# A 32-year-old client with major depressive disorder is admitted following a recent job loss. The client makes intermittent eye contact, speaks slowly, and says, "I do not see how things will get better." Which response by the nurse is most therapeutic?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=363582&lang=en  
> language: en  
> subject: Therapeutic Communication  
> category: PSI

## Question

A 32-year-old client with major depressive disorder is admitted following a recent job loss. The client makes intermittent eye contact, speaks slowly, and says, "I do not see how things will get better." Which response by the nurse is most therapeutic?

## Option

1. Why do you think you lost your job?
2. Tell me more about how the job loss has affected you. **✔ Correct answer**
3. You should focus on finding a new job soon.
4. Things will get better in time. Many people lose their jobs.

**Correct answer: 2**

## Explanation

Therapeutic communication uses open-ended, exploratory, non-judgmental responses to build trust and clarify the client experience. Inviting the client to share more about the impact of the job loss validates feelings and gathers data without imposing the nurse agenda. False reassurance, why-questions, and giving advice are classic communication blocks that minimize feelings, sound accusatory, or take responsibility from the client.

## In-depth explanation

Clinical Judgment
Therapeutic communication priorities: empathy, active listening, open-ended exploration. The client is expressing hopelessness; safety screening for suicidal ideation should follow. Validating feelings precedes problem solving in NCLEX therapeutic communication.

Memory Tip
SOLER + open-ended: Sit upright, Open posture, Lean forward, Eye contact, Relax

KR vs US
Hildegard Peplau and Joyce Travelbee frameworks are taught in both US and Korean nursing curricula. Cultural humility is universal but expression styles differ. Korean clients may avoid direct eye contact as respect; this is not avoidance.

## Clinical scenario

Clinical Practice Guide
ANA Standards of Practice + Peplau Interpersonal Theory:
- Open-ended questions: "Tell me more about ...", "What is that like for you?"
- Reflection: restate client words to confirm understanding.
- Silence: allow processing time.
- Always include suicide screening when hopelessness is expressed: ask directly "Are you having thoughts of harming yourself?"
- Document client words verbatim, not paraphrased, when assessing safety.

Caution
Avoid 12 communication blocks: false reassurance, advice, agreement, disagreement, defending, judgmental responses, value statements, why-questions, probing, requesting explanation, changing subject, generalizing. "You should..." / "Do not worry..." / "Why..." all violate therapeutic communication.

## Key concepts

- **Therapeutic communication** — Goal-directed, client-centered communication that promotes understanding, expression of feelings, and problem solving. Built on empathy, active listening, open-ended questions, and unconditional positive regard. Foundation of nurse-client relationships in mental health and beyond.
- **Active listening / SOLER** — Egan SOLER framework: Sit squarely facing the client, Open posture, Lean toward the client, Eye contact, Relaxed demeanor. Combined with reflection and clarification to convey full attention.
- **Communication blocks** — 12 nontherapeutic responses to avoid: false reassurance, giving advice, agreement, disagreement, defending, judgmental responses, value statements, why-questions, probing, requesting explanation, changing subject, generalizing. NCLEX consistently tests recognition of these.

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