Question 1

Upon entering a client’s room, the client angrily states, “I’ve barely seen you in hours! You are a terrible nurse!” Which response by the nurse is appropriate?

Accepted Answer

Answer reason: ” Therapeutic communication prioritizes acknowledging the client’s feelings and inviting them to identify needs rather than defending or dismissing. This response uses reflection/validation (“you feel…”) and an open-ended, problem-solving question that can de-escalate anger and restore collaboration. Option A becomes defensive and can escalate conflict by arguing about timing. Option D is minimizing and comparative, which invalidates the client’s experience and worsens agitation, and option B abruptly changes the subject without addressing the emotion.

Question 2

The nurse is assessing a toddler when the parent states, “I smoke cigarettes at home sometimes. I know I shouldn’t. Do you think I’m the world’s worst parent?” How should the nurse respond?

Accepted Answer

Answer reason: " Therapeutic communication uses open-ended, nonjudgmental questions to explore feelings and promote insight. This response acknowledges the parent’s expressed guilt and invites reflection without shaming, which supports rapport and readiness for change. It helps the nurse assess the parent’s perception and motivation before offering education or resources. In contrast, immediately advising cessation or stating health impacts can feel confrontational and may shut down further disclosure, while minimizing (“It’s okay…”) dismisses the concern and reduces urgency about secondhand smoke risk.

Question 3

An adult male on the unit informs the nurse that he feels unsafe in the hospital. He states the FBI is out to get him and there are hidden cameras and microphones in the room. “You are probably one of them,” he states. What is the most therapeutic response from the nurse?

Accepted Answer

Answer reason: ” Therapeutic communication with a delusional/paranoid client focuses on acknowledging the client’s feelings and promoting safety without validating the delusion. This response conveys empathy (“frightening”) and reinforces the nurse’s role and the unit’s priority (maintaining safety), which helps reduce anxiety and build rapport. Options that directly argue about “wrong/no proof” can escalate defensiveness and mistrust. Offering to switch nurses reinforces the paranoia and undermines the therapeutic relationship rather than stabilizing it.

Question 4

A client who is delusional says to the nurse, "The federal guards were sent to kill me." What is the best response of the nurse?

Accepted Answer

Answer reason: "I don't know anything about the guards. Do you feel afraid that people are trying to hurt you?" The therapeutic approach to delusions is to avoid validating or directly arguing with the false belief while focusing on the client’s feelings and safety. This response uses neutral language, does not reinforce the delusion, and invites the client to share emotions (fear) so the nurse can assess distress and potential risk. Directly contradicting the delusion can increase defensiveness, damage rapport, and escalate agitation. Exploring the underlying feeling supports de-escalation and opens the door to reality-based support and further assessment.

Question 5

When prompted by the nurse to attend a group therapy session, a client with agoraphobia reports a choking feeling and begins to cry uncontrollably. Which is the appropriate response by the nurse?

Accepted Answer

Answer reason: An acute surge of anxiety/panic requires calm presence, reduced stimuli, and clear, concrete communication to help the client regain control and feel safe. Remaining with the client provides containment and decreases feelings of abandonment that can intensify agoraphobic distress. Short, simple sentences support impaired concentration during panic and guide slow breathing/grounding without overwhelming the client. Leaving to get help can escalate fear, and light touch may be perceived as intrusive or threatening in an anxious client, worsening the reaction.

Question 6

The nurse is caring for the client who sustained multiple injuries and chest trauma in an MVA. The client has developed ARDS, and the HCP requests that the family be updated about this. Which information should the nurse plan to discuss with the family?

Accepted Answer

Answer reason: ARDS is a severe, life-threatening condition with significant mortality risk. The nurse should provide honest, accurate, and balanced information without giving false reassurance or absolute statements. This option appropriately communicates seriousness while avoiding guarantees. Option A gives false reassurance. Option B assumes an outcome prematurely. Option C is incorrect because ARDS is not always fatal.

Question 7

A client with paraplegia from a T10 injury is getting ready to transfer to a rehabilitation hospital. When the nurse offers to assist him, the client throws his suitcase on the floor and says, “You don’t want to help me.” What is the most appropriate response by the nurse?

Accepted Answer

Answer reason: This response uses therapeutic communication by acknowledging the client’s emotions and offering insight into a possible underlying cause (fear of rehabilitation). It encourages expression of feelings and builds rapport. Option A is defensive. Option B avoids addressing the client’s emotions. Option D is confrontational and nontherapeutic.

Question 8

The nurse is communicating with the client receiving hospice care. Which statement is ineffective because it displays the nurse’s personal beliefs?

Accepted Answer

Answer reason: This statement reflects the nurse’s personal opinion and imposes a value judgment on the client’s decision, which is nontherapeutic. Hospice care requires neutral, supportive communication that respects client autonomy without influencing decisions.

Question 9

A client who smoked marijuana daily for 10 years tells a nurse, “I don’t have any goals, and I just don’t know what to do.” What is the most appropriate nursing intervention for this client?

Accepted Answer

Answer reason: Reflection helps the client explore feelings and thoughts by restating or paraphrasing their statement, encouraging deeper self-awareness and problem-solving. This is appropriate when a client expresses uncertainty or lack of direction. Open-ended questions are useful but less targeted than reflection in this context, while focusing or nonverbal methods alone do not adequately facilitate exploration of the client’s concerns.

Question 10

The technology-driven, critical care environment is fast paced and directed toward monitoring and treating life-threatening changes in client conditions. To the families of critical care clients, four behaviors indicate caring. These include?

Accepted Answer

Answer reason: Families of critically ill clients perceive caring through presence, honest communication, and human connection. Touch conveys empathy, reassurance, and support in a high-stress environment. Closed communication and withholding information reduce trust, and open visiting hours alone do not directly reflect interpersonal caring behavior.

Question 11

A patient newly diagnosed with bipolar disorder is being discharged on a new prescription. He expresses concerns about how the medication will change his behavior and ability to function. “I don’t want to be in a mind fog all the time like a zombie.” What is the best response from the nurse?

Accepted Answer

Answer reason: “I imagine starting a new medication can cause some anxiety. This medication should help your impulse control and mood swings, but if you are having concerns or uncomfortable symptoms I highly suggest talking with your provider.” Therapeutic communication should validate the patient’s feelings, provide accurate general education about the purpose of treatment, and encourage appropriate follow-up for side effects without dismissing the concern. This response acknowledges anxiety about starting medication, connects treatment to expected benefits in bipolar disorder, and gives a safe plan to contact the prescriber if adverse effects occur. Options that imply “anything can happen” or “let’s see what happens” are vague and do not reduce anxiety or support informed decision-making. Reassuring the patient that sedation “shouldn’t” occur and emphasizing abnormal movements also risks misinformation and unnecessary alarm, since many mood stabilizers/antipsychotics can affect alertness and require individualized monitoring.

Question 12

The nurse is caring for a client experiencing auditory hallucinations. Which of the following statements would be most appropriate for the nurse to make to the client?

Accepted Answer

Answer reason: Therapeutic communication for hallucinations prioritizes safety, conveys empathy, and helps the client reorient to reality without validating the perceptual disturbance. This response acknowledges the client’s distress and then gently redirects attention to concrete, observable stimuli and the nurse’s voice, which can reduce anxiety and support reality testing. Asking detailed content questions can be appropriate when assessing for command hallucinations, but the most appropriate immediate nursing statement should include clear grounding and redirection. This approach also avoids reinforcing the hallucination as real while still supporting the client emotionally.

Question 13

Which type of communication is characterized by an individual’s inner thoughts?

Accepted Answer

Answer reason: Intrapersonal communication refers to internal self-talk, reflection, and the processing of one’s own thoughts and feelings. Inner thoughts occur within the individual rather than between people, which distinguishes it from interpersonal communication. Nonverbal communication describes messages conveyed through body language, facial expressions, and tone rather than internal cognition. Small-group communication involves interaction among multiple individuals and is therefore not an internal process.

