8.
A client who has recently been diagnosed with AIDS comments
Therapeutic Communication
1. The mother of a 23-month old child works in a factory at night and
says if she misses any more work she will be fired. She is worried
about leaving the child in the hospital at night because he is so
young. What would be an appropriate nursing response?
a. “He is really too young to suffer any untoward
consequences.”
b. “It’s okay to leave; just leave a favorite toy.”
c. It would be better if you could stay, but we will take
good care of him.”
d. “You will have a lot of expenses in the future, so you
had better to go work.”
2. A 9 year old client with leukemia asks, “Will I die?” What is an
initial therapeutic response based on the needs of the dying
child?
a. “Think about getting well instead of dying.”
b. “Tell me what you are thinking about dying.”
c. “You need to ask your doctor.”
d. “I really don’t know.”
3. An infant is scheduled for pyloromyotomy. The mother begins to
cry and says “I’m such a bad mother.” What is an appropriate
response by the nurse?
a. “Tell me what makes you think that you are a bad
mother”
b. “Don’t cry; your baby will be fine.”
c. You are really having a bad time; aren’t you?”
d. The nurse says nothing and puts her arms around
the mother.”
4. An elderly client begins to cry during morning care. Which
question by the nurse would be most appropriate and solicit the
best response by the client?
a. “Why are you crying?”
b. “What’s the matter with you?”
c. “You’re not going to cry again, are you?
d. “You seem very sad. Can you tell me what’s
bothering you?
5. A client says, “I think everyone is out to get me. I don’t trust you
at all.” The nurse’s best response would be?
a. “I really don’t think everyone is out to get you. You
just think so.”
b. I don’t understand why you think everyone is out to
get you. I know I am not one of those people.”
c. “How could you think everyone is out to get you
when everyone is trying to help you?
d. “I know you think everyone is out to get you, but I
don’t see it that way.”
6. The nurse at the crisis intervention center asks a new female
client, who has come because her husband is planning a
divorce, her reasons for seeking help. The client responds by
describing her first meeting with her husband when they were
both teenagers. When doing crisis intervention, the nurse’s
most therapeutic response would be:
a. “You’re avoiding talking about the divorce.”
b. “What does this have to do with your divorce?”
c. “And now your husband is asking for a divorce.”
d. “Would you like to tell me more about the early
years?”
7. The nurse enters the room of an agitated, angry client to
administer an ordered antipsychotic medication. The client
shouts, “Get out of here!” The nurse’s best approach would be
to:
a. Say, I’ll be back in 15 minutes and we can talk.”
b. Get assistance and give the client the medication by
injection.
c. Explain why it is necessary that the client take the
medication
d. Say, “You must take the medicine that has been
ordered for you.”
to the nurse, “There are so many rotten people around. Why
couldn’t one of them get AIDS instead of me?” The nurse could
best respond:
a. “I can understand why you’re afraid of death.”
b. “It seems unfair that you should have this disease.”
c. “I’m sure you really don’t wish this on someone
else.”
d. “Have you thought of speaking with a minister?”
9. A husband is upset that his wife’s delirium tremens have
persisted for the second day. The initial response by the nurse
that would be most appropriate is:
a. “I see that you are very worried. Medications are
being used to lessen your wife’s discomfort.”
b. “This is totally normal. I suggest that you go home
because there is nothing you can do to help at this
time.”
c. “Are you afraid that your wife may die? I assure that
very few alcoholics die during detoxification
process.”
d. “The staff is making your wife comfortable while she
is undergoing the withdrawal process. Your wife will
not feel pain.”
10. When speaking with a client diagnosed with schizophrenia, the
nurse notices that the client keeps interjecting sentences that
have nothing to do with the main thoughts being expressed.
The client asks whether the nurse understands. The nurse
should reply:
a. “You aren’t making any sense, let’s talk about
something else.”
b. “I’d like to understand what you are saying, but you
are too confused now.”
c. “Why don’t you take a rest and then we can talk
again later this afternoon.”
d. “I’d like to understand what you are saying, but I’m
having difficulty following you.”
11. A newly admitted client looks at but does not respond to the
nurse. The nurse’s most appropriate action would be to state:
a. “I guess you would rather be alone for now; I will
return later so we can talk.”
b. “I am talking to you. Are you having trouble
understanding what I am saying?”
c. “I am here to tell you about the services available to
you on the mental health unit and to offer you my
help”.
d. “This is the mental health unit of the hospital. We
have many services to offer. Let me tell you about
them.”
12. In an attempt to remain objective and support a client during a
crisis, the nurse uses imagination and determination to project
the self into the client’s emotions. The nurse accomplishes this
using the technique known as:
a. empathy
b. sympathy
c. projection
d. acceptance
13. After a traumatic event a client is extremely upset and exhibits
pressured and rambling speech. A therapeutic technique that
the nurse can use when a client’s communication rambles
would be:
a. touch
b. silence
c. focusing
d. summarizing
14. When communicating with a client with a psychiatric diagnosis,
the nurse uses silence. When silence is used in therapeutic
communication, clients should feel:
a. unhurried to answer
b. it is their turn to talk
c. the nurse is thinking
 d. there is nothing more to say
15. The nurse tells a client that talking with the staff members is
part of the therapy program. The client responds, “I don’t see
how talking to you can possibly help.” The nurse’s most
appropriate response would be:
a. “I can see how you would feel that way now, but
hopefully you’ll change your mind.”
b. “You will never know whether or not it is helpful
unless you are willing to give it a try.”
c. “The one-to-one relationship has proven itself very
helpful for others. Why don’t you give it a try?
d. “Hopefully, I can help you sort out your thoughts and
feelings so you can better understand them.”
