A client on an acute mental health unit states to a nurse, "Tie a bow.
Row the boat.
Now I know.
Whoa! I see you, yo." The nurse should document that the client is exhibiting which of the following speech alterations?
Neologisms.
Echolalia.
Word salad.
Clang associations.
The Correct Answer is D
A. Neologisms involve the creation of new, meaningless words that are not understood by others. The client is using real words, so this pattern does not reflect newly invented language.
B. Echolalia refers to the repetition of words or phrases spoken by others. The client’s speech is not repeating another person’s words but instead shows a pattern based on sound.
C. Word salad is characterized by completely disorganized, incoherent speech with no logical or grammatical connection between words. Although unusual, the client’s speech maintains structure and is linked by sound patterns rather than being entirely random.
D. Clang associations occur when speech is driven by the sound of words, such as rhyming or punning, rather than meaning. The client’s use of rhyming phrases like “bow,” “boat,” “know,” and “yo” demonstrates this pattern clearly.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A: Incorrect. Aspirin can trigger asthma attacks in some children and should be avoided.
B: Incorrect. The peak expiratory flow meter should be used daily, not just when the child has symptoms, and the highest reading should be recorded, not the average.
C: Incorrect. Carpet can harbor dust mites, mold, and other allergens that can worsen asthma. It is better to have hardwood or tile floors and washable rugs.
D: Correct. Influenza immunization can prevent serious complications from respiratory infections in children with asthma.
Correct Answer is B
Explanation
- A. Incorrect. Withholding pain medications for 24 hr after the old patch is removed is a harmful action that could cause severe withdrawal symptoms and uncontrolled pain for the client. The nurse should respect the client's right to refuse treatment and explore the reasons for their decision.
- B. Correct. Asking another nurse to witness the disposal of the new patch is a safe and legal action that follows the policies and procedures for handling controlled substances. The nurse should document the disposal of the new patch and report it to the appropriate authority.
- C. Incorrect. Sealing the patches in a plastic bag and placing them in the client's trash basket is an unsafe and illegal action that could lead to diversion, misuse, or accidental exposure of fentanyl to others. The nurse should dispose of the patches in a secure and designated container that prevents access by unauthorized persons.
- D. Incorrect. Sticking the two patches to each other and placing them in the sharps bin is an unsafe and improper action that could cause contamination, injury, or infection to others who handle or dispose of sharps waste. The nurse should dispose of the patches separately and carefully, avoiding contact with their adhesive surfaces.
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