Therapeutic Communication Techniques NCLEX Practice Quiz & Reviewer (50 Questions)

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Therapeutic Communication Techniques in Nursing NCLEX Practice Questions
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Welcome to your reviewer and NCLEX practice quiz guide about therapeutic communication techniques in nursing! In this nursing test bank, test your knowledge and understanding about therapeutic communication. The goal of this quiz is to help student nurses on how to answer therapeutic communication questions in the NCLEX.


Therapeutic Communication Techniques in Nursing Practice Quiz

In this section are the NCLEX practice questions to help you familiarize yourself with therapeutic communication items. Included in this nursing test bank are 50 questions divided into two parts. We hope that this practice quiz will help you gain an understanding of the essential elements and concepts of therapeutic communication.

Quizzes included in this guide are:

Guidelines

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  • Since this is a review, answers and rationales are shown after you click on the "Check" button. 
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  • After the quiz, please make sure to read the questions and rationales again by click on the "View Questions" button. 
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Part 1: Therapeutic Communication in Nursing NCLEX Practice Quiz (25 Questions)

This is the first part of your therapeutic communication quiz. Be sure to read the rationales after each question. Good luck and we hope you learn a lot!

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Therapeutic Communication in Nursing

The guide below is your reviewer for the concepts of therapeutic communication in nursing. We’ve made it as condense as possible by including only the key facts to help you refresh your memory!

Learning the techniques of therapeutic communication is an important skill that nurses should possess since communication is an integral part of being a nurse. This is a study guide about the basic principles of therapeutic communication, its purpose, differences of verbal and nonverbal communication, and lastly, the different therapeutic communication techniques.

What is Therapeutic Communication?

Therapeutic communication is an interpersonal interaction between the nurse and the client during which the nurse focuses on the client’s specific needs to promote an effective exchange of information. Skilled use of therapeutic communication techniques helps the nurse understand and empathize with the client’s experience.

Goals of Therapeutic Communication

Therapeutic communication can help nurses to accomplish many goals:

  • Establish a therapeutic nurse-client relationship.
  • Identify the most important client concern at that moment (the client-centered goal).
  • Assess the client’s perception of the problem as it unfolds; this includes detailed actions (behaviors and messages) of the people involved and the client’s thoughts and feelings about the situation, others, and self.
  • Facilitate the client’s expression of emotion.
  • Teach the client and the family necessary self-care skills.
  • Recognize the client’s needs.
  • Implement interventions designed to address the client’s needs.
  • Guide the client toward identifying the plan of action to a satisfying and socially acceptable resolution.

Verbal Communication Skills

Verbal communication consists of the words a person uses to speak to one or more listeners.

  • Using concrete messages. The nurse should use words that are as clear as possible when speaking to the client so that the client can understand the message; in a concrete message, the words are explicit and need no interpretation, the speaker uses nouns instead of pronouns; concrete questions are clear, direct, and easy to understand.
  • Using therapeutic communication techniques. The choice of technique depends on the intent of the interaction and the client’s ability to communicate verbally; overall, the nurse selects techniques that facilitate the interaction and enhance communication between client and nurse.
  • Avoiding nontherapeutic communication. In contrast, there are many nontherapeutic techniques that nurses should avoid; these responses cut off communication and make it more difficult for the interaction to continue.
  • Interpreting signals or cues. To understand what a client means, the nurse watches and listens carefully for cues; cues are verbal or nonverbal messages that signal keywords or issues for the client; finding cues is a function of active listening often, cue words introduced by the client can help the nurse to know what to ask next or how to respond to the client.

Nonverbal Communication Skills

Therapeutic communication also involves nonverbal communication is behavior that a person exhibits while delivering verbal content.

