NCLEX Psychosocial Alterations (Mod 4)
1. 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
D Associative looseness: C Clang association
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.
2. 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?"
,NCLEX Psychosocial Alterations (Mod 4)
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.": 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?"
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.
,NCLEX Psychosocial Alterations (Mod 4)
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.
3. 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."
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.": A "Try not to liste
to the voices right now so that I can talk with you."
Rationale: The appropriate statement by the nurse is the one that does not acknowl- edge 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
,NCLEX Psychosocial Alterations (Mod 4)
shy."
4. 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.": D "Let's talk more about your feeling that th
whole thing is over for you. This is important, and I may need to share your feelings with other
staff members."
Rationale: The therapeutic response seeks clarification, employs paraphrasing, and informs the
client that the nurse needs to share any information that requires crisis
1. 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
D Associative looseness: C Clang association
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.
2. 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?"
,NCLEX Psychosocial Alterations (Mod 4)
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.": 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?"
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.
,NCLEX Psychosocial Alterations (Mod 4)
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.
3. 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."
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.": A "Try not to liste
to the voices right now so that I can talk with you."
Rationale: The appropriate statement by the nurse is the one that does not acknowl- edge 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
,NCLEX Psychosocial Alterations (Mod 4)
shy."
4. 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.": D "Let's talk more about your feeling that th
whole thing is over for you. This is important, and I may need to share your feelings with other
staff members."
Rationale: The therapeutic response seeks clarification, employs paraphrasing, and informs the
client that the nurse needs to share any information that requires crisis
