Domain C · Communication · 2–8% of scored items
NDHCE communication practice questions
5 original questions from the DHPrep starter set, with the correct answer and a rationale for every option. 1 of them use a shared case profile.
Communication in this set is a clinical action with a correct scope, not a tone. An option can sound kind and still withhold a fact the client needs, or sound direct and still overclaim what you saw.
Five starter questions match a blueprint share of about 2–8% of scored items. Four are spoken or nonverbal: what you say, in the moment, when a client asks for a judgment you cannot yet make. One is written: what belongs in the record for the next reader. One of the five uses a shared case profile.
How to work this set. Split a spoken response into three sentences you could actually say: what you observed, what you cannot conclude, and what happens next. The stronger option usually contains all three. On the written item, fail any note that would leave the next clinician believing a conclusion this visit did not establish.
Demonstrate effective oral and non-verbal communication
3 standalone questions in the free set.
Question 1
A client returns to the clinic after a restoration placed at another office chipped. The client asks the dental hygienist, "Did that dentist do poor work? I need to know whether I should complain." The chipped area is visible, and the record shows the restoration was placed four months ago. The dentist will be available next week. Which response best demonstrates open, honest and clear communication?
- A. Tell the client the previous dentist's technique was poor, since the client has a right to know what happened.
- B. Explain that the cause cannot be discussed today and that the client should wait until the dentist is available next week.
- C. Acknowledge the visible finding, state what cannot be determined today, and describe the options and next steps.Correct answer
- D. Reassure the client that chipping is normal and that nothing further needs to be done.
Answer
C. Acknowledge the visible finding, state what cannot be determined today, and describe the options and next steps.
Acknowledge the visible finding, be explicit about what cannot be determined at this visit, and describe the options and next steps (C).
Rationale
Open, honest and clear communication means giving the client accurate information that is within your knowledge, without overstating it and without withholding relevant facts. The hygienist can see the chipped restoration and can confirm that a chipped restoration can result from several causes, including occlusal loading, material factors, and pre-existing defects. No one who did not place and assess the restoration can conclude that technique was at fault, so assigning blame would be an unsupported judgment about another professional, and could also mislead the client about the strength of their complaint. Delaying all discussion is not required for honesty: the client can be given accurate information now and connected to the dentist for definitive assessment. False reassurance removes the client's opportunity to make a complaint or to seek repair, which is the client's decision to make. The response in C keeps the client informed and preserves both professional respect and the client's autonomy about what to do with the information.
Why each option lands where it does
- A. Stating that another dentist's technique was poor goes beyond what the hygienist can determine. The client does have a right to accurate information about their own care, but that right does not make an unverifiable judgment about a colleague appropriate or helpful.
- B. Saying nothing today is not necessary: the observable finding can be acknowledged and documented immediately. Deferring entirely withholds information the client is entitled to hear and leaves them uncertain about whether care is needed promptly.
- C (correct). This response separates what is known from what is not, gives the client a realistic picture, and identifies the next step without prescribing what the client should do about the other office. It maintains honesty and professional restraint together.
- D. Chipping four months after placement is not automatically "normal," and reassurance without assessment may discourage a client from having the restoration evaluated. It also answers a question the hygienist cannot yet answer.
Decision rule. When asked to judge another professional's work, describe observable facts and the limits of your knowledge, then point to the appropriate next step rather than assigning blame or withholding information.
Takeaway. Give the client the accurate information you have, name the limits of what you can determine, and let the client decide how to use it.
Common miss. That honesty about another provider's work requires commenting on that provider's competence.
Question 2
Which spoken explanation most clearly tells a client when and how to use interdental brushes?
- A. Clean between your teeth once a day before you brush, sliding the brush gently into each space and moving it back and forth a few times.Correct answer
- B. Perform interdental cleaning as prescribed for your periodontal condition.
- C. Use the interdental device whenever you feel it is needed.
- D. Clean interproximally at your discretion, ensuring adequate biofilm disruption.
Answer
A. Clean between your teeth once a day before you brush, sliding the brush gently into each space and moving it back and forth a few times.
Once a day, before brushing, sliding the brush gently into each space and moving it back and forth (A).
