Comprehensive exams for Mental Health Q 104
A client with paranoid-type schizophrenia becomes angry and tells the nurse to leave him alone. The nurse should
A. Tell him that she’ll leave for now but will return soon.
B. Ask him if it’s okay if she sits quietly with him.
C. Ask him why he wants to be left alone.
D. Tell him that she won’t let anything happen to him.
Correct Answer: A. Tell him that she’ll leave for now but will return soon.
If the client tells the nurse to leave, the nurse should leave but let the client know that she’ll return so that he doesn’t feel abandoned. If a client is found to be very paranoid, solitary or one-on-one activities that require concentration are appropriate. Client is free to choose his level of interaction; however, the concentration can help minimize distressing paranoid thoughts or voices.
Option B: Not heeding the client’s request can agitate him further. Teach the client to remove himself briefly when feeling agitated and work on some anxiety relief exercises (e.g., meditations, rhythmic exercise, deep breathing exercise). Teach client skills in dealing with anxiety and increasing a sense of control.
Option C: Also, challenging the client isn’t therapeutic and may increase his anger. If the client is very withdrawn, one-on-one activities with a “safe” person initially should be planned. They learn to feel safe with one person, then gradually might participate in a structured group activity. Useful coping skills that the client will need include conversational and assertiveness skills. These are fundamental skills for dealing with the world, which everyone uses daily with more or less skill.
Option D: False reassurance isn’t warranted in this situation. Ensure that the goals set are realistic; whether in the hospital or community. Avoids pressure on the client and sense of failure on part of the nurse/family. This sense of failure can lead to mutual withdrawal. If the client is delusional/hallucinating or is having trouble concentrating at this time, provide very simple concrete activities with the client (e.g., looking at a picture or doing a painting). Even simple activities help draw the client away from delusional thinking into reality in the environment.