WGU D344 master set
What is the primary goal of therapeutic communication? To promote patient growth, insight, problem-solving, and healing. Rationale:
Therapeutic communication focuses on the patient's needs rather than the nurse's.
D344 Tip: If an answer promotes exploration of feelings, it is usually therapeutic.
What is empathy? The ability to understand and communicate understanding of a patient's feelings
while maintaining professional boundaries. Rationale: Empathy promotes trust and
therapeutic alliance. D344 Tip: Empathy is not the same as sympathy.
What is sympathy? Sharing another person's feelings or emotional experience. Rationale: Sympathy
may shift focus away from the patient and is less therapeutic. D344 Tip: Choose
empathy over sympathy on the OA.
What is clarification? Requesting additional information to better understand a patient's message.
Rationale: Clarification reduces misunderstanding. Example: "Can you tell me what
you mean by stoned?"
What is reflection? Directing feelings, ideas, or questions back to the patient. Rationale: Reflection
encourages self-exploration and insight.
What is restating? Repeating the main idea of what a patient has said. Rationale: Demonstrates active
listening and understanding.
What is paraphrasing? Restating a patient's message in different words. Rationale: Helps confirm
understanding and encourages elaboration.
What is exploring? Encouraging the patient to discuss a topic further. Rationale: Facilitates deeper
assessment and understanding.
What is focusing? Helping the patient concentrate on one issue at a time. Rationale: Useful when
patients are vague or overly talkative.
What is silence as a therapeutic technique? Allowing pauses in conversation for reflection and processing. Rationale: Silence
encourages deeper thought and emotional expression.
Why is silence considered therapeutic? It provides time for reflection and emotional processing. Rationale: Patients often
reveal important information after a period of silence.
What is offering self? Making oneself available to the patient. Rationale: Builds trust and conveys caring.
Example: "I'd like to sit with you for a while."
What is active listening? Fully concentrating on what the patient is saying verbally and nonverbally.
Rationale: Promotes understanding and rapport.
What is attending behavior? Using eye contact, posture, and presence to demonstrate interest. Rationale:
Encourages communication and trust.
What is the therapeutic alliance? A collaborative relationship between clinician and patient. Rationale: Strong
alliances improve outcomes.
, WGU D344 master set
What is genuineness? Congruence between what the nurse says and does. Rationale: Patients are more
likely to trust authentic interactions.
What is immediacy? Discussing what is occurring in the current interaction. Rationale: Helps address
communication issues as they arise.
What is broad opening? Allowing the patient to choose the direction of conversation. Example: "Where
would you like to begin?" Rationale: Encourages autonomy.
What is validation? Confirming mutual understanding of communication. Rationale: Prevents
misinterpretation.
What is presenting reality? Offering reality-based information without arguing. Rationale: Useful when
responding to delusions or hallucinations.
What is the best response to a patient experiencing a Focus on the patient's feelings rather than challenging the delusion. Rationale:
delusion? Challenging may damage trust.
A patient says, "The CIA is watching me through the "It sounds like you're concerned about your privacy." Rationale: Reflects feelings
lights." What is the most therapeutic response? without validating the delusion.
Why should nurses avoid arguing with delusions? It increases defensiveness and reduces trust. Rationale: Focus on emotions rather
than content.
What is a closed-ended question? A question that can be answered briefly, often yes or no. Rationale: Useful for
obtaining specific information.
What is an open-ended question? A question encouraging detailed responses. Rationale: Produces richer assessment
data.
Why are open-ended questions preferred in psychiatric They encourage exploration and detailed responses. Rationale: Improve
interviews? assessment quality.
What is a nontherapeutic "why" question? A question that may make patients feel defensive. Rationale: Often perceived as
judgmental.
What is giving advice? Telling patients what they should do. Rationale: Generally nontherapeutic because it
discourages independent problem-solving.
Why is advice-giving usually nontherapeutic? It fosters dependence and decreases autonomy. Rationale: Patients need to
develop their own coping skills.
What is false reassurance? Providing unrealistic comfort. Example: "Everything will be fine." Rationale:
Minimizes patient concerns.
