A nurse is caring for a client who has paranoid personality disorder. Which of the following findings should the nurse expect? (Select all that apply.).

Answer is d. Maintain eye contact with the client and summarize the client’s feelings.

a. Identify other housing options and sources of transportation: While it is essential to address practical needs such as housing and transportation for clients who have experienced a crisis like a house fire, it is not the immediate priority when the client is in acute emotional distress. In this scenario, the client is expressing emotional distress and may not be ready to focus on practical solutions. Therefore, addressing the client's emotional needs should take precedence over addressing practical concerns.

b. Notify the facility chaplain to request scheduling an appointment: While spiritual support can be beneficial for individuals coping with trauma or loss, it should not be the immediate response when a client is in acute emotional distress. While the chaplain's support may be sought later as part of the client's holistic care, it should not precede addressing the client's immediate emotional needs.

c. Confirm that everything will be all right because belongings can be replaced: This option is incorrect because it offers false reassurance and dismisses the client's feelings about their loss. While it is true that belongings can be replaced, the emotional impact of losing possessions, especially in a traumatic event like a house fire, should not be trivialized. The client's feelings of distress and uncertainty are valid and should be acknowledged and addressed by the nurse.

d. Maintain eye contact with the client and summarize the client’s feelings: Correct. This action demonstrates therapeutic communication, which is crucial in providing an atmosphere of support and safety for the client. Maintaining eye contact shows empathy, support, and advocacy, indicating to the client that their feelings are being heard and validated. Summarizing the client's feelings allows the nurse to demonstrate active listening and understanding, fostering trust and rapport between the nurse and client. By prioritizing the client's emotional needs, the nurse can help the client begin to process their feelings and move towards coping and problem-solving.

In summary, the correct answer is d because maintaining eye contact with the client and summarizing their feelings demonstrates therapeutic communication, which is essential in providing support and validation for the client's emotional distress. This approach allows the nurse to establish rapport and trust with the client, facilitating further therapeutic interventions and support.

Choice D rationale:

Setting limits on the client's behavior and maintaining consistency is essential when dealing with a client experiencing a manic episode. Manic episodes are characterized by impulsive and often disruptive behaviors. By setting clear limits, the nurse establishes boundaries that help manage the disruptive behavior and maintain a safe and therapeutic environment. Consistency in approach is vital to avoid confusion and to provide the client with a sense of stability during a time when their judgment and impulse control might be impaired.

Choice A rationale:

Warning the client that further disruptions will result in seclusion might escalate the situation and potentially worsen the client's agitation. It's crucial to use non-confrontational approaches when dealing with clients experiencing manic episodes to prevent increased agitation and aggression.

Choice B rationale:

Ignoring the client's behavior is not a suitable approach, as it could lead to a deterioration of the situation and potentially compromise the safety and well-being of both the client and others on the unit. It's important to address disruptive behavior promptly and appropriately.

Choice C rationale:

Asking the client to recommend consequences for her disruptive behavior might not be effective during a manic episode. Clients in a manic state might not have a realistic or rational perspective on their behavior, and involving them in determining consequences could lead to unreasonable outcomes.