Therapeutic Communication Mental Health Nursing Townsend Test Bank Chapter 7

Therapeutic Communication Study Guide with Practice Questions and Answers

Therapeutic communication is an important topic in psychiatric mental health nursing because nurses use these skills to build trust, understand patients, and provide effective care. Many exam questions focus on recognizing the difference between therapeutic and nontherapeutic responses and choosing the most appropriate communication technique.

This study guide includes 39 practice questions from Chapter 7 of Townsend's Psychiatric Mental Health Nursing. The questions cover key concepts such as therapeutic communication techniques, active listening, the SOLER model, motivational interviewing, feedback, and the transactional communication model.

Each question includes an answer and rationale to help you understand the reasoning behind the correct choice and review important concepts from the chapter.

This is one chapter from the complete test bank. The full resource includes questions from all 43 chapters, covering topics such as psychopharmacology, therapeutic groups, crisis intervention, and psychiatric disorders.

Access the complete set here: Test Bank for Davis Advantage for Psychiatric Mental Health Nursing, 10th Edition (Townsend).

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

Client: "When I get angry, I get into a fistfight with my partner or I take it out on the kids." Nurse: "I notice that you are smiling as you talk about this physical violence."

1. Encouraging comparison
2. Exploring
3. Formulating a plan of action
4. Making observations

Rationale: The nurse is using making observations by noting that the client smiles while describing physical violence. This technique verbalizes what is observed and encourages the client to compare personal perceptions with those of the nurse. Encouraging comparison asks the client to compare similarities and differences in ideas or experiences; formulating a plan of action helps the client prevent anger or anxiety from escalating — neither fits here.

2. 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."

1. Restating
2. Offering general leads
3. Focusing
4. Accepting

Rationale: The nurse is restating — repeating the main idea of what the client said to confirm it was heard and understood. Offering general leads encourages the client to continue; focusing narrows in on a single idea or word and works well with a client who jumps between thoughts (but isn't therapeutic with an anxious client); accepting conveys receptiveness and regard.

3. 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?"

1. Reflecting
2. Making observations
3. Formulating a plan of action
4. Giving recognition

Rationale: The nurse is formulating a plan of action — helping the client explore alternatives to drinking. Using this technique instead of direct confrontation about a poor coping choice can prevent anger or anxiety from escalating. Reflecting refers the client's questions or feelings back to them; making observations verbalizes what's perceived; giving recognition acknowledges the client's awareness.

4. The nurse is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a general lead?

1. "Do you know why you are here?"
2. "Are you feeling depressed or anxious?"
3. "Yes, I see. Go on."
4. "Can you chronologically order the events that led to your admission?"

Rationale: "Yes, I see. Go on" is a general lead — it encourages the client to keep sharing with minimal input from the nurse. The other options are closed or leading questions that don't serve this function.

5. 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?

1. The nontherapeutic technique of "giving advice"
2. The therapeutic technique of "formulating a plan of action"
3. The therapeutic technique of "presenting reality"
4. The nontherapeutic technique of "giving false reassurance"

Rationale: This statement gives false reassurance — it indicates there's no cause for anxiety, which devalues the client's feelings. Giving advice tells the client what to do; formulating a plan of action helps identify a plan for behavior change; presenting reality corrects a misperception of the environment. None of those apply here.

6. A client diagnosed with posttraumatic stress disorder is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which utterance made by the nurse is an example of a broad opening?

1. "What occurred prior to the traumatic event, and when did you go to the emergency department?"
2. "What would you like to talk about?"
3. "I notice you seem uncomfortable discussing this."
4. "How can we help you feel safe during your stay here?"

Rationale: "What would you like to talk about?" is a broad opening — it lets the client take the initiative in introducing the topic and emphasizes the client's role in the interaction. Option 1 places events in sequence, option 3 makes an observation, and option 4 formulates a plan of action.

7. 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?

1. "You appear to be talking to someone I do not see."
2. "Please describe what you are seeing."
3. "Why do you continually look in the corner of this room?"
4. "If you hum a tune, the voices may not be so distracting."

Rationale: "You appear to be talking to someone I do not see" is a making-observations statement — it verbalizes what's perceived and encourages the client to recognize specific behaviors. Option 2 is a general lead, option 3 is a nontherapeutic request for explanation that can feel intimidating, and option 4 is nontherapeutic advice-giving.

