Question

1. A nurse is caring for a client who has schizophrenia and is experiencing delusions. Which of the following actions should the nurse take?

1. Encourage the client to rest quietly in bed twice per day
2. Direct long conversations about the delusions toward reality-based topics.
3. Avoid assessing client’s delusions
4. Allow the client unlimited time to discuss the delusions when they occur.

Answer 1

A nurse is caring for a client who has schizophrenia and is experiencing delusions. Which of the following actions should the nurse take?

a)Encourage the client to rest quietly in bed twice per day

b) Direct long conversations about the delusions toward reality-based topics.

c) Avoid assessing client’s delusions

d) Allow the client unlimited time to discuss the delusions when they occur.

Answer:

(B) Direct long conversations about the delusions toward reality-based topics.

Justification :

the nurse should promote the patient's ability to reality test.

Managing Delusions:

Patients cope with delusions in several ways. Some adapt by learning to live with them. Others

deny the presence of these troublesome symptoms. Still others seek to understand the symptom and become empowered

to manage delusions when they occur.

The art of communicating with people who have delusions requires the development of trust. Patients with cognitive disorders have difficulty processing language; therefore

the beginning of trust is more readily accomplished through

nonverbal communication.

Patients with delusions perceive the environment as very

stimulating. It is essential for the nurse to approach the

patient with calmness and empathy. Patients report they can

literally “feel the vibrations” of others and can “sense if the

nurse is with me or against me.” Once trust is established,

the use of clear, direct, and simple statements becomes significant in communicating with people who have delusions.Patients with schizophrenia are very sensitive to rejection.

When they sense anxiety and avoidance in the nurse, they

often feel annoyed, inadequate, and hopeless. Sensing rejection by health care professionals also can lead to anger on the

part of the patient.

With insight into the illness and symptoms, the patient can

differentiate experiences with delusions from those that are

reality based. In the meantime the nurse should not underestimate the power of a delusion and the patient’s inability to

differentiate the delusion from reality.

The intervention plan should be followed consistently

by the entire treatment team. If the nurse resorts to “trying

anything” to gain compliance, care will be inconsistent and

will create an even more chaotic environment for the patient,

who already has great difficulty identifying reality.