  • Facial expression. The human face produces the most visible, complex, and sometimes confusing nonverbal messages; facial movements connect with words to illustrate meaning; this connection demonstrates the speaker’s internal dialogue.
  • Body language. Body language (gestures, postures, movements, and body positions) is a nonverbal form of communication; closed body positions, such as crossed legs or arms folded across the chest, indicate that the interaction might threaten the listener who is defensive or not accepting; a better, more accepting body position is to sit facing the client with both feet on the floor, knees parallel, hands at the side of the body, and legs uncrossed or crossed only at the ankle.
  • Vocal cues. Vocal cues are nonverbal sound signals transmitted along with the content: voice volume, tone, pitch, intensity, emphasis, speed, and pauses augment the sender’s message; volume, the loudness of the voice, can indicate anger, fear, happiness, or deafness; tone can indicate whether someone is relaxed, agitated, or bored; pitch varies from shrill and high to low and threatening; intensity is the power, severity, and strength behind the words; emphasis refers to accents on words or phrases that highlight the subject, and speed is the number of words spoken per minute.
  • Eye contact. The eyes have been called the mirror of the soul because they often reflect our emotions; eye contact, looking into the other person’s eyes during communication, is used to assess the other person and the environment and to indicate whose turn it is to speak; it increases during listening but decreases while speaking.

Therapeutic Communication Techniques

Choosing the appropriate therapeutic communication technique is critical in establishing and maintaining the nurse-patient relationship. These techniques are discussed below:

