Question 1

A 78-year-old African-American male who is alert and oriented has been receiving hemodialysis three times per week for the last 5 years. The client’s condition has gradually declined and he tells the dialysis nurse, “I do not want to do this anymore. I am tired and ready to let my body shut down. I know I will die, but I am ready.” What is the most appropriate response by the nurse?

Accepted Answer

Answer reason:  Therapeutic communication prioritizes clarification and exploration of the client’s meaning before responding with teaching, advice, or emotional influence. This client is alert and oriented, so the nurse should first confirm whether he is expressing a desire to stop dialysis versus general fatigue or depression, which guides immediate safety assessment and next steps (e.g., provider/palliative care consult). The correct response uses a neutral, open-ended clarification that validates the seriousness without judging or persuading. Sharing personal stories, minimizing feelings, or invoking guilt about family are non-therapeutic and can shut down further disclosure.

Question 2

The female nurse is sitting across a table from the Latino male she has been educating about testicular self-examination. When the client successfully verbalizes the process, the nurse excitedly praises the client, leans over the table, and makes the "OK" sign with her thumb and forefinger. The client angrily gets up and abruptly leaves the room. What likely caused the client’s abrupt departure?

Accepted Answer

Answer reason: Nonverbal communication is culturally mediated, and the same hand gesture can convey very different meanings across cultures. In some Latin American cultures, the “OK” sign may be perceived as an insulting or obscene symbol, which can abruptly rupture rapport despite correct teaching content. The client’s sudden anger and leaving fits a perceived disrespect more than routine modesty or a simple end-of-session cue. While leaning forward can reduce personal space, that typically causes discomfort rather than an angry, immediate exit unless paired with a highly offensive signal.

Question 3

A 21-year-old client starts crying during a clinic visit and says to the nurse, “I found a lump in my breast last night; I’m scared I might have cancer!” Which fact should the nurse consider when formulating a response to the client?

Accepted Answer

Answer reason: In young adults, most newly discovered breast lumps are benign, and age is a strong predictor that a fibroadenoma is more likely than malignancy. This fact supports a nurse response that validates fear while providing realistic reassurance and encouraging prompt evaluation rather than catastrophizing. Option A is incorrect because breast cancer risk is generally low at age 21 compared with older age groups. Option B describes a concerning finding, but it is not the most appropriate general fact to anchor communication with a 21-year-old who has just noticed a lump.

Question 4

The client asks the nurse if there is anything he could do to impregnate his wife because his sperm count is “only 40 million.” In responding to the client, which factor should the nurse consider?

Accepted Answer

Answer reason: Normal semen parameters commonly cite a lower reference limit around 15 million sperm/mL, so a count described as 40 million is generally not, by itself, a barrier to conception. The safest nursing response is to correct the misconception and reduce anxiety with accurate, supportive education rather than implying infertility. Saying conception is not possible is incorrect and could cause unnecessary distress and delay appropriate evaluation. Testosterone supplementation is not a routine nursing suggestion for fertility concerns and can suppress spermatogenesis, potentially worsening fertility.

Question 5

The nurse is teaching the Muslim client how to correctly latch her baby to her breast for breastfeeding. Two student nurses are observing the instruction. Later, the client requests that the nurse not be allowed to provide her postpartum care. What most likely caused the client to be uncomfortable with the nurse?

Accepted Answer

Answer reason: Many Muslim clients have modesty norms that limit exposure of the body in front of nonessential observers, especially unrelated individuals or mixed company. Having two student nurses present can be perceived as an unnecessary audience, making the client feel her privacy and dignity were not protected. This can damage trust and lead the client to refuse further care from that nurse. Broad statements that Muslim women do not breastfeed in the hospital or delay breastfeeding are inaccurate generalizations and do not explain the reaction specifically tied to being observed.

Question 6

The pregnant client tells the nurse that she smokes two packs per day (PPD) of cigarettes, has smoked in other pregnancies, and has never had any problems. What is the nurse’s best response?

Accepted Answer

Answer reason: “I’m glad that your other pregnancies went well. Smoking can cause both maternal and fetal problems, and it is best if you could quit smoking.” This situation calls for therapeutic, nonjudgmental communication that acknowledges the client’s perspective while providing accurate health teaching and motivating behavior change. This response validates her experience and then links smoking to real maternal-fetal risks, appropriately encouraging cessation without using fear or blame. A common pitfall is using threats (e.g., predicting miscarriage), which can increase defensiveness and reduce engagement in cessation counseling. Another incorrect approach is giving misinformation or false reassurance, such as implying that smoking less eliminates risk or that smoking causes a large baby.