8. A nurse maintains an uncrossed arm and leg posture. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening?

1. S
2. O
3. L
4. E

Rationale: SOLER stands for sitting Squarely facing the client, Open posture, Leaning forward, establishing Eye contact, and Relaxing. An uncrossed arm and leg posture is open posture — the O.

9. Which action by the nurse, who is first meeting a client, would likely send a nonverbal message that is inappropriate for the therapeutic relationship?

1. The nurse provides eye contact intermittently during the meeting.
2. The nurse is dressed in business casual attire; a tattoo is visible.
3. The nurse offers a handshake during the initial interaction with the client.
4. The nurse gives a client a strong hug at the end of the meeting.

Rationale: A strong hug typically signals attraction or attachment and is inappropriate for establishing a therapeutic relationship. Intermittent eye contact shows interest, a visible tattoo under business casual attire is generally acceptable, and a handshake is a polite, accepting gesture on first meeting.

10. 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?

1. Giving approval
2. Interpreting
3. Presenting reality
4. Making observations

Rationale: This is the nontherapeutic technique of giving approval, it implies the nurse has the right to judge whether the client's behavior is "good" or "bad," which creates conditional acceptance. Interpreting assigns meaning to unconscious material, presenting reality corrects a misperception, and making observations verbalizes what's perceived — none apply here.

11. What is the purpose of a nurse providing appropriate feedback?

1. To provide the client with good advice
2. To advise the client on appropriate behaviors
3. To evaluate the client's behavior
4. To give the client critical information

Rationale: Feedback exists to give the client critical information — not to give advice or evaluate behavior.

12. The nurse is providing therapeutic feedback to a client who exhibited an angry outburst in a group setting. Which is appropriate for the nurse to say to the client?

1. "Why do you continue to alienate your peers by your angry outbursts?"
2. "You accomplish nothing when you lose your temper like that."
3. "Showing your anger in that manner is very childish and insensitive."
4. "During group, you raised your voice, yelled at a peer, and slammed the door."

Rationale: Appropriate feedback describes specific, observed behavior without evaluation or judgment, giving the client information about how they're perceived so they can consider modifying their behavior. Options 1–3 are judgmental or accusatory and put the client on the defensive rather than helping them reflect.

13. A client diagnosed with dependent personality disorder states, "Do you think I should move out of my parents' house and get a job?" Which nursing response is most appropriate?

1. "It would be best to do that to increase independence."
2. "Why would you want to leave a secure home?"
3. "Let's discuss and explore all of your options."
4. "I'm afraid you would feel very guilty leaving your parents."

Rationale: "Let's discuss and explore all of your options" encourages the client to formulate ideas and decide independently rather than relying on the nurse's opinion. Options 1 and 4 are advice-giving, and option 2 is an intimidating request for explanation.

14. Why is it important for the nurse to demonstrate active listening during a client interaction?

1. The client will be able to understand the nurse's instructions better.
2. The client will feel a sense of trust and acceptance by the nurse.
3. The client will change his or her behavior if active listening is used.
4. The client will be able to provide feedback to the nurse for improvement.

Rationale: Active listening conveys acceptance of the client and helps build trust. It doesn't necessarily improve the client's ability to follow instructions, and on its own doesn't drive behavior change — it's one part of motivational interviewing, not the whole process. Feedback from the client for the nurse's improvement is gathered through process recording, not active listening.

15. 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." Which of the following responses by the nurse is an example of reflection?

1. "The smoke was too thick. You couldn't have gone back in."
2. "You're feeling guilty because you weren't able to save your children."
3. "Focus on the fact that you could have lost all four of your children."
4. "It's best if you try not to think about what happened. Try to move on."

Rationale: Reflection identifies the client's emotional response and reflects it back so it can be recognized and accepted. Option 1 is disagreeing, which implies inaccuracy and can put the client on the defensive; options 3 and 4 are both advice-giving.

16. A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) washes her hands continually. This behavior prevents her from attending unit activities. Which nursing statement best addresses this situation?

