# A nurse is caring for a client with schizophrenia who has been experiencing auditory hallucinations and paranoid delusions for the past week. The client refuses to take prescribed antipsychotic medication, stating "The voices tell me the pills are poison." What is the most appropriate initial nursing intervention?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=543378  
> language: ko  
> subject: Mental Health

## 문제

A nurse is caring for a client with schizophrenia who has been experiencing auditory hallucinations and paranoid delusions for the past week. The client refuses to take prescribed antipsychotic medication, stating "The voices tell me the pills are poison." What is the most appropriate initial nursing intervention?

## 보기

1. Explain to the client that the voices are not real and the medication is safe
2. Acknowledge the client's experience without reinforcing the delusion and explore their concerns about the medication **✔ 정답**
3. Contact the physician immediately to request a court order for involuntary medication administration
4. Mix the medication in the client's food without their knowledge to ensure compliance

**정답: 2**

## 해설

Therapeutic communication validates the client's experience without reinforcing delusions, building trust to address medication concerns. Other options are non-therapeutic or violate autonomy.

## 심화 해설

Clinical Judgment
This question asks what initial intervention a nurse should take for a patient with schizophrenia who refuses medication due to psychotic symptoms (auditory hallucinations, delusions). The core is therapeutic communication and building trust. The patient is refusing medication because of a delusional belief ("the medicine is poison"). At this point, attempting to deny the patient's reality or persuade them logically (Option 1) will only increase defensiveness and damage the therapeutic relationship. Instead, the approach should acknowledge the emotions the patient is experiencing ("fear, worry") without agreeing with the delusional content itself. Option 2 is a response that perfectly embodies this, validating the patient's subjective experience and exploring specific concerns about the medication, thereby building trust and opening the door to cooperation. This is an essential first step for subsequent education, support, or other interventions if needed (e.g., reviewing a change to an injectable medication).

Memory Tip
**A**cknowledge Feelings, **E**xplore Concerns (**A**FE-C). Acknowledge the patient's **feelings (A)** and **explore (E)** their concerns about the medication. Arguing or forcing destroys the relationship.

KR vs US
In Korea, there may be cases where medication compliance is induced by relying on family pressure or the authority of medical staff, but in the US NGN/CJMM, the principles of patient autonomy and Trauma-Informed Care are heavily emphasized. Coercion or deception (Option 4) is ethically and legally unacceptable and fundamentally destroys the therapeutic relationship.

## 임상 시나리오

Clinical Practice Guide
When a patient with a psychotic disorder such as schizophrenia refuses medication: 1) Talk in a safe environment. 2) Reflect their feelings, such as, "It must be frightening and confusing to hear voices telling you the medication is dangerous." 3) Ask about specific concerns, like, "What particularly worries you about the medication?" 4) Provide information and support based on the concerns the patient expresses (e.g., side effects, doubts about effectiveness).
Caution
In SATA (Select All That Apply) questions, the option "Logically refute the patient's delusions" is almost always incorrect. Also, "Immediately request forced medication from the doctor" (option 3) is not an initial intervention. It is a last resort considered only when all therapeutic approaches have failed and there is an immediate risk to the patient or others.

## 핵심 개념

- **Schizophrenia** — Schizophrenia. A major mental illness that impairs reality testing, characterized by auditory hallucinations, delusions, disorganized thinking, and inappropriate affect.
- **Auditory Hallucinations** — Auditory hallucinations. A symptom of perceiving sounds that do not actually exist, commonly seen in schizophrenia.
- **Paranoid Delusions** — Persecutory delusion. An unjustified, fixed, false belief that one will be harmed.
- **Therapeutic Communication** — Therapeutic communication. It is an intentional conversation technique used to acknowledge and reflect the patient's emotions, build a trusting relationship, and achieve treatment goals.
- **Medication Compliance/Adherence** — Medication adherence. It refers to the extent to which a patient takes medication as prescribed. In psychiatric nursing, improving adherence is key to preventing relapse and restoring function.

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