A nurse is discussing the use of mechanical restraints with a newly licensed nurse. Which of the following situations should the nurse include as an indication for placing a client in mechanical restraints?

Self-destructive behavior despite alternative interventions

Discipline for throwing objects at staff

Punishment for verbally abusing other clients

Coercion to take prescribed medications

Answer and Explanation

The Correct Answer is A

A. Self-destructive behavior despite alternative interventions: Mechanical restraints may be considered when a client poses an immediate risk of harm to themselves, and alternative interventions have been ineffective or are not feasible.

B. Discipline for throwing objects at staff: Mechanical restraints are not appropriate as a form of discipline. Restraints should only be used when there is an imminent risk of harm to the client or others.

C. Punishment for verbally abusing other clients: The use of restraints as a form of punishment is not ethical or appropriate. Restraints should be employed solely to prevent harm, not as a disciplinary measure.

D. Coercion to take prescribed medications: Coercion to take medications is not a valid reason for using mechanical restraints. Alternative approaches, such as therapeutic communication or discussing the need for medications with the client, should be explored.

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Correct Answer is B

Explanation

A. "Did you take your medicine this morning?": While medication adherence is important, this response does not directly address the client's distress or validate their experience. It may come across as dismissive.

B. "I'm sure the voices sound scary, I don't hear any voices speaking.": This response acknowledges the client's experience without confirming or denying the presence of the voices. It expresses empathy and provides reassurance, fostering a therapeutic relationship.

C. "The devil only talks to people who are receptive to his influence": This response introduces a belief system that may not align with the client's reality and could be perceived as judgmental. It's important to avoid imposing personal beliefs on clients experiencing hallucinations.

D. "You are not going to hell. You are a good person": While expressing support and reassurance is positive, making definitive statements about the client's fate or goodness may not be helpful. It's more effective to acknowledge the distress without making absolute affirmations.

A. This therapy will increase the clients motivation to gain weight B. This therapy will provide the client with control over behavioral choices C. This therapy will reward the client for perfectionist achievement D. This therapy will protect the client from parental overindulgence

Correct Answer is B

Explanation

A. "This therapy will increase the client's motivation to gain weight": Behavior modification focuses on changing specific behaviors through reinforcement or consequences. While motivation may be a component, the primary goal of behavior modification is to address and modify specific behaviors, such as eating habits, rather than solely relying on motivation.

B. "This therapy will provide the client with control over behavioral choices": Anorexia nervosa often involves issues of control, and behavior modification can empower the individual to regain control over their eating behaviors in a structured and supportive manner. It involves setting goals, reinforcing positive behaviors, and providing a sense of control within the therapeutic framework.

C. "This therapy will reward the client for perfectionist achievement": While anorexia nervosa is associated with perfectionism, rewarding for perfectionist achievement may inadvertently reinforce unhealthy behaviors. Behavior modification aims to promote positive behaviors related to health and well-being rather than reinforcing perfectionism.

D. "This therapy will protect the client from parental overindulgence": Behavior modification is not primarily focused on protecting the client from external factors like parental overindulgence. Instead, it aims to modify specific behaviors through positive reinforcement or consequences.

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A nurse is discussing the use of mechanical restraints with a newly licensed nurse. Which of the following situations should the nurse include as an indication for placing a client in mechanical restraints?

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A nurse is discussing the use of mechanical restraints with a newly licensed nurse. Which of the following situations should the nurse include as an indication for placing a client in mechanical restraints?