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NCLEX-RN · Psychosocial Integrity

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NCLEX-RN Therapeutic Communication, Coping and Crisis Summary

Importance
★★★★☆ (4 / 5)
Weight
About 4 of 8 Psychosocial Integrity questions (50%)

Therapeutic communication, coping with illness and loss, grief, crisis intervention, abuse and neglect, and cultural awareness.

📖 See Therapeutic Communication, Coping and Crisis concepts →

Therapeutic Communication, Coping and Crisis: must-know points

  • Open-ended, feeling-focused responses
  • Stages of grief
  • Mandatory reporting of abuse

Therapeutic Communication, Coping and Crisis: 6 sample questions

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."
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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
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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."
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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 questionReviewedPsychosocial Integrity › Therapeutic Communication, Coping and Crisis★★★★☆

Question 4. The nurse needs to explain discharge instructions to a client who speaks only Spanish. The nurse does not speak Spanish. What should the nurse do?

  1. ① Ask the client's 12-year-old child to interpret
  2. ② Arrange for a trained medical interpreter
  3. ③ Speak slowly and loudly in English
  4. ④ Use only hand gestures and pictures
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Answer: ② Arrange for a trained medical interpreter

Key point: Use a trained medical interpreter, not family members

A trained medical interpreter (in person, by phone, or by video) gives accurate, private communication. Clients have a right to language help. Medical words are hard to translate, and mistakes can cause harm.

Wrong choices

  • "Ask the client's 12-year-old child to interpret" is wrong. Children and family members may not know medical words, may change the message, and the client may not share private information.
  • "Speak slowly and loudly in English" does not help someone who does not understand English.
  • "Use only hand gestures and pictures" is not enough for important discharge instructions.
Practice questionReviewedPsychosocial Integrity › Therapeutic Communication, Coping and Crisis★★★★☆

Question 5. The wife of a client with advanced cancer tells the nurse, "If God lets him live until our daughter's wedding, I will go to church every day." Which stage of grief is the wife showing?

  1. ① Acceptance
  2. ② Denial
  3. ③ Bargaining
  4. ④ Anger
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Answer: ③ Bargaining

Key point: Bargaining: trying to make a deal to delay a loss

In bargaining, a person tries to make a deal, often with a higher power, to delay or change a loss. "If ... then I will ..." statements are typical. The nurse listens without judgment and supports the family.

Wrong choices

  • "Denial" would sound like refusing to believe the illness is real, such as "The tests must be wrong."
  • "Anger" would show as blaming or hostility, such as "Why is this happening to us?" said with rage.
  • "Acceptance" would show calm recognition of the loss and planning for it.
Practice questionReviewedPsychosocial Integrity › Therapeutic Communication, Coping and Crisis★★★★☆

Question 6. A client is brought to the emergency department after her house burned down. She is crying and says she cannot think straight. In crisis intervention, what is the nurse's first priority?

  1. ① Encourage the client to make major life decisions today
  2. ② Assess the client's immediate safety, including any thoughts of self-harm
  3. ③ Explore how the client's childhood affects her reaction
  4. ④ Refer the client for long-term counseling
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Answer: ② Assess the client's immediate safety, including any thoughts of self-harm

Key point: Crisis intervention: safety first, then immediate needs

Crisis intervention is short-term and focused on the present. The first priority is safety: Is the client hurt? Is she thinking of harming herself? After safety, the nurse helps with immediate needs such as a place to stay, contacts support people, and helps the client use coping skills.

Wrong choices

  • "Explore how the client's childhood affects her reaction" belongs to long-term therapy, not a crisis.
  • "Make major life decisions today" is not wise. People in crisis have trouble thinking clearly.
  • "Refer the client for long-term counseling" may help later, but it does not meet her urgent needs now.

Test yourself.

Therapeutic Communication, Coping and Crisis: 5 questions →Psychosocial Integrity: 5 questions →