A nurse is planning discharge for a client who has borderline personality disorder. Which of the following interventions should be included for this client?

Rationale:

Choice A is incorrect. Alprazolam does not have any known dietary interactions with aged cheeses. This information is specific to monoamine oxidase inhibitors (MAOIs), not benzodiazepines like alprazolam.

Choice B is incorrect. While some benzodiazepines can have side effects like drowsiness or dizziness that might indirectly affect blood pressure, alprazolam itself is not known to directly cause an increase in blood pressure.

Choice D is incorrect. Doubling the next dose of medication if a dose is missed is dangerous and can lead to overdose and increased risk of serious side effects. The client should be instructed to contact their doctor if they miss a dose.

Choice C is correct. Alprazolam is a pregnancy category D medication, meaning it has positive evidence of fetal risk. Studies have shown an increased risk of birth defects, including cleft lip and palate, in babies exposed to alprazolam during pregnancy. Therefore, it is crucial for women of childbearing age to use a reliable form of contraception while taking alprazolam to prevent unintended pregnancy and potential harm to the fetus.

Additional teaching points for the nurse:

The nurse should inform the client about the specific risks associated with alprazolam during pregnancy and the importance of discussing alternative treatment options if pregnancy is desired.

The nurse should emphasize the importance of using a reliable form of contraception that is effective both during and after treatment with alprazolam, as the medication can remain in the system for some time after the last dose.

The nurse should provide the client with resources on contraception and reproductive health, and encourage her to talk to her doctor about any s or concerns she may have.

Choice A rationale: A client with Obsessive Compulsive Disorder (OCD) who insists on mopping the floor in the day room does not pose a direct threat to themselves or others. OCD is characterized by obsessions (persistent, intrusive

thoughts) and compulsions (repetitive behaviors that the person feels compelled to perform). The act of mopping the floor could be a compulsion for this client. While it may be disruptive or unusual, it is not harmful. Therefore, restraints would not be appropriate in this situation.

Choice B rationale: A client with a personality disorder who tries to manipulate staff to gain privileges can be challenging to manage, but this behavior does not warrant the use of restraints. Personality disorders are characterized by enduring patterns of behavior, cognition, and inner experience that deviate from the expectations of the individual’s culture. These patterns are inflexible and pervasive across many personal and social situations.

While manipulation can be frustrating for staff, it is not a danger to the client or others, and other interventions should be used to manage this behavior.

Choice C rationale: A client with Bulimia Nervosa who refuses to come to the dining room for meals is exhibiting behavior related to their eating disorder, but this does not justify the use of restraints. Bulimia Nervosa is characterized by recurrent episodes of binge eating followed by compensatory behaviors such as vomiting, fasting, or excessive exercise. Refusal to eat in a communal setting like a dining room is not uncommon for individuals with eating disorders. This behavior should be addressed through therapeutic interventions, not restraints.

Choice D rationale: A client who is just recovering from a benzