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NCLEX therapeutic communication practice questions

20 free NCLEX-style therapeutic communication questions: open-ended responses, reflecting feelings, and the blocks the exam marks wrong, like why questions and false reassurance, with full rationales.

Tap an answer to check it, or open "Show the answer and rationale" under each question. Every client is fictional. For exam practice only, not medical advice.

Question 1 of 20

A client with type 2 diabetes tells the nurse that she also sees a traditional healer from her community, who gave her an herbal tea to drink each day for her blood sugar. Which response by the nurse is most appropriate?

  1. 'Herbal teas are generally safe as long as you take your diabetes pills.'
  2. 'Please stop the tea until your provider says that it is safe.'
  3. 'Keep drinking the tea, and check your blood sugar more often for now.'
  4. 'What's in the tea? Let's check it against your other medicines.'
Show the answer and rationale

Answer: D

Culturally responsive care blends the client's traditional practices with the treatment plan whenever they are not harmful, so the nurse respects the healer's role and asks what the tea contains so the provider and pharmacist can check for interactions and effects on blood glucose. Continuing the tea while checking glucose more often sounds balanced, but it accepts an unknown product without finding out what is in it. Telling her to stop the tea before anyone knows what it contains dismisses the practice and may lead her to hide it, and assuming herbal products are safe overlooks real risks, including low blood glucose when they are combined with diabetes medicines.

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Question 2 of 20

A 58-year-old client with type 2 diabetes had a below-the-knee amputation of the right leg 3 days ago. When the nurse begins the dressing change, the client turns toward the wall and says, 'Just get it over with. I don't want to see it.' Which response by the nurse is most therapeutic?

  1. 'You'll be caring for the limb at home, so it's best to start looking at it today.'
  2. 'Once you're fitted for a prosthesis, no one will be able to tell the difference.'
  3. 'That's okay. I'll tell you how it is healing, and you can look when you're ready.'
  4. 'I can ask your provider for something to help you relax before each dressing change.'
Show the answer and rationale

Answer: C

Not wanting to see a new amputation is a common early response to a change in body image, and the client sets the pace for looking. Accepting the choice while describing how the limb is healing in plain, neutral words gives information and leaves the door open, and the nurse offers again at later dressing changes. Urging the client to look today because home care is coming is the runner-up: looking is a real goal, but pushing it before the client is ready adds distress and can harden the avoidance. Promising that no one will tell is false reassurance, and medication to relax treats a normal emotional response as something to sedate.

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Question 3 of 20

A client admitted to a mental health unit with depression mentions that her divorce became final last week, then says, 'I really don't want to get into that today.' Which response by the nurse is most appropriate?

  1. 'That's understandable. Many clients find divorce one of their hardest losses.'
  2. 'That's fine. If you want to talk about it later, I'll be here.'
  3. 'Talking it through with someone often helps more than holding it in.'
  4. 'It might help to get it off your chest. What happened between you?'
Show the answer and rationale

Answer: B

Respecting the client's wish not to discuss a painful topic, while making clear that the nurse will be available later, builds trust and leaves the client in control of the pace. The runner-up invites her to get it off her chest and asks what happened: it sounds like an invitation to talk, but it probes a topic the client has just declined and can make her withdraw. Saying that talking helps more than holding it in is gentler advice, yet it still argues with her stated wish, and noting that many clients find divorce a hard loss generalizes her experience instead of responding to her.

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Question 4 of 20

A client at 9 weeks of gestation with a planned pregnancy tells the nurse, 'Some days I'm thrilled, and other days I wonder if we've made a mistake.' Which response by the nurse is most appropriate?

  1. 'Have you talked with your partner about these feelings?'
  2. 'That's very common, and the feelings often fade by the second trimester.'
  3. 'It sounds as if part of you may not want to continue this pregnancy.'
  4. 'Mixed feelings early in pregnancy are common. Tell me more.'
Show the answer and rationale

Answer: D

Ambivalence is a normal response in the first trimester, even when a pregnancy is planned, as the client adjusts to the changes ahead, so the nurse normalizes the feeling and invites her to explore it. Saying the feelings often fade by the second trimester is true and normalizing, but it is reassurance that closes the topic instead of exploring it. Asking about her partner shifts the focus away from her own feelings with a yes-or-no question. Suggesting she may not want to continue treats normal ambivalence as a wish to end the pregnancy, which nothing in her statement suggests.