Question 14

The nurse is working with a client who despite making a heroic effort was unable to rescue a neighbor trapped in a house fire. Which clientfocused action should the nurse engage in during the working phase of the nurse-client relationship?

Accepted Answer

Answer reason: A failed rescue commonly triggers guilt, helplessness, intrusive thoughts, and complicated grief, and unaddressed affect can impede adaptive coping and recovery. Focusing on exploring feelings directly supports emotional processing and facilitates healthier coping strategies and meaning-making. In contrast, immediate self-harm assessment is a safety priority only when cues suggest suicidal risk, and general functional assessment is less targeted to therapeutic work around this trauma.

Question 15

A client states, "People think I'm no good, you know what I mean?" Which response by the nurse is most therapeutic?

Accepted Answer

Answer reason: The most therapeutic response encourages the client to express feelings and clarify meaning without judgment. Open-ended statements promote communication and help the nurse better understand the client’s perspective. The other options either provide false reassurance, interpret the situation, or impose judgment, which can hinder effective communication.

Question 16

A child is brought to the emergency department after experiencing a first-time seizure at school. The father states there is no family history of epilepsy. What is the nurse’s best response?

Accepted Answer

Answer reason: A single seizure does not confirm a diagnosis of epilepsy. The most appropriate response is honest and avoids false reassurance or premature conclusions. This statement provides accurate information while acknowledging uncertainty and supporting further evaluation.

Question 17

A nurse is caring for a client who has developed rational detachment. Which of the following interventions should the nurse take first?

Accepted Answer

Answer reason: Rational detachment is a defense/coping pattern where the client intellectualizes or stays emotionally distant to avoid distress. The first nursing priority is therapeutic communication that helps the client identify and verbalize emotions, which is necessary before effective coping skills can be taught. Interventions like structured problem-solving, exercise, or group therapy can be helpful later, but they are less effective if the client is still avoiding emotional processing. Promoting expression of feelings also enables assessment of underlying anxiety, grief, or depression that may require additional interventions.

Question 18

A client scheduled for hip replacement surgery expresses anxiety to the nurse regarding the upcoming surgery. Which response by the nurse is most therapeutic?

Accepted Answer

Answer reason: ” Therapeutic communication prioritizes open-ended assessment of the client’s perceptions and understanding before giving information or reassurance. This response invites the client to verbalize concerns, reveals misconceptions, and guides individualized teaching that can reduce preoperative anxiety. In contrast, broad reassurance minimizes feelings and may shut down further discussion, while immediately launching into detailed explanations can overwhelm a fearful client and may miss what they actually need. Exploring the client’s current knowledge is also a safe starting point before clarifying expectations about the procedure and recovery.

Question 19

Situation : Dennis 40 y/o married man, an electrical engineer was admitted with the diagnosis of paranoid disorders. He has became suspicious and distrustful 2 months before admission. Upon admission, he kept on saying, "my wife has been planning to kill me." Q. Most appropriate nursing intervention for a client with suspicious behaviour is one of the following?

Accepted Answer

Answer reason: A calm, consistent, nonjudgmental approach with clear, simple communication reduces misinterpretation and helps maintain safety and rapport. Attempts to constantly reality-orient or talk excessively can be perceived as intrusive or coercive and can escalate defensiveness. Competitive activities may worsen mistrust and agitation, and forced cheerfulness can seem insincere, further reinforcing paranoid beliefs.

Question 20

During which phase of the nurse/client relationship should the nurse discuss confidentiality and establish boundaries?

Accepted Answer

Answer reason: This is done at the beginning of the relationship when roles are clarified, the purpose of interactions is explained, and consent-related topics such as confidentiality and its limits are reviewed. Establishing boundaries early helps prevent role confusion and reduces the risk of boundary crossings later in care. The working phase focuses on implementing the plan and exploring issues, while termination focuses on closure and evaluating progress rather than initial ground rules.

