Personality and Mood Disorders Q 105

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Kyle is a client with an anxious, fearful personality who has difficulty accomplishing work assignments because of his fear of failure. He has been referred to the employee assistance program because of repeated absences from work and evidence of an alcohol problem. Which nursing diagnosis would be most appropriate?

  

     A. Ineffective coping

     B. Decisional conflict

     C. Disturbed thought process

     D. Risk for self-directed violence

    

    

Correct Answer: A. Ineffective coping

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The client is experiencing difficulty in occupational functioning as well as problems with alcohol; therefore, he meets the criteria for the diagnosis of Ineffective coping. Work with the client on problem-solving skills using a situation that is bothering the client. Client might not know how to articulate the problem. Helping identify alternatives gives the client a sense of control. Evaluating the pros and cons of the alternatives facilitates choosing potential solutions.

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Option B: Keep goals very realistic and go in small steps. There are no overnight successes with people with personality disorders. It can take a long time to positively change ingrained, life-long, maladaptive habits; however, change is always possible.

Option C: Identify behavioral limits and behaviors that are expected. Client needs a clear structure. Expect frequent testing of limits initially. Maintaining limits can enhance feelings of safety in the client.

Option D: If the client becomes hostile or projects blame onto you or staff, project a neutral, calm demeanor, and avoid power struggles. Focus on the client’s underlying feelings. Defuses tension and opens up productive interaction.

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