Personality and Mood Disorders Q 13
A nurse is orienting a new client to the unit when another client rushes down the hallway and asks the nurse to sit down and talk. The client requesting the nurse’s attention is extremely manipulative and uses socially acting-out behaviors when demands are unmet. The nurse should:
A. Suggest that the client requesting attention speak with another staff member.
B. Leave the new client and talk with the other client to avoid precipitating acting out behavior.
C. Tell the interrupting client to sit down and be patient, stating, “I’ll be back as soon as possible.”
D. Introduce the two clients and suggest that the client join the new client and the nurse on the tour.
Correct Answer: C. Tell the interrupting client to sit down and be patient, stating, “I’ll be back as soon as possible.”
This sets realistic limits on behavior without rejecting the client. 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 A: Be clear with the client as to the unit/hospital/clinic policies. Give brief concrete reasons for the rules, if asked, and then move on. Institutional policies provide structure and safety. Be very clear about the consequences if policies/limits are not adhered to. Client needs to understand the consequences of breaking the rules.
Option B: When limits or policies are not followed, enforce the consequences in a matter-of-fact, nonjudgmental manner. Enforces that the client is responsible for his or her own actions. Make a clear and concrete written plan of care so other staff can follow. Helps minimize manipulations and might help encourage cooperation.
Option D: Some clients might attempt to instill guilt when they do not get what they want. Remain neutral but firm. Nurses often want to be seen as “nice” However, being professional and maintaining limits is the better therapeutic approach.