Question 1

A client who attempted suicide is admitted to an inpatient psychiatric unit. After the client states, "I fail at everything", which response by a nurse is appropriate?

Accepted Answer

Answer reason: " Using therapeutic communication, the nurse should encourage the client to explore feelings and the meaning behind an absolute, self-defeating statement. An open-ended question facilitates expression and assessment of hopelessness and cognitive distortions that can accompany suicidality. This response invites elaboration without endorsing the negative belief or prematurely trying to “cheer up” the client. In contrast, asking for successes can feel minimizing, and reflecting the statement or offering reassurance without exploration may not move the interaction toward understanding and safety planning.

Question 2

The client who was in a near-fatal car accident 3 weeks ago is diagnosed with post-traumatic stress syndrome (PTSD) and prescribed paroxetine (Paxil), an SSRI. The client asks the nurse, “Will this medication really help me? I don't like feeling this way.” Which statement is the nurse's best response?

Accepted Answer

Answer reason:  Therapeutic communication uses reflection and clarification to validate feelings and encourage the client to express specific concerns. This response identifies the underlying worry and invites further discussion without giving false reassurance or inaccurate timelines. SSRIs such as paroxetine can help PTSD symptoms but typically take weeks to achieve full effect, so promising improvement in a couple of days is misleading. Stating that therapy is the only treatment is incorrect and may undermine adherence to a combined treatment plan.

Question 3

The wife of a client diagnosed as HIV-positive states she will never be able to have sexual intercourse again. How should the nurse respond?

Accepted Answer

Answer reason: " HIV is transmitted through blood and certain body fluids, so counseling should focus on risk-reduction rather than abstinence-only messages. Protected sex with correct, consistent barrier use substantially reduces transmission risk and supports a realistic, supportive plan for intimacy. Avoiding specific sex acts alone is insufficient because vaginal intercourse can still transmit HIV if protection is not used. Statements discouraging all sexual activity can increase fear, stigma, and relationship strain instead of providing accurate, actionable education.

Question 4

The parent of a child with neuroblastoma verbalizes regret at not coming in earlier for the child’s complaints. What is an appropriate response by the nurse?

Accepted Answer

Answer reason: ” Therapeutic communication helps reduce parental guilt by providing accurate information and realistic reassurance without dismissing feelings or making judgmental statements. Neuroblastoma often presents with nonspecific, vague symptoms, so delayed recognition can occur even with attentive parenting, making early diagnosis challenging. This response supports the parent by normalizing the difficulty of early detection and reduces self-blame while staying factual. Telling the parent they “shouldn’t blame yourself” is less effective because it blocks emotional processing and may feel minimizing. Statements describing it as a common brain tumor or easily diagnosed due to obvious symptoms are inaccurate and can increase confusion or distress.

Question 5

Which of the following is the most appropriate statement to greet a client?

Accepted Answer

Answer reason:  Therapeutic communication begins with introducing oneself and verifying the client’s identity using open-ended, respectful questions. Asking the client to state their name supports accurate identification and builds rapport while inviting participation in the interaction. Using a presumed name risks misidentification and can undermine trust if incorrect. Comfort statements are appropriate but should follow initial identification and introduction to ensure safe, client-centered communication.

Question 6

The nurse is changing the dressing over a client's infected wound. The client tells the nurse, "I would not need all of this care if someone on the staff here had taken care of me correctly." Which of the following responses would be most appropriate for the nurse to make?

Accepted Answer

Answer reason: " Therapeutic communication prioritizes acknowledging and validating the client’s expressed feelings before attempting problem-solving. This statement reflects the client’s emotion and invites further discussion, which can de-escalate anger and help clarify concerns about perceived poor care. Offering referrals or focusing on the wound response shifts prematurely to tasks and may communicate dismissal of the client’s complaint. Asking what the nurse can do right now is supportive but less effective than first identifying and reflecting the underlying emotion driving the accusation.

Question 7

The client screams at the triage nurse, "You are all incompetent here! I have been waiting for 2 hours!" How should the nurse respond initially?

Accepted Answer

Answer reason: "I see that you are upset. Let's focus on how I can help you." Therapeutic communication begins by acknowledging the client’s emotion and then redirecting toward problem-solving and assessing needs. This response validates feelings without agreeing with the insult, helps de-escalate, and keeps the interaction focused on care. Threatening security is not the initial step unless there is imminent danger, and it can escalate agitation. Defending staff or offering a generic apology for the wait does not effectively redirect the client toward immediate triage needs and assistance.

