# Situation: A 24-year-old man with schizophrenia is admitted to the psychiatric unit. He stopped taking his antipsychotic medicine 2 months ago. For weeks he has stayed in his room, has rarely bathed, and has stopped going to work. He has no history of violence. On the third day he refuses his meal tray, saying the staff are putting poison in his food. Which action is BEST?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629982  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 24-year-old man with schizophrenia is admitted to the psychiatric unit. He stopped taking his antipsychotic medicine 2 months ago. For weeks he has stayed in his room, has rarely bathed, and has stopped going to work. He has no history of violence.

On the third day he refuses his meal tray, saying the staff are putting poison in his food. Which action is BEST?

## 보기

1. Taste a spoonful of his food in front of him to prove it is safe
2. Offer sealed, packaged food that he can open himself **✔ 정답**
3. Explain that the kitchen follows strict food safety standards
4. Let him skip meals until his medicine controls the belief

**정답: 2**

## 해설

A persecutory delusion is neither argued with nor agreed with; the nurse meets the nutritional need in a way the client can accept. Sealed, commercially packaged food that he opens himself keeps him eating without debating the belief. Tasting the food or arguing with facts engages the delusion, and letting him skip meals neglects nutrition.

## 심화 해설

Clinical context

A 24-year-old man with schizophrenia has been off antipsychotic medication for 2 months. He now presents with negative symptoms (social withdrawal, poor hygiene, unemployment) and an active persecutory delusion: he believes staff are poisoning his food. The immediate nursing priority is to maintain adequate nutrition without reinforcing or challenging the delusion.

Why the correct answer is sealed, packaged food

A persecutory delusion is a fixed, false belief that cannot be corrected by logical argument or evidence. The nurse’s role is not to debate the belief, but to meet the client’s nutritional need in a way the client can accept without engaging the delusional content. Offering commercially sealed food that the client opens himself removes the perceived route of tampering—staff handling or kitchen preparation—and allows him to eat while preserving his sense of control and safety.

Key point! In delusional thinking, the perception of threat is real to the client. The goal is to bypass the delusion, not to disprove it.

Why the other options are incorrect

| Option | Problem |
| --- | --- |
| 1. Taste the food | Tasting the food does not prove safety to a person with a delusion; it can be interpreted as part of the poisoning plot or as the nurse being fooled. It also engages the delusion rather than sidestepping it. |
| 3. Explain food safety standards | Arguing with facts or appealing to logic is ineffective against a fixed false belief. The client will not be reassured by rational explanation. |
| 4. Let him skip meals | Withholding or delaying nutrition until medication takes effect neglects a basic physiological need and can lead to dehydration, weakness, and worsening clinical status. |

Pathophysiology and clinical rationale

Schizophrenia is a highly polygenic disorder involving disturbances in neuronal and synaptic function across multiple brain regions . Dopamine receptor blockade remains the core mechanism of all currently approved antipsychotic drugs , which is why medication adherence is critical. This client stopped his antipsychotic 2 months ago, allowing psychotic symptoms—including persecutory delusions—to re-emerge.

Persecutory delusions are not simply “wrong ideas” that can be corrected with education. They are fixed beliefs that persist despite contradictory evidence. The nursing approach therefore focuses on symptom management and safety, not on convincing the client that his belief is false.

Watch out! Do not argue with the delusion, and do not agree with it. A neutral, non-confrontational response that addresses the underlying need—nutrition—is safest.

Clinical application

When a client refuses food due to a poisoning delusion, the nurse should first assess the level of risk and the client’s willingness to accept alternative food sources. Sealed, individually packaged items such as commercially wrapped sandwiches, crackers, fruit cups, or bottled beverages are often acceptable because the client can verify the seal and open them himself. This strategy preserves autonomy and reduces the perceived threat.

The nurse should also continue to monitor intake and output, weight, and hydration status. Antipsychotic medication should be restarted as prescribed, but nutritional support cannot wait for the delusion to resolve. Meeting basic needs while the delusion is still active is a core nursing responsibility.

Key point! In psychiatric nursing, the correct response to a delusion is often not to address the delusion directly, but to find a practical workaround that maintains safety and physiological stability.

## 임상 시나리오

Persecutory Delusion and Meal RefusalMaintaining nutrition without engaging the delusion
When a client refuses food due to a persecutory delusion of poisoning, the priority is to meet nutritional needs without arguing with or reinforcing the belief. Offer commercially sealed, packaged food that the client opens himself to bypass the perceived route of tampering.

Do not taste the food, explain kitchen safety standards, or appeal to logic. A fixed false belief is not corrected by evidence and may incorporate the nurse's actions into the delusion.

CautionSkipping meals until medication controls the belief neglects nutrition and can lead to dehydration or weight loss. Address the need now, not after the delusion resolves.

## 핵심 개념

- **persecutory delusion** — A fixed, false belief that one is being harmed, harassed, or plotted against, not corrected by logic or evidence.
- **negative symptoms** — Deficits in normal functioning in schizophrenia, such as social withdrawal, poor hygiene, and avolition.
- **therapeutic communication** — Nursing techniques that avoid arguing with or reinforcing delusions while addressing the client's underlying needs.
- **nutritional support** — Interventions to maintain adequate intake when psychiatric symptoms interfere with eating.
- **antipsychotic nonadherence** — Discontinuation of antipsychotic medication, a common cause of symptom relapse in schizophrenia.

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