A nurse is caring for a client who has schizophrenia. The client is in the dayroom and shouting at other clients, stating, “Do not eat the food here. The staff is poisoning the food!” The nurse should document that the client is experiencing which type of delusion?

Somatic

Persecutory

Erotomanic

Grandiose

Answer and Explanation

The Correct Answer is B

Choice A Reason:

Somatic.

Somatic delusions involve a false belief that there is something physically wrong with one’s body, such as having a serious illness or a physical defect. In this scenario, the client’s belief that the food is poisoned does not relate to their own body but rather to an external threat, making somatic delusions an incorrect classification.

Choice B Reason:

Persecutory.

This is the correct response. Persecutory delusions, also known as paranoid delusions, involve the belief that one is being targeted, harassed, or conspired against. The client’s statement that the staff is poisoning the food reflects a belief that they are being harmed or targeted, which is characteristic of persecutory delusions. These types of delusions are the most common in schizophrenia and often involve themes of being persecuted or plotted against.

Choice C Reason:

Erotomanic.

Erotomanic delusions involve the false belief that another person, often someone of higher status, is in love with the individual. This type of delusion is not relevant to the client’s statement about the food being poisoned, as it does not involve any romantic or affectionate themes.

Choice D Reason:

Grandiose.

Grandiose delusions involve an inflated sense of one’s own importance, power, knowledge, or identity. The client’s belief about the food being poisoned does not reflect an exaggerated sense of self-importance or power, making grandiose delusions an incorrect classification for this scenario.

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Correct Answer is C

Explanation

Choice A Reason:

Administer the medication with food.

Administering clonazepam with food can help reduce gastrointestinal discomfort, but it is not the most critical consideration. While it is beneficial to minimize potential side effects like nausea, it does not address the primary safety concerns associated with clonazepam use.

Choice B Reason:

Administer the medication to the client at night to avoid daytime sedation.

Administering clonazepam at night can help avoid daytime sedation, which is a common side effect of benzodiazepines. However, this is not the most critical safety concern. While managing sedation is important, it does not address the potential for more serious interactions and risks.

Choice C Reason:

Encourage the client to avoid drinking alcohol when taking this medication.

This is the correct response. Alcohol can significantly increase the sedative effects of clonazepam, leading to dangerous levels of sedation, respiratory depression, and even death. It is crucial to educate clients about the risks of combining alcohol with benzodiazepines to prevent potentially life-threatening interactions.

Choice D Reason:

Assess for history of smoking.

While assessing for a history of smoking is part of a comprehensive health assessment, it is not the most critical consideration when administering clonazepam. Smoking does not have the same immediate and severe interaction risks with clonazepam as alcohol does.

A. Flumazenil B. Chlorpromazine C. Lithium carbonate D. Methadone

Correct Answer is A

Explanation

Choice A Reason:

Flumazenil is a benzodiazepine receptor antagonist used to reverse the effects of benzodiazepines like diazepam. It works by competitively inhibiting the action of benzodiazepines at the GABA receptor, thereby reversing sedation and other effects. Flumazenil is typically administered in cases of benzodiazepine overdose to counteract the sedative effects and restore normal respiratory function. However, it should be used cautiously as it can precipitate withdrawal and seizures in patients with long-term benzodiazepine use.

Choice B Reason:

Chlorpromazine is an antipsychotic medication primarily used to treat schizophrenia and other psychotic disorders. It is not indicated for the treatment of benzodiazepine overdose. Chlorpromazine works by blocking dopamine receptors in the brain, which helps to manage symptoms of psychosis but does not counteract the effects of benzodiazepines. Therefore, it would not be an appropriate choice in this scenario.

Choice C Reason:

Lithium carbonate is a mood stabilizer commonly used in the treatment of bipolar disorder. It helps to reduce the severity and frequency of mania and can also help to relieve or prevent bipolar depression. Lithium does not have any antagonistic effects on benzodiazepines and is not used in the treatment of benzodiazepine overdose. Thus, it would not be the correct medication to administer in this case.

Choice D Reason:

Methadone is a long-acting opioid used for pain management and as part of medication-assisted treatment for opioid use disorder. It works by binding to the same receptors in the brain as other opioids, helping to reduce withdrawal symptoms and cravings. Methadone does not counteract the effects of benzodiazepines and is not used in the treatment of benzodiazepine overdose. Therefore, it would not be an appropriate choice in this scenario.

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A nurse is caring for a client who has schizophrenia. The client is in the dayroom and shouting at other clients, stating, “Do not eat the food here. The staff is poisoning the food!” The nurse should document that the client is experiencing which type of delusion?

Nursing Test Bank

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Correct Answer is C

Explanation

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Correct Answer is A

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