A nurse is reviewing the DSM-5 diagnostic criteria for schizophrenia. Which of the following symptoms must be present for a client to be diagnosed with schizophrenia? (Select all that apply.)

Choice A reason:

“It is now time for you to bathe. Do you want to wear the red or green shirt?” This statement is therapeutic as it provides clear instructions and offers the client a choice, promoting autonomy and cooperation. It addresses the need for hygiene in a respectful and supportive manner.

Choice B reason:

“Do you really think it is okay not to bathe? What is going on with you?” This statement is confrontational and judgmental. It may make the client feel defensive or ashamed, which can hinder the therapeutic relationship and the client’s willingness to engage in self-care.

Choice C reason:

“This is it! You are getting a bath! There are three of us here to bathe you!” This statement is coercive and does not respect the client’s autonomy. Forcing the client to bathe without their consent can escalate the situation and damage trust between the client and the nurse.

Choice D reason:

“I’m going to ignore your lack of self-care because it is an aspect of the disorder.” Ignoring the client’s hygiene issues is not therapeutic. While it is important to understand that self-care deficits can be part of the disorder, the nurse should still address these issues in a supportive and respectful manner.

Choice A reason:
Admission to a locked inpatient psychiatric unit is a more restrictive environment. While necessary for some clients, it limits their freedom and autonomy. The least restrictive environment principle seeks to avoid such settings unless absolutely necessary.

Choice B reason:
Placement in a secured padded room is highly restrictive and typically used only in extreme cases where the client poses an immediate danger to themselves or others. This setting is far from the least restrictive environment.

Choice C reason:
Involuntary commitment to an outpatient community mental health center represents a less restrictive environment. It allows the client to receive necessary treatment and support while remaining in the community, maintaining a higher level of independence and normalcy.

Choice D reason:
Medication administration for sedation to the point where the client cannot get out of bed is a highly restrictive intervention. It significantly limits the client’s autonomy and is not aligned with the principle of providing care in the least restrictive environment.