Substance Abuse and Abuse Q 18
Which of the following nursing interventions is applicable for a hospitalized client with mania who is exhibiting manipulative behavior. Select all that apply.
A. Communicate expected behaviors to the client.
B. Enforce rules and inform the client that he or she will not be allowed to attend group therapy sessions.
C. Ensure that the client knows that he or she is not in charge of the nursing unit.
D. Be clear with the client regarding the consequences of exceeding limits set regarding behavior.
E. Assist the client in testing out alternative behaviors for obtaining needs.
Correct Answers: A, D, & E
Interventions for dealing with the client exhibiting manipulative behavior include setting clear, consistent, and enforceable limits on manipulative behaviors; being clear with the client regarding the consequences of exceeding limits set; following through with the consequences in a non-punishment manner; and assisting the client in identifying strengths and in testing out alternative behaviors for obtaining needs. Decrease environmental stimuli (e.g., by providing a calming environment or assigning a private room).
Option B: Enforcing rules and informing the client that he or she will not be allowed to attend group therapy sessions is a violation of the client’s rights. 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.
Option C: Ensuring the client knows that he or she is not in charge of the nursing unit is inappropriate, power struggles need to be avoided. 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.