Eliminate Answer Choices

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There are many questions on the NCLEX-PN^® exam that require you to select the correct therapeutic communication response. As with other NCLEX-PN^® exam questions, one of the biggest errors that students commit when trying to answer this type of question is to look for the correct answer. Remember, you are selecting the best answer from the four possible answers that you are given. To select the best answer, you must eliminate answer choices. Let’s look at some of the different answer choices you can eliminate:

• “Don’t worry” answers: Eliminate answer choices that offer false reassurance. These type of responses discourage communication between the LPN/LVN and the client by not allowing the client to explore his or her own ideas and feelings. False reassurance also discounts what the client is feeling. Examples include:
  • “It is going to be OK.”
  • “Don’t worry. Your doctors will do everything necessary for your care.”
• “Let’s explore” answers: Another incorrect answer choice that many graduate practical/vocational nurses select is the choice that includes the word “explore.” On the NCLEX-PN^® exam, avoid being a junior psychiatrist. It isn’t the practical/vocational nurse’s role to delve into the reasons why the client is feeling a particular way. The client must be allowed to verbalize the fact that he or she is sad, angry, fearful, or overwhelmed. Examples include:
  • “Let’s talk about why you didn’t take your medication.”
  • “Tell me why you really injured yourself.”
• “Why” questions: Eliminate answer choices that include “why” questions: ones that seek reasons or justification. “Why” questions imply disapproval of the client, who may become defensive. A “why” question can come in many forms and need not always begin with “why.” Any response that puts the client on the defensive is nontherapeutic and therefore incorrect. Examples include:
  • “What makes you think that?”
  • “Why do you feel this way?”
• Authoritarian answers: Eliminate answer choices in which the LPN/LVN is telling the client what to do without regard to the client’s desires or feelings. Examples include:
  • Insisting that the client follow unit rules
  • Insisting that the client do what you command, immediately
• Nurse-focused answers: Eliminate answer choices in which the focus of the comment is on the LPN/LVN. Be careful, because these answer choices may sound very empathetic. The focus of your communication should always be on the client. Examples include:
  • “That happened to me once.”
  • “I know from experience this is hard for you.”
• Closed-ended questions: Eliminate answer choices that include closed-ended questions that can be answered with yes, no, or another monosyllabic response. Closed-ended questions discourage the client from sharing thoughts and feelings. Examples include:
  • “Are you feeling guilty about what happened?”
  • “How many children do you have?”

Eliminating these types of nontherapeutic responses that appear as answer choices is a very effective strategy when answering therapeutic communication questions. Don’t simply look for the specific words that you see here; you may need to “translate” the answer choices into the above errors of therapeutic communication.