Delmars Paranoia Disorders

4. an important role of the nurse is to facilitate social interactions between a client who is paranoid and the client's peers. the nurse implements this intervention based on the understanding that a client with paranoid personality disorder 1. is gregarious and outgoing in socialization style. 2. tends to exhibit loose boundaries when sharing feelings. 3. likes to be around large groups of people. 4. tends to be isolated and lacks social skills.

. 4. 4. a client with paranoid personality disorder often becomes socially isolated because of suspiciousness toward others. this client would not be gregarious or outgoing. such clients do not feel that they have a problem. a client who suffers from paranoia would not have social skills that would be enhanced by being around or sharing with others.

8. when planning the care of a client who is paranoid, the nurse should include which of the following interventions to increase the sense of trust? 1. give the client the nurse's home phone number for support 2. spend more time with this client than with other clients 3. solicit the client's participation in the development of the treatment plan 4. fulfill all of the client's requests to provide assurance of active listening

. 8. 3. soliciting a client's participation in the development of the treatment plan is an effective way to get a client who is paranoid to improve communication and participation in the treatment plan and to develop a trusting relationship. giving a client a home phone number or spending more time with this client than with other clients violates professional boundaries. fulfilling all of the client's requests can cause the client to become more suspicious.

1. the wife of a client with paranoid personality disorder asks the nurse why the client keeps blaming her for plotting against him. which of the following is the appropriate response by the nurse? 1. "a client with paranoid personality disorder suspects others' motives." 2. "a client with paranoid personality disorder prefers solitary activities." 3. "a client with paranoid personality disorder lacks interests or hobbies." 4. "a client with paranoid personality disorder is emotionally detached."

1. 1. suspicion of others is a hallmark of paranoid personality disorder. preferring solitary activities, lacking interest in hobbies or other interests, and becoming emotionally detached are all clinical manifestations of an individual with schizoid personality disorder.

10. a client experiencing paranoid behavior believes that the drugs are poisonous and doesn't want to take them. which of the following nursing interventions should the nurse include in this client's plan of care? 1. administer the drugs intravenously if the client refuses to take them orally 2. tell the client that taking the drugs are a part of the treatment 3. restrict the client to the room until the client agrees to take the drugs 4. inform the client that the doctor ordered the drugs and they are necessary

10. 2. the most appropriate intervention for a client who thinks the drugs are poisonous is to be direct with the client and tell the client that the drugs are an important part of the treatment. forcing the client to take the drugs, restricting the client to the room until the drugs are taken, or informing the client that the doctor ordered the drugs would not work, because this is a suspicious client who will not respond to reason.

11. the nurse should instruct a client with paranoid delusions to avoid which of the following beverages? select all that apply: [ ] 1. coffee [ ] 2. ginger ale [ ] 3. lemonade [ ] 4. whole milk [ ] 5. cola [ ] 6. chocolate milkshake

11. 1. 5. 6. a client who has paranoid delusions should be instructed to avoid caffeinecontaining beverages because the stimulating effects of caffeine may contribute to feelings of paranoia and anxiety. coffee, cola, and a chocolate milkshake all contain caffeine.

12. which of the following does the nurse evaluate as a disturbance in the activities of daily living for a client who is paranoid? the client 1. goes to the grocery store only when more food is needed. 2. signs up for the meals on wheels service. 3. refuses to eat any food item that is not prepackaged and can be self-opened. 4. goes over to the neighbor's house for dinner once a week on friday evenings.

12. 3. a disturbance in the activities of daily living for a client who is paranoid is to refuse to eat any food that is not prepackaged and can be self-opened. a client with paranoia would not sign up for meals on wheels or go to a neighbor's house for dinner because the client did not prepare the food and may believe it is contaminated. going to the grocery store when more food is needed is not an impairment to the activities of daily living.

13. a client who has been diagnosed with paranoid delusions frequently takes issues to the legal system, resulting in court hearings. this is most likely due to the fact that 1. the client initiates legal action due to the persecutory content of the delusions. 2. other individuals are taking the client to court because of the client's poor decisions. 3. the client has often been taken advantage of by other individuals. 4. the client doesn't know how else to get the attention of individuals who hurt the client.