Question 7

The nurse is discussing the infant’s diagnosis of hypoplastic left heart syndrome (HLHS) with the parents. The father states, “Shouldn’t this get better when the heart grows in size with the baby?” How should the nurse respond to the father?

Accepted Answer

Answer reason:  HLHS is a structural congenital defect in which the left-sided pumping chamber and outflow are underdeveloped and will not “catch up” simply with the infant’s overall growth. The most therapeutic response gives clear, accurate information directly addressing the father’s misconception without adding alarm or false reassurance. Options emphasizing being “very sick” or “saving your baby’s life” are emotionally loaded, can increase anxiety, and do not specifically answer the growth question. The statement about limited heart growth in early childhood is inaccurate and shifts away from the core issue that anatomy will not self-correct.

Question 8

The HCP explains the disease process and recommended treatment to the teenage client diagnosed with Hodgkin’s lymphoma. Which statement made by the client to the nurse indicates understanding of the diagnosis and treatment?

Accepted Answer

Answer reason:  Hodgkin’s lymphoma is a highly treatable malignancy, and standard therapy commonly involves radiation, chemotherapy, or combined-modality treatment depending on stage and risk factors. This statement reflects accurate understanding of both the cancer diagnosis and the realistic prognosis with appropriate treatment. Option A shows misunderstanding by implying it is not cancer, and option C is inaccurate because surgical laparotomy is not the typical staging approach in modern management. Option D reflects fear and ineffective coping rather than comprehension of treatment outcomes.

Question 9

The mother of the pediatric client consults the nurse because her daughter, who has alopecia from chemotherapy, refuses to wear the wig that she wants her to wear. The mother states she feels uncomfortable when people stare at her daughter. Which response is most appropriate?

Accepted Answer

Answer reason:  This situation calls for therapeutic communication that acknowledges the mother’s distress and invites exploration of feelings without judging or assuming motives. An open-ended reflection helps the nurse assess the parent’s concerns, supports coping, and can uncover family dynamics around the child’s autonomy and body image during chemotherapy. Options A and B are leading and potentially blaming, which can increase defensiveness and shut down communication. Option D provides relevant teaching but does not address the immediate psychosocial issue the mother is presenting.

Question 10

The high school student is crying and says to the school nurse, “I had unprotected sex last week with someone who has been doing IV drugs; now I’m scared I might have HIV!” Which is the nurse’s best initial response?

Accepted Answer

Answer reason:  Therapeutic communication begins with acknowledging and reflecting the client’s feelings to build trust and encourage further disclosure. This response uses reflection and validation, helping the student feel heard and opening the door to assess risk details, timing, and needed supports. Option A offers false reassurance and minimizes a legitimate concern, which can shut down communication. Options B and C jump prematurely into testing/parent involvement without first addressing acute distress, assessing safety, and establishing rapport.

Question 11

The school nurse is talking with the adolescent who is concerned about hair loss due to tinea capitis. Which response by the nurse is most appropriate?

Accepted Answer

Answer reason:  This uses therapeutic communication by assessing the adolescent’s understanding and inviting them to share prior teaching, which helps correct misconceptions and supports coping. It avoids false reassurance and provides an opening to give accurate, tailored education about prognosis once the nurse knows what the client believes. In contrast, minimizing statements like “Don’t worry” can shut down expression of feelings, and “why is this bothering you?” can sound judgmental and defensive-provoking. Exploring what the provider already explained also supports continuity of care and reinforces consistent messaging.

Question 12

The mother of the 13-year-old female tells the clinic nurse, “I hope that no one tries to get me to agree to have my daughter get that new vaccine that is supposed to prevent some STIs. My daughter is not and will not be having sex until she is married.” What is the nurse’s best response?

Accepted Answer

Answer reason: “I believe that you are talking about Gardasil. Tell me what you’ve heard about the vaccine.” Therapeutic communication starts with an open-ended, nonjudgmental assessment of the patient/parent’s beliefs and knowledge to identify misconceptions and readiness to learn. This response invites the mother to share concerns, allowing the nurse to correct inaccurate information and provide education without confrontation or shame. It also supports a collaborative, respectful discussion about preventive care appropriate for the child’s age. Option A is argumentative and likely to escalate defensiveness, while options B and D prematurely defer or provide information without first assessing what the mother understands.

