A nurse is caring for a client who has schizophrenia. The client is in the dayroom and shouting at other clients, stating, “Do not eat the food here. The staff is poisoning the food!” The nurse should document that the client is experiencing which type of delusion?

Somatic

Persecutory

Erotomanic

Grandiose

Answer and Explanation

The Correct Answer is B

Choice A Reason:

Somatic.

Somatic delusions involve a false belief that there is something physically wrong with one’s body, such as having a serious illness or a physical defect. In this scenario, the client’s belief that the food is poisoned does not relate to their own body but rather to an external threat, making somatic delusions an incorrect classification.

Choice B Reason:

Persecutory.

This is the correct response. Persecutory delusions, also known as paranoid delusions, involve the belief that one is being targeted, harassed, or conspired against. The client’s statement that the staff is poisoning the food reflects a belief that they are being harmed or targeted, which is characteristic of persecutory delusions. These types of delusions are the most common in schizophrenia and often involve themes of being persecuted or plotted against.

Choice C Reason:

Erotomanic.

Erotomanic delusions involve the false belief that another person, often someone of higher status, is in love with the individual. This type of delusion is not relevant to the client’s statement about the food being poisoned, as it does not involve any romantic or affectionate themes.

Choice D Reason:

Grandiose.

Grandiose delusions involve an inflated sense of one’s own importance, power, knowledge, or identity. The client’s belief about the food being poisoned does not reflect an exaggerated sense of self-importance or power, making grandiose delusions an incorrect classification for this scenario.

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Correct Answer is A

Explanation

Choice A Reason:

The statement “Autonomy” is correct. Autonomy is the ethical principle that respects an individual’s right to make their own decisions and act on their own values. By allowing clients to choose whether or not to attend group therapy, the unit manager is preserving the clients’ autonomy. This approach acknowledges the clients’ ability to make informed decisions about their own treatment and respects their personal preferences and values1. Autonomy is a fundamental principle in healthcare, emphasizing the importance of respecting patients’ rights to self-determination.

Choice B Reason:

The statement “Justice” is incorrect. Justice refers to the ethical principle of treating individuals fairly and equitably. While justice is an important consideration in healthcare, the policy of allowing clients to choose whether or not to attend group therapy is more directly related to respecting their autonomy rather than ensuring equitable treatment. Justice would be more relevant in ensuring that all clients have equal access to group therapy sessions and resources.

Choice C Reason:

The statement “Beneficence” is incorrect. Beneficence is the ethical principle that involves acting in the best interest of the client and promoting their well-being. While encouraging group therapy can be seen as an act of beneficence, the specific policy of allowing clients to choose whether or not to attend is more aligned with respecting their autonomy. Beneficence focuses on doing good for the client, whereas autonomy emphasizes the client’s right to make their own choices.

Choice D Reason:

The statement “Veracity” is incorrect. Veracity refers to the ethical principle of truthfulness and honesty in interactions with clients. While veracity is crucial in maintaining trust and transparency in the therapeutic relationship, the policy of allowing clients to choose whether or not to attend group therapy is primarily about respecting their autonomy. Veracity would be more relevant in ensuring that clients are fully informed about the benefits and potential risks of group therapy.

A. Lorazepam B. Valproic Acid C. Bupropion D. Sertraline

Correct Answer is A

Explanation

Choice A Reason:

Lorazepam is a benzodiazepine commonly used to manage acute agitation and anxiety. It works by enhancing the effect of the neurotransmitter GABA, which has a calming effect on the brain. Lorazepam is often administered in emergency situations to quickly reduce agitation and prevent escalation to violence. Its rapid onset of action makes it an ideal choice for managing acute episodes of agitation and potential assault.

Choice B Reason:

Valproic acid is an anticonvulsant and mood stabilizer used primarily for the treatment of epilepsy and bipolar disorder. While it can help manage mood swings and prevent manic episodes, it is not typically used for the immediate management of acute agitation or aggression. Its effects are not rapid enough to address an escalating situation effectively.

Choice C Reason:

Bupropion is an atypical antidepressant used to treat major depressive disorder and to support smoking cessation. It works by inhibiting the reuptake of norepinephrine and dopamine, but it does not have the sedative properties needed to manage acute agitation or aggression. Therefore, it is not suitable for immediate intervention in a potentially violent situation.

Choice D Reason:

Sertraline is a selective serotonin reuptake inhibitor (SSRI) used to treat depression, anxiety disorders, and other mood disorders. While it is effective for long-term management of anxiety and depression, it does not have the rapid calming effects required for managing acute agitation or potential assault. SSRIs generally take several weeks to achieve their full therapeutic effect.

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A nurse is caring for a client who has schizophrenia. The client is in the dayroom and shouting at other clients, stating, “Do not eat the food here. The staff is poisoning the food!” The nurse should document that the client is experiencing which type of delusion?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Group therapy is strongly encouraged, but not mandatory, in an inpatient psychiatric unit. The unit manager’s policy is that clients can make a choice about whether or not to attend group therapy. Which ethical principle does the unit manager’s policy preserve?

Correct Answer is A

Explanation

A nurse would expect to administer which of the following medications to a client who is escalating to the point of a possible assault?

Correct Answer is A

Explanation

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