NUR 253 Exam 3 | Actual test Questions
and Answers | 2025 Update | 100%
Correct-Galen.
Section 1: Therapeutic Communication & Nurse-Client Relationship
1. A nurse is caring for a client who is experiencing severe anxiety. Which of the following
actions should the nurse take first?
A. Encourage the client to discuss their feelings.
B. Administer a PRN anti-anxiety medication.
C. Stay with the client and use a calm, quiet voice.
D. Teach the client deep breathing exercises.
Correct Answer: C
Rationale: The client with severe anxiety has a narrowed perceptual field and cannot
process teaching or complex conversations. The priority is safety and presence. Staying with the
client and using a calm voice helps reduce anxiety. Medication may be needed, but the first
action is therapeutic presence. Teaching is ineffective during severe anxiety.
2. A client tells the nurse, "I feel like I'm a burden to everyone." Which of the following
responses by the nurse is therapeutic?
A. "You shouldn't feel that way; everyone loves you."
B. "Why do you think you are a burden?"
C. "You feel as though you are a burden to others?"
D. "Let's talk about something more positive."
Correct Answer: C
Rationale: Restating the client's feelings validates their experience and encourages further
exploration without judgment. "Why" questions can be defensive. Giving reassurance
("everyone loves you") minimizes feelings. Changing the subject is nontherapeutic.
3. Which of the following behaviors by the nurse indicates a boundary violation in the nurse-
client relationship?
A. Calling the client by their preferred name.
B. Accepting a small gift from the client.
C. Sharing personal information about the nurse's marital problems.
D. Maintaining confidentiality of the client's diagnosis.
Correct Answer: C
, Rationale: Sharing personal problems is a boundary violation (self-disclosure that is not
therapeutic). Accepting a small gift may be acceptable depending on facility policy, but sharing
personal marital issues is never appropriate.
4. A nurse is using the technique of "offering self." Which statement demonstrates this
technique?
A. "I'll stay with you for a while."
B. "I understand how you feel."
C. "Tell me more about that."
D. "Let's go to the dayroom."
Correct Answer: A
Rationale: "Offering self" involves making oneself available to the client without expecting
anything in return. It demonstrates presence and willingness to be with the client.
5. A client with paranoid schizophrenia says, "The FBI is watching me through the TV." Which
response is most therapeutic?
A. "That's not true; the TV is just a TV."
B. "I don't see anyone watching you, but I understand you feel that way."
C. "Why do you think the FBI is watching you?"
D. "Let's turn off the TV so you feel safer."
Correct Answer: B
Rationale: This response acknowledges the client's feelings without validating the delusion
or arguing. It presents reality (I don't see anyone) while empathizing. Arguing with a delusion
can increase agitation.
6. Which of the following is an example of a non-therapeutic communication technique?
A. Silence
B. Reflecting
C. Giving advice
D. Clarifying
Correct Answer: C
Rationale: Giving advice implies the nurse knows best and discourages the client from
problem-solving. It can foster dependency.
7. A nurse is assessing a client for suicide risk. Which question is most appropriate?
A. "You're not thinking of hurting yourself, are you?"
B. "Do you have a plan to kill yourself?"
C. "Are you feeling sad today?"
D. "You wouldn't do anything stupid, would you?"
, Correct Answer: B
Rationale: Asking directly about a plan is essential for assessing lethality. "You're not
thinking..." is a leading question that discourages honesty. "Stupid" is judgmental.
8. A client is admitted to the psychiatric unit. The nurse says, "I'll be your nurse today. Let's
discuss your goals for this admission." This is an example of which phase of the nurse-client
relationship?
A. Pre-interaction
B. Orientation
C. Working
D. Termination
Correct Answer: B
Rationale: The orientation phase involves establishing trust, defining the relationship, and
setting goals. The pre-interaction phase is before meeting the client. The working phase is the
therapeutic work. Termination is ending the relationship.
9. A client says, "I can't sleep. I just lie there thinking about everything." Which response by
the nurse is most therapeutic?
A. "You should try warm milk."
B. "What kinds of things are you thinking about?"
C. "You need to relax."
D. "I'll get you a sleeping pill."
Correct Answer: B
Rationale: Exploring the client's thoughts helps identify the cause of insomnia and allows
the client to process. Offering advice or medication prematurely may not address the underlying
issue.
