A nurse is caring for a client who is receiving morphine intravenously. Which of the following findings indicates the client is experiencing morphine toxicity?

Rationale:

A. The client experiences self-doubt when making decisions: Indecisiveness and self-doubt are common symptoms of major depressive disorder and do not reflect improvement. They typically indicate ongoing low self-esteem and cognitive impairment.

B. The client exhibits a flat affect: A flat or blunted affect is a hallmark of depressive states. Persistence of this symptom suggests the depression is still significantly impacting the client’s emotional expression.

C. The client can express angry feelings: Being able to express emotions such as anger can indicate emotional engagement and increased energy, which are signs of clinical improvement in depression.

D. The client looks down when speaking to others: This behavior suggests ongoing feelings of worthlessness or poor self-confidence, commonly seen in depressive states and not indicative of recovery.

Rationale:

A. Client's chief complaint: Hearing voices is an auditory hallucination, which is a hallmark positive symptom of schizophrenia. Hallucinations reflect a distortion of reality and are typically responsive to antipsychotic treatment.

B. Client's job performance history: Poor job performance reflects functional decline, which is a negative symptom (e.g., avolition or anhedonia), not a positive one. It indicates loss of normal function rather than distortion.

C. Client's relationships with family and friends: Social withdrawal is another negative symptom, reflecting a lack of interest or emotional engagement. Positive symptoms are additions to normal experience, not losses like this.

D. Client's copying nurses' words: Repeating others’ words is known as echolalia, a disorganized thought manifestation commonly seen in schizophrenia. It indicates impaired cognitive processing and communication.

E. Client's statement about their mother: The delusional belief that their mother is trying to kill them represents a paranoid delusion, a classic positive symptom. Such fixed false beliefs are unrelated to reality and resistant to logic.

F. Client's speech pattern: Unclear, jumbled, and disorganized speech reflects disorganized thinking, another positive symptom of schizophrenia. This makes coherent communication and goal-directed behavior difficult.