Which of the following actions should the nurse take for a client who lost all possessions in a house fire and states, "I have no idea what I am going to do. I cannot think right now."?

Choice A Reason:

The response "What are the voices telling you to do?" is appropriate because it allows the nurse to assess the content of the hallucinations and determine if there is an immediate risk of harm to the client or others. This approach shows empathy and concern for the client's experience while gathering crucial information to ensure safety. Understanding the nature of the voices can help the nurse provide appropriate interventions and support.

Choice B Reason:

Telling the client "You need to tell the voices to leave you alone" is not an effective response. This statement can be dismissive and may not acknowledge the client's distress. Clients with schizophrenia may not have the ability to control their hallucinations, and this response does not provide the necessary support or validation of their experience.

Choice C Reason:

The statement "You need to understand that there are no voices" is dismissive and invalidates the client's experience. Clients with schizophrenia perceive their hallucinations as real, and telling them that the voices do not exist can increase their distress and mistrust. It is important to acknowledge the client's experience while providing reassurance and support.

Choice D Reason:

Asking "Why do you think you are hearing the voices?" may not be helpful in the moment of acute distress. This question can be confusing and does not address the client's immediate fear and anxiety. The priority should be to assess the content of the hallucinations and ensure the client's safety rather than exploring the reasons behind the hallucinations.

Choice A Reason:
"I understand that you feel like you don't need it; however, the provider thinks it will help." This response acknowledges the client's feelings but immediately contradicts them by emphasizing the provider's opinion. This can make the client feel invalidated and less likely to engage in therapy. A therapeutic response should validate the client's feelings and encourage open communication without imposing the provider's perspective.

Choice B Reason:
"You don't feel like group therapy is for you. Tell me more about what you know about group therapy." This response is therapeutic because it validates the client's feelings and invites them to share their thoughts and knowledge about group therapy. It opens up a dialogue, allowing the nurse to understand the client's perspective better and address any misconceptions or fears they may have. This approach fosters a collaborative and empathetic relationship, which is crucial in therapeutic settings.

Choice C Reason:
"I am not saying that you need therapy, but I am sure it will help you." This response attempts to reassure the client but can come across as dismissive of their feelings. It implies that the nurse knows better than the client, which can create a power imbalance and hinder the therapeutic relationship. Effective therapeutic communication should empower the client and respect their autonomy.

Choice D Reason:
"You don't have to be afraid to go. Our therapists are very understanding." While this response aims to reassure the client, it assumes that fear is the primary reason for their reluctance. It does not validate the client's expressed feelings or invite further discussion. Therapeutic communication should be based on active listening and addressing the client's specific concerns.