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 A
Explanation
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The correct answer is Choice A.
Choice A rationale: Forming a committee of staff members to investigate current staffing issues is the first step the nurse manager should take. This is because it is important to understand the root cause of the problem before implementing any changes. By forming a committee, the nurse manager can gather different perspectives and insights from the staff members who are directly affected by the staffing issues. This will help in identifying the specific problems and coming up with effective solutions. Furthermore, involving the staff in the decision-making process can increase their acceptance of the changes and reduce resistance.
Choice B rationale: Providing support to staff members who are resistant to staffing changes is an important step, but it should not be the first action. Before providing support, the nurse manager needs to understand the specific issues causing the resistance. This can be achieved by forming a committee of staff members to investigate the staffing issues.
Choice C rationale: Scheduling a staff meeting to present the different options to staff members is a crucial step in the process. However, this should be done after the nurse manager has a clear understanding of the staffing issues and has identified potential solutions. Presenting options without first understanding the problem may lead to ineffective solutions and increased resistance from staff members.
Choice D rationale: Giving the staff members advance written notice of staffing changes is a necessary step to ensure transparency and to give staff members time to adjust. However, this should be done after the nurse manager has identified the staffing issues, explored potential solutions, and decided on the changes to be implemented.
Correct Answer is D
Explanation
A. The time of the provider’s last evaluation provides important clinical context regarding the client’s current status and any recent changes in the plan of care. This helps the receiving team anticipate follow-up assessments and interventions.
B. The client’s most recent ventilator settings are relevant because the client was recently weaned from mechanical ventilation. This information helps evaluate respiratory stability and guides ongoing monitoring for complications after a pneumonectomy.
C. The timing of the last dose of pain medication is essential for safe and effective pain management. It allows the receiving nurse to plan subsequent doses and monitor for effectiveness or adverse effects.
D. The frequency with which the client presses the call button does not contribute meaningful clinical information for the transfer report. It does not directly affect physiological status, treatment decisions, or continuity of care.
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