Question 21

A patient doesn’t wish to work with a certain nurse because that nurse reminds the patient of their mother. What behavior is the patient exhibiting?

Accepted Answer

Answer reason: Here, the client’s reaction to the nurse is driven by the nurse resembling the client’s mother, which fits this projection pattern. Countertransference is the reverse (the nurse projecting feelings onto the client), so it does not match the stem. Agitation is a behavioral state of restlessness, and nonmaleficence is an ethical principle, neither explaining the relationship-based reaction described.

Question 22

A nurse is providing outpatient treatment in a mental health center when a client starts crying and tells the nurse her husband has filed for divorce. Which is the best response made by the nurse?

Accepted Answer

Answer reason: Therapeutic communication prioritizes empathy and reflection to validate feelings and encourage further expression. This statement acknowledges the client’s distress without judging, advising, or shifting focus away from the client’s emotions. Asking “why” can sound blaming and may shut down communication, especially when the client is already crying. Offering advice about children or suggesting counseling is premature problem-solving before the client has had the chance to process and verbalize feelings.

Question 23

The nurse is caring for a client who is intubated and on the ventilator. The client is alert but cannot talk while intubated. Which method of communication would be the best choice for this client?*?

Accepted Answer

Answer reason: A picture/communication board supports effective expression of common needs (pain, suctioning, repositioning, toileting) even if the client is weak or has limited fine-motor writing ability. Pen-and-paper can be difficult with sedation, weakness, or poor coordination, making it less consistently effective. Lip-reading by family is inaccurate and risks misinterpretation, and blinking-only communication restricts the client to closed-ended questions and reduces autonomy.

Question 24

The nurse is preparing a staff development conference on milieu therapy. Which of the following information should the nurse include?

Accepted Answer

Answer reason: Milieu therapy is based on the principle that the therapeutic environment itself is an active part of treatment, using structure, predictable routines, and a supportive emotional climate to promote safety and adaptive behavior. This option captures the core elements: the setting, the unit structure, and the interpersonal/emotional atmosphere as contributors to recovery. Option D is a common distractor because milieu is not laissez-faire; it is intentionally structured with clear limits to reduce anxiety and prevent escalation. Option A is incomplete and misleading because milieu therapy is primarily a psychiatric/psychosocial intervention rather than one centered on physical well-being.

Question 25

A client newly diagnosed with diabetes tells the nurse, "I can't take any insulin made from pigs or cows." Which of the following responses by the nurse is best?

Accepted Answer

Answer reason: This response provides accurate, relevant information while respecting the client’s concern without dismissing it. Modern insulin is recombinant (synthetic), eliminating the need for animal-derived products. Other options are either inaccurate, dismissive, or unnecessarily focused on cost.

Question 26

A patient in the second trimester of pregnancy becomes upset when the health care provider (HCP) schedules several screening tests. The patient voices concern that something is wrong with her baby. Which statement by the nurse will reduce the patient's anxiety?

Accepted Answer

Answer reason: This statement uses clear teaching to correct the misconception that multiple screenings mean something is wrong, which reduces anxiety. It also distinguishes screening from diagnostic testing, which is important because diagnostic tests are used after an abnormal screen to confirm or rule out conditions. In contrast, saying it is “better to identify problems” can imply a high likelihood of fetal abnormality and may increase worry.

Question 27

Which of the following is the highest priority intervention for the nurse who is working with a child with phobia?

Accepted Answer

Answer reason: Encouraging a child to verbalize fears helps the nurse assess triggers, intensity, and coping resources, and it reduces internalized anxiety by validating feelings. This also creates an entry point for gradual desensitization or exposure planning in a developmentally appropriate way rather than forcing confrontation. Immediately making the child face the fear can escalate panic and reduce cooperation, while “protecting” reinforces avoidance and maintains the phobia. While reducing fear/anxiety is a goal, expression is the most immediate, nurse-driven intervention that supports assessment and rapport.