, WGU D344 master set
Why is false reassurance harmful? It invalidates feelings and may damage trust. Rationale: Patients may feel
misunderstood.
What is approval? Sanctioning or praising a patient's actions. Rationale: Can imply judgment and
discourage honest communication.
Why is disapproval nontherapeutic? It may make patients defensive or ashamed. Rationale: Therapeutic communication
is nonjudgmental.
What is probing? Persistent questioning beyond the patient's readiness. Rationale: May increase
anxiety and resistance.
What is changing the subject? Redirecting conversation away from the patient's concern. Rationale:
Nontherapeutic because it blocks communication.
Why should nurses avoid excessive self-disclosure? It shifts focus away from the patient. Rationale: The patient should remain the
center of attention.
When is self-disclosure appropriate? Only when it clearly benefits the patient. Rationale: Must have a therapeutic
purpose.
What is countertransference? The nurse's emotional reactions to a patient based on personal experiences.
Rationale: Can impair objectivity.
What is transference? The patient's unconscious redirection of feelings onto the clinician. Rationale:
Common in therapeutic relationships.
What is rapport? A feeling of mutual trust and understanding. Rationale: Essential for effective
communication.
What is the orientation phase of the nurse-patient The introductory phase where trust and expectations are established. Rationale:
relationship? Foundation of the therapeutic relationship.
What occurs during the working phase? Exploration of problems, feelings, and solutions. Rationale: Most therapeutic work
occurs here.
What occurs during the termination phase? Evaluation of progress and ending the relationship. Rationale: Encourages
independence and closure.
What is the most important focus during the orientation Establishing trust and identifying patient concerns. Rationale: Sets the stage for
phase? future work.
Why are boundaries important in psychiatric nursing? They protect both patient and clinician. Rationale: Promote safety and
professionalism.
, WGU D344 master set
What is a boundary violation? Actions that exploit or harm the patient. Rationale: Violates professional ethics.
What is a boundary crossing? A minor departure from traditional boundaries that may be clinically appropriate.
Rationale: Must benefit the patient.
What is congruent communication? Verbal and nonverbal messages match. Rationale: Increases credibility.
What is incongruent communication? Verbal and nonverbal messages conflict. Rationale: May indicate anxiety or
unresolved feelings.
A patient says, "My marriage is great," while fidgeting and Mixed or incongruent communication. Rationale: Verbal and nonverbal messages
avoiding eye contact. What type of communication is conflict.
present?
What is nonverbal communication? Communication through behavior, facial expressions, posture, and gestures.
Rationale: Often conveys emotions more accurately than words.
What is the primary purpose of clarification? To ensure the nurse accurately understands the patient's meaning. Rationale:
Clarification reduces misunderstandings and improves assessment accuracy. D344
Tip: Clarification is often the best response when patient wording is vague.
A patient says, "I feel stoned." What is the most "Can you tell me what you mean by stoned?" Rationale: This is clarification and
therapeutic response? seeks the patient's meaning. D344 Tip: Avoid assuming what the patient means.
What therapeutic technique is demonstrated by saying, Validation. Rationale: Validation confirms mutual understanding between nurse and
"Am I understanding correctly that..."? patient.
What is the goal of validation? To ensure the message received is the message intended. Rationale: Prevents
miscommunication and incorrect assumptions.
A patient frequently looks toward the door during an "I notice you keep looking toward the door." Rationale: Making observations
interview. What is the best response? encourages exploration without assumptions. D344 Tip: Observation is usually more
therapeutic than interpretation.
What is making observations? Verbally noting behaviors or appearances observed. Rationale: Encourages
patients to discuss feelings associated with behaviors.
Why should assumptions be avoided? They may be inaccurate and block communication. Rationale: Assessment should
be based on patient exploration rather than nurse conclusions.
What is confrontation in therapeutic communication? Pointing out discrepancies between thoughts, feelings, and behaviors. Rationale:
Helps patients gain insight when used appropriately.
When should confrontation be used? After rapport and trust have been established. Rationale: Premature confrontation
can damage the therapeutic relationship.
