A nurse in an acute care mental health facility is sitting with a client who has schizophrenia. The client whispers to the nurse, "I'm being kept in this prison against my will. Please try to get me out." Which of the following responses should the nurse make?
"We are here to help you and give you the care that you need right now."
"Do you feel that you don't belong here?"
"Try to take some deep breaths, and I'm sure you'll feel better."
"Why do you feel that you need to leave?"
The Correct Answer is A
Choice A reason: This response is empathetic and reassuring, affirming the nurse's role in providing care and support, which is essential in managing patients with schizophrenia who may experience feelings of paranoia or imprisonment.
Choice B reason: Asking if the patient feels they don't belong could reinforce feelings of alienation or paranoia. It's important to provide reassurance rather than question their sense of belonging.
Choice C reason: While deep breathing can be a calming technique, assuring the patient they will feel better may not address their immediate concerns or the reality of their feelings.
Choice D reason: Asking why they feel the need to leave could challenge the patient's experience and potentially escalate their distress. It's important to validate their feelings and provide reassurance.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Ensuring the patient has no questions before signing the consent is a standard and appropriate practice.
Choice B reason: A nurse can witness the patient's signature on the consent form, which is a normal procedure.
Choice C reason: Consent is not universally good for 30 days; it is specific to the procedure and timing, and this statement could mislead and cause legal issues.
Choice D reason: Saying that informed consent protects the hospital from all lawsuits is incorrect and could lead to a false sense of security, as informed consent is about patient autonomy, not just legal protection.
Correct Answer is A
Explanation
Choice A reason: This question assesses abstract thinking and judgment by asking the client to consider a hypothetical situation and propose a solution.
Choice B reason: Asking about the city of birth is a fact-based question and does not assess abstract thinking or judgment.
Choice C reason: Inquiring about breakfast is a recall question and does not evaluate abstract thinking or judgment.
Choice D reason: Asking who the president is tests knowledge of current events, not abstract thinking or judgment.
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