16. The nurse states, “You look discouraged.” The client replies,
“I’m a bother. Not much good to anyone anymore. My wife
would at least get some insurance money when I died.” The
nurse’s most therapeutic response would be:
a. “I can understand how you feel.”
b. “You feel so bad you wish you were dead.”
c. “We all have days we feel like that. Let’s talk about
your diet.”
d. “I know it’s hard, but don’t let it get you down or let
your wife hear you.”
17. When a withdrawn patient says does not want to talk, the nurse
says:
a. “Can you tell me what have been going on with
you?”
b. “You seem to be upset, what are you thinking right
now?
c. “Why do you feel this way?”
d. “It is all right, I would like to spend time with you.
We don’t have to talk.”
18. During a nurse-patient interaction. The nurse asks one of the
following questions to help her in assessing the coping style of
Glenda:
a. “How are you feeling right now?”
b. “Do you have anyone to talk to?”
c. “What do you think would help your situation?”
d. “How does this problem in your work affects your
life?”
19. One afternoon, after visiting hours, Ace became agitated and
talkative. The nurse using the collaboration technique of
communication would ask him:
a. “What would you like to discuss?”
b. “Perhaps you and I can discover what causes you
anxiety.”
c. “What are you thinking about?”
d. “Has this ever happened before?”
20. After a therapy session with the psychologist in the mental
health clinic, a client tells nurse that the therapist is uncaring
and impersonal. The nurse could be best respond:
a. “Your therapist is really very good.”
b. “I hope that the rest of the staff is caring.”
c. “The therapist is there to help you, try to
cooperate.”
d. “You have strong feelings about your therapy
session and your therapist.”
21. A client on a psychiatric unit who has been hearing voices is
receiving a neuroleptic medication for the first time. The client
takes the cup of water and pill and stares at them. The most
therapeutic response by the nurse is:
a. “You have to take the medicine.”
b. “This is the medication that your doctor ordered.”
c. “There must be reason you don’t want to take your
medicine.”
d. “This is medicine that your doctor wants you to
have. Swallow it.”
22. A female client terminally ill with cancer says to the nurse, “My
husband is avoiding me. He doesn’t love me anymore because
of this damn tumor.” The nurse’s most appropriate response
would be:
a. “What makes you think he doesn’t love you?”
b. “Avoidance is a defense; he needs your help to
cope.”
c. “He is probably having difficulty dealing with your
illness.”
d. “You seem very upset. Tell me how your husband
avoiding you.”
23. A young child suspected of being sexually abused says to the
nurse, “Did I do something bad?” the nurse’s most therapeutic
reply would be:
a. “Who said you did something bad.”
b. “What do you mean something bad?”
c. “Do you think that you did something bad?”
d. “I’m not sure I would say it was something bad.”
24. During a nurse’s interview with a client who has been sexually
assaulted, the woman states that she should have fought back.
The most therapeutic response by the nurse would be:
a. “You are feeling guilty about submitting.”
b. “You may have submitted, but you are alive.”
c. “It’s over; let’s not explore what could you have done.”
d. “It is hard to know, but it’s all right now; you are alive.”
25. A female client with acute schizophrenia tells the nurse,
“Everyone hates me.” The best response by the nurse would be:
a. “Tell me more about this.”
b. “Everyone does not hate you.”
c. “The feeling is part of your illness.”
d. “You maybe doing something to promote this
feeling.”
26. A client has been hospitalized for two days for treatment of
hepatitis A. when the nurse enters the client’s room, he asks the
nurse to leave him alone and stop bothering him. Which among
the ff. responses by the nurse would be most appropriate?
a. “I understand and will leave you along for now.”
b. “Why are you angry with me?”
c. “Are you upset because you do not feel better?”
d. “You seem upset this morning.”
27. The nurse attempts to begin conversation with the client but
the client did not respond. Which of the following responses
would be appropriate?
a. I will see you later so we can talk again
b. I will sit here with you
c. I will get you a pen and paper so you can write
d. I will look for another nurse who will talk to you
28. In therapeutic co9mmunication, one of the techniques is
focusing. This is best exemplified by one of the following
statements:
a. “Tell me more about.”
b. “I would like to spend time with you.”
c. “I am not sure I follow.”
d. “This point seems worth looking at more closely.”
29. Fely tells the nurse, “I feel like a bloated balloon.” An
appropriate response which indicates nurse’s understanding of
the client’s experience is:
a. “Yes, you really look like a bloated balloon.”
b. “You are upset. I can not allow you to deal with it now.”
c. “Why don’t you look at yourself at the mirror.”
d. “This causes you to feel anxious?”
30. When interacting with Ronnie, who may become suddenly and
explosively angry, the nurse should:
a. tell him to calm down and stop using derogatory language
b. use gentle and caring touch to calm him
c. point out how angry he is becoming, confront the angry
behavior
d. take a calm, quiet, non confrontational approach, do not
argue
31. 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?”
32. 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.”
33. 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
34. 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
35. 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.”
36. On review of the patient's 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.
37. 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.
38. 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.
39. 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
40. 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.”
41. 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
42. 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
43. 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
44. 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
45. 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.”