A nurse is assessing a preschooler. Which of the following findings should indicate to the nurse a need for speech therapy? (Select all that apply.)

A. Using frequent touch to provide client support: While touch can be comforting for some clients, individuals with schizophrenia, especially those experiencing paranoid delusions, may interpret touch as threatening or intrusive. Therefore, using frequent touch may exacerbate the client's paranoia and increase their distress.

B. Directly telling the client that delusions are not real: Directly challenging the client's delusions may cause them to become defensive or agitated. It is unlikely to be effective in changing the client's beliefs and may damage the therapeutic relationship. Instead, the nurse should use therapeutic communication techniques to explore the client's perceptions and validate their feelings while gently offering alternative perspectives.

C. Limiting the number of questions asked during assessments: Individuals experiencing frequent hallucinations and paranoid delusions may have difficulty concentrating and processing information. Limiting the number of questions asked during assessments reduces cognitive overload and helps prevent overwhelming the client. The nurse should prioritize asking clear, concise questions relevant to the client's immediate needs.

D. Placing the client in seclusion if visual hallucinations are present: Seclusion should only be used as a last resort and when absolutely necessary to ensure the safety of the client or others. It is not an appropriate intervention for managing hallucinations alone. Instead, the nurse should employ therapeutic communication techniques, provide a safe and supportive environment, and use prescribed medications as indicated to manage the client's symptoms.

A. Decreased auditory and visual acuity: Decreased auditory and visual acuity are not typically associated with primary dementia. While sensory impairments may occur with aging, they are not direct manifestations of dementia.

B. Decreased display of emotions: While individuals with dementia may experience changes in emotional expression, such as mood swings or emotional lability, a decreased display of emotions is not a universal manifestation. Some individuals may exhibit heightened emotional responses or become more emotionally labile as the disease progresses.

C. Forgetfulness gradually progressing to disorientation: This is the correct choice. Forgetfulness is often one of the initial signs of dementia, and it typically progresses to more severe cognitive impairments, including disorientation to time, place, and person. As dementia advances, individuals may become increasingly confused about their surroundings and lose track of time and events.

D. Personality traits that are opposite of original traits: While some changes in personality and behavior may occur in individuals with dementia, such as agitation, irritability, or apathy, personality traits that are opposite of the original traits are not necessarily characteristic of primary dementia. Personality changes in dementia are often more related to cognitive decline and impairment rather than a complete reversal of personality traits.