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HESI Extra Credit Module 4 Exam with Rationale [NEW!!] 2022 (49 Pages) 100% CORRECT $15.49
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HESI Extra Credit Module 4 Exam with Rationale [NEW!!] 2022 (49 Pages) 100% CORRECT
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MODULE 4 Exam Questions 1. 1.ID: 5 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? A. Neologism B. Word salad C. Clang association Correct D. Associat...

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  • April 20, 2022
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  • 2021/2022
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MODULE 4 Exam Questions
1. 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?
A. Neologism
B. Word salad
C. Clang association Correct
D. Associative looseness
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 .
.

2. 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?
A. Telling the parents, “Medication noncompliance is the most frequent reason that
people with this diagnosis relapse.”
B. 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.”
C. 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
D. 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.”
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 .
.

3. 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?
A. “Try not to listen to the voices right now so that I can talk with you.” Correct
B. “I think that you can help him stop his behavior if you concentrate.”
C. “Tell him I said to mind his p’s and q’s or I’ll call the police on him.”
D. “I think that you’re trying to share your own feelings toward me, but you’re
shy.” Incorrect
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 .


4. 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?
A. “What do you mean, ‘The whole thing is over’?” Incorrect
B. “Over? Well, that sounds pretty drastic to me. Let’s discuss this in the strictest
confidence.”
C. “Can you tell me more about why it’s over for you? I’ll keep your thoughts strictly
confidential.”
D. “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
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 .
.

5. 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?
A. “No, I wasn’t, but I am now, thanks to you.” Correct
B. “I hadn’t thought of that, but I can see that you are.”
C. “Of course not, but there are days when I think that I should be.”
D. “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 .
.

6. 6.ID: 9476886322
A client who has expressed suicidal ideation in the past says to the nurse, while shuffling several
documents in an effort to organize them, “Well, I’m feeling so much better now since I got organized.
My lawyer wrote my will and durable power of attorney.” Which response by the nurse is most
appropriate?
A. “Good grief! You don’t look organized to me.”
B. “Okay, what are you up to today? Your behavior is not appropriate.”
C. “You talk about getting organized. Are you thinking of killing yourself?” Correct
D. “If you keep behaving like this, you know that I’ll have to tell the health care
provider, and we’ll have to seclude you.”
Rationale: The client is exhibiting behaviors that indicate plans for suicide. Talking of suddenly
“feeling so much better” and putting affairs in order are key verbal and behavioral clues that the
client is planning to commit suicide. In exclaiming, “Good grief! You don’t look organized to me,” the

, nurse nontherapeutically uses hysterical exaggeration, which minimizes the client’s feelings. In
asking, “Okay, what are you up to today? Your behavior is not appropriate,” the nurse uses teasing
to determine the client’s behaviors, which minimizes them. Additionally, the nurse is employing a
nontherapeutic technique of judging. In stating, “If you keep behaving like this, you know that I’ll
have to tell the health care provider and we’ll have to seclude you,” the nurse uses a threat.
Test-Taking Strategy: Focus on the information in the question and note the relationship between the
words “expressed suicidal ideation” in the question and “thinking of killing yourself” in the correct
option. Review: the clues that indicate the potential for suicide .
.

7. 7.ID: 9476896317
An adolescent client says, “I’m just a burden to my folks. They wish I’d never been born. My dad told
me he had to marry Mom because she got pregnant.” Which response by the nurse would be
therapeutic?
A. “You’re feeling that your folks didn’t want you, but they chose to marry and have
you.” Correct
B. “You feel that you were a burden and not wanted? Let’s talk with your parents to
see whether you’re right.”
C. “Let’s speak with your parents about what you’ve just told me. Let’s ask whether
you were truly unwanted.”
D. “Sounds like your father was very inappropriate, but I’m certain that he didn’t
mean that you were a burden to him.”
Rationale: In the correct option, the nurse uses reflection to explore the client’s lethality risk and then
uses reframing to determine whether the client is able to view what happened in a different way. In
suggesting, “You feel that you were a burden and not wanted? Let’s talk with your parents to see
whether you’re right,” the nurse uses paraphrasing but is then nontherapeutic in trying to persuade
the client to talk to the parents. In suggesting, “Let’s speak with your parents about what you’ve just
told me. Let’s ask whether you were truly unwanted,” the nurse uses a parental approach, which
may be threatening to the client, who seems to have been unable to talk with the parents before
now. In stating, “Sounds like your father was very inappropriate, but I’m certain that he didn’t mean
that you were a burden to him,” the nurse offers an opinion about the client’s father and then
provides false reassurance.
Test-Taking Strategy: Eliminate the options that are comparable or alike and address discussing the
client’s feelings with the parents. In selecting from the remaining options, remember to focus on the
client’s feelings. This will direct you to the correct option. Review: therapeutic communication
techniques .
.

8. 8.ID: 9476897762
A client says to the nurse, “I’ve ruined my life. I left college with only a few credits to go. I keep telling
myself that I’m going to make it as a writer, but I’ll be a loser and a nothing for the rest of my life.”
Which response by the nurse is therapeutic?

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