A nurse is reinforcing teaching with a client who has chronic stress.
Which of the following instructions should the nurse provide?

Choice A rationale

Asking a client with paranoid personality disorder why they are suspicious can be perceived as confrontational and challenging. Individuals with this disorder have a pervasive distrust of others, and directly questioning their suspicions is likely to increase their defensiveness and further impair the therapeutic relationship. A more indirect and gradual approach is necessary to build trust.

Choice B rationale

Using an overly friendly approach can be misinterpreted by a client with paranoid personality disorder. Their inherent distrust may lead them to suspect ulterior motives behind such excessive friendliness, making them more suspicious and resistant to forming a therapeutic alliance. A neutral and professional demeanor is more likely to be perceived as safe and trustworthy.

Choice C rationale

Being vague when answering a client's questions about instructions can exacerbate the mistrust inherent in paranoid personality disorder. Clear, consistent, and direct communication is essential to build trust and reduce suspicion. Vagueness can be interpreted as dishonesty or an attempt to deceive, further damaging the therapeutic relationship.

Choice D rationale

Demonstrating a neutral demeanor is the most appropriate strategy when beginning a therapeutic relationship with a client who has paranoid personality disorder. A neutral approach avoids appearing overly friendly or confrontational, allowing the client to feel safer and less threatened. This helps to establish a sense of predictability and trustworthiness, which is crucial for building rapport with individuals who are inherently suspicious of others' intentions.

Choice A rationale

Encouraging the client to nap during the day might disrupt their sleep-wake cycle further, potentially increasing nighttime wandering. Daytime napping can reduce the need for nighttime sleep in individuals with Alzheimer's disease.

Choice B rationale

Administering an antianxiety medication before bedtime may sedate the client but does not address the underlying cause of the nighttime wandering and can have side effects, including increased confusion and risk of falls in older adults.

Choice C rationale

Placing a lock at the top of doors leading outside is a crucial safety measure for clients with Alzheimer's disease who wander at night. This prevents them from leaving the home unsupervised and potentially getting lost or injured.

Choice D rationale

Using light restraints while the client is in bed is generally not recommended and should be a last resort due to ethical and safety concerns. Restraints can increase agitation and anxiety and may cause physical harm.