Question 13

The nurse is caring for the 3-year-old burn victim who is the only child of a single parent. The parent has not visited the child for 2 days, and the child is crying and says, “I want my mommy!” The nurse telephones the parent, who says, “I cannot stand to see my baby in so much pain knowing that I am responsible for this.” Which is the best response by the nurse?

Accepted Answer

Answer reason: “It sounds like you are feeling guilty. Can you come in to talk about how we can help you and your child?” Therapeutic communication prioritizes reflecting feelings and using open-ended, supportive prompts to engage the caregiver without judgment. This response accurately identifies the parent’s expressed emotion (guilt) and invites collaboration to support both the parent and child, which can strengthen coping and facilitate needed visitation/attachment. It avoids pressuring the parent or shifting the focus to the nurse’s needs, while still moving toward a constructive plan. By contrast, focusing on urgency or asking “why” can increase defensiveness and shut down communication at a time when rapport and emotional support are essential.

Question 14

The child is diagnosed with TB after returning to the US. from a trip to Africa. During the assessment, the nurse observes that the parents do not talk about the child’s diagnosis as TB or use the word “TB” but rather use only the word “it.” Which statement made by the nurse is best?

Accepted Answer

Answer reason:  The priority is therapeutic communication that explores emotions and possible stigma while keeping the conversation open and nonjudgmental. An open-ended invitation helps the parents express fears, guilt, denial, or cultural concerns that may be driving their avoidance of naming the illness. This approach builds rapport and provides assessment data that can guide teaching and adherence support. In contrast, a “why” question can sound accusatory and shut down communication, and shifting immediately to symptoms or cure focuses on tasks before addressing the family’s coping needs.

Question 15

The client with a history of aggressive behavior to ward staff and peers states to the nurse, “Everyone is just so touchy; I don’t see where I’m being too aggressive.” Which nursing action should be included in the therapeutic plan of care to best effect a difference in perceptions?

Accepted Answer

Answer reason: Perception change is most effectively supported through therapeutic communication that provides clear, specific feedback and reality orientation about how behaviors are experienced by others. Facilitated dialogue helps the client link actions (tone, volume, proximity, threats) to others’ reactions, increasing insight and reducing misinterpretation that “others are just touchy.” This approach also allows the nurse to set behavioral expectations and collaboratively identify alternative responses before escalation occurs. In contrast, simply reviewing unit rules or asking staff to be more patient does not directly address the client’s distorted appraisal of their behavior or build insight needed for lasting change.

Question 16

The client states to the nurse, “I can’t sleep. I’m getting just a few hours of sleep at night. I started a new job, and I can’t do my best without getting enough sleep.” The client’s history includes a recent breakup with a long-term companion. Which should be the nurse’s initial statement?

Accepted Answer

Answer reason:  Initial therapeutic communication should begin with open-ended assessment to clarify the problem before interpreting causes or offering reassurance. This response gathers specific baseline and current sleep data (pattern, duration, change), which is essential to identify insomnia severity and guide next questions about stressors, coping, and sleep hygiene. The other options either prematurely interpret/normalize the situation or lead the client toward a suspected cause, which can shut down communication and miss important contributors. A focused, nonjudgmental assessment statement is the safest and most effective first step.

Question 17

The mother of the teenager diagnosed with anorexia nervosa confides in the nurse that she has always been very protective and is concerned her over protectiveness is the reason her child developed the eating disorder. Which statement is the most therapeutic response by the nurse?

Accepted Answer

Answer reason:  This uses therapeutic communication by exploring the mother’s feelings and thought process with an open-ended, nonjudgmental question. It encourages reflection and elaboration without confirming blame or providing premature reassurance, which helps build rapport and supports coping. It also avoids shifting focus to the child or prompting speculation about the child’s perceptions, keeping the conversation centered on the speaker’s expressed concern. In contrast, reassurance or citing “no research” can shut down communication and minimize the mother’s distress rather than helping her process it.

Question 18

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: “Getting a DUI can be depressing. You aren’t thinking about hurting yourself, are you?” Therapeutic communication prioritizes safety while using direct, clear questions to assess suicide risk when depression is suspected. This response acknowledges the situational stressor and immediately screens for self-harm in a straightforward, nonjudgmental way. The other options either imply blame, make premature treatment decisions, or shift the focus to referral without first assessing immediate risk. In a potentially depressed client facing major losses and legal consequences, suicide assessment is the most therapeutic and clinically urgent nursing action.

