This is the full-text copy of the 100-item quiz Therapeutic Communication Techniques NCLEX Practice Quiz (50 Questions)
Use this page to print a copy of the quiz or export it via PDF.
CREATING PDF. For most modern browsers like Chrome, Safari, Firefox, Edge, you can simply click on File> Print > Save as PDF to create a PDF version of this page.
For more quizzes, please visit Nursing Test Bank and Nursing Practice Questions for Free.
Therapeutic Communication Practice Quiz #1 (25 Questions)
A patient with a diagnosis of major depression who has attempted suicide says to the nurse, “I should have died! I’ve always been a failure. Nothing ever goes right for me.” Which response demonstrates therapeutic communication?
- A. “You have everything to live for.”
- B. “Why do you see yourself as a failure?”
- C. “Feeling like this is all part of being depressed.”
- D. “You’ve been feeling like a failure for a while?”
Correct Answer: D. “You’ve been feeling like a failure for a while?”
Responding to the feelings expressed by a patient is an effective therapeutic communication technique. The correct option is an example of the use of restating. It’s frequently useful for nurses to summarize what patients have said after the fact. This demonstrates to patients that the nurse was listening and allows the nurse to document conversations. Ending a summary with a phrase like “Does that sound correct?” gives patients explicit permission to make corrections if they’re necessary.
- Option A: Some people confuse empathizing with sympathizing. To establish a good nurse-patient relationship, the nurse should use empathy, not sympathy. Sympathy is defined as the feelings of concern or compassion one shows for another. By sympathizing, the nurse projects his or her own concerns to the client, thus, inhibiting the client’s expression of feelings.
- Option B: This option blocks communication because it minimizes the patient’s experience and does not facilitate exploration of the patient’s expressed feelings. In addition, the use of the word “why” is nontherapeutic.
- Option C: Internal validation is a non-therapeutic communication technique. This refers to making an assumption about the meaning of someone else’s behavior that is not validated by the other person (jumping into conclusion).
When the community health nurse visits a patient at home, the patient states, “I haven’t slept the last couple of nights.” Which response by the nurse illustrates a therapeutic communication response to this patient?
- A. “I see.”
- B. “Really?”
- C. “You’re having difficulty sleeping?”
- D. “Sometimes, I have trouble sleeping too.”
Correct Answer: C. “You’re having difficulty sleeping?”
The correct option uses the therapeutic communication technique of restatement. Although restatement is a technique that has a prompting component to it, it repeats the patient’s major theme, which assists the nurse in obtaining a more specific perception of the problem from the patient.
- Option A: An essential factor to build a therapeutic nurse-client relationship is showing genuine interest to the client. For the nurse to do this, he or she should be open, honest, and display congruent behavior. Congruence only occurs when the nurse’s words match with her actions.
- Option B: Stay away from nontherapeutic habits such as asking irrelevant personal questions, stating personal opinions, or showing disapproval. Ask open-ended questions, such as, “Tell me about your difficulties,” to encourage the patient to take the lead in the discussion, and prompt him by suggesting he tell you more.
- Option D: This option is not a therapeutic response since it does not encourage the patient to expand on the problem. Offering personal experiences moves the focus away from the patient and onto the nurse.
A patient experiencing disturbed thought processes believes that his food has been poisoned. Which communication technique should the nurse use to encourage the patient to eat?
- A. Using open-ended questions and silence.
- B. Sharing personal preference regarding food choices.
- C. Documenting reasons why the patient does not want to eat.
- D. Offering opinions about the necessity of adequate nutrition.
Correct Answer: A. Using open-ended questions and silence.
Open-ended questions and silence are strategies used to encourage patients to discuss their problems. Sharing personal food preferences is not a patient-centered intervention. One of the most important skills of a nurse is developing the ability to establish a therapeutic relationship with clients. For interventions to be successful with clients in a psychiatric facility and in all nursing specialties it is crucial to build a therapeutic relationship.
- Option B: Focusing on one’s self is a non-therapeutic communication technique. This refers to responding in a way that focuses attention on the nurse instead of the client. An essential factor to build a therapeutic nurse-client relationship is showing genuine interest to the client. For the nurse to do this, he or she should be open, honest, and display congruent behavior. Congruence only occurs when the nurse’s words match with her actions.
- Option C: Focusing on the negative should be done less than giving options for the patient. Encourage the patient to consider the pros and cons of possible options. In dealing with clients their interest should be the nurse’s greatest concern. Thus, empathizing with them is the best technique as it acknowledges the feelings of the client and at the same time, it allows a client to talk and express his or her emotions.
