A nurse is caring for the client.

Exhibits

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

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 for Correct Choices:

• Decrease environmental stimulation: Reducing stimulation helps manage restlessness by preventing sensory overload, which can exacerbate agitation in clients with schizophrenia. A calm environment supports focus and reduces the risk of escalation or aggressive behavior.
• Provide constructive diversions: Constructive diversions such as quiet activities or art can channel aggressive energy into safe outlets. For a client expressing paranoia and aggression toward staff, structured and non-threatening engagement is therapeutic and promotes emotional regulation.
• Use visual cues to promote attention to tasks: Clients with schizophrenia often struggle with distractibility and disorganized thought processes. Visual prompts and step-by-step guides help them focus and complete hygiene tasks that would otherwise be overwhelming or forgotten.

Rationale for Incorrect Choices:

• Avoid discussing the client’s negative emotions: Suppressing emotional expression is countertherapeutic. Clients benefit from validating their emotions through supportive communication, which also builds trust and rapport necessary for effective care.
• Discourage participation in physical exercise: Exercise can be beneficial in reducing anxiety and agitation. Discouraging movement may increase restlessness or internal distress in clients who need outlets for excess energy.
• Minimize engagement with the client: Withdrawal from the client may reinforce feelings of paranoia or abandonment. Consistent therapeutic engagement is essential for building trust and managing disruptive behaviors.
• Place the client in a room away from the nurses’ station: Isolating a paranoid and aggressive client may increase their risk of harming themselves or others. Close observation near the nurses’ station ensures safety and quick intervention if escalation occurs.
• Instruct client to perform tasks independently: Clients with cognitive disruptions may not be able to initiate or complete hygiene without cues. Expecting full independence without support can lead to frustration, noncompliance, or neglect of self-care.
• Enact consequences for uncompleted hygiene tasks: Punitive measures are inappropriate for clients with psychiatric disorders who are impaired in their ability to carry out daily routines. Behavioral reinforcement must be therapeutic and supportive, not disciplinary.