A nurse is caring for a client with paranoid personality disorder who is extremely suspicious of the nursing staff and other clients. Which of the following nursing approaches is appropriate when establishing a therapeutic relationship with this client?

Disclose some personal information to the client to demonstrate approachability.

Approach the client frequently throughout the day for brief interactions.

Adopt a neutral attitude when providing care.

Wait for the client to initiate interaction.

Answer and Explanation

The Correct Answer is C

C. A neutral attitude communicates respect, professionalism, and non-threatening intentions. It helps to minimize the client's feelings of being scrutinized or manipulated and creates a safe environment for the client to engage in therapeutic interactions.

A. Disclosing personal information may further exacerbate the client's mistrust and suspicion, as they may interpret it as confirmation of their paranoid beliefs or as an attempt to manipulate them.

B. Approaching the client frequently throughout the day may be overwhelming and increase the client's suspicion. Clients with paranoid personality disorder often feel threatened by perceived intrusions into their personal space or privacy.

D. While it's essential to respect the client's autonomy and boundaries, waiting for the client to initiate interaction may prolong the establishment of a therapeutic relationship, especially with a client who is suspicious and mistrustful.

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Correct Answer is []

Explanation

Alcohol withdrawal syndrome refers to the collection of symptoms that occur when individuals who are dependent on alcohol abruptly reduce or stop their alcohol intake.

Benzodiazepines, such as diazepam or lorazepam, are commonly used to manage symptoms such as anxiety, tremors, and seizures.

Providing a safe environment also ensures that the client does not involve in self-harming activities due to hallucinations.

Alcohol withdrawal syndrome is associated with an increased risk of seizures, particularly within the first 48 hours after cessation of alcohol consumption. Seizures can range from mild to severe and may be life-threatening if not promptly managed.

Chronic alcohol abuse can lead to dehydration and electrolyte imbalances due to increased urinary output, decreased fluid intake, and poor nutrition. Additionally, alcohol withdrawal itself can exacerbate fluid and electrolyte disturbances due to vomiting, diarrhea, diaphoresis, and increased metabolic demand.

A. Give the client a PRN sleeping medication. B. Encourage the client to go back to bed. C. Explore alternatives to pacing the floor with the client. D. Remain with the client.

Correct Answer is D

Explanation

D. Remaining with the client provides support and reassurance during a period of agitation and restlessness. The presence of the nurse can help the client feel safe and supported, and it allows the nurse to assess the client's condition closely and intervene as needed.

A. While administering a PRN (as needed) sleeping medication may be considered in some situations, it is not the first-line intervention when a client is experiencing agitation and restlessness.

B. Encouraging the client to return to bed may be appropriate if they are willing and able to do so. However, if the client is agitated and pacing the floor, they may not feel comfortable or able to go back to bed.

C. Exploring alternatives to pacing the floor involves assessing the client's needs and preferences and identifying activities or strategies that may help alleviate agitation and promote relaxation. However, proper observation of the client behavior should be prioritized.

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A nurse is caring for a client with paranoid personality disorder who is extremely suspicious of the nursing staff and other clients. Which of the following nursing approaches is appropriate when establishing a therapeutic relationship with this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is []

Explanation

A nurse is caring for a client who is having difficulty sleeping and is pacing the floor. The client's head down, and he is wringing his hands. Which of the following actions should the nurse take?

Correct Answer is D

Explanation

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