Therapeutic communication NCLEX-RN Practice Questions

Therapeutic communication NCLEX-RN Practice Questions help you strengthen a core competency within the Psychosocial Integrity domain. Effective nurse–patient communication supports trust, safety, adherence, and patient-centered outcomes across settings—from acute crises to long-term coping. In this practice set, you’ll apply techniques such as open-ended questions, reflection, clarification, silence, presenting reality, limit setting, and culturally competent strategies. Each scenario mirrors real clinical decision-making, requiring you to discern therapeutic from nontherapeutic responses, avoid common pitfalls (false reassurance, “why” questions, advice-giving), and prioritize safety. Use these questions to refine clinical judgment, increase confidence, and build fluency with evidence-based language that validates feelings, explores meaning, and empowers patients and families throughout the care continuum.

Q1. A client with depression says, “I’m a failure; nothing will ever change.” Which response by the nurse is most therapeutic?

• “You’re not a failure. Things will get better soon.”
• “Why do you think you’re a failure?”
• “It sounds like you’re feeling hopeless right now. Can you tell me more about what’s been hardest for you?”
• “Let’s focus on the positives; you’re here getting help.”

Correct Answer: It sounds like you’re feeling hopeless right now. Can you tell me more about what’s been hardest for you?

Q2. A client reports hearing voices telling them to hurt themselves. Which response demonstrates therapeutic communication and prioritizes safety?

• “The voices aren’t real; just try to ignore them.”
• “I don’t hear the voices, but I know they feel real to you. What are they saying right now?”
• “Why are you listening to the voices?”
• “Let’s watch TV so you’ll stop thinking about it.”

Correct Answer: I don’t hear the voices, but I know they feel real to you. What are they saying right now?

Q3. Before surgery, an anxious client asks, “Am I going to die?” Which response is best?

• “No, the surgeon is excellent; you’ll be fine.”
• “What are your biggest concerns about the surgery?”
• “Don’t worry; thousands have this procedure.”
• “Why would you think that?”

Correct Answer: What are your biggest concerns about the surgery?

Q4. A client begins to cry during an assessment. What is the most therapeutic initial response?

• Change the subject to avoid upsetting the client further.
• Say, “Don’t cry; everything will be okay.”
• Offer a tissue and say, “I can sit with you. Would you like to talk about what you’re feeling?”
• Continue asking the next assessment question.

Correct Answer: Offer a tissue and say, “I can sit with you. Would you like to talk about what you’re feeling?”

Q5. A hospitalized client flirts with the nurse and asks for personal contact outside of work. Which response maintains boundaries and remains therapeutic?

• “I’m flattered, but I’m very busy after work.”
• “Our relationship is professional. Let’s focus on your health goals and how I can support you here.”
• “Maybe when you’re discharged, we can talk.”
• Ignore the comment and leave the room.

Correct Answer: Our relationship is professional. Let’s focus on your health goals and how I can support you here.

Q6. A manic client repeatedly interrupts others during group therapy. Which statement is most therapeutic?

• “You need to stop talking now.”
• “If you don’t be quiet, you’ll be removed.”
• “I want to hear what you have to say, and others need time too. You’ll have 2 minutes to finish, then we’ll listen to the next person.”
• “Why can’t you let others speak?”

Correct Answer: I want to hear what you have to say, and others need time too. You’ll have 2 minutes to finish, then we’ll listen to the next person.

Q7. Which communication strategy is best when interacting with a client who has expressive aphasia after a stroke?

• Ask multiple questions at once to gather more information quickly.
• Use short, simple questions and allow ample time for responses.
• Speak loudly and repeatedly until the client answers.
• Avoid using gestures to prevent confusion.

Correct Answer: Use short, simple questions and allow ample time for responses.

Q8. A client says, “You wouldn’t understand; you have a perfect life.” Which response is most therapeutic?

• “I do understand; I’ve had problems too.”
• “It sounds like you feel alone and misunderstood. Help me understand what this is like for you.”
• “Many people feel that way; it’s normal.”
• “Why would you say that to me?”

Correct Answer: It sounds like you feel alone and misunderstood. Help me understand what this is like for you.

