A nurse is assessing a client who has paranoid personality disorder. Which of the following findings should the nurse expect?

Takes advantage of others for her own benefit

Believes that others are deceiving her

Shows exaggerated expression of emotions

Demonstrates detachment from others

Answer and Explanation

The Correct Answer is B

A. Takes advantage of others for her own benefit:
This behavior is not specific to paranoid personality disorder. Instead, it may be seen in individuals with antisocial personality disorder, who disregard the rights of others and exploit them for personal gain. People with paranoid personality disorder are more characterized by a pervasive distrust of others and a belief that others are out to harm or deceive them.

B. Believes that others are deceiving her:
This is a hallmark symptom of paranoid personality disorder. Individuals with this disorder often exhibit extreme distrust and suspicion, believing that others have hidden motives or are deliberately trying to deceive, harm, or manipulate them. This suspiciousness and belief in the untrustworthiness of others are key features of paranoid personality disorder.

C. Shows exaggerated expression of emotions:
Exaggerated expression of emotions is not a defining characteristic of paranoid personality disorder. People with this disorder tend to display a guarded and suspicious demeanor rather than exaggerated emotional expressions. Their interpersonal interactions are often marked by skepticism and wariness.

D. Demonstrates detachment from others:
Detachment from others is more characteristic of schizoid personality disorder, not paranoid personality disorder. Individuals with schizoid personality disorder tend to be emotionally detached and have limited interest in social interactions. In contrast, individuals with paranoid personality disorder are highly suspicious and tend to assume that others are hostile or malevolent, leading to interpersonal difficulties rooted in their intense distrust.

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Correct Answer is B

Explanation

A. Obtain a prescription for restraints on an as-needed basis:
Restraints should never be used on an as-needed basis without a specific, individualized order from a healthcare provider. Restraints are a significant intervention that should only be used when necessary, and they require a clear prescription outlining the duration, reason, and method of application.

B. Have the provider assess the client within 1 hour after applying the restraints:
This option is the correct choice. It is crucial to involve the healthcare provider promptly after restraints are applied. The provider needs to assess the patient's physical and mental status, and the appropriateness of the restraints, and consider alternatives or modifications to the intervention. Regular assessments ensure the patient's safety and well-being while addressing the initial reason for applying restraints.

C. Request that the provider renew the prescription for restraints every 8 hours:
Restraining a patient every 8 hours without ongoing assessment and a clear clinical rationale is inappropriate and goes against best practices. Restraints should only be used when absolutely necessary and should be reevaluated frequently. Requesting a renewal on a fixed schedule without considering the patient's changing condition is not a safe or ethical approach.

D. Evaluate the client hourly while the restraints are applied:
While regular monitoring of a patient in restraints is essential, evaluating the patient every hour might not be sufficient, especially in the early stages after the application of restraints. The patient should be continuously monitored, with assessments conducted more frequently, especially immediately after applying the restraints, to ensure their safety and well-being.

A. Implement measures to prevent intentional self-inflicted injury. B. Discuss the appropriate use of assertive behavior with the client. C. Encourage the client to attend weekly support group meetings. D. Assist the client to maintain awareness of her thoughts and feelings.

Correct Answer is A

Explanation

A. Implement measures to prevent intentional self-inflicted injury:
This choice is the priority. Individuals with borderline personality disorder are at an increased risk of self-harm and suicidal behaviors. Implementing measures to prevent intentional self-inflicted injury, such as close monitoring, removing potentially harmful objects, and creating a safe environment, is crucial to ensuring the client's safety and well-being.

B. Discuss the appropriate use of assertive behavior with the client:
Teaching assertive behavior is an important aspect of therapy for individuals with borderline personality disorder. Learning to express emotions and needs in a healthy, assertive manner can improve their interpersonal skills and relationships. However, this choice is secondary to ensuring the client's safety. Safety concerns need to be addressed before moving on to other therapeutic interventions.

C. Encourage the client to attend weekly support group meetings:
Support group meetings can provide valuable social support and a sense of belonging for individuals with borderline personality disorder. Being part of a supportive community can offer understanding and coping strategies. While this is a beneficial intervention, it is not the priority. Safety concerns and addressing self-harm risk take precedence.

D. Assist the client to maintain awareness of her thoughts and feelings:
Developing self-awareness and emotional regulation skills is essential in managing borderline personality disorder. Techniques such as mindfulness and dialectical behavior therapy (DBT) can help individuals become more aware of their thoughts and emotions. While important for long-term management, this intervention is not the priority when immediate safety concerns are present. Safety should always be the first focus of care.

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