Practice Question
A nurse in a mental health facility is collecting a blood specimen from a client. The client is hallucinating and states, "That looks like a snake, and I won't let it take all of my blood.”. Which of the following responses should the nurse make?.
Answer Choices:
Correct Answer:
"I'm using a syringe to obtain your blood, not a snake.”.
Rationale:
🔷 Presents reality: This response gently corrects the hallucination by providing a factual explanation without arguing or reinforcing the false perception.
🔷 Therapeutic communication: A calm and non-confrontational reality orientation helps reduce anxiety and build trust.
🔷 Maintains safety: By clarifying the situation, the nurse helps the client feel more secure, which is essential during procedures like blood collection.
🔷 Avoids confrontation or dismissal: Statements like “You must be mistaken” or “Snakes cannot be in the clinic” are dismissive and may increase agitation in a hallucinating client.
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This question is from ATI PN Mental Health Eastern Suffolk College2-2023 which contains 46 questions.
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From Exam
ATI PN Mental Health Eastern Suffolk College2-2023
46 Questions
View Full Exam Start PracticingQuestion Details
- Category: LPN Nursing Exam(s)
- Subcategory: LPN ATI Exams
- Domain: Mental Health
- Answer Choices: 4