D.

24-48 months

Defense Mechanism 13. Which of the following is not a sign of anxiety?

A. Dyspnea
B. Hyperventilation
C. Moist mouth
1. Which of the following is not one of the key steps in the
D. GI symptoms
grief process?
14. Which of the following best describes a person that is
A. Denial
completely awake falling asleep spontaneously?
B. Anger
A. Cataplexy
C. Bargaining
B. Narcolepsy
D. Rejection
C. Transitional sleep
2. Which of the following matches the definition: covering up
D. REM absence
a weakness by stressing a desirable or stronger trait?
15. Which of the following best describes a person that is
A. Compensation
unable to tell you were there hand or foot is?
B. Projection
A. Autotopagnosia
C. Rationalization
B. Cataplexy
D. Dysphoria
C. Ergophobia
3. Which of the following waveforms is most commonly
D. Anosognosia
found with light sleepers?
16. Which of the following is not a characteristic of a panic
A. Theta
disorder?
B. Alpha
A. Nausea
C. Beta
B. Excessive perspiration
D. Zeta
C. Urination
4. Which of the following months matches with an infant first
D. Chest pain
having the ability to sit-up independently?
17. Which of the following categories would a 70 year old
A. 4 months
adult be placed in?
B. 6 months
A. Intimacy vs. Isolation
C. 8 months
B. Generativitiy vs. Stagnation
D. 10 months
C. Integrity vs. Despair
5. Object permanence for toddlers develops in this age range?
D. Longevity vs. Guilt
A. 5-10 months
18. Which of the following categories would a 60 year old
B. 10-14 months
adult be placed in?
C. 12-24 months
A. Intimacy vs. Isolation
D. 15-24 months
B. Generativitiy vs. Stagnation
6. Which of the following matches the definition: attributing
C. Integrity vs. Despair
of our own unwanted trait onto another person?
D. Longevity vs. Guilt
A. Compensation
19. Which of the following categories would a 20 year old
B. Projection
adult be placed in?
C. Rationalization
A. Intimacy vs. Isolation
D. Dysphoria
B. Generativitiy vs. Stagnation
7. Which of the following matches the definition: the
C. Integrity vs. Despair
justification of behaviors using reason other than the real
D. Longevity vs. Guilt
reason?
20. Which of the following describes a person using words
A. Compensation
that have no known meaning?
B. Projection
A. Neologisms
C. Rationalization
B. Neolithic
D. Dysphoria
C. Verbalism
8. Which of the following matches the definition: response to
D. Delusional blocking
severe emotion stress resulting in involuntary disturbance of
physical functions?
A. Conversion disorder
B. Depressive reaction
C. Bipolar disorder
D. Alzheimer’s disease
9. Which of the following waveforms is most commonly
found when you are awake?
A. Theta
B. Alpha
C. Beta
D. Zeta
10. The REM sleep cycle occur approximately every ____
minutes?
A. 45
B. 60
C. 75
D. 90
11. Which of the following reflexes is not found at birth?
A. Babinski
B. Palmar
C. Moro
D. Flexion
12. Parallel play for toddlers develops in this age range?
A. 5-10 months
B. 10-14 months
C. 12-24 months
 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
Therapeutic Communication involuntary commitment.
8. When reviewing the admission assessment, the nurse notes
that a patient was admitted to the mental health unity
1. A patient with a diagnosis of major depression who has involuntarily. Based on this type of admission, the nurse
attempted suicide says to the nurse, “I should have died! I’ve should provide which intervention for this patient?
always been a failure. Nothing ever goes right for me.” Which
response demonstrates therapeutic communication?
A. Monitor closely for harm to self or others.
B. Assist in completing an application for admission.
A. “You have everything to live for.” C. Supply the patient with written information about their
B. “Why do you see yourself as a failure?” mental illness.
C. “Feeling like this is all part of being depressed.” D. Provide an opportunity for the family to discuss why
D. “You’ve been feeling like a failure for a while?” they felt the admission was needed.
2. When the community health nurse visits a patient at home, 9. The nurse is preparing a patient for the termination phase of
the patient states, “I haven’t slept the last couple of nights.” the nurse-patient relationship. The nurse prepares to
Which response by the nurse illustrates a therapeutic implement which nursing task that is MOST APPROPRIATE
communication response to this patient. for this phase?

