An adolescent hospitalized after a physical outburst tells the nurse, "I’m going to kill my father, but you can’t tell anyone." Select the nurse’s best response.

Choice A reason: Encouraging the patient to argue with auditory hallucinations can escalate distress and reinforce engagement with the voices, which is non-therapeutic in schizophrenia management. Evidence-based practice emphasizes reducing focus on hallucinations through coping strategies, not confrontation, making this choice incorrect.

Choice B reason: Teaching distraction techniques, like listening to music, is an evidence-based non-pharmacological intervention for managing auditory hallucinations. It helps shift attention away from the voices, reducing their intensity and promoting coping, aligning with psychiatric nursing principles, making this the correct choice.

Choice C reason: Administering an additional dose of antipsychotic medication without prescriber consultation violates nursing scope of practice and safety protocols. It risks toxicity and side effects, such as extrapyramidal symptoms, making this choice unsafe and incorrect for managing hallucinations.

Choice D reason: Advising the patient to ignore hallucinations is oversimplified and often ineffective, as it dismisses the distress caused by symptoms. This approach lacks therapeutic support and does not provide practical coping strategies, making it less appropriate than teaching distraction techniques.

Choice A reason: Assault involves a threat of harm without physical contact. Forcing medication involves actual physical intervention, not just a threat, making assault incorrect. Battery better describes the unauthorized physical act in this scenario, as it involves direct contact.

Choice B reason: Battery is the unauthorized physical contact or use of force on a patient, such as forcibly administering medication against their objection. This violates patient autonomy and ethical standards, aligning with the scenario, making this the correct term for the nurse’s action.

Choice C reason: Negligence involves failing to meet a standard of care, causing harm, such as ignoring a patient’s needs. Forcing medication is an active violation, not a failure to act, making negligence incorrect for this intentional physical intervention.

Choice D reason: Malpractice involves professional negligence causing harm, typically through substandard care. Forcing medication is a deliberate act of battery, not a failure in skill or judgment, making malpractice less precise than battery for this scenario.