13. 1. a client with persecutory delusions frequently initiates legal action because of the belief that others are attacking him. it is through the court actions that the client attempts to remedy these beliefs about the other individuals. other individuals taking the client to court because of the client's poor decisions is focusing on the thoughts and actions of someone other than the client. the client being taken advantage of also focuses on the other individual's thoughts and actions, rather than the client's. a client with persecutory delusions is not trying to get attention; instead, the issue is about rectification for the perceived wrongs done to the client.

14. a client who has paranoid delusional disorder has been having spousal difficulties but is making good progress at work during this quarter. the nurse identifies which of the following as the most likely cause of the client's behavior? 1. the client is projecting frustrated energy into work 2. the client would rather be at work than at home 3. the client's paranoia causes worry about the work situation 4. the client's delusions mainly affect relationships

14. 4. clients with delusional disorders can generally function adequately when they do not focus on their delusional belief system, which usually affects social and marital relationships. because of this, the client would be able to manage adequately in the work environment.

15. a client who has been diagnosed with paranoid delusional disorder is developing healthier interpersonal relationships. During this development, the nurse encourages the client to 1. identify people with whom it is safe to talk . 2. talk about the delusions whenever they occur. 3. remember the paranoid thoughts until the next therapy session. 4. seek feedback regarding the realistic nature of the delusion.

15. 1. establishment of trust and a safe relationship is important and difficult for the client who has paranoid delusions. talking about the client's delusions whenever they occur, remembering the paranoid thoughts until the next therapy session, and seeking feedback regarding the realistic nature of the delusion all focus on the delusional thoughts.

16. a client is diagnosed with paranoid schizophrenia and has been hospitalized due to auditory hallucinations resulting in verbal threats. these hallucinations are of a persecutory nature. which of the following is the most appropriate nursing diagnosis? 1. noncompliance 2. health maintenance, ineffective 3. personal identity, disturbed 4. sensory perception, disturbed

16. 4. hallucinations are, by definition, perceptual distortions and are not the result of deliberate choices. therefore, the most appropriate nursing diagnosis is disturbed sensory perception. nursing diagnoses of noncompliance, ineffective health maintenance, and Disturbed personal identity would all involve deliberate choices.

17. a nurse teaching a class on paranoid personality disorder correctly describes the client as appearing angry and argumentative, but in reality the client feels 1. shy and awkward. 2. vulnerable and powerless. 3. depressed and suicidal. 4. secure and confident.

17. 2. clients who have paranoid personality disorder use denial and projection as their main defense mechanisms, because in reality they feel vulnerable and powerless. shy, awkward, depressed, suicidal, secure, andconfident may co-occur with paranoia, although they do not explain the projection of insecurity into anger.

18. a client is being evaluated for headaches and paranoid delusions. a computerized tomography (ct) scan reveals a brain tumor. the diagnosis of paranoid delusional disorder is in question at this point because the 1. clinical manifestations present along with a medical condition. 2. client is only suspicious of the physician. 3. client is not experiencing any hallucinations . 4. clinical manifestations really aren't delusions.

18. 1. medical issues must be diagnosed and evaluated as a potential cause of clinical manifestations that may also appear psychiatric in nature.

19. a nurse has worked to establish a relationship with a client who has been diagnosed with paranoid personality disorder. it has been difficult to make any progress based on what classic features of the client's thought pattern? select all that apply: [ ] 1. auditory hallucinations [ ] 2. social isolation [ ] 3. sense of distrust [ ] 4. suspiciousness in others [ ] 5. argumentative [ ] 6. perceives other's motives are malevolent

19. 3. 4. 6. mistrust and suspiciousness toward others and perceiving their motives as malevolent accompanies the paranoia found in paranoid personality disorder and becomes a barrier to establishing a client-provider relationship. features of paranoid schizophrenia include auditory hallucinations, social isolation, and argumentative.