Question 19

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 may use splitting, idealizing one staff member while devaluing another, which can undermine team consistency. The therapeutic response acknowledges the client’s feeling while gathering concrete information and keeping the focus on the client’s perceptions rather than endorsing the comparison. It avoids emotional overinvolvement and boundary-crossing statements that reinforce dependency. Options that express personal loss or special attachment are nontherapeutic because they strengthen maladaptive attachment and reinforce splitting dynamics.

Question 20

The young adult after being robbed is attending counseling sessions to address anxiety issues. What is the nurse’s best response when the client asks, “When will things get better for me?”?

Accepted Answer

Answer reason:  The core principle is therapeutic communication: validate the client’s feelings, normalize a stress response after trauma, and offer realistic, supportive hope without giving false reassurance or rigid timelines. This response acknowledges the trauma and conveys that improvement is expected while emphasizing the client’s growing sense of control, which supports coping and engagement in therapy. Options that promise improvement in a specific number of weeks risk minimizing individual variation and can feel dismissive if symptoms persist. Telling the client not to worry and to focus on the future is nontherapeutic because it blocks expression and implies the client’s feelings are inappropriate.

Question 21

The client states, “I go out just about every weekend and drink pretty heavily with my friends. Does that mean I’m dependent on alcohol?” Which is the best response by the nurse?

Accepted Answer

Answer reason: “It sounds like you feel guilty about how much you drink. Tell me more about this.” Therapeutic communication prioritizes open-ended exploration, reflection of feelings, and assessment rather than premature labeling or reassurance. This response acknowledges the client’s emotion and invites elaboration, which helps clarify patterns, consequences, and possible criteria for a substance use disorder. Options that declare the client is or is not dependent are judgmental and can shut down disclosure, especially when the nurse lacks enough assessment data. Providing a definition of dependence may be educational, but it is less therapeutic than first encouraging the client to talk more and assessing readiness to change.

Question 22

The client often avoids talking about cocaine use by refocusing on other problems such as losing a job and family discord. Which is the most helpful response by the nurse when the client avoids discussing using cocaine?

Accepted Answer

Answer reason:  Therapeutic communication for substance use focuses on exploring the client’s perceptions and the function the substance serves, using open-ended, nonjudgmental questions. This response acknowledges the client’s stated stressors while gently linking them to cocaine use in a way that reduces defensiveness and supports insight. It invites reflection on patterns (using to cope) without confronting or blaming, which is more likely to keep the client engaged. In contrast, a directive statement that all problems are related to cocaine use is confrontational and can shut down discussion, and dismissing current problems undermines rapport and motivation.

Question 23

The client receiving treatment for substance dependence has not been attending group therapy. Which response by the nurse to confront this behavior is best?

Accepted Answer

Answer reason:  Confrontation in substance-use treatment should be direct, reality-based, and focused on observed inconsistency between stated goals and behaviors while avoiding shame or coercion. This response clearly points out the discrepancy and invites the client to take responsibility for engaging in the plan of care. It maintains a therapeutic, nonjudgmental tone and supports motivation for change by emphasizing personal accountability. In contrast, responses that guilt, lecture, or prematurely offer an “easier” alternative can reinforce avoidance and reduce commitment to group treatment.

Question 24

The spouse of the client who is currently in inpatient treatment for substance abuse tells the nurse, “We’ve done this so many times. I don’t think my spouse is ever going to change. Do you think it’s time for me to get a divorce?” Which response by the nurse is most helpful?

Accepted Answer

Answer reason:  Therapeutic communication prioritizes reflection and empathy to help the speaker identify and explore feelings without giving advice or making predictions. This response accurately reflects the spouse’s emotion, encourages further discussion, and maintains a nonjudgmental stance. It avoids directing the spouse toward a major life decision, which would be inappropriate and potentially harmful. In contrast, predicting relapse or refusing engagement shuts down communication and can increase distress rather than support coping and problem-solving.

Question 25

The client expresses ambivalence about quitting smoking and also the fear of “getting fat” and “looking like a cow.” The client wonders if that is worse than smoking. Which response by the nurse is most helpful?

Accepted Answer

Answer reason: “It sounds like you are afraid of weight gain. Tell me about both the good and bad things that might happen if you give up smoking.” This uses therapeutic communication consistent with motivational interviewing by reflecting the client’s stated fear and inviting exploration of ambivalence. Open-endedly discussing perceived pros and cons supports autonomy and helps the client move toward change talk rather than feeling judged or pressured. It also validates the emotion without reinforcing distorted body-image language or making unrealistic promises. In contrast, advice-giving or arguing for quitting can increase resistance, and focusing on weight status shifts away from the client’s readiness and concerns.