Rationale
Clear spoken instruction answers two questions in the client's own vocabulary: what to do and when to do it. This option gives a frequency, a sequence, a physical description of the action and a pace, all without clinical terms. The other options each fail a different way. Referring to a prescription for periodontal condition gives no instruction at all — the client still does not know when or how. Whenever you feel it is needed leaves both timing and technique to guesswork, which for a skill that depends on gentle, consistent placement is likely to produce missed spaces or rough use. Cleaning interproximally at your discretion is spoken in words most clients do not use and still says nothing concrete about how the brush should move.
Why each option lands where it does
- A (correct). A daily frequency, a clear sequence and a physical description of the movement give the client everything needed to try it tonight.
- B. As prescribed refers to an instruction that was never given in the sentence, leaving the client with no usable guidance.
- C. Whenever needed transfers the clinical decision to the client without teaching the technique or the schedule that makes it work.
- D. Technical vocabulary and discretion language assume knowledge the client may not have and still omit frequency and technique.
Decision rule. When giving verbal self-care instruction, state frequency, sequence and the physical motion in common language; remove terms the client would need a glossary for.
Takeaway. Plain spoken instruction names the action and the schedule in everyday words: what to do, when, and how it should feel.
Common miss. That professional terminology makes an instruction more precise for the client.
Question 3
A client says, 'I know you told me to floss, but by the end of the day I am just too tired to do anything more.' Which response best demonstrates active listening and empathy?
- A. Flossing only takes a minute, so I am sure you can find the time if you try.
- B. Most clients say that at first, so my advice is to build the habit anyway.
- C. Let us check whether your gums are improving before we discuss your routine.
- D. Reflect his evening comment and invite him to say more before solving.Correct answer
Answer
D. Reflect his evening comment and invite him to say more before solving.
Reflect what the client said about his evenings and invite him to say more before solving (D).
Rationale
Active listening is visible when the response shows the speaker was heard — naming the difficulty in his terms — and empathy keeps judgement out of that reflection. The keyed answer does both, and the invitation to say more gathers the detail any workable plan will need. The other responses move to correction or solution before understanding. Telling him a minute is not much dismisses the fatigue he actually described. Observing that others feel the same way normalises the problem but still instructs him to push through it. Deferring the conversation to outcome data turns a disclosure about his capacity into a charting matter and signals the concern was not taken seriously. Listening first is also practical: the plan that emerges from his evenings is likelier to survive than one imposed on them.
Why each option lands where it does
- A. Reassuring him the task is small denies the tiredness he described and answers a feeling with arithmetic.
- B. Normalising the struggle is not the same as hearing it, and build the habit anyway repeats the instruction he has just said is failing.
- C. Redirecting to clinical outcomes postpones his disclosure and implies the barrier only matters if the numbers change.
- D (correct). Reflection plus an invitation for more shows he was heard and gathers what a realistic plan needs — the essence of active listening.
Decision rule. Respond to stated obstacles by reflecting the client's experience without judgement and exploring before problem-solving.
Takeaway. Show you heard the obstacle in the client's own terms and invite more before offering solutions.
Common miss. That encouragement and quick fixes demonstrate good listening.
Use written communication effectively
1 standalone question in the free set.
Question 4
A dental hygienist is writing the narrative note after completing a periodontal assessment for a returning client. Which entry best demonstrates clear and accurate written expression in a clinical record?
- A. The entry "Pt difficult today; didn't seem to care much about flossing again" records the visit's main finding.
- B. "Gums looked bad in a few spots; recommended better home care."
- C. "Client needs to improve; will try harder next time."
- D. The entry that records measurable findings, the client's reported behaviour, and the action taken.Correct answer
Answer
D. The entry that records measurable findings, the client's reported behaviour, and the action taken.
The entry that records measurable findings, the client's reported behaviour, and the action taken (D).
Rationale
A clinical record exists to inform the next reader, and that requires specifics. The best entry states measurable findings — bleeding on probing at named aspects — plus the client's self-reported behaviour in her own terms and the intervention actually performed, each of which can be rechecked later and none of which guesses at motives or meanings. The other entries fail on the same axis: "difficult" and "didn't seem to care" record the writer's impression instead of behaviour; "looked bad" resists re-measurement and comparison; and "needs to improve" belongs to no one measurable and will never be actionable at the next visit. Objective, specific, dated entries turn a chart into a usable instrument rather than a diary of attitudes.