Q9. A palliative client shares, “I don’t want to be a burden to my family.” What is the best response?

• “You’re not a burden; they love you.”
• “Let’s not talk about that now.”
• “You’re worried about being a burden. What makes you feel that way?”
• “Why do you think you’re a burden?”

Correct Answer: You’re worried about being a burden. What makes you feel that way?

Q10. A client discloses intimate partner violence. Which initial response is most therapeutic?

• “You should leave immediately.”
• “I’m concerned for your safety. Help is available. Can you tell me what happens at home and what you need right now?”
• “Are you sure you’re not exaggerating?”
• “Let’s not put this in your chart.”

Correct Answer: I’m concerned for your safety. Help is available. Can you tell me what happens at home and what you need right now?

Q11. A preschooler is hospitalized after a traumatic event. Which statement by the nurse promotes therapeutic play to express feelings?

• “Let’s take this test and answer my questions.”
• “Show me with the dolls what happened and how you feel.”
• “You’re safe now; no need to talk about it.”
• “Don’t worry; big kids don’t cry.”

Correct Answer: Show me with the dolls what happened and how you feel.

Q12. A client asks, “Should I leave my spouse?” Which response is best?

• “Yes, that’s the safest choice.”
• “No, marriages take work.”
• “What options have you considered, and what matters most to you in making this decision?”
• “Why are you asking me?”

Correct Answer: What options have you considered, and what matters most to you in making this decision?

Q13. An angry client is shouting about a delayed medication. What is the nurse’s best therapeutic response?

• “Calm down right now.”
• “If you keep yelling, I’ll call security.”
• “I want to help. Let’s move to a quieter place and talk about what’s upsetting you.”
• “You’re overreacting.”

Correct Answer: I want to help. Let’s move to a quieter place and talk about what’s upsetting you.

Q14. A family requests that the nurse not tell the client about a new cancer diagnosis due to cultural beliefs. What response is most therapeutic and ethical?

• “I cannot keep information from the client.”
• “I will ask the client how much information they want to receive and who they want involved in discussions.”
• “I’ll tell the physician to handle it.”
• “We must follow hospital policy and tell everything.”

Correct Answer: I will ask the client how much information they want to receive and who they want involved in discussions.

Q15. A client with limited English proficiency needs discharge teaching. Which approach is best?

• Use a family member to interpret the teaching.
• Speak louder and repeat the instructions.
• Provide printed materials in English and ask them to read at home.
• Arrange a certified medical interpreter and speak directly to the client using short, clear statements.

Correct Answer: Arrange a certified medical interpreter and speak directly to the client using short, clear statements.

Q16. After learning of a poor prognosis, a client is tearful and silent. Which action demonstrates therapeutic use of silence?

• Continuing the assessment to avoid awkwardness
• Sitting quietly at the bedside, maintaining soft eye contact, and waiting for the client to speak
• Saying, “Don’t cry; everything happens for a reason.”
• Changing the subject to a neutral topic

Correct Answer: Sitting quietly at the bedside, maintaining soft eye contact, and waiting for the client to speak

Q17. A client says, “I can’t stand this chemo. It makes me so sick I want to quit.” Which response is best?

• “You have to keep going to get better.”
• “Many people get sick from chemo.”
• “You’re feeling exhausted and discouraged. What worries you most about continuing treatment?”
• “Why would you quit now?”

Correct Answer: You’re feeling exhausted and discouraged. What worries you most about continuing treatment?

Q18. A client says, “I wish I could go to sleep and never wake up.” What is the nurse’s priority response?

• “You shouldn’t talk like that.”
• “Are you thinking about killing yourself?”
• “Think about your family.”
• “Let’s distract you with a walk.”

Correct Answer: Are you thinking about killing yourself?

Q19. A client with moderate dementia says, “I need to go home; my wife is waiting,” but the wife died years ago. Which response is most therapeutic?

• “Your wife died years ago; you’re confused.”
• “Let’s talk about your wife. What did you enjoy doing together? Then we can have some tea.”
• “You’re not going anywhere.”
• “Why do you think she’s waiting?”

Correct Answer: Let’s talk about your wife. What did you enjoy doing together? Then we can have some tea.

Q20. Which behavior best demonstrates active listening during a client interview?

