A client and his wife are visiting in the day room of an ...

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A client and his wife are visiting in the day room of an inpatient psychiatric unit when a client with acute psychosis experiencing auditory hallucinations sits down next to them and begins talking to the voices.
 
   Which of the following nursing actions is most appropriate? 1. Take the client with psychosis by the hand and lead the client to another area in the day room.
  2. Announce over the intercom that visiting hours are over.
  3. Observe the situation and intervene only if the client with psychosis becomes aggressive.
  4. Remind the client with psychosis to respect the privacy of the other client and his wife.

Question 2

The nurse knows that obtaining a smoking cessation contract from a client will:
 
  1. Help clients adapt through change.
  2. Increase positive reinforcement through adaptation.
  3. Facilitate change through contracts.
  4. Formulate well-thought-out plans.

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Answer to Question 1

4
Rationale: The nurse needs to give instructions or directions at the level of the client's ability. Providing a verbal prompt to a client with acute psychosis who may not realize that another client's privacy is being invaded is the most appropriate proactive strategy. Waiting until aggressive behavior occurs before intervening puts the other client and his wife at risk. Physically leading the client away from the situation assumes a parental role and does not promote independent behavior. Announcing that visiting hours are over is not appropriate unless this is true, and it could confuse clients with psychosis who have auditory hallucinations.

Answer to Question 2

2
Rationale: The therapist's goal in operant conditioning is to help the individual increase positive reinforcement through more adaptive and effective behaviors. The effort to change health-related behaviors can be facilitated with a behavioral contract. An effective behavioral contract must be tailored for the individual, and a comprehensive behavioral assessment is necessary to formulate such a contract, as is the formulation of practical, measurable, and feasible objectives and goals.