Parents ask a nurse how they should reply when their child, diagnosed with schizophrenia disorder, tells them that voices command the child to harm others. Which is the appropriate nursing response?

"Focus on the feelings generated by the hallucinations and present reality."

Ignore what they are saying, while attempting to discover the underlying cause."

"Present objective evidence that the voices are not real."

Tell them to stop discussing the voices.

Answer and Explanation

The Correct Answer is A

a. "Focus on the feelings generated by the hallucinations and present reality." This approach validates the child's experience and feelings while gently orienting them to reality, which is a therapeutic communication technique.
b. "Ignore what they are saying, while attempting to discover the underlying cause." Ignoring the child’s statements can make them feel dismissed and could increase their distress. It is important to address their experience directly and compassionately.
c. "Present objective evidence that the voices are not real." Presenting objective evidence may not be effective as the child’s belief in the voices can be very strong, and this approach may lead to further agitation.
d. "Tell them to stop discussing the voices." This approach is dismissive and does not help the child manage their symptoms or feel understood. It is important to engage with the child’s experience constructively.

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Correct Answer is C

Explanation

a. "I can make that promise to you based on nurse-client privilege." Nurse-client confidentiality is important, but it doesn't apply to threats of violence. The nurse has a duty to protect the client and others.
b. "Those kinds of thoughts will make your hospitalization longer." While true, this response doesn't directly address the safety concern and might be perceived as judgmental.
c. "I cannot promise that. Confidentiality does not include plans to hurt others." This is a clear and honest statement. It explains the limitations of confidentiality and prioritizes safety.
d. "You should share this thought with your psychiatrist." While encouraging the client to talk to a psychiatrist is a good suggestion, it doesn't directly address the confidentiality issue or the immediate threat.

A. Encourage alone time for the client in seclusion B. Assess one time for self-harm during treatment C. Discuss alternative coping strategies with the client D. Allow for unlimited discussion of physical symptoms

Correct Answer is C

Explanation

a. Encourage alone time for the client in seclusion: Encouraging alone time in seclusion may exacerbate feelings of isolation and is not typically recommended for clients with conversion disorder, who may benefit more from social support and therapeutic interventions.
b. Assess one time for self-harm during treatment: While assessing for self-harm is important, it is not specific to conversion disorder and should be part of routine nursing care for all clients, regardless of diagnosis.
c. Discuss alternative coping strategies with the client: This is correct because exploring alternative coping strategies can help the client manage stressors and symptoms associated with conversion disorder in healthier ways.
d. Allow for unlimited discussion of physical symptoms: Allowing unlimited discussion of physical symptoms may reinforce symptom focus and is not typically recommended in the treatment of conversion disorder, where the focus is on addressing underlying psychological distress.

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Parents ask a nurse how they should reply when their child, diagnosed with schizophrenia disorder, tells them that voices command the child to harm others. Which is the appropriate nursing response?

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