DHS Staff Nurse - 2018 (Shift-2nd)
Mental Health Nursing
Easy
A client tells the nurse, "I am a spy for the FBI. I am an eye, an eye in the sky". The nurse recognizes that this is an example of?
Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)
Explanation
- Clang association is a formal thought disorder where the choice of words is dictated by their sound, often involving rhymes and puns, rather than by their meaning.
- The client's statement links 'spy,' 'FBI,' 'eye,' and 'sky' purely based on their rhyming sounds, which is the defining characteristic of a clang association.
- This type of speech pattern indicates a disturbance in the thought process, commonly associated with psychotic disorders like schizophrenia or mania.
Why Other Options Were Wrong
- Option A: Echolalia is the pathological, parrot-like repetition of words or phrases spoken by another person. The client in the scenario is generating their own sentence, not repeating the nurse's words.
- Option B: Word salad is a more severe form of thought disorganization, characterized by a confused and unintelligible mixture of random words and phrases that do not form a coherent sentence. The client's statement, while illogical, still has grammatical structure.
- Option D: Loosened association (or derailment) involves a sequence of ideas that are not logically connected and shift from one topic to another. While the client's thought is illogical, the primary organizing principle is sound (rhyme), which is more specific to clang association.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Thought Process Abnormalities in Psychiatric Nursing to guide bedside assessment, documentation, and the next nursing action.
- Recognizing different types of thought disorders is a crucial nursing assessment skill in psychiatry. It helps in diagnosing the underlying condition and evaluating the effectiveness of treatment.
- When communicating with a client exhibiting clang associations, the nurse should use simple, concrete language and avoid complex or abstract phrases. It is important to gently reorient the client to reality without challenging their statements directly.
- What if the client said, 'I am a spy... the government is watching me through the TV'? This would be an example of a persecutory delusion (thought content) rather than a clang association (thought process), requiring a different nursing approach focused on safety and reality testing.
How to Approach the Question
- First, carefully analyze the client's statement: 'I am a spy for the FBI. I am an eye, an eye in the sky.'
- Identify the key characteristic of the speech. Notice the rhyming words: spy, FBI, eye, sky.
- Next, review the definitions of the options provided. This is a recall-based question requiring knowledge of psychiatric terminology.
- Echolalia is repeating others. This is not happening.
- Word salad is a random jumble of words. This statement has some structure.
- Loosened association is jumping between unrelated topics. This statement sticks to one theme, linked by sound.
Concept Tested & Keywords
- Concept Tested: Thought Process Abnormalities in Psychiatric Nursing
- Stem keywords: spy for the FBI, eye in the sky, speech pattern
- Lead-in keywords: example of
- Clinical cues: The client's statement contains rhyming words ('spy', 'FBI', 'eye', 'sky'), which is the primary clue.
Question ID
QWMX9uy2mM1VnB3nuO7Me_
Reference Book
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 3795-3797
E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 50-52
Practise the full DHS Staff Nurse - 2018 (Shift-2nd)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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