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Question 5 of 20

A 76-year-old client's biopsy shows advanced stomach cancer, and the provider plans to discuss the results this afternoon. The client's son tells the nurse, 'In our culture we protect our elders from news like this. Please don't tell my father he has cancer.' Which action by the nurse is most appropriate?

  1. Agree to keep the diagnosis from the client, since the family knows his values best
  2. Ask the client privately how much he wants to know and who should hear his results
  3. Explain to the son that his father has a legal right to know his own diagnosis
  4. Request an ethics consultation before the provider meets with the client today
Show the answer and rationale

Answer: B

In many cultures families shield elders from bad news, while US practice rests on the client's right to decide. Asking the client himself, in private, how much he wants to know and whether he would rather the family receive the information honors both, because a competent client may choose to hand that role to his son. Telling the son that his father has a right to know is the runner-up: it is true, but it sets up a conflict and assumes the client would not prefer the family's way. Simply agreeing to withhold the diagnosis lets the son decide for a competent adult, and an ethics consultation is premature before anyone has asked the client.

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Question 6 of 20

A client with advanced heart failure tells the nurse, 'I must have done something terrible for God to punish me like this.' Which response by the nurse is most appropriate?

  1. 'Would you like me to ask the chaplain to come by and talk with you?'
  2. 'You see your illness as a punishment. Tell me more about that.'
  3. 'Many clients find that prayer helps them cope with a serious illness.'
  4. 'God doesn't punish people with illness. Heart failure is a disease.'
Show the answer and rationale

Answer: B

The statement signals spiritual distress, so the nurse reflects the feeling and invites the client to explore it, then offers spiritual care if the client wishes. The runner-up offers a chaplain visit, which is a genuinely useful step, but it acts on the concern before the nurse has heard what the client believes or wants, so exploration comes first. Telling the client that God does not punish people imposes the nurse's beliefs and argues with the client's, and suggesting that prayer helps many clients generalizes and gives advice instead of listening to this client.

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Question 7 of 20

A client shouts at the nurse, 'I've had my call light on for 20 minutes! This place is a joke!' Which response by the nurse is most therapeutic?

  1. 'I know the wait felt long. Let me explain why we're running behind tonight.'
  2. 'There's no need to raise your voice with me. I'm here now.'
  3. 'You're upset that no one came when you needed help. What do you need?'
  4. 'Your light was answered as quickly as we could. What can I do for you?'
Show the answer and rationale

Answer: C

Acknowledging the client's frustration and asking what is needed validates the feeling and moves toward solving the problem, which usually defuses anger. The runner-up is answering as quickly as possible and then asking what the client needs: it does offer help, but leading with a defense disputes the client's experience and keeps the focus on the staff. Explaining why the unit is running behind also defends the staff instead of hearing the feeling, and scolding the client for raising a voice dismisses the frustration behind the outburst. Each of those responses tends to escalate the conflict.

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Question 8 of 20

A 62-year-old client admitted 2 days ago with a myocardial infarction has turned on the call light six times in the past hour, each time with a small request. On the last visit the client says, 'I just don't like being alone in here. What if something happens and nobody knows?' Which action by the nurse is most appropriate?

  1. Ask the provider for a prescription for an as-needed antianxiety medication
  2. Promise to check in every 30 minutes, and then return at each of those times
  3. Remind the client to save the call light for urgent needs so others can be helped
  4. Explain that the cardiac monitor alerts the nurses' station if the rhythm changes
Show the answer and rationale

Answer: B

Frequent call-light use with small requests often signals anxiety about being alone, and promising checks at set times, then keeping the promise, builds trust and lowers the need to call. Explaining the remote monitor is the runner-up: accurate information helps, but it does not meet the client's need for human contact, and many clients still fear that no one is watching. Medication is not the first response to understandable situational anxiety, and telling the client to save the call light for emergencies adds to the fear and may delay the report of real symptoms such as chest pain.