A. “I see.” A. Planning short-term goals

B. “Really?” B. Making appropriate referrals
C.  “You’re having difficulty sleeping?” C. Developing realistic solutions
D. “Sometimes, I have trouble sleeping too.” D. Identifying expected outcomes
3. A patient experiencing disturbed thought processes believes 10. The nurse employed in a mental health clinic is greeted by
that his food is being poisoned. Which communication a neighbor in a local grocery store. The neighbors says to the
technique should the use to encourage the patient to eat? nurse, “How is Mary doing? She is my best friend and is seen
at your clinic every week.” Which is the MOST
A. Using open-ended questions and silence APPROPRIATE nursing response?
B. Sharing personal preference regarding food choices
C. Documenting reasons why the patient does not want to A. “I can not discuss any patient situation with you.”
eat B. “If you want to know about Mary, you need t ask her
D. Offering opinions about the necessity of adequate yourself.”
nutrition C. “Only because you’re worried about a friend, I’ll tell you
4. A patient admitted to a mental health unit for treatment of that she is improving.”
psychotic behavior spends hours at the locked exit door D. “Being her friend, you know she is having a difficult
shouting. “Let me out. There’s nothing wrong with me. I don’t time and deserves her privacy.”
belong here.” What defense mechanism is the patient 11. The nurse calls security and has physical restraints applied
implementing? when a client who was admitted voluntarily becomes both
physically and verbally abusive while demanding to be
A. Denial discharged from the hospital. Which represents the possible
B. Projection legal ramifications for the nurse associated with these
C. Regression interventions? Select all that apply.
D. Rationalization A. Libel
5. A patient diagnosed with terminal cancer says to the nurse B. Battery
“I’m going to die, and I wish my family would stop hoping for C. Assault
a cure! I get so angry when they carry on like this. After all, D. Slander
I’m the one who’s dying.” Which response by the nurse is E. False Imprisonment
therapeutic? 12. The nurse in the mental health unit recognizes which of the
following as therapeutic communication techniques? Select all
A. “Have you shared your feelings with your family?” that apply.
B. “I think we should talk more about your anger with your A. Restating
family.” B. Listening
C. “You’re feeling angry that your family continues to hope C. Asking the patient “Why?”
for you to be cured?” D. Maintaining neutral responses
D. “You are probably very depressed, which is E. Providing acknowledgment and feedback
understandable with such a diagnosis.” F. Giving advice and approval or disapproval
6. On review of the patients record, the nurse notes the 13. A patient being seen in the emergency department
admission was voluntary. Based on this information, the nurse immediately after being sexually assaulted appears calm and
anticipates which patient behavior? controlled. The nurse analyzes this behavior as indicating
which defense mechanism?
A. Fearfulness regarding treatment measures.
B. Anger and aggressiveness directed toward others. A. Denial
C. An understanding of the pathology and symptoms of the B. Projection
diagnosis. C. Rationalization
D. A willingness to participate in the planning of the care D. Intellectualization
and treatment plan. 14. A patient’s unresolved feelings related to loss would be
7. A patient admitted voluntarily for treatment of an anxiety MOST LIKELY observed during which phase of the
disorder demands to be released from the hospital. Which therapeutic nurse-patient relationship?
action should the nurse take INITIALLY?
A. Trusting
A. Contact the patient’s health care provider (HCP). B. Working
 C. Orientation D. “How can we help you feel safe during your stay here?”
D. Termination 22. A nurse is assessing a client diagnosed with schizophrenia
15. Which statement demonstrates the BEST understanding of for the presence of hallucinations. Which therapeutic
the nurse’s role regarding ensuring that each client’s rights are communication technique used by the nurse is an example of
respected? making observations?

A. “Autonomy is the fundamental right of each and every A. “You appear to be talking to someone I do not see.”
client.” B. “Please describe what you are seeing.”
B. “A patient’s rights are guaranteed by both state and C. “Why do you continually look in the corner of this
federal laws.” room?”
C. “Being respectful and concerned will ensure that I’m D. “If you hum a tune, the voices may not be so
attentive to my patient’s rights.” distracting.”
D. “Regardless of the patient’s conditions, all nurses have 23. A nurse maintains an uncrossed arm and leg posture. This
the duty to respect patient rights.” nonverbal behavior is reflective of which letter of the SOLER
16. Which therapeutic communication technique is being used acronym for active listening?
in this nurse-client interaction?
