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?

Sarcastically states, “That group is only for crazy people with problems.”

Scornfully states, “No, can’t you see that I’m having a séance with my mom?”

Suspiciously states, “No, that room has been bugged.”

Hesitantly states, “OK, but only if I can sit next to you.”

Answer and Explanation

The Correct Answer is A

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.

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Correct Answer is A

Explanation

Paranoid personality disorder is a Cluster A condition marked by pervasive distrust and suspicion of others. Individuals with this disorder often believe that others are exploiting, harming, or deceiving them, even without evidence. They are hypervigilant, reluctant to confide in others, and may interpret benign remarks or events as threatening. These clients often appear guarded, hostile, or aloof, and they may isolate themselves due to their suspiciousness. Unlike psychotic disorders, their beliefs do not reach delusional intensity, but their thought patterns are rigid and resistant to change. They are often difficult to engage in therapeutic relationships due to their mistrust.

Rationale for correct answer

A. The statement “Everyone wants to hurt me” reflects the suspiciousness and pervasive mistrust characteristic of paranoid personality disorder. These clients often isolate themselves and interpret others’ actions as threatening, even in neutral or supportive environments.

Rationale for incorrect answers

B. Exploiting others for cigarettes reflects manipulative and irresponsible behavior more typical of antisocial personality disorder, a Cluster B condition. Paranoid individuals are more likely to avoid interaction than to manipulate others.

C. Shyness and avoidance due to low self-esteem are features of avoidant personality disorder, a Cluster C condition. Paranoid individuals avoid others due to mistrust, not feelings of inadequacy.

D. Allowing others to make decisions reflects submissiveness, which is characteristic of dependent personality disorder. Paranoid individuals are controlling and mistrustful, not passive or deferential.

Take Home Points

Paranoid personality disorder involves pervasive mistrust and misinterpretation of others’ intentions as hostile.
These individuals often isolate themselves and are resistant to forming trusting relationships.
It must be differentiated from avoidant personality disorder, which involves social withdrawal due to fear of rejection.
Unlike Cluster B disorders, paranoid individuals are not manipulative or emotionally volatile.

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 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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which scenario would the nurse expect to observe if the client were diagnosed with paranoid personality disorder?

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

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?

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

Which behaviors should a nurse expect when working with a client with histrionic personality disorder? Select all that apply

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

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

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

A client diagnosed with a personality disorder insists that a grandmother, through reincarnation, has come back to life as a pet kitten. The thought process described is reflective of which personality disorder?

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