A client with schizophrenia has been hospitalized for a week and placed on an antipsychotic medication. The client tells the nurse of hearing multiple voices all day long arguing about whether the client is a good or bad person. The client says, "Everyone tells me that the voices are not real, but they are driving me crazy." What is the best action by the nurse?

Question

Quizplus · Accepted Answer

Auditory hallucinations are the most common type of hallucination and are typically experienced by individuals with a diagnosis of schizophrenia, bipolar disorder, or other psychotic illness. Antipsychotic medication therapy is the first-line treatment of hallucinations and other psychotic symptoms. However, most psychotropic drugs may take some time to be completely effective and may not eliminate hallucinatory episodes entirely. Clients should be encouraged to develop alternate methods for coping with the hallucinations. One approach is increasing the amount of external auditory stimulation in the environment. Individuals with auditory hallucinations have reported that increasing the amount of external sound (eg, watching TV or listening to music through headphones) makes it easier to ignore internal sounds from the hallucinations. Other methods of managing auditory hallucinations include voice dismissal (telling the voices to go away) and cognitive behavioral therapy (assists clients in learning new ways to think about and deal with their symptoms). (Option A) Reading a book may provide some distraction, but it does not increase external auditory stimulation. (Option C) The medication may not start to work for another 2 weeks and may not eliminate these symptoms entirely. (Option D) The client is hearing voices all day long; ignoring them is not as effective as an activity that distracts the client from the hallucinations. Educational objective: Although antipsychotic medication is the first-line treatment for diminishing or eliminating psychotic symptoms, such as hallucinations, clients need other strategies for coping with distressing symptoms. Increasing external auditory stimulation often helps distract the client from the internal voices and focus on reality.

A Client with Schizophrenia Has Been Hospitalized for a Week