Question 28

A nurse is working at a pregnancy crisis clinic. She is caring for a 15-year-old girl who is there for a pregnancy test. When the nurse gives her the positive result, the girl becomes distraught and seems overwhelmed. The nurse begins to discuss the patient’s situation with her and shares that she too was once an unwed mother at the age of 16. In terms of therapeutic communication, this example most specifically demonstrates which of its essential conditions?

Accepted Answer

Answer reason: Here, the nurse reveals her own history of being an unwed mother as a way to help the adolescent feel less alone and to open discussion, which is the defining feature of this technique. Empathy would be primarily reflected by naming and validating the patient’s feelings rather than shifting focus to the nurse’s experience. Respect and genuineness are broad helping attitudes but do not specifically describe sharing one’s personal story.

Question 29

A nurse is caring for a patient who is experiencing auditory hallucinations. Which of the following should be the nurse’s initial response?

Accepted Answer

Answer reason: ” Assessing command content and intent is the priority because hallucinations can direct self-harm or harm to others and require immediate safety interventions. Asking what the voices say quickly determines risk level, need for increased observation, and whether to implement emergency measures. This response also communicates interest without validating the hallucination as reality and keeps the focus on the patient’s experience. In contrast, asking frequency can be useful later, but it does not first address potential imminent danger.

Question 30

A female client with hypochondriasis discloses that she may decide to leave the psychiatric facility without completing her course of treatment and seek exploratory surgery. The nurse's best response is which of the following?

Accepted Answer

Answer reason: " The priority is therapeutic communication that explores the client’s thoughts, feelings, and motivations without judging or threatening, which helps build rapport and supports insight. An open-ended prompt invites the client to elaborate, allowing assessment of anxiety, somatic preoccupation, and any safety risks while keeping the interaction client-centered. Threats about involuntary commitment or invoking the physician as authority are coercive and can escalate resistance rather than promote engagement in care. Dismissing the client’s plan as “useless” is nontherapeutic and invalidating, which can worsen mistrust and reinforce help-seeking through medical procedures instead of addressing underlying distress.

Question 31

The nurse is conducting family therapy with a family in which one member has a progressively debilitating illness. Which comment by the nurse is most likely to facilitate the family's use of the healthy coping mechanism known as productive interdependence?

Accepted Answer

Answer reason: " Productive interdependence is a healthy family coping pattern in which members share roles, communicate needs, and appropriately both give and accept support. This statement explicitly encourages teamwork and reciprocal help-seeking/help-giving, which prevents caregiver overload and promotes adaptive functioning as illness progresses. Option 1 addresses role distribution but does not directly reinforce mutual support and collaboration as clearly as the team-based framing. Option 4 promotes overfunctioning by the family and removes autonomy from the ill member, which can increase dysfunction rather than healthy interdependence.

Question 32

The infant is asymptomatic for HIV infection. After the checkup, the mother tells the nurse that she is so pleased that the infant will not get HIV. The nurse should make which most appropriate response to the mother?

Accepted Answer

Answer reason: " HIV in infants can have a delayed clinical presentation, and absence of symptoms at one visit does not rule out infection or future symptom development. The most appropriate nursing response is to give accurate, concrete information that corrects false reassurance while maintaining a supportive tone. This option provides realistic timing of symptom onset and reframes the mother’s certainty without judgment. In contrast, statements that simply reassure or imply that lack of symptoms makes infection unlikely provide misleading reassurance and can reduce adherence to needed follow-up testing and monitoring.

Question 33

The mother with human immunodeficiency virus (HIV) infection brings her 10-month-old infant to the clinic for a routine checkup. The health care provider has documented that the infant is asymptomatic for HIV infection. After the checkup, the mother tells the nurse that she is so pleased that the infant will not get HIV. The nurse should make which most appropriate response to the mother?

Accepted Answer

Answer reason: " Asymptomatic status at 10 months does not definitively rule out pediatric HIV, because symptom onset is variable and some infected children present later in infancy or early childhood. The nurse’s most appropriate response provides accurate, non-misleading information and corrects the mother’s premature conclusion without giving false reassurance. This supports informed follow-up and ongoing monitoring/testing rather than implying the child is HIV-free based solely on current lack of symptoms. Options that agree with the mother’s assumption or infer low likelihood from absence of symptoms are unsafe because they can reduce adherence to continued surveillance and care.

