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Difficulty: MediumMental Health Concepts

During the morning medication pass on an inpatient psychiatric unit, a client with schizophrenia pushes the medication cup away. The client states, "I cannot swallow those. The voices warned me that they are filled with poison." Which response by the practical nurse (PN) is most therapeutic?

  1. It sounds very frightening to hear that. I do not hear the voices, but this is your prescribed medication.Answer
  2. B
    Why do you believe the voices are telling you that these pills are poisoned?
  3. C
    You do not need to worry about poison because our pharmacy checks all medications carefully.
  4. D
    If you refuse to swallow the pills, I will have to inform the provider to order an injection.

Answer

The most therapeutic response validates the client's fear, presents reality regarding the hallucinations, and states the factual nature of the medication.
The correct response effectively uses three therapeutic techniques: expressing empathy for the client's fear, presenting reality by clarifying that the nurse does not hear the voices, and offering information about the medication. This approach maintains safety and trust without reinforcing the psychosis.

Step-by-Step Solution

1
Analyze the client's behavior and statements.
The client is experiencing active auditory hallucinations and a paranoid delusion about the medication being poisoned.
Identifying the psychiatric symptoms guides the selection of the appropriate communication technique.
2
Recall therapeutic communication principles for clients with hallucinations and delusions.
The nurse should acknowledge the client's feelings, present reality without arguing, and avoid validating the delusion.
Arguing with a delusion is ineffective, while validating the underlying emotion builds trust.
3
Evaluate the options against non-therapeutic communication blocks.
Eliminate options that ask 'why', argue with logic, provide false reassurance, or use threats.
These blocks escalate anxiety and damage the therapeutic relationship.

Key Concept

Therapeutic Communication during Hallucinations
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Topics

Mental Health Concepts

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