As you go in to give R.B. his medication, he speaks to you in fragmented sentences. "Is that a bird? the little flowers jump up and down. What says the moon?"
Before you can say anything, he asks, "do you see
that bird over my bed? she is telling me not to leave this room. If I move she will swoop down and try to
peck at my eyes. Be careful!"
Is he having a delusion or a hallucination? Explain your answer.
Which responses by the nurse are appropriate? Select all that apply.
a. "I don't see a bird over your head, but I can understand how that would be upsetting to
you."
b. "There is no bird over your bed."
c. "Tell me more about what you are seeing."
d. "The voice you are hearing is part of your illness. It can't hurt you."
e. "I'll come back to talk to you when you are settled down."
He is having a hallucination. Hallucinations involve perceiving a sensory experience for which there
is no external stimulus (he sees a bird over his bed and hears it talking to him). A delusion is a false
belief that a person thinks is true even with evidence to the contrary. For example, a person sees a
bed and becomes fearful because he believes it is his coffin.
Answer: a, c, d
Keep a calm demeanor and stay with the patient. If you do not understand what R.B. is saying, you
need to let him know. It is important to be gentle but clear. Tell R.B. that you are not understanding
him, and that you would like to be able to understand him. It is important not to negate what R.B. is
experiencing, yet you need to offer what you perceive. Tell him, "I do not see a bird over your bed,
but I can understand how that would be upsetting to you." Do not argue with the patient. Notify the
physician if his behavior becomes aggressive.
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