The nurse is asking a diagnosed schizophrenic patient how they slept and they respond, "This is a new day in May and I can't wait to play." Which communication pattern does the nurse identify?

Circumstantiality.

Clang association.

Tangentiality.

Neologism.

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Circumstantiality refers to a communication pattern where the individual provides excessive, unnecessary details before reaching the point. In this scenario, the patient's response is not characterized by providing excessive details but rather by the use of words that sound alike but have no meaningful connection.

Choice B rationale:

Clang association is a communication pattern where the individual's speech is characterized by rhyming or the repetition of words that sound similar but lack logical connection. The patient's response, "This is a new day in May and I can't wait to play," demonstrates this pattern, as the words "May" and "play" rhyme but don't form a coherent sentence.

Choice C rationale:

Tangentiality refers to a communication pattern where the individual goes off-topic and never returns to the original subject. The patient's response, while seemingly off-topic, is not a clear example of tangentiality, as the words used are related in a rhyming manner rather than being entirely unrelated.

Choice D rationale:

Neologism refers to the creation of new words or phrases that are not part of any recognized language. The patient's response does not involve the creation of entirely new words; instead, it involves the use of existing words that rhyme but lack a coherent connection.

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Correct Answer is C

Explanation

The correct answer is choice C.

Choice A rationale:

Planning a therapeutic diet is important for overall client care, but it might not be the first priority. The client's significant weight loss and distorted body image require more immediate attention to address potential underlying mental health concerns..

Choice B rationale:

Providing a structured environment is beneficial, but it might not be the first priority in this situation. The client's distorted perception of weight and significant weight loss necessitate more immediate assessment and intervention.

Choice C rationale:

Assessing the client's nutritional status is the first priority in this scenario. The client's weight loss of 11 kg (25 lb) over 3 months and belief that she is fat are indicators of a possible eating disorder. Nutritional assessment helps determine the severity of the issue and guides appropriate interventions.

Choice D rationale:

While requesting a mental health consult is important, it is not the first priority. Addressing the client's immediate physical health, which includes assessing her nutritional status and potential risk for complications related to her distorted body image, takes precedence.

A. Reviewing the client's toxicology laboratory report. B. Initiating suicide precautions. C. Making a contract with the client for eating behavior. D. Administering the Hamilton Depression Scale.

Correct Answer is B

Explanation

Choice A rationale:

Reviewing the client's toxicology laboratory report is not the priority action in this situation. While assessing toxicology can provide valuable information, the immediate concern is the client's safety due to their admission of thoughts of self-harm with a plan. Toxicology can be relevant but addressing the immediate risk takes precedence.

Choice B rationale:

Initiating suicide precautions is the priority action in this case. The client's admission of thoughts of self-harm with a plan indicates a high risk for suicide. Suicide precautions involve closely monitoring the client, removing any potential means of self-harm, and providing a safe environment. Addressing the client's immediate safety is of utmost importance.

Choice C rationale:

Making a contract with the client for eating behavior is not the priority action in this situation. While eating behavior might be a concern for some individuals with borderline personality disorder, depression, and substance abuse, the client's current statement about self-harm takes precedence. Ensuring the client's safety comes before addressing other aspects of their care.

Choice D rationale:

Administering the Hamilton Depression Scale is not the priority action in this scenario. While assessing the severity of the client's depression is important, the immediate concern is their safety due to the expressed thoughts of self-harm. Once the client's safety is ensured, further assessment and evaluation can take place.

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The nurse is asking a diagnosed schizophrenic patient how they slept and they respond, "This is a new day in May and I can't wait to play." Which communication pattern does the nurse identify?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in the ER is admitting a client who has experienced a weight loss of 11 kg (25 lb) in the past 3 months. The client weighs 40 kg (88 lb) and believes she is fat. Which of the following aspects of care should the nurse consider the first priority for this client?

Correct Answer is C

Explanation

A nurse in the Emergency Department is caring for a client with symptoms of depression and admits to thoughts of self-harm with a plan. The client has a history of borderline personality disorder, depression, and substance abuse. Which of the following is the priority action by the nurse?

Correct Answer is B

Explanation

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