A. S
 Client: “When I get angry, I get into a fistfight with my B. O
wife or I take it out on the kids.” C. L
 Nurse: “I notice that you are smiling as you talk about D. E
this physical violence.” E. R
A. Encouraging comparison 24. An instructor is correcting a nursing student’s clinical
B. Exploring worksheet. Which instructor statement is the best example of
C. Formulating a plan of action effective feedback?
D. Making observations
17. Which therapeutic communication technique is being used A. “Why did you use the client’s name on your clinical
in this nurse-client interaction? worksheet?”
B. “You were very careless to refer to your client by name
 Client: “My father spanked me often.” on your clinical worksheet.”
 Nurse: “Your father was a harsh disciplinarian.” C. “Surely you didn’t do this deliberately, but you breached
A. Restatement confidentiality by using the client’s name.”
B. Offering general leads D. “It is disappointing that after being told, you’re still
C. Focusing using client names on your worksheet.”
D. Accepting 25. After assertiveness training, a formerly passive client
18. Which therapeutic communication technique is being used appropriately confronts a peer in group therapy. The group
in this nurse-client interaction? leader states, “I’m so proud of you for being assertive. You are
so good!” Which communication technique has the leader
 Client: “When I am anxious, the only thing that calms employed?
me down is alcohol.”
 Nurse: “Other than drinking, what alternatives have you A. The nontherapeutic technique of giving approval
explored to decrease anxiety?” B. The nontherapeutic technique of interpreting
A. Reflecting C. The therapeutic technique of presenting reality
B. Making observations D. The therapeutic technique of making observations
C. Formulating a plan of action 26. What is the purpose of a nurse providing appropriate
D. Giving recognition feedback?
19. Nurse Patrick is interviewing a newly admitted psychiatric
client. Which nursing statement is an example of offering a A. To give the client good advice
“general lead”? B. To advise the client on appropriate behaviors
C. To evaluate the client’s behavior
A. “Do you know why you are here?” D. To give the client critical information
B. “Are you feeling depressed or anxious?” 27. A client who frequently exhibits angry outbursts is
C. “Yes, I see. Go on.” diagnosed with antisocial personality disorder. Which
D. “Can you chronologically order the events that led to appropriate feedback should a nurse provide when this client
your admission?” experiences an angry outburst?
20. A nurse states to a client, “Things will look better
tomorrow after a good night’s sleep.” This is an example of A. “Why do you continue to alienate your peers by your
which communication technique? angry outbursts?”
B. “You accomplish nothing when you lose your temper
A. The therapeutic technique of “giving advice” like that.”
B. The therapeutic technique of “defending” C. “Showing your anger in that manner is very childish and
C. The nontherapeutic technique of “presenting reality” insensitive.”
D. The nontherapeutic technique of “giving false D. “During group, you raised your voice, yelled at a peer,
reassurance” left, and slammed the door.”
21. A client diagnosed with post-traumatic stress disorder is 28. A client diagnosed with dependant personality disorder
admitted to an inpatient psychiatric unit for evaluation and states, “Do you think I should move from my parent’s house
medication stabilization. Which therapeutic communication and get a job?” Which nursing response is most appropriate?
technique used by the nurse is an example of a broad opening?
A. “It would be best to do that in order to increase
A. “What occurred prior to the rape, and when did you go to independence.”
the emergency department?” B. “Why would you want to leave a secure home?”
B. “What would you like to talk about?” C. “Let’s discuss and explore all of your options.”
C. “I notice you seem uncomfortable discussing this.”
 D. “I’m afraid you would feel very guilty leaving your B. “I’ll sit with you until it is time for your family session.”
parents.” C. “I notice you are wearing a new dress and you have
29. When interviewing a client, which nonverbal behavior washed your hair.”
should a nurse employ? D. “I’m happy that you are now taking your medications.
They will really help.”
A. Maintaining indirect eye contact with the client 36. A client is struggling to explore and solve a problem.
B. Providing space by leaning back away from the client Which nursing statement would verbalize the implication of
C. Sitting squarely, facing the client the client’s actions?
D. Maintaining open posture with arms and legs crossed
30. A mother rescues two of her four children from a house A. “You seem to be motivated to change your behavior.”
fire. In the emergency department, she cries, “I should have B. “How will these changes affect your family
gone back in to get them. I should have died, not them.” What relationships?”
is the nurse’s best response? C. “Why don’t you make a list of the behaviors you need to
change.”
