NCLEX Practice Test On Therapeutic Communication

1. When the community health nurse visits a patient at home. the patient states. "I haven't slept the last couple of nights." Which response by the nurse illustrates a therapeutic communication response to this patient?

“I see.”

“Really?”

“You’re having difficulty sleeping?”

“Sometimes. I have trouble sleeping too.”

The correct option uses the therapeutic communication technique of restatement. Although restatement is a technique that has a prompting component to it. it repeats the patient’s major theme. which assists the nurse in obtaining a more specific perception of the problem from the patient.Options A. B. and D: The remaining options are not therapeutic responses since none encourage the patient to expand on the problem. Offering personal experiences moves the focus away from the patient and onto the nurse.

Explanation

The correct option uses the therapeutic communication technique of restatement. Although restatement is a technique that has a prompting component to it. it repeats the patient’s major theme. which assists the nurse in obtaining a more specific perception of the problem from the patient.Options A. B. and D: The remaining options are not therapeutic responses since none encourage the patient to expand on the problem. Offering personal experiences moves the focus away from the patient and onto the nurse.

2. A patient admitted to a mental health unit for treatment of psychotic behavior spends hours at the locked exit door shouting. "Let me out. There's nothing wrong with me. I don't belong here." What defense mechanism is the patient implementing?

Denial

Projection

Regression

Rationalization

Denial is a refusal to admit to a painful reality. which was treated as if it does not exist.Option B: In projection. a person unconsciously rejects emotionally unacceptable features and attributes them to other persons. objects. or situations.Option C: Regression allows the patient to return to an earlier. more comforting. although less mature. a way of behaving.Option D: Rationalization is justifying illogical or unreasonable ideas. actions. or feelings by developing acceptable explanations that satisfy the teller and the listener.

Explanation

Denial is a refusal to admit to a painful reality. which was treated as if it does not exist.Option B: In projection. a person unconsciously rejects emotionally unacceptable features and attributes them to other persons. objects. or situations.Option C: Regression allows the patient to return to an earlier. more comforting. although less mature. a way of behaving.Option D: Rationalization is justifying illogical or unreasonable ideas. actions. or feelings by developing acceptable explanations that satisfy the teller and the listener.

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

Fearfulness regarding treatment measures.

Anger and aggressiveness directed toward others.

An understanding of the pathology and symptoms of the diagnosis.

A willingness to participate in the planning of the care and treatment plan.

In general. patients seek voluntary admission. If a patient seeks voluntary admission. the most likely expectation is the patient will participate in the treatment program since they are actively seeking help.Options A. B. and C: The remaining options are not characteristics of this type of admission. Fearfulness. anger. and aggressiveness are more characteristic of an involuntary admission. Voluntary admission does not guarantee a patient’s understanding of their illness. only of their desire for help.

Explanation

In general. patients seek voluntary admission. If a patient seeks voluntary admission. the most likely expectation is the patient will participate in the treatment program since they are actively seeking help.Options A. B. and C: The remaining options are not characteristics of this type of admission. Fearfulness. anger. and aggressiveness are more characteristic of an involuntary admission. Voluntary admission does not guarantee a patient’s understanding of their illness. only of their desire for help.

4. A patient experiencing disturbed thought processes believes that his food is has been poisoned. Which communication technique should the use to encourage the patient to eat?

Using open-ended questions and silence

Sharing personal preference regarding food choices

Documenting reasons why the patient does not want to eat

Offering opinions about the necessity of adequate nutrition

Open-ended questions and silence are strategies use to encourage patients to discuss their problems. Sharing personal food preferences is not a patient-centered intervention.Options B. C. and D: The remaining options are not helpful to the patient because they do not encourage the patient to express feelings. The nurse should not offer opinions and should encourage the patient to identify the reasons for the behavior.

Explanation

Open-ended questions and silence are strategies use to encourage patients to discuss their problems. Sharing personal food preferences is not a patient-centered intervention.Options B. C. and D: The remaining options are not helpful to the patient because they do not encourage the patient to express feelings. The nurse should not offer opinions and should encourage the patient to identify the reasons for the behavior.

5. When reviewing the admission assessment. the nurse notes that a patient was admitted to the mental health unit involuntarily. Based on this type of admission. the nurse should provide which intervention for this patient?

Monitor closely for harm to self or others.

Assist in completing an application for admission.

Supply the patient with written information about their mental illness.

Provide an opportunity for the family to discuss why they felt the admission was needed.

Involuntary admission is necessary when a person is a danger to self or others or is in need of psychiatric treatment regardless of the patient’s willingness to consent to the hospitalization.Option B: A written request is a component of a voluntary admission.Option C: Providing written information regarding the illness is likely premature initially.Option D: The family. may have had no role to play in the patient’s’ admission.

Explanation

Involuntary admission is necessary when a person is a danger to self or others or is in need of psychiatric treatment regardless of the patient’s willingness to consent to the hospitalization.Option B: A written request is a component of a voluntary admission.Option C: Providing written information regarding the illness is likely premature initially.Option D: The family. may have had no role to play in the patient’s’ admission.

6. The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbors ask the nurse. "How is Mary doing? She is my best friend and is seen at your clinic every week." Which is the MOST APPROPRIATE nursing response?

“I can not discuss any patient situation with you.”

“If you want to know about Mary. you need t ask her yourself.”

“Only because you’re worried about a friend. I’ll tell you that she is improving.”

“Being her friend. you know she is having a difficult time and deserves her privacy.”