2. a client diagnosed with paranoid personality disorder has been hospitalized because of his suspicions and threats toward the company boss. while in the hospital, the client continues to be suspicious of the nursing staff. the primary goal for this client would be which of the following? 1. inform the client that the boss has no harmful intentions 2. promote the development of trust with the nursing staff 3. educate the client about the legal risks of harming the boss 4. convince the client of the true motives of the nurses

2. 2. promoting the development of trust with the nursing staff is the best goal for a client who is experiencing paranoia. this will support and encourage the client to make better progress in treatment and begin to trust the staff.

20. a client with paranoid schizophrenia has been seeing a public health nurse every week for drug administration and compliance. the current drugs have been effective in decreasing positive clinical manifestations. the nurse anticipates that the client will report 1. a decrease in motivation to go to church . 2. a week without hearing voices . 3. seeing his dead grandmother . 4. a schedule that has become very busy with social outings.

20. 2. a client who reports a week without hearing voices demonstrates a decrease in positive clinical manifestations. lack of motivation is a negative clinical manifestation, and a decrease in the motivation to go to church would indicate no improvement in the client's condition. a client who sees his dead grandmother is having a positive clinical manifestation, clearly demonstrating that the client is still in the throes of paranoid schizophrenia. more social activities is a negative clinical manifestation, indicating an improvement in the client's condition.

21. which of the following interventions should the nurse include in a plan of care for a client with paranoid personality disorder? select all that apply: [ ] 1. remove dangerous objects from the client's environment [ ] 2. identify impulsive thoughts and behaviors [ ] 3. instruct the client on relaxation techniques such as visual imagery, deep breathing, and progressive muscle relaxation [ ] 4. encourage recreational games or cooperative sports [ ] 5. provide assistance in utilizing anger control techniques [ ] 6. provide opportunity for the development of problem-solving skills

21. 1. 2. 5. nursing interventions for paranoid personality disorder include removing dangerous objects from the client's environment, providing assistance in utilizing anger control techniques, and identifying impulsive thoughts and behavior. interventions for paranoid delusional disorder include instructing the client on relaxation techniques such as visual imagery, deep breathing, and progressive muscle relaxation; encouraging recreational games or cooperative sports; and providing opportunity for the development of problem-solving skills.

22. the registered nurse is preparing to delegate nursing tasks to a licensed practical nurse. which of the following tasks should the nurse delegate to a licensed practical nurse? 1. evaluate a client suspected of having paranoid schizophrenia for delusions 2. Document a client's paranoid behavior 3. assess a client with paranoia for auditory hallucinations 4. instruct a client's family on the clinical features of paranoid schizophrenia

22. 2. nursing tasks that involve the skills of evaluating, assessing, and instructing are reserved for the registered nurse. a licensed practical nurse may document a client's paranoid behavior.

23. which of the following is a priority goal for the nurse to plan in the care of a client who experiences paranoid delusions? 1. absence of delusions 2. establishment of trust 3. participation in all unit activities 4. independent activities of daily living

23. 2. as with many psychiatric disorders, establishing trust is paramount to the success of the nurse-client therapeutic relationship.

24. a client who suffers from paranoid delusions utilizes denial as a defense mechanism. the nurse wants to foster other ways of dealing with the anxiety that the client experiences. the nurse could best do this by planning for the client to be involved in which of the following activities? 1. community mental health support group 2. psychodynamic group therapy 3. adult education class on emotions 4. individualized relaxation therapy

24. 4. a client with paranoid delusions is most likely to deal with the anxiety in situations by getting involved in relaxation therapy. attempting to get clients involved in group therapy or an education class would foster further paranoia because of the group environment.

25. a client who has been diagnosed with paranoid delusional disorder is getting ready for an evening discharge. this client has a history of expressing anger by threatening to hurt family members with household objects. in preparation for discharge, the nurse should instruct the family that which of the following is a priority if the client becomes threatening? 1. call the client's health care provider in the morning 2. encourage the client to go to a quiet room to cool down 3. remove any potential weapons from the home 4. administer an extra dose of a prescribed drug when the anger surfaces

25. 3. the first action to take when discharging a client who in the past threatened to hurt family members with household items would

26. in preparation for practicing new coping skills, the nurse assists the client with paranoia in 1. asking for the physician's methods. 2. copying other clients' techniques. 3. learning by reading books. 4. identifying personal manifestations of anxiety.

