Which characteristic presents the greatest risk for injury to others in a patient diagnosed with schizophrenia?

Correct Answer: D

Rationale: Paranoia in patients with schizophrenia can lead to aggressive behaviors, including violence, which poses a significant risk of injury to others. Individuals experiencing paranoia may perceive others as threats and act defensively or aggressively in response, increasing the likelihood of harm to those around them.

Correct Answer: C

Rationale: The correct answer is **C: "You say you hear voices, what are they telling you?"** because it employs **therapeutic communication techniques** that validate the patient's experience while encouraging further dialogue about their symptoms. This approach aligns with psychiatric nursing principles of **active listening, empathy, and nonjudgmental exploration** of the patient's reality. By asking the patient to elaborate, the nurse gathers clinically relevant information (e.g., content, frequency, and tone of hallucinations) without dismissing or escalating distress. It also fosters trust, as the patient feels heard rather than corrected, which is critical for therapeutic rapport. **Why other options are incorrect:** 1. **A: "I know you say you hear voices, but I cannot hear them."** This response **invalidates** the patient’s subjective experience by contrasting it with the nurse’s reality, which can alienate the patient. While it acknowledges the hallucination, the word "but" negates the patient’s perspective, potentially increasing feelings of isolation or mistrust. Therapeutic communication avoids **confrontation** unless safety is at risk, as it may reinforce delusional rigidity or defensiveness. 2. **B: "Stop listening to the voices, they are NOT real."** This is **countertherapeutic** for several reasons. First, it **directly challenges** the patient’s reality, which they perceive as factual. Hallucinations are involuntary; telling a patient to "stop" is ineffective and may provoke frustration or agitation. Second, the emphatic "NOT real" can escalate anxiety, as the patient’s brain processes the voices as real sensory input. Effective interventions focus on **coping strategies** (e.g., distraction) rather than denial. 3. **D: "Please tell the voices to leave you alone for now."** While less confrontational than B, this option **misunderstands the nature of psychotic symptoms**. Commanding a patient to dismiss hallucinations oversimplifies their lack of control over the experience. It may imply that the patient is choosing to engage with the voices, which can induce guilt or shame. Instead, nurses should help patients **develop agency** (e.g., "Would you like to try focusing on my voice instead?"). **Key distinctions:** - **Correct answer (C)** explores the symptom **collaboratively**, prioritizing assessment and rapport. - **Incorrect answers (A, B, D)** either dismiss, confront, or misinterpret the patient’s reality, undermining therapeutic goals. - Effective psychiatric communication **balances validation** ("You say you hear...") with **clinical inquiry** ("...what are they telling you?"), avoiding power struggles while gathering data to guide care. This rationale underscores the importance of **patient-centered, evidence-based communication** in psychiatric nursing, particularly for altered thought processes where empathy and validation are foundational to intervention.

Correct Answer: D

Rationale: Anosognosia is a lack of insight that affects patients with schizophrenia, leading them to deny or lack awareness of their illness. This lack of awareness often results in patients refusing medication because they genuinely believe they are not ill and do not need treatment. It is crucial for healthcare providers to approach such situations with understanding and empathy, recognizing the impact of anosognosia on treatment adherence.

Correct Answer: C

Rationale: The patient's symptoms, including stiffness, diaphoresis, inability to respond verbally, and vital sign abnormalities, are indicative of neuroleptic malignant syndrome (NMS), a serious and potentially life-threatening side effect of antipsychotic medications. Administering a medication such as benztropine intramuscularly is the priority to address the dystonic reaction associated with NMS. This intervention can help alleviate symptoms and prevent further complications. Holding the medication and contacting the prescriber may be necessary but addressing the acute symptoms takes precedence. Wiping the patient with a cold washcloth or alcohol would not address the underlying medical emergency. Reassuring the patient about tardive dyskinesia is irrelevant and not the immediate concern in this scenario.

Correct Answer: C

Rationale: Individuals with schizophrenia often turn to excessive alcohol consumption as a way to manage symptoms of anxiety and depression. This maladaptive coping mechanism can exacerbate the challenges associated with schizophrenia and may hinder effective treatment outcomes. Recognizing the presence of anxiety and depression alongside alcohol abuse is crucial for providing holistic care and support to individuals with schizophrenia.