1. "Everyone diagnosed with OCD needs to control their ritualistic behaviors."
2. "It is important for you to discontinue these ritualistic behaviors."
3. "Why are you asking for help if you won't participate in unit therapy?"
4. "Let's figure out a way for you to attend unit activities and still wash your hands."

Rationale: This is formulating a plan of action — working with the client to develop a solution without damaging the therapeutic relationship or raising anxiety. Options 1 and 2 are advice-giving, and option 3 is an intimidating request for explanation.

17. Which example of a therapeutic communication technique would be most effective in the planning phase of the nursing process?

1. "We've discussed past coping skills. Let's see if these coping skills can be effective now."
2. "Please tell me in your own words what brought you to the hospital."
3. "This new approach worked for you. Keep it up."
4. "I noticed that you seem to be responding to voices that I do not hear."

Rationale: Formulating a plan of action helps the client plan in advance for a stressful situation, which fits the planning phase. Option 2 is exploring, which is more suited to assessment; option 3 is advice-giving; option 4 is presenting reality, useful for misperceptions but not specific to planning.

18. A client tells the nurse, "I feel like my mother does not want me to return home after I leave the hospital." Which nursing response is therapeutic?

1. "It's quite common for clients to feel that way after a lengthy hospitalization."
2. "Why don't you talk to your mother? You may find out she doesn't feel that way."
3. "Your mother seems like an understanding person. I'll help you approach her."
4. "You feel that your mother does not want you to come back home?"

Rationale: This is restating — repeating the client's main idea to confirm understanding and invite them to continue or clarify. Option 1 minimizes the client's feelings, option 2 is advice-giving, and option 3 is false reassurance.

19. Which feature distinguishes motivational interviewing from other therapeutic techniques?

1. Motivational interviewing establishes a contract for change.
2. Motivational interviewing is the only patient-centered communication strategy.
3. Motivational interviewing allows the nurse to inform the client's choices.
4. Motivational interviewing focuses on what the client wants.

Rationale: Motivational interviewing promotes behavior change by centering the client's own motivation and wants — not a formal contract, and not the nurse directing the client's choices. It's also one of several patient-centered approaches, not the only one.

20. Which nursing statement is a good example of the therapeutic communication technique of giving recognition?

1. "You did not attend group today. Can we talk about that?"
2. "I'll sit with you until it is time for your family session."
3. "I noticed you are wearing a new dress and have washed your hair."
4. "I'm happy that you are now taking your medications. They will really help."

Rationale: Giving recognition acknowledges and indicates awareness without judgment — more appropriate than complimenting, which reflects the nurse's opinion. Option 1 is making observations/exploring, option 2 is offering self, and option 4 is giving approval (nontherapeutic).

21. A client is trying to explore and solve a problem. Which nursing statement is an example of verbalizing the implied?

1. "You seem to be motivated to change your behavior."
2. "How will these changes affect your family relationships?"
3. "Why don't you make a list of the behaviors you need to change?"
4. "The team recommends that you make only one behavioral change at a time."

Rationale: Verbalizing the implied puts into words what the client has only implied or said indirectly. Option 2 is reflecting, and option 4 is advice-giving.

22. The nurse says to a newly admitted client, "Tell me more about what led up to your hospitalization." What is the purpose of this therapeutic communication technique?

1. To reframe the client's thoughts about mental health treatment
2. To put the client at ease
3. To explore a subject, idea, experience, or relationship
4. To communicate that the nurse is listening to the conversation

Rationale: This is exploring — delving further into a subject to facilitate the client's understanding of events, especially useful with clients who tend to stay on a superficial level of communication. It isn't meant to reframe thoughts, put the client at ease, or simply signal that the nurse is listening.

23. 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 would be the instructor's best response?

1. "It's scary to feel put on the spot by a client. Nurses don't always have the answers."
2. "Remember, clients, not nurses, are responsible for their own choices and decisions."
3. "Just keep the client's best interests in mind and do the best that you can."
4. "Set a goal to continue to work on this aspect of your practice."

Rationale: This response gives the clearest rationale for why nurses should avoid advice-giving: it's a nontherapeutic technique that implies the nurse knows best and that the client can't direct their own care. The other options don't explain why advice-giving should be avoided.

24. A student nurse is learning about the appropriate use of touch when communicating with clients diagnosed with psychiatric disorders. Which statement made by the instructor best provides information about this aspect of therapeutic communication?

