A client who has schizophrenia is talking to the nurse and states, "Do you hear that? I am scared. The voices are telling me to do horrible things which of the following responses by the nurse is appropriate?
"You need to understand there are no voices"
What are the voices telling you to do?
What do you think is causing you to heal the voices?
"You need to tell the forces to leave you alone.
The Correct Answer is B
a. "You need to understand there are no voices": Denying the client's experience can be invalidating and unhelpful.
b. What are the voices telling you to do? (Correct)A key principle in responding to someone experiencing auditory hallucinations is to validate their experience and ask open-ended questions. This helps the client feel heard and allows the nurse to assess the severity of the situation and potential safety risks.
c. What do you think is causing you to hear the voices? While exploring the cause of hallucinations can be part of therapy, in the immediate situation, focusing on what the voices are saying and assessing safety is more important.
d. "You need to tell the forces to leave you alone": This is confrontational and doesn't acknowledge the client's fear. It might also reinforce the belief in the voices having power.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
a. Client and staff safety: This is correct because ensuring the safety of both the client and staff is the top priority, especially in cases of reported aggression.
b. Medication compliance: While medication compliance is important, it is secondary to ensuring immediate safety in this scenario.
c. Client education: Client education is valuable but may not be the immediate priority when safety concerns are present.
d. Group participation: While group participation may be beneficial for the client's treatment, it is not the priority when safety issues are at stake.
Correct Answer is D
Explanation
a. Focused conversations on various foods: While a healthy relationship with food is a treatment goal, focusing excessively on food during therapy sessions might indicate continued preoccupation, not necessarily a positive change.
b. Is able to binge eat without purging: This might seem positive on the surface, but it doesn't address the underlying problem of binge eating. The goal is to develop healthy eating habits and reduce both bingeing and purging behaviors.
c. Gained ten pounds in one week: Rapid weight gain is unlikely to be a healthy or sustainable outcome in bulimia nervosa treatment. It's important to focus on healthy weight management alongside addressing the core eating disorder behaviors.
d. Demonstrated healthy coping mechanisms that decreased anxiety (Correct): Bulimia nervosa involves recurrent episodes of binge eating followed by purging behaviors. Recovery involves developing healthy coping mechanisms to manage anxiety and reduce the urge to binge or purge. This is a key indicator of progress.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.