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:

Ask open-ended questions.

While asking open-ended questions can be useful in many therapeutic settings, it may not be the best approach when dealing with delusional clients. Open-ended questions can sometimes lead to more elaborate delusional thinking and may not help in grounding the client in reality. Instead, focusing on the present moment and concrete reality can be more effective in managing delusions.

Choice B Reason:

Focus on what is happening in the here and now.

This is the correct response. Focusing on the present moment helps to ground the client in reality and can reduce the intensity of delusional thoughts. By directing the client’s attention to their immediate environment and current activities, the nurse can help the client stay connected to reality and reduce the impact of their delusions.

Choice C Reason:

Assume knowledge of what is meant when the client talks about “they.”

Assuming knowledge of what the client means when they refer to “they” can reinforce delusional thinking. It is important for the nurse to clarify and understand the client’s perspective without validating the delusion. This approach helps maintain a therapeutic relationship while not reinforcing false beliefs.

Choice D Reason:

Limit contact to one or two short interactions daily.

Limiting contact to one or two short interactions daily is not an effective strategy for managing delusions. Clients with delusions often need consistent and supportive interactions to help them stay grounded in reality. Frequent, brief interactions can provide the necessary support and reassurance without overwhelming the client.

Choice A Reason:

This will help with medication compliance.

This is the correct response. Long-acting injectable (LAI) antipsychotics like risperidone IM are often used to improve medication compliance in patients who have difficulty remembering to take their oral medications regularly. By administering the medication every two weeks, the treatment team can ensure that the client receives a consistent dose, reducing the risk of relapse due to missed doses. This approach is particularly beneficial for clients with schizophrenia, as consistent medication adherence is crucial for managing symptoms and preventing hospitalizations.

Choice B Reason:

It will help him remember to take his medication.

While this statement is related to medication compliance, it is not entirely accurate. The purpose of switching to an injectable form is to eliminate the need for the client to remember to take daily doses. Instead, the healthcare provider administers the medication at regular intervals, ensuring adherence without relying on the client’s memory.

Choice C Reason:

This has a faster onset of action.

This statement is incorrect. The onset of action for long-acting injectable risperidone is not necessarily faster than the oral form. In fact, LAIs are designed to release the medication slowly over time to maintain stable blood levels. The primary advantage of LAIs is improved adherence, not a faster onset of action.

Choice D Reason:

This new medication is stronger and will clear his symptoms faster.

This statement is also incorrect. The strength of the medication and the speed at which it clears symptoms are not the primary reasons for switching to an injectable form. The goal is to ensure consistent medication levels and improve adherence, not to increase the potency or speed of symptom relief.