Therapeutic communication items test one thing: whether you can hear what a client is really saying and answer in a way that keeps them talking. NMCN therapeutic communication questions rarely ask you to define a term. Most of them drop you into a short nurse–client exchange and ask which reply is best — or which one a nurse should avoid. This page teaches you the item shapes, how the wrong options are built, and a simple method for choosing the right one. It does not contain leaked or actual examination questions. Question formats and syllabus content can change, so confirm current details with the Nursing and Midwifery Council of Nigeria (NMCN). Ready to test yourself? Take free NMCN practice questions.
Common Therapeutic Communication Item Formats
Communication items look different from calculation or drug items. There is usually no figure to work out. The whole task sits in the wording of the stem and the four or five replies underneath it.
Most of them arrive in one of four shapes:
| Format | What you are asked | What it tests |
|---|---|---|
| Best response | Which reply should the nurse give? | Choosing a therapeutic technique that fits the moment |
| Nontherapeutic identification | Which statement by the nurse is nontherapeutic / should be avoided? | Recognising blocks to communication |
| Dialogue evaluation | What technique did the nurse use? Did the interaction go well? | Naming and judging what happened in an exchange |
| Term matching | Which term describes the nurse's statement? | Vocabulary — restating, reflecting, clarifying, silence |
The stem is where the answer hides. Words like initially, best, most appropriate, avoid and except change the job completely. Read the stem twice before you look at the options. The wider set of formats used across the paper is covered in NMCN Exam Patterns: Recurring Question Formats to Expect.
Best Response vs Nontherapeutic Response
These two feel similar but ask opposite things, and mixing them up is one of the most common ways students lose easy marks.
In a best response item, every option is something a nurse could plausibly say. You pick the one that opens the conversation, accepts the client's feeling, and stays on the client's topic. The other three are not outrageous — they are just weaker.
In a nontherapeutic response item, you pick the option that breaks a communication principle. Three options will be sound and one will shut the client down. The trap is that the nontherapeutic option often sounds kind or reassuring in ordinary conversation. "Don't worry, everything will be fine" is a warm thing to say to a friend. In a nursing item it is false reassurance, and it is usually the answer to a "which is nontherapeutic" question.
Practical rule: if the stem contains a negative — nontherapeutic, avoid, except, least appropriate — circle it mentally before you read the options. Your brain will otherwise drift towards picking the good reply out of habit.
What Makes an Option Nontherapeutic
Wrong options are not random. They are built from a fixed set of communication blocks, and once you can name them you will spot them quickly.
- Giving advice. "You should leave him and move on." The nurse takes over the client's decisions instead of helping the client think.
- False reassurance. "It will all work out, don't worry." It dismisses the fear the client just expressed.
- Changing the subject. "Let's talk about something more cheerful." It tells the client their concern is unwelcome.
- Asking "why". "Why did you stop your medication?" It can sound like an accusation and invites the client to justify themselves. "What made it hard to keep taking it?" works better.
- Closed questions. "Are you sleeping well?" invites yes or no and ends the exchange there.
- Approval or disapproval. "That was a very good decision." Praise sounds positive, but it places the nurse in a judging position, and clients learn to perform for approval.
- Defending. "The ward is not noisy, we keep it quiet at night." The nurse protects the institution instead of hearing the complaint.
- Minimising. "Other people have it much worse." It shrinks the client's experience.
- Probing. Firing several questions in a row with no space to answer.
- Interpreting too early. "You're only saying that because you're angry with your mother." The nurse supplies a meaning the client has not offered.
Each of those tells the client, in effect, that their feeling is too much trouble. A therapeutic reply does the opposite: it shows the feeling was heard and leaves room for more.
How to Choose an Open, Accepting Reply
You do not need to memorise a list of techniques to answer these items. Run every option through the same short set of checks.
- Find the feeling. Underline the emotion in the client's line — fear, shame, anger, hopelessness. The right option usually names or respects it.
- Ask who the statement is about. A therapeutic reply keeps the focus on the client. A reply about the nurse, the hospital, the family or the doctor is usually a decoy.
- Check for added facts. Options that introduce information the client never gave — a diagnosis, a motive, a promise about the future — are almost always wrong.
- Test whether it opens or closes. Would the client find it easy to say more after that reply? If not, the option closes the conversation.
- Prefer the plain, honest sentence. The correct option is often the quietest one: a short restatement, an offer to listen, or a well-placed silence.
Useful techniques you will see named in options include restating ("So you felt ignored when no one came"), reflecting ("You sound frightened about going home"), offering a general lead ("Tell me more about that"), clarifying ("I'm not sure I followed — you said the voices started when?"), and using silence.
Worked Example: Nurse-Client Dialogue
Client: "My husband didn't visit again today. I don't think he cares anymore."
Options:
- "Don't worry, I'm sure he'll come tomorrow."
- "You feel your husband has stopped caring because he didn't visit."
- "Why do you think he didn't come?"
- "You shouldn't say that. He probably has work."
Best answer: 2. It restates the client's feeling without adding a single fact she did not give, and it invites her to continue.
Option 1 is false reassurance and makes a promise about tomorrow that the nurse cannot keep. Option 3 uses "why", which can land as a demand that she justify her feeling — and it shifts the focus onto the husband's reasons. Option 4 disapproves of the client and defends the husband, so the client learns to keep such feelings to herself.
Notice what the correct option did not do. It did not solve anything, give advice, or supply a diagnosis. That restraint is the whole technique.
Quick Practice: Label the Response
Cover the answers, label each nurse statement as therapeutic or nontherapeutic, and name the technique where you can.
- "Everything will be fine, you'll see."
- "Tell me more about that."
- "You shouldn't feel that way about your mother."
- "So you're saying the medication makes you drowsy in the morning?"
- "Let's talk about something happier."
- "Why did you stop taking your drugs?"
Answers. 1 — nontherapeutic, false reassurance. 2 — therapeutic, offering a general lead. 3 — nontherapeutic, disapproval or value judgement. 4 — therapeutic, restating or paraphrasing. 5 — nontherapeutic, changing the subject. 6 — weak, because "why" can sound accusatory; "What made it difficult to keep taking the medication?" is the stronger version.
Two habits will carry you further than memorising techniques. First, read the stem for the negative words before you look at the options, so you know whether you are hunting a good reply or a bad one. Second, when you review a past question, write the technique name beside every option, including the wrong ones — that is where most of the learning sits. For anything time-sensitive about the examination itself, including the current syllabus and paper format, go to the Nursing and Midwifery Council of Nigeria rather than a student forum.