- Option D: The remaining option is not helpful to the patient because they do not encourage the patient to express feelings. The nurse should not offer opinions and should encourage the patient to identify the reasons for the behavior.
A patient admitted to a mental health unit for treatment of psychotic behavior spends hours at the locked exit door shouting. “Let me out. There’s nothing wrong with me. I don’t belong here.” What defense mechanism is the patient implementing?
- A. Denial
- B. Projection
- C. Regression
- D. Rationalization
Correct Answer: A. Denial.
Denial is a refusal to admit to a painful reality, which was treated as if it does not exist. It involves blocking external events from awareness. If some situation is just too much to handle, the person refuses to experience it. This is a primitive and dangerous defense – no one disregards reality and gets away with it for long! It can operate by itself or, more commonly, in combination with other, more subtle mechanisms that support it.
- Option B: In projection, a person unconsciously rejects emotionally unacceptable features and attributes them to other persons, objects, or situations. Projection is a psychological defense mechanism proposed by Anna Freud in which an individual attributes unwanted thoughts, feelings, and motives onto another person.
- Option C: Regression allows the patient to return to an earlier, more comforting, although less mature, way of behaving. This is a movement back in psychological time when one is faced with stress. Regression functions as a form of retreat, enabling a person to psychologically go back in time to a period when the person felt safer.
- Option D: Rationalization is justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller and the listener. Rationalization is a defense mechanism proposed by Anna Freud involving a cognitive distortion of “the facts” to make an event or an impulse less threatening.
A patient diagnosed with terminal cancer says to the nurse “I’m going to die, and I wish my family would stop hoping for a cure! I get so angry when they carry on like this. After all, I’m the one who’s dying.” Which response by the nurse is therapeutic?
- A. “Have you shared your feelings with your family?”
- B. “I think we should talk more about your anger with your family.”
- C. “You’re feeling angry that your family continues to hope for you to be cured?”
- D. “You are probably very depressed, which is understandable with such a diagnosis.”
Correct Answer: C. “You’re feeling angry that your family continues to hope for you to be cured?”
Restating is a therapeutic communication technique in which the nurse repeats what the patient says to show understanding and to review what was said. Restating is done to clarify the client’s message by repeating the same statement back to the client.
- Option A: Judgements place a positive or negative value on the client and their messages. The therapeutic nurse-client relationship must be, at all times, nonjudgmental, open, and honest.
- Option B: While it is appropriate for the nurse to attempt to assess the patient’s ability to discuss feelings openly with family members, it does not help the patient discuss the feelings causing the anger.
- Option D: The nurse’s attempt to focus on the central issue of anger is premature. The nurse would never make a judgment regarding the reason for the patient’s feelings; this is non-therapeutic in the one-to-one relationship.
On review of the patient’s record, the nurse notes the admission was voluntary. Based on this information, the nurse anticipates which patient’s behavior?
- A. Fearfulness regarding treatment measures.
- B. Anger and aggressiveness directed toward others.
- C. An understanding of the pathology and symptoms of the diagnosis.
- D. A willingness to participate in the planning of the care and treatment plan.
Correct Answer: D. A willingness to participate in the planning of the care and treatment plan.
In general, patients seek voluntary admission. If a patient seeks voluntary admission, the most likely expectation is the patient will participate in the treatment program since they are actively seeking help. Voluntary admission to an acute inpatient psychiatric hospital occurs when a person goes for psychiatric evaluation and the evaluating mental health provider and patient agree that the patient would benefit from hospitalization and meets criteria for hospitalization.
- Option A: Fearfulness is characteristic of involuntary admission. Involuntary admission to an acute inpatient psychiatric hospital occurs when the patient does not agree to hospitalization on a locked inpatient psychiatric unit, but a mental health professional evaluates the patient and believes that, as a result of mental illness, the patient is at risk of harming self or others, or is unable to care for self.
- Option B: The remaining option is not characteristic of this type of admission. Anger and aggressiveness are more characteristic of involuntary admission. Involuntary admissions to psychiatric hospitals, regardless of their beneficial effects, violate the patients’ autonomy. To keep such measures at a minimum and develop less restricting and coercive alternatives, a better understanding of the psychiatric emergency situations which end up in involuntary admissions is needed.
