A nurse is planning care for a client who demonstrates manipulative behavior. Which of the following interventions should be included in the plan of care?

Avoid discussing past behaviors with the client.

Institute consequences for manipulative behavior.

Allow manipulation so as to not raise the client's anxiety.

Bargain with the client to discourage manipulative behavior.

Answer and Explanation

The Correct Answer is B

Rationale:

Choice A: Avoid discussing past behaviors with the client is incorrect. While avoiding dwelling on the past is important, discussing past manipulative behaviors in a safe and therapeutic environment can help the client gain insight into their patterns and triggers. This awareness is crucial for developing future coping mechanisms and preventing further manipulation.

Choice C: Allow manipulation so as to not raise the client's anxiety is incorrect. Allowing manipulation reinforces the behavior and undermines the client's well-being. It also sets a dangerous precedent for interactions with others.

While addressing anxiety is important, it should not be at the cost of condoning manipulation.

Choice D: Bargain with the client to discourage manipulative behavior is incorrect. Bargaining implies making concessions in exchange for the client stopping their manipulation. This approach can be ineffective and even reinforce the manipulative behavior as the client learns to negotiate for desired outcomes. Instead, clear boundaries and consistent consequences are more effective in addressing manipulation.

Rationale for Choice B:

Instituting consequences for manipulative behavior provides a clear and consistent response to the client's actions. This can help to limit the behavior and encourage the client to develop alternative coping mechanisms.

Consequences should be:

Fair and proportional: The consequence should be related to the specific manipulative behavior and not be overly harsh or punitive.

Consistent: The same consequence should be applied each time the manipulative behavior occurs. This predictability helps the client understand the cause-and-effect relationship between their actions and the consequences.

Enforceable: The consequence should be something that can be realistically implemented and followed through on. While implementing consequences, it's important to:

Maintain a therapeutic relationship: Address the behavior in a calm and professional manner, focusing on the behavior itself and not personal attacks.

Communicate clearly: Explain the consequences to the client in advance and ensure they understand the connection between their actions and the outcome.

Provide alternative coping mechanisms: Offer the client support and guidance in developing healthier ways to express their needs and manage their emotions.

By setting clear boundaries and consistently implementing consequences, nurses can help clients with manipulative behaviors learn to interact in a more positive and productive way. This ultimately benefits the client, their relationships, and their overall well-being.

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Correct Answer is A

Explanation

The adverse effect the nurse should report to the provider is A. Sweating and fever.

This combination of symptoms is a key indicator of Serotonin Syndrome, a potentially life-threatening condition that, while rare with buspirone alone, can occur, particularly if the client is taking other medications that increase serotonin (like SSRIs or MAOIs).

The nurse should report these signs immediately because:

Sweating (Diaphoresis) and High Fever (Hyperthermia) are core components of the triad of symptoms for Serotonin Syndrome (autonomic instability).
Serotonin Syndrome also involves changes in mental status (e.g., confusion, hallucinations, which is option D) and neuromuscular hyperactivity (e.g., muscle rigidity, tremors).
This is a medical emergency that requires immediate intervention to prevent complications like rhabdomyolysis, metabolic acidosis, and renal failure.

In comparison:

C. Decreased appetite is a common, generally mild, and manageable side effect.
D. Hallucinations are a serious central nervous system side effect, but when presented alongside the life-threatening systemic signs of Serotonin Syndrome (A), option A represents the more urgent and dangerous adverse reaction.
B. Discolored urine is not a standard adverse effect and would need investigation, but is not as acutely critical as signs of Serotonin Syndrome.

A. A client who has schizophrenia and is taking antipsychotic medication. B. An older adult client who has pancreatitis and is taking enzymes. C. An adult client who has type 2 diabetes mellitus and is taking insulin. D. A client who is in the third trimester of pregnancy and taking iron supplements.

Correct Answer is A

Explanation

Choice A rationale:

Antipsychotic medications are a class of drugs commonly used to treat schizophrenia and other psychotic disorders. They work by blocking dopamine receptors in the brain. However, dopamine is also involved in motor control, and blocking its receptors can lead to extrapyramidal symptoms (EPS).

EPS are a group of movement disorders that can be caused by antipsychotic medications. They include: Akathisia: A feeling of restlessness and an inability to sit still.

Dystonia: Involuntary muscle contractions that can cause twisting or spasms.

Parkinsonism: Symptoms similar to Parkinson's disease, such as tremor, rigidity, and slowness of movement. Tardive dyskinesia: Involuntary, repetitive movements of the face, tongue, or other body parts.

The risk of developing EPS is higher with older antipsychotic medications, such as haloperidol and chlorpromazine. Newer antipsychotic medications, such as risperidone and olanzapine, are less likely to cause EPS, but they can still occur.

Clients who are taking antipsychotic medications should be monitored for EPS. If EPS develop, the medication may need to be changed or the dose reduced.

Choice B rationale:

Enzymes are not known to cause EPS. They are used to treat pancreatitis by helping the body to digest food.

Choice C rationale:

Insulin is not known to cause EPS. It is used to treat type 2 diabetes mellitus by helping the body to control blood sugar levels.

Choice D rationale:

Iron supplements are not known to cause EPS. They are often taken by pregnant women to prevent iron deficiency anemia.

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A nurse is planning care for a client who demonstrates manipulative behavior. Which of the following interventions should be included in the plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has generalized anxiety disorder and is taking buspirone. Which of the following adverse effects should the nurse report to the provider?

Correct Answer is A

Explanation

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Correct Answer is A

Explanation

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