Psychiatric Medications Q 70
David with paranoid schizophrenia repeatedly uses profanity during an activity therapy session. Which response by the nurse would be most appropriate?
A. "Your behavior won't be tolerated. Go to your room immediately."
B. "You're just doing this to get back at me for making you come to therapy."
C. "Your cursing is interrupting the activity. Take time out in your room for 10 minutes."
D. "I'm disappointed in you. You can't control yourself even for a few minutes."
Correct Answer: C. “Your cursing is interrupting the activity. Take time out in your room for 10 minutes.”
The nurse should set limits on client behavior to ensure a comfortable environment for all clients. 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 A: The nurse should accept hostile or quarrelsome client outbursts within limits without becoming personally offended. Use a calm and firm approach. This provides structure and control for a client who is out of control. Use short, simple, and brief explanations or statements. A short attention span limits understanding to small pieces of information.
Option B: This is incorrect because it implies that the client’s actions reflect feelings toward the staff instead of the client’s own misery. 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. Redirect agitation and potentially violent behaviors with physical outlets in an area of low stimulation (e.g., punching bag). This can help to relieve pent-up hostility and relieve muscle tension.
Option D: Judgmental remarks may decrease the client’s self-esteem. Maintain a firm, calm, and neutral approach at all times. These behaviors by the staff can escalate environmental stimulation and, consequently, manic activity. Once the manic client is out of control, seclusion might be required, which can be traumatic to the manic individual as well as the staff.