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Question 9 of 20

A client with terminal pancreatic cancer tells the nurse, 'If I can just make it to my granddaughter's wedding in June, I'll be ready to go.' Which response by the nurse is most appropriate?

  1. 'Let's focus on keeping you strong so you can be there.'
  2. 'It sounds like you're bargaining, which is a normal part of grief.'
  3. 'Setting a goal like the wedding can help you keep fighting.'
  4. 'The wedding sounds very important to you. Tell me about it.'
Show the answer and rationale

Answer: D

The client is bargaining, trying to postpone a loss in exchange for reaching a goal, and the nurse supports the client by listening and exploring what the event means. The runner-up focuses on keeping the client strong enough to reach the wedding: it is caring and goal-aligned, but it steers the talk toward treatment and the body instead of what the day means to the client. Framing the goal as a reason to keep fighting imposes the nurse's agenda on it, and naming the stage as bargaining is accurate but turns the talk toward theory rather than inviting the client to share.

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Question 10 of 20

A nurse is discussing advance care planning with a 68-year-old client with end-stage kidney disease. The client says, 'In my family's tradition, talking about death can make it happen. I don't want to talk about dying.' Which response by the nurse is most appropriate?

  1. 'Talking about death won't cause it, but I can see why the idea worries you.'
  2. 'Could we talk about what someone in a situation like yours might want?'
  3. 'Without a plan in place, others may have to make choices you wouldn't want.'
  4. 'I understand. We'll skip the advance directive, and I'll note that you declined.'
Show the answer and rationale

Answer: B

In some traditions, speaking about death or a bad outcome is believed to bring it about, so the nurse respects the belief and changes the approach, for example by talking about a hypothetical person in a similar situation or asking whether a family member should lead the discussion. Warning that others may make unwanted choices is the runner-up because it is true, but it pressures the client and ignores the belief. Correcting the belief dismisses it, even when paired with empathy, and simply recording a refusal ends a conversation that could still happen in a way the client accepts.

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Question 11 of 20

A 71-year-old client with metastatic lung cancer has decided to stop chemotherapy and enroll in hospice. In the hallway, the client's daughter tells the nurse, 'She's just giving up. Please talk her into one more round.' Which response by the nurse is most appropriate?

  1. 'I'll ask her oncologist to go over the benefits of one more round with her.'
  2. 'Choosing hospice isn't giving up, and she can change her mind later on.'
  3. 'This is hard to hear. Would it help to sit down with her and hear her reasons?'
  4. 'It's her decision to make, and the team has to respect what she wants.'
Show the answer and rationale

Answer: C

The client has made an informed choice, and the daughter is grieving the loss to come. Acknowledging how hard this is and offering a conversation where she can hear her mother's reasons and goals supports the daughter without undermining the client. Saying that the team must respect the decision is the runner-up because it is true, but it ends the conversation and leaves the daughter alone with her distress. Reassuring her that hospice is not giving up is accurate but skips her feelings, and asking the oncologist to push more treatment works against a competent client's choice.

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Question 12 of 20

The son of a client who is dying of metastatic prostate cancer comes out of the room and shouts at the nurse, 'He's moaning in there! You people are just letting him suffer!' The client's last dose of morphine was 3 hours ago, and an as-needed dose is available now. Which response by the nurse is best?

  1. 'Anger is a normal part of grief. Would you like to talk with the chaplain?'
  2. 'Moaning near the end of life doesn't always mean that he's in pain.'
  3. 'This is hard to watch. Let's go in together and see what he needs.'
  4. 'I can see you're upset, but please lower your voice. Others are resting.'
Show the answer and rationale

Answer: C

A family member's anger at the bedside of a dying client often comes from helplessness and fear that the client is suffering, and the concern may be valid. Acknowledging the feeling and going in with the son to assess the client, then giving the available as-needed dose if the assessment shows pain, answers both the emotion and the problem. Saying that moaning may not mean pain is the runner-up because it is meant to comfort, but offered before any assessment it dismisses both his concern and a possible need for medication. Asking him to lower his voice puts unit rules ahead of his distress, and labeling his anger as grief and calling the chaplain sidesteps the complaint.

