NURSING NCLEX MODULE 4 QUESTIONS AND ANSWERS
Submission Details
• Submission Time: 9:48 PM
• Points Awarded: 93
• Points Missed: 7
• Number of Attempts Allowed: 1
• Not Scored: 0
• Percentage: 93%
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
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.”
Submission Details
• Submission Time: 9:48 PM
• Points Awarded: 93
• Points Missed: 7
• Number of Attempts Allowed: 1
• Not Scored: 0
• Percentage: 93%
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
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.”
