a. Educational beliefs
b. Occupational beliefs
c. Personal beliefs
d. Professional beliefs

c

6. A patient is complaining that he has made many trips to the emergency department over several years to have his low back pain treated. Despite his ongoing efforts, nothing is making the pain better. Which of the following is the best example of an empathetic statement?

a. I have had lots of problems with low back pain.
b. When my back hurts, a few acetaminophen make it better.
c. You must be very frustrated that it is not getting better.
d. Your pain will probably never totally go away.

c

7. Which of the following is the best definition of active listening?

a. Hardly hearing what the patient is saying and watching the patient's body language closely
b. Hearing the words the patient is saying and dismissing the meaning of those words
c. Hearing the words the patient is saying and paying attention to the significance of those words
d. Repeating back each of your patient's statements and watching the patient's reaction

c

8. Which of the following is the best definition of sympathy?

a. Discounting the patient's complaint of illness
b. Experiencing emotions disproportionate to the situation
c. Sharing the patient's feelings or emotional state
d. Understanding the patient's experience of illness

c

9. Which of the following is the best definition of empathy?

a. Discounting the patient's complaint of illness
b. Experiencing emotions disproportionate to the situation
c. Sharing the patient's feelings or emotional state
d. Understanding the patient's experience of illness

d

10. What information is usually the first component of the patient interview?

a. Dispatch information about the patient's chief complaint
b. Friendly greeting to the patient and bystanders
c. Patient's description of his or her chief complaint
d. Visual examination of patient's general condition

a

11. Which of the following is the best example of a nonverbal cue?

a. Description of patient's history from caregivers
b. Dispatch information about patient's mechanism of injury
c. General impression of patient's condition
d. Responses from patient about the events before injury

c

12. Your patient is a 55-year-old male with severe lower abdominal pain. He is on the toilet and is attempting to have a bowel movement. He looks pale and ashen. Which question would be best to start your interaction with the patient?

a. Hello, my name is Bob. Are you in pain?
b. Hello, my name is Bob. Can I help?
c. Hello, my name is Bob. What was the last thing you ate?
d. Hello, my name is Bob. When was your last bowel movement?

b

13. A 12-year-old male was hit by a car while riding his bike. He is awake and oriented. His only complaint is left hip and leg pain where he was struck. He was wearing a helmet that is still intact on his head. While your partner stabilizes the patient's c-spine, you ask him questions about the incident. Which question or statement could give you the most information about the collision?

a. Describe exactly what happened.
b. Does your belly hurt when I push on it?
c. Push your feet against my hands.
d. Were you hit by the car today?

a

14. When are direct questions most useful?

a. To assess the patient's level of consciousness
b. To determine the patient's general health history
c. To gather specific details about the patient's symptoms
d. To learn the patient's chief complaint

c

15. Which of the following is the best example of an open-ended question?

a. Are you allergic to any pain medications?
b. Do you have any shortness of breath?
c. Have you ever had surgery?
d. What symptoms are you experiencing?

d

16. After a patient describes the onset, pain level, and other symptoms associated with his or her headache, you repeat key points of the patient's response to encourage the patient to say more about the headache. Which interview technique are you using?

a. Clarification
b. Confrontation
c. Facilitation
d. Reflection

d

17. A patient with shortness of breath is describing her health history when her husband interrupts her. To encourage the patient to say more about her history, you say, 'Go ahead, tell me more. I am listening.' Which interview technique are you using?

a. Clarification
b. Confrontation
c. Facilitation
d. Reflection

c

18. A patient is suffering from chronic low back pain. He tells you the pain is like a sting that starts in his flank and runs down his leg. You are not clear on what the patient means by a 'sting,' so you ask, 'Can you be more specific so I can better understand your pain?' Which interview technique are you using?

