After being in the hospital for one month, a client with schizophrenia states that voices are telling them they will die tonight. The client asks the nurse if this is true. The client’s statement and question indicate that they:
Have a poor prognosis.
Are not improving and may be getting worse.
Are questioning the hallucination and want reassurance from the nurse.
Will begin to enter the manic phase of their illness.
The Correct Answer is C
Choice A: 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: 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: 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: 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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A Reason:
“This is a difficult transition. Let’s formulate a plan to keep you feeling safe.”
This response is the most supportive because it acknowledges the client’s feelings and offers a proactive solution. By recognizing the difficulty of the transition and suggesting a plan to ensure the client’s safety, the nurse provides reassurance and practical support. This approach helps to build trust and shows empathy, which is crucial in a therapeutic relationship.
Choice B Reason:
“It’s the policy that patients can only live here for 30 days. Let’s try to extend it.”
While this response acknowledges the client’s fear, it focuses on policy rather than addressing the client’s immediate emotional needs. Extending the stay might not be feasible or beneficial in the long term. The primary goal should be to empower the client to feel safe and supported outside the facility.
Choice C Reason:
“You’ve had a month to come up with a plan to work on your well-being.”
This response can come across as dismissive and unsupportive. It implies that the client should have already resolved their fears, which may increase their anxiety and feelings of inadequacy. The focus should be on providing immediate support and reassurance rather than criticizing the client’s progress.
Choice D Reason:
“Hopefully you learned from being in counseling. I’m sure this will work out fine.”
This response is overly optimistic and does not address the client’s current fears. It provides false reassurance without offering any concrete support or solutions. The client needs to feel heard and supported, not just reassured that everything will be fine.
Correct Answer is D
Explanation
Choice A Reason:
The statement “The client is always aware that their behaviors are maladaptive” is incorrect. While individuals with neurotic behavior may sometimes recognize that their behaviors are maladaptive, this awareness is not consistent. Neurotic behaviors are often automatic and unconscious efforts to manage deep anxiety. Therefore, the client may not always be aware of the maladaptive nature of their actions.
Choice B Reason:
The statement “The client uses adaptive defense mechanisms to cope” is incorrect. Neurotic behavior typically involves the use of maladaptive defense mechanisms rather than adaptive ones. These mechanisms, such as denial, repression, or projection, are employed to manage anxiety and stress but do not effectively resolve the underlying issues. Adaptive defense mechanisms, on the other hand, are more constructive and promote healthier coping strategies.
Choice C Reason:
The statement “The client never has mood or personality changes” is incorrect. Neurotic behavior is often associated with mood swings and emotional instability. Clients with neurotic tendencies may experience frequent changes in mood and may struggle with regulating their emotions. Therefore, it is inaccurate to state that the client never has mood or personality changes.
Choice D Reason:
The statement “The client does not experience loss of contact with reality” is correct. Neurotic behavior, unlike psychotic behavior, does not involve a loss of contact with reality4. Clients with neurotic tendencies remain aware of their surroundings and can distinguish between reality and their internal experiences4. This characteristic differentiates neurotic behavior from more severe mental health conditions such as schizophrenia, where a loss of reality is a key feature.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today