A client with schizophrenia says, "The food tray is poisoned, so I will not eat." Which response by the nurse is best?
1The food feels unsafe to you; I can offer a sealed item that you can open✓ Correct answer
2No one poisoned the food, and you must eat the entire meal before it gets cold
3Why would the kitchen staff choose to harm you through the food
4Skip this meal and eat after the belief about poisoning has resolved
Explanation
The nurse acknowledges the client's distress without agreeing with the delusion and offers a practical, lower-threat food choice. Arguing, exploring delusional logic, coercing intake, or accepting ongoing meal refusal can increase mistrust or compromise nutrition.
Quick answer Validate the fear without validating the delusion, then offer a safe practical choice.
Why this is correct A therapeutic response names the client's experience without confirming that poisoning occurred. A sealed item the client can open reduces perceived threat, preserves choice, and supports nutrition while the nurse continues assessment and treatment.
Easy analogy or mental picture The nurse builds a bridge around a blocked road instead of arguing that the road is open. The bridge is the acceptable food option; the comparison does not mean avoiding assessment of medical risk, command hallucinations, or worsening psychosis.
Memory hook Acknowledge the feeling, do not confirm the belief, and offer a workable choice.
NCLEX decision rule With a fixed false belief, respond to emotion and safety rather than debating content. Use calm reality-based language, preserve dignity, offer concrete choices, and assess nutrition and broader risk.
Why the other choices are wrong Direct contradiction and coercion increase mistrust. Asking for the delusion's logic can reinforce it, while simply allowing meal refusal fails to address nutrition and the underlying distress.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
Psychosis and Schizophrenia in Adults: Prevention and ManagementNational Institute for Health and Care Excellence, reviewed 2025
Clinical Practice GuideFor Direct suicide risk assessment, compare the complete cue pattern with the client's current stability, ordered data, and expected nursing scope.
CautionDo not choose an action from one isolated cue when the full scenario changes priority or safety.
Suicide Risk — The possibility that a client may harm or kill themself.
Direct Question — A clear, specific question used to assess risk without ambiguity.
Safety Assessment — Evaluation of immediate danger, intent, plan, means, and protective factors.