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Question 13 of 20

A 45-year-old client admitted with a bleeding duodenal ulcer has a hemoglobin of 6.9 g/dL. The client is alert and oriented and says, 'I'm one of Jehovah's Witnesses. I won't accept a blood transfusion, even if I could die without it.' Which response by the nurse is most appropriate?

  1. 'Without blood, your hemoglobin could drop low enough to stop your heart.'
  2. 'Which treatments are acceptable to you? I'll share them with your provider.'
  3. 'I'll ask the provider about a court order, since your life is in danger.'
  4. 'Your family may see this differently. Would you like me to call them in to talk?'
Show the answer and rationale

Answer: B

A competent adult may refuse blood. Jehovah's Witnesses refuse whole blood and its four primary components, red cells, white cells, platelets, and plasma, but each person decides about fractions such as clotting factors, so asking which treatments are acceptable respects the belief and gives the provider what is needed to plan alternatives. Warning that the heart could stop is the runner-up: the risks must be explained, but that is the provider's informed-refusal discussion, and from the nurse now it sounds like pressure. Calling in family to change the client's mind and seeking a court order both override a competent adult's decision.

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Question 14 of 20

During a group therapy session on a mental health unit, one client has talked for most of the hour and interrupts others whenever they begin to speak. Which response by the nurse leading the group is most appropriate?

  1. 'You're talking too much, and the others never get a chance.'
  2. 'Thank you for sharing. Let's hear how others have handled this.'
  3. 'We need to move on now. Who else would like to share next?'
  4. 'Group, please give him your attention until he finishes his point.'
Show the answer and rationale

Answer: B

The group leader acknowledges the monopolizing member's contribution and then redirects the discussion to other members, which protects that member's self-esteem while keeping the group productive. The runner-up moves the group on and invites someone else to share, which does redirect, but it cuts the client off without any acknowledgment and can feel like a public dismissal. Criticizing the client in front of peers is humiliating, and asking the group to keep listening until he finishes rewards the monopolizing and silences everyone else.

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Question 15 of 20

A 26-year-old client with ulcerative colitis had a total colectomy with an ileostomy 5 days ago. While the nurse is teaching pouch emptying, the client asks quietly, 'Will I ever be able to have sex without this getting in the way?' Which response by the nurse is best?

  1. 'That's a good question to bring up with your surgeon at the follow-up visit.'
  2. 'Let's finish the pouch care first, and then we can talk about that another day.'
  3. 'If your partner truly cares about you, the ostomy won't change anything.'
  4. 'Many people with an ostomy return to an active sex life. What worries you most?'
Show the answer and rationale

Answer: D

Concerns about sexuality after an ostomy are common, and a client who raises the topic is ready to discuss it, so the nurse answers honestly that many people return to an active sex life and then asks about the specific worry; practical tips such as emptying the pouch beforehand or using a pouch cover can follow. Postponing the topic until pouch care is learned is the runner-up because teaching is under way, but it signals that the concern is unwelcome and may not be raised again. Sending the question to the surgeon deflects something within nursing scope, and tying acceptance to the partner's love is false reassurance.

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Question 16 of 20

A client who has met with the nurse for one-to-one sessions during a 3-week stay on a mental health unit will be discharged tomorrow. The client says, 'You've helped me more than anyone. Can I have your phone number so we can stay in touch?' Which response by the nurse is most appropriate?

  1. 'Contact stays here on the unit, but I'll check on you weekly through your outpatient counselor.'
  2. 'I can't share my number, but you can call the unit and ask for me after you leave.'
  3. 'Let's exchange contact information so we can check in once you're settled at home.'
  4. 'Our work ends when you leave. Let's review your progress and supports.'
Show the answer and rationale

Answer: D

In termination, the nurse keeps the relationship professional, reviews progress, and helps the client rely on outpatient providers and personal supports after discharge, as in the key response. The runner-up is checking on the client weekly through the outpatient counselor: the contact is indirect, but the nurse is still arranging ongoing personal follow-up after discharge, which prolongs attachment instead of transferring trust to the new provider. Inviting calls to the unit to ask for the nurse and exchanging contact information to check in at home also continue a personal relationship beyond the therapeutic one.