26. 4. before planning interventions for new coping skills for a client, the nurse needs to consider the client's manifestations of anxiety. anxiety is a common emotion with paranoia. asking the physician for other coping methods, copying other clients' techniques, and reading books all focus on sources other than the client. the focus should be on the client and the client's needs.

3. two staff members are talking and laughing about their weekend activities in the hall outside the room of a client diagnosed with paranoid personality disorder. the client appears annoyed and is suspicious of them while they are talking. which of the following is the most appropriate intervention? 1. encourage the client to engage in the conversation 2. report the staff members' inappropriate behavior 3. inform the staff members that the talking can be misinterpreted as secretiveness 4. close the door to the client's room

3. 3. behavior that can be interpreted as secretive by a client who is paranoid will reinforce the client's feelings of suspiciousness. a client who is paranoid may interpret seeing two staff members talking outside the client's room as being secretive

5. the nurse monitors for which of the following assessment findings in a client with paranoid personality disorder? select all that apply: [ ] 1. is highly suspicious of others and finds hidden meanings [ ] 2. persecutory delusions [ ] 3. belief or paranoia that the person or loved ones are singled out or being victimized, such as being watched by the fbi, being followed, or being plotted against [ ] 4. mistrusts others, including friend and relatives [ ] 5. feelings of being conspired against, spied or cheated on, poisoned or drugged, or harassed [ ] 6. believes others are exploiting him

5. 1. 4. 6. assessment findings for paranoid personality disorder include highly suspicious of others; finds hidden meanings; mistrusts others, including friends and relatives; and believes others are exploiting him. assessment findings include belief or paranoia that the person or loved ones are singled out for being victimized, such as being watched by the fbi, being followed, or being plotted against. assessment findings for paranoid schizophrenia include persecutory delusions.

6. which of the following assessment finds are common in paranoia from substance withdrawal from amphetamines? select all that apply: [ ] 1. increased appetite [ ] 2. paranoia [ ] 3. tremors or seizures [ ] 4. tachycardia or hypertension [ ] 5. restlessness and agitation [ ] 6. Disorientation

6. 2. 5. 6. assessment findings in amphetamine withdrawal include paranoia, restlessness and agitation, and disorientation. increased appetite is an assessment finding for cocaine and crack cocaine withdrawal. tremors or seizures and tachycardia and hypertension are assessment finding for alcohol withdrawal.

7. the nurse assesses for what characteristics in a client suspected of having paranoid schizophrenia? select all that apply: [ ] 1. a sense of distrust and suspiciousness in others; perceives their motives to be malevolent [ ] 2. Devastating disorder affecting an individual's thinking, language, emotions, ability to perceive reality, and social behavior [ ] 3. predominant features are delusions and hallucinations [ ] 4. ideas of reference [ ] 5. average age of onset is late adolescence or early adulthood [ ] 6. angry or violent

7. 2. 3. 5. features of paranoid schizophrenia include that it is a devastating disorder affecting an individual's thinking, language, emotions, ability to perceive reality, and social behavior. paranoid schizophrenia has an average age of onset in late adolescence or early adulthood and is characterized by delusions and hallucinations. features of paranoid personality disorder include a sense of distrust and suspiciousness toward others and perceiving the motives of others as malevolent. ideas of reference and being angry or violent are features of paranoid delusional disorder

9. which of the following interventions would be most appropriate for the nurse to implement for a client in a paranoid state who is having difficulty falling asleep and has tried reading, taking a warm bath, and drinking warm milk, all of which have been unsuccessful? 1. instruct the client to try all of these again but for a longer time 2. administer a prescribed drug for relaxation 3. offer the client a back rub 4. encourage the client to listen to the radio

9. 2. after unsuccessful attempts to sleep, as evidenced by reading, drinking milk, or taking a warm bath, the next appropriate intervention would be to offer a prescribed drug for relaxation. it would be inappropriate to instruct the client to try these measures for a longer time period, to give the client a back rub, or to encourage the client to listen to the radio because the client has already tried nondrugrelated measures and continues to be frustrated.