Therapeutic Communication TechniqueExampleRationale
Accepting.
Indicating reception
“Yes.”
“I understand what you said.”
Nodding
An accepting response indicates the nurse has heard and followed the train of thought.
Broad openings.
Allowing the client to take the initiative in introducing the topic.
“Is there something you’d like to talk about?” 
“Where would you like to begin?”
Broad openings make explicit that the client has the lead in the interaction.
Consensual validation.
Searching for mutual understanding, for accord in the meaning of the words.
“Tell me whether my understanding of it agrees with yours.”For verbal communication to be meaningful, it is essential that the words being used have the same meaning for both (all) participants.
Encouraging comparison.
Asking that similarities and differences be noted.
“Was it something like…?”Have you had similar experiences?Comparing ideas, experiences, or relationships brings out many recurrent themes.
Encouraging description of prescriptions.
Asking the client to verbalize what he or she perceives.
“Tell me when you feel anxious.”
“Do tell me what is happening?”
“What does the voice seem to be saying?”
To understand the client, the nurse must see things from his or her perspective.
Encouraging expression
Asking the client to appraise the quality of his or her experiences.
“What are your feelings in regard to...?”
“Does this contribute to your distress?”
The nurse asks the client to consider people and events in light of his or her own values.
Exploring.
Delving further into a subject or idea.
“Tell me more about that.” 
“Would you describe it more fully?”
When clients deal with topics superficially, exploring can help them examine the issue more fully.
Focusing.
Concentrating on a single point.
“This point seems worth looking at more closely.”The nurse encourages the client to concentrate his or her energies on a single point, which may prevent a multitude of factors or problems from overwhelming the client.
Formulating a plan of action.
Asking the client to consider kinds of behavior likely to be appropriate in future situations.
“What could you do to let your anger out harmlessly?”It may be helpful for the client to plan in advance what he or she might do in future similar situations.
General leads.
Giving encouragement to continue.
“Go on.”  
“And then?”
General leads indicate that the nurse is listening and following what the client is saying without taking away the initiative for interaction.
Giving information.
Making available the facts that the client needs.
“My name is…”
"These are your medications..."  
“Visiting hours are…”
Informing the client of facts increases his or her knowledge about a topic or lets the client know what to expect.
Giving recognition.
Acknowledging, indicating awareness.
“Good morning Mr…”  
“You’ve finished your list of things to do.”
Greeting the client by name, indicating awareness of change, or noting efforts the client has made all show that the nurse recognizes the client as a person, as an individual.
Making observations.
Verbalizing what the nurse perceives.
“You appear tense.”
“Are you uncomfortable when..?”
Sometimes clients cannot verbalize or make themselves understood.
Offering self.
Making oneself available.
“I’ll sit with you awhile.”The nurse can offer his or her presence, interest, and desire to understand.
Placing event in time or sequence.
Clarifying the relationship of events in time.
“What seemed to lead up to…?”Putting events in proper sequence helps both the nurse and client to see them in perspective.
Presenting reality.
Offering for consideration that which is real.
“I see no one else in the room.”When it is obvious that the client is misinterpreting reality, the nurse can indicate what is real.
Reflecting.
Directing client actions, thoughts, and feelings back to client.
Client: “Do you think I should tell the doctor?”
Nurse: “Do you think you should?”
Reflection encourages the client to recognize or accept his or her own feelings.
Restating.
Repeating the main idea expressed.
Client: “I can’t sleep. I stay awake all night.”
Nurse: “You have difficulty sleeping.”
The nurse repeats what the client has said in approximately or nearly the same words the client has used.
Seeking information.
Seeking to make clear that which is not meaningful or that which is vague.
“I’m not sure that I follow. Could you tell me more?”The nurse should seek clarification through interactions with clients.
Silence.
Absence of verbal communication, which provides time for the client to put thoughts or feelings into words, to regain composure, or to continue talking.
Nurse says nothing but continues to make eye contact and conveys interest.Silence often encourages the client to verbalize, provided that it is interested and expectant.
Suggesting collaboration.
Offering to share, to strive, to work with the client for his or her benefit.
“Perhaps you and I can discuss and discover the triggers for your anxiety.”The nurse seeks to offer a relationship in which the client can identify problems in living with others, grow emotionally, and improve the ability to form satisfactory relationships.
Summarizing.
Organizing and summing up that which has gone before.
“So in summary..."
"Have I got this straight?”
Summarization seeks to bring out the important points of the discussion and to increase the awareness and understanding of both participants.
Translating into feelings.
Seeking to verbalize client’s feelings that he or she expresses only indirectly.
Client: “I’m dead.”
Nurse: “Are you suggesting that you feel lifeless?”
Often what the client says, when taken literally, seems meaningless or far removed from reality.
Verbalizing the implied.
Voicing what the client has hinted or suggested.
Client: “I can’t talk to you or anyone. It’s a waste of time.”
Nurse: “Do you feel that no one understands?”
Putting into words what the client has implied or said indirectly tends to make the discussion less obscure.
Voicing doubt.
Expressing uncertainty about the reality of the client’s perception.
“Isn’t that unusual?”“Really?”Another means of responding to distortions of reality is to express doubt.
Open-ended comments.
Unfinished sentences that prompt the client to continue. Questions that cannot be answered with a one-word answer.
“Tell me more about your pain.”
“Tell me about your family.”
Allows client to decide what content is relevant.
Clarifying.
Makes the meaning of client’s message clear.
Client: “Whenever I talk to my doctor, I feel so upset.”
Nurse: “Tell me what is making you upset?”
Prevents nurse from making assumptions about client’s message.
Confronting.
Nurse’s verbal response to incongruence between client’s words and actions.
Client: “I am so angry at her!” (Stated while smiling).
Nurse: “You said you are angry, yet you are smiling?”
Encourages client to recognize potential areas for change.
Setting limits.
Stating expectations for appropriate behavior.
Nurse: “It seems that you are feeling unsure of how to behave right now.”
Client: “What do you mean?”
Nurse: “Well, you are asking me a lot of personal questions. The reason you are here is because you have some health issues and problems. Tell me more clearly what brought you here to the clinic so I can help you.?”
Establishing behavioral parameters.

Non-Therapeutic Communication

Non-Therapeutic communication involves words, phrases, actions, and tones that make a patient feel uncomfortable, increase their stress, and worsen their mental and even physical wellbeing.

