Which therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient's nursing diagnosis is altered thought processes?

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: 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.

Correct Answer: B

Rationale: In managing bipolar disorder, it is vital to educate the patient and their support system about triggers like alcohol and caffeine, the significance of good sleep, and the need for family involvement. However, the statement in choice B is incorrect. While antidepressants need to be carefully monitored in bipolar disorder, they can be used in conjunction with mood stabilizers to manage depression in some cases.

Correct Answer: C

Rationale: **Rationale:** **Correct Answer (C) - "Lithium may help me lose the few extra pounds I tend to carry around."** This statement is incorrect and demonstrates a misunderstanding of lithium therapy. Lithium is not associated with weight loss; in fact, it is widely documented to cause **weight gain** as a common side effect. The mechanism involves increased thirst and fluid retention, metabolic changes, and potential hypothyroidism, all of which can contribute to higher body weight. Patients are often counseled about this side effect to manage expectations and adopt strategies like dietary modifications. Thus, the idea that lithium aids weight loss is factually wrong and reflects a lack of proper education about the medication’s effects. **Incorrect Choices:** **A: "I remind myself to consistently drink six 12-ounce glasses of fluid every day."** This statement is accurate and reflects proper understanding. Lithium requires **adequate hydration** to maintain therapeutic serum levels and reduce the risk of toxicity. Dehydration can lead to elevated lithium concentrations, increasing the likelihood of adverse effects like tremors, confusion, or renal damage. Patients are typically advised to consume 2–3 liters of fluids daily and maintain consistent salt intake. The specificity of "six 12-ounce glasses" aligns with general guidelines, showing the patient’s awareness of this critical requirement. **B: "I discussed the diuretic prescribed by my cardiologist with my psychiatric care provider."** This statement is correct and demonstrates **appropriate medication management**. Diuretics (especially thiazides) can significantly increase lithium levels by reducing renal excretion, posing a risk of toxicity. Coordination between healthcare providers is essential to adjust lithium doses or monitor levels closely when diuretics are used. The patient’s proactive communication reflects an understanding of the importance of interdisciplinary care and lithium’s narrow therapeutic index. **D: "I take my lithium on an empty stomach to help with absorption."** While this statement contains a common misconception, it is not entirely incorrect. Lithium is generally **well-absorbed** regardless of food, though taking it with food may reduce gastrointestinal side effects like nausea. However, the belief that empty stomach administration enhances absorption is not clinically significant enough to be harmful, as bioavailability is not drastically affected. Thus, this choice does not reflect a critical misunderstanding like option C does. **Conclusion:** Option C stands out as the only choice that directly contradicts evidence-based knowledge about lithium, while the others reflect either correct practices (A, B) or minor, non-critical inaccuracies (D). The focus on weight loss is particularly misleading, as it could delay interventions for actual side effects like weight gain or electrolyte imbalances.