a. Clarification
b. Confrontation
c. Facilitation
d. Interpretation

a

19. You are called to a college dormitory room to treat an 18-year-old female who is complaining of rapid breathing, chest pain, and tingling in her hands. When you arrive, she is pacing around her room. You notice many empty coffee cups and a lot of open books and notebooks. Because she looks anxious, you ask her directly, 'What is making you so anxious?' Which interview technique are you using?

a. Clarification
b. Confrontation
c. Facilitation
d. Interpretation

b

20. You are called to a family practice medical clinic to treat a 75-year-old man who arrive at the clinic approximately 20 minutes ago. The clinic staff members recognized that the patient had several signs of a myocardial infarction. The patient is loudly complaining that he just paid for a cab to the clinic and does not have insurance for the nearest hospital. As your partner begins to attach the patient to the cardiac monitor, you say to the patient, 'You have signs of a heart attack, which could cause your heart to stop. I know you are upset, but you need to get to the hospital as soon as possible.' Which interview technique are you using?

a. Clarification
b. Confrontation
c. Facilitation
d. Interpretation

d

21. Your partner consistently calls all male patients 'buddy' and all female patients 'sweetie.' Which term best describes your partner's use of these words?

a. Harassing
b. Labeling
c. Patronizing
d. Scrutinizing

c

22. Your town is the home to a large public university. It is Saturday night, and your coverage area includes a section of student housing. Your partner tells you, 'We are going to have a lot of drunks tonight.' Which term best describes your partner's use of these words?

a. Harassing
b. Labeling
c. Patronizing
d. Scrutinizing

b

23. You are called to assess a 45-year-old male patient whom you know well from many previous calls. He always complains of chest pain, shortness of breath, and a severe headache. Every time you have taken him to the emergency department, he is quickly discharged with a reminder to take his antianxiety medications. He is complaining of the same set of symptoms today. What assessments steps, given your previous experience with the patient, are indicated?

a. Complete patient assessment
b. Initial assessment only
c. Secondary assessment only
d. Transport without assessment

a

24. What should you do when persons other than the patient are trying to provide information about the patient?

a. Ask the patient to confirm all information.
b. Consider the person's relationship to the patient.
c. Ignore the information that is being provided.
d. Require the person to sign the patient care report.

b

25. You are called to a skilled nursing facility to transport an 83-year-old male with dementia and suspected influenza. Which source is best for gathering the patient's medical history?

a. The patient
b. The patient's nurse
c. The patient's primary care physician
d. The patient's roommate

b

26. While in your patient's home, you noticed a diploma on his wall. He went to your state's university. Later in the ambulance, you ask the patient what he thinks of the university's basketball team this season. What are you attempting to do?

a. Avoid sensitive personal topics
b. Build rapport with the patient
c. Label the patient as a basketball fan
d. Provide the patient false assurance

b

27. What is the primary purpose of developing rapport with the patient?

a. To gain the patient's trust
b. To increase chance of payment collection
c. To outline barriers to conversation
d. To simplify assessment

a

28. Which of the following is an example of an information source that is found during the patient physical examination?

a. Dispatch call information
b. First responder MOI description
c. Medical identification bracelets
d. Names of prescription medication

c

29. Why is it helpful to review the patient's prescription medications?

a. To calculate the patient's monthly drug costs
b. To document the patient's preferred pharmacy
c. To learn the patient's medical problems
d. To suggest an alternative physician

c

30. What does DNR stand for?

a. Do not release
b. Do not rescue
c. Do not resuscitate
d. Do not revive

c

31. During the assessment your patient, a 34-year-old male who fell off his roof while trimming branches, becomes increasingly angry. Your partner is holding the cervical spine, but the patient is demanding that you let him up. What is your best next action?

a. Calmly explain your actions to the patient.
b. Quickly run away from the patient.
c. Speak with a loud and harsh tone.
d. Strengthen cervical spine stabilization.

a

32. Which of the following is the best strategy for interviewing older patients?

a. Ask questions quickly and coarsely.
b. Speak loudly and slowly at all times.
c. Stand in front and at eye level.
d. Use pet names such as 'sweetie' and 'gramps.'

c

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