Question

a patient with schizophrenia tells the nurse that she is a descendant of the windsor family in great britain and is the heir to the royal throne. which statement made by the nurse is most therapeutic?

\wow! when do you think youll become queen?\
\youre hallucinating. you are not a member of the royal family.\
\thats an interesting observation. im going to notify the psychiatrist so we can change your medication.\
\i dont feel you are a royal since you were born and raised in the united states. you are a patient in a facility and i am your nurse.\

Explanation:

Analyze the patient's presentation

The patient is presenting with a delusion of grandeur (believing she is the heir to the British royal throne).

Evaluate the communication options

• Option 1 reinforces and feeds into the delusion, which is non-therapeutic.
• Option 2 directly challenges, argues with, and belittles the patient's belief, which can damage the therapeutic alliance.
• Option 3 is dismissive, threatening, and inappropriately focuses on medication changes rather than immediate therapeutic communication.
• Option 4 presents reality gently without arguing, validates the patient's background, and clearly defines the professional boundaries of the nurse-patient relationship.

Determine the most therapeutic response

Option 4 is the most therapeutic response because it gently casts doubt on the delusion by presenting objective reality (born and raised in the United States) and reinforces the reality of the immediate environment and professional relationship (you are a patient, I am your nurse).

Answer:

• “Wow! When do you think you’ll become queen?”
• “You’re hallucinating. You are not a member of the royal family.”
• “That’s an interesting observation. I’m going to notify the psychiatrist so we can change your medication.”
• “I don’t feel you are a royal since you were born and raised in the United States. You are a patient in a facility and I am your nurse.” (Correct answer)