Getting the client’s response or the way you communicate with them are mainstay of the local boards, be it the NCLEX or the NLE. The psychosocial focus has been a central thread throughout all of the clinical areas: medical-surgical nursing, maternity and pediatric nursing, and most especially psychiatric nursing. It just shows that effective communication is key in establishing therapeutic relationships. These type of questions are relatively easy to answer especially if you read these five principles on answering therapeutic communication questions: 

1. Responses that focus on the client’s feelings

Most clients at some time find it difficult to express their feelings whether they have a terminal illness, pregnant, or are scheduled for surgery. Any nursing response that elicits these feelings would be therapeutic. Listen and attend to those client cues. For example the question below:

SITUATION: A 20 year old college student is admitted to the medical ward because of sudden onset of paralysis of both legs. Nikki reveals that the boyfriend has been pressuring her to engage in premarital sex. The most therapeutic response by the nurse is:

a. “I can refer you to a spiritual counselor if you like.”
b. “You shouldn’t allow anyone to pressure you into sex.”
c. “It sounds like this problem is related to your paralysis.”
d. “How do you feel about being pressured into sex by your boyfriend?”

For this question, the correct answer is D. The statement focuses on the expression of feelings and is therapeutic. Option A is is not therapeutic because the nurse passes the responsibility to the counselor. Option B. is giving advice is not therapeutic as it virtually terminates the conversation. Option C is not also therapeutic because if confronts the underlying cause.

When it seems as if clients would like to discuss fears, concerns, angry feelings, then encourage their expression.

2. Responses that are honest and direct

It is important that the nurse is honest with her responses to encourage trust and build a therapeutic relationship. Honesty will support a trustful and a firm relationship.

Situation: An old woman was brought for evaluation due to the hospital for evaluation due to increasing forgetfulness and limitations in daily function. She says to the nurse who offers her breakfast, “Oh no, I will wait for my husband. We will eat together” The therapeutic response by the nurse is:

a. “Your husband is dead. Let me serve you your breakfast.”
b. “I’ve told you several times that he is dead. It’s time to eat.”
c. “You’re going to have to wait a long time.”
d. “What made you say that your husband is alive?

The correct answer is option A. Since the client has signs of dementia, she should be reoriented to reality and be focused on there here and now. Option B is not a helpful approach because of the short term memory of the client. Option C indicates a pompous response. Option D is cognitive limitation of the client makes the client incapable of giving explanation.

3. Responses that involve active listening

Encouraging clients to talk through verbal and nonverbal techniques is supportive and serves to further the relationship.

The nurse observes a client pacing in the hall. Which statement by the nurse may help the client recognize his anxiety?

A. “I guess you’re worried about something, aren’t you?
B. “Can I get you some medication to help calm you?”
C. “Have you been pacing for a long time?”
D. “I notice that you’re pacing. How are you feeling?”

The answer here is D. By acknowledging the observed behavior and asking the client to express his feelings the nurse can best assist the client to become aware of his anxiety. In option A, the nurse is offering an interpretation that may or may not be accurate; the nurse is also asking a question that may be answered by a “yes” or “no” response, which is not therapeutic. In option B, the nurse is intervening before accurately assessing the problem. Option C, which also encourages a “yes” or “no” response, avoids focusing on the client’s anxiety, which is the reason for his pacing.

4. Responses that indicate acceptance of the client

Accept the client whatever or how he is regardless of his condition and verbalizations. Additionally, you would not want to reject the client even if you could not condone or accept his behavior.

A male client tells the nurse he was involved in a car accident while he was intoxicated. What would be the most therapeutic response from nurse Julia?

A. “Why didn’t you get someone else to drive you?”
B. “Tell me how you feel about the accident.”
C. “You should know better than to drink and drive.”
D. “I recommend that you attend an Alcoholics Anonymous meeting.”

Choosing option A would make the client feel defensive and intimidated. Option C is judgemental, remember any judgemental approach is not therapeutic. Option D is about giving advice and here, the nurse suggests that the client isn’t capable of making decisions, thus fostering dependency. For this question, option B is the correct answer as it encourages the widest range of client response and makes the client be an active participant in the conversation.

5. Responses that pick up or relate to to the client’s cues

Responding to an important cue is essential therapeutic technique if the nurse is to focus on the client and maintain a goal-focused interaction.

A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) washes hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation?

A. “Everyone diagnosed with OCD needs to control their ritualistic behaviors.”
B. “It is important for you to discontinue these ritualistic behaviors.”
C. “Why are you asking for help if you won’t participate in unit therapy?”
D. “Let’s figure out a way for you to attend unit activities and still wash your hands.”

The most appropriate statement by the nurse is, “Let’s figure out a way for you to attend unit activities and still wash your hands.” This statement reflects the therapeutic communication technique of formulating a plan of action. The nurse attempts to work with the client to develop a plan without damaging the therapeutic relationship or increasing the client’s anxiety.

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