- Option C: Voluntary admission does not guarantee a patient’s understanding of their illness, only of their desire for help. A mental health professional will evaluate an individual who goes to one of the above facilities and will determine whether the patient is appropriate for an inpatient psychiatric unit.
A patient admitted voluntarily for the treatment of an anxiety disorder demands to be released from the hospital. Which action should the nurse take initially?
- A. Contact the patient’s health care provider (HCP).
- B. Call the patient’s family to arrange for transportation.
- C. Attempt to persuade the patient to stay for only a few more days.
- D. Tell the patient that leaving would likely result in an involuntary commitment.
Correct Answer: A. Contact the patient’s health care provider (HCP).
In general, patients seek voluntary admission. Voluntary patients have the right to demand and obtain release. The nurse needs to be familiar with the state and facility policies and procedures. The best nursing action is to contact the HCP, who has the authority to discuss discharge with the patient.
- Option B: While arranging for safe transportation is appropriate it is premature in this situation and should be done only with the patient’s permission. If the patient later requests discharge, the hospital can hold the patient on the unit for up to 72 hours until a mental health professional can evaluate the patient for safety concerns. The patient will be discharged if the evaluating mental health professional determines that the patient is safe for discharge.
- Option C: While it is appropriate to discuss why the patient feels the need to leave and the possible outcomes of leaving against medical advice, attempting to get the patient to agree to stay “a few more days” has little value and will not likely be successful.
- Option D: Many states require that the patient submits a written release notice to the facility staff members, who reevaluate the patient’s condition for possible conversion to involuntary status if necessary, according to criteria established by law. While this is a possibility, it should not be used as a threat to the patient.
When reviewing the admission assessment, the nurse notes that a patient was admitted to the mental health unit involuntarily. Based on this type of admission, the nurse should provide which intervention for this patient?
- A. Monitor closely for harm to self or others.
- B. Assist in completing an application for admission.
- C. Supply the patient with written information about their mental illness.
- D. Provide an opportunity for the family to discuss why they felt the admission was needed.
Correct Answer: A. Monitor closely for harm to self or others.
Involuntary admission is necessary when a person is a danger to himself or others or is in need of psychiatric treatment regardless of the patient’s willingness to consent to the hospitalization. The person must pose a “clear and present danger” to self or others based upon statements and behavior that occurred in the past 30 days.
- Option B: A written request is a component of voluntary admission. Involuntary admission to an acute inpatient psychiatric hospital occurs when the patient does not agree to hospitalization on a locked inpatient psychiatric unit, but a mental health professional evaluates the patient and believes that, as a result of mental illness, the patient is at risk of harming self or others, or is unable to care for self.
- Option C: Providing written information regarding the illness is likely premature initially. The decision to discharge the patient or request a longer commitment is made by the treatment team based on concerns for the safety of the patient or others.
- Option D: The family may have had no role to play in the patient’s admission. However, any person (including police and doctors) can petition or request an involuntary psychiatric evaluation for another person. The person requesting the evaluation is known as the “petitioner.” A request for an evaluation can be made by going to any CRC or by calling a mobile crisis team to come to the petitioner’s home.
The nurse is preparing a patient for the termination phase of the nurse-patient relationship. The nurse prepares to implement which nursing task that is most appropriate for this phase?
- A. Planning short-term goals
- B. Making appropriate referrals
- C. Developing realistic solutions
- D. Identifying expected outcomes
Correct Answer: B. Making appropriate referrals.
Tasks of the termination phase include evaluating patient performance, evaluating achievement of expected outcomes, evaluating future needs, making appropriate referrals, and dealing with the common behaviors associated with termination. After the client’s problems or issues are addressed, the relationship needs to be completed before it can be terminated.
- Option A: The working or middle phase of the relationship is where nursing interventions frequently take place. Problems and issues are identified and plans to address these are put into action. Positive changes may alternate with resistance and/or lack of change.
- Option C: Develop realistic solutions belong to the working phase. New problems and needs may emerge as the nurse-client relationship develops and as earlier identified issues are addressed. The nurse advocates for the client to ensure that the client’s perspectives and priorities are reflected in the plan of care.
- Option D: The remaining options identify tasks appropriate for the working phase of the relationship. The nurse assists the client to explore thoughts (e.g. views of self, others, environment, and problem-solving), feelings (e.g. grief, anger, mistrust, sadness), and behaviors (e.g. promiscuity, aggression, withdrawal, hyperactivity).