1. "Touch carries a different meaning for different individuals."
2. "Touch is often used when deescalating volatile client situations."
3. "Touch is used to convey interest and warmth."
4. "Touch is best combined with empathy when dealing with anxious clients."

Rationale: Touch can elicit both negative and positive reactions depending on the person and the circumstances — it isn't reliably de-escalating, isn't guaranteed to convey warmth, and isn't necessarily improved by pairing it with empathy.

25. Which nursing statement is a good example of the therapeutic communication technique of focusing?

1. "Describe one of the best things that happened to you this week."
2. "I'm having a difficult time understanding what you mean."
3. "Your counseling session is in 30 minutes. I'll stay with you until then."
4. "You mentioned your relationship with your father. Let's discuss that further."

Rationale: Focusing takes notice of a single idea or word and works especially well with a client who's moving rapidly from one thought to another. Option 2 is seeking clarification and validation, and option 3 is offering self.

26. A client begins fasting at 10 p.m. for a blood test the next morning. The morning of the test, the client finds out it has been canceled. The client expresses hostility toward the nurse and states, "You are incompetent!" Which is the nurse's best response?

1. "Do you believe that I caused your blood test to be canceled?"
2. "I see that you are upset, but I feel uncomfortable when you swear at me."
3. "Have you ever thought about ways to express anger appropriately?"
4. "I'll give you some space. Let me know if you need anything."

Rationale: Effective feedback is specific and descriptive rather than evaluative, and it focuses on a behavior the client can actually modify — here, the swearing. Options 1, 3, and 4 don't name the specific behavior in a way the client can act on.

27. During a nurse-client interaction, which nursing statement may belittle the client's feelings and concerns?

1. "Don't worry. Everything will be alright."
2. "You appear uptight."
3. "I notice you have bitten your nails to the quick."
4. "You are jumping to conclusions."

Rationale: "Don't worry. Everything will be alright" belittles feelings — it misjudges the degree of the client's discomfort and suggests a lack of empathy and understanding. Options 2 and 3 are making observations, and option 4 doesn't minimize the client's feelings in the same way.

28. A client on an inpatient psychiatric unit tells the nurse, "I should have died, because I am totally worthless." To encourage the client to continue talking about feelings, which should be the nurse's initial response?

1. "How would your family feel if you died?"
2. "You feel worthless now, but that can change with time."
3. "You've been feeling sad and alone for some time now?"
4. "It is great that you have come in for help."

Rationale: This is reflection — referring the client's feelings back to them so they can be recognized and accepted, which invites the client to keep talking. Option 1 is probing, option 2 belittles the client's feelings, and option 4 is giving approval.

29. Which nursing response is an example of the nontherapeutic communication technique of requesting an explanation?

1. "Can you tell me why you said that?"
2. "Keep your chin up. I'll explain the procedure to you."
3. "There is always an explanation for both good and bad behaviors."
4. "Are you not understanding the explanation I provided?"

Rationale: Requesting an explanation asks the client to justify their thoughts, feelings, or behavior — asking "why" can feel intimidating and puts the client in a position of having to defend themselves. Option 2 is a stereotyped comment, and option 3 implies the nurse is passing judgment on the client's behavior as good or bad.

30. 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?

1. "Does your husband treat you like this very often?"
2. "What do you think is your role in this relationship?"
3. "Why do you think he behaved like that?"
4. "Describe what happened during your time with your husband."

Rationale: This is exploring — delving further into the experience, which is especially helpful with a client who tends to stay on a superficial level. Options 1 and 2 are probing, and option 3 is requesting an explanation.

31. Which statement reflects the therapeutic communication technique the nurse should use when communicating with a client who is experiencing auditory hallucinations?

1. "My sister has the same diagnosis as you, and she also hears voices."
2. "I understand that the voices seem real to you, but I do not hear any voices."
3. "Why not turn up the radio so that the voices are muted."
4. "I wouldn't worry about these voices. The medication will make them disappear."

Rationale: This is presenting reality — the nurse states their own perception of the situation when the client has a misperception of the environment. Option 3 is giving advice, and options 1 and 4 don't address the client's misperception directly.

