A client on the inpatient psychiatric unit is scheduled for discharge tomorrow. Which of the following statements would indicate that the client is ready for discharge?

Choice A Reason:

Ask the client direct questions about the hallucinations.

This response is the most appropriate because it allows the nurse to assess the content and nature of the hallucinations directly. By understanding what the client is experiencing, the nurse can better evaluate the risk of harm to the client or others and develop an appropriate care plan. Direct questioning helps in identifying whether the hallucinations are commanding the client to perform harmful actions, which is crucial for ensuring safety. This approach aligns with therapeutic communication techniques that emphasize understanding the client’s experience and providing appropriate interventions.

Choice B Reason:

Act as if the hallucinations are real.

This response is not appropriate because it can reinforce the client’s delusions and hallucinations, making it harder for them to distinguish between reality and their hallucinations. It is important for the nurse to maintain a reality-based approach while being empathetic and supportive. Acknowledging the client’s feelings without validating the hallucinations helps in maintaining a therapeutic environment.

Choice C Reason:

Instruct the client to argue with the voices.

Instructing the client to argue with the voices is not recommended as it can increase the client’s distress and confusion. Instead, the nurse should help the client develop coping strategies to manage the hallucinations, such as distraction techniques or reality testing. Encouraging the client to engage in a confrontation with their hallucinations can exacerbate their symptoms and is not a therapeutic approach.

Choice D Reason:

Explain to the client that the hallucinations will subside soon.

This response is not appropriate because it provides false reassurance. Hallucinations may not subside quickly, and the client needs realistic support and coping strategies to manage their symptoms. Providing false hope can undermine the client’s trust in the nurse and the treatment process. Instead, the nurse should focus on helping the client manage their symptoms effectively.

Choice A Reason:

Lorazepam is a benzodiazepine commonly used to manage acute agitation and anxiety. It works by enhancing the effect of the neurotransmitter GABA, which has a calming effect on the brain. Lorazepam is often administered in emergency situations to quickly reduce agitation and prevent escalation to violence. Its rapid onset of action makes it an ideal choice for managing acute episodes of agitation and potential assault.

Choice B Reason:

Valproic acid is an anticonvulsant and mood stabilizer used primarily for the treatment of epilepsy and bipolar disorder. While it can help manage mood swings and prevent manic episodes, it is not typically used for the immediate management of acute agitation or aggression. Its effects are not rapid enough to address an escalating situation effectively.

Choice C Reason:

Bupropion is an atypical antidepressant used to treat major depressive disorder and to support smoking cessation. It works by inhibiting the reuptake of norepinephrine and dopamine, but it does not have the sedative properties needed to manage acute agitation or aggression. Therefore, it is not suitable for immediate intervention in a potentially violent situation.

Choice D Reason:

Sertraline is a selective serotonin reuptake inhibitor (SSRI) used to treat depression, anxiety disorders, and other mood disorders. While it is effective for long-term management of anxiety and depression, it does not have the rapid calming effects required for managing acute agitation or potential assault. SSRIs generally take several weeks to achieve their full therapeutic effect.