Question 8

A client who is diagnosed with breast cancer asks the nurse, "Am I going to die?" Which statement by the nurse promotes a therapeutic relationship?

Accepted Answer

Answer reason: " Therapeutic communication focuses on acknowledging emotion and using open-ended questions to explore the client’s meaning and fears. This response validates a normal fear response to a cancer diagnosis and invites the client to share specific concerns, which builds trust and supports coping. It avoids offering false reassurance or making predictions about prognosis, which can shut down communication. In contrast, redirecting to the chaplain without first exploring feelings may feel dismissive and does not address the immediate emotional need.

Question 9

Which of the following forms of the nurse's non-verbal communication might convey disinterest toward the client?

Accepted Answer

Answer reason: Crossing the arms over the chest creates a physical barrier and reduces approachability, undermining rapport and therapeutic presence. In contrast, leaning forward and tilting the head are generally indicators of attentiveness and active listening. While steepling fingers can convey confidence or evaluation, it is less directly associated with disinterest than a closed, guarded posture.

Question 10

A toddler-aged client with acute otitis media has had a febrile seizure. The parents brought the child to the emergency department. Which teaching does the nurse include in the discharge instructions?

Accepted Answer

Answer reason: This teaching directly addresses the most common parental concern after an ED visit and supports safe discharge by setting realistic expectations. Routine anti-epileptic therapy is not indicated after a simple febrile seizure because risks outweigh benefits. Tepid sponging (especially hourly) is uncomfortable and not recommended as a primary fever strategy, and giving antipyretics around the clock does not reliably prevent recurrence and can increase dosing-error risk.

Question 11

A female client who was the victim of sexual violence rape 2 months ago is receiving therapy for post traumatic stress disorder (PTSD). She says to the nurse, "It's all my fault. I should have known not to accept a drink from someone I just met in a bar." What is the best response by the nurse?

Accepted Answer

Answer reason: "You could not have anticipated the rape. You did not deserve or ask for it." Therapeutic communication for sexual assault survivors focuses on validating feelings while clearly removing blame from the victim. This response directly challenges self-blame and reinforces that responsibility lies solely with the perpetrator, which supports trauma recovery and reduces shame. The other responses are directive and judgmental (telling the client to “stop thinking” or “stop blaming yourself”), which can shut down disclosure and worsen guilt. A nonjudgmental, supportive statement is the safest and most therapeutic approach for PTSD-related cognitive distortions.

Question 12

The nurse is preparing to implement teaching about a heart-healthy diet and activity levels for a client who has had a myocardial infarction and the client's spouse. The client says, “I don’t see why I need any teaching. I don’t think I need to change anything right now.” Which response is most appropriate?

Accepted Answer

Answer reason:  Therapeutic communication prioritizes open-ended questions to explore the client’s perceptions, readiness to change, and barriers after an MI. This response is nonjudgmental and invites the client to verbalize concerns (e.g., fear, misinformation, low perceived risk), which is necessary before effective education can occur. It supports engagement and allows the nurse to tailor teaching to the client’s needs and stage of change. In contrast, labeling the client as “in denial” or insisting on teaching is confrontational and can increase resistance rather than build rapport.

Question 13

A client expresses concern about facial appearance after surgery for excision of a melanoma on the side of the nose. What is the best response by the nurse?

Accepted Answer

Answer reason: "Scar tissue formation is part of the natural healing process. We will teach you how to care for your wound to minimize any complications." The key principle is therapeutic communication: acknowledge the client’s concern, provide realistic information, and offer supportive teaching that promotes coping. This response validates body-image distress while setting appropriate expectations about normal healing and focuses on actionable wound-care measures that reduce infection, dehiscence, and poor scarring. It avoids minimizing the concern or shifting the focus to fear-based outcomes. By contrast, suggesting make-up is premature problem-solving and does not address immediate healing priorities or the client’s emotional need for reassurance and education.

Question 14

A client has just returned to the room after having a mammogram. The client is teary and in a shaky voice says to the nurse, "The radiology technician told me that it looks really bad - the tumor in my breast is very large." Which is the best response by the nurse?

