What are the voices saying to you? A compassionate first response when clients report hearing voices.

When a client reports hearing voices, what is the most appropriate initial response by the nurse?

• A. What are the voices saying to you?
• B. Your head is turned as if listening
• C. I don't hear anyone but you
• D. Let's discuss your anxiety

Answer: (A)

When a client reports hearing voices, the most appropriate initial response by the nurse is to ask what the voices are saying to them. This approach demonstrates active listening and acknowledges the client's experience. By asking this question, the nurse opens a dialogue that allows the client to express their feelings and thoughts about the hallucinations. It also provides the nurse with important information about the content and nature of the voices, which can be crucial for assessment and determining the best course of care. Engaging with the client's experience in this manner can help build trust and rapport, which is essential in therapeutic relationships. Additionally, understanding the specifics of what the client is hearing may inform the nurse about the severity of the client's symptoms and their safety. The other choices, while potentially relevant in future interactions, do not directly address the client's immediate experience. A statement about not hearing anyone but the client may dismiss their feelings and invalidate their experience. Commenting on the client’s body language does not engage with their report of hearing voices, and discussing anxiety might not be pertinent at the moment when the primary focus should be on the auditory hallucinations.

When a client says they hear voices, the very first thing a nurse does can set the whole interaction on a constructive track. It’s one moment where words matter more than you might expect. The instinct to quiet or redirect can be strong, but the best initial response is a simple, direct invitation to share more: What are the voices saying to you?

Let me explain why that question works so well in real life care. It does more than satisfy curiosity. It signals that you’re present, you’re listening, and you respect the client’s lived experience. It opens a doorway for the person to describe what’s real for them in that moment—content, tone, intensity, and frequency. And because the content of the voices can reveal a lot about safety and emotional state, gathering this information early helps the nurse determine the next steps with greater accuracy.

The power of an open, nonjudgmental question

• You validate the experience. Hearing voices can be scary and isolating. When a client hears that you’re not dismissing or rewriting their reality, trust starts to grow.

• You gather essential details. By asking what the voices are saying, you learn whether the content urges harm, commands, or self-recriticism. You learn about the loudness, the number of voices, and whether they’re constant or intermittent.

• You set a calm, collaborative tone. The patient feels invited to participate in their own care plan rather than being treated as a problem to be managed.

• You establish a baseline for safety. Content matters. If the voices instruct self-harm or harm to others, you’ll need to act quickly and appropriately.

A quick example of how this sounds in practice

• Nurse: What are the voices saying to you?

• Client: They’re telling me to hide in the closet and not talk to anyone.

• Nurse: That sounds very real to you. How long have you been hearing them, and how strong is the urge to listen?

• Client: It’s been getting louder over the last few days.

• Nurse: I’m glad you told me. Let’s talk about what we can do to keep you safe and make sure you’re supported right now.

Why the other options fall short (and what they miss)

Now, consider other possible lines a nurse might choose. Some might seem helpful in the moment, but they don’t engage the client’s experience in the same way.

• B. Your head is turned as if listening

This tells the client something about your body language, not about their reality. It can feel like an observation from a distance, which might make the client feel misunderstood or judged. The human connection you want to build isn’t enhanced by focusing on what you notice about their posture.

• C. I don’t hear anyone but you

This might come across as dismissive or as if you’re contradicting the client. It can create a power imbalance—like you’re the one who controls what is real, which can shut down honest dialogue and leave the client feeling unheard.

• D. Let’s discuss your anxiety

While anxiety can be connected to psychosis or distress, jumping straight to anxiety shifts attention away from the immediate experience of the voices. It may be a relevant topic later, but it doesn’t address the client’s reported perception head-on and can delay essential assessment.

In short, the lead question about what the voices are saying keeps the focus where it belongs: the client’s current experience, its impact, and the safety implications. It’s practical, yes, but it’s also human.

What to do after that first, guiding question

The opening question is just the start. Here’s how to navigate the next steps with care and competence:

• Listen deeply and reflectively. After the client shares, paraphrase what you heard to confirm understanding. For example: “So the voices are urging you to stay hidden. That’s very distressing for you.” Reflections show you are tracking, not just hearing.

• Assess safety without sensationalism. Ask clarifying questions about command hallucinations or instructions to harm. If there’s any risk, coordinate with the treatment team and follow protocol for safety.

