A nurse is beginning a therapeutic relationship with a client who has paranoid personality disorder.
Which of the following strategies should the nurse plan to use?.
Demonstrate a neutral demeanor.
Be vague when answering the client's questions about instructions.
Ask the client why he is suspicious of others.
Use an overly friendly approach.
The Correct Answer is A
Choice A rationale:
Demonstrating a neutral demeanor helps build trust with a client who has paranoid personality disorder. It’s important to avoid showing too much emotion, which could be misinterpreted by the client.
Choice B rationale:
Being vague when answering the client’s questions about instructions could increase the client’s paranoia. Clear and direct communication is essential.
Choice C rationale:
Asking the client why he is suspicious of others could lead to defensive behavior. It’s better to focus on building trust and understanding.
Choice D rationale:
Using an overly friendly approach could be perceived as insincere or manipulative by a client with paranoid personality disorder. A neutral demeanor is more effective.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Checking blood pressure once a week is a good practice, especially for clients on medications that can affect blood pressure.
Choice B rationale:
Chewing sugar-free gum several times daily is not harmful and can help with dry mouth, a common side effect of haloperidol.
Choice C rationale:
Avoiding alcohol while taking haloperidol is recommended as alcohol can increase the side effects of the medication.
Choice D rationale:
Spending several hours a day outside gardening when it’s sunny can lead to a condition called photosensitivity, a side effect of haloperidol. The client should be advised to wear protective clothing and sunscreen when outside.
Correct Answer is {"A":{"answers":"B"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"A"}}
Explanation
| Potential Provider Prescription | Expected or Unexpected? | Explanation |
|---|---|---|
| Administer acyclovir. | Unexpected | Acyclovir is an antiviral medication used to treat infections like herpes simplex virus (HSV) and varicella-zoster virus (VZV). The client’s confusion, agitation, and hallucinations do not suggest a viral infection as the primary cause. |
| Administer lorazepam. | Expected | Lorazepam is a benzodiazepine that can be used for acute agitation, anxiety, or delirium-related distress. Since the client is agitated and confused, lorazepam is an appropriate intervention. |
| Initiate 1:1 supervision. | Expected | The client is confused, agitated, and hallucinating, which increases the risk of self-harm, wandering, or injury. 1:1 supervision ensures safety. |
| Administer 0.9% sodium chloride 125 mL/hr by continuous IV infusion. | Expected | The client has dry mucous membranes, suggesting possible dehydration, which can contribute to confusion and agitation. IV fluids help restore hydration. |
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