NCLEX Question Strategies: Communication Questions

  • 11 January, 2023

I don't know about you, but I consider myself to be a pretty good communicator! But the fact is, sometimes I say the wrong thing, am not focused on the person talking to me, or just selfishly turn the whole conversation back to myself. Sometimes I'm not a good communicator; I'm a good TALKER! Therapeutic communication involves LISTENING to and OBSERVING and is just as important as learning how to SPEAK to someone. So, when I step into the role of the nurse, my communication strategies need to shift.

On the NCLEX exam, you will come across questions that deal with communication strategies and building a trusting relationship with the client. Therapeutic communication falls under the Psychosocial Integrity category, but these questions are not just focused on the mental health setting or the client with a mental health disorder. Therapeutic communication strategies should be considered in all questions related to nursing and patient interaction. And although good communication skills are critical in interactions with co-workers, healthcare providers, clients, and the client's families, when it comes to NCLEX questions, your focus should be on the client.

NCLEX Question Strategies: Communication Questions

In this Blog,

A few strategies to use when answering NCLEX questions on communication:


A few strategies to use when answering NCLEX questions on communication:

1. Look for TRUST and COMFORT: As you read an NCLEX question, ask yourself how you would feel as a client with the nurse's actions or responses - would it make you feel comfortable and trusting, or would it put a barrier between you? Chances are that if it makes you feel that way, it would make the client feel that way too. The correct responses to therapeutic communication questions should help to build a therapeutic relationship between the nurse and the client.

2. Look for the BEST Answer: As with all NCLEX questions, remember that you are not looking for the correct answer; you need to select the best answer. One or all of the answers provided may be correct, but only one of the answers is the best.

3. Look for THERAPEUTIC Techniques: A therapeutic response will usually involve one of these communication techniques:
  • Accepting - allowing a client to express their feelings or talk about their actions without feeling judged is key to building a trusting relationship.
  • Active Listening - listening attentively (this usually means the nurse is not multi-tasking and is looking at the client). The nurse should pause other activities to look at and make eye contact with the client when possible.
  • Non-Verbal Responses - assessing nonverbal communication messages as well as making sure your own body language is non-threatening and open. A person's facial expressions, along with the way they sit, stand, fidget, or make (or don't make) eye contact, all communicate a message.
  • Broad Openings - showing an interest in the client to encourage the client to talk and allow the client to direct the conversation and topic.
  • Clarifying - asking questions regarding any vague or unclear information from the client.
  • Focusing - focusing the communication from a client down to a single, most important topic.
  • Reflecting/Restating - repeating or paraphrasing what the client said in a different way to make the client's answers clearer.
  • Silence - remember that silence is golden! Sometimes the client may need a few moments to think about what has been said. Brief silence can help show acceptance and empathy but also allows the client to be the leader in the conversation.

4. Look for NON-THERAPEUTIC Responses - With therapeutic communication questions, some of your answer choices should be able to be eliminated easily. You should be able to eliminate at least one or two answers based on non-therapeutic language. Here are a few answer examples that can be eliminated:

"Don't worry! Everything is going to be OK!" - Answers like this offer false reassurance, are often not truthful, and don't allow the client to properly express their feelings. Instead, look for the answer that provides truthful information to the client to build trust. Truthful answers might be, "you may feel some pain during the procedure. The procedure should be quick, and the provider will try to keep you as comfortable as possible." Or "I hear you saying you're scared; can you tell me what you're scared of?"

"Why...?" "What were you thinking?"- Although we all want to know the "why", in most settings, asking "why" is nontherapeutic. When you start asking a client why they did something, such as why they didn't take their medication, it puts the client on the defensive. Responses like this tell the client they have done something wrong and may shut down the therapeutic aspect of communication. Instead, focus on simply allowing the client to express if he or she feels scared, anxious, sad, mad, etc. Responses that encourage the client to talk might say, "tell me more about..."

"Are you mad?" "Are you in pain?" "Did you take your medicine today?" - Asking the client a question that provides only a yes or no answer or any other one-syllable answer doesn't encourage the client to use their own words to express what is happening or to expand on the situation. Instead, the client should be asked open-ended questions. Remember that a big part of therapeutic communication includes listening. Always look for a response that gives the nurse a better opportunity to listen than talk.

"I know how you feel!" - A response like this takes the focus away from the client and puts it on the nurse. Therapeutic responses should be client-focused. Instead, look for a response that offers validation of the client's feelings, such as, "that must have been scary for you. Tell me what happened."

I hope these suggestions will help you narrow down your answer choices to the BEST answer! And at the risk of sounding very non-therapeutic...as you go into your NCLEX exam, I know how you feel! 😉 To help you feel even more prepared entering the exam, EduMind is here to help you with a full review course!
About the Author: Lana Wilkins, MSN, BSN, RN

Lana Wilkins is a Registered Nurse with over 16 years of professional nursing. She is a nursing educator, consultant, Subject Matter Expert, and writer with a passion for helping students and new nurses. She holds a B.S. in Nursing from the University of Oklahoma and a M.S. in Nursing Education from Western Governors University. Outside of the world of nursing she can be found managing the chaos of 2 kids, a husband, and a cat, being crafty, or spending time with friends.

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