When working with a client with paranoid personality disorder, a nurse should:

Approach the client in a businesslike manner to work on establishing trust.

Approach the client first with social conversation to work on developing social relationships.

Include jokes when conversing with the client to work on reducing the client’s serious behavior.

Arrive 15 minutes after the appointed time to work on eliminating hidden meanings.

Answer and Explanation

The Correct Answer is A

Paranoid personality disorder is a chronic psychiatric condition characterized by pervasive distrust, suspicion, and interpersonal detachment. These individuals are hypersensitive to perceived threats and often misinterpret benign interactions as hostile. They are reluctant to confide in others and may bear long-standing grudges. Their guardedness and fear of exploitation impair their ability to form close relationships. Therapeutic engagement requires consistency, emotional neutrality, and clear boundaries to avoid reinforcing their suspicions.

Rationale for correct answer

A. A structured, businesslike approach minimizes emotional ambiguity and helps establish predictability, which is essential for building trust with paranoid clients. This method respects their need for control and reduces perceived threats. By focusing on tasks and maintaining professional boundaries, the nurse avoids triggering the client's suspicion or misinterpretation of motives, facilitating therapeutic rapport.

Rationale for incorrect answers

B. Initiating with social conversation may be perceived as intrusive or manipulative. Paranoid clients often view friendliness as a cover for hidden agendas, which can heighten their defensiveness and hinder rapport.

C. Using jokes can be misinterpreted as ridicule or sarcasm. These clients are highly sensitive to perceived slights and may interpret humor as mocking, which can escalate mistrust and hostility.

D. Arriving late reinforces the client’s belief in hidden meanings or intentional disrespect. Timeliness is critical in maintaining consistency and demonstrating reliability, which are essential to reduce paranoid ideation.

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Correct Answer is A

Explanation

Paranoid personality disorder is a Cluster A condition marked by pervasive distrust and suspicion of others. Individuals with this disorder often believe that others are exploiting, harming, or deceiving them, even without evidence. They are hypervigilant, reluctant to confide in others, and may interpret benign remarks or events as threatening. These clients often appear guarded, hostile, or aloof, and they may isolate themselves due to their suspiciousness. Unlike psychotic disorders, their beliefs do not reach delusional intensity, but their thought patterns are rigid and resistant to change. They are often difficult to engage in therapeutic relationships due to their mistrust.

Rationale for correct answer

A. The statement “Everyone wants to hurt me” reflects the suspiciousness and pervasive mistrust characteristic of paranoid personality disorder. These clients often isolate themselves and interpret others’ actions as threatening, even in neutral or supportive environments.

Rationale for incorrect answers

B. Exploiting others for cigarettes reflects manipulative and irresponsible behavior more typical of antisocial personality disorder, a Cluster B condition. Paranoid individuals are more likely to avoid interaction than to manipulate others.

C. Shyness and avoidance due to low self-esteem are features of avoidant personality disorder, a Cluster C condition. Paranoid individuals avoid others due to mistrust, not feelings of inadequacy.

D. Allowing others to make decisions reflects submissiveness, which is characteristic of dependent personality disorder. Paranoid individuals are controlling and mistrustful, not passive or deferential.

Take Home Points

Paranoid personality disorder involves pervasive mistrust and misinterpretation of others’ intentions as hostile.
These individuals often isolate themselves and are resistant to forming trusting relationships.
It must be differentiated from avoidant personality disorder, which involves social withdrawal due to fear of rejection.
Unlike Cluster B disorders, paranoid individuals are not manipulative or emotionally volatile.

A. Sarcastically states, “That group is only for crazy people with problems.” B. Scornfully states, “No, can’t you see that I’m having a séance with my mom?” C. Suspiciously states, “No, that room has been bugged.” D. Hesitantly states, “OK, but only if I can sit next to you.”

Correct Answer is A

Explanation

Cluster B personality disorders include antisocial, borderline, histrionic, and narcissistic types. These disorders are marked by emotional dysregulation, impulsivity, and dramatic or erratic behavior. Clients often struggle with interpersonal relationships, exhibit manipulative or attention-seeking behaviors, and may respond to perceived criticism with hostility or sarcasm. Anger and defensiveness are common, especially when confronted with therapeutic interventions. Their reactions are often externalized, and they may resist group settings due to fear of judgment or loss of control.

Rationale for correct answer

A. The sarcastic remark reflects defensiveness and hostility, which are common in Cluster B disorders. Clients may use sarcasm to deflect vulnerability and avoid emotional exposure in group therapy. This response also demonstrates a lack of insight and resistance to therapeutic engagement, consistent with the interpersonal challenges seen in these disorders.

Rationale for incorrect answers

B. Scornful responses involving bizarre content are more typical of Cluster A disorders, such as schizotypal personality disorder. Cluster B clients may be dramatic, but they do not usually exhibit magical thinking or psychotic-like speech.

C. Suspiciousness and paranoid ideation are hallmark features of Cluster A disorders, particularly paranoid personality disorder. Cluster B clients are more likely to externalize blame through emotional outbursts than through paranoid delusions.

D. Hesitant cooperation and seeking proximity suggest traits of dependent personality disorder, which falls under Cluster C. Cluster B individuals are less likely to seek closeness and more likely to challenge authority or resist group participation.

Take Home Points

Cluster B personality disorders involve emotional instability, impulsivity, and dramatic interpersonal behavior.
Sarcasm and hostility are common defense mechanisms used to avoid vulnerability.
These disorders differ from Cluster A (odd/eccentric) and Cluster C (anxious/fearful) in their interpersonal style.
Group therapy may provoke resistance due to fear of judgment or loss of control.

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When working with a client with paranoid personality disorder, a nurse should:

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Naxlex Comprehensive Predictor Exams

Which scenario would the nurse expect to observe if the client were diagnosed with paranoid personality disorder?

Correct Answer is A

Explanation

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Correct Answer is A

Explanation

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