A nurse is caring for a client who has schizophrenia and tells the nurse. "They lie about me all the time and they are trying to poison my food." Which of the following statements should the nurse make?
Why do you think you are being lied about and poisoned?"
You are mistaken. Nobody is lying about you or trying to poison you."
Who is lying about you and trying to poison you?"
You seem to be having very frightening thoughts."
The Correct Answer is D
A. "Why do you think you are being lied about and poisoned?": This question may come across as confrontational or challenging, potentially increasing the client's anxiety or defensiveness. It's important to acknowledge the client's feelings rather than questioning their beliefs directly.
B. "You are mistaken. Nobody is lying about you or trying to poison you.": This statement is dismissive and may cause the client to feel invalidated. It is crucial to acknowledge the client's feelings and experiences, even if they are not based on reality.
C. "Who is lying about you and trying to poison you?": This question may unintentionally reinforce the delusional thinking by suggesting that someone is indeed lying or trying to poison the client. It's essential to avoid validating or encouraging the delusional content.
D. "You seem to be having very frightening thoughts.": This statement acknowledges the client's emotions without directly challenging the delusional content. It shows empathy and creates an open and non-confrontational environment, allowing the client to express their feelings and experiences.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. "I can see that you are angry. Let's discuss ways to approach Peter with your concerns."
This response is empathetic and invites the client to discuss their concerns. However, it doesn't explicitly address the client's request for the nurse to take action. The more appropriate approach would involve the nurse taking direct responsibility for addressing the issue.
B. "Why are you overreacting to the issue?"
This response may be perceived as dismissive and judgmental. It does not validate the client's concerns or address the issue constructively.
C. "You should bring this to the attention of your treatment team."
While involving the treatment team is important, the client has directly approached the nurse with a concern. It is appropriate for the nurse to take the initial step in addressing the issue directly rather than immediately redirecting the client to the treatment team.
D. "I'll talk to Peter and present your concerns."
This is the most appropriate response. It acknowledges the client's concerns, takes responsibility for addressing the issue, and ensures that the client's voice is heard. The nurse can discuss the matter with Peter and work towards a resolution.
Correct Answer is D
Explanation
A. Limit time for the client to perform activities:
This option may increase agitation and frustration for the client with Alzheimer's disease. It is generally not recommended to limit their time for activities, as it may lead to distress.
B. Rotate assignment of daily caregivers:
Consistency in caregivers is often beneficial for individuals with Alzheimer's disease. Constantly changing caregivers can lead to confusion and anxiety for the client. Thus, rotating caregivers is not the best approach.
C. Provide an activity schedule that changes from day to day:
Individuals with Alzheimer's disease often benefit from routine and predictability. Changing the activity schedule daily can cause confusion and disorientation. Therefore, it is not the most appropriate intervention.
D. Talk the client through tasks one step at a time:
This is the best choice because breaking down tasks into simple, manageable steps can help individuals with Alzheimer's disease understand and follow instructions. It promotes a sense of accomplishment and reduces frustration. This approach is aligned with the principles of dementia care.
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