Accepted Answer

Answer reason: "I can see that you are very upset. Let's talk about what happened." Therapeutic communication prioritizes acknowledging the client’s emotions and inviting expression to reduce anxiety and build trust. This response validates the client’s distress and opens the door to explore what was said without confirming or interpreting diagnostic results. Reporting or criticizing the technician shifts the focus away from the client’s immediate emotional needs and can escalate distress. Deferring to the provider about treatment may be appropriate later, but it does not address the client’s current fear and need to process the interaction.

Question 15

A client with advanced multiple sclerosis (MS) has been a resident in a nursing home for the past 2 years. One day, the client tells the nurse, "I want to get out of here and try living in my own home." What is the best response by the nurse?

Accepted Answer

Answer reason: " Therapeutic communication prioritizes open-ended exploration of the client’s feelings, goals, and perceived benefits/risks before problem-solving. This response invites the client to elaborate and clarifies meaning, supporting autonomy and helping the nurse assess readiness and expectations for independent living. Options that immediately propose solutions or focus on barriers can shut down discussion and may communicate judgment or discouragement. Asking about caregivers is relevant later, but first the nurse should explore the client’s perspective to guide collaborative planning.

Question 16

A nurse is caring for a client who is at 8 weeks of gestation with twins and primigravida. The client states that even though she and her husband planned this pregnancy, she is experiencing many ambivalent feelings about it. Which of the following responses should the nurse make?

Accepted Answer

Answer reason: " Ambivalence is a common, expected emotional response in early pregnancy, even when the pregnancy is planned, and reassurance/normalization helps reduce anxiety and supports adaptation. This statement validates the client’s feelings without judgment and communicates that her experience can be within normal limits. Asking about telling the husband shifts focus away from the client’s immediate concerns and may feel pressuring. Expressing concern or suggesting counseling prematurely can pathologize normal adjustment and may increase distress rather than provide supportive communication.

Question 17

A female victim of a sexual assault is being seen in the crisis center. The client states that she still feels “as though the rape just happened yesterday,” even though it has been a few months since the incident. Which is the most appropriate nursing response?

Accepted Answer

Answer reason:  Trauma responses can include intrusive memories and a sense of reliving the event, and the nurse should use therapeutic communication to promote expression and assessment without judgment. This open-ended prompt validates the client’s experience and invites her to explore triggers and symptoms in a safe, patient-led way. The other statements either minimize the experience, give false reassurance, or shift prematurely into problem-solving, which can shut down disclosure and increase distress. Encouraging narrative sharing also helps the nurse assess safety, coping, and the need for additional crisis/mental health supports.

Question 18

Your manic patient says, "Everything I do is great." How should you respond?

Accepted Answer

Answer reason:  In mania, grandiosity and inflated self-esteem are common, so the nurse should use therapeutic communication that gently explores reality without arguing or reinforcing the delusion. This response uses open-ended questioning to prompt reflection on past experiences and introduces reality testing in a nonconfrontational way. Options that praise or encourage the statement can intensify manic behavior and reduce insight. A blunt corrective statement is likely to be perceived as judgmental and can escalate defensiveness or agitation, making engagement harder.

Question 19

The nurse speaks with a client and the spouse who have been undergoing family counseling. The client's spouse states, "You never take any responsibility for the messes you always cause!" Which response by the nurse is best?

Accepted Answer

Answer reason: " Therapeutic communication in family counseling aims to reduce hostile, blaming statements and promote constructive, problem-focused dialogue. This response sets a respectful limit on ineffective communication and redirects the couple toward healthier interaction patterns without escalating conflict. It is more therapeutic than a “why” question, which can sound accusatory and increase defensiveness. The other options either minimize the issue or change the subject rather than addressing the dysfunctional communication in the moment.

Question 20

The client in the unit is expressing to the nurse that his son’s complaining is making him feel anxious. He asks the nurse if she will talk to his son during his visit later in the day. Which is the most therapeutic response by the nurse?

Accepted Answer

Answer reason: The therapeutic approach is to support the client’s autonomy and promote effective coping and communication rather than taking over the interaction. This response collaborates with the client to plan a constructive way to address the issue directly with his son, reducing anxiety while preserving family roles and boundaries. It uses problem-solving and empowerment, which are key elements of therapeutic communication. In contrast, options that probe the son’s motives or criticize the request can shift focus away from the client’s needs or create defensiveness and shame.

Question 21

A toddler with suspected conjunctivitis is crying and refuses to sit still during the eye examination. Which is the most appropriate statement for the nurse to make to the child?