A. “The smoke was too thick. You couldn’t have gone back D.  “The team recommends that you make only one
in.” behavioral change at a time.”
B. “You’re feeling guilty because you weren’t able to save 37. The nurse asks a newly admitted client, “What can we do
your children.” to help you?” What is the purpose of this therapeutic
C. “Focus on the fact that you could have lost all four of communication technique?
your children.”
D. “It’s best if you try not to think about what happened. A. To reframe the client’s thoughts about mental health
Try to move on.” treatment
31. A newly admitted client diagnosed with obsessive- B. To put the client at ease
compulsive disorder (OCD) washes hands continually. This C. To explore a subject, idea, experience, or relationship
behavior prevents unit activity attendance. Which nursing D. To communicate that the nurse is listening to the
statement best addresses this situation? conversation
38. A student nurse tells the instructor, “I’m concerned that
A. “Everyone diagnosed with OCD needs to control their when a client asks me for advice I won’t have a good
ritualistic behaviors.” solution.” Which should be the nursing instructor’s best
B. “It is important for you to discontinue these ritualistic response?
behaviors.”
C. “Why are you asking for help if you won’t participate in A. “It’s scary to feel put on the spot by a client. Nurses
unit therapy?” don’t always have the answer.”
D. “Let’s figure out a way for you to attend unit activities B. “Remember, clients, not nurses, are responsible for their
and still wash your hands.” own choices and decisions.”
32. Which example of a therapeutic communication technique C.  “Just keep the client’s best interests in mind and do the
would be effective in the planning phase of the nursing best that you can.”
process? D.  “Set a goal to continue to work on this aspect of your
practice.”
A. “We’ve discussed past coping skills. Let’s see if these 39. A student nurse is learning about the appropriate use of
coping skills can be effective now.” touch when communicating with clients diagnosed with
B. “Please tell me in your own words what brought you to psychiatric disorders. Which statement by the instructor best
the hospital.” provides information about this aspect of therapeutic
C. “This new approach worked for you. Keep it up.” communication?
D. “I notice that you seem to be responding to voices that I
do not hear.” A. “Touch carries a different meaning for different
33. A client tells the nurse, “I feel bad because my mother individuals.”
does not want me to return home after I leave the hospital.” B. “Touch is often used when deescalating volatile client
Which nursing response is therapeutic? situations.”
C. “Touch is used to convey interest and warmth.”
A. “It’s quite common for clients to feel that way after a D. “Touch is best combined with empathy when dealing
lengthy hospitalization.” with anxious clients.”
B. “Why don’t you talk to your mother? You may find out 40. Which nursing statement is a good example of the
she doesn’t feel that way.” therapeutic communication technique of focusing?
C. “Your mother seems like an understanding person. I’ll
help you approach her.” A. “Describe one of the best things that happened to you
D. “You feel that your mother does not want you to come this week.”
back home?” B. “I’m having a difficult time understanding what you
34. A client’s younger daughter is ignoring curfew. The client mean.”
states, “I’m afraid she will get pregnant.” The nurse responds, C. “Your counseling session is in 30 minutes. I’ll stay with
“Hang in there. Don’t you think she has a lot to learn about you until then.”
life?” This is an example of which communication block? D. “You mentioned your relationship with your father. Let’s
discuss that further.”
A. Requesting an explanation 41. After fasting from 10 p.m. the previous evening, a client
B. Belittling the client finds out that the blood test has been canceled. The client
C. Making stereotyped comments swears at the nurse and states, “You are incompetent!” Which
D. Probing is the nurse’s best response?
35. Which nursing statement is a good example of the
therapeutic communication technique of giving recognition? A. “Do you believe that I was the cause of your blood test
being canceled?”
A. “You did not attend group today. Can we talk about B. “I see that you are upset, but I feel uncomfortable when
that?” you swear at me.”
 C.  “Have you ever thought about ways to express anger B. Verbalizing the implied and the defense mechanism of
appropriately?” denial
D.  “I’ll give you some space. Let me know if you need C. Reflection and the defense mechanism of projection
anything.” D. Encouraging descriptions of perceptions and the defense
42. During a nurse-client interaction, which nursing statement mechanism of displacement
may belittle the client’s feelings and concerns? 49. Which of the following individuals are communicating a
message? (Select all that apply.)