Non-Therapeutic ResponsesExamplesRationale
Reassuring“I would not worry about that.”Indicating that there is no cause of anxiety.
Giving approval“That’s good!”Offering unnecessary approval, on the other hand, implies that the behavior being praised is the only acceptable one.
Rejecting“Let’s not discuss about that!”Refusing to consider or showing contempt for the client’s ideas or behavior.
Disapproving“That’s bad!”Denouncing the client’s ideas or behavior.
Agreeing“That’s right!”
“I agree!”
Indicating accord with the client.
Disagreeing“I definitely disagree with what you’re saying!”
“I don’t believe that!”
Opposing to client’s idea.
Advising“I think you should…”
“Why don’t you…”
Telling the client what to do.
Probing“Tell me more about your love story from the day you fell in love!”Persistent questioning the client. It is invasive, uncomfortable for most clients, and a threat to the client's right to privacy and confidentiality. Probing the client with questions that are not relevant to their health care and health-related concerns is never appropriate.
Indicating the existence of an external source.“Who told you that you were God?!”Attributing the source of thoughts, feelings, and behavior to others, or to outside influence.
Belittling feelings expressed.Client: “I have nothing to live for. I wish I was dead!”
Nurse: “Everybody gets down in the dumps!”
Misjudging the degree of client’s discomfort.
Using denialClient: “I’m nothing!”
Nurse: “Don’t be silly!”
Refusing to admit that problem exists.
Interpreting“What you really mean is…”
“Unconsciously, you’re saying…”
Seeking to make conscious that which is unconscious, telling the client the meaning of his experiences.
Introducing an unrelated topicClient: “I’d like to die!”
Nurse: “Did you have visitors this weekend?”
Changing the subject.

Tips in Answering Therapeutic Communication Questions

Getting the client’s response or the way you communicate with them is a mainstay of the NCLEX. The psychosocial focus of nursing is a central thread throughout all of the clinical areas. Effective communication is an essential way to establish 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 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 it 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 a cognitive limitation of the client makes the client incapable of giving an 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 the client’s cues

Responding to an important cue is an essential therapeutic communication 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.

If you need more information or practice quizzes, please do visit the following links:

Sources and References

The following are the sources and references used for this article. Including some articles and journals we find interesting:

  1. Abdolrahimi, M., Ghiyasvandian, S., Zakerimoghadam, M., & Ebadi, A. (2017). Therapeutic communication in nursing students: A Walker & Avant concept analysisElectronic physician9(8), 4968.
  2. Berman, A., Snyder, S. J., Kozier, B., Erb, G. L., Levett-Jones, T., Dwyer, T., … & Parker, B. (2014). Kozier & Erb’s Fundamentals of Nursing Australian Edition (Vol. 3). Pearson Higher Education AU.
  3. Keltner, N. L. (2013). Psychiatric nursing. Elsevier Health Sciences.
  4. Kozier, B. (2008). Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8/e (With DVD). Pearson Education India.
  5. Rosenberg, S., & Gallo-Silver, L. (2011). Therapeutic communication skills and student nurses in the clinical settingTeaching and learning in nursing6(1), 2-8.
  6. Ruesch, J. (1961). Therapeutic communication.
  7. Sleeper, J. A., & Thompson, C. (2008). The use of hi-fidelity simulation to enhance nursing students’ therapeutic communication skillsInternational Journal of Nursing Education Scholarship5(1), 1-12.
  8. Stuart, G. W. (2014). Principles and practice of psychiatric nursing-e-book. Elsevier Health Sciences.
  9. Wachtel, P. L. (1993). Therapeutic communication: Principles and effective practice. Guilford Press.
  10. Wachtel, P. L. (2011). Therapeutic communication: Knowing what to say when. Guilford Press.
  11. Webster, D. (2014). Using standardized patients to teach therapeutic communication in psychiatric nursingClinical simulation in nursing10(2), e81-e86.
  12. Weber, K., & Farrell, T. (2016). Developing therapeutic communication skills: Integration of standardized client simulation in an associate degree nursing program.
  13. Videbeck, S. L. (2010). Psychiatric-mental health nursing. Lippincott Williams & Wilkins.
Gil Wayne graduated in 2008 with a bachelor of science in nursing. He earned his license to practice as a registered nurse during the same year. His drive for educating people stemmed from working as a community health nurse. He conducted first aid training and health seminars and workshops for teachers, community members, and local groups. Wanting to reach a bigger audience in teaching, he is now a writer and contributor for Nurseslabs since 2012 while working part-time as a nurse instructor. His goal is to expand his horizon in nursing-related topics. He wants to guide the next generation of nurses to achieve their goals and empower the nursing profession.

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