Question 26

A client presents with dark urine, fatigue, and generalized pruritus. Lab results reveal elevated serum bilirubin and increased bile salts. The diagnosis is made of biliary cirrhosis. The client asks what is happening in his body. What is the nurse’s best response?

Accepted Answer

Answer reason:  Biliary cirrhosis is driven by cholestasis from impaired bile flow, leading to retention of bile salts and bilirubin. This retention explains pruritus (bile salts deposited in the skin) and dark urine (increased excretion of conjugated bilirubin). An explanation centered on biliary obstruction and resulting inflammation aligns directly with the client’s symptoms and labs. The other options describe unrelated processes such as toxin release, alcoholic cirrhosis, or hepatic congestion from heart failure, which do not best match the presented findings.

Question 27

The nurse is caring for a newborn who has been diagnosed with a ventricular septal defect. The newborn is not exhibiting any signs of heart failure. The parents ask the nurse why the doctors do not want to perform surgery immediately on the newborn. Which is the most appropriate response?

Accepted Answer

Answer reason:  Small ventricular septal defects commonly decrease in size or close spontaneously over time, and in an asymptomatic newborn without heart failure, immediate surgery is often unnecessary. The most appropriate nursing response provides a clear, accurate physiologic rationale that addresses the parents’ question and reduces anxiety. Options A and D are vague, non-educational statements that do not explain the clinical plan or expected course. Option B focuses on feelings rather than providing the medical reasoning the parents are seeking.

Question 28

A 13-year-old boy admitted with a fractured femur had an open reduction and internal fixation 2 days ago and currently is in traction. He asks the nurse what would happen to him if a terrorist decided to bomb the hospital. What’s the nurse’s best response?

Accepted Answer

Answer reason:  Therapeutic communication begins with exploring the child’s perceptions and feelings to identify the real source of anxiety and correct misconceptions. An open-ended question invites the patient to elaborate, helps the nurse assess fear level and coping, and creates a pathway to provide developmentally appropriate reassurance and facts. In contrast, offering false reassurance or minimizing the concern can shut down communication and increase anxiety. Belittling the child’s worry is nontherapeutic and damages trust, especially in an anxious adolescent who needs validation and support.

Question 29

A client has followed her antipsychotic medication regimen for a number of years. Her physician has prescribed antibiotic therapy for a newly acquired urinary tract infection. What is the most important nursing intervention?

Accepted Answer

Answer reason: The key nursing principle is ensuring safe medication use through patient education and confirmation of understanding, especially when adding a new drug to a long-term psychotropic regimen. Teaching about indications, dosing schedule, and adverse effects helps prevent nonadherence, missed doses, and delayed reporting of complications (e.g., allergy, severe diarrhea, or worsening mental status). Using a teach-back/return demonstration verifies comprehension rather than assuming the client understood instructions. Hospitalization or administering via a visiting nurse is not indicated when the client has demonstrated years of adherence and there is no evidence of inability to self-manage. A broad psychoeducational program is less immediate than targeted, safety-focused medication teaching for the newly prescribed antibiotic.

Question 30

A nurse is caring for a 39-year-old male client who recently underwent surgery and is having difficulty accepting changes in his body image. Which nursing intervention is most appropriate?

Accepted Answer

Answer reason: Active listening allows the client to verbalize both losses and strengths, helping reduce anxiety and facilitating realistic adaptation. Limiting viewing of the incision reinforces avoidance and can worsen distress and lack of acceptance. Redirecting only to future plans or encouraging repression of anger blocks emotional processing and is nontherapeutic, increasing the risk of maladaptive coping.

Question 31

The resuscitation team has been performing CPR on the child for 15 minutes. The mother, who is present during the resuscitation, asks when CPR would be stopped. What is the most appropriate response by the nurse?

Accepted Answer

Answer reason:  This situation requires therapeutic communication that addresses acute distress while maintaining appropriate professional boundaries during an emergency. An open-ended, clarifying question acknowledges emotion and helps the nurse assess the parent’s specific fear, which guides immediate support without giving false reassurance or premature prognostic statements. It also avoids implying that the parent influences the clinical decision to stop resuscitation, which is inappropriate and could create guilt or conflict. By contrast, offering optimistic statements about revival or detailing decision criteria can be experienced as dismissive or as providing information the nurse may not be able to accurately predict in that moment.

Question 32

The nurse is collecting information about the preoperative client’s recreational drug use. Which statement by the nurse is most effective?

