A newly admitted patient diagnosed with schizophrenia says, The ...

[ericka1]

A newly admitted patient diagnosed with schizophrenia says, The voices are bothering me. They yell and tell me I am bad. I have got to get away from them. Select the nurse's most helpful reply.
 
  a. Do you hear the voices often?
  b. Do you have a plan for getting away from the voices?
  c. I'll stay with you. Focus on what we are talking about, not the voices.
  d. Forget the voices and ask some other patients to play cards with you.

Question 2

A community mental health nurse wants to establish a relationship with a very withdrawn patient diagnosed with schizophrenia. The patient lives at home with a supportive family. Select the nurse's best plan.
 
  a. Visit daily for 4 days, then every other day for 1 week; stay with patient for 20 minutes, accept silence; state when the nurse will return.
  b. Arrange to spend 1 hour each day with the patient; focus on asking questions about what the patient is thinking or experiencing; avoid silences.
  c. Visit twice daily; sit beside the patient with a hand on the patient's arm; leave if the patient does not respond within 10 minutes.
  d. Visit every other day; remind the patient of the nurse's identity; encourage the patient to talk while the nurse works on reports.

[dpost18]

Answer to Question 1

ANS: C
Staying with a distraught patient who is hearing voices serves several purposes: ongoing observation, the opportunity to provide reality orientation, a means of helping dismiss the voices, the opportunity of forestalling an action that would result in self-injury, and general support to reduce anxiety. Asking if the patient hears voices is not particularly relevant at this point. Asking if the patient plans to get away from the voices is relevant for assessment purposes but is less helpful than offering to stay with the patient while encouraging a focus on their discussion. Suggesting playing cards with other patients shifts responsibility for intervention from the nurse to the patient and other patients.

Answer to Question 2

ANS: A
Severe constraints on the community mental health nurse's time will probably not allow more time than what is mentioned in the correct option; yet, important principles can be used. A severely withdrawn patient should be met at the patient's own level, with silence accepted. Short periods of contact are helpful to minimize both the patient's and the nurse's anxiety. Predictability in returning as stated will help build trust. An hour may be too long to sustain a home visit with a withdrawn patient, especially if the nurse persists in leveling a barrage of questions at the patient. Twice-daily visits are probably not possible, and leaving after 10 minutes would be premature. Touch may be threatening. Working on reports suggests the nurse is not interested in the patient.

[ericka1]

Excellent

[bdobbins]

TYSM