The nurse is conducting a mental status exam on a patient with schizophrenia. The patient reveals to the nurse that he hears voices in his head. What is the nurse's priority assessment?

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2. The patient is experiencing auditory hallucinations. The nurse's priority is to determine if the hallucinations are command hallucinations, which may place the patient in danger of harming himself or others. The nurse's priority is not to determine if the hallucinations are fantasy-oriented. While the nurse will assess if the patient has a disturbance in thought process and orientation, these are not the most important things for the nurse to assess regarding the patient's symptoms.

The Nurse Is Conducting a Mental Status Exam on a Patient