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Therapeutic communication

Therapeutic Communication

1. 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?"


2. 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."


3. A patient experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the 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


4. 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


5. 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."


6. On review of the patient's record, the nurse notes the admission was voluntary. Based on this information, the nurse anticipates which patient 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.


7. The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbors says to 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 t 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."


8. 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."


9. 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 on 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


10. 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


11. 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?"


12. 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 nontherapeutic technique of "presenting reality"
D The nontherapeutic technique of "giving false reassurance"


13. 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?"


14. 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."


15. A client who frequently exhibits angry outbursts is diagnosed with antisocial personality disorder. Which appropriate feedback should a nurse provide when this client experiences an angry outburst?
A "Why do you continue to alienate your peers by your angry outbursts?"
B "You accomplish nothing when you lose your temper like that."
C "Showing your anger in that manner is very childish and insensitive."
D "During group, you raised your voice, yelled at a peer, left, and slammed the door."


16. A client diagnosed with dependant personality disorder states, "Do you think I should move from my parent's house and get a job?" Which nursing response is most appropriate?
A "It would be best to do that in order to increase independence."
B "Why would you want to leave a secure home?"
C "Let's discuss and explore all of your options."
D "I'm afraid you would feel very guilty leaving your parents."


17. When interviewing a client, which nonverbal behavior should a nurse employ?
A Maintaining indirect eye contact with the client
B Providing space by leaning back away from the client
C Sitting squarely, facing the client
D Maintaining open posture with arms and legs crossed


18. A mother rescues two of her four children from a house fire. In the emergency department, she cries, "I should have gone back in to get them. I should have died, not them." What is the nurse's best response?
A "The smoke was too thick. You couldn't have gone back in."
B "You're feeling guilty because you weren't able to save your children."
C "Focus on the fact that you could have lost all four of your children."
D "It's best if you try not to think about what happened. Try to move on."


19. 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."


20. Which example of a therapeutic communication technique would be effective in the planning phase of the nursing process?
A "We've discussed past coping skills. Let's see if these coping skills can be effective now."
B "Please tell me in your own words what brought you to the hospital."
C "This new approach worked for you. Keep it up."
D "I notice that you seem to be responding to voices that I do not hear."


21. A client tells the nurse, "I feel bad because my mother does not want me to return home after I leave the hospital." Which nursing response is therapeutic?
A "It's quite common for clients to feel that way after a lengthy hospitalization."
B "Why don't you talk to your mother? You may find out she doesn't feel that way."
C "Your mother seems like an understanding person. I'll help you approach her."
D "You feel that your mother does not want you to come back home?"


22. Which nursing statement is a good example of the therapeutic communication technique of giving recognition?
A "You did not attend group today. Can we talk about that?"
B "I'll sit with you until it is time for your family session."
C "I notice you are wearing a new dress and you have washed your hair."
D "I'm happy that you are now taking your medications. They will really help."


23. A client is struggling to explore and solve a problem. Which nursing statement would verbalize the implication of the client's actions?
A "You seem to be motivated to change your behavior."
B "How will these changes affect your family relationships?"
C "Why don't you make a list of the behaviors you need to change."
D "The team recommends that you make only one behavioral change at a time."


24. A student nurse tells the instructor, "I'm concerned that when a client asks me for advice I won't have a good solution." Which should be the nursing instructor's best response?
A "It's scary to feel put on the spot by a client. Nurses don't always have the answer."
B "Remember, clients, not nurses, are responsible for their own choices and decisions."
C "Just keep the client's best interests in mind and do the best that you can."
D "Set a goal to continue to work on this aspect of your practice."


25. Which nursing statement is a good example of the therapeutic communication technique of focusing?
A "Describe one of the best things that happened to you this week."
B "I'm having a difficult time understanding what you mean."
C "Your counseling session is in 30 minutes. I'll stay with you until then."
D "You mentioned your relationship with your father. Let's discuss that further."


26. After fasting from 10 p.m. the previous evening, a client finds out that the blood test has been canceled. The client swears at the nurse and states, "You are incompetent!" Which is the nurse's best response?
A "Do you believe that I was the cause of your blood test being canceled?"
B "I see that you are upset, but I feel uncomfortable when you swear at me."
C "Have you ever thought about ways to express anger appropriately?"
D "I'll give you some space. Let me know if you need anything."


27. During a nurse-client interaction, which nursing statement may belittle the client's feelings and concerns?
A "Don't worry. Everything will be alright."
B "You appear uptight."
C "I notice you have bitten your nails to the quick."
D "You are jumping to conclusions."


28. A client on an inpatient psychiatric unit tells the nurse, "I should have died because I am totally worthless." In order to encourage the client to continue talking about feelings, which should be the nurse's initial response?
A "How would your family feel if you died?"
B "You feel worthless now, but that can change with time."
C "You've been feeling sad and alone for some time now?"
D "It is great that you have come in for help."


29. Which nursing response is an example of the nontherapeutic communication block of requesting an explanation?
A "Can you tell me why you said that?"
B "Keep your chin up. I'll explain the procedure to you."
C "There is always an explanation for both good and bad behaviors."
D "Are you not understanding the explanation I provided?"


30. A client states, "You won't believe what my husband said to me during visiting hours. He has no right treating me that way." Which nursing response would best assess the situation that occurred?
A "Does your husband treat you like this very often?"
B "What do you think is your role in this relationship?"
C "Why do you think he behaved like that?"
D "Describe what happened during your time with your husband."


31. Which therapeutic communication technique should the nurse use when communicating with a client who is experiencing auditory hallucinations?
A "My sister has the same diagnosis as you and she also hears voices."
B "I understand that the voices seem real to you, but I do not hear any voices."
C "Why not turn up the radio so that the voices are muted."
D "I wouldn't worry about these voices. The medication will make them disappear."


32. Which nursing statement is a good example of the therapeutic communication technique of offering self?
A "I think it would be great if you talked about that problem during our next group session."
B "Would you like me to accompany you to your electroconvulsive therapy treatment?"
C "I notice that you are offering help to other peers in the milieu."
D "After discharge, would you like to meet me for lunch to review your outpatient progress?"


33. A client with a history of major depression tells the nurse "I wish I weren't alive. I have been a failure my entire life and I am totally useless to anyone." The most therapeutic response to the client is:
A "You've been feeling like a failure your entire life?"
B "You shouldn't talk like that. You're not a failure."
C "Once the antidepressants start working you will feel better about yourself."
D "Things could be worse. You should be grateful for what you have."


34. The nurse is completing the sexual history section of the admission assessment. The client tells the nurse "I don't want to talk about this. This is private between my spouse and me." Which nurse response reflects empathy?
A "Yes, I know just how you feel."
B "I know some of these questions are difficult for you."
C "I am a professional nurse and I know what I am doing."
D "I understand this is difficult for you to talk about, but I have to complete the admission assessment."


35. A patient recovering from a bilateral mastectomy for breast cancer tearfully tells the nurse that she is feeling depressed and worthless as a woman. Which communication phrase is not effective?
A "Many women have body image concerns after undergoing this surgery."
B "Tell me more about how you feel."
C "Why do you feel depressed and worthless?"
D "How long have you been feeling this way?"

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