A nurse is caring for a client who has schizophrenia and notices changes in the client’s behavior.
Which of the following behaviors is the nurse’s priority to report to the provider?

The correct answer is choicec. The client paces in the hallway during the day and most of the night.

Choice A rationale:Giving away personal items and money can indicate impulsivity and poor judgment, which are common in manic episodes. However, this behavior does not pose an immediate physical risk to the client or others.

Choice B rationale:Hostility and sarcasm towards staff can indicate irritability and agitation, which are also common in mania. While this behavior can disrupt the therapeutic environment, it is not the highest priority unless it escalates to physical aggression.

Choice C rationale:Pacing in the hallway during the day and most of the night indicates severe hyperactivity and potential exhaustion. This behavior poses a significant risk to the client’s physical health due to the possibility of dehydration, exhaustion, and other complications from lack of rest.

Choice D rationale:Demonstrating flight of ideas is a cognitive symptom of mania where the client rapidly shifts from one idea to another. While this can affect communication and thought processes, it does not pose an immediate physical risk.

In summary, the priority is to address behaviors that pose the greatest immediate risk to the client’s physical health and safety.

Choice A rationale:

Establishing rapport with the client is essential when caring for someone experiencing acute anxiety. It creates a foundation of trust and understanding, which can help the client feel more comfortable and willing to engage in therapeutic interventions. Here's a detailed explanation of why rapport is crucial in this context:

Reduces Anxiety: A strong rapport can help to reduce the client's anxiety by fostering a sense of safety and security. When a client feels understood and supported, it can help to calm their nervous system and decrease the intensity of their anxiety symptoms.

Increases Communication: Effective communication is essential for identifying the cause of anxiety and developing appropriate interventions. When a nurse has a good rapport with a client, the client is more likely to be open and honest about their thoughts, feelings, and experiences. This can lead to a more accurate assessment and a more effective treatment plan.

Improves Cooperation: Clients who have a good rapport with their nurse are more likely to cooperate with treatment recommendations. This is because they trust the nurse's expertise and feel confident that the nurse has their best interests in mind.

Enhances Coping: A strong therapeutic relationship can help to improve the client's coping skills. The nurse can provide support, encouragement, and guidance as the client learns to manage their anxiety.

Techniques for establishing rapport:

Active listening: Pay close attention to the client's verbal and nonverbal communication, demonstrating that you are genuinely interested in what they have to say.

Empathy: Show understanding and compassion for the client's experiences and feelings.

Respect: Treat the client with dignity and respect, acknowledging their autonomy and choices.

Genuineness: Be authentic and honest in your interactions with the client.

Trustworthiness: Demonstrate that you are reliable and dependable, and that you will maintain confidentiality.

Cultural sensitivity: Be aware of and respect the client's cultural background and beliefs.

Choice B rationale:

Avoiding eye contact can convey disinterest, disrespect, or dishonesty, which can further heighten anxiety. Maintaining appropriate eye contact demonstrates attentiveness, empathy, and understanding, which can help to build trust and rapport.

Choice C rationale:

Speaking in a high-pitched voice can be perceived as agitated or tense, which can exacerbate the client's anxiety. It's essential to speak in a calm, soothing, and reassuring tone to promote relaxation and a sense of safety.

Choice D rationale:

Validating the client's feelings and identifying the cause of anxiety are crucial steps in effective anxiety management.

Validation helps the client feel understood and accepted, while identifying the cause can guide the development of appropriate interventions to address the underlying triggers.