Personality and Mood Disorders Q 49
The client is arrogant and manipulative. In ensuring a therapeutic milieu, the nurse does one of the following:
A. Agree on a consistent approach among the staff assigned to the client.
B. Suggest that the client take a leading role in the social activities.
C. Provide the client with extra time for one on one sessions.
D. Allow the client to negotiate the plan of care.
Correct Answer: A. Agree on a consistent approach among the staff assigned to the client.
A consistent firm approach is appropriate. This is a therapeutic way to handle attempts of exploiting the weakness in others or create conflicts among the staff. Bargaining should not be allowed. Maintain a consistent approach, employ consistent expectations, and provide a structured environment. Clear and consistent limits and expectations minimize the potential for the client’s manipulation of staff.
Option B: This is not therapeutic because the client tends to control and dominate others. Use a calm and firm approach. Provides structure and control for a client who is out of control.
Option C: Limits are set for interaction time. Alert staff if a potential for seclusion appears imminent. Usual priority of interventions would be firmly setting limits. If nursing interventions (quiet environment and firm limit setting) and chemical restraints (tranquilizers–e.g., haloperidol [Haldol]) have not helped dampen escalating manic behaviors, then seclusion might be warranted.
Option D: Allowing the client to negotiate, may reinforce manipulative behavior. Remain neutral as possible; Do not argue with the client. The client can use inconsistencies and value judgments as justification for arguing and escalating mania.