A 16-year-old client diagnosed with schizophrenia disorder experiences command hallucinations to harm others. The client's parents ask a nurse, "Where do the voices come from?" Which is the appropriate nursing response?
"There is a chemical imbalance of the brain, which leads to altered perceptions."
"The hallucinations are caused by medication interactions."
"There is too little serotonin in the brain, causing delusions and hallucinations."
Abnormal hormonal changes have precipitated auditory hallucinations."
The Correct Answer is A
a. "There is a chemical imbalance of the brain, which leads to altered perceptions." Schizophrenia is a complex mental health disorder with a strong biological component. While the exact cause is unknown, it's believed to involve abnormalities in brain chemistry and neurotransmitters. This is a general explanation that avoids going into too much detail but acknowledges the biological basis of hallucinations.
b. "The hallucinations are caused by medication interactions." Hallucinations are a core symptom of schizophrenia and not necessarily caused by medication interactions.
c. "There is too little serotonin in the brain, causing delusions and hallucinations." While serotonin might be involved in schizophrenia, it's not the only neurotransmitter implicated.
d. Abnormal hormonal changes have precipitated auditory hallucinations." Hormonal changes might influence mood, but they are not the primary cause of auditory hallucinations in schizophrenia.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
a. restating: Restating involves repeating the client's message to ensure understanding and encourage further communication. It is a therapeutic technique.
b. maintaining neutral responses. Neutral responses can be therapeutic as they provide nonjudgmental listening and support.
c. listening: Active listening is a fundamental therapeutic communication technique, essential for understanding the client's concerns and building rapport.
d. asking the client, "Why?" Asking "Why?" can be non-therapeutic as it may make the client feel defensive and pressured to justify their feelings or actions. It can hinder open communication.
Correct Answer is ["D"]
Explanation
a. Blood pressure 110/70: This is within normal range for many individuals and is not immediately concerning in the post-operative context.
b. heart rate 86: This is a normal heart rate for most individuals and is not concerning post-operatively.
c. Hypoactive bowel sounds: Hypoactive bowel sounds are common post-operatively due to anesthesia and are not immediately concerning.
d. Increased restlessness Increased restlessness can be a sign of pain, anxiety, hypoxia, or other complications and should be addressed promptly.
e. Negative Homan's sign: A negative Homan’s sign indicates no apparent deep vein thrombosis and is a positive finding.
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