Module 4
1.ID: 9476884715
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.”
· “I think that you’re trying to share your own feelings toward me, but you’re shy.”
Rationale: The appropriate statement by the nurse is the one that does not acknowledge
the client’s hallucinations. By responding, “I think that you can help him stop his
,behavior if you concentrate” or “Tell him I said to mind his p’s and q’s or I’ll call the
police on him,” the nurse acknowledges the hallucinations. The nurse attempts to
interpret the client’s thinking with a statement such as “I think that you’re trying to share
your own feelings toward me, but you’re shy.”
Test-Taking Strategy: Note the strategic words “most appropriate.” Use your knowledge
of therapeutic communication techniques and remember that the nurse should not
acknowledge the client’s hallucinations. Also note that the correct option is the only one
that encourages realistic verbalization from the client. Review: therapeutic
communication techniques with a client who is hallucinating .
References: 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 (pp. 287, 288). St. Louis: Saunders.
Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Content Area: Mental Health
Giddens Concepts: Communication, Psychosis
HESI Concepts: Cognition—Psychosis, Communication
Awarded 1.0 points out of 1.0 possible points.
4.ID: 9476882056
A client says to the nurse, “It’s over for me — the whole thing is over.” Which response
by the nurse would be therapeutic?
· “What do you mean, ‘The whole thing is over’?”
· “Can you tell me more about why it’s over for you? I’ll keep your thoughts
strictly confidential.” Incorrect
· “Let’s talk more about your feeling that the whole thing is over for you. This is
important, and I may need to share your feelings with other staff members.”
Correct
· “Over? Well, that sounds pretty drastic to me. Let’s discuss this in the strictest
confidence.”
Rationale: The therapeutic response seeks clarification, employs paraphrasing, and
informs the client that the nurse needs to share any information that requires crisis
intervention with other staff members. Asking, “What do you mean, ‘The whole thing is
over’?” employs paraphrasing, but the message is blunt and closed-ended. In stating,
“Over? Well, that sounds pretty drastic to me. Let’s discuss this in the strictest
confidence,” the nurse uses hysterical exaggeration (at an inappropriate time) and gives
incorrect information regarding confidentiality. In stating, “Can you tell me more about
why it’s over for you? I’ll keep your thoughts strictly confidential,” the nurse uses the
therapeutic technique of seeking clarification but does not clarify with the client that the
information might need to be shared.
Test-Taking Strategy: Eliminate the options that are comparable or alike and indicate that
shared information will be maintained as confidential. To select from the remaining
, options, focus on the statement that addresses the client’s feelings. Review: therapeutic
communication techniques .
Reference: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp.
27-31). St. Louis: Mosby.
Cognitive Ability: Applying
Client Needs: Safe and Effective Care Environment
Integrated Process: Communication and Documentation
Content Area: Mental Health
Giddens Concepts: Psychosis, Safety
HESI Concepts: Cognition—Psychosis, Safety
Awarded 0.0 points out of 1.0 possible points.
5.ID: 9476895020
The nurse performing a lethality assessment asks the client whether he is thinking of
suicide. Which statement by the client would be of most concern to the nurse?
· “I hadn’t thought of that, but I can see that you are.”
· “No, I wasn’t, but I am now, thanks to you.” Correct
· “Of course not, but there are days when I think that I should be.” Incorrect
· “What is suicide going to do for me except get me excommunicated from the
church?”
Rationale: The client’s response that he is now thinking about suicide is of the greatest
concern to the nurse. In making the statement “I hadn’t thought of that, but I can see that
you are” the client projects his own thoughts of suicide onto the nurse. In stating, “Of
course not, but there are days when I think that I should be,” the client is being sarcastic
but is not specifically talking about suicide. In stating, “What is suicide going to do for
me except get me excommunicated from the church?” the client indicates that suicide is
not an option because of his religious beliefs.
Test-Taking Strategy: Note the strategic word “most.” Note the words “but I am now” in
the correct option. This is the only option that identifies definite suicidal thoughts.
Review: lethality assessment in the suicidal client .
References: 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. 412). St. Louis: Saunders.
Cognitive Ability: Analyzing
Client Needs: Safe and Effective Care Environment
Integrated Process: Nursing Process/Assessment
Content Area: Mental Health
Giddens Concepts: Psychosis, Safety
HESI Concepts: Cognition—Psychosis, Safety
Awarded 0.0 points out of 1.0 possible points.
6.ID: 9476886322
A client who has expressed suicidal ideation in the past says to the nurse, while shuffling
1.ID: 9476884715
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.”
