# A client with schizophrenia says, "The voices are telling me to do something bad." Which response is the nurse's priority?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=394024&lang=en  
> language: en  
> subject: Mental Health Concepts  
> category: PSI

## Question

A client with schizophrenia says, "The voices are telling me to do something bad." Which response is the nurse's priority?

## Option

1. Tell the client the voices are not real and should be ignored.
2. Offer headphones and ask the client to stay alone in the room.
3. Ask what the voices are saying and assess for risk of harm. **✔ Correct answer**
4. Change the subject to a pleasant activity.

**Correct answer: 3**

## Explanation

Command hallucinations require immediate safety assessment. The nurse should ask what the voices are saying and assess whether the client may harm self or others. Arguing about reality, isolating the client, or distracting before risk assessment can miss an urgent safety threat.

## In-depth explanation

Clinical Judgment
When hallucinations include commands, the first nursing question is about safety and specific content.

Memory Tip
Command voice: ask content, assess danger.

KR vs US
NCLEX psychiatric safety items reward direct risk assessment, not reassurance alone.

## Clinical scenario

Clinical Practice Guide
NIMH describes hallucinations as hearing or seeing things others do not, including voices that may tell a person to do something. Safety assessment is essential when harmful commands are possible.

Caution
Ask direct, calm questions about suicidal or violent thoughts when risk cues appear.

## Key concepts

- **Hallucination** — A sensory experience, such as hearing voices, that occurs without an external stimulus.
- **Command Hallucination** — A hallucination that directs the person to take an action.
- **Risk Assessment** — Focused questions and observations used to evaluate possible harm to self or others.

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