10. Which of the following is a sign of countertransference?
A. The nurse feels angry at the client for missing a session.
B. The nurse feels empathy for the client's situation.
C. The nurse maintains professional boundaries.
D. The nurse documents objectively.
Correct Answer: A
Rationale: Countertransference is the nurse's emotional reaction to the client based on the
nurse's own unresolved issues. Anger at a client for missing a session may indicate a personal
trigger.
11. A client with borderline personality disorder says, "You're the only nurse who understands
me. The others are terrible." Which response is best?
, A. "I'm glad you feel that way."
B. "That's not true; all the nurses are good."
C. "It sounds like you feel the other nurses don't understand you."
D. "You shouldn't say bad things about my colleagues."
Correct Answer: C
Rationale: This response reflects the client's feeling without endorsing the splitting
behavior. It acknowledges the client's experience while remaining neutral.
12. A nurse is conducting a mental status exam. Which question assesses the client's
orientation?
A. "What day is it today?"
B. "Who is the president?"
C. "What does 'a rolling stone gathers no moss' mean?"
D. "How are you feeling?"
Correct Answer: A
Rationale: Orientation refers to time, place, and person. Asking the date assesses
orientation to time. Asking about the president assesses general knowledge. Proverb
interpretation assesses abstract thinking.
13. A client is crying. Which action by the nurse is most appropriate?
A. Leave the client alone to cry.
B. Sit with the client and offer a tissue.
C. Tell the client to stop crying.
D. Ask the client why they are crying.
Correct Answer: B
Rationale: Sitting with the client provides support and presence. Leaving them alone may
increase feelings of isolation. Telling them to stop is dismissive. Asking "why" may be too direct
initially.
14. Which of the following statements by the nurse demonstrates the use of "clarification"?
A. "I'm not sure I understand. Could you explain that again?"
B. "You seem angry today."
C. "Let's talk about your family."
D. "I'll be back in an hour."
Correct Answer: A
Rationale: Clarification is used when the message is unclear. It helps the nurse understand
the client's communication.
and Answers | 2025 Update | 100%
Correct-Galen.
Section 1: Therapeutic Communication & Nurse-Client Relationship
1. A nurse is caring for a client who is experiencing severe anxiety. Which of the following
actions should the nurse take first?
A. Encourage the client to discuss their feelings.
B. Administer a PRN anti-anxiety medication.
C. Stay with the client and use a calm, quiet voice.
D. Teach the client deep breathing exercises.
Correct Answer: C
Rationale: The client with severe anxiety has a narrowed perceptual field and cannot
process teaching or complex conversations. The priority is safety and presence. Staying with the
client and using a calm voice helps reduce anxiety. Medication may be needed, but the first
action is therapeutic presence. Teaching is ineffective during severe anxiety.
2. A client tells the nurse, "I feel like I'm a burden to everyone." Which of the following
responses by the nurse is therapeutic?
A. "You shouldn't feel that way; everyone loves you."
B. "Why do you think you are a burden?"
C. "You feel as though you are a burden to others?"
D. "Let's talk about something more positive."
Correct Answer: C
Rationale: Restating the client's feelings validates their experience and encourages further
exploration without judgment. "Why" questions can be defensive. Giving reassurance
("everyone loves you") minimizes feelings. Changing the subject is nontherapeutic.
3. Which of the following behaviors by the nurse indicates a boundary violation in the nurse-
client relationship?
A. Calling the client by their preferred name.
B. Accepting a small gift from the client.
C. Sharing personal information about the nurse's marital problems.
D. Maintaining confidentiality of the client's diagnosis.
Correct Answer: C
, Rationale: Sharing personal problems is a boundary violation (self-disclosure that is not
therapeutic). Accepting a small gift may be acceptable depending on facility policy, but sharing
personal marital issues is never appropriate.
4. A nurse is using the technique of "offering self." Which statement demonstrates this
technique?
A. "I'll stay with you for a while."
B. "I understand how you feel."
C. "Tell me more about that."
D. "Let's go to the dayroom."
Correct Answer: A
Rationale: "Offering self" involves making oneself available to the client without expecting
anything in return. It demonstrates presence and willingness to be with the client.
