Name That Hallucination!
A patient says, “Someone keeps knocking, but nobody is at the door!” The nurse confirms there is no knocking. Which type of hallucination is this?
Auditory—hearing a sound without an outside source.
A frightened patient says, “There’s someone standing behind you!” Nobody is there. What could the nurse say?
“I don’t see anyone there, but I can see you’re frightened. I’m here with you.” Accept similar responses that acknowledge feelings without agreeing with the hallucination.
A patient says, “The voices are telling me to do something.” What does the nurse need to find out next?
What the voices are telling them to do and whether they feel compelled or intend to follow the commands.
A patient taking quetiapine says, “I get dizzy when I stand up.” What side effect might explain this?
Answer: Orthostatic hypotension—a drop in blood pressure when standing. Reinforce rising slowly and assist as needed to prevent falls.
A patient says, “There are bugs crawling under my skin!” No insects are present. Which type of hallucination is this?
Tactile—a sensation of touch without an outside source.
A nurse also pretends to hear the patient’s voices to “make them feel understood.” Is this therapeutic?
No. Acknowledge the patient’s feelings without reinforcing the hallucination.
A patient is frightened and overwhelmed in a noisy room with several visitors. What environmental change could help?
Reduce unnecessary noise and visitors and provide a calm, predictable environment.
A patient taking risperidone reports unexpected milk discharge from their breasts. Which hormone may be elevated?
Prolactin. Unexpected milk discharge is called galactorrhea.
One patient smells burning rubber when there is no source. Another experiences an unexplained bitter taste without a matching source. Name BOTH types of hallucinations.
Olfactory involves smell; gustatory involves taste.
A patient keeps looking toward an empty corner and seems distracted. Instead of assuming what’s happening, what should the nurse ask?
A calm, direct question such as, “Are you hearing or seeing something right now?” Follow up about what they’re experiencing.
A hospitalized patient who was previously alert suddenly becomes confused and sees animals on the bed. Should the nurse assume this is schizophrenia? What should happen next?
No. Report the acute change promptly and assist with assessment for an underlying medical cause, including possible delirium.
A patient wants a peer-led mental health support group. Their family also wants support. Which organization from our presentation offers groups for BOTH?
NAMI—NAMI Connection for adults with mental health conditions and NAMI Family Support Group for loved ones.
DOUBLE TROUBLE! A patient briefly sees a figure while falling asleep. Another hears someone call their name while waking up. What are these two sleep-related hallucinations called?
Hypnagogic happens while falling asleep; hypnopompic happens while waking up.
A patient hears voices but reports no harmful commands. They say, “Talking with someone usually helps.” What patient-centered action could the nurse take?
Offer a calm conversation and help the patient use that coping strategy. Evaluate whether it reduces distress rather than choosing a distraction without their input.
PRIORITY ROUND! A patient says, “The voice says to hurt myself, and I think I’m going to do it.” What should the nurse do immediately?
Stay with the patient, summon help immediately, and initiate facility safety procedures. Reduce access to harmful objects safely and notify the appropriate healthcare team.
A patient taking haloperidol can’t sit still and feels intense restlessness. Name this side effect.
Akathisia—an extrapyramidal symptom (EPS).