The nurse accepts a client who is being transferred to the mental health unit and understands that the client is distractible and is exhibiting a decreased ability to concentrate. The nurse has only 15 minutes to talk with the client. To develop a treatment plan for this client, which assessment is most important for the nurse to obtain?

Choice A reason: Controlling the unit reflects grandiosity or mania, not paranoia. Paranoid clients are more likely to exhibit hostility due to perceived threats. This behavior is less typical of paranoia’s suspicious nature, making it incorrect for expected behavior in a paranoid client.

Choice B reason: Open hostility for no apparent reason is common in paranoia, as clients misinterpret others’ actions as threatening due to delusional beliefs. This aligns with psychiatric descriptions of paranoid behavior, making it the most expected behavior for a client with paranoia during assessment.

Choice C reason: Repeated suicide attempts are associated with depression or borderline personality disorder, not primarily paranoia. Hostility from perceived threats is more characteristic of paranoia, making suicide attempts less expected and incorrect for the typical behavior in this client.

Choice D reason: Talking to voices suggests hallucinations, more common in schizophrenia with auditory hallucinations than in paranoia alone. Hostility from suspicion is a more direct paranoid behavior, making this incorrect, as hallucinations are not the primary expected feature of paranoia.

Choice A reason: Marijuana may increase heart rate but has a lower risk for myocardial infarction compared to methamphetamine. Methamphetamine’s intense vasoconstriction and catecholamine surge directly precipitate cardiac ischemia, making marijuana less likely to have caused the client’s heart attack, thus incorrect for highest risk.

Choice B reason: Benzodiazepines are sedatives with minimal direct cardiac effects, unlike methamphetamine, which causes severe vasoconstriction and hypertension, increasing infarction risk. Benzodiazepines are not strongly linked to myocardial infarction, making this incorrect for the substance posing the highest risk in this client’s history.

Choice C reason: Chronic alcohol use contributes to cardiomyopathy but is less likely to cause acute myocardial infarction than methamphetamine, which induces intense coronary vasospasm and stress. Alcohol’s cardiac effects are more gradual, making this incorrect for the highest-risk substance for the client’s prior heart attack.

Choice D reason: Methamphetamine, a potent stimulant, causes severe vasoconstriction, hypertension, and catecholamine release, significantly increasing myocardial infarction risk through coronary artery spasm and ischemia. This aligns with cardiology evidence for drug-induced cardiac events, making it the substance posing the highest risk for the client’s heart attack.