A nurse is caring for a young adult client who has acute schizophrenic disorder and tells the nurse, "Yesterday noon the sun moon went over the rover to see the lawnmower.”. Which of the following manifestations is the client exhibiting?
Delusional disorder.
Anhedonia.
Associative looseness.
Hallucination.
The Correct Answer is C
Choice A rationale:
Delusional disorder is characterized by the presence of one or more delusions for a month or longer, which could be plausible but are not real. This is not the case here.
Choice B rationale:
Anhedonia refers to the inability to experience pleasure, a common symptom in many mental disorders, including depression. It does not apply to this situation.
Choice C rationale:
Associative looseness, or loose associations, is a thought disorder characterized by speech in which ideas shift from one subject to another that is unrelated or minimally related. The client’s statement is an example of this.
Choice D rationale:
Hallucinations are sensory experiences that occur in the absence of actual stimulation. The client’s statement is not a hallucination, but a disorganized thought process.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Discouraging clients from discussing NSSH with friends may not be beneficial. Open communication can provide support and understanding.
Choice B rationale:
Early recognition is crucial to successful treatment. Timely intervention can prevent the escalation of self-harm behaviors and facilitate recovery.
Choice C rationale:
Recognizing NSSH as an attention-seeking behavior can be a misconception. NSSI is a complex behavior often associated with various underlying issues like emotional distress.
Choice D rationale:
Asking the client why they do this as soon as possible may not always be helpful. The focus should be on understanding their feelings and providing support.
Correct Answer is A
Explanation
Choice A rationale:
Adherence to medication, especially after the resolution of acute psychosis, is crucial when taking an antipsychotic like clozapine. This is because discontinuation can lead to a relapse of symptoms.
Choice B rationale:
There’s no specific need to limit fluid intake when taking an antipsychotic.
Choice C rationale:
While routine blood cell count laboratory work is important, it’s not specific to red blood cells but rather to monitor for agranulocytosis, a potential side effect of clozapine.
Choice D rationale:
Avoiding foods that contain tyramine is typically associated with monoamine oxidase inhibitors, not antipsychotics like clozapine.
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