5. A client with paranoid schizophrenia says, "The FBI is watching me through the TV." Which
response is most therapeutic?
A. "That's not true; the TV is just a TV."
B. "I don't see anyone watching you, but I understand you feel that way."
C. "Why do you think the FBI is watching you?"
D. "Let's turn off the TV so you feel safer."
Correct Answer: B
Rationale: This response acknowledges the client's feelings without validating the delusion
or arguing. It presents reality (I don't see anyone) while empathizing. Arguing with a delusion
can increase agitation.
6. Which of the following is an example of a non-therapeutic communication technique?
A. Silence
B. Reflecting
C. Giving advice
D. Clarifying
Correct Answer: C
Rationale: Giving advice implies the nurse knows best and discourages the client from
problem-solving. It can foster dependency.
7. A nurse is assessing a client for suicide risk. Which question is most appropriate?
A. "You're not thinking of hurting yourself, are you?"
B. "Do you have a plan to kill yourself?"
C. "Are you feeling sad today?"
D. "You wouldn't do anything stupid, would you?"
, Correct Answer: B
Rationale: Asking directly about a plan is essential for assessing lethality. "You're not
thinking..." is a leading question that discourages honesty. "Stupid" is judgmental.
8. A client is admitted to the psychiatric unit. The nurse says, "I'll be your nurse today. Let's
discuss your goals for this admission." This is an example of which phase of the nurse-client
relationship?
A. Pre-interaction
B. Orientation
C. Working
D. Termination
Correct Answer: B
Rationale: The orientation phase involves establishing trust, defining the relationship, and
setting goals. The pre-interaction phase is before meeting the client. The working phase is the
therapeutic work. Termination is ending the relationship.
9. A client says, "I can't sleep. I just lie there thinking about everything." Which response by
the nurse is most therapeutic?
A. "You should try warm milk."
B. "What kinds of things are you thinking about?"
C. "You need to relax."
D. "I'll get you a sleeping pill."
Correct Answer: B
Rationale: Exploring the client's thoughts helps identify the cause of insomnia and allows
the client to process. Offering advice or medication prematurely may not address the underlying
issue.
10. Which of the following is a sign of countertransference?
A. The nurse feels angry at the client for missing a session.
B. The nurse feels empathy for the client's situation.
C. The nurse maintains professional boundaries.
D. The nurse documents objectively.
Correct Answer: A
Rationale: Countertransference is the nurse's emotional reaction to the client based on the
nurse's own unresolved issues. Anger at a client for missing a session may indicate a personal
trigger.
11. A client with borderline personality disorder says, "You're the only nurse who understands
me. The others are terrible." Which response is best?
, A. "I'm glad you feel that way."
B. "That's not true; all the nurses are good."
C. "It sounds like you feel the other nurses don't understand you."
D. "You shouldn't say bad things about my colleagues."
Correct Answer: C
Rationale: This response reflects the client's feeling without endorsing the splitting
behavior. It acknowledges the client's experience while remaining neutral.
12. A nurse is conducting a mental status exam. Which question assesses the client's
orientation?
A. "What day is it today?"
B. "Who is the president?"
C. "What does 'a rolling stone gathers no moss' mean?"
D. "How are you feeling?"
Correct Answer: A
Rationale: Orientation refers to time, place, and person. Asking the date assesses
orientation to time. Asking about the president assesses general knowledge. Proverb
interpretation assesses abstract thinking.
13. A client is crying. Which action by the nurse is most appropriate?
A. Leave the client alone to cry.
B. Sit with the client and offer a tissue.
C. Tell the client to stop crying.
D. Ask the client why they are crying.
Correct Answer: B
Rationale: Sitting with the client provides support and presence. Leaving them alone may
increase feelings of isolation. Telling them to stop is dismissive. Asking "why" may be too direct
initially.
14. Which of the following statements by the nurse demonstrates the use of "clarification"?
A. "I'm not sure I understand. Could you explain that again?"
B. "You seem angry today."
C. "Let's talk about your family."
D. "I'll be back in an hour."
Correct Answer: A
Rationale: Clarification is used when the message is unclear. It helps the nurse understand
the client's communication.