The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbors ask the nurse, “How is Mary doing? She is my best friend and is seen at your clinic every week.” Which is the most appropriate nursing response?
- A. “I can not discuss any patient situation with you.”
- B. “If you want to know about Mary, you need to ask her yourself.”
- C. “Only because you’re worried about a friend, I’ll tell you that she is improving.”
- D. “Being her friend, you know she is having a difficult time and deserves her privacy.”
Correct Answer: A. “I cannot discuss any patient situation with you.”
The nurse is required to maintain confidentiality regarding the patient and the patient’s care. Confidentiality is basic to the therapeutic relationship and is a patient’s right. The most appropriate response to the neighbor is the statement of that responsibility in a direct, but polite manner. A blunt statement that does not acknowledge why the nurse cannot reveal patient information may be taken as disrespectful and uncaring.
- Option B: Some people working in mental health, such as phone crisis counselors or life coaches, are not licensed by their state. These people may not be legally required to protect client confidentiality. Yet most agree not to reveal identifying information about their clients anyway.
- Option C: Confidentiality includes not just the contents of therapy, but often the fact that a client is in therapy. For example, it is common that therapists will not acknowledge their clients if they run into them outside of therapy in an effort to protect client confidentiality.
- Option D: The remaining options identify statements that do not maintain patient confidentiality. Therapists who break confidentiality can get in trouble with state licensing boards. They can also be sued by their clients in some cases.
The nurse calls security and has physical restraints applied when a client who is admitted voluntarily becomes both physically and verbally abusive while demanding to be discharged from the hospital. Which represents the possible legal ramifications for the nurse associated with these interventions? Select all that apply.
- A. Libel
- B. Battery
- C. Assault
- D. Slander
- E. False Imprisonment
Correct Answer: B, C, and E.
Voluntary admission to an acute inpatient psychiatric hospital occurs when a person goes for psychiatric evaluation and the evaluating mental health provider and patient agree that the patient would benefit from hospitalization and meets the criteria for hospitalization.
- Option A: Libel is the publication of writing, pictures, cartoons, or any other medium that exposes a person to public hatred, shame, disgrace, or ridicule, or induce an ill opinion of a person, and are not true.
- Option B: Battery is the intentional act of causing physical harm to someone. Unlike assault, one doesn’t have to warn the victim or make him fearful before hurting them for it to count as a battery.
- Option C: Assault and battery are related to the act of restraining the patient in a situation that did not meet the criteria for such an intervention. If the mental health professional evaluates the patient and feels that he/she is at risk of harm to self/others or unable to care for self, the mental health professional can convert the admission to involuntary admission.
- Option D: Slander is not applicable here since the nurse did not verbally make untrue statements about the patient. If the patient later requests discharge, the hospital can hold the patient on the unit for up to 72 hours until a mental health professional can evaluate the patient for safety concerns. The patient will be discharged if the evaluating mental health professional determines that the patient is safe for discharge.
- Option E: A false imprisonment is an act with the intent to confine a person to a specific area. The nurse can be charged with false imprisonment if the nurse prohibits a patient from leaving the hospital if the patient has been admitted voluntarily and if no agency or legal policies exist for detaining the patient.
The nurse in the mental health unit recognizes which of the following as therapeutic communication techniques? Select all that apply.
- A. Restating
- B. Listening
- C. Asking the patient “Why?”
- D. Maintaining neutral responses
- E. Providing acknowledgment and feedback
- F. Giving advice and approval or disapproval
Correct Answer: A, B, D, and E.
Therapeutic communication techniques include listening, maintaining silence, maintaining neutral responses, using broad openings and open-ended questions, focusing and refocusing, restating, clarifying and validating, sharing perceptions, reflecting, providing acknowledgment and feedback, giving information, presenting reality, encouraging formulation of a plan of action, providing nonverbal encouragement, and summarizing
- Option A: Restating is done to clarify the client’s message by repeating the same statement back to the client. For example, when a client says, “I am ready to do some walking” and the nurse says, “Did I hear you say that you are now ready to do some walking?”
- Option B: Active listening involves showing interest in what patients have to say, acknowledging that you’re listening and understanding, and engaging with them throughout the conversation. Nurses can offer general leads such as “What happened next?” to guide the conversation or propel it forward.
- Option C: Asking why is often interpreted as being accusatory by the patient and should also be avoided. Challenging, simply defined in this context, is forcing the client to defend and justify their opinions, beliefs, and feelings. Challenging shows a lack of respect for the client and a lack of acceptance of the client as a unique being who has and is entitled to, their own beliefs and opinions. The client has valid feelings that should never be challenged by the nurse.
