A client with schizophrenia says there are bugs crawling all over ...

[Jramos095]

A client with schizophrenia says there are bugs crawling all over the walls. The most appropriate response by the nurse would be:
 
  1. There are no bugs on the walls.
  2. I am going to have to put you in seclusion.
  3. You are disturbing the other clients.
  4. You might see bugs, but I do not.

Question 2

In order to help prevent the side effect of neuroleptic malignant syndrome (NMS), the nurse should monitor the client for:
 
  1. dehydration.
  2. constipation.
  3. excess fluid intake.
  4. overeating.

[amit]

Answer to Question 1

Answer: 4

1. Telling the client there are no bugs on the walls could be seen as a challenge to the client and is not a therapeutic response.
2. It is never appropriate to threaten a client.
3. A mentally ill client is not going to understand or care whether the other clients are disturbed.
4. Schizophrenics need a reality check when they hallucinate. The nurse should validate the client and then let the client know that the nurse does not see or hear the same thing.

Answer to Question 2

Answer: 1

1. NMS is a medical emergency that can result in death. Dehydration, poor nutrition, and concurrent illness can increase the client's risk for NMS.
2. Constipation is not a risk factor for NMS.
3. Excessive fluid intake is not a risk factor for NMS.
4. Overeating is not a risk factor for NMS.

[Jramos095]

TYSM

Thanks for the timely response, appreciate it