Which observation by the nurse is supportive of a diagnosis of avoidant personality disorder?

A. Client fears criticism from others, including staff: This supports a diagnosis of avoidant personality disorder. Individuals with this disorder are highly sensitive to criticism or rejection, which leads them to avoid social situations despite often desiring close relationships.

B. Client shows no remorse when accidentally breaking another client’s television: This aligns more closely with antisocial personality disorder, which is characterized by disregard for others and lack of empathy or remorse.

C. Client cries loudly whenever requests are denied: This is more consistent with borderline personality disorder, where emotional regulation is poor, and reactions to perceived rejection or frustration are intense and disproportionate.

D. Client talks about three failed marriages: Multiple failed relationships are more suggestive of borderline personality disorder, which is marked by instability in interpersonal relationships, not the avoidance and fear of rejection typical of avoidant personality disorder.

A. Provide fluids and monitor electrolytes to prevent dehydration: Hydration and electrolyte balance are important supportive measures in Neuroleptic Malignant Syndrome (NMS), but they are not the immediate priority. The underlying cause, dopamine blockade from antipsychotics, must first be addressed by stopping the offending drug.

B. Increase the dose of haloperidol to manage agitation: Increasing the antipsychotic dose would worsen NMS, as haloperidol and other dopamine antagonists are the main cause. This intervention would intensify muscle rigidity, hyperthermia, and autonomic instability.

C. Withhold the haloperidol and initiate cooling measures: This is the priority action. Immediate discontinuation of the antipsychotic removes the trigger, while cooling helps reduce hyperthermia. These steps prevent progression of the life-threatening syndrome and stabilize the client.

D. Administer a dose of acetaminophen to reduce the fever: Acetaminophen may lower temperature in infections, but in NMS the hyperthermia results from severe muscle rigidity and altered hypothalamic regulation. Cooling measures and stopping the medication are more effective interventions than antipyretics alone.