Question 34

The healthcare provider scheduled the client for a right lung lobectomy. The night before surgery, the client told the nurse, “I am very afraid to have this kind of disease. It is so dire. It should have quit smoking years ago.” The best response of the nurse would be?

Accepted Answer

Answer reason: “It is okay to be afraid. What is it about cancer that you fear?” Therapeutic communication prioritizes acknowledging feelings and using open-ended questions to explore the client’s concerns. This response validates fear without minimizing it and invites the client to identify specific worries (e.g., pain, death, surgery outcomes), which guides targeted support and teaching before surgery. In contrast, self-disclosure shifts focus to the nurse, and reassurance/denial about smoking causation can invalidate the client’s emotions and undermine trust. Clarifying the meaning behind the statement helps reduce anxiety and promotes coping by encouraging expression and problem-focused planning.

Question 35

The client with newly diagnosed Parkinson’s disease states, “I just don’t think I can handle having Parkinson’s disease.” What is the nurse’s best first response?

Accepted Answer

Answer reason: You sound overwhelmed. Can you tell me more? Therapeutic communication starts with acknowledging the client’s expressed feelings and using an open-ended invitation to explore concerns. This response reflects and validates the emotion (“overwhelmed”) and encourages elaboration, which helps assess coping, identify specific fears, and build trust. In contrast, reassurance/comparison (e.g., telling the client others manage it) can minimize the client’s distress and shut down further discussion. Offering solutions or focusing on specifics too early is less effective than first establishing understanding of the client’s emotional experience.

Question 36

A client seen in the neighborhood clinic reports “eye problems” and generalized weakness that became markedly worse after using a friend’s hot tub. The client provides long, detailed responses to initial demographic questions. What is the best question for the nurse to ask at this time?

Accepted Answer

Answer reason:  Using therapeutic communication, the nurse should begin with an open-ended, patient-centered prompt that encourages elaboration of the primary symptom and supports accurate assessment. This response focuses on clarifying the most clinically relevant complaint rather than presuming a cause or steering the client toward a specific explanation. It also helps establish key symptom details (onset, severity, associated findings) needed to determine urgency and next steps. In contrast, asking the client to be briefer prioritizes the nurse’s agenda and can shut down disclosure, while attributing symptoms to the hot tub is leading and may bias the history.

Question 37

A 92-year-old client who is very hard of hearing is hospitalized. Which action by the nurse is appropriate when conducting the admission interview and assessment of the client?

Accepted Answer

Answer reason: Effective communication with hearing-impaired older adults relies on optimizing visual cues and speech clarity rather than volume. Facing the client improves lip-reading and nonverbal cue interpretation, and a normal pitch is easier to understand because high-pitched speech is often harder to hear with presbycusis. Shouting can distort speech and may be perceived as disrespectful, worsening comprehension and rapport. Cleaning cerumen with cotton swabs is unsafe due to risk of impaction or canal injury and is not an interview strategy. Changing hearing-aid batteries may help if malfunction is identified, but the universally appropriate interview technique is clear, face-to-face communication.

Question 38

The nurse is preparing a presentation for staff about the effects of humor in nursing situations. What feedback would indicate to the nurse that the participants understand the role of humor in the healthcare setting?

Accepted Answer

Answer reason: When used appropriately and sensitively, it can increase attention and engagement, which supports learning and recall during patient education and staff interactions. It also helps normalize stress and can facilitate coping without minimizing the patient’s experience. The distractors misrepresent humor’s typical therapeutic effects by portraying it as distancing, aggression-provoking, or ineffective as a coping strategy.

Question 39

Barbara is a client with a borderline personality disorder. She is defensive and emotionally labile and often becomes suddenly and explosively angry. When interacting with her, you as a nurse would?

