Communication & Interpersonal Skills

A patient who is deaf and uses British Sign Language needs to give consent for a procedure. What is the most appropriate action?

• AProceed without any explanation, because the procedure is a routine one
• BAsk a family member to interpret to save time
• CArrange a registered BSL interpreter to ensure accurate communication✓
• DWrite everything down on paper and assume that the patient has understood it

Answer: Valid consent requires the patient to understand the information given, so a registered interpreter should be arranged for a BSL user. Relying on family members risks inaccurate or biased interpretation.

During a difficult conversation, a patient becomes upset and tearful. Which response demonstrates effective therapeutic communication?

• AAcknowledge their feelings, allow silence and listen actively✓
• BTell them not to worry and reassure them that everything will be fine
• CQuickly change the subject to something lighter to lift the patient's mood
• DLeave the room to give them some privacy, and do not return for the rest of the shift

Answer: Active listening, acknowledging emotions and allowing silence show empathy and build therapeutic rapport. Dismissing feelings or offering false reassurance undermines effective communication.

When handing over a patient using the SBAR tool, what does the 'R' stand for?

• ARecord
• BResult
• CRecommendation✓
• DResponse

Answer: In SBAR the letters stand for Situation, Background, Assessment and Recommendation. The recommendation states what the nurse wants to happen next, supporting safe and structured handover.

A patient with limited English appears not to understand their discharge instructions. What is the safest approach?

• AAsk another patient on the ward who speaks the language to do the translating
• BUse a professional interpreter and check understanding with teach-back✓
• CSpeak louder and use more hand gestures
• DGive them written leaflets in English and assume that they will read them later

Answer: A professional interpreter ensures accurate communication, and teach-back confirms the patient genuinely understands. This protects patient safety and supports informed self-care after discharge.

A distressed relative is shouting at a nurse in a busy corridor. What is the most appropriate first response?

• AShout back at the relative to assert control of the situation in the corridor
• BWalk away and ignore the relative until they have calmed down on their own
• CStay calm, lower your voice and offer to talk privately✓
• DThreaten to call the security team straight away unless the relative stops shouting

Answer: Remaining calm, using a quiet tone and offering a private space helps de-escalate the situation and shows respect. Matching aggression or dismissing the person escalates conflict.

Which of these is an open question?

• AWould you say you are in pain at the moment?
• BHave you taken your tablets this morning, as usual?
• CHow have you been feeling since the operation?✓
• DDid you manage to sleep well on the ward last night?

Answer: Open questions invite a fuller answer and cannot be answered with just yes or no. The other examples are closed questions.

In Egan's SOLER model of active listening, what does the 'O' stand for?

• AOffer advice
• BObserve silence
• CObtain consent
• DOpen posture✓

Answer: SOLER stands for Sit squarely, Open posture, Lean slightly forward, Eye contact and Relax. It describes non-verbal behaviours that show attentive listening.

In the SPIKES framework for breaking bad news, what does the first 'S' stand for?

• ASetting✓
• BSupport
• CSummary
• DSilence

Answer: SPIKES stands for Setting, Perception, Invitation, Knowledge, Emotions and Strategy (or summary). It begins by choosing a private, suitable setting.

How should you communicate with a patient who wears hearing aids?

• ASpeak slowly and exaggerate every word you say
• BSpeak loudly into their ear from beside the bed
• CWrite every message down and avoid speaking
• DFace them and speak clearly in a quiet place✓

Answer: Facing the person helps lip-reading, and clear speech with less background noise helps the hearing aid. Shouting and exaggerated speech distort sounds and lip patterns.

A person with a learning disability brings a hospital passport. What is it?

• AA form giving the hospital consent for all treatment
• BA record of the person's hospital appointments
• CA travel document needed to transfer between wards
• DA document about their needs, health and preferences✓

Answer: A hospital passport gives staff important information about the person, such as how they communicate, their health needs and what they like and dislike, so reasonable adjustments can be made.

Why should a patient's child not normally be used as an interpreter?

• AChildren are not allowed to visit hospital wards at all
• BChildren usually speak a different language from parents
• CIt is faster to use a professional interpreter by phone
• DIt risks errors, distress and breached confidentiality✓

Answer: Family members, especially children, may translate inaccurately, filter information or be distressed by it, and the patient may not speak freely. A professional interpreter should be used.

What is Makaton?

• AA written test of a patient's understanding of English
• BA pain assessment tool for people with dementia
• CA system of signs and symbols used with speech✓
• DA handover tool used between nursing shifts

Answer: Makaton uses signs and symbols alongside speech to support communication, and is widely used with people who have learning disabilities.

A patient is becoming agitated and raising their voice. Which approach is recommended to de-escalate the situation?

• ASpeak calmly, give them space and listen✓
• BStand close and tell them firmly to calm down at once
• CCall security straight away before speaking to them
• DIgnore the behaviour until they stop shouting

Answer: De-escalation techniques include a calm, non-threatening manner, allowing personal space and listening to the person's concerns. Restrictive options are a last resort.

A patient is about to have an intimate examination. What should they be offered?

• AA sedative
• BA leaflet only
• CA chaperone✓
• DA visitor

Answer: Patients should be offered a chaperone for intimate examinations, and their wishes and any decision should be recorded.

A patient has expressive aphasia after a stroke. How can you best support communication?

• AUse long, detailed explanations so nothing is left out
• BSpeak to their relatives instead, as the patient cannot understand
• CAsk simple closed questions and use pictures, allowing extra time✓
• DFinish their sentences quickly so they do not become frustrated

Answer: In expressive aphasia the person often understands more than they can say. Simple yes/no questions, communication aids and time help them express themselves.

In the ISBAR handover tool, what does the 'I' stand for?

• AInstruct
• BInform
• CInvestigate
• DIdentify✓

Answer: ISBAR adds 'Identify' (yourself and the patient) to Situation, Background, Assessment and Recommendation.

A relative tells you they want to complain about their mother's care. What should you do first?

• ATell them to put it in writing to the chief executive first
• BExplain that staff shortages are to blame, so nobody is at fault
• CListen, acknowledge their concern and explain how to complain✓
• DSuggest they wait until their mother has been discharged

Answer: Listening and acknowledging the concern may resolve it early. They should be told how to raise a formal complaint, for example through the Patient Advice and Liaison Service (PALS) in England.