Personality and Mood Disorders Q 97
When a client with a personality disorder begins demonstrating manipulative behavior, which of the following nursing actions are most appropriate? Select all that apply.
A. Ask the client to think about the consequences of behavior.
B. Allow the client time to perform specific rituals.
C. Develop a consistent team approach to handle the client's behaviors.
D. Help the client to express anxiety verbally rather than with specific symptoms.
E. Provide immediate feedback concerning the client's specific behaviors.
F. Set limits in a clear, direct manner.
Correct Answers: A, C, E, F
These interventions allow the nurse to immediately confront the client’s manipulative behavior and provide consistent structure (through limit-setting and team approach).
Option A: Be very clear about the consequences if policies/limits are not adhered to. The client needs to understand the consequences of breaking the rules.
Option B: This is appropriate for the client with obsessive-compulsive behavior. During the beginning of treatment, allow plenty of time for rituals. Do not be judgmental or verbalize disapproval of the behavior to deny the client this activity can precipitate panic level of anxiety.
Option C: Make a clear and concrete written plan of care so other staff can follow. Helps minimize manipulations and might help encourage cooperation.
Option D: For someone with somatization problems. Encourage the client to explore feelings and concerns (e.g., identify fears, loneliness, self-hate). Client is used to acting out feelings.
Option E: Give the client positive attention when behaviors are appropriate and productive. Avoid giving any attention (when possible and not dangerous to self or others) when the client’s behaviors are inappropriate.
Option F: Use assertiveness when setting limits on the client’s unreasonable demands for attention and time. Firm, clear, nonjudgmental limits give the client structure.