- Option D: Focusing on the subject at hand decreases the risk of having these kinds of distractions impair the therapeutic communication process. For example, the nurse may say, “Mr. Burke, your family is very interesting and successful. Thank you for sharing this information with me. Now, let’s discuss your diabetes and the insulin that you will be taking after you leave the hospital”.
- Option E: Recognition, acknowledgment, and acceptance of the client and their thoughts which are conveyed during communication are therapeutic communication techniques and strategies that give the nurse the opportunity to let the client know that you are interested in them and respectful of them and their thoughts.
- Option F: Providing advice or giving approval or disapproval are barriers to communication. Telling the client what to do, giving opinions, or making decisions for the client, implies the client cannot handle his or her own life decisions and that the nurse is accepting responsibility.
A patient being seen in the emergency department immediately after being sexually assaulted appears calm and controlled. The nurse analyzes this behavior as indicating which defense mechanism?
- A. Denial
- B. Projection
- C. Rationalization
- D. Intellectualization
Correct Answer: A. Denial
Denial is the refusal to admit to a painful reality and maybe a response by a victim of sexual abuse. In this case, the patient is not acknowledging the trauma of the assault either verbally or nonverbally. If a situation is just too much to handle, the person may respond by refusing to perceive it or by denying that it exists.
- Option B: Projection is transferring one’s internal feelings, thoughts, and unacceptable ideas and traits to someone else. Projection is a psychological defense mechanism proposed by Anna Freud in which an individual attributes unwanted thoughts, feelings, and motives onto another person.
- Option C: Rationalization is justifying the unacceptable attributes of oneself. Rationalization is a defense mechanism proposed by Anna Freud involving a cognitive distortion of “the facts” to make an event or an impulse less threatening.
- Option D: Intellectualization is the excessive use of abstract thinking or generalizations to decrease painful thinking. In psychology, this behavior pattern is referred to as intellectualization, a defense mechanism, which according to Freud involves engrossing oneself so deeply in the reasoning aspect of a situation that you completely disregard the emotional aspect that is involved.
A patient’s unresolved feelings related to loss would be most likely observed during which phase of the therapeutic nurse-patient relationship?
- A. Trusting
- B. Working
- C. Orientation
- D. Termination
Correct Answer: D. Termination
In the termination phase, the relationship comes to a close. Ending treatment sometimes may be traumatic for patients who have come to value the relationship and the help. Because loss is an issue, any unresolved feelings related to loss may resurface during this phase.
- Option A: Sometimes during the working phase of the relationship, the nurse may choose to self-disclose information about themselves to relate to the client. Limited self-disclosure may be beneficial when it helps the client express their feelings as they relate their experience to what the nurse has disclosed. Sharing personal information with a client can deepen trust.
- Option B: Within this phase, relevant treatment goals are established to guide nursing interventions and client actions, and the conversation in the working phase turns to active problem solving related to assessed needs. Clients can more deeply disclose concerns/issues that they are having.
- Option C: The nurse begins to build a sense of trust by providing the client with basic information (name, professional status, and essential information about the purpose and nature of the relationship). Introductions are important even when the client is confused, aphasic, unresponsive, or unable to respond. Nonverbal supportive communication such as a handshake, eye contact, a smile, and appropriate body language reinforce spoken words.
Which statement demonstrates the best understanding of the nurse’s role regarding ensuring that each client’s rights are respected?
- A. “Autonomy is the fundamental right of each and every client.”
- B. “A patient’s rights are guaranteed by both state and federal laws.”
- C. “Being respectful and concerned will ensure that I’m attentive to my patient’s rights.”
- D. “Regardless of the patient’s conditions, all nurses have the duty to respect patient rights.”
Correct Answer: C. “Being respectful and concerned will ensure that I’m attentive to my patients’ rights.”
The nurse needs to respect and have concern for the patient; this is vital to protecting the patient’s rights. Patient rights are a subset of human rights. Whereas the concept of human rights refers to minimum standards for the ways persons can expect to be treated by others, the concept of ethics refers to customary standards for the ways persons should treat others.
- Option A: While it is true that autonomy is a basic client right, there are other rights that must also be both respected and facilitated. Commonly established rights tend to derive from a core set of ethical principles, including autonomy of the patient, beneficence, nonmaleficence, (distributive) justice, patient-provider fiduciary (trusting) relationship, and inviolability of human life.
