A nurse includes the nursing diagnosis of Disturbed thought processes secondary to paranoia in the care plan for a newly admitted client diagnosed with schizophrenia. Which approach is most appropriate for this client?

1. A

   Avoid laughing or whispering in front of the client

2. B

   Begin to identify social supports in the community

3. C

   Encourage the client to interact with others on the unit

4. D

   Have the client sign a written release of information form

Appeared in: NORCET -4 , 2023

Explanation

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• Clients with paranoia experience intense suspiciousness and may have delusions of persecution.
• They often misinterpret neutral environmental cues, such as laughing or whispering, as being directed at them (ideas of reference).
• Avoiding these behaviors is a key therapeutic technique to build trust, reduce the client's anxiety, and create a safe environment.
• This approach validates the client's feelings without reinforcing the delusion and is a foundational step in establishing a nurse-client relationship.

Why Other Options Were Wrong

• Option B: This is an important part of discharge planning, not the immediate priority for a newly admitted client in an acute paranoid state.
• Option C: Forcing social interaction can feel threatening and increase anxiety in a paranoid client.
• Option D: Requesting a signature on a form can exacerbate suspicion and mistrust in a paranoid individual.

Related Visual

• Visual 1: Flowchart: Prioritizing Nursing Interventions for Acute Paranoia. This visual would show that establishing safety and trust is the first step, followed by managing symptoms, and then moving towards psychoeducation and discharge planning.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Nursing interventions for paranoia in schizophrenia to guide bedside assessment, documentation, and the next nursing action.
• Building a therapeutic alliance with a paranoid client is foundational to all other treatments; it begins with creating a non-threatening environment.
• Failure to manage the environment can lead to client agitation, escalation, and refusal of necessary treatment, posing a safety risk to the client and others.
• What if? If the client had been on the unit for a week and their paranoia was decreasing, encouraging participation in a small, structured group activity (a modified version of Option C) might be appropriate to begin addressing social isolation.

How to Approach the Question

• First, identify the client's core problem from the stem: 'newly admitted' and 'paranoia'.
• This indicates the client is in an acute phase, and their primary symptom is intense suspicion.
• Analyze each option based on how it addresses acute paranoia and the need to establish trust.
• Option A directly addresses a common trigger for paranoid thoughts (whispering) and focuses on building a safe environment.
• Options B, C, and D are all interventions that are appropriate at later stages of treatment but are premature or counterproductive for a newly admitted, highly suspicious client.
• Therefore, select the option that prioritizes safety and trust-building in the initial phase of care.

Concept Tested & Keywords

• Concept Tested: Nursing interventions for paranoia in schizophrenia
• Stem keywords: Disturbed thought processes, paranoia, schizophrenia, newly admitted
• Lead-in keywords: most appropriate
• Clinical cues: Client is newly admitted, indicating an acute phase of illness.
• Clinical cues: Diagnosis of paranoia suggests high levels of suspicion and potential for misinterpreting stimuli.

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