A nurse is instructing a nursing assistant on how to assist a patient with bathing.

The patient has hemiparesis on the left side due to a stroke.

Which of the following statements by the nursing assistant demonstrates understanding of the teaching?

The correct answer is Choice C

Choice A rationale: This question prematurely assumes the client is experiencing command hallucinations, which are auditory hallucinations instructing the individual to perform specific actions, often dangerous. Scientifically, this bypasses the essential diagnostic step of characterizing the hallucination type. Without understanding onset, frequency, and context, asking about obedience risks escalating paranoia or defensiveness. Psychiatric assessment requires chronological and phenomenological data before evaluating risk. Prematurely probing intent may compromise rapport and hinder accurate clinical evaluation.

Choice B rationale: While substance-induced psychosis is a differential diagnosis, asking about hallucinogen use before establishing the nature and onset of symptoms may be perceived as accusatory. Scientifically, the DSM-5 criteria for substance-induced psychotic disorder require temporal correlation between substance use and symptom onset. Without knowing when the voices began, this question lacks diagnostic precision. A thorough psychiatric history must precede substance screening to avoid bias and ensure accurate etiological classification of hallucinations.

Choice C rationale: Establishing the onset of auditory hallucinations is foundational in psychiatric assessment. Scientifically, the timeline helps differentiate between transient, substance-induced, and chronic psychotic disorders such as schizophrenia. Early onset may suggest prodromal schizophrenia, while abrupt onset could indicate delirium or drug-induced psychosis. Understanding duration also informs risk stratification and treatment planning. This question respects clinical sequencing, allowing the nurse to gather essential data before exploring content, belief, or behavioral response to hallucinations.

Choice D rationale: Exploring the client’s belief about the reality of voices is part of assessing insight, but it should follow initial characterization of the hallucinations. Scientifically, insight evaluation helps determine the severity of psychosis and guides treatment adherence predictions. However, asking this prematurely may confuse or distress the client. Insight is typically assessed after establishing symptom chronology, frequency, and impact. Premature probing of belief risks misinterpretation and may hinder therapeutic engagement in early assessment stages.

Choice A rationale:

Washing the patient's left side first and then moving to the right side does not demonstrate an individualized approach or consideration for the patient's preferences and abilities. It is important to involve the patient in the decision-making process, especially when they have hemiparesis, to promote their autonomy and comfort.

Choice B rationale:

Washing the patient's right side first and then moving to the left side does not consider the patient's preference and may not align with their abilities or comfort. It is essential to prioritize the patient's preferences and needs.

Choice C rationale:

Washing both sides of the patient at the same time, starting from the head and moving down, may not be feasible or comfortable for the patient, especially if they have hemiparesis. This approach does not demonstrate an individualized care plan based on the patient's specific condition.

Choice D rationale:

Asking the patient which side they prefer to wash first and then following their preference is the most patient-centered and appropriate approach. This approach respects the patient's autonomy and ensures that their needs and comfort are prioritized during the bathing process. It allows for individualized care based on the patient's abilities and preferences.