章节:Schizophrenia, Other Psychoses, and Cognitive Disorders

SC
正确指数:100% 正确的次数:0 错误的次数:0 7377---A newly admitted client diagnosed with paranoid schizophrenia is pacing rapidly and wringing his hands. He states that another client is out to get him. Then he says, “Protect me, select me, reject me.” The nurse should next:

Saunders Comprehensive Review for the NCLEX-RN® Examination, 7e (Saunders Comprehensive Review for Nclex-Rn)

1. administer his oral PRN lorazepam and haloperidol.
2. place the client in temporary seclusion before he has a chance to hurt others.
3. call the healthcare provider (HCP) for a prescription for restraints.
4. ask the other clients to leave the immediate area.

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正确答案:
1. administer his oral PRN lorazepam and haloperidol.
解释 :
The client’s anxiety as reflected in rapid pacing and clang associations is rising as a result of his paranoid delusions. Administering the lorazepam and haloperidol will help the anxiety and delusions. The client is not threatening others at this point, so seclusion, restraints, and asking clients to leave the area are not necessary.