A nurse is caring for a client who has borderline personality disorder (BPD). What should the nurse monitor in the client’s Medication Administration Record?

The rationale for Choice A:

Limiting time for rituals to 30 minutes each day may not be effective and could potentially increase anxiety. Individuals with OCD often feel a strong compulsion to perform their rituals, and abruptly restricting their ability to do so can heighten distress and lead to increased attempts to engage in the rituals, even in a covert manner. This can create a cycle of anxiety and frustration.

Gradual exposure and response prevention (ERP) therapy is a more effective approach to reducing ritualistic behaviors. It involves gradually exposing the individual to anxiety-provoking stimuli while helping them to resist engaging in their compulsions. This process is done in a controlled and supportive environment, to help the individual learn to manage their anxiety and reduce their reliance on rituals.

Rationale for Choice B:

Providing a stimulating environment is not generally recommended for individuals with OCD. Excessive stimulation can exacerbate anxiety and trigger compulsive behaviors. A calmer and more structured environment is often more beneficial.

Individuals with OCD often thrive in environments that provide predictability and a sense of control. A structured schedule can help to reduce uncertainty and create a sense of order, which can in turn help to reduce anxiety and the urge to engage in compulsive behaviors. Rationale for Choice C:

Negative reinforcement is not an appropriate or effective intervention for OCD. It involves punishing or removing a desired stimulus in response to a behavior, with the aim of decreasing the likelihood of that behavior occurring again. However, this approach can be counterproductive in OCD, as it can increase anxiety and make the individual more likely to engage in their rituals in order to avoid the negative consequences.

Positive reinforcement, such as praise and encouragement, is more effective in promoting desired behaviors. This approach focuses on rewarding the individual for making progress in reducing their ritualistic behaviors, which can help to increase motivation and create a more positive and supportive environment for change.

Rationale for Choice D:

Providing a structured schedule of activities can be a very effective intervention for OCD. It can help to reduce anxiety, provide a sense of control, and minimize the time available for engaging in compulsive rituals.

A structured schedule can include a variety of activities, such as:

Mealtimes

Personal hygiene routines

Work or school activities

Leisure activities

Relaxation exercises

Social interactions

The schedule should be tailored to the individual's specific needs and preferences. It is important to ensure that the activities are enjoyable and meaningful to the individual, as this will increase their motivation to participate.

The nurse can work with the individual to develop a schedule that is realistic and achievable. The schedule should be reviewed and adjusted regularly as the individual makes progress.

Choice A rationale:

Meaningless phrases are a hallmark symptom of schizophrenia and can indicate a worsening of the client's psychosis. This is a significant finding because it suggests that the client's ability to think clearly and communicate effectively is deteriorating.

Prompt reporting to the provider is crucial to ensure timely assessment and intervention, which may include medication adjustments or other therapeutic measures to address the worsening psychosis.

Early intervention is essential to prevent further decline in the client's mental state and to minimize the risk of harm to self or others.

I'll provide detailed rationales for the other choices, even though they are not the priority to report:

Choice B rationale:

Refusal to eat can be a symptom of schizophrenia, but it is not as immediate of a concern as meaningless phrases. It's important to monitor the client's nutritional intake and address any underlying causes of the refusal to eat, but this can typically be managed through nursing interventions without requiring immediate provider notification.

Choice C rationale:

Substance use can exacerbate schizophrenia symptoms and should be addressed, but it is not the priority to report in this scenario. The nurse should assess the client's substance use history and patterns, provide education and counseling on the risks of substance use, and collaborate with the provider to develop a treatment plan that addresses both the schizophrenia and the substance use.

Choice D rationale:

Decreased energy level can be a symptom of schizophrenia, but it is also a common symptom of many other conditions. It's important to assess the client's overall health and identify any potential causes of the decreased energy level, but it is not typically a priority to report to the provider unless it is severe or accompanied by other concerning symptoms