The nurse is caring for a client diagnosed with bipolar disorder. During the morning assessment, the client tells the nurse that she hears people in the room behind her bed talking about her. Which response by the nurse best reflects therapeutic communication?

  1. “What do you hear them saying?”
  2. “I will see if we can move you to another room.”
  3. “I will notify your doctor in case he wants to change your medications.”
  4. “I understand that the voices seem real to you, but I don’t see or hear anyone else in here.”
Number 4 is correct.
Rationale: Orienting the client to reality is the best therapeutic communication tool to use with this client. Presenting reality does not belittle the client or disregard her feelings, but provides an alternative line of thought to consider. Asking what the voices are saying encourages the behavior and may further confuse the client. Offering to move the patient to another room implies agreement that the voices are real. Notifying the physician is important with new-onset symptoms but is not a therapeutic response for this client as it fails to reorient to reality.