A nurse is caring for a client with paranoid personality disorder who is extremely suspicious of the nursing staff and other clients. Which of the following nursing approaches is appropriate when establishing a therapeutic relationship with this client?

Disclose some personal information to the client to demonstrate approachability.

Approach the client frequently throughout the day for brief interactions.

Adopt a neutral attitude when providing care.

Wait for the client to initiate interaction.

Answer and Explanation

The Correct Answer is C

C. A neutral attitude communicates respect, professionalism, and non-threatening intentions. It helps to minimize the client's feelings of being scrutinized or manipulated and creates a safe environment for the client to engage in therapeutic interactions.

A. Disclosing personal information may further exacerbate the client's mistrust and suspicion, as they may interpret it as confirmation of their paranoid beliefs or as an attempt to manipulate them.

B. Approaching the client frequently throughout the day may be overwhelming and increase the client's suspicion. Clients with paranoid personality disorder often feel threatened by perceived intrusions into their personal space or privacy.

D. While it's essential to respect the client's autonomy and boundaries, waiting for the client to initiate interaction may prolong the establishment of a therapeutic relationship, especially with a client who is suspicious and mistrustful.

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Correct Answer is D

Explanation

D. Victims of abuse, especially perpetrated by family members, may feel conflicted about reporting the abuse due to feelings of guilt, shame, or fear of repercussions.

A. This implies that the client may believe they cannot report the abuse because they perceive abuse as only valid if there is physical evidence of harm. However, it's important to recognize that abuse can take various forms, including emotional, psychological, financial, and neglectful abuse, which may not always leave physical evidence.

B. While it's true that cases of abuse perpetrated by family members can be complex and challenging to address legally, there are laws and resources available to protect victims of family abuse. Many jurisdictions have laws specifically addressing domestic violence and elder abuse.

C. Reporting abuse to appropriate authorities, such as adult protective services or law enforcement, does not necessarily require hiring legal representation.

A. Provide a structured environment for the client. B. Identify the client's nutritional status. C. Plan a therapeutic diet for the client. D. Request a mental health consult.

Correct Answer is B

Explanation

A. A structured environment can include regular meal times, consistent routines, and clear expectations. While providing a structured environment is important in the overall management of eating disorders, it may not address the immediate concerns related to the client's severe weight loss and distorted body image.
B. Given the client's significant weight loss and distorted body image, assessing their nutritional status is crucial in understanding the extent of the problem and determining appropriateinterventions.
interventions. However, the client’s symptoms point to a mental health problem.
C. While planning a therapeutic diet is an essential component of the client's long-term treatment plan, it may not be the first priority given the client's current medical and psychological status.

D.Given the client's distorted body image, severe weight loss, and belief that she is fat, requesting a mental health consult is not the first priority. The physiological needs should be addressed first

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A nurse is caring for a client with paranoid personality disorder who is extremely suspicious of the nursing staff and other clients. Which of the following nursing approaches is appropriate when establishing a therapeutic relationship with this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A coherent older client has been financially and emotionally abused by their adult children for the past several years but has not reported the abuse to anyone. Which is the most likely reason that the client has not reported the abuse?

Correct Answer is D

Explanation

A nurse is admitting a client who has experienced a weight loss of 11 kg (25 lb) in the past 3 months. The client weighs 40 kg (88 lb) and believes she is fat. Which of the following aspects of care should the nurse consider the first priority for this client?

Correct Answer is B

Explanation

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