A nurse is caring for a client who has been diagnosed with schizophrenia. The client is unable to speak, although there is no known pathological dysfunction. The nurse documents that the client is experiencing?

1. A

   Mutism

2. B

   Verbigeration

3. C

   Pressured speech

4. D

   Poverty of speech

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

• Mutism is defined as a persistent absence of speech in a person who is physically capable of speaking.
• The question describes a client who is 'unable to speak' and has 'no known pathological dysfunction,' which is the clinical definition of mutism.
• In schizophrenia, mutism is a classic feature of catatonic stupor, a severe form of the illness requiring immediate attention.

Why Other Options Were Wrong

• Option B: Verbigeration is the obsessive repetition of random words or phrases. The client in the scenario is not speaking at all, rather than repeating words.
• Option C: Pressured speech is rapid, urgent, and often loud speech that is difficult for others to interrupt. This is the opposite of having no speech.
• Option D: Poverty of speech, or alogia, refers to a significant decrease in the amount of speech. The person gives brief, empty, and limited responses but is not completely silent.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Speech and thought process abnormalities in schizophrenia to guide bedside assessment, documentation, and the next nursing action.
• Recognizing mutism is critical as it can indicate a severe underlying condition like catatonia, which is a medical emergency requiring intervention to prevent complications like dehydration and malnutrition.
• Nurses must use non-verbal communication techniques and closely observe for signs of distress, pain, or basic needs (like hunger or thirst) since the client cannot verbalize them.
• What if? If the client was speaking but only in brief, empty, one-word replies, the correct answer would be 'Poverty of speech' (alogia), which is a negative symptom of schizophrenia.

How to Approach the Question

• First, analyze the key information in the stem: the client has a diagnosis of schizophrenia and is 'unable to speak' despite no physical reason.
• The core symptom to identify is the complete absence of speech.
• Next, evaluate each option's definition against this core symptom.
• Mutism means an absence of speech. This is a direct match with the client's presentation.
• Verbigeration (repetition), Pressured speech (rapid speech), and Poverty of speech (reduced speech) all involve some form of verbalization, which contradicts the client's inability to speak.
• Therefore, select the term that precisely defines a total lack of speech without a physical cause.

Concept Tested & Keywords

• Concept Tested: Speech and thought process abnormalities in schizophrenia.
• Stem keywords: schizophrenia, unable to speak, no known pathological dysfunction
• Lead-in keywords: experiencing
• Negative lead-in flag: false

Question ID

Q0FbXo1TSea2FTfdwTMkJT

Copy ID

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) pp. 3852-3854, 2343-2345