A nurse is establishing rapport with a client who has paranoid personality disorder. Which strategy should the nurse plan to use?

• A. Demonstrate a neutral demeanor.
• B. Be vague when answering the client's questions about instructions.
• C. Use an overly friendly approach.
• D. Ask the client why he is suspicious of others.

Answer: (A)

A client with paranoid personality disorder interprets people’s actions as threatening and may react defensively to anything that feels intrusive or judgmental. Using a neutral, consistent, nonthreatening demeanor helps establish safety and trust. When the nurse speaks in a calm, predictable, and honest way, it signals reliability and reduces the chance that the client will misread the intent behind the nurse’s actions. This steady presence sets clear boundaries and avoids conveying warmth that might be perceived as manipulation or control, which can heighten distrust. By staying matter-of-fact and nonconfrontational, the nurse supports open communication and helps the client feel seen without triggering defensiveness.

Being vague about instructions can feed the client’s suspicion that information is being hidden or manipulated. An overly friendly approach can be interpreted as insincere or as a lure, triggering the client’s mistrust. Simply asking why the client is suspicious can come across as accusing and escalate anxiety. The neutral, straightforward stance is the most effective way to foster rapport under these conditions.