At 11:00 AM, a patient with schizophrenia who exhibits concrete thinking asks the nurse for PRN acetaminophen (Tylenol). However, he last had it at 8:00 AM, and it is ordered only every 4 hours. Which nursing response would be most therapeutic?
a. "I'm sorry, it's not quite time yet; please come back again in 1 hour.".
b. "I'm sorry, it's not quite time yet; please come back again at 12 noon.".
c. "It's not time yet; please come back when both hands of the clock point straight up.".
d. "It's not time yet; I will let you know when it is time. Perhaps a nap would help?"
C
Persons who think concretely have difficulty understanding and using abstract concepts such as the passage of time. Schizophrenia itself also interferes with one's ability to judge the passage of time. Therefore, giving the patient the needed information in the most concrete (literal, specific) manner possible is desirable, and telling him "when the hands of the clock both point straight up" is the most specific response here. Letting the patient know when it is time makes the patient dependent on the nurse and removes an opportunity to practice a needed skill. It also leaves the patient without any way to judge when the nurse might next give him the medication, which is likely to increase his anxiety.
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