ANSWERS
a client diagnosed with schizophrenia is experiencing auditory hallucinations. a
nurse makes the following statements when interacting with this client. place
these statements in the order in which they should occur:
1. I do not hear any voices
2. come with me for a walk
3. hearing voices must be frightening
4. the voices you hear are part of your illness
5. lets play cards with another client in the recreation room correct answer 3.
hearing voices must be frightening
4. the voices you hear are part of your illness
1. I do not hear any voices
2. come with me for a walk
5. lets play cards with another client in the recreation room
a client experiencing hallucinations tells a nurse, "the voices are telling me I'm no
good" the client asks whether the nurse hears the voices. which is the nurses
most appropriate response?
1. no, I do not hear the voices, but I believe you can hear them
2. it is the voice of your conscience, which only you can control
3. those voices are coming from within you; only you can hear them
4. hearing the voices are a symptoms of your illness; don't pay attention to them
correct answer 1. no, I do not hear the voices, but I believe you can hear them
, a client in the early dementia stage of Alzheimers disease is admitted to a long
term care facility. which activities must the nurse initiate? SATA
1. weigh the client once a week
2. have specialized rehabilitation equipment available
3. keep the client in pajamas and robe most of the day
4. establish a schedule with periods of rest after activities
5. review the clients weekly budget and use of community resources
6. set up a plan for weekly entertainment through a senior citizens group correct
answer 1. weigh the client once a week
2. have specialized rehabilitation equipment available
4. establish a schedule with periods of rest after activities
a client is delusional, talking about people who are putting to do harm. a nurse
identifies that the client is pacing more than usual and is concerned that the client
is beginning to lose control. what is the best nursing interventions?
1. advise the client to use a punching bag
2. move the client to a quiet place on the unit
3. encourage the client to sit down for a while
4. allow the client to continue pacing with supervision correct answer 2. move the
client to a quiet place on the unit
a client tells the nurse "I am a terrible, evil person; the voices are telling me that
god needs to punish me". what is the nurses most therapeutic initial response?
1. god is loving and will not punish you
2. those voices you are hearing are a fantasy
3. tell me what you are thinking about yourself