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.

Answer and Explanation

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.

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Correct Answer is B

Explanation

a. Sharing limited personal information: Sharing personal information can blur professional boundaries and make the client feel uncomfortable.
b. Being reliable, honest, and consistent during interactions: Predictability and consistency build trust, especially for someone with a condition that can distort reality.
c. Establishing personal contact with family members: Involving family members may not always be appropriate and could violate the client's privacy. It's best to proceed with the client's consent
d. Sitting close to the client to establish rapport: Sitting too close can be perceived as intrusive and might make the client feel uneasy.

A. can stop taking this medication abruptly without serious complications." B. will need scheduled blood work in order to monitor for toxic levels of this drug C. will not drink alcohol while taking this medication." D. Will have to take this medication for the rest of my life."

Correct Answer is C

Explanation

a. Can stop taking this medication abruptly without serious complications: Abruptly stopping diazepam, especially after long-term use, can lead to withdrawal symptoms like anxiety, seizures, and insomnia.
b. Will need scheduled blood work in order to monitor for toxic levels of this drug: While monitoring might be necessary in some cases, it's not typical for everyone on diazepam.
c. Will not drink alcohol while taking this medication. (Correct) Diazepam is a central nervous system depressant. Alcohol has similar effects, and combining them can significantly increase the risk of drowsiness, impaired coordination, and respiratory depression. Understanding this interaction is crucial for safe medication use.
d. Will have to take this medication for the rest of my life: The duration of diazepam therapy depends on the individual and the condition being treated.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia disorder?

Correct Answer is B

Explanation

A nurse is providing discharge teaching to a client prescribed diazepam. Which client statement would indicate that the client teaching was effective? "

Correct Answer is C

Explanation

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