Accepted Answer

Answer reason: “What herbs, medications, and recreational drugs such as cocaine do you take, and how often do you take them? These affect the type and amount of anesthesia you need.” The key principle is to obtain complete, accurate preoperative substance-use information using a nonjudgmental, specific, and clinically relevant approach to reduce anesthesia and perioperative risk. This option normalizes the assessment by including herbs/medications and recreational drugs, asks for frequency, and links disclosure to a concrete safety rationale (anesthetic dosing and reactions), which improves client honesty. It also uses an example to clarify what is meant by “recreational drugs,” reducing ambiguity. In contrast, vague or stigmatizing phrasing (e.g., “illegal substances”) can decrease disclosure and lead to missed risks such as withdrawal, hemodynamic instability, or drug interactions.

Question 33

The nurse is caring for the client with Alzheimer’s disease who is yelling Obscenities at the staff. The client’s spouse tearfully states to the nurse, “Never would you have heard those things before the Alzheimer’s. I wish that you would have known my spouse before the sickness.” Which is the best response by the nurse?

Accepted Answer

Answer reason:  This situation calls for therapeutic communication that acknowledges and validates the spouse’s emotions without judging the client’s behavior. An empathic reflection helps the spouse feel heard and supported, which can reduce distress and open the door to further discussion and coping strategies. Asking “why” can sound accusatory and may increase guilt or defensiveness, and focusing on disease duration shifts away from the spouse’s immediate emotional need. Inviting reminiscing may be supportive later, but the priority first response is to name and validate the spouse’s feelings in the moment.

Question 34

When attempting to teach the client about medications, the client states, “Just tell my wife. She gives me all my pills.” Which is the nurse’s best response?

Accepted Answer

Answer reason: “You need to learn about your medications. What will you do if your wife isn’t around?” Patient education should promote self-management and assess readiness, barriers, and support needs while maintaining the client’s responsibility for their own care when capable. This response acknowledges the client’s reliance on the spouse and uses a focused, open-ended question to explore a safety risk (what happens if the caregiver is unavailable) and to motivate engagement in learning. It also redirects teaching back to the client without blaming, which supports autonomy and long-term adherence. Options that shift all teaching to the wife or simply validate the arrangement fail to assess the client’s understanding and can increase risk if the spouse cannot administer medications or if errors occur.

Question 35

An adult daughter is sitting at the bedside of her mother, a devout Baptist, who developed a serious postoperative infection. Which statement by the nurse to the daughter demonstrates empathy?

Accepted Answer

Answer reason: "You’ve been here a long time and look exhausted. Tell me how things are going for you." Empathy in therapeutic communication is recognizing another person’s emotional state and inviting them to share their experience. This response reflects observation of the daughter’s fatigue and opens the door for her to express feelings and needs, supporting coping. Option A is a nontherapeutic “I know how you feel” response and shifts focus to the nurse’s experience. Option D mixes information-giving with introducing the nurse’s religious practice, which can feel presumptive rather than exploring the daughter’s perspective.

Question 36

The clinic nurse is caring for four clients. Which interaction demonstrates the use of the communication technique of reflection?

Accepted Answer

Answer reason: Adolescent: “My mom won’t let me pierce my tongue.” Nurse: “What would it be like to have a pierced tongue?” Reflection is a therapeutic technique that redirects the client’s feelings, ideas, or questions back to the client to encourage self-exploration and deeper expression. The nurse’s question invites the adolescent to examine personal meaning, motivations, and potential consequences rather than seeking approval or advice. Option C is clarification (seeking specific data about high vs low glucose), not reflection. Option D gives advice and prematurely reassures, which can shut down expression and is unsafe given the hopeless statement.

Question 37

While collecting information from the 16-year-old who is in the first trimester of pregnancy, the nurse learns that the client drinks four to six alcoholic beverages three to four times a week. Based on the client’s current developmental stage, what should the nurse’s initial focus of care?

Accepted Answer

Answer reason: Building trust first improves disclosure about substance use and readiness to accept counseling, which is critical in a pregnant teen with heavy alcohol intake. Immediate teaching about fetal effects or personal risks is important, but it is less likely to be effective if delivered before establishing a therapeutic relationship. Once trust is established, the nurse can then assess safety, supports, and initiate brief intervention and referral resources tailored to the client.

Question 38

The nurse is administering medication to an elderly client who has no visitors. The nurse enters the room, quickly giving the client a cup of medications and pouring some water. The client takes the pills and, as the client hands the medication cup back to the nurse, grabs onto the nurse’s hand tightly. What is the most logical rationale for the client’s action?

