A client with schizophrenia has had 2 hospitalizations within the past 9 months due to non-adherence to medications and their counseling plan. What measures should the nurse and the mental health treatment team recommend for tertiary prevention? (Select All That Apply)

Choice A Reason:

Recognizing signs of escalating anxiety is a crucial skill for clients with GAD. This awareness allows them to identify early warning signs and implement coping strategies before anxiety becomes overwhelming. Early recognition can prevent the escalation of symptoms and reduce the impact on daily functioning. This skill is often developed through cognitive-behavioral therapy (CBT) and other therapeutic interventions that focus on self-awareness and self-monitoring.

Choice B Reason:

Avoiding all situations that cause stress is not a practical or effective strategy for managing GAD. While it is important to reduce unnecessary stress, complete avoidance can lead to increased anxiety and avoidance behaviors, which can worsen the disorde. Instead, clients are encouraged to develop coping strategies to manage stress and face anxiety-provoking situations gradually5. This approach helps build resilience and reduces the overall impact of anxiety on their lives.

Choice C Reason:

Recognizing the need to take medications as ordered is essential for effective management of GAD. Medication adherence ensures that the client maintains therapeutic levels of medication, which can help control symptoms and prevent relapse. Non-adherence to medication regimens is a common issue in mental health treatment and can lead to worsening symptoms and increased risk of hospitalization. Therefore, understanding and adhering to prescribed medications is a key component of effective care.

Choice D Reason:

Utilizing relaxation techniques to limit anxiety is a highly effective strategy for managing GAD. Techniques such as deep breathing, progressive muscle relaxation, and mindfulness can help reduce physiological arousal and promote a sense of calm. These techniques are often taught in therapy and can be practiced regularly to help manage anxiety symptoms. Incorporating relaxation techniques into daily routines can significantly improve the client’s ability to cope with stress and anxiety.

Choice E Reason:

Discussing plans to handle panic attacks if they occur is an important aspect of managing GAD. Having a clear plan in place can help the client feel more in control and reduce the fear of experiencing a panic attack. This plan may include strategies such as deep breathing, grounding techniques, and seeking support from trusted individuals. By preparing for potential panic attacks, clients can reduce their overall anxiety and improve their ability to manage symptoms effectively.

Choice A Reason: Have a poor prognosis

A poor prognosis in schizophrenia is typically associated with persistent and severe symptoms, lack of response to treatment, and significant functional impairment. While the client’s statement about hearing voices is concerning, it does not necessarily indicate a poor prognosis on its own. Prognosis in schizophrenia is multifactorial and depends on various factors, including the duration of untreated psychosis, adherence to treatment, and the presence of supportive social networks.

Choice B Reason: Are not improving and may be getting worse

This choice suggests that the client’s condition is deteriorating. While the presence of hallucinations can indicate a lack of improvement, it is important to consider the context. The client’s ability to question the hallucination and seek reassurance from the nurse suggests a level of insight that is often associated with better outcomes. Insight into one’s condition is a positive prognostic factor in schizophrenia.

Choice C Reason: Are questioning the hallucination and want reassurance from the nurse

This is the correct answer. The client’s question indicates that they are aware that the voices might not be real and are seeking reassurance from the nurse. This level of insight is crucial in managing schizophrenia, as it can lead to better adherence to treatment and improved outcomes. Insight into the nature of hallucinations and delusions is often a sign of a more favorable prognosis.

Choice D Reason: Will begin to enter the manic phase of their illness

Mania is characterized by elevated mood, increased activity, and other symptoms such as decreased need for sleep and grandiosity. It is more commonly associated with bipolar disorder than schizophrenia. The client’s statement about hearing voices predicting their death does not align with the typical presentation of mania. Therefore, this choice is not applicable in this context.