Psych NCLEX Exam for Therapeutic Communication

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Published on February 21, 2017 by NCLEX Exams

Psych NCLEX Exam for Therapeutic Communication In Text Mode: All questions and answers are given for reading and answering at your own pace.

Question 1. Which nursing statement is a good example of the therapeutic communication technique of focusing?
A). “Describe one of the best things that happened to you this week.”.
B). “I’m having a difficult time understanding what you mean.”.
C). “Your counseling session is in 30 minutes. I’ll stay with you until then.”.
D). “You mentioned your relationship with your father. Let’s discuss that further.”.

Question 1 Answer: D). “You mentioned your relationship with your father. Let’s discuss that further.”.
Question 1 Explanation: This is an example of the therapeutic communication technique of focusing. Focusing takes notice of a single idea or even a single word and works especially well with a client who is moving rapidly from one thought to another.

Question 2. The nurse in the mental health unit recognizes which of the following as therapeutic communication techniques? Select all that apply.
A). Restating.
B). Listening.
C). Asking the patient “Why?”.
D). Maintaining neutral responses.
E). Providing acknowledgment and feedback.
F). Giving advice and approval or disapproval.

Question 2 Answer: A). Restating. AND B). Listening. AND D). Maintaining neutral responses. AND E). Providing acknowledgment and feedback.
Question 2 Explanation: Therapeutic communication techniques include listening, maintaining silence, maintaining neutral responses, using broad openings and open-ended questions, focusing and refocusing, restating, clarifying and validating, sharing perceptions, reflecting, providing acknowledgment and feedback, giving information, presenting reality, encouraging formulation of a plan of action, providing nonverbal encouragement, and summarizing Asking why is often interpreted as being accusatory by the patient and should also be avoided. Providing advice or giving approval or disapproval are barriers to communication.

Question 3. The nurse asks a newly admitted client, “What can we do to help you?” What is the purpose of this therapeutic communication technique?
A). To reframe the client’s thoughts about mental health treatment.
B). To put the client at ease.
C). To explore a subject, idea, experience, or relationship.
D). To communicate that the nurse is listening to the conversation.

Question 3 Answer: C). To explore a subject, idea, experience, or relationship.
Question 3 Explanation: 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.

Question 4. The nurse calls security and has physical restraints applied when a client who was admitted voluntarily becomes both physically and verbally abusive while demanding to be discharged from the hospital. Which represents the possible legal ramifications for the nurse associated with these interventions? Select all that apply.
A). Libel.
B). Battery.
C). Assault.
D). Slander.
E). False Imprisonment.

Question 4 Answer: B). Battery. AND C). Assault. AND E). False Imprisonment.
Question 4 Explanation: False imprisonment is an act with the intent to confine a person to a specific area. The nurse can be charged with false imprisonment if the nurse prohibits a patient from leaving the hospital if the patient has been admitted voluntarily and if no agency or legal policies exist for detaining the patient. Assault and battery are related to the act of restraining the patient in a situation that did not meet criteria for such an intervention. Libel and slander are not applicable here since the nurse did not write or verbally make untrue statements about the patient.

Question 5. 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?”.

Question 5 Answer: B). “What would you like to talk about?”.
Question 5 Explanation: 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.

Question 6. 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.
A). “I see.”.
B). “Really?”.
C). “You’re having difficulty sleeping?”.
D). “Sometimes, I have trouble sleeping too.”.

Question 6 Answer: C). “You’re having difficulty sleeping?”.
Question 6 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 patients major theme, which assists the nurse to obtain a more specific perception of the problem from the patient. 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

Question 7. 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.”.

Question 7 Answer: D). “During group, you raised your voice, yelled at a peer, left, and slammed the door.”.
Question 7 Explanation: 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.

Question 8. A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) washes hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation?
A). “Everyone diagnosed with OCD needs to control their ritualistic behaviors.”.
B). “It is important for you to discontinue these ritualistic behaviors.”.
C). “Why are you asking for help if you won’t participate in unit therapy?”.
D). “Let’s figure out a way for you to attend unit activities and still wash your hands.”.

Question 8 Answer: D). “Let’s figure out a way for you to attend unit activities and still wash your hands.”.
Question 8 Explanation: The most appropriate statement by the nurse is, “Let’s figure out a way for you to attend unit activities and still wash your hands.” This statement reflects the therapeutic communication technique of formulating a plan of action. The nurse attempts to work with the client to develop a plan without damaging the therapeutic relationship or increasing the client’s anxiety.

