A nurse is caring for the client.

Exhibits

Select the 5 findings that indicate the client's condition has improved.

Rationale:

A. Expresses pain freely and loudly: Many Chinese American clients may view overt pain expression as a loss of control or dignity. Cultural norms often encourage stoicism, and clients may underreport pain unless directly asked in a sensitive and respectful manner.

B. Prefers foods that maintain a balance of hot and cold within the body: Traditional Chinese medicine emphasizes balance, particularly of hot and cold elements, especially during the postpartum period. Clients may prefer warm foods and drinks to restore balance and promote healing after childbirth.

C. Prefers to make direct eye contact with health care personnel: In Chinese cultural contexts, direct eye contact can be considered disrespectful or confrontational, especially toward authority figures. Avoiding eye contact may be a sign of respect rather than disinterest.

D. Tends to be very expressive with gestures and body language: Chinese American clients may communicate in a more reserved and controlled manner, often minimizing the use of expressive gestures. Nonverbal communication may be subtle, requiring attentive observation.

Rationale for Correct Choices:

• Auditory hallucinations: The client reports hearing voices telling them to act (“I'm being told that it's better to end myself...”), which is a clear example of auditory hallucinations. These are a core positive symptom of schizophrenia and often command in nature.
• Echolalia: The client repeating the nurse’s words indicates echolalia, which reflects disorganized thought and speech. It is another classic positive symptom of schizophrenia and demonstrates impaired cognitive filtering.

Rationale for Incorrect Choices:

• Magical thinking: Magical thinking involves believing one’s thoughts can cause events in the physical world, such as thinking they can control others with their mind. This is not evident in the client’s current statements.
• Thought deletion: Thought deletion is the belief that external forces are removing thoughts from one’s mind. The client does not express this; instead, they report added stimuli (voices), not missing thoughts.
• Boundary impairment: Boundary impairment involves difficulty recognizing personal space or ownership, such as using others’ belongings inappropriately. This behavior has not been described in the current assessment.