• Document content and impact. Note the content, frequency, loudness, and how the voices affect functioning. Record associated symptoms, mood, sleep, and substance use. Clear notes help the whole team see the bigger picture.

• Keep the conversation open and non-judgmental. Use simple language, avoid jargon, and check in frequently about comfort and consent for sharing more.

• Begin to build a supportive plan. Early steps might include grounding techniques, a calm environment, and a safety plan. Involve the client in decisions as much as possible to maintain autonomy.

• Consider broader factors. Substance use, withdrawal, medication side effects, and medical conditions can contribute to hallucinations. Screen for sleep deprivation, dehydration, or infection, depending on the setting.

A practical roadmap for nurses

• Start with presence, not correction. Acknowledge the experience before moving toward assessment.

• Use open-ended questions. “What are the voices saying to you?” vs “Do you hear voices?” invites fuller, richer responses.

• Follow with brief, non-leading questions. For instance: “Are the voices telling you to do something right now?” or “Do they speak to you about any danger?”

• Check on safety, then comfort. Ask about agitation, fear, and coping strategies. Offer grounding options like slow breathing or noting tactile sensations in the environment.

• Invite collaboration. Ask what helps most in moments of distress and what should be avoided.

• Plan for the moment after. Ensure the client isn’t isolated; arrange for a supportive presence, if appropriate, and discuss next steps with the interprofessional team.

Emotional resonance and cultural nuance

Hearing voices happens in a human context. It’s not just a clinical symptom; it can be tied to stress, trauma, grief, poverty, or cultural experiences where voices have different meanings. The nurse’s role includes listening for those meanings and validating the client’s feelings without rushing to a label.

• Be culturally aware. Some clients interpret voices through spiritual or cultural lenses. A respectful stance is to ask about what the voices mean to them personally.

• Hold space for fear and hope. People experiencing voices often grapple with fear, confusion, or, occasionally, relief in a paradoxical way. Acknowledge those emotions with balanced honesty.

• Avoid sensationalism. Keep language calm and professional, avoiding drama. The goal is steady, supportive engagement.

Real-world flavor: tiny dialogues that feel real

• Nurse: What are the voices saying to you?

• Client: They’re telling me I’m in danger at night.

• Nurse: That sounds really unsettling. How often does that happen, and what helps you feel safer at those times?

• Client: It spikes around 2 a.m. A glass of water helps, and I talk to myself softly.

• Nurse: Let’s plan a simple routine for late hours—water by your bed, a reflective moment, and someone you can call if it gets too loud.

A few quick tips that actually work

• Use plain language with concrete steps. This isn’t the time for fancy phrasing; clarity beats cleverness.

• Stay curious and nonverbally present. A patient who feels your calm presence is more likely to share honestly.

• Keep the patient involved in decisions. Even small choices—where to sit, when to check in—build trust.

• Coordinate care. Involve social workers, psychiatrists, and occupational therapists to tailor safety and coping strategies.

• Reflect after the encounter. A short note for yourself or a brief debrief with a colleague helps you refine your approach for the next client.

A gentle reminder

You don’t have to solve the mystery of the voices in one conversation. The aim is to establish trust, gather accurate information, and ensure safety while supporting the client’s humanity. That initial question—What are the voices saying to you?—isn’t a trapdoor; it’s a bridge. A bridge to understanding, care, and a plan that feels doable to someone who’s feeling overwhelmed.

Quick checklist for the first contact

• Open with the guiding question.

• Listen, reflect, and invite more detail.

• Assess safety and potential risk.

• Document content and impact on daily life.

• Check for contributing factors (substance use, meds, medical issues).

• Involve the client in next steps and safety planning.

• Provide a calm, supportive environment and maintain ongoing contact.

Final thoughts

In mental health care, the moment you choose to listen first can redefine a client’s experience of care. The initial response isn’t about fixing a problem instantly; it’s about validating a lived experience, gathering critical information, and laying the groundwork for safety and healing. The voices, in their own way, tell a story about fear, distress, and the human struggle to make sense of chaos. Your role is to listen, to respond with compassion, and to walk with the client toward a place of steadier ground.

If you’re ever unsure in a tense moment, remember this: leading with a question that centers the client’s experience keeps the focus where it belongs. It’s practical, yes, but it’s deeply human—and that combination matters more than you might think.