• Filling in pauses to keep the conversation moving
• Multitasking while the client talks
• Leaning forward, nodding, and maintaining appropriate eye contact
• Quickly offering solutions to problems

Correct Answer: Leaning forward, nodding, and maintaining appropriate eye contact

Q21. A client asks the nurse about another patient’s condition. Which response is therapeutic and maintains confidentiality?

• “They’re doing fine; don’t worry.”
• “I can’t share information about other patients. Let’s talk about your concerns.”
• “You’ll hear during group therapy.”
• “Ask their family instead.”

Correct Answer: I can’t share information about other patients. Let’s talk about your concerns.

Q22. Which strategy is best when communicating with an older adult with hearing impairment?

• Speak rapidly to finish quickly.
• Face the client, speak slowly in a lower pitch, and reduce background noise.
• Shout to ensure they hear you.
• Cover your mouth so they focus on listening.

Correct Answer: Face the client, speak slowly in a lower pitch, and reduce background noise.

Q23. A client with PTSD is trembling and says, “I feel like I’m back there.” Which response is most therapeutic?

• “It’s over now; stop thinking about it.”
• “You’re safe here with me. Let’s take slow breaths together—can you tell me where you are right now?”
• “Why do you keep reliving it?”
• “You should be over this by now.”

Correct Answer: You’re safe here with me. Let’s take slow breaths together—can you tell me where you are right now?

Q24. A client refuses a prescribed medication, stating, “I don’t want that.” What is the nurse’s best initial response?

• “You must take it; it’s ordered.”
• “If you refuse, I’ll document noncompliance.”
• “Can you share your concerns about the medication so we can address them together?”
• “Why won’t you cooperate?”

Correct Answer: Can you share your concerns about the medication so we can address them together?

Q25. A client uses profanity and insults directed at the nurse. Which response is therapeutic and sets limits?

• “If you keep that up, I’ll ignore you.”
• “I want to help you, and I can’t continue while being insulted. We can talk when you feel calmer.”
• “That’s very disrespectful; apologize now.”
• Ignore the behavior and leave without explanation.

Correct Answer: I want to help you, and I can’t continue while being insulted. We can talk when you feel calmer.

Q26. Which approach is best when communicating with a delirious client who is disoriented and agitated?

• Provide lengthy explanations to reduce confusion.
• Use short, simple sentences, reorient frequently, and provide calm reassurance.
• Challenge their misperceptions to correct them.
• Ignore questions to avoid reinforcing confusion.

Correct Answer: Use short, simple sentences, reorient frequently, and provide calm reassurance.

Q27. A postpartum client says, “I’m a bad mother because breastfeeding isn’t working.” Which response is most therapeutic?

• “Lots of mothers fail at breastfeeding.”
• “Don’t say that—you’re a great mom.”
• “You’re feeling disappointed. What has been most difficult, and how can I support your goals?”
• “Why can’t you figure it out?”

Correct Answer: You’re feeling disappointed. What has been most difficult, and how can I support your goals?

Q28. Using motivational interviewing with a client ambivalent about alcohol use, which question best elicits change talk?

• “Why don’t you just stop drinking?”
• “What are the good and not-so-good things about your drinking?”
• “You need to go to treatment.”
• “Aren’t you worried about your liver?”

Correct Answer: What are the good and not-so-good things about your drinking?

Q29. A hospitalized client repeatedly asks the nurse to stay at the bedside all day. Which response balances support and boundaries?

• “I can’t be here; don’t ask again.”
• “I’ll stay as long as you want.”
• “I’ll check on you every hour and respond to your call light. Let’s plan specific times to talk about your concerns.”
• “Why are you so needy?”

Correct Answer: I’ll check on you every hour and respond to your call light. Let’s plan specific times to talk about your concerns.

Q30. A client says after diagnosis, “This can’t be cancer—the test must be wrong.” Which response is most therapeutic?

• “You’re in denial.”
• “The test is accurate; accept it.”
• “Getting this news is overwhelming. What questions or concerns are on your mind right now?”
• “Let’s not talk about it until you’re ready.”

Correct Answer: Getting this news is overwhelming. What questions or concerns are on your mind right now?

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