A. “Don’t worry. Everything will be alright.” A. A mother spanking her son for playing with matches
B. “You appear uptight.” B. A teenage boy isolating himself and playing loud music
C. “I notice you have bitten your nails to the quick.” C. A biker sporting an eagle tattoo on his biceps
D. “You are jumping to conclusions.” D. A teenage girl writing, “No one understands me”
43. A client on an inpatient psychiatric unit tells the nurse, “I E. A father checking for new e-mail on a regular basis
should have died because I am totally worthless.” In order to 50. A mother rescues two of her four children from a house
encourage the client to continue talking about feelings, which fire. In the emergency department, she cries, “I should have
should be the nurse’s initial response? gone back in to get them. I should have died, not them.” What
is the nurse’s best response?
A. “How would your family feel if you died?”
B. “You feel worthless now, but that can change with A. “The smoke was too thick. You couldn’t have gone back
time.” in.”
C. “You’ve been feeling sad and alone for some time B. “You’re feeling guilty because you weren’t able to save
now?” your children.”
D. “It is great that you have come in for help.” C. “Focus on the fact that you could have lost all four of
44. Which nursing response is an example of the your children.”
nontherapeutic communication block of requesting an D. “It’s best if you try not to think about what happened.
explanation? Try to move on.”
Answers and Rationales
A. “Can you tell me why you said that?” 1. Answer: D. “You’ve been feeling like a failure for a
B. “Keep your chin up. I’ll explain the procedure to you.” while?” Responding to the feelings expressed by a
C. “There is always an explanation for both good and bad patient is an effective therapeutic communication
behaviors.” technique. The correct option is an example of the use of
D. “Are you not understanding the explanation I provided?” restating. The remaining options block communication
45. A client states, “You won’t believe what my husband said because they minimize the patient’s experience and do
to me during visiting hours. He has no right treating me that not facilitate exploration of the patient’s expressed
way.” Which nursing response would best assess the situation feelings. In addition, use of the word “why” is
that occurred? nontherapeutic.
2. Answer: C. “You’re having difficulty sleeping?” The
A. “Does your husband treat you like this very often?” correct option uses the therapeutic communication
B. “What do you think is your role in this relationship?” technique of restatement. Although restatement is a
C. “Why do you think he behaved like that?” technique that has a prompting component to it, it
D. “Describe what happened during your time with your repeats the patients major theme, which assists the nurse
husband.” to obtain a more specific perception of the problem from
46. Which therapeutic communication technique should the the patient. The remaining options are not therapeutic
nurse use when communicating with a client who is responses since none encourage the patient to expand on
experiencing auditory hallucinations? the problem. Offering personal experiences moves the
focus away from the patient and onto the nurse
A. “My sister has the same diagnosis as you and she also 3. Answer: A. Using open-ended questions and
hears voices.” silence. Open-ended questions and silence are strategies
B. “I understand that the voices seem real to you, but I do use to encourage patients to discuss their problems.
not hear any voices.” Sharing personal food preferences is not a patient-
C. “Why not turn up the radio so that the voices are muted.” centered intervention. The remaining options are not
D. “I wouldn’t worry about these voices. The medication helpful to the patient because they do not encourage the
will make them disappear.” patient to express feelings. The nurse should not offer
47. Which nursing statement is a good example of the opinions and should encourage the patient to identify the
therapeutic communication technique of offering self? reasons for the behavior.
4. Answer: A. Denial. Denial is refusal to admit to a painful
reality, which is treated as if it does not exist. In
A. “I think it would be great if you talked about that projection, a person unconsciously rejects emotionally
problem during our next group session.” unacceptable features and attributes them to other
B. “Would you like me to accompany you to your persons, objects, or situations. Regression allows the
electroconvulsive therapy treatment?” patient to return to an earlier, more comforting, although
C. “I notice that you are offering help to other peers in the less mature, way of behaving. Rationalization is
milieu.” justifying illogical or unreasonable ideas, actions, or
D. “After discharge, would you like to meet me for lunch to feelings by developing acceptable explanations that
review your outpatient progress?” satisfy the teller and the listener.