Accepted Answer

Answer reason: Clients with borderline personality disorder can have intense affective instability and rapid escalation to anger, so de-escalation and limit-setting are most effective when the nurse remains calm and avoids power struggles. A quiet, nonthreatening stance reduces stimulation and helps prevent further escalation, while arguing tends to increase defensiveness and loss of control. Confrontational statements can be experienced as rejection or criticism and may intensify emotional lability and impulsive behavior. Threatening restraints is coercive and can worsen agitation; restraints are a last resort for imminent safety risk, not a communication strategy. Touch can be misinterpreted when the client is dysregulated and may increase risk of escalation or boundary problems.

Question 40

After a right hemicolectomy for treatment of colon cancer, a 57-year old client is reluctant to turn while on bed rest. Which action by the nurse would be appropriate?

Accepted Answer

Answer reason: Therapeutic communication begins with patient education and addressing the patient’s concerns to promote cooperation with necessary postoperative care. Turning reduces risk of atelectasis, pneumonia, impaired circulation, and pressure injuries—key preventable complications during bed rest after abdominal surgery. Providing a clear rationale supports informed participation and may uncover barriers such as fear of pain or incision disruption, allowing the nurse to then offer analgesia, splinting, and assistance. In contrast, citing an order is authoritarian and often increases resistance, and waiting until the patient feels ready can delay essential prevention measures.

Question 41

A nurse is providing care for a refugee who has recently relocated. The client is withdrawn and has difficulty communicating. Which of the following interventions should the nurse prioritize?

Accepted Answer

Answer reason: The priority with a withdrawn client who has difficulty communicating is to establish rapport using therapeutic communication that invites expression and assessment of coping. Open-ended exploration helps the nurse identify emotions, needs, and potential trauma-related concerns while signaling acceptance and support. Premature reassurance can shut down communication and may invalidate the client’s experience, and pushing social activities can increase distress before trust and readiness are assessed. Focusing first on the client’s feelings creates the foundation for later interventions such as discussing relocation stressors and connecting to supportive resources.

Question 42

You’re caring for a 28 y.o. woman with hepatitis B. She’s concerned about the duration of her recovery. Which response isn’t appropriate?

Accepted Answer

Answer reason: Therapeutic communication requires acknowledging the patient’s concerns and facilitating expression rather than dismissing or minimizing feelings. Telling her not to worry is a nontherapeutic response that can invalidate anxiety and shut down further discussion about realistic recovery expectations. In contrast, encouraging expression of feelings and providing education about potential outcomes support coping and informed decision-making. Offering resources such as financial counseling is also appropriate when aligned with an identified need and can reduce stressors that affect recovery.

Question 43

One party time, you saw Maria eating a big piece of cake. As a concerned nurse you would tell her?

Accepted Answer

Answer reason: Therapeutic communication should be respectful, nonjudgmental, and focused on supporting the client’s insight and self-management. This response uses a calm reminder connected to the client’s health condition and treatment, which promotes informed decision-making without shaming or confrontation. Options that criticize or label the client are judgmental and can damage rapport, reducing openness to education. A blunt command to stop is less therapeutic and may provoke resistance rather than encouraging adherence and safer choices.

Question 44

A female client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. When the client asks the nurse about the paralysis, how should the nurse respond?

Accepted Answer

Answer reason: Guillain-Barré syndrome typically causes an acute, ascending demyelinating neuropathy with progressive weakness that is often reversible with supportive care and immunotherapy. Providing realistic reassurance supports coping while remaining consistent with expected recovery patterns, even when temporary ventilatory support is required. Telling the client the paralysis is permanent is inaccurate and increases distress. Predicting a specific recovery sequence (or framing paralysis as permanent) goes beyond what can be guaranteed and is less therapeutic than giving accurate, hopeful information.

Question 45

During the evening round, Nurse Tina saw Mr. Toralba meditating and afterwards started singing prayerful hymn. What would be the best response of Nurse Tina?