Question 9. A patient’s unresolved feelings related to loss would be MOST LIKELY observed during which phase of the therapeutic nurse-patient relationship?
A). Trusting.
B). Working.
C). Orientation.
D). Termination.

Question 9 Answer: D). Termination.
Question 9 Explanation: In the termination phase, the relationship comes to a close. Ending treatment sometimes may be traumatic for patients who have come to value the relationship and the help. Because loss is an issue, any unresolved feelings related to loss may resurface during this phase. The remaining options are not specifically associated with this issue of unresolved feelings.

Question 10. 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.”.

Question 10 Answer: C). “You’ve been feeling sad and alone for some time now?”.
Question 10 Explanation: 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.

Question 11. 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?
A). Denial.
B). Projection.
C). Regression.
D). Rationalization.

Question 11 Answer: A). Denial.
Question 11 Explanation: Denial is refusal to admit to a painful reality, which is treated as if it does not exist. In projection, a person unconsciously rejects emotionally unacceptable features and attributes them to other persons, objects, or situations. Regression allows the patient to return to an earlier, more comforting, although less mature, way of behaving. Rationalization is justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller and the listener.

Question 12. 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.

Question 12 Answer: B). Verbalizing the implied and the defense mechanism of denial.
Question 12 Explanation: 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.

Question 13. A nurse states to a client, “Things will look better tomorrow after a good night’s sleep.” This is an example of which communication technique?
A). The therapeutic technique of “giving advice”.
B). The therapeutic technique of “defending”.
C). The nontherapeutic technique of “presenting reality”.
D). The nontherapeutic technique of “giving false reassurance”.

Question 13 Answer: D). The nontherapeutic technique of “giving false reassurance”.
Question 13 Explanation: The nurse’s statement, “Things will look better tomorrow after a good night’s sleep.” is an example of the nontherapeutic technique of giving false reassurance. Giving false reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the client’s feelings.

Question 14. 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?”.

Question 14 Answer: D). “You feel that your mother does not want you to come back home?”.
Question 14 Explanation: 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.

Question 15. 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.”.

Question 15 Answer: D). “Describe what happened during your time with your husband.”.
Question 15 Explanation: 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.

Question 16. 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?
A). “The smoke was too thick. You couldn’t have gone back in.”.
B). “You’re feeling guilty because you weren’t able to save your children.”.
C). “Focus on the fact that you could have lost all four of your children.”.
D). “It’s best if you try not to think about what happened. Try to move on.”.

Question 16 Answer: B). “You’re feeling guilty because you weren’t able to save your children.”.
Question 16 Explanation: The best response by the nurse is, “You’re experiencing feelings of guilt because you weren’t able to save your children.” This response utilizes the therapeutic communication technique of reflection which identifies a client’s emotional response and reflects these feelings back to the client so that they may be recognized and accepted.

Question 17. Which example of a therapeutic communication technique would be effective in the planning phase of the nursing process?
A). “We’ve discussed past coping skills. Let’s see if these coping skills can be effective now.”.
B). “Please tell me in your own words what brought you to the hospital.”.
C). “This new approach worked for you. Keep it up.”.
D). “I notice that you seem to be responding to voices that I do not hear.”.

Question 17 Answer: A). “We’ve discussed past coping skills. Let’s see if these coping skills can be effective now.”.
Question 17 Explanation: This is an example of the therapeutic communication technique of formulating a plan of action. By the use of this technique, the nurse can help the client plan in advance to deal with a stressful situation which may prevent anger and/or anxiety from escalating to an unmanageable level.

Question 18. Which nursing response is an example of the nontherapeutic communication block of requesting an explanation?
A). “Can you tell me why you said that?”.
B). “Keep your chin up. I’ll explain the procedure to you.”.
C). “There is always an explanation for both good and bad behaviors.”.
D). “Are you not understanding the explanation I provided?”.

Question 18 Answer: A). “Can you tell me why you said that?”.
Question 18 Explanation: This nursing statement is an example of the nontherapeutic communication block of requesting an explanation. Requesting an explanation is when the client is asked to provide the reason for thoughts, feelings, behaviors, and events. Asking “why” a client did something or feels a certain way can be very intimidating and implies that the client must defend his or her behavior or feelings.

