A client diagnosed with schizophrenia disorder states, "My psychiatrist is out to get me. I'm sad that the voice is telling me to stop the psychiatrist." What symptom is the client exhibiting, and what is the nurse's legal responsibility related to this symptom?
Altered thought processes; call an emergency treatment team meeting.
Command hallucinations; warn the psychiatrist.
Persecutory delusions; orient the client to reality.
Magical thinking; administer an antipsychotic medication.
The Correct Answer is B
a. Altered thought processes; call an emergency treatment team meeting. While altered thought processes are present, the urgent concern is the command hallucination directing the client to harm the psychiatrist. An emergency treatment team meeting may not provide the immediate intervention required.
b. Command hallucinations; warn the psychiatrist. This is correct because the client is experiencing command hallucinations that pose a direct threat to the psychiatrist. The nurse has a duty to warn the potential victim and ensure the safety of both the client and others.
c. Persecutory delusions; orient the client to reality. Persecutory delusions are present, but the immediate danger from the command hallucinations takes precedence. Orienting the client to reality does not address the urgent safety issue.
d. Magical thinking; administer an antipsychotic medication. Magical thinking is not the correct symptom here. Administering medication is part of treatment but does not address the immediate safety concern.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
a. Excessive time spent discussing psychosocial stressors: Somatic Symptom Disorder focuses on physical symptoms, not necessarily psychological factors.
b. Disproportionate and persistent thoughts about the seriousness of one's symptoms: This is a hallmark symptom of Somatic Symptom Disorder. The client is likely preoccupied with their health beyond what's medically warranted.
c. Amnestic episodes in which the client is pain free: Amnesia is not a characteristic symptom of Somatic Symptom Disorder.
d. Lack of physical symptoms: Somatic Symptom Disorder by definition involves physical symptoms, even if they are not medically explained.
Correct Answer is A
Explanation
a. Pulling out their hair (Correct): Trichotillomania is a mental health disorder characterized by the repetitive pulling out of one's hair. This behavior often serves as a way to cope with anxiety or negative emotions. It's the defining characteristic of the condition.
b. Pretending to be sick: Malingering, or pretending to be sick for secondary gain, is not a characteristic behavior of Trichotillomania.
c. Aphanie: Aphanie is a complete or partial loss of the sense of touch. It's not related to anxiety relief or Trichotillomania.
d. Amnesia: Amnesia is memory loss. While anxiety can be a contributing factor in some amnestic cases, it's not a behavior used to relieve anxiety.
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