Accepted Answer

Answer reason: Toddlers respond best to simple, concrete, nonthreatening approaches that build trust and invite cooperation through play and curiosity. Offering to show the flashlight is a developmentally appropriate distraction that helps reduce fear and increases the likelihood the child will allow the brief eye exam. Telling a child “don’t be scared” dismisses feelings and provides false reassurance rather than support. Bargaining or delaying the exam reinforces avoidance and can make future procedures harder by rewarding refusal.

Question 22

A home health nurse is visiting a 72-year-old client who had coronary artery bypass grafting (CABG) surgery 2 weeks ago. The client reports being forgetful and becoming teary easily. How should the nurse respond?

Accepted Answer

Answer reason: "These symptoms can be common after major surgery. It will take 4-6 weeks to completely heal and start to feel normal again." Postoperative emotional lability and mild cognitive changes can occur after major cardiac surgery and are often transient during early recovery. The most therapeutic nursing response acknowledges the client’s experience, normalizes it within the expected postoperative course, and provides realistic time frames for recovery. This approach reduces anxiety without dismissing concerns and supports coping and adaptation. Minimizing feelings (“don’t worry”) is nontherapeutic, and jumping to antidepressant treatment prematurely bypasses assessment and could mislabel normal recovery-related symptoms.

Question 23

A client is scheduled for coronary artery bypass surgery in the morning. In the middle of the night, the nurse finds the client wide awake. The client demonstrates symptoms of extreme anxiety and tells the nurse about wanting to refuse the surgery. Which statement by the nurse would be most appropriate?

Accepted Answer

Answer reason: " Therapeutic communication uses open-ended, nonjudgmental prompts to explore anxiety and uncover specific fears or misconceptions. This response invites the client to express feelings, which helps the nurse assess coping, provide targeted information, and reduce preoperative distress. In contrast, reassurance about the surgeon minimizes the client’s emotion and can shut down further discussion. Asking “why” can sound accusatory, and focusing immediately on refusal rights does not address the acute anxiety driving the statement or support emotional processing before decision-making.

Question 24

A client diagnosed with mania tells a nurse, “I think you’re very pretty. Maybe we could go to my room.” Which response by the nurse is most therapeutic?

Accepted Answer

Answer reason: " Therapeutic communication with a manic client requires clear, consistent limit-setting and maintenance of professional boundaries. This response directly addresses the inappropriate invitation without shaming the client and re-establishes the nurse–client relationship framework. Stating offense introduces the nurse’s feelings and can escalate behavior, while redirecting to an activity avoids setting an explicit boundary. Seclusion is a restrictive intervention reserved for imminent danger and is not indicated solely for verbal boundary testing.

Question 25

An African American female is diagnosed with breast cancer. It is most important for the LPN/LVN to take which action?

Accepted Answer

Answer reason: Nursing psychosocial care starts with assessment of the patient’s meaning and understanding of the diagnosis before providing teaching or coping strategies. Exploring the client’s perception identifies knowledge gaps, fears, cultural beliefs, and readiness to engage in treatment decisions, which guides individualized interventions. Offering a one-size-fits-all approach ignores differing emotional responses and is not therapeutic. Emphasizing higher death rates is nontherapeutic and may increase anxiety without addressing the client’s specific concerns; coping-skill reinforcement is helpful but is best done after assessing the client’s current appraisal and needs.

Question 26

A client with a 20-year history of schizophrenia is hospitalized. The client appears visibly upset, approaches the nurse, and says in a shaky voice, "I can't find my headband. I can't find my headband. The oil is going to leak out of the crack in my head." What is the best response by the nurse?

Accepted Answer

Answer reason: " Clients with psychosis benefit from interventions that reduce anxiety while maintaining reality-based, supportive communication. This response acknowledges the client’s distress and offers concrete assistance without validating the delusional content. Providing companionship and a simple, goal-directed activity can de-escalate agitation and strengthen rapport, which improves cooperation with care. Asking about “oil leaking” explores the delusion as if it were real, while bluntly denying it can increase defensiveness and mistrust; threatening missed breakfast is nontherapeutic and escalates anxiety.

Question 27

The nurse is conducting a home visit to assess an elderly client with advanced heart failure who lives alone. When the nurse asks about sodium intake, the client becomes angry and says, "I'm so tired of people telling me what to do! I'm going to eat what I want, so leave me alone!" Which of the following is the most appropriate response by the nurse?