Question 19. After fasting from 10 p.m. the previous evening, a client finds out that the blood test has been canceled. The client swears at the nurse and states, “You are incompetent!” Which is the nurse’s best response?
A). “Do you believe that I was the cause of your blood test being canceled?”.
B). “I see that you are upset, but I feel uncomfortable when you swear at me.”.
C). “Have you ever thought about ways to express anger appropriately?”.
D). “I’ll give you some space. Let me know if you need anything.”.

Question 19 Answer: B). “I see that you are upset, but I feel uncomfortable when you swear at me.”.
Question 19 Explanation: This is an example of the appropriate use of feedback. Feedback should be directed toward behavior that the client has the capacity to modify.

Question 20. Which statement demonstrates the BEST understanding of the nurse’s role regarding ensuring that each client’s rights are respected?
A). “Autonomy is the fundamental right of each and every client.”.
B). “A patient’s rights are guaranteed by both state and federal laws.”.
C). “Being respectful and concerned will ensure that I’m attentive to my patient’s rights.”.
D). “Regardless of the patient’s conditions, all nurses have the duty to respect patient rights.”.

Question 20 Answer: C). “Being respectful and concerned will ensure that I’m attentive to my patient’s rights.”.
Question 20 Explanation: The nurse needs to respect and have concern for the patient; this is vital to protecting the patient’s rights. While it is true the autonomy is a basic client right, there are other rights that must also be both respected and facilitated. State and federal laws do protect a patient’s rights, but it is sensitivity to those rights that will ensure that the nurse secures these rights for the patient. It is a fact that safeguarding a patient’s rights are a nursing responsibility, but stating that fact does not show understanding or respect for the concept.

Question 21. Which therapeutic communication technique is being used in this nurse-client interaction?

Client: “When I get angry, I get into a fistfight with my wife or I take it out on the kids.”
Nurse: “I notice that you are smiling as you talk about this physical violence.”
A). Encouraging comparison.
B). Exploring.
C). Formulating a plan of action.
D). Making observations.

Question 21 Answer: D). Making observations.
Question 21 Explanation: The nurse is using the therapeutic communication technique of making observations when noting that the client smiles when talking about physical violence. The technique of making observations encourages the client to compare personal perceptions with those of the nurse.

Question 22. On review of the patients record, the nurse notes the admission was voluntary. Based on this information, the nurse anticipates which patient behavior?
A). Fearfulness regarding treatment measures..
B). Anger and aggressiveness directed toward others..
C). An understanding of the pathology and symptoms of the diagnosis..
D). A willingness to participate in the planning of the care and treatment plan..

Question 22 Answer: D). A willingness to participate in the planning of the care and treatment plan..
Question 22 Explanation: In general, patients seek voluntary admission. If a patient seeks voluntary admission, the most likely expectations is the patient will participate in the treatment program since they are actively seeking help. 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.

Question 23. 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?
A). “Have you shared your feelings with your family?”.
B). “I think we should talk more about your anger with your family.”.
C). “You’re feeling angry that your family continues to hope for you to be cured?”.
D). “You are probably very depressed, which is understandable with such a diagnosis.”.

Question 23 Answer: C). “You’re feeling angry that your family continues to hope for you to be cured?”.
Question 23 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. 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. 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.

Question 24. When interviewing a client, which nonverbal behavior should a nurse employ?
A). Maintaining indirect eye contact with the client.
B). Providing space by leaning back away from the client.
C). Sitting squarely, facing the client.
D). Maintaining open posture with arms and legs crossed.

Question 24 Answer: C). Sitting squarely, facing the client.
Question 24 Explanation: When interviewing a client, the nurse should employ the nonverbal behavior of sitting squarely, facing the client. Facilitative skills for active listening can be identified by the acronym SOLER. SOLER includes sitting squarely facing the client (S), open posture when interacting with a client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).

Question 25. Which nursing statement is a good example of the therapeutic communication technique of giving recognition?
A). “You did not attend group today. Can we talk about that?”.
B). “I’ll sit with you until it is time for your family session.”.
C). “I notice you are wearing a new dress and you have washed your hair.”.
D). “I’m happy that you are now taking your medications. They will really help.”.

Question 25 Answer: C). “I notice you are wearing a new dress and you have washed your hair.”.
Question 25 Explanation: This is an example of the therapeutic communication technique of giving recognition. Giving recognition acknowledges and indicates awareness. This technique is more appropriate than complimenting the client which reflects the nurse’s judgment.

Question 26. 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.

