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.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","D","E"]
Explanation
Choice A reason: Sharing personal loss shifts the focus away from the patient, which is not therapeutic. Self-disclosure in this way can hinder supportive communication.
Choice B reason: Suggesting a grief support group acknowledges the patient’s feelings while offering a constructive coping resource. It validates distress and provides support.
Choice C reason: Leaving the patient when they are emotionally vulnerable conveys abandonment instead of support, which is not therapeutic.
Choice D reason: Normalizing grief as a process that takes time offers reassurance without minimizing the client’s emotions. It helps the patient understand that healing is gradual.
Choice E reason: Encouraging the patient to share coping strategies promotes expression of feelings and helps the nurse assess adaptive versus maladaptive coping mechanisms.
Correct Answer is D
Explanation
Choice A reason: Focusing only on medications neglects the interpersonal development central to Peplau’s model. The orientation phase emphasizes relationship building, not task-centered care.
Choice B reason: Allowing expression without structure or guidance does not fulfill the orientation phase, which requires the nurse to actively build trust and clarify roles.
Choice C reason: Excessive distance prevents rapport, which is essential in the orientation phase where the foundation for a therapeutic relationship must be established.
Choice D reason: Establishing trust, being consistent, and clarifying client expectations define the orientation phase of Peplau’s theory. This phase sets the groundwork for collaboration and progress in treatment.
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