- Option B: State and federal laws do protect a patient’s rights, but it is sensitivity to those rights that will ensure that the nurse secures these rights for the patient. As such, rights and ethics are usually flip sides of the same coin, and behind every ‘patient right’ is one or more ethical principles from which that right is derived.
- Option D: It is a fact that safeguarding a patient’s rights is a nursing responsibility, but stating that fact does not show understanding or respect for the concept. Establishing clearly defined patient rights helps standardize care across healthcare fields and enables patients to have uniform expectations during their treatment.
Which therapeutic communication technique is being used in this nurse-client interaction?
Client: “When I get angry, I get into a fistfight with my wife, or I take it out of the kids.”
Nurse: “I notice that you are smiling as you talk about this physical violence.”
- A. Encouraging comparison
- B. Exploring
- C. Formulating a plan of action
- D. Making observations
Correct Answer: D. Making observations
The nurse is using the therapeutic communication technique of making observations when noting that the client smiles when talking about physical violence. The technique of making observations encourages the client to compare personal perceptions with those of the nurse.
- Option A: Often, patients can draw upon experience to deal with current problems. By encouraging them to make comparisons, nurses can help patients discover solutions to their problems.
- Option B: Exploring, in contrast to invasive and non-therapeutic probing, is using techniques that encourage the client to provide more details and information about a particular topic or health care problem.
- Option C: Formulating a plan of action refers to asking the client to consider the kinds of behavior likely to be appropriate in future situations. For example, the nurse asks the client, “What could you do to let your anger out harmlessly?”
Which therapeutic communication technique is being used in this nurse-client interaction?
Client: “My father spanked me often.”
Nurse: “Your father was a harsh disciplinarian.”
- A. Restatement
- B. Offering general leads
- C. Focusing
- D. Accepting
Correct Answer: A. Restatement
The nurse is using the therapeutic communication technique of restatement. Restatement involves repeating the main idea of what the client has said. The nurse uses this technique to communicate that the client’s statement has been heard and understood.
- Option B: Providing a lead to the client enables the client to continue discussing things with the nurse and it also facilitates the client’s beginning a new discussion that is focused on a particular thing. For example, the nurse may say, “Tell me about your concerns relating to your new medications”. Hopefully, the client will take this lead and begin a discussion about their new medications and their concerns relating to them with the nurse.
- Option C: Focusing with the client is a therapeutic communication technique used by nurses, and other members of the health care team, that facilitates the client’s abilities to focus on and pay attention to the matters at hand, which should reflect the client’s priorities. At times, some clients may use the nurse’s presence to talk about things not even related to their health care and their health care problems.
- Option D: Recognition, acknowledgment, and acceptance of the client and their thoughts which are conveyed during communication are therapeutic communication techniques and strategies that give the nurse the opportunity to let the client know that you are interested in them and respectful of them and their thoughts It also allows the client to recognize that the nurse is open, honest and without any bias or judgments.
Which therapeutic communication technique is being used in this nurse-client interaction?
Client: “When I am anxious, the only thing that calms me down is alcohol.”
Nurse: “Other than drinking, what alternatives have you explored to decrease anxiety?”
- A. Reflecting
- B. Making observations
- C. Formulating a plan of action
- D. Giving recognition
Correct Answer: C. Formulating a plan of action
The nurse is using the therapeutic communication technique of formulating a plan of action to help the client explore alternatives to drinking alcohol. The use of this technique, rather than direct confrontation regarding the client’s poor coping choice, may serve to prevent anger or anxiety from escalating.
- Option A: This therapeutic communication technique reflects and mirrors what the nurse believes the client’s feelings to be underneath the words. It mirrors, or reflects, the patient’s feelings, not words, back to the client so that the client’s feelings can be further explored and expressed by the patient.
- Option B: Making observations refers to verbalizing what the nurse perceives. For example, the nurse says, “You appear tense.” or “I notice you are biting your lip.” Sometimes clients cannot verbalize or make themselves understood. Or the client may not be ready to talk.
- Option D: Recognition, acknowledgment and acceptance of the client and their thoughts which are conveyed during communication are therapeutic communication techniques and strategies that give the nurse the opportunity to let the client know that you are interested in them and respectful of them and their thoughts It also allows the client to recognize that the nurse is open, honest and without any bias or judgements.
Nurse Patrick is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a general lead?
- A. “Do you know why you are here?”