Question 26 Answer: C). Making stereotyped comments.
Question 26 Explanation: 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.

Question 27. 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?
A). “The smoke was too thick. You couldn’t have gone back in.”.
B). “You’re feeling guilty because you weren’t able to save your children.”.
C). “Focus on the fact that you could have lost all four of your children.”.
D). “It’s best if you try not to think about what happened. Try to move on.”.

Question 27 Answer: B). “You’re feeling guilty because you weren’t able to save your children.”.
Question 27 Explanation: The best response by the nurse is, “You’re experiencing feelings of guilt because you weren’t able to save your children.” This response utilizes the therapeutic communication technique of reflection which identifies a client’s emotional response and reflects these feelings back to the client so that they may be recognized and accepted.

Question 28. Which therapeutic communication technique should the nurse use when communicating with a client who is experiencing auditory hallucinations?
A). “My sister has the same diagnosis as you and she also hears voices.”.
B). “I understand that the voices seem real to you, but I do not hear any voices.”.
C). “Why not turn up the radio so that the voices are muted.”.
D). “I wouldn’t worry about these voices. The medication will make them disappear.”.

Question 28 Answer: B). “I understand that the voices seem real to you, but I do not hear any voices.”.
Question 28 Explanation: This is an example of the therapeutic communication technique of presenting reality. Presenting reality is when the client has a misperception of the environment. The nurse defines reality or indicates his or her perception of the situation for the client.

Question 29. The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbors says to 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?
A). “I can not discuss any patient situation with you.”.
B). “If you want to know about Mary, you need t ask her yourself.”.
C). “Only because you’re worried about a friend, I’ll tell you that she is improving.”.
D). “Being her friend, you know she is having a difficult time and deserves her privacy.”.

Question 29 Answer: A). “I can not discuss any patient situation with you.”.
Question 29 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. The remaining options identify statements that do not maintain patient confidentiality.

Question 30. An instructor is correcting a nursing student’s clinical worksheet. Which instructor statement is the best example of effective feedback?
A). “Why did you use the client’s name on your clinical worksheet?”.
B). “You were very careless to refer to your client by name on your clinical worksheet.”.
C). “Surely you didn’t do this deliberately, but you breached confidentiality by using the client’s name.”.
D). “It is disappointing that after being told, you’re still using client names on your worksheet.”.

Question 30 Answer: C). “Surely you didn’t do this deliberately, but you breached confidentiality by using the client’s name.”.
Question 30 Explanation: The instructor’s statement, “Surely you didn’t do this deliberately, but you breached confidentiality by using the client’s name.” is an example of effective feedback. Feedback is a method of communication to help others consider a modification of behavior. Feedback should be descriptive, specific, and directed toward a behavior that the person has the capacity to modify and should impart information rather than offer advice or criticize the individual.

Question 31. Which nursing statement is a good example of the therapeutic communication technique of offering self?
A). “I think it would be great if you talked about that problem during our next group session.”.
B). “Would you like me to accompany you to your electroconvulsive therapy treatment?”.
C). “I notice that you are offering help to other peers in the milieu.”.
D). “After discharge, would you like to meet me for lunch to review your outpatient progress?”.

Question 31 Answer: B). “Would you like me to accompany you to your electroconvulsive therapy treatment?”.
Question 31 Explanation: This is an example of the therapeutic communication technique of offering self. Offering self makes the nurse available on an unconditional basis, increasing client’s feelings of self-worth. Professional boundaries must be maintained when using the technique of offering self.

Question 32. A nurse maintains an uncrossed arm and leg posture. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening?
A). S.
B). O.
C). L.
D). E.
E). R.

Question 32 Answer: B). O.
Question 32 Explanation: The nurse should identify that maintaining an uncrossed arm and leg posture is nonverbal behavior that reflects the “O” in the active-listening acronym SOLER. The acronym SOLER includes sitting squarely facing the client (S), open posture when interacting with the client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).

Question 33. 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?
A). “You have everything to live for.”.
B). “Why do you see yourself as a failure?”.
C). “Feeling like this is all part of being depressed.”.
D). “You’ve been feeling like a failure for a while?”.

Question 33 Answer: D). “You’ve been feeling like a failure for a while?”.
Question 33 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. 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.

Question 34. 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.”.

Question 34 Answer: C). “Let’s discuss and explore all of your options.”.
Question 34 Explanation: 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.