48. A client slammed a door on the unit several times. The 5. Answer: C. “You’re feeling angry that your family
nurse responds, “You seem angry.” The client states, “I’m not continues to hope for you to be cured?” Restating is a
angry.” What therapeutic communication technique has the therapeutic communication technique in which the nurse
nurse employed and what defense mechanism is the client repeats what the patient says to show understanding and
unconsciously demonstrating? to review what was said. While it is appropriate for the
nurse to attempt to assess the patient’s ability to discuss
A. Making observations and the defense mechanism of feelings openly with family members, it does not help
suppression 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 12. Answer: A, B, D, and E. Therapeutic communication
regarding the reason for the patient’s feeling, this is non- techniques include listening, maintaining silence,
therapeutic in the one-to-one relationship. maintaining neutral responses, using broad openings and
6. Answer: D. A willingness to participate in the planning open-ended questions, focusing and refocusing,
of the care and treatment plan. In general, patients seek restating, clarifying and validating, sharing perceptions,
voluntary admission. If a patient seeks voluntary reflecting, providing acknowledgment and feedback,
admission, the most likely expectations is the patient will giving information, presenting reality, encouraging
participate in the treatment program since they are formulation of a plan of action, providing nonverbal
actively seeking help. The remaining options are not encouragement, and summarizing Asking why is often
characteristics of this type of admission. Fearfulness, interpreted as being accusatory by the patient and should
anger, and aggressiveness are more characteristic of an also be avoided. Providing advice or giving approval or
involuntary admission. Voluntary admission does not disapproval are barriers to communication.
guarantee a patient’s understanding of their illness, only 13. Answer: A. Denial. Denial is refusal to admit to a painful
of their desire for help. reality and may be a response by a victim of sexual
7. Answer: A. Contact the patient’s health care provider abuse. In this case the patient is not acknowledging the
(HCP). In general, patients seek, voluntary admission. trauma of the assault either verbally or nonverbally.
Voluntary patients have the right to demand and obtain Projection is transferring one’s internal feelings,
release. The nurse needs to be familiar with the state and thoughts, and unacceptable ideas and traits to someone
facility policies and procedures. The best nursing action else. Rationalization is justifying the unacceptable
is to contact the HCP, who has the authority to discuss attributes about oneself. Intellectualization is the
discharge with the patient. While arranging for safe excessive use of abstract thinking or generalizations to
transportation is appropriate it is premature in this decrease painful thinking.
situation and should be done only with the patient’s’ 14. Answer: D. Termination. In the termination phase, the
permission. While it is appropriate to discuss why the relationship comes to a close. Ending treatment
patient feels the need to leave and the possible outcomes sometimes may be traumatic for patients who have come
of leaving against medical advice, attempting to get the to value the relationship and the help. Because loss is an
patient to agree to staying “a few more days” has little issue, any unresolved feelings related to loss may
value and will not likely be successful. Many states resurface during this phase. The remaining options are
require that the patient submit a written release notice to not specifically associated with this issue of unresolved
the facility staff members, who reevaluate the patient’s feelings.
condition for possible conversion to involuntary status if 15. Answer: C. “Being respectful and concerned will ensure
necessary, according to criteria established by law. that I’m attentive to my patients’ rights.” The nurse
While this is a possibility, it should not be used as a needs to respect and have concern for the patient; this is
threat to the patient. vital to protecting the patient’s rights. While it is true the
8. Answer: A. Monitor closely for harm to self or autonomy is a basic client right, there are other rights
others. Involuntary admission is necessary when a that must also be both respected and facilitated. State and
person is a danger to self or others or is in need of federal laws do protect a patient’s rights, but it is
psychiatric treatment regardless of the patient’s sensitivity to those rights that will ensure that the nurse
willingness to consent to the hospitalization. A written secures these rights for the patient. It is a fact that
request is a component of a voluntary admission. safeguarding a patient’s rights are a nursing
Providing written information regarding the illness is responsibility, but stating that fact does not show
likely premature initially. The family may have had no understanding or respect for the concept.
role to play in the patient’s’ admission. 16. Answer: D. Making observations. The nurse is using the
9. Answer: B. Making appropriate referrals. Tasks of the therapeutic communication technique of making
termination phase include evaluating patient observations when noting that the client smiles when
performance, evaluating achievement of expected talking about physical violence. The technique of
outcomes, evaluating future needs, making appropriate making observations encourages the client to compare
referrals and dealing with the common behaviors personal perceptions with those of the nurse.
associated with termination. The remaining options 17. Answer: A. Restatement. The nurse is using the
identify tasks appropriate for the working phase of the therapeutic communication technique of restatement.
relationship. Restatement involves repeating the main idea of what the
10. Answer: A. “I cannot discuss any patient situation with client has said. The nurse uses this technique to
you.” The nurse is required to maintain confidentiality communicate that the client’s statement has been heard
regarding the patient and the patient’s care. and understood.
