A nurse begins a relationship with a client with the diagnosis of schizotypal personality disorder. What is the initial nursing action?

Set limits on manipulative behavior.

Encourage participation in group therapy.

Respect the client’s need for social isolation.

Recognize that seductive behavior is expected.

Answer and Explanation

The Correct Answer is D

Schizotypal personality disorder is a Cluster A personality disorder marked by pervasive social deficits, cognitive-perceptual distortions, and eccentric behavior. Individuals often exhibit social anxiety, odd beliefs, and paranoid ideation. They may appear aloof, have few close relationships, and struggle with interpersonal intimacy. Speech may be vague or metaphorical, and behavior can seem eccentric or peculiar. Unlike schizophrenia, they do not have persistent psychosis, but transient psychotic episodes may occur under stress. Functioning is often impaired, especially in occupational and social domains.

Rationale for correct answer

D. The client’s behavior aligns with introversion and emotional detachment, which are hallmark traits of schizotypal personality disorder. These individuals avoid close relationships, exhibit social withdrawal, and often appear emotionally cold or indifferent. Their discomfort with intimacy and suspicion of others contributes to their isolation. The emotional constriction and interpersonal deficits are consistent with the DSM-5 diagnostic criteria.

Rationale for incorrect answers

A. The term rigid is more characteristic of obsessive-compulsive personality disorder, where individuals are preoccupied with order, perfectionism, and control. Schizotypal individuals are not controlling but rather socially anxious and withdrawn.

B. Submissiveness and immaturity are more typical of dependent personality disorder, where individuals rely excessively on others for decision-making and support. Schizotypal clients are more socially detached and suspicious, not dependent.

C. Arrogance and attention-seeking behaviors are associated with narcissistic or histrionic personality disorders. Schizotypal individuals tend to avoid attention due to their discomfort in social situations and do not seek admiration or approval.

Take Home Points

Schizotypal personality disorder involves social withdrawal, eccentric behavior, and cognitive-perceptual distortions without persistent psychosis.
It must be differentiated from schizophrenia, which includes sustained delusions and hallucinations.
Unlike Cluster B disorders, schizotypal individuals avoid attention and exhibit emotional constriction.
Treatment focuses on building trust, supporting social skills, and managing transient psychotic symptoms.

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Correct Answer is A

Explanation

Cluster B personality disorders include antisocial, borderline, histrionic, and narcissistic types. These disorders are marked by emotional dysregulation, impulsivity, and dramatic or erratic behavior. Clients often struggle with interpersonal relationships, exhibit manipulative or attention-seeking behaviors, and may respond to perceived criticism with hostility or sarcasm. Anger and defensiveness are common, especially when confronted with therapeutic interventions. Their reactions are often externalized, and they may resist group settings due to fear of judgment or loss of control.

Rationale for correct answer

A. The sarcastic remark reflects defensiveness and hostility, which are common in Cluster B disorders. Clients may use sarcasm to deflect vulnerability and avoid emotional exposure in group therapy. This response also demonstrates a lack of insight and resistance to therapeutic engagement, consistent with the interpersonal challenges seen in these disorders.

Rationale for incorrect answers

B. Scornful responses involving bizarre content are more typical of Cluster A disorders, such as schizotypal personality disorder. Cluster B clients may be dramatic, but they do not usually exhibit magical thinking or psychotic-like speech.

C. Suspiciousness and paranoid ideation are hallmark features of Cluster A disorders, particularly paranoid personality disorder. Cluster B clients are more likely to externalize blame through emotional outbursts than through paranoid delusions.

D. Hesitant cooperation and seeking proximity suggest traits of dependent personality disorder, which falls under Cluster C. Cluster B individuals are less likely to seek closeness and more likely to challenge authority or resist group participation.

Take Home Points

Cluster B personality disorders involve emotional instability, impulsivity, and dramatic interpersonal behavior.
Sarcasm and hostility are common defense mechanisms used to avoid vulnerability.
These disorders differ from Cluster A (odd/eccentric) and Cluster C (anxious/fearful) in their interpersonal style.
Group therapy may provoke resistance due to fear of judgment or loss of control.

A. Able to trust those who treat the client well B. Sees the goodwill of others when none exists C. Acts the opposite of what the client may be thinking or feeling D. Analyzes the behavior of others to find hidden and threatening meanings

Correct Answer is D

Explanation

Paranoid personality disorder is a Cluster A disorder characterized by pervasive distrust and suspiciousness of others. Individuals interpret others’ motives as malevolent, often without sufficient evidence. They are hypervigilant, reluctant to confide in others, and may bear grudges. These clients frequently misinterpret benign remarks or behaviors as hostile or threatening. They are not delusional but their cognitive distortions and interpersonal sensitivity lead to chronic interpersonal difficulties. The condition is ego-syntonic, meaning the person does not view their behavior as problematic, and they often resist treatment due to mistrust of providers.

Rationale for correct answer

D. Individuals with paranoid personality disorder frequently analyze others’ behaviors for hidden meanings, often interpreting neutral or positive actions as threats. This hypervigilance and misinterpretation are central features of the disorder and contribute to their social isolation and interpersonal conflict.

Rationale for incorrect answers

A. Trust is impaired in paranoid personality disorder, even toward those who treat them well. These individuals often question motives and may perceive kindness as manipulation or deceit.

B. Rather than seeing goodwill where none exists, these clients tend to perceive malevolence even when none is present. They are unlikely to interpret others’ actions positively without suspicion.

C. Acting opposite to thoughts or feelings is more characteristic of disorders involving emotional dysregulation or manipulative behavior, such as borderline or histrionic personality disorders. Paranoid individuals are more likely to act in line with their suspicious thoughts.

Take Home Points

Paranoid personality disorder involves pervasive distrust and misinterpretation of others’ motives as threatening.
These individuals often analyze others’ behavior for hidden meanings and are resistant to forming trusting relationships.
Unlike psychotic disorders, paranoid personality disorder does not involve delusions but rather fixed suspicious beliefs.
It is important to differentiate paranoid personality disorder from schizophrenia and delusional disorder, which involve psychosis.

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A nurse begins a relationship with a client with the diagnosis of schizotypal personality disorder. What is the initial nursing action?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse encourages an angry client to attend group therapy. Knowing that the client has been diagnosed with a cluster B personality disorder, which client response might the nurse expect?

Correct Answer is A

Explanation

Which behavior should a nurse expect a client diagnosed with paranoid personality disorder to exhibit?

Correct Answer is D

Explanation

Which diagnostic criterion describes schizotypal personality disorder?

Clients with a schizotypal personality disorder are most likely to benefit from which of the following nursing interventions?

When working with a client with paranoid personality disorder, a nurse should:

Which behavior should a nurse expect a client diagnosed with paranoid personality disorder to exhibit?

An adult is diagnosed with schizotypal personality disorder. How should a nurse describe the client’s behavior?

When working with a client diagnosed with paranoid personality disorder, a nurse understands that the client most likely:

Which of the following should a nurse include as a primary outcome for an individual with schizoid personality disorder?

A nurse notices that a client with paranoid personality disorder demonstrates some instances of spying behaviors on other clients on the unit. Which nursing intervention should the nurse institute?