The nurse is required to maintain confidentiality regarding the patient and the patient’s care. Confidentiality is basic to the therapeutic relationship and is a patient’s right. The most appropriate response to the neighbor is the statement of that responsibility in a direct. but polite manner. A blunt statement that does not acknowledge why the nurse cannot reveal patient information may be taken as disrespectful and uncaring.Options B. C. and D: The remaining options identify statements that do not maintain patient confidentiality.

Explanation

The nurse is required to maintain confidentiality regarding the patient and the patient’s care. Confidentiality is basic to the therapeutic relationship and is a patient’s right. The most appropriate response to the neighbor is the statement of that responsibility in a direct. but polite manner. A blunt statement that does not acknowledge why the nurse cannot reveal patient information may be taken as disrespectful and uncaring.Options B. C. and D: The remaining options identify statements that do not maintain patient confidentiality.

7. A patient diagnosed with terminal cancer says to the nurse "I'm going to die. and I wish my family would stop hoping for a cure! I get so angry when they carry on like this. After all. I'm the one who's dying." Which response by the nurse is therapeutic?

“Have you shared your feelings with your family?”

“I think we should talk more about your anger with your family.”

“You’re feeling angry that your family continues to hope for you to be cured?”

“You are probably very depressed. which is understandable with such a diagnosis.”

Restating is a therapeutic communication technique in which the nurse repeats what the patient says to show understanding and to review what was said.Options A and B: While it is appropriate for the nurse to attempt to assess the patient’s ability to discuss feelings openly with family members. it does not help the patient discuss the feelings causing the anger.Option D: The nurse’s attempt to focus on the central issue of anger is premature. The nurse would never make a judgment regarding the reason for the patient’s feeling; this is non-therapeutic in the one-to-one relationship.

Explanation

Restating is a therapeutic communication technique in which the nurse repeats what the patient says to show understanding and to review what was said.Options A and B: While it is appropriate for the nurse to attempt to assess the patient’s ability to discuss feelings openly with family members. it does not help the patient discuss the feelings causing the anger.Option D: The nurse’s attempt to focus on the central issue of anger is premature. The nurse would never make a judgment regarding the reason for the patient’s feeling; this is non-therapeutic in the one-to-one relationship.

8. A patient admitted voluntarily for the treatment of an anxiety disorder demands to be released from the hospital. Which action should the nurse take INITIALLY?

Contact the patient’s health care provider (HCP).

Call the patient’s family to arrange for transportations.

Attempt to persuade the patient to stay for only a few more days.

Tell the patient that leaving would likely result in an involuntary commitment.

In general. patients seek. voluntary admission. Voluntary patients have the right to demand and obtain release. The nurse needs to be familiar with the state and facility policies and procedures. The best nursing action is to contact the HCP. who has the authority to discuss discharge with the patient.Option B: While arranging for safe transportation is appropriate it is premature in this situation and should be done only with the patient’s’ permission.Option C: While it is appropriate to discuss why the patient feels the need to leave and the possible outcomes of leaving against medical advice. attempting to get the patient to agree to stay “a few more days” has little value and will not likely be successful.Option D: Many states require that the patient submits a written release notice to the facility staff members. who reevaluate the patient’s condition for possible conversion to involuntary status if necessary. according to criteria established by law. While this is a possibility. it should not be used a a threat to the patient.

Explanation

In general. patients seek. voluntary admission. Voluntary patients have the right to demand and obtain release. The nurse needs to be familiar with the state and facility policies and procedures. The best nursing action is to contact the HCP. who has the authority to discuss discharge with the patient.Option B: While arranging for safe transportation is appropriate it is premature in this situation and should be done only with the patient’s’ permission.Option C: While it is appropriate to discuss why the patient feels the need to leave and the possible outcomes of leaving against medical advice. attempting to get the patient to agree to stay “a few more days” has little value and will not likely be successful.Option D: Many states require that the patient submits a written release notice to the facility staff members. who reevaluate the patient’s condition for possible conversion to involuntary status if necessary. according to criteria established by law. While this is a possibility. it should not be used a a threat to the patient.

9. A patient with a diagnosis of major depression who has attempted suicide says to the nurse. "I should have died! I've always been a failure. Nothing ever goes right for me." Which response demonstrates therapeutic communication?

“You have everything to live for.”

“Why do you see yourself as a failure?”

“Feeling like this is all part of being depressed.”

“You’ve been feeling like a failure for a while?”

Responding to the feelings expressed by a patient is an effective therapeutic communication technique. The correct option is an example of the use of restating.Options A. B. C: The remaining options block communication because they minimize the patient’s experience and do not facilitate exploration of the patient’s expressed feelings. In addition. use of the word “why” is nontherapeutic.

Explanation

Responding to the feelings expressed by a patient is an effective therapeutic communication technique. The correct option is an example of the use of restating.Options A. B. C: The remaining options block communication because they minimize the patient’s experience and do not facilitate exploration of the patient’s expressed feelings. In addition. use of the word “why” is nontherapeutic.

10. The nurse is preparing a patient for the termination phase of the nurse-patient relationship. The nurse prepares to implement which nursing task that is MOST APPROPRIATE for this phase?

Planning short-term goals

Making appropriate referrals

Developing realistic solutions

Identifying expected outcomes

Tasks of the termination phase include evaluating patient performance. evaluating achievement of expected outcomes. evaluating future needs. making appropriate referrals and dealing with the common behaviors associated with termination.Options A. C. and D: The remaining options identify tasks appropriate for the working phase of the relationship.

Explanation

Tasks of the termination phase include evaluating patient performance. evaluating achievement of expected outcomes. evaluating future needs. making appropriate referrals and dealing with the common behaviors associated with termination.Options A. C. and D: The remaining options identify tasks appropriate for the working phase of the relationship.