Accepted Answer

Answer reason: A sudden, tight hand grasp in a context of rushed care commonly represents a nonverbal attempt to obtain attention and connection. With no visitors and minimal interaction, the client may use touch to prolong contact and invite engagement when verbal opportunities are limited. This fits therapeutic communication principles: recognizing and responding to nonverbal cues as a bid for interaction. Confusion would more likely present with disorientation or inability to follow medication administration rather than a purposeful, timed grasp. “Reminisce” is too specific and not directly supported by the brief, situational cue described.

Question 39

During a therapeutic communication session, a patient informs his nurse that he has a panic attack when he is around snakes. The patient continues to tell his nurse that when he was younger, his older brother would always throw snakes at him or put them in his bed. If the nurse used a reflecting therapeutic response with this patient, which statement would she most likely use?

Accepted Answer

Answer reason: " Reflecting (restating) is a therapeutic communication technique that mirrors the client’s message to validate feelings and help the client recognize connections in their own narrative. This response captures the patient’s stated trigger and links it to the described childhood experience without introducing new content or shifting focus away from the patient. It avoids excessive fact-finding that can feel interrogative and instead promotes insight into the origin of the panic response. By summarizing the meaning of what was shared, it supports further exploration of emotions and coping. The other options primarily seek details or redirect to a different topic rather than reflecting the patient’s central message.

Question 40

The best way for the RN to communicate with this client would be?

Accepted Answer

Answer reason: This response acknowledges the client’s distress and redirects toward treatment without reinforcing the hallucination as factual. Telling the client the animals do not exist is confrontational and can increase defensiveness and mistrust. Asking detailed questions about the animals explores and potentially validates the hallucination, which can intensify symptoms rather than reduce anxiety and promote care.

Question 41

During a group discussion in the nursing unit, one of the students says: "I believe that people with mental disabilities are dangerous and should be avoided." What is the best response from the nurse in this situation?

Accepted Answer

Answer reason: Therapeutic communication first acknowledges the speaker’s emotion and then gently challenges inaccurate, stigmatizing beliefs in a nonjudgmental way to keep the discussion safe and open. This response validates the student’s concern while setting a corrective framework that the statement reflects misinformation, which helps reduce stigma without escalating defensiveness. Options that immediately cite facts or redirect the group may be helpful later, but they can miss the initial step of addressing the underlying bias and maintaining rapport. Addressing the myth directly supports respectful attitudes toward people with disabilities and models professional communication for the group.

Question 42

Which statement would be most appropriate for the nurse to make?

Accepted Answer

Answer reason: “You have a lot going on. How does eating, or not eating, make you feel!?” Therapeutic communication prioritizes open-ended, nonjudgmental questions that explore feelings and motivations while conveying acceptance. This response invites the client to reflect on the emotional function of eating behaviors, which is especially important when disordered eating is a coping strategy. It avoids praising appearance or giving advice that can feel minimizing and shut down disclosure. In contrast, monitoring meals is controlling and can increase resistance, shame, or power struggles rather than building insight and rapport.

Question 43

A family unit you are caring for is experiencing a situational crisis that has led to dysfunctional communication within the family. You have recommended that the entire family and members of the extended family who live in the family's home begin family therapy. The grandparents tell you that their grandson, who is addicted to prescription painkillers, is the cause of the problem. Since he is not their son, they feel that they do not have to participate in this group therapy. How should you respond to these grandparents?

Accepted Answer

Answer reason: A core principle in family systems nursing is that one member’s substance use disorder affects the functioning, roles, and communication patterns of the entire household. This response provides clear education while validating the situation and gently reframing the problem from “one person’s issue” to a shared family impact, which supports engagement in therapy. It avoids judgment and avoids coercion, which helps reduce defensiveness and supports therapeutic alliance. In contrast, minimizing their involvement or implying it is “not their problem” reinforces denial and undermines treatment participation. It is also more appropriate than citing a provider “order,” since participation should be collaborative rather than framed as compliance.

Question 44

When establishing goals for a client who has had an abdominal perineal resection with a colostomy, which is a realistic outcome 4 weeks after the surgery? The client will?

Accepted Answer

Answer reason: At about 4 weeks after an abdominoperineal resection with a permanent colostomy, a key realistic goal is psychosocial adjustment, including willingness to discuss body-image and sexual-function concerns. Openly expressing these concerns indicates early adaptation and allows targeted education and referrals (e.g., wound/ostomy nurse, counseling). In contrast, routine irrigation is not universally appropriate for all colostomies and is typically individualized and taught after healing and bowel pattern stability, so making it a standard goal can be unrealistic. Daily pouch changes are generally unnecessary and can increase skin irritation; pouching systems are usually changed every few days unless leaking or skin issues occur.