· “I think that you’re trying to share your own feelings toward me, but you’re shy.”
Rationale: The appropriate statement by the nurse is the one that does not acknowledge
the client’s hallucinations. By responding, “I think that you can help him stop his
,behavior if you concentrate” or “Tell him I said to mind his p’s and q’s or I’ll call the
police on him,” the nurse acknowledges the hallucinations. The nurse attempts to
interpret the client’s thinking with a statement such as “I think that you’re trying to share
your own feelings toward me, but you’re shy.”
Test-Taking Strategy: Note the strategic words “most appropriate.” Use your knowledge
of therapeutic communication techniques and remember that the nurse should not
acknowledge the client’s hallucinations. Also note that the correct option is the only one
that encourages realistic verbalization from the client. Review: therapeutic
communication techniques with a client who is hallucinating .
References: 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 (pp. 287, 288). St. Louis: Saunders.
Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Content Area: Mental Health
Giddens Concepts: Communication, Psychosis
HESI Concepts: Cognition—Psychosis, Communication
Awarded 1.0 points out of 1.0 possible points.
4.ID: 9476882056
A client says to the nurse, “It’s over for me — the whole thing is over.” Which response
by the nurse would be therapeutic?
· “What do you mean, ‘The whole thing is over’?”
· “Can you tell me more about why it’s over for you? I’ll keep your thoughts
strictly confidential.” Incorrect
· “Let’s talk more about your feeling that the whole thing is over for you. This is
important, and I may need to share your feelings with other staff members.”
Correct
· “Over? Well, that sounds pretty drastic to me. Let’s discuss this in the strictest
confidence.”
Rationale: The therapeutic response seeks clarification, employs paraphrasing, and
informs the client that the nurse needs to share any information that requires crisis
intervention with other staff members. Asking, “What do you mean, ‘The whole thing is
over’?” employs paraphrasing, but the message is blunt and closed-ended. In stating,
“Over? Well, that sounds pretty drastic to me. Let’s discuss this in the strictest
confidence,” the nurse uses hysterical exaggeration (at an inappropriate time) and gives
incorrect information regarding confidentiality. In stating, “Can you tell me more about
why it’s over for you? I’ll keep your thoughts strictly confidential,” the nurse uses the
therapeutic technique of seeking clarification but does not clarify with the client that the
information might need to be shared.
Test-Taking Strategy: Eliminate the options that are comparable or alike and indicate that
shared information will be maintained as confidential. To select from the remaining
, options, focus on the statement that addresses the client’s feelings. Review: therapeutic
communication techniques .
Reference: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp.
27-31). St. Louis: Mosby.
Cognitive Ability: Applying
Client Needs: Safe and Effective Care Environment
Integrated Process: Communication and Documentation
Content Area: Mental Health
Giddens Concepts: Psychosis, Safety
HESI Concepts: Cognition—Psychosis, Safety
Awarded 0.0 points out of 1.0 possible points.
5.ID: 9476895020
The nurse performing a lethality assessment asks the client whether he is thinking of
suicide. Which statement by the client would be of most concern to the nurse?
· “I hadn’t thought of that, but I can see that you are.”
· “No, I wasn’t, but I am now, thanks to you.” Correct
· “Of course not, but there are days when I think that I should be.” Incorrect
· “What is suicide going to do for me except get me excommunicated from the
church?”
Rationale: The client’s response that he is now thinking about suicide is of the greatest
concern to the nurse. In making the statement “I hadn’t thought of that, but I can see that
you are” the client projects his own thoughts of suicide onto the nurse. In stating, “Of
course not, but there are days when I think that I should be,” the client is being sarcastic
but is not specifically talking about suicide. In stating, “What is suicide going to do for
me except get me excommunicated from the church?” the client indicates that suicide is
not an option because of his religious beliefs.
Test-Taking Strategy: Note the strategic word “most.” Note the words “but I am now” in
the correct option. This is the only option that identifies definite suicidal thoughts.
Review: lethality assessment in the suicidal client .
References: 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. 412). St. Louis: Saunders.
Cognitive Ability: Analyzing
Client Needs: Safe and Effective Care Environment
Integrated Process: Nursing Process/Assessment
Content Area: Mental Health
Giddens Concepts: Psychosis, Safety
HESI Concepts: Cognition—Psychosis, Safety
Awarded 0.0 points out of 1.0 possible points.
6.ID: 9476886322
A client who has expressed suicidal ideation in the past says to the nurse, while shuffling
