April, a 10-year-old admitted to inpatient pediatric care, has been getting more and more wound up and is losing self-control in the day room. Time-out does not appear to be an effective tool for April to engage in self-reflection. April's mother admits to putting her in time-out up to 20 times a day. The nurse recognizes that:

Correct Answer: B

Rationale: The correct choice is B because the scenario clearly demonstrates that time-out has lost its intended therapeutic effect for April. The key indicators are her increasing agitation and loss of self-control in the day room, coupled with the mother's report of excessive use (20 times/day). Time-out, when used appropriately, is meant to be a brief, infrequent intervention that helps a child regulate emotions—not a habitual or punitive measure. Here, its overuse has likely led to desensitization, making it ineffective for promoting self-reflection or behavioral change. The nurse's recognition that time-out is no longer working aligns with evidence-based practice, which emphasizes adapting interventions when they fail to meet therapeutic goals. Choice A is incorrect because it misinterprets the mother's reliance on time-out as a "baseline" discipline rather than recognizing its misuse. While time-out can be part of a structured discipline plan, its excessive application (20 times/day) suggests it has become counterproductive. Baseline discipline should be consistent and effective, not a repetitive, futile cycle that exacerbates dysregulation. The question explicitly states April is losing self-control, which contradicts the idea that time-out is serving a functional role in her care. Choice C is incorrect because it assumes April's behavior is goal-directed (seeking alone time) without evidence. The scenario describes escalating dysregulation, not intentional behavior to gain solitude. Time-out is typically aversive for children; enjoyment would be atypical and inconsistent with the presentation of worsening agitation. The rationale also ignores the mother's overuse of the strategy, which is the more plausible explanation for its ineffectiveness. Choice D is incorrect because it escalates to restrictive measures (seclusion/restraint) without justification. Restraint should only be used as a last resort for imminent safety risks, not as a replacement for a failed behavioral intervention. The nurse’s role is to de-escalate, not intensify, restrictive practices. The scenario does not indicate aggression or harm, so jumping to seclusion/restraint violates the principle of least restrictive intervention and overlooks alternative strategies like positive behavioral support or environmental modifications. The core issue is the misapplication of time-out, not the need for more extreme measures. Effective nursing judgment involves recognizing when an intervention fails and exploring alternatives, not doubling down on punitive approaches. The correct answer (B) reflects this clinical reasoning, while the other choices either justify the status quo (A), misinterpret behavior (C), or propose an unethical overcorrection (D).

Correct Answer: B

Rationale: During the prodromal phase of schizophrenia, individuals may exhibit subtle changes in behavior or interests. An unusual interest in numbers and specific topics may be a sign of cognitive disturbances that can precede the onset of schizophrenia. While the other choices may also be observed in adolescents, an unusual interest in numbers and specific topics is more specifically linked to potential prodromal symptoms of schizophrenia.

Correct Answer: A

Rationale: Screening males aged 15 to 25 for early symptoms of schizophrenia is a well-chosen intervention as this age group is at a higher risk for developing the condition. Early identification can lead to timely treatment and better outcomes, making this intervention particularly effective in addressing the population at risk for schizophrenia.

Correct Answer: C

Rationale: Schizophrenia is often associated with comorbid conditions such as alcohol use disorder, major depressive disorder, polydipsia, and metabolic syndrome. Stomach cancer is not a common associated condition with schizophrenia and would not be a typical focus of assessment in managing a patient with this mental health disorder.

Correct Answer: D

Rationale: First-generation antipsychotic medications are effective in reducing hallucinations in patients with schizophrenia. These medications primarily target positive symptoms such as hallucinations and delusions. Therefore, the nurse should inform the patient that she should experience a reduction in hallucinations with the prescribed first-generation antipsychotic medication.