What is the primary goal of therapeutic communication? To promote patient growth, insight, problem-solving, and healing. Rationale:
Therapeutic communication focuses on the patient's needs rather than the nurse's.
D344 Tip: If an answer promotes exploration of feelings, it is usually therapeutic.
What is empathy? The ability to understand and communicate understanding of a patient's feelings
while maintaining professional boundaries. Rationale: Empathy promotes trust and
therapeutic alliance. D344 Tip: Empathy is not the same as sympathy.
What is sympathy? Sharing another person's feelings or emotional experience. Rationale: Sympathy
may shift focus away from the patient and is less therapeutic. D344 Tip: Choose
empathy over sympathy on the OA.
What is clarification? Requesting additional information to better understand a patient's message.
Rationale: Clarification reduces misunderstanding. Example: "Can you tell me what
you mean by stoned?"
What is reflection? Directing feelings, ideas, or questions back to the patient. Rationale: Reflection
encourages self-exploration and insight.
What is restating? Repeating the main idea of what a patient has said. Rationale: Demonstrates active
listening and understanding.
What is paraphrasing? Restating a patient's message in different words. Rationale: Helps confirm
understanding and encourages elaboration.
What is exploring? Encouraging the patient to discuss a topic further. Rationale: Facilitates deeper
assessment and understanding.
What is focusing? Helping the patient concentrate on one issue at a time. Rationale: Useful when
patients are vague or overly talkative.
What is silence as a therapeutic technique? Allowing pauses in conversation for reflection and processing. Rationale: Silence
encourages deeper thought and emotional expression.
Why is silence considered therapeutic? It provides time for reflection and emotional processing. Rationale: Patients often
reveal important information after a period of silence.
What is offering self? Making oneself available to the patient. Rationale: Builds trust and conveys caring.
Example: "I'd like to sit with you for a while."
What is active listening? Fully concentrating on what the patient is saying verbally and nonverbally.
Rationale: Promotes understanding and rapport.
What is attending behavior? Using eye contact, posture, and presence to demonstrate interest. Rationale:
Encourages communication and trust.
What is the therapeutic alliance? A collaborative relationship between clinician and patient. Rationale: Strong
alliances improve outcomes.
, WGU D344 master set
What is genuineness? Congruence between what the nurse says and does. Rationale: Patients are more
likely to trust authentic interactions.
What is immediacy? Discussing what is occurring in the current interaction. Rationale: Helps address
communication issues as they arise.
What is broad opening? Allowing the patient to choose the direction of conversation. Example: "Where
would you like to begin?" Rationale: Encourages autonomy.
What is validation? Confirming mutual understanding of communication. Rationale: Prevents
misinterpretation.
What is presenting reality? Offering reality-based information without arguing. Rationale: Useful when
responding to delusions or hallucinations.
What is the best response to a patient experiencing a Focus on the patient's feelings rather than challenging the delusion. Rationale:
delusion? Challenging may damage trust.
A patient says, "The CIA is watching me through the "It sounds like you're concerned about your privacy." Rationale: Reflects feelings
lights." What is the most therapeutic response? without validating the delusion.
Why should nurses avoid arguing with delusions? It increases defensiveness and reduces trust. Rationale: Focus on emotions rather
than content.
What is a closed-ended question? A question that can be answered briefly, often yes or no. Rationale: Useful for
obtaining specific information.
What is an open-ended question? A question encouraging detailed responses. Rationale: Produces richer assessment
data.
Why are open-ended questions preferred in psychiatric They encourage exploration and detailed responses. Rationale: Improve
interviews? assessment quality.
What is a nontherapeutic "why" question? A question that may make patients feel defensive. Rationale: Often perceived as
judgmental.
What is giving advice? Telling patients what they should do. Rationale: Generally nontherapeutic because it
discourages independent problem-solving.
Why is advice-giving usually nontherapeutic? It fosters dependence and decreases autonomy. Rationale: Patients need to
develop their own coping skills.
What is false reassurance? Providing unrealistic comfort. Example: "Everything will be fine." Rationale:
Minimizes patient concerns.
