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?

Address the client’s actions that interfere with creating social relationships.

Talk with the client about the need to follow the rules established for the unit.

Encourage the client to evaluate and change personal thinking patterns.

Tell the client that his negative feelings are causing personality changes.

Answer and Explanation

The Correct Answer is B

Paranoid personality disorder is a Cluster A disorder characterized by pervasive distrust, suspiciousness, and a tendency to interpret others’ motives as malevolent. These individuals often misinterpret benign actions as threatening, are hypervigilant, and may exhibit guarded or hostile behavior. They typically lack insight into their condition and are reluctant to accept psychological explanations for their behavior. Interventions must prioritize structure, consistency, and clear boundaries to reduce perceived threats and maintain safety in therapeutic environments.

Rationale for correct answer

B. Clients with paranoid personality disorder respond best to clear structure and consistent enforcement of rules. Addressing the behavior in terms of unit expectations, rather than personal flaws, reduces defensiveness and maintains therapeutic rapport. This approach avoids challenging the client’s distorted perceptions directly, which could escalate mistrust or hostility, and instead focuses on observable behavior and unit norms.

Rationale for incorrect answers

A. Focusing on relationships may be perceived as intrusive or judgmental by a paranoid client. They are unlikely to accept that their behavior interferes with social connection, and such feedback may increase suspicion or withdrawal.

C. Encouraging self-reflection on thinking patterns is more appropriate for clients with insight, such as those with anxiety or depressive disorders. Paranoid individuals typically lack insight and may view such suggestions as accusatory or manipulative.

D. Attributing behavior to feelings or personality changes risks invalidating the client’s experience. Paranoid clients often externalize blame and are unlikely to accept emotional explanations, which may be interpreted as an attack on their character.

Take Home Points

Paranoid personality disorder involves pervasive distrust, suspicion, and misinterpretation of others’ motives.
Interventions should emphasize structure, consistency, and behavioral boundaries rather than emotional insight.
Avoid challenging paranoid beliefs directly; instead, focus on observable behavior and unit expectations.
Differentiate from schizophrenia by the absence of persistent hallucinations or delusions.

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Correct Answer is D

Explanation

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.

A. Ask the client to join the medication education group. B. Provide one-on-one teaching in the client’s room. C. During rounds, have the physician ask if the client has any questions. D. Let the client read the medication information handout.

Correct Answer is B

Explanation

Paranoid personality disorder is a Cluster A disorder marked by pervasive distrust, suspiciousness, and a tendency to interpret others’ motives as threatening. These clients often feel vulnerable in group settings and may misinterpret neutral actions as hostile. They are hypervigilant, reluctant to share personal information, and may resist interventions perceived as manipulative. Effective nursing care requires individualized communication, clear boundaries, and a nonjudgmental approach that respects the client’s need for control and privacy.

Rationale for correct answer

B. Providing one-on-one teaching in the client’s room minimizes perceived threats and respects the client’s need for privacy and control. This approach reduces anxiety, builds trust, and allows for tailored explanations without the pressure of group dynamics. It also avoids triggering suspiciousness that may arise in public or unfamiliar settings.

Rationale for incorrect answers

A. Group education may provoke anxiety or mistrust in paranoid clients. They often feel threatened in group environments and may interpret others’ behavior as targeting or judging them, impairing learning.

C. Having the physician ask during rounds may feel impersonal or coercive. Paranoid clients may perceive this as a setup or interrogation, especially in a public setting with multiple staff present.

D. Reading a handout alone does not address the client’s need for clarification or reassurance. Paranoid individuals may misinterpret written information or distrust its source, leading to increased confusion or resistance.

Take Home Points

Paranoid personality disorder involves pervasive distrust and hypersensitivity to perceived threats.
One-on-one teaching builds trust and reduces anxiety in clients with paranoid traits.
Group settings and impersonal interactions may increase suspicion and hinder therapeutic engagement.
Written materials alone are insufficient; personalized verbal communication is essential.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is B

Explanation

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