— 心理社會完整性 · MEDIUM · MCQ —
一位患有思覺失調症的病人出現聽幻覺，並告訴護理師：「聲音說你們想要毒害我。」護理師最恰當的回應是？
A client with schizophrenia who is experiencing auditory hallucinations tells the nurse, 'The voices are telling me that you are trying to poison me.' Which response is most appropriate?
- AI understand that you hear voices, but I do not hear them.✓ 正解我了解你聽到聲音，但我沒有聽到。
- BThe voices are not real, so you should ignore them.那些聲音不是真的，所以你應該忽略它們。
- CWhy would you think that I want to harm you?你為什麼認為我想傷害你？
- DI promise that no one here is trying to poison you.我保證這裡沒有人試圖毒害你。
— Explanation · 中文詳解 —
處理幻覺的原則是承認病人的主觀體驗，同時將自己與幻覺進行區隔（Reality testing）。直接反駁或爭論病人的妄想通常會導致病人防衛心增加。A選項展現了治療性溝通，既肯定病人的感知，又堅定自己的現實界線。
This response validates the client’s subjective experience without reinforcing the delusion, thereby maintaining a therapeutic boundary between the nurse’s reality and the client’s hallucinations. Directly arguing against the client’s beliefs or demanding explanations can increase defensiveness and damage the therapeutic alliance.
✦ 台美臨床差異
台灣精神科病房強調藥物順從性，美國則更強調心理社交治療與病人自主決策的討論。