Accepted Answer

Answer reason: Meditation and singing a prayerful hymn can be a healthy spiritual practice that reduces anxiety and promotes comfort, so the therapeutic response is acceptance and respect. Redirecting the client to sleep is unnecessary unless rest is clinically required or the behavior is causing disturbance. Reporting or documenting may be appropriate only if there is a safety, behavioral, or unit-policy concern, but the best immediate response is nonjudgmental support.

Question 46

The client with BPD states to the nurse, "Hey, you know what! You are my favorite nurse. That night nurse sure doesn't understand me the way you do." Which response by the nurse is most therapeutic?

Accepted Answer

Answer reason: "I'm glad you're comfortable with me. Which night nurse doesn't understand you?" Clients with borderline personality disorder commonly use splitting and idealization/devaluation, so the therapeutic approach is to maintain professional boundaries while gently exploring the client’s perceptions. This response acknowledges the client’s feelings without reciprocating attachment or reinforcing a “favorite nurse” dynamic. It also invites clarification about the concern with the night nurse, which can redirect toward specific behaviors/needs and support consistent, team-based care. The other options either encourage dependency, self-disclose/blur boundaries, or reinforce the split by aligning emotionally with the client.

Question 47

The client who was recently divorced and has a court appearance the following week for DUI is seeing the nurse for possible depression. Which statement by the nurse is most therapeutic?

Accepted Answer

Answer reason: "I’m concerned about your drinking. I’d like you to talk with our chemical dependency staff." Therapeutic communication uses a nonjudgmental, supportive tone and focuses on the client’s stated and observed problem while offering a concrete next step. This response expresses concern without blame, acknowledges the likely role of alcohol use in the client’s current stressors, and facilitates appropriate referral for assessment and treatment. In contrast, implying judgment or assigning blame can shut down disclosure and damage rapport, and forcing sequencing (“before we treat your depression”) is directive and can feel punitive. While suicide screening is important when depression is suspected, doing it in a leading, abrupt manner here is less therapeutic than first establishing rapport and collaboratively addressing the alcohol-use concern driving the crisis.

Question 48

The husband of a client diagnosed with a brain tumor tells the nurse, "I don't think I can make it if something happens to my wife. I love her so much." What is the most appropriate response from the nurse?

Accepted Answer

Answer reason: Therapeutic communication prioritizes exploring the client’s (or family member’s) feelings and meaning behind a distressing statement before offering advice or solutions. This open-ended question invites the husband to elaborate on his fears and specific concerns, which helps the nurse assess coping, supports, and risk for complicated grief or crisis. It avoids false reassurance, which can shut down communication and invalidate emotions. Options that immediately refer out or focus on logistics may be helpful later, but they bypass the immediate need to acknowledge and assess the emotional distress.

Question 49

The nurse is performing an admission assessment on an elderly client with Alzheimer disease (AD). The nurse should do which of the following when communicating with the client?

Accepted Answer

Answer reason: Short, simple sentences with one idea at a time improve comprehension and decrease frustration during an admission assessment. Open-ended questions can overwhelm the client and lead to confabulation or anxiety, making the history less reliable. Speaking loudly is not therapeutic unless hearing impairment is present and may be perceived as hostile, and unexpected touch can startle or be misinterpreted, increasing agitation.

Question 50

The psychiatric nurse is working with clients diagnosed with generalized anxiety disorders, phobias, obsessive-compulsive disorders, and post-traumatic stress syndrome. Which intervention is most important when working with these clients?

Accepted Answer

Answer reason: Anxiety-spectrum disorders are highly sensitive to perceived criticism, and a nonjudgmental stance is the foundation for a therapeutic nurse–client relationship. Maintaining acceptance and neutrality reduces shame/defensiveness and increases trust, which is necessary before clients can safely explore fears, obsessions/compulsions, or trauma-related symptoms. Ventilation of feelings can be helpful, but it is less effective and may even escalate anxiety if rapport and psychological safety are not firmly established first. Teaching about medications and giving praise are supportive strategies, yet they are secondary to establishing therapeutic communication that prevents worsening anxiety and promotes engagement in care.

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