The nurse enters the room of a client with schizophrenia the day after the client has been admitted to an inpatient setting and says, "I would like to spend some time talking with you." The client stares straight ahead and remains silent. Which would be the best response by the nurse?

"I've got some other things I can do now. I hope you'll feel like talking later."

"You would feel better if you would tell me what you're thinking."

"You don't need to talk right now. I'll just sit here for a few minutes."

"I can see you want to be alone. I'll come back another time."

Answer and Explanation

The Correct Answer is C

Schizophrenia is a chronic psychiatric condition characterized by neurocognitive deficits and positive or negative symptoms. Silent behavior often reflects alogia or severe social withdrawal, common negative symptoms resulting from disorganized thought processes. Management requires a non-threatening presence and patience to establish trust while the patient experiences impaired reality testing and difficulty with interpersonal communication or verbal expression.

Rationale:

A. Leaving immediately when a client is silent can be interpreted as rejection. It misses an opportunity to build a therapeutic presence, which is essential during the early admission period. The nurse must show consistent interest in the client's well-being regardless of the client's current ability to engage in verbal dialogue.

B. Telling a client they would feel better if they spoke is a non-therapeutic assumption. This uses a should statement that pressures the client and may increase their internal anxiety. Clients with schizophrenia often cannot easily articulate their thoughts, and such statements disregard the complex biological nature of their communication barriers.

C. Offering to sit in silence demonstrates unconditional acceptance and patience. This technique, known as offering self, reduces the pressure on the client to perform socially while reinforcing nurse availability. It creates a safe environment that can eventually lower the client's defenses and facilitate future therapeutic interaction.

D. Stating the client wants to be alone is an inaccurate interpretation of silence. In schizophrenia, silence is often a symptom of the illness rather than a conscious choice for social isolation. Assuming the client's intent without verbal confirmation can lead to premature termination of necessary nursing assessments and therapeutic contact.

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Correct Answer is A

Explanation

Eating disorders frequently develop within family systems characterized by enmeshment and high levels of perfectionism. These dynamics often involve interpersonal rigidity where the client lacks age-appropriate autonomy and uses disordered eating as a compensatory mechanism for a perceived lack of control. Research indicates that maladaptive family functioning, including poor conflict resolution and high parental expectations, contributes significantly to the maintenance of the pathology.

Rationale:

A. Overcontrolling parents are a hallmark finding in the family structures of individuals with eating disorders. The client often feels stifled and powerless, leading them to exert extreme control over their caloric intake and body weight. This behavior serves as a dysfunctional attempt to establish independence and a separate sense of self within a restrictive environment.

B. A lack of interest is rarely the primary dynamic; instead, there is typically intrusive over-involvement by family members. Families are often hyper-focused on the client's achievements and appearance, creating a high-pressure environment. This over-scrutiny contributes to the client’s internal distress and the subsequent development of maladaptive eating behaviors to cope with the pressure.

C. The number of siblings is not a consistent or diagnostic indicator of eating disorder development. While sibling rivalry can exist, the core psychological drivers are related to the quality of attachments and parental control rather than family size. Focusing on the number of siblings overlooks the more critical qualitative aspects of the family’s emotional and behavioral interactions.

D. Although families may believe they are being helpful, the relationships are often critically demanding rather than genuinely supportive. True supportive and encouraging relationships are protective factors that are typically missing or distorted in the pre-morbid history of these clients. Interventions often focus on transforming these controlling interactions into healthy, autonomy-supporting dynamics to facilitate recovery.

A. Suppression B. Dissociation C. Intellectualization D. Displacement

Correct Answer is C

Explanation

The client is using intellectualization, a defense mechanism where an individual deals with emotional stressors or conflicts by excessively using abstract thinking or making generalizations to control or minimize disturbing feelings. By focusing on the clinical and physiologic details of the death, the client creates a buffer between themselves and the intense pain of grief.

Rationale:

A. Suppression is a conscious, intentional exclusion of feelings or thoughts from one’s awareness (e.g., "I won't think about that until tomorrow"). In this scenario, the client is talking about the event but has stripped it of its affective (emotional) component, which is a more automatic, unconscious process.

B. Dissociation involves a breakdown in the usually integrated functions of consciousness, memory, or perception. Although it can involve an emotional numbness, it often presents as a feeling of being outside one's body or having gaps in memory. The client here is fully present and recalls the events clearly; they are simply treating a personal tragedy as a scientific case study.

C. The client avoids the emotional reality of the son's death by focusing on the facts and logic of the physical process. This allows the person to remain detached and avoid the overwhelming vulnerability associated with the loss. In psychiatric nursing, we see this when clients use medical jargon to describe their own terminal illness or trauma.

D. Displacement is the redirection of feelings from a threatening or painful source to a safer, neutral target such as being angry at a doctor because you are actually grieving. The client in this scenario isn't shifting their emotion to a new target; they are removing the emotion entirely through clinical analysis.

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The nurse enters the room of a client with schizophrenia the day after the client has been admitted to an inpatient setting and says, "I would like to spend some time talking with you." The client stares straight ahead and remains silent. Which would be the best response by the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

While assessing the family dynamics of a client with an eating disorder, which does the nurse most likely discover?

Correct Answer is A

Explanation

The nurse is assessing a client who is talking about the client's son's recent death, but who shows no emotion of any kind. The client describes the physiologic events that occurred as the son died. The nurse recognizes that the client is using which defense mechanism?

Correct Answer is C

Explanation

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