Why each option lands where it does
- A. Labels like difficult and didn't care record impressions and mind-reading, not observable clinical or behavioural data.
- B. Vague descriptions cannot be compared across visits and support no specific change in care.
- C. Requiring the client to try harder documents an evaluative judgment with no findings and no action taken.
- D (correct). Measurable findings, client-reported behaviour and the intervention performed give the next reader everything needed.
Decision rule. Write clinical records as objective findings, client-reported facts and actions taken, avoiding vague descriptors and conclusions about attitude.
Takeaway. Chart entries earn their place by being specific, measurable and free of judgments about the person.
Common miss. That a note becomes clinical documentation once it is written in the chart.
Case-based questions
Each profile below is shared with questions that test other domains. This page reprints the profile and only the questions tagged to this domain. The rest of that profile is on the domain page for each other question.
Case profile 1
Mr. Daniel Osei is a 58-year-old long-haul truck driver who visits town twice a month. He takes lisinopril and amlodipine for hypertension, reports occasional heartburn, and his most recent blood pressure reading was 152/94. He drinks two to three colas during overnight drives and has limited access to fresh food on the road. His last dental visit was two years ago. He prefers to be shown things rather than read them, and he keeps a soft toothbrush and no interdental aids in his work bag.
Question 5
After recommending interdental cleaning, the hygienist notices Mr. Osei skimming a printed handout without reading it, and he says he prefers being shown. Which communication approach best fits his needs?
- A. Hand him a more detailed pamphlet that explains the technique step by step for later reference.
- B. Repeat the verbal explanation more slowly, using the same words as before.
- C. Demonstrate the technique, have him practise it, and confirm understanding with teach-back.Correct answer
- D. Email him an instructional video and assume the video will cover anything he misses.
Answer
C. Demonstrate the technique, have him practise it, and confirm understanding with teach-back.
Demonstrate the technique, have him practise it, and confirm understanding with teach-back (C).
Rationale
Adjusting communication means changing how the message is delivered when the first format does not land. Mr. Osei has already signalled that he prefers being shown: this is a format mismatch, not a motivation problem. Demonstration with guided practice uses the channel he prefers, and asking him to explain the technique back verifies understanding in a way neither a handout nor repetition can. A longer pamphlet repeats the format that failed, and repeating identical words more slowly does not adapt to the receiver. Deferring everything to a video places the explanation where the hygienist cannot confirm it was understood and cannot correct technique errors while they can still be fixed.
Why each option lands where it does
- A. A denser version of the format he just skimmed increases reading load without addressing the delivery mismatch.
- B. Repeating the same words at a different speed does not change the channel the client has trouble with.
- C (correct). Demonstration with practice and teach-back delivers the message through his preferred channel and verifies it worked.
- D. An unverified video leaves the clinic without evidence of understanding and removes the opportunity to correct errors directly.
Decision rule. Adapt communication by matching the format to the client's stated preference and checking comprehension directly, rather than repeating or escalating the format that did not work.
Takeaway. When the format, not the message, is the problem, switch channels: show, practise, and confirm with teach-back.
Common miss. That more information in the same format solves an understanding problem.
Related study guides
- Client-centred communication on the NDHCE
Use it to separate a respectful tone from a response that actually gives the client the facts and the next step.
Frequently asked questions
What kinds of communication questions are in the free set?
Four ask what you say out loud when a client wants an answer you cannot fully give. One asks what the written record should contain. The blueprint range DHPrep uses is about 2–8% of scored items. The skill being tested is accuracy with a next step, not a warm tone by itself.
How do I choose between two answers that both sound respectful?
Split the response into what you observed, what you cannot conclude, and what happens next. The stronger option usually does all three. An option that withholds the observation, or that blames another clinician, fails even when the wording is polite.
Is there a written-communication question?
Yes, one. Treat the chart as a message to the next clinician. If an option would leave that reader with a conclusion the visit did not establish, it is not the key.
Practice more with DHPrep
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DHPrep is an independent preparation service. These are original practice questions, not official NDHCE items, and not a prediction of an exam result. DHPrep is not affiliated with, endorsed by, or sponsored by the Federation of Dental Hygiene Regulators of Canada (FDHRC). The US NBDHE has its own starter set inside an account; these pages are the Canadian questions only.