An 84-year-old male tells you that he is hearing and seeing demons. He has a history of schizophrenia. He denies any other complaints. His vital signs are P 64, R 12, BP 122/74, and SpO2 is 98% on room air. You should:

• A. Tell him not to worry because you will protect him.
• B. Ask him to point to where the demons are.
• C. Tell him that you cannot see or hear them.
• D. Ask him if it is alright with the demons if you transport him to the hospital.

Answer: (C)

In this situation, the priority is to respond in a calm, nonjudgmental way and to avoid arguing about the patient’s hallucinations. When someone with psychosis describes seeing or hearing things that aren’t real, acknowledge the experience without challenging its reality and without encouraging the delusion. Saying that you can’t see or hear the demons conveys boundaries and safety while not disputing what the patient is perceiving. It helps keep the interaction respectful and reduces the chance of escalation, while you continue to provide care and arrange transport as needed.

The other options are less appropriate because they either marginalize the patient, engage with the delusion in a way that can escalate or confuse the situation, or introduce an odd or dismissive stance. Maintaining a supportive, reality-grounded approach is the best path here.