Nokea
A patient diagnosed with schizophrenia begins to talk about 'cracklomers' in the local shopping mall. The term 'cracklomers' should be documented using what term?
- A. Neologism
- B. Concrete thinking
- C. Thought insertion
- D. An idea of reference
Correct Answer: A
Rationale: A neologism is a newly coined word having special meaning to the patient. 'Cracklomers' is not a known word. Concrete thinking refers to the inability to think abstractly. Thought insertion refers to thoughts of others that are implanted in one's mind. An idea of reference is a type of delusion in which trivial events are given personal significance.
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A patient diagnosed with schizophrenia tells the nurse, 'I eat skiller. Tend to end. Easter. It blows away. Get it?' Select the nurse's best response.
- A. Nothing you are saying is clear.
- B. Your thoughts are very disconnected.
- C. Try to organize your thoughts, and then tell me again.
- D. I am having difficulty understanding what you are saying.
Correct Answer: D
Rationale: When a patient's speech is loosely associated, confused, and disorganized, pretending to understand is useless. The nurse should tell the patient that he or she is having difficulty understanding what the patient is saying. If a theme is discernible, ask the patient to talk about the theme. The incorrect options tend to place blame for the poor communication with the patient. The correct response places the difficulty with the nurse rather than being accusatory.
Patients diagnosed with schizophrenia who are suspicious and withdrawn generally present with what additional characteristic?
- A. Universally fear sexual involvement with therapists.
- B. Are socially disabled by the positive symptoms of schizophrenia.
- C. Exhibit a high degree of hostility as evidenced by rejecting behavior.
- D. Avoid relationships because they become anxious with emotional closeness.
Correct Answer: D
Rationale: When an individual is suspicious and distrustful and perceives the world and the people in it as potentially dangerous, withdrawal into an inner world can be a defense against uncomfortable levels of anxiety. When someone attempts to establish a relationship with such a patient, the patient's anxiety rises until trust is established. No evidence suggests that withdrawn patients with schizophrenia universally fear sexual involvement with therapists. In most cases, it is not considered true that withdrawn patients with schizophrenia are socially disabled by the positive symptoms of schizophrenia or exhibit a high degree of hostility by demonstrating rejecting behavior.
A newly admitted patient diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The patient states, 'I saw two doctors talking in the hall. They were plotting to kill me.' The nurse may correctly assess this as what classic behavior?
- A. Echolalia
- B. An idea of reference
- C. A delusion of infidelity
- D. An auditory hallucination
Correct Answer: B
Rationale: Ideas of reference are misinterpretations of the verbalizations or actions of others that give special personal meanings to these behaviors; for example, when seeing two people talking, the individual assumes they are talking about him or her. The other terms do not correspond with the scenario.
A newly admitted patient diagnosed with schizophrenia says, 'The voices are bothering me. They weigh They yell and tell me I'm bad. I have got to get away from them.' Select the nurse's most helpful reply.
- A. Do you hear the voices often?
- B. Do you have a plan for getting away from the voices?
- C. I will stay with you. Focus on what we are talking about, not the voices.
- D. Forget about the voices. Ask some other patients to sit and talk with you.
Correct Answer: C
Rationale: Staying with a distraught patient who is hearing voices serves several purposes: ongoing observation, the opportunity to provide reality orientation, a means of helping dismiss the voices, the opportunity of forestalling an action that would result in self-injury, and general support to reduce anxiety. Asking if the patient hears voices is not particularly relevant at this point. Asking if the patient plans to 'get away from the voices' is relevant for assessment purposes but is less helpful than offering to stay with the patient while encouraging a focus on their discussion. Asking other patients to talk incorrectly shifts responsibility for intervention from the nurse to other patients.
A patient diagnosed with schizophrenia says, 'High heat. Last time here. Did you get a coat?' What type of verbalization is evident?
- A. Neologism
- B. Idea of reference
- C. Thought broadcasting
- D. Associative looseness
Correct Answer: D
Rationale: Looseness of association refers to jumbled thoughts incoherently expressed to the listener. Neologisms are newly coined words. Ideas of reference are a type of delusion. Thought broadcasting is the belief that others can hear one's thoughts.