Confidentiality is basic to the therapeutic relationship 18. Answer: C. Formulating a plan of action. The nurse is
and is a patient’s right. The most appropriate response to using the therapeutic communication technique of
the neighbor is the statement of that responsibility in a formulating a plan of action to help the client explore
direct, but polite manner. A blunt statement that does not alternatives to drinking alcohol. The use of this
acknowledge why the nurse cannot reveal patient technique, rather than direct confrontation regarding the
information may be taken as disrespectful and uncaring. client’s poor coping choice, may serve to prevent anger
The remaining options identify statements that do not or anxiety from escalating.
maintain patient confidentiality. 19. Answer: C. “Yes, I see. Go on.” The nurse’s statement,
11. Answers: B, C and E. False imprisonment is an act with “Yes, I see. Go on.” is an example of the therapeutic
the intent to confine a person to a specific area. The communication technique of a general lead. Offering a
nurse can be charged with false imprisonment if the general lead encourages the client to continue sharing
nurse prohibits a patient from leaving the hospital if the information.
patient has been admitted voluntarily and if no agency or 20. Answer: D. The nontherapeutic technique of “giving
legal policies exist for detaining the patient. Assault and false reassurance” The nurse’s statement, “Things will
battery are related to the act of restraining the patient in a look better tomorrow after a good night’s sleep.” is an
situation that did not meet criteria for such an example of the nontherapeutic technique of giving false
intervention. Libel and slander are not applicable here reassurance. Giving false reassurance indicates to the
since the nurse did not write or verbally make untrue client that there is no cause for anxiety, thereby
statements about the patient. devaluing the client’s feelings.
21. Answer: B. “What would you like to talk about?” The and reflects these feelings back to the client so that they
nurse’s statement, “What would you like to talk about?” may be recognized and accepted.
is an example of the therapeutic communication 31. Answer: D. “Let’s figure out a way for you to attend unit
technique of giving broad openings. Using a broad activities and still wash your hands.”  The most
opening allows the client to take the initiative in appropriate statement by the nurse is, “Let’s figure out a
introducing the topic and emphasizes the importance of way for you to attend unit activities and still wash your
the client’s role in the interaction. hands.” This statement reflects the therapeutic
22. Answer:A. “You appear to be talking to someone I do communication technique of formulating a plan of
not see.” The nurse is making an observation when action. The nurse attempts to work with the client to
stating, “You appear to be talking to someone I do not develop a plan without damaging the therapeutic
see.” Making observations involves verbalizing what is relationship or increasing the client’s anxiety.
observed or perceived. This encourages the client to 32. Answer: A. “We’ve discussed past coping skills. Let’s
recognize specific behaviors and make comparisons with see if these coping skills can be effective now.” This is
the nurse’s perceptions. an example of the therapeutic communication technique
23. Answer: B. O. The nurse should identify that of formulating a plan of action. By the use of this
maintaining an uncrossed arm and leg posture is technique, the nurse can help the client plan in advance
nonverbal behavior that reflects the “O” in the active- to deal with a stressful situation which may prevent
listening acronym SOLER. The acronym SOLER anger and/or anxiety from escalating to an unmanageable
includes sitting squarely facing the client (S), open level.
posture when interacting with the client (O), leaning 33. Answer: D. “You feel that your mother does not want
forward toward the client (L), establishing eye contact you to come back home?” This is an example of the
(E), and relaxing (R). therapeutic communication technique of restatement.
