護理師正在照顧一位患有思覺失調症且正在經歷聽幻覺的病人。病人說：「那些聲音一直說我是個壞人！」下列哪項回應具備治療性？
A nurse is caring for a client with schizophrenia who is experiencing auditory hallucinations. The client says, 'The voices are telling me I am a bad person!' Which response by the nurse is therapeutic?
- ALet's go to the dayroom and watch TV to drown them out.我們去日間病房看電視，蓋過那些聲音。
- BI don't hear any voices; you are just imagining them.我沒聽到任何聲音；你只是想像出來的。
- CWhat exactly are the voices saying to you right now?現在那些聲音到底在跟你說什麼？
- DI believe the voices are real to you, but I do not hear them.✓ 正解我相信那些聲音對你來說很真實，但我聽不到。
處理幻覺的核心概念是『呈現現實』（Presenting Reality）與『認可感受』（Validating Feelings），而不去強化幻覺的內容。選項 D 同時做到了這兩點：它承認了幻覺對病人來說是真實的感官體驗，但也清楚地表達了護理師並沒有相同的感官經驗，這有助於建立現實感。選項 B 雖然呈現了現實，但語氣過於生硬，直接否定病人的體驗，會損害信任關係；選項 C 雖然能獲取資訊，但在已知幻覺性質後，過度糾結於內容（尤其是負面評價）可能會增加病人的焦慮；選項 A 雖然是一種分散注意力的技巧，但在這題的情境下，建立現實感比逃避幻覺更為優先。
The nurse should acknowledge the client's experience while gently presenting reality, as this validates their feelings without reinforcing the hallucination. Option D effectively communicates that while the voices are real to the client, the nurse does not hear them, helping to ground the client in reality. Other options either dismiss the client's experience, focus excessively on the hallucination content, or delay necessary reality orientation.
美國 NCLEX 考試強調『呈現現實』的精準措辭（I do not hear them），這在美國臨床護理中是核心規範。台灣臨床護理有時會更傾向於使用溫情或安撫的語言，但在處理精神症狀時，過度的安撫若不包含現實呈現，可能會讓病人對護理師的專業性產生混淆。