NCLEX-PN® ExaminationPsychosocial IntegrityHard
A client with schizophrenia is admitted to an inpatient psychiatric unit. The practical nurse observes the client frequently talking to themselves, gesturing at empty spaces, and appearing fearful. Which therapeutic communication technique would be most appropriate for the nurse to use initially?
- A“It looks like you're seeing something that isn't there. Are you feeling scared?”
- B“I understand you're experiencing things that aren't real, but you are safe here.”
- C“Tell me more about what you are seeing and hearing.”
- D“I don't see anyone there. Who are you talking to?”
Show answer & explanationAnswer & explanation
Correct answer: A. “It looks like you're seeing something that isn't there. Are you feeling scared?”
This option acknowledges the client's experience without validating the hallucination, then focuses on the client's emotional response (fear). It uses an empathic, non-confrontational approach, which is crucial for building trust and de-escalating distress in clients experiencing psychosis.
Why the other options are wrong
- B. While stating they are safe is good, directly telling the client their experiences 'aren't real' can be confrontational and dismissive, similar to option A.
- C. Asking to 'tell me more' about the hallucination can validate it and reinforce the delusion/hallucination, potentially increasing the client's distress or engagement with it.
- D. Directly challenging the hallucination can alienate the client and damage trust.
Therapeutic Communication: Hallucinations
When a client is hallucinating, therapeutic communication involves acknowledging their experience without validating the hallucination, and then focusing on their feelings or the impact of the experience.
- Do not argue or agree with the hallucination.
- Focus on the client's feelings and provide reassurance.
- Redirect to reality-based topics and activities.
Memory trick: Acknowledge Feeling, Not the Illusion.