24. Answer: C. “Surely you didn’t do this deliberately, but Restatement is the repeating of the main idea that the
you breached confidentiality by using the client’s client has verbalized. This lets the client know whether
name.” The instructor’s statement, “Surely you didn’t do or not an expressed statement has been understood and
this deliberately, but you breached confidentiality by gives him or her the chance to continue, or clarify if
using the client’s name.” is an example of effective necessary.
feedback. Feedback is a method of communication to 34. Answer: C. Making stereotyped comments. This is an
help others consider a modification of behavior. example of the nontherapeutic communication block of
Feedback should be descriptive, specific, and directed making stereotyped comments. Clichés and trite
toward a behavior that the person has the capacity to expressions are meaningless in a therapeutic nurse-client
modify and should impart information rather than offer relationship.
advice or criticize the individual. 35. Answer: C. “I notice you are wearing a new dress and
25. Answer: A. The nontherapeutic technique of giving you have washed your hair.” This is an example of the
approval.  The group leader has employed the therapeutic communication technique of giving
nontherapeutic technique of giving approval. Giving recognition. Giving recognition acknowledges and
approval implies that the nurse has the right to pass indicates awareness. This technique is more appropriate
judgment on whether the client’s ideas or behaviors are than complimenting the client which reflects the nurse’s
“good” or “bad.” This creates a conditional acceptance judgment.
of the client. 36. Answer: A. “You seem to be motivated to change your
26. Answer: D. To give the client critical information. The behavior.” This is an example of the therapeutic
purpose of providing appropriate feedback is to give the communication technique of verbalizing the implied.
client critical information. Feedback should not be used Verbalizing the implied puts into words what the client
to give advice or evaluate behaviors. has only implied or said indirectly.
27. Answer: D. “During group, you raised your voice, yelled 37. Answer: C. To explore a subject, idea, experience, or
at a peer, left, and slammed the door.” The nurse is relationship. This is an example of the therapeutic
providing appropriate feedback when stating, “During communication technique of exploring. The purpose of
group, you raised your voice, yelled at a peer, left, and using exploring is to delve further into the subject, idea,
slammed the door.” Giving appropriate feedback experience, or relationship. This technique is especially
involves helping the client consider a modification of helpful with clients who tend to remain on a superficial
behavior. Feedback should give information to the client level of communication.
about how he or she is perceived by others. Feedback 38. Answer: B. “Remember, clients, not nurses, are
should not be evaluative in nature or be used to give responsible for their own choices and decisions.” Giving
advice. advice tells the client what to do or how to behave. It
28. Answer: C. “Let’s discuss and explore all of your implies that the nurse knows what is best and that the
options.” The most appropriate response by the nurse is, client is incapable of any self-direction. It discourages
“Let’s discuss and explore all of your options.” In this independent thinking.
example, the nurse is encouraging the client to formulate 39. Answer: A. “Touch carries a different meaning for
ideas and decide independently the appropriate course of different individuals.” Touch can elicit both negative and
action. positive reactions, depending on the people involved and
29. Answer: C. Sitting squarely, facing the client. When the circumstances of the interaction.
interviewing a client, the nurse should employ the 40. Answer: D. “You mentioned your relationship with your
nonverbal behavior of sitting squarely, facing the client. father. Let’s discuss that further.” This is an example of
Facilitative skills for active listening can be identified by the therapeutic communication technique of focusing.
the acronym SOLER. SOLER includes sitting squarely Focusing takes notice of a single idea or even a single
facing the client (S), open posture when interacting with word and works especially well with a client who is
a client (O), leaning forward toward the client (L), moving rapidly from one thought to another.
establishing eye contact (E), and relaxing (R). 41. Answer: B. “I see that you are upset, but I feel
30. Answer: B. “You’re feeling guilty because you weren’t uncomfortable when you swear at me.” This is an
able to save your children.” The best response by the example of the appropriate use of feedback. Feedback
nurse is, “You’re experiencing feelings of guilt because should be directed toward behavior that the client has the
you weren’t able to save your children.” This response capacity to modify.
utilizes the therapeutic communication technique of 42. Answer: A. “Don’t worry. Everything will be
reflection which identifies a client’s emotional response alright.” 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.
43. Answer: C. “You’ve been feeling sad and alone for some
time now?” 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.
44. Answer: A. “Can you tell me why you said that?” 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.
45. Answer: D. “Describe what happened during your time
with your husband.” 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.
46. Answer: B. “I understand that the voices seem real to
you, but I do not hear any voices.” 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.
47. Answer: B. “Would you like me to accompany you to
your electroconvulsive therapy treatment?” 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.
48. Answer: B. Verbalizing the implied and the defense
mechanism of denial. 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.
49. Answer: A, B, C, D. 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.
50. Answer: B. “You’re feeling guilty because you weren’t
able to save your children.” 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.