NURSING 101 module 4 with complete solution

A schizophrenic client says, “I’m away for the day ... but don’t think we should play or do we

have feet of clay?” Which alteration in the client’s speech does the nurse document?

• Word salad

• Associative looseness

• Clang association Correct

• Neologism

Rationale: Clang association is the meaningless rhyming of words in which the rhyming is more

important than the context of the words. A neologism is a made-up word that has meaning only

to the client. Word salad is the term for a mixture of meaningless phrases, either to the client or

to the listener. Associative looseness is a term used to describe schizophrenic speech in which

connections and threads are interrupted or missing.

Test-Taking Strategy: Knowledge of the speech patterns exhibited by the client with

schizophrenia is needed to answer this question. Focus on the subject in the question, the

meaningless rhyming of words. Review: these speech patterns .

Reference: Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental health nursing: A

communication approach to evidence-based care (p. 281). St. Louis: Saunders.

Cognitive Ability: Applying

Client Needs: Psychosocial Integrity

Integrated Process: Communication and Documentation

Content Area: Mental Health

Giddens Concepts: Clinical Judgment, Psychosis

HESI Concepts: Clinical Decision-Making/Clinical Judgment, Cognition—Psychosis Awarded

1.0 points out of 1.0 possible points.

2.ID: 9476884735

A client with schizophrenia and his parents are meeting with the nurse. One of the young man’s

parents says to the nurse, “We were stunned when we learned that our son had schizophrenia. He

was no different than from his older brother when they were growing up. Now he’s had another

relapse, and we can’t understand why he stopped his medication.” Which response by the nurse

is appropriate?

• Telling the parents, “Medication noncompliance is the most frequent reason that people

with this diagnosis relapse.”

• Saying to the parents, “Your concerns are appropriate, but I wonder whether your son

was having trouble telling someone that he had concerns about his medication.” 

• Asking the client, “How can we help you to take your medicine or to tell us when you’re

having problems so that your medication can be adjusted?” Correct

• Telling the parents, “Well, it’s his decision to take his medicine, but it’s yours to have

him live with you if he stops the medication.”

Rationale: The therapeutic response is the one in which the nurse models speaking directly to the

client. This facilitates further assessment of the situation and helps elicit the causes of and

motivations for the client’s behavior for both the nurse and the family. In the correct option, the

nurse also seeks clarification of the degree of openness and mutuality felt by the client and his

family toward each other. The nurse provides information to the family when stating that

noncompliance is the most frequent reason for relapse in people with this diagnosis. However,

the statement is nontherapeutic at this time because it does not facilitate the expression of

feelings. The nurse uses a superego style of communication when stating, “Well, it’s his decision

to take his medicine, but it’s yours to have him live with you if he stops the medication.” The

content of this statement may be true, but it is nontherapeutic in that it carries a threatening

message and may prevent the family from trusting the nurse. By stating, “Your concerns are

appropriate, but I wonder whether your son was having trouble telling someone that he had

concerns about his medication,” the nurse gives approval and prematurely analyzes the client’s

motivation without sufficient assessment.

Test-Taking Strategy: Use your knowledge of therapeutic communication techniques and

remember to focus on the client’s feelings. Also note that the correct option is the only option in

which the nurse directly addresses the client. Review: therapeutic communication techniques .

Reference: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp. 27-31).

St. Louis: Mosby.

Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental health nursing: A

communication approach to evidence-based care (p. 297). St. Louis: Saunders.

Cognitive Ability: Applying

Client Needs: Psychosocial Integrity

Integrated Process: Communication and Documentation

Content Area: Mental Health

Giddens Concepts: Adherence, Psychosis

HESI Concepts: Behaviors—Adherence, Cognition—Psychosis Awarded

1.0 points out of 1.0 possible points.

3.ID: 9476898981

An acutely ill schizophrenic client says to the nurse, “He keeps saying that he likes you, and I

keep telling him you’re married, but he won’t listen, and I think he’s going to get fresh with

you.” Once the nurse has determined that the client is hallucinating, which response to the client

would be most appropriate statement?

• “Try not to listen to the voices right now so that I can talk with you.” Correct

• “Tell him I said to mind his p’s and q’s or I’ll call the police on him.”

• “I think that you can help him stop his behavior if you concentrate.”