- B. “Are you feeling depressed or anxious?”
- C. “Yes, I see. Go on.”
- D. “Can you chronologically order the events that led to your admission?”
Correct Answer: C. “Yes, I see. Go on.”
The nurse’s statement, “Yes, I see. Go on.” is an example of the therapeutic communication technique of a general lead. Offering a general lead encourages the client to continue sharing information. General leads indicate that the nurse is listening and following what the client is saying without taking away the initiative for the interaction.
- Option A: Asking the client why he is here is a type of exploring. Exploring refers to delving further into a subject or idea. When clients deal with topics superficially, exploring can help them examine the issue more fully. Any problem or concern can be better understood if explored in depth.
- Option B: Asking the client if he is depressed or anxious may be inappropriate because it may put words into the client’s mouth. It would be best to let the client speak out by offering him leads or encouraging him to voice out his feelings through exploring.
- Option D: Placing events in time or sequences refer to clarifying the relationship of events in time. Putting events in proper sequence helps both the nurse and the client to see them in perspective. The client may gain insight into cause-and-effect behavior and consequences.
A nurse states to a client, “Things will look better tomorrow after a good night’s sleep.” This is an example of which communication technique?
- A. The therapeutic technique of “giving advice”.
- B. The therapeutic technique of “defending”.
- C. The non therapeutic technique of “presenting reality”.
- D. The non-therapeutic technique of “giving false reassurance”.
Correct Answer: D. The non-therapeutic technique of “giving false reassurance.”
The nurse’s statement, “Things will look better tomorrow after a good night’s sleep.” is an example of the nontherapeutic technique of giving false reassurance. Giving false reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the client’s feelings.
- Option A: Telling the client what to do, giving opinions, or making decisions for the client, implies the client cannot handle his or her own life decisions and that the nurse is accepting responsibility.
- Option B: Defensiveness occurs when the nurse feels the need to defend themselves, their actions, their employers, or others for their failures and shortcomings. Again, this technique fulfills the needs of the nurse rather than the client and, as such, it is not therapeutic.
- Option C: Presenting reality is offering for consideration that which is real. When it is obvious that the client is misinterpreting reality, the nurse can indicate what is real. The nurse does this by calmly and quietly expressing the nurse’s perceptions or the facts not by way of arguing with the client to consider, not to “convince” the client that he is wrong.
A client diagnosed with post-traumatic stress disorder is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique used by the nurse is an example of a broad opening?
- A. “What occurred prior to the rape, and when did you go to the emergency department?”
- B. “What would you like to talk about?”
- C. “I notice you seem uncomfortable discussing this.”
- D. “How can we help you feel safe during your stay here?”
Correct Answer: B. “What would you like to talk about?”
The nurse’s statement, “What would you like to talk about?” is an example of the therapeutic communication technique of giving broad openings. Using a broad opening allows the client to take the initiative in introducing the topic and emphasizes the importance of the client’s role in the interaction.
- Option A: Placing events in time or sequences refers to clarifying the relationship of events in time. Putting events in proper sequence helps both the nurse and the client to see them in perspective. The client may gain insight into cause-and-effect behavior and consequences.
- Option C: Making observations refers to verbalizing what the nurse perceives. For example, the nurse says, “You appear tense.” or “I notice you are biting your lip.” Sometimes clients cannot verbalize or make themselves understood. Or the client may not be ready to talk.
- Option D: Theme identification allows the nurse to identify underlying issues and problems experienced by the client that emerge repeatedly during a nurse-client relationship. It allows the nurse to best promote the client’s exploration and understanding of important problems.
A nurse is assessing a client diagnosed with schizophrenia for the presence of hallucinations. Which therapeutic communication technique used by the nurse is an example of making observations?
- A. “You appear to be talking to someone I do not see.”
- B. “Please describe what you are seeing.”
- C. “Why do you continually look in the corner of this room?”
- D. “If you hum a tune, the voices may not be so distracting.”
Correct Answer: A. “You appear to be talking to someone I do not see.”
The nurse is making an observation when stating, “You appear to be talking to someone I do not see.” Making observations involves verbalizing what is observed or perceived. This encourages the client to recognize specific behaviors and make comparisons with the nurse’s perceptions.
- Option B: Encouraging description of perceptions is asking the client to verbalize what he or she perceives. To understand the client, the nurse must see things from the client’s perspective. Encouraging the client to describe fully may relieve the tension the client is feeling, and he might be less likely to take action on ideas that are harmful or frightening.