Accepted Answer

Answer reason: "It sounds like you are angry. Tell me what's bothering you." Therapeutic communication prioritizes acknowledging the client’s expressed emotion and using an open-ended invitation to explore concerns. This response reflects and validates the anger while encouraging the client to share underlying fears, loss of control, or barriers to dietary adherence, which supports rapport and further assessment. In contrast, offering to leave or shifting to a task can be perceived as dismissive and may shut down communication. Mind-reading statements that claim to “know” what the client feels can feel judgmental or inaccurate and can escalate defensiveness. Exploring the emotion first creates a safer path to collaborative problem-solving about sodium restrictions and self-care.

Question 28

A client with renal failure recently started dialysis and is unable to work due to ongoing health problems. The client's spouse has started working for a cleaning service to replace the lost income. The dialysis nurse notices that the client has become withdrawn and increasingly frustrated by small inconveniences when coming to dialysis. Which is the most appropriate first response by the nurse?

Accepted Answer

Answer reason: Therapeutic communication begins with making an observation and inviting the client to share feelings, which helps establish rapport and assess coping. This statement reflects and validates the nurse’s perception without judging, minimizing, or changing the subject, encouraging the client to elaborate on what is driving withdrawal and irritability. Offering solutions like support groups is premature before fully exploring the client’s concerns and readiness. Labeling feelings as “normal” can unintentionally minimize the client’s experience and shut down further discussion, and asking about the spouse’s job redirects away from the client’s emotions.

Question 29

The nurse is teaching a client of American Indian heritage how to self-administer insulin. As the nurse describes the necessary steps in the injection process, the client continuously avoids eye contact and occasionally turns away from the nurse. Which action is most appropriate for the nurse to take in this situation?

Accepted Answer

Answer reason: The nurse should use culturally sensitive communication, avoid imposing personal norms (eg, forcing eye contact), and evaluate learning using an objective method. Having the client perform a return demonstration directly confirms psychomotor skill acquisition and patient safety for insulin administration. Confronting the client about “paying attention” or tracking their movements to force eye contact risks disrespect and can hinder rapport and learning.

Question 30

A client with multiple co-morbidities, including chronic obstructive pulmonary disease, diabetes, and chronic kidney disease, has just been told by the health care provider of the need to start dialysis. The client is in tears and says to the nurse, "I don't know what I'm going to do; everything was so overwhelming before, and now this." Which is the best response by the nurse?

Accepted Answer

Answer reason: " Therapeutic communication prioritizes acknowledging emotion and using open-ended questions to assess the client’s feelings, stressors, and coping ability. This response invites the client to express concerns and helps the nurse identify specific needs (education, resources, support) before offering solutions. The other options minimize feelings, give false reassurance, or shift focus to outcomes not guaranteed, which can shut down communication and increase anxiety. Exploring what feels overwhelming establishes rapport and provides the best foundation for supportive teaching and planning around dialysis.

Question 31

A worried mother confides in the nurse that she wants to change physicians because her infant is not getting better. The best response by the nurse is which of the following?

Accepted Answer

Answer reason: "You always have an option to change. Tell me about your concerns." Therapeutic communication prioritizes acknowledging the parent’s feelings, supporting autonomy, and using an open-ended question to assess concerns. This response validates worry without defending the provider and invites the mother to share specific issues that may reveal unmet needs, misunderstandings, or clinical red flags. It also upholds the client’s right to participate in care decisions while keeping the conversation focused on the infant’s care plan. The other options are nontherapeutic because they offer reassurance, personal opinions, or appeals to authority, which can shut down communication and increase distrust.

Question 32

The mother of a 28-year-old client who is taking clozapine (Clozaril) states, "Something is wrong. My son is drooling like a baby." Which of the following responses by the nurse would be most helpful?

Accepted Answer

Answer reason: " Clozapine can commonly cause sialorrhea, and the most helpful nursing response both acknowledges the symptom and offers a practical, immediate coping strategy. Providing clear information reduces anxiety and supports adherence while maintaining the client’s comfort and dignity. Options that minimize concern or rely on vague reassurance do not address the family’s worry or the symptom’s management. Framing it simply as an “adverse reaction” without education or action is less therapeutic and may increase alarm rather than guide care.

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Therapeutic Communication Practice Test 12

Therapeutic Communication NCLEX Practice Test

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