Question 45

The nurse is observing a staff member caring for a client who has schizophrenia and is experiencing auditory hallucinations. Which of the following statements by the staff member to the client would require the nurse to intervene?

Accepted Answer

Answer reason: “You are imagining things. No one is talking to you right now.” Therapeutic communication with hallucinations focuses on acknowledging the client’s feelings, presenting reality without arguing, and offering distraction or engagement. This statement is confrontational and dismissive, which can increase agitation, damage rapport, and escalate paranoid or defensive behavior. The preferred approach is to validate the distress and gently reality-orient (e.g., noting the staff does not hear voices) while offering coping strategies or structured activities. Options offering music or group activity provide distraction and help reduce attention to hallucinations, and acknowledging the client’s upset supports trust without reinforcing the hallucination.

Question 46

A client diagnosed with obsessive-compulsive disorder arrives late for an appointment with the nurse at the outpatient clinic. During the interview, he fidgets restlessly, has trouble remembering what topic is being discussed, and says he thinks he is going crazy. Which statement by the nurse best deals with the client's feelings of "going crazy"?

Accepted Answer

Answer reason: Therapeutic communication uses clarification and exploration to help the client describe vague, fearful statements and to assess anxiety and thought content. This response invites the client to define what “going crazy” means to them, which validates feelings and opens the door to targeted support and assessment. The alternatives either minimize the concern, shift the focus to the nurse’s judgment, or use a potentially stigmatizing label (“crazy”), all of which can shut down communication. In an anxious client with OCD symptoms, encouraging concrete description is the safest way to reduce distress and guide appropriate intervention.

Question 47

A nurse is caring for a postoperative client who underwent abdominal surgery. The client's surgical incision is closed with staples. During the dressing change, the client expresses concerns about the appearance of the incision and asks the nurse about its healing process. Which response by the nurse is appropriate?

Accepted Answer

Answer reason: " Surgical staples are nonabsorbable skin-closure devices and do not dissolve, so providing accurate education reduces anxiety and supports realistic expectations for wound healing. This response is therapeutic because it acknowledges the client’s concern and offers factual information about the normal plan for staple removal. Saying to avoid looking at the incision discourages engagement and does not address the client’s question. Advising that the incision must be kept dry “at all times” is overly absolute and can be inaccurate depending on provider orders and timing of postoperative showering.

Question 48

Which of the following statements would be effective therapeutic communication for a client who is struggling with severe depression?

Accepted Answer

Answer reason: ” Clients with severe depression often have low energy, slowed thinking, and difficulty engaging, so supportive presence and simple, non-demanding communication is therapeutic. This statement offers acceptance and companionship without pressuring the client to speak or perform, which helps build trust and decreases isolation. By contrast, asking “why” can feel blaming and may increase guilt or defensiveness, while evaluative praise can be perceived as minimizing or can pressure the client to meet expectations. A calm offer to stay with the client supports safety and connection while allowing the client to share at their own pace.

Question 49

The client’s daughter is verbally concerned and tells the nurse, “She is a lot worse today than normal. Every evening is bad but why is she so confused?” Which of the following responses from the nurse would be least impactful for building a trusting relationship with the family?

Accepted Answer

Answer reason: Therapeutic communication builds trust by validating concerns and providing specific, patient-centered information rather than using generalized, dismissive statements. This response minimizes the daughter’s report of an acute change and relies on an age-based stereotype, which can make the family feel unheard and reduce confidence in the care team. In contrast, discussing plausible reversible contributors (e.g., delirium triggers, infection) acknowledges the concern and supports collaborative problem-solving. Offering reassurance about safety checks also demonstrates an action plan and supports transparency, which strengthens rapport.

Question 50

The nurse is caring for an older adult with advanced dementia. The client asks about her deceased sister, "When will my sister come to visit me this afternoon?" Which is the best response from the nurse?

Accepted Answer

Answer reason: Advanced dementia often makes reality orientation distressing and ineffective, so the priority is supportive communication that reduces anxiety and preserves dignity. This response validates the client’s feelings and uses reminiscence/redirection to a safe, meaningful topic, which can improve comfort without reinforcing the mistaken belief. Telling the client that her sister died can trigger repeated grief and agitation because the loss is experienced as “new” each time. Responses that are vague or imply the sister may still arrive risk fostering false hope and confusion rather than providing therapeutic support.

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