- Option C: Requesting an explanation is asking the client to provide reasons for thoughts, feelings, behaviors, and events. There is a difference between asking the client to describe what is occurring and or has taken place and asking him to explain why. Usually, a “why” question is intimidating.
- Option D: Telling the client what to do and giving an opinion or making decisions for the client is nontherapeutic. It implies that the client cannot handle life decisions and only the nurse knows what is best for the client.
A nurse maintains an uncrossed arm and leg posture. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening?
- A. S
- B. O
- C. L
- D. E
- E. R
Correct Answer: B. O.
The nurse should identify that maintaining an uncrossed arm and leg posture is nonverbal behavior that reflects the “O” in the active-listening acronym SOLER. Open posture when interacting with the client (O). Crossing the arms would make the nurse anxious or defensive.
The acronym SOLER includes:
- Option A: Sitting squarely facing the client (S). Sit and face the client. The nurse should sit attentively at an angle to the client so that she can look at them directly and show them that she is listening to them and paying attention.
- Option C: Leaning forward toward the client (L). The nurse should lean forward to show that she is interested in what the client is talking about. It also means that the client can lower their voice if they wish to if they are talking about personal issues, for example.
- Option D: Establishing eye contact (E). Maintaining eye contact shows that the nurse is interested and listening to what the client has to say. It does not mean that the nurse has to stare at the client because this can make them feel uncomfortable, but maintain good, positive eye contact.
- Option E: Relaxing (R). R stands for relaxed body language. This shows the client that the nurse is not in a rush to get away, but is letting them talk at their own pace.
An instructor is correcting a nursing student’s clinical worksheet. Which instructor statement is the best example of effective feedback?
- A. “Why did you use the client’s name on your clinical worksheet?”
- B. “You were very careless to refer to your client by name on your clinical worksheet.”
- C. “Surely you didn’t do this deliberately, but you breached confidentiality by using the client’s name.”
- D. “It is disappointing that after being told, you’re still using client names on your worksheet.”
Correct Answer: C. “Surely you didn’t do this deliberately, but you breached confidentiality by using the client’s name.”
The instructor’s statement, “Surely you didn’t do this deliberately, but you breached confidentiality by using the client’s name.” is an example of effective feedback. Feedback is a method of communication to help others consider a modification of behavior. Feedback should be descriptive, specific, and directed toward a behavior that the person has the capacity to modify and should impart information rather than offer advice or criticize the individual.
- Option A: Some students need to be nudged to achieve at a higher level and others need to be handled very gently so as not to discourage learning and damage self-esteem. A balance between not wanting to hurt a student’s feelings and providing proper encouragement is essential.
- Option B: When feedback is predominantly negative, studies have shown that it can discourage student effort and achievement (Hattie & Timperley, 2007, Dinham). A teacher has the distinct responsibility to nurture a student’s learning and to provide feedback in such a manner that the student does not leave feeling defeated.
- Option D: Providing feedback means giving students an explanation of what they are doing correctly and incorrectly. However, the focus of the feedback should be based essentially on what the students are doing right. It is most productive to a student’s learning when they are provided with an explanation and example as to what is accurate and inaccurate about their work.
After assertiveness training, a formerly passive client appropriately confronts a peer in group therapy. The group leader states, “I’m so proud of you for being assertive. You are so good!” Which communication technique has the leader employed?
- A. The non-therapeutic technique of giving approval.
- B. The non-therapeutic technique of interpreting.
- C. The therapeutic technique of presenting reality.
- D. The therapeutic technique of making observations.
Correct Answer: A. The non-therapeutic technique of giving approval.
The group leader has employed the non therapeutic technique of giving approval. Giving approval implies that the nurse has the right to pass judgment on whether the client’s ideas or behaviors are “good” or “bad.” This creates a conditional acceptance of the client.
- Option B: Interpreting is making conscious that which is unconscious to the client; telling the client the meaning of his or her experience. The client’s thoughts and feelings are his own, not to be interpreted by the nurse or for hidden meaning.
- Option C: Presenting reality refers to offering for consideration that which is real. When it is obvious that the client is misinterpreting reality, the nurse can indicate what is real. The nurse does this by calmly and quietly expressing the nurse’s perceptions or the facts not by way of arguing with the client or belittling his experience.
- Option D: Making observations refers to verbalizing what the nurse perceives. Sometimes clients cannot verbalize or make themselves understood. Or the client may not be ready to talk.