1. 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 madeup 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.
TestTaking 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 evidencebased 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 DecisionMaking/Clinical Judgment, Cognition—Psychosis
Awarded 1.0 points out of 1.0 possible points.
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.
TestTaking 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. 2731). St.
Louis: Mosby.
Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental health nursing: A communication
approach to evidencebased 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. 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.”
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.”
TestTaking 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. 2731). St.
Louis: Mosby.
Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental health nursing: A communication
approach to evidencebased 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. 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’?”
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 closedended. 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.
TestTaking 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. 2731). 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 1.0 points out of 1.0 possible points.
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.
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