NCLEX · Mental Health Concepts

A client with schizophrenia tells the nurse, 'The government has planted a chip in my brain to control my thoughts.' How should the nurse respond?

Correct answer

Calmly acknowledge the client's distress without reinforcing the delusion, then redirect to the client's feelings and immediate needs

  1. A Agree that this is possible to build rapport
  2. B Calmly acknowledge the client's distress without reinforcing the delusion, then redirect to the client's feelings and immediate needs
  3. C Argue that this is impossible and confront the belief directly
  4. D Ignore the statement and change the subject

Why this is the answer

A DELUSION is a fixed false belief that is not supported by reality and not part of the client's cultural or religious background. This client is expressing a PARANOID DELUSION (a common type in schizophrenia). THERAPEUTIC APPROACH: DO NOT: AGREE or reinforce the delusion ('That's possible') — reinforcing a false belief delays reality testing and worsens symptoms; ARGUE or confront the delusion directly ('That's impossible, chips can't be planted') — arguing is ineffective because delusions are not amenable to logical persuasion and may escalate the client's agitation or distrust of staff; IGNORE — dismissing the statement invalidates the client's distress. DO: ACKNOWLEDGE THE CLIENT'S DISTRESS without reinforcing the content of the delusion ('I can see that this is upsetting/frightening for you'); REDIRECT to feelings ('That sounds like a frightening experience for you') or to immediate needs ('Let's talk about what we can do to help you feel safe right now'); REMAIN CALM AND NON-THREATENING — paranoid clients may perceive threat from sudden movements, raised voices, too many staff; ASSESS for safety — is the client a danger to self or others based on the delusion?; DOCUMENT the specific content of the delusion. TYPES OF DELUSIONS: PARANOID (being followed, controlled, harmed); GRANDIOSE (special powers, famous identity); REFERENTIAL (events, objects, people have special meaning directed at the client); SOMATIC (false beliefs about the body); EROTOMANIC (belief that a person loves you); NIHILISTIC (belief that one is dead or doesn't exist). NURSING GOAL: keep the therapeutic relationship, keep the client safe, avoid reinforcing symptoms, and redirect to functioning in reality.
Source: NCLEX-PN Test Plan: Psychosocial — Mental Health, Delusions