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NCLEX-RN · Psychosocial Integrity

NCLEX-RN: Therapeutic Communication, Coping and Crisis Concepts

Importance ★★★★☆ · 50% (estimate)

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Overview

This chapter teaches how to talk with clients in a way that helps them. It also covers how people cope with illness and loss, how to help in a crisis, how to respond to abuse, and how to respect culture and language.

Therapeutic responses keep the focus on the client's feelings. Open-ended questions and reflecting feelings invite the client to talk. Responses that block talk include 'why' questions, false reassurance, giving your own advice, changing the subject and talking about yourself.

Grief often moves through denial, anger, bargaining, depression and acceptance, but not always in order. In a crisis, focus on safety and the problem right now. Nurses must report suspected child abuse, and often elder abuse as state law requires, and a client facing partner violence should be interviewed alone. When a client speaks another language, use a trained medical interpreter, not a family member.

Key concepts

  • Open-ended question

    A question that cannot be answered with yes or no, such as 'What has this week been like for you?' It invites the client to share feelings.

    Memory tipStart with 'Tell me about...', 'How...' or 'What...'.

  • Reflecting feelings

    Naming the feeling you hear and giving it back to the client, such as 'You sound frightened about the surgery.'

    Memory tipOn the exam, the right answer often names a feeling and keeps the focus on the client.

  • Non-therapeutic responses

    Replies that shut down talk: 'why' questions, false reassurance ('Everything will be fine'), giving advice, changing the subject, or talking about yourself.

    Memory tipCross out any answer that promises a good outcome or asks 'why'.

  • Stages of grief

    A common way to describe grief: denial, anger, bargaining, depression and acceptance. People may skip stages or go back and forth.

    Memory tipBargaining often sounds like 'If I can just live until my daughter's wedding...'.

  • Crisis intervention

    Short-term help focused on the problem happening now. First make sure the client is safe, then help the client find support and next steps.

    Memory tipSafety first, then the here and now. Deep past issues wait.

  • Mandatory reporting

    Nurses must report suspected child abuse or neglect in every state. Duties to report abuse of older or dependent adults are set by state law and vary by state. Proof is not needed; reasonable suspicion is enough.

    Memory tipInterview a client about possible abuse alone, away from the partner or caregiver.

  • Medical interpreter

    A trained interpreter is used when the client and nurse do not share a language. Family members, especially children, should not interpret health information.

    Memory tipSpeak to the client, not the interpreter, and use short sentences.

Often tested

  • Pick the response that is open-ended and focused on the client's feelings.
  • Avoid 'why' questions, false reassurance and giving advice.
  • Grief stages do not always happen in order.
  • Suspected child abuse must be reported; elder abuse reporting rules vary by state. Suspicion is enough.
  • Interview a possible abuse victim alone and use a trained interpreter when needed.

Easy to confuse: Helpful and unhelpful replies

Client saysTherapeuticNon-therapeutic
'I'm scared about tomorrow.''Tell me more about what scares you.''Don't worry, you'll be fine.'
'I didn't take my pills.''What made it hard to take them?''Why didn't you take them?'
'Should I stop treatment?''What are your thoughts about it?''If I were you, I would...'

3 sample questions

Verified practice questions from this unit.

Practice questionReviewedPsychosocial Integrity › Therapeutic Communication, Coping and Crisis★★★★☆

Question 1. A client says, "I'm really scared about my surgery tomorrow." Which response by the nurse is most therapeutic?

  1. ① "Everyone feels that way before surgery."
  2. ② "Why are you scared?"
  3. ③ "Don't worry. Your surgeon is excellent."
  4. ④ "Tell me more about what is worrying you."
▼ Show answer and explanation▲ Hide answer and explanation

Answer: ④ "Tell me more about what is worrying you."

Key point: Open-ended questions invite clients to share feelings

An open-ended statement such as "Tell me more" invites the client to talk about the fear. This helps the nurse learn what the client is worried about (pain, anesthesia, results) and give the right support or information.

Wrong choices

  • "Don't worry. Your surgeon is excellent" is false reassurance. It brushes off the client's feelings.
  • "Why are you scared?" asks "why," which can make the client feel they must defend their feelings.
  • "Everyone feels that way" generalizes and makes the client's feelings seem unimportant.
Practice questionReviewedPsychosocial Integrity › Therapeutic Communication, Coping and Crisis★★★★☆

Question 2. While caring for a 4-year-old, the nurse notices bruises in different stages of healing on the child's back. The parent's story does not match the injuries. What should the nurse do?

  1. ① Ask the parents for permission to make a report
  2. ② Wait until there is clear proof of abuse before reporting
  3. ③ Report the suspected abuse to the agency required by state law, such as child protective services
  4. ④ Tell the parents that the nurse thinks they hurt the child
▼ Show answer and explanation▲ Hide answer and explanation

Answer: ③ Report the suspected abuse to the agency required by state law, such as child protective services

Key point: Nurses must report suspected child abuse; proof is not needed

Nurses are mandated reporters. State laws require them to report suspected child abuse or neglect. Proof is not needed; a reasonable suspicion is enough. Bruises in different stages of healing and a story that does not match the injuries are warning signs. The nurse also documents the findings objectively and keeps the child safe.

Wrong choices

  • "Wait until there is clear proof" is wrong. The law requires reporting a suspicion; investigators decide if abuse happened.
  • "Ask the parents for permission" is wrong. Permission is not needed and could put the child at greater risk.
  • "Tell the parents that the nurse thinks they hurt the child" could make the situation more dangerous for the child.
Practice questionReviewedPsychosocial Integrity › Therapeutic Communication, Coping and Crisis★★★★☆

Question 3. A client who was just told that his cancer has spread says quietly, "I don't see the point of going on anymore." Which response by the nurse is best?

  1. ① "Are you thinking about killing yourself?"
  2. ② "You have so much to live for."
  3. ③ "I'll come back later when you're feeling better."
  4. ④ "Let's talk about something more positive."
▼ Show answer and explanation▲ Hide answer and explanation

Answer: ① "Are you thinking about killing yourself?"

Key point: Ask directly about suicide when a client hints at it

A statement such as "I don't see the point of going on" may be a hint of suicidal thinking. The nurse should ask directly and clearly. Asking about suicide does not put the idea in a person's head. It shows the nurse takes the client seriously and lets the nurse check for risk and keep the client safe.

Wrong choices

  • "You have so much to live for" brushes off the client's feelings and may stop him from talking.
  • "Let's talk about something more positive" changes the subject and ignores a possible safety risk.
  • "I'll come back later" leaves the client alone when he may be at risk.
Practice 5 questions from this unit →