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
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
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
a. Interrupt the handwashing and insist the client come to meals with everyone else. Interrupting ritualistic behaviors abruptly can increase distress and is not recommended. It may also reinforce the belief that the ritual is necessary.
b. Provide the client's meals later and after the other clients have eaten. This is not appropriate as it accommodates the OCD behavior and disrupts the mealtime routine for other clients.
c. Notify the client when it is 30 minutes before the meal so they can begin their handwashing. This is not appropriate as it enables the ritualistic behavior and may lead to increased anxiety if the client feels rushed to complete their ritual.
d. Allow the client to continue as is but provide them access to the kitchen. This is correct because it respects the client's autonomy while also providing an opportunity for gradual exposure therapy, where the client can work with the nurse to gradually reduce the time spent on rituals.
Correct Answer is C
Explanation
a. The unit can be managed with fewer staff. Seclusion requires close monitoring by staff.
b. Clients are encouraged to communicate with others. Seclusion is meant to be a temporary measure to prevent further harm, not necessarily to promote communication.
c. The reduced sensory input allows the client to regain control. Seclusion is a time-limited safety intervention used when a client poses a danger to themselves or others. It provides a safe space with reduced stimulation to allow the client to calm down and regain control.
d. Clients are forced to be responsible for themselves. Seclusion is not a punitive measure. The goal is to ensure safety and facilitate regaining control.
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