A 32-year-old male client with a history of arrests and substance use is admitted to the psychiatric unit for court-mandated evaluation. During the assessment, he is superficially charming, manipulates staff to get privileges, violates unit rules without remorse, and blames others for his behavior. Which of the following nursing interventions is most appropriate for managing this client?
Provide consistent structured rules and set firm limits on behavior.
Use sympathy and reassurance to reduce the client’s resistance to authority.
Allow the client flexibility in decision-making to encourage independence and self-direction.
Develop a close, personal rapport with the client to build trust and encourage emotional expression.
The Correct Answer is A
Choice A reason: Consistent rules and firm boundaries are essential when working with individuals who display antisocial traits. Structure minimizes opportunities for manipulation and helps maintain safety and fairness on the unit.
Choice B reason: Offering sympathy and reassurance may reinforce manipulative behavior and undermine professional boundaries. It does not address the core issue of rule violation and lack of accountability.
Choice C reason: Allowing too much flexibility may increase opportunities for the client to exploit staff and disregard rules. This approach is counterproductive when dealing with manipulative behaviors.
Choice D reason: Developing a close, personal rapport risks blurring professional boundaries. Clients with these traits may exploit such relationships to gain privileges, which can disrupt treatment and unit structure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: This presentation is consistent with neuroleptic malignant syndrome (NMS), a rare but life-threatening reaction to antipsychotics characterized by severe muscle rigidity, hyperthermia, altered mental status, and autonomic dysfunction. Immediate discontinuation of the drug and emergency treatment are required.
Choice B reason: Restlessness and inability to sit still are signs of akathisia, an extrapyramidal side effect of antipsychotics. While distressing and requiring management, it is not life-threatening compared to NMS.
Choice C reason: A flat affect and reduced speech are negative symptoms of schizophrenia and may persist despite treatment. These are concerning for quality of life but do not require urgent medical intervention.
Choice D reason: Mild weight gain is a known side effect of many antipsychotics. It should be monitored and managed with lifestyle modifications but does not represent an immediate threat.
Correct Answer is B
Explanation
Choice A reason: Telling the patient to stop thinking a certain way invalidates their feelings and is not therapeutic.
Choice B reason: Offering presence and calm support provides safety and helps reduce anxiety. It is the most therapeutic intervention for severe anxiety.
Choice C reason: Telling the patient not to worry may feel dismissive, and in severe anxiety the patient may not be able to process reassurance.
Choice D reason: Asking "why" is not effective when the patient is overwhelmed by severe anxiety, as they cannot engage in rational discussion at that moment.
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