32. Which nursing response is the best example of the therapeutic communication technique of offering self?

1. "I think it would be great if you talked about that problem during our next group session."
2. "Would you like me to accompany you to your electroconvulsive therapy treatment?"
3. "I notice that you are offering help to other peers in the milieu."
4. "After discharge, would you like to meet me for lunch to review your outpatient progress?"

Rationale: Offering self makes the nurse available on an unconditional basis, which increases the client's sense of self-worth, while the healthcare provider still maintains professional nursing boundaries. Option 1 is advice-giving, option 3 is making observations, and option 4 crosses professional boundaries by proposing contact after discharge rather than offering unconditional presence now.

33. Which of the following best represents a patient-centered approach that promotes a change in behavior?

1. Process recordings
2. Providing guidance
3. Motivational interviewing
4. Therapeutic communication

Rationale: Motivational interviewing is an evidence-based and patient-centered communication style that promotes behavior change by guiding clients to explore their own motivation and the pros and cons of their decisions. Process recordings are a tool for improving communication technique, and therapeutic communication broadly underpins the relationship without specifically driving behavior change.

34. Which statement reflects the model of transactional communication?

1. Individuals use nonverbal body language to communicate.
2. Individuals simultaneously perceive each other.
3. Individuals use touch as a means of social communication.
4. Individuals use facial expressions to convey feelings.

Rationale: In the transactional model, both participants simultaneously perceive and listen to each other and are mutually involved in creating meaning in the relationship. The other options each describe a single channel of communication (nonverbal cues, touch, facial expression) rather than the transactional, two-way nature of the model.

35. The nurse observes a client sitting alone and crying after a group therapy session. The nurse sits in the chair nearest the client and states, "I see you are crying. I'd like to sit with you for a few minutes." Which communication technique is the nurse using?

1. Making an observation
2. Offering a general lead
3. Presenting reality
4. Silence

Rationale: The nurse is verbalizing and acknowledging what's observed — that the client is crying — which helps the client recognize their own feelings and behaviors.

36. A client tells the nurse, "I have nothing left to enjoy in life. My children are grown and married." The nurse replies, "I'm sure you are looking forward to having grandchildren." Which communication technique is this considered?

1. Giving advice
2. Reflecting
3. Using denial
4. Verbalizing the implied

Rationale: The nurse's response denies that a problem exists, which blocks discussion and avoids helping the client explore their difficulty. Reflecting would refer the client's own feelings back to them, and verbalizing the implied would put into words what the client indirectly suggested — this response does neither.

Multiple Response

37. Which individuals are communicating a message? Select all that apply.

1. A parent spanking her child for playing with matches
2. A teenager isolating himself and playing loud music
3. A biker sporting an eagle tattoo on a bicep
4. A teenager writing, "No one understands me"
5. A parent checking for new e-mail on a regular basis

Rationale: Spanking, isolating oneself, getting a tattoo, and writing a statement are all ways of communicating a message — an estimated 70% to 90% of communication is nonverbal. Checking e-mail doesn't count here because communication is a transaction between a sender and a receiver who are mutually engaged; checking for new mail doesn't involve that kind of interaction.

38. Which preexisting conditions influence the outcome of communication? Select all that apply.

1. Gender
2. Distance
3. Eye contact
4. Values
5. Paralanguage

Rationale: Gender, distance, and values are all preexisting conditions that shape how communication unfolds — gender through culturally recognized signals, distance through territoriality and environment, and values through symbolic behaviors that reflect belief systems. Eye contact and paralanguage are types of nonverbal communication in the workplace itself, not preexisting conditions that influence it.

39. Which nursing statements demonstrate useful feedback? Select all that apply.

1. "Hitting the wall yesterday was not the best way to express your anger."
2. "The hospital has a support group on Tuesdays for those who want to quit smoking."
3. "It appears you want to sit near the nurses' station when the morning meeting starts."
4. "Your behavior has been unacceptable since you were admitted to this unit."
5. "I noticed you participated in group more this afternoon than this morning."

Rationale: Useful feedback imparts information rather than advice, is specific rather than general, and targets a behavior the client has the capacity to modify — options 2, 3, and 5 all do this. Option 1 is delayed-response feedback given a day after the behavior, which limits its usefulness, and option 4 is too general to help the client identify what to change.