NCLEX questions and answers therapeutic communication Graded A

NCLEX questions and answers therapeutic communication Graded A A client diagnosed with dependant personality disorder states, "Do you think I should move from my parent's house and get a job?" Which nursing response is most appropriate? A "It would be best to do that in order to increase independence." B "Why would you want to leave a secure home?" C "Let's discuss and explore all of your options." D "I'm afraid you would feel very guilty leaving your parents." - ANS- C The most appropriate response by the nurse is, "Let's discuss and explore all of your options." In this example, the nurse is encouraging the client to formulate ideas and decide independently the appropriate course of action. A client diagnosed with post-traumatic stress disorder is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique used by the nurse is an example of a broad opening? A "What occurred prior to the rape, and when did you go to the emergency department?" B "What would you like to talk about?" C "I notice you seem uncomfortable discussing this." D "How can we help you feel safe during your stay here?" - ANS- B The nurse's statement, "What would you like to talk about?" is an example of the therapeutic communication technique of giving broad openings. Using a broad opening allows the client to take the initiative in introducing the topic and emphasizes the importance of the client's role in the interaction. A client is struggling to explore and solve a problem. Which nursing statement would verbalize the implication of the client's actions? A "You seem to be motivated to change your behavior." B "How will these changes affect your family relationships?" C "Why don't you make a list of the behaviors you need to change." D "The team recommends that you make only one behavioral change at a time." - ANS- A This is an example of the therapeutic communication technique of verbalizing the implied. Verbalizing the implied puts into words what the client has only implied or said indirectly. A client on an inpatient psychiatric unit tells the nurse, "I should have died because I am totally worthless." In order to encourage the client to continue talking about feelings, which should be the nurse's initial response? A "How would your family feel if you died?" B "You feel worthless now, but that can change with time." C "You've been feeling sad and alone for some time now?" D "It is great that you have come in for help." - ANS- C This nursing statement is an example of the therapeutic communication technique of reflection. When reflection is used, questions and feelings are referred back to the client so that they may be recognized and accepted. A client slammed a door on the unit several times. The nurse responds, "You seem angry." The client states, "I'm not angry." What therapeutic communication technique has the nurse employed and what defense mechanism is the client unconsciously demonstrating? A Making observations and the defense mechanism of suppression B Verbalizing the implied and the defense mechanism of denial C Reflection and the defense mechanism of projection D Encouraging descriptions of perceptions and the defense mechanism of displacement - ANS- B This is an example of the therapeutic communication technique of verbalizing the implied. The nurse is putting into words what the client has only implied by words or actions. Denial is the refusal of the client to acknowledge the existence of a real situation, the feelings associated with it, or both. A client states, "You won't believe what my husband said to me during visiting hours. He has no right treating me that way." Which nursing response would best assess the situation that occurred? A "Does your husband treat you like this very often?" B "What do you think is your role in this relationship?" C "Why do you think he behaved like that?" D "Describe what happened during your time with your husband." - ANS- D This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication. A client tells the nurse, "I feel bad because my mother does not want me to return home after I leave the hospital." Which nursing response is therapeutic? A "It's quite common for clients to feel that way after a lengthy hospitalization." B "Why don't you talk to your mother? You may find out she doesn't feel that way." C "Your mother seems like an understanding person. I'll help you approach her." D "You feel that your mother does not want you to come back home?" - ANS- D This is an example of the therapeutic communication technique of restatement. Restatement is the repeating of the main idea that the client has verbalized. This lets the client know whether or not an expressed statement has been understood and gives him or her the chance to continue, or clarify if necessary. A client who frequently exhibits angry outbursts is diagnosed with antisocial personality disorder. Which appropriate feedback should a nurse provide when this client experiences an angry outburst? A "Why do you continue to alienate your peers by your angry outbursts?" B "You accomplish nothing when you lose your temper like that." C "Showing your anger in that manner is very childish and insensitive." D "During group, you raised your voice, yelled at a peer, left, and slammed the door." - ANS- D The nurse is providing appropriate feedback when stating, "During group, you raised your voice, yelled at a peer, left, and slammed the door." Giving appropriate feedback involves helping the client consider a modification of behavior. Feedback should give information to the client about how he or she is perceived by others. Feedback should not be evaluative in nature or be used to give advice. A client with a history of major depression tells the nurse "I wish I weren't alive. I have been a failure my entire life and I am totally useless to anyone." The most therapeutic response to the client is: A "You've been feeling like a failure your entire life?" B "You shouldn't talk like that. You're not a failure." C "Once the antidepressants start working you will feel better about yourself." D "Things could be worse. You should be grateful for what you have." - ANS- A Rationale: 1. "You shouldn't talk like that. You're not a failure." Telling clients how they should or should not feel invalidates their feelings and is nontherapeutic. 2. "Once the antidepressants start working you will feel better about yourself." The client's depressive symptomatology should improve with antidepressants. However, this response is not the most therapeutic at this time. 3. "Things could be worse. You should be grateful for what you have." This response minimizes the client's feelings and can be perceived as punitive. 4. "You've been feeling like a failure your entire life?" This response restates what the client said and in doing so encourages the client to continue talking. A client's younger daughter is ignoring curfew. The client states, "I'm afraid she will get pregnant." The nurse responds, "Hang in there. Don't you think she has a lot to learn about life?" This is an example of which communication block? A Requesting an explanation B Belittling the client C Making stereotyped comments D Probing - ANS- C This is an example of the nontherapeutic communication block of making stereotyped comments. Clichés and trite expressions are meaningless in a therapeutic nurse-client relationship. A mother rescues two of her four children from a house fire. In the emergency department, she cries, "I should have gone back in to get them. I should have died, not them." What is the nurse's best response?