, WGU D344 master set
Why is false reassurance harmful? It invalidates feelings and may damage trust. Rationale: Patients may feel
misunderstood.
What is approval? Sanctioning or praising a patient's actions. Rationale: Can imply judgment and
discourage honest communication.
Why is disapproval nontherapeutic? It may make patients defensive or ashamed. Rationale: Therapeutic communication
is nonjudgmental.
What is probing? Persistent questioning beyond the patient's readiness. Rationale: May increase
anxiety and resistance.
What is changing the subject? Redirecting conversation away from the patient's concern. Rationale:
Nontherapeutic because it blocks communication.
Why should nurses avoid excessive self-disclosure? It shifts focus away from the patient. Rationale: The patient should remain the
center of attention.
When is self-disclosure appropriate? Only when it clearly benefits the patient. Rationale: Must have a therapeutic
purpose.
What is countertransference? The nurse's emotional reactions to a patient based on personal experiences.
Rationale: Can impair objectivity.
What is transference? The patient's unconscious redirection of feelings onto the clinician. Rationale:
Common in therapeutic relationships.
What is rapport? A feeling of mutual trust and understanding. Rationale: Essential for effective
communication.
What is the orientation phase of the nurse-patient The introductory phase where trust and expectations are established. Rationale:
relationship? Foundation of the therapeutic relationship.
What occurs during the working phase? Exploration of problems, feelings, and solutions. Rationale: Most therapeutic work
occurs here.
What occurs during the termination phase? Evaluation of progress and ending the relationship. Rationale: Encourages
independence and closure.
What is the most important focus during the orientation Establishing trust and identifying patient concerns. Rationale: Sets the stage for
phase? future work.
Why are boundaries important in psychiatric nursing? They protect both patient and clinician. Rationale: Promote safety and
professionalism.
, WGU D344 master set
What is a boundary violation? Actions that exploit or harm the patient. Rationale: Violates professional ethics.
What is a boundary crossing? A minor departure from traditional boundaries that may be clinically appropriate.
Rationale: Must benefit the patient.
What is congruent communication? Verbal and nonverbal messages match. Rationale: Increases credibility.
What is incongruent communication? Verbal and nonverbal messages conflict. Rationale: May indicate anxiety or
unresolved feelings.
A patient says, "My marriage is great," while fidgeting and Mixed or incongruent communication. Rationale: Verbal and nonverbal messages
avoiding eye contact. What type of communication is conflict.
present?
What is nonverbal communication? Communication through behavior, facial expressions, posture, and gestures.
Rationale: Often conveys emotions more accurately than words.
What is the primary purpose of clarification? To ensure the nurse accurately understands the patient's meaning. Rationale:
Clarification reduces misunderstandings and improves assessment accuracy. D344
Tip: Clarification is often the best response when patient wording is vague.
A patient says, "I feel stoned." What is the most "Can you tell me what you mean by stoned?" Rationale: This is clarification and
therapeutic response? seeks the patient's meaning. D344 Tip: Avoid assuming what the patient means.
What therapeutic technique is demonstrated by saying, Validation. Rationale: Validation confirms mutual understanding between nurse and
"Am I understanding correctly that..."? patient.
What is the goal of validation? To ensure the message received is the message intended. Rationale: Prevents
miscommunication and incorrect assumptions.
A patient frequently looks toward the door during an "I notice you keep looking toward the door." Rationale: Making observations
interview. What is the best response? encourages exploration without assumptions. D344 Tip: Observation is usually more
therapeutic than interpretation.
What is making observations? Verbally noting behaviors or appearances observed. Rationale: Encourages
patients to discuss feelings associated with behaviors.
Why should assumptions be avoided? They may be inaccurate and block communication. Rationale: Assessment should
be based on patient exploration rather than nurse conclusions.
What is confrontation in therapeutic communication? Pointing out discrepancies between thoughts, feelings, and behaviors. Rationale:
Helps patients gain insight when used appropriately.
When should confrontation be used? After rapport and trust have been established. Rationale: Premature confrontation
can damage the therapeutic relationship.
