A college student brings his roommate to the clinic because the roommate has been talking to someone who is not present. The student tells the practical nurse (PN) that his roommate is acting strange.

Which question should the PN ask the client next?

The correct answer is Choice C

Choice A rationale: This question prematurely assumes the client is experiencing command hallucinations, which are auditory hallucinations instructing the individual to perform specific actions, often dangerous. Scientifically, this bypasses the essential diagnostic step of characterizing the hallucination type. Without understanding onset, frequency, and context, asking about obedience risks escalating paranoia or defensiveness. Psychiatric assessment requires chronological and phenomenological data before evaluating risk. Prematurely probing intent may compromise rapport and hinder accurate clinical evaluation.

Choice B rationale: While substance-induced psychosis is a differential diagnosis, asking about hallucinogen use before establishing the nature and onset of symptoms may be perceived as accusatory. Scientifically, the DSM-5 criteria for substance-induced psychotic disorder require temporal correlation between substance use and symptom onset. Without knowing when the voices began, this question lacks diagnostic precision. A thorough psychiatric history must precede substance screening to avoid bias and ensure accurate etiological classification of hallucinations.

Choice C rationale: Establishing the onset of auditory hallucinations is foundational in psychiatric assessment. Scientifically, the timeline helps differentiate between transient, substance-induced, and chronic psychotic disorders such as schizophrenia. Early onset may suggest prodromal schizophrenia, while abrupt onset could indicate delirium or drug-induced psychosis. Understanding duration also informs risk stratification and treatment planning. This question respects clinical sequencing, allowing the nurse to gather essential data before exploring content, belief, or behavioral response to hallucinations.

Choice D rationale: Exploring the client’s belief about the reality of voices is part of assessing insight, but it should follow initial characterization of the hallucinations. Scientifically, insight evaluation helps determine the severity of psychosis and guides treatment adherence predictions. However, asking this prematurely may confuse or distress the client. Insight is typically assessed after establishing symptom chronology, frequency, and impact. Premature probing of belief risks misinterpretation and may hinder therapeutic engagement in early assessment stages.