A 45-year-old client with a delusional disorder believes that their neighbor is spying on them through hidden cameras in their home. The client is anxious but willing to discuss their belief. What is the most appropriate nursing response to support reality testing?
"That’s impossible. Your neighbor wouldn’t do that."
"You should stop worrying about this; it’s not real."
"If you think there are cameras, we should find them together."
"I understand this is frightening for you. I haven’t seen any cameras, and the police haven’t found anything. Let’s talk about what might help you feel more secure."
The Correct Answer is D
Choice A reason: Directly rejecting the belief is non-therapeutic and may increase defensiveness, damaging trust.
Choice B reason: Telling the client to stop worrying invalidates their feelings and dismisses the emotional impact of the delusion.
Choice C reason: Participating in the delusion by “looking for cameras” reinforces the false belief, which is not supportive of reality testing.
Choice D reason: Acknowledging the client’s fear while gently presenting reality and shifting toward problem-solving helps maintain trust and supports reality testing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Offering medication immediately does not address the client’s emotional state and undermines the use of therapeutic communication, which is the first-line intervention for moderate anxiety.
Choice B reason: This response is generic and educational, which is not appropriate in a crisis moment. The client needs immediate support and de-escalation.
Choice C reason: This response is inappropriate and harmful, suggesting a restraint that is not indicated and would likely worsen the client’s distress.
Choice D reason: This is the best therapeutic response. It provides a safe environment for the client to express feelings and decreases external stimuli, helping to reduce anxiety.
Correct Answer is D
Explanation
Choice A reason: Zero tablets would result in the patient not receiving the required medication.
Choice B reason: Three tablets equal 15 mg, which is above the prescribed dose and could cause adverse effects.
Choice C reason: Half a tablet equals 2.5 mg, which is insufficient to meet the 10 mg prescribed dose.
Choice D reason: Two tablets equal the prescribed 10 mg, which is correct.
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