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Question 17 of 20

A client tells the nurse that her former husband died last week. They divorced 10 years ago but stayed close, and she says, 'I can't stop crying, but I feel like I don't have the right to be this upset. Everyone acts like it shouldn't matter to me.' Which response by the nurse is most therapeutic?

  1. 'Why do you think the people around you feel it shouldn't matter?'
  2. 'He mattered to you, and your grief is real. Tell me more about him.'
  3. 'Crying is a healthy release, and it will get easier with time.'
  4. 'A grief support group could help. Would you like information about one?'
Show the answer and rationale

Answer: B

Disenfranchised grief is grief that others do not openly recognize or support, as after the death of a former spouse, a pregnancy loss, or the death of a pet, and the nurse helps by validating the loss and inviting the client to talk about it. Offering a grief support group is a reasonable later step, but suggesting it now moves past her feelings before the nurse has acknowledged them. Saying it will get easier with time is false reassurance that minimizes what she feels, and asking why others feel that way puts her on the defensive and shifts the focus away from her loss.

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Question 18 of 20

The daughter of a client with advanced Alzheimer's disease says to the nurse, 'My brothers think Mom should move to a memory care facility. What would you do if she were your mother?' Which response by the nurse is most therapeutic?

  1. 'Try not to feel torn about it โ€” moving her is what most families eventually do.'
  2. 'It's a hard decision. What are you weighing as you think it over?'
  3. 'I can't decide for your family, but let me tell you what usually works best at this stage.'
  4. 'Memory care staff are trained for this stage, so your brothers may have a point.'
Show the answer and rationale

Answer: B

Inviting the daughter to say what she is weighing helps her explore her own thoughts and feelings and reach a decision that fits her family's values; the nurse can add facts about care options or arrange a family meeting with social work. The runner-up is noting that the brothers may have a point: it sounds factual, but it sides with one part of the family and can deepen the conflict between the siblings. Telling her what usually works best substitutes the nurse's judgment for the family's, and urging her not to feel torn dismisses feelings she has not yet had a chance to express.

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Question 19 of 20

A 19-year-old client was the driver in a car crash 2 days ago in which his best friend, a passenger, was killed. The client has a fractured femur and keeps saying, 'It should have been me. I was the one driving.' He denies any thoughts of harming himself. Which response by the nurse is most therapeutic?

  1. 'It sounds like you're carrying a lot of guilt about what happened.'
  2. 'I can sit with you for a while if you'd like to talk about your friend.'
  3. 'Writing a letter to your friend, saying what you wish you could tell him, may help.'
  4. 'You can't blame yourself for something you couldn't control.'
Show the answer and rationale

Answer: A

Survivor guilt is common after a crash in which someone else died, and the client needs to voice it before he can work through it. Reflecting the guilt he has named invites him to keep talking and shows the nurse is not afraid of the feeling; the nurse keeps reassessing for thoughts of self-harm as he talks. The runner-up is telling him he cannot blame himself for something he could not control: it sounds kind, but it argues with his feelings and closes the topic. Sitting with him to talk about his friend offers presence but steers away from the guilt he is voicing, and suggesting a letter to his friend is a later coping step, not a response to what he has just said.

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Question 20 of 20

A nurse is admitting a client who speaks limited English. The client's 12-year-old daughter offers to interpret. Which action by the nurse is most appropriate?

  1. Arrange a qualified medical interpreter by phone, video, or in person
  2. Ask a bilingual housekeeper on the unit to interpret for the admission
  3. Speak slowly in English and use gestures to confirm understanding
  4. Accept the daughter's offer, since the client trusts her and she is fluent
Show the answer and rationale

Answer: A

A qualified medical interpreter, whether in person, by phone, or by video, ensures accurate and confidential communication, and federal rules bar relying on a minor child to interpret except in an emergency when no qualified interpreter is available. A child may leave out or soften sensitive information and should not carry that burden, and an untrained bilingual employee may lack medical vocabulary and compromises privacy. Slow English and gestures cannot confirm understanding; the nurse also documents the client's preferred language and the interpreter used.

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