The nurse is observing the interaction between a mother and schizophrenic son. The son states, "The man visiting me said you went on vacation without me." The mother replied, "There is no man, you are just making that up." When interacting with the mother privately, which reply from the mother would the nurse suggest?
"I am not on vacation. I am here with you."
"How can I go on vacation. I do not have any money."
"Stop saying that. You know better. No one told you that."
"Just forget about that and let's talk about something else."
The Correct Answer is A
A. "I am not on vacation. I am here with you." This response calmly reassures the client by affirming the mother’s presence, which helps address the son’s confusion without directly challenging his perception.
B. "How can I go on vacation? I do not have any money." This response could increase confusion and does not address the son's needs effectively. It could also lead to unnecessary discussions that might not be helpful.
C. "Stop saying that. You know better. No one told you that." This response is dismissive and confrontational, which may exacerbate the son’s distress and could damage the therapeutic relationship.
D. "Just forget about that and let's talk about something else." This response avoids addressing the son’s concerns, which can make him feel dismissed and not listened to, potentially worsening his symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Grab bars: Grab bars are useful for preventing falls in the bathroom but are unrelated to the client’s atrophy of olfactory organs, which affects the sense of smell.
B. Nonslip mats: Nonslip mats can help prevent falls but are not related to the client’s diminished sense of smell.
C. Baseboard heaters: Baseboard heaters are unrelated to olfactory atrophy and do not address the safety concerns associated with a reduced sense of smell.
D. A smoke detector: A smoke detector is essential for this client because the atrophy of olfactory organs means the client may not be able to detect the smell of smoke, increasing the risk of not noticing a fire.
Correct Answer is C
Explanation
A. "I can see that you're uncomfortable now, so we can wait until tomorrow." Delaying the medication could worsen the client's condition and does not address the underlying reason for the refusal.
B. "If you refuse these pills, you'll have to get an injection." This response is coercive and could damage trust between the client and the nurse. It does not explore the client's concerns.
C. "What is it about the medicine that you don't like?" This response is therapeutic as it opens a dialogue with the client to understand their concerns, which can help in addressing the reluctance and promoting adherence to the medication.
D. "You know you have to take this medicine for your own good." This response is paternalistic and dismisses the client's autonomy and concerns, which may lead to further resistance.
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