Question 35. Which of the following individuals are communicating a message? (Select all that apply.)
A). A mother spanking her son for playing with matches.
B). A teenage boy isolating himself and playing loud music.
C). A biker sporting an eagle tattoo on his biceps.
D). A teenage girl writing, “No one understands me”.
E). A father checking for new e-mail on a regular basis.

Question 35 Answer: A). A mother spanking her son for playing with matches. AND B). A teenage boy isolating himself and playing loud music. AND C). A biker sporting an eagle tattoo on his biceps. AND D). A teenage girl writing, “No one understands me”.
Question 35 Explanation: The nurse should determine that spanking, isolating, getting tattoos, and writing are all ways in which people communicate messages to others. It is estimated that about 70% to 90% of communication is nonverbal.

Question 36. What is the purpose of a nurse providing appropriate feedback?
A). To give the client good advice.
B). To advise the client on appropriate behaviors.
C). To evaluate the client’s behavior.
D). To give the client critical information.

Question 36 Answer: D). To give the client critical information.
Question 36 Explanation: The purpose of providing appropriate feedback is to give the client critical information. Feedback should not be used to give advice or evaluate behaviors.

Question 37. Nurse Patrick is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a “general lead”?
A). “Do you know why you are here?”.
B). “Are you feeling depressed or anxious?”.
C). “Yes, I see. Go on.”.
D). “Can you chronologically order the events that led to your admission?”.

Question 37 Answer: C). “Yes, I see. Go on.”.
Question 37 Explanation: The nurse’s statement, “Yes, I see. Go on.” is an example of the therapeutic communication technique of a general lead. Offering a general lead encourages the client to continue sharing information.

Question 38. A nurse is assessing a client diagnosed with schizophrenia for the presence of hallucinations. Which therapeutic communication technique used by the nurse is an example of making observations?
A). “You appear to be talking to someone I do not see.”.
B). “Please describe what you are seeing.”.
C). “Why do you continually look in the corner of this room?”.
D). “If you hum a tune, the voices may not be so distracting.”.

Question 38 Answer: A). “You appear to be talking to someone I do not see.”.
Question 38 Explanation: The nurse is making an observation when stating, “You appear to be talking to someone I do not see.” Making observations involves verbalizing what is observed or perceived. This encourages the client to recognize specific behaviors and make comparisons with the nurse’s perceptions.

Question 39. Which therapeutic communication technique is being used in this nurse-client interaction?

Client: “My father spanked me often.”
Nurse: “Your father was a harsh disciplinarian.”
A). Restatement.
B). Offering general leads.
C). Focusing.
D). Accepting.

Question 39 Answer: A). Restatement.
Question 39 Explanation: The nurse is using the therapeutic communication technique of restatement. Restatement involves repeating the main idea of what the client has said. The nurse uses this technique to communicate that the client’s statement has been heard and understood.

Question 40. 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?
A). Planning short-term goals.
B). Making appropriate referrals.
C). Developing realistic solutions.
D). Identifying expected outcomes.

Question 40 Answer: B). Making appropriate referrals.
Question 40 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. The remaining options identify tasks appropriate for the working phase of the relationship.

Question 41. A patient admitted voluntarily for treatment of an anxiety disorder demands to be released from the hospital. Which action should the nurse take INITIALLY?
A). Contact the patient’s health care provider (HCP)..
B). Call the patient’s family to arrange for transportations..
C). Attempt to persuade the patient to stay for only a few more days..
D). Tell the patient that leaving would likely result in an involuntary commitment..

Question 41 Answer: A). Contact the patient’s health care provider (HCP)..
Question 41 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. While arranging for safe transportation is appropriate it is premature in this situation and should be done only with the patient’s’ permission. 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 staying “a few more days” has little value and will not likely be successful. Many states require that the patient submit 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 as a threat to the patient.

Question 42. Which therapeutic communication technique is being used in this nurse-client interaction?

Client: “When I am anxious, the only thing that calms me down is alcohol.”
Nurse: “Other than drinking, what alternatives have you explored to decrease anxiety?”
A). Reflecting.
B). Making observations.
C). Formulating a plan of action.
D). Giving recognition.

Question 42 Answer: C). Formulating a plan of action.
Question 42 Explanation: The nurse is using the therapeutic communication technique of formulating a plan of action to help the client explore alternatives to drinking alcohol. The use of this technique, rather than direct confrontation regarding the client’s poor coping choice, may serve to prevent anger or anxiety from escalating.

Question 43. A student nurse tells the instructor, “I’m concerned that when a client asks me for advice I won’t have a good solution.” Which should be the nursing instructor’s best response?
A). “It’s scary to feel put on the spot by a client. Nurses don’t always have the answer.”.
B). “Remember, clients, not nurses, are responsible for their own choices and decisions.”.
C). “Just keep the client’s best interests in mind and do the best that you can.”.
D). “Set a goal to continue to work on this aspect of your practice.”.

Question 43 Answer: B). “Remember, clients, not nurses, are responsible for their own choices and decisions.”.
Question 43 Explanation: Giving advice tells the client what to do or how to behave. It implies that the nurse knows what is best and that the client is incapable of any self-direction. It discourages independent thinking.

Question 44. When reviewing the admission assessment, the nurse notes that a patient was admitted to the mental health unity involuntarily. Based on this type of admission, the nurse should provide which intervention for this patient?
A). Monitor closely for harm to self or others..
B). Assist in completing an application for admission..
C). Supply the patient with written information about their mental illness..
D). Provide an opportunity for the family to discuss why they felt the admission was needed..

Question 44 Answer: A). Monitor closely for harm to self or others..
Question 44 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. A written request is a component of a voluntary admission. Providing written information regarding the illness is likely premature initially. The family may have had no role to play in the patient’s’ admission.

Question 45. After assertiveness training, a formerly passive client appropriately confronts a peer in group therapy. The group leader states, “I’m so proud of you for being assertive. You are so good!” Which communication technique has the leader employed?
A). The nontherapeutic technique of giving approval.
B). The nontherapeutic technique of interpreting.
C). The therapeutic technique of presenting reality.
D). The therapeutic technique of making observations.

Question 45 Answer: A). The nontherapeutic technique of giving approval.
Question 45 Explanation: The group leader has employed the nontherapeutic technique of giving approval. Giving approval implies that the nurse has the right to pass judgment on whether the client’s ideas or behaviors are “good” or “bad.” This creates a conditional acceptance of the client.

Question 46. A patient being seen in the emergency department immediately after being sexually assaulted appears calm and controlled. The nurse analyzes this behavior as indicating which defense mechanism?
A). Denial.
B). Projection.
C). Rationalization.
D). Intellectualization.

Question 46 Answer: A). Denial.
Question 46 Explanation: Denial is refusal to admit to a painful reality and may be a response by a victim of sexual abuse. In this case the patient is not acknowledging the trauma of the assault either verbally or nonverbally. Projection is transferring one’s internal feelings, thoughts, and unacceptable ideas and traits to someone else. Rationalization is justifying the unacceptable attributes about oneself. Intellectualization is the excessive use of abstract thinking or generalizations to decrease painful thinking.

Question 47. During a nurse-client interaction, which nursing statement may belittle the client’s feelings and concerns?
A). “Don’t worry. Everything will be alright.”.
B). “You appear uptight.”.
C). “I notice you have bitten your nails to the quick.”.
D). “You are jumping to conclusions.”.

Question 47 Answer: A). “Don’t worry. Everything will be alright.”.
Question 47 Explanation: This nursing statement is an example of the nontherapeutic communication block of belittling feelings. Belittling feelings occur when the nurse misjudges the degree of the client’s discomfort, thus a lack of empathy and understanding may be conveyed.

Question 48. 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.”.

Question 48 Answer: A). “You seem to be motivated to change your behavior.”.
Question 48 Explanation: 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.

Question 49. A student nurse is learning about the appropriate use of touch when communicating with clients diagnosed with psychiatric disorders. Which statement by the instructor best provides information about this aspect of therapeutic communication?
A). “Touch carries a different meaning for different individuals.”.
B). “Touch is often used when deescalating volatile client situations.”.
C). “Touch is used to convey interest and warmth.”.
D). “Touch is best combined with empathy when dealing with anxious clients.”.

Question 49 Answer: A). “Touch carries a different meaning for different individuals.”.
Question 49 Explanation: Touch can elicit both negative and positive reactions, depending on the people involved and the circumstances of the interaction.

Question 50. A patient experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the use to encourage the patient to eat?
A). Using open-ended questions and silence.
B). Sharing personal preference regarding food choices.
C). Documenting reasons why the patient does not want to eat.
D). Offering opinions about the necessity of adequate nutrition.

Question 50 Answer: A). Using open-ended questions and silence.
Question 50 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. 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.

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