The client hears the word "match." The client replies, "A match. I like matches. They are the light of the world. God will light the world. Let your light shine." Which communication pattern does the nurse identify?

Clang association

Word salad

Ideas of reference

Loose association

Answer and Explanation

The Correct Answer is D

a. Clang association: Clang associations involve the use of words based on their sound rather than their meaning, often rhyming or having a similar sound. This pattern is not evident in the client’s response.
b. Word salad: Word salad refers to a jumble of words or phrases that lack logical coherence, which is not characteristic of the given response. The client's speech, while disorganized, still contains recognizable connections.
c. Ideas of reference: Ideas of reference involve the belief that common elements of the environment are directly related to oneself. This pattern is not shown in the client's response.
d. Loose association: Loose associations involve thoughts that are not logically connected to one another. The client’s response shows a series of loosely connected ideas, fitting the pattern of loose associations

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Correct Answer is C

Explanation

a. Administer the 6mg Benztropine orally with a full glass of water on an empty stomach: Benztropine is an anticholinergic medication used to manage the extrapyramidal side effects (EPS) of antipsychotics. However, it's important to consult the healthcare provider before administering any additional medications.
b. Ask the healthcare provider to increase the dose of Haloperidol to assist with the side effect: Increasing the dose of Haloperidol might worsen the tardive dyskinesia symptoms.
c. Hold the dose of Haloperidol and notify the healthcare provider. (Correct) Haloperidol is an antipsychotic medication with a known side effect of tardive dyskinesia, which manifests as involuntary facial and body movements. Stopping the medication and informing the provider is crucial to determine the best course of action, which might involve dose adjustment or switching medications

d. Explain to the client that the side effects should diminish in one to two weeks: Tardive dyskinesia can be a persistent side effect, and reassurance without addressing the medication is not helpful.

A. Reaction Formation B. Projection C. Sublimation D. Repression

Correct Answer is C

Explanation

a. Reaction Formation: Reaction formation involves expressing the opposite of what one truly feels. Exploring a career that involves controlled expression of anger (such as professional wrestling) can be seen as a reaction formation against uncontrolled anger.
b. Projection: Projection involves attributing one's own unacceptable feelings or thoughts to others. Exploring a career in professional wrestling does not involve projecting one's own feelings onto others.
c. Sublimation: This is correct because sublimation involves channeling unacceptable impulses into socially acceptable activities. Exploring a career in professional wrestling could be seen as channeling anger into a constructive and socially acceptable outlet.
d. Repression: Repression involves pushing unacceptable thoughts or memories out of consciousness. Exploring a career in professional wrestling does not involve repressing anger but rather finding a way to express it constructively.

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The client hears the word "match." The client replies, "A match. I like matches. They are the light of the world. God will light the world. Let your light shine." Which communication pattern does the nurse identify?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is assessing a client diagnosed with schizophrenia, who has been prescribed Haloperidol for the past year. On assessment, the nurse notices that the client is demonstrating bizarre facial and tongue movements. What is the priority nursing intervention?

Correct Answer is C

Explanation

The nurse is caring for a client who has anger management issues and starts to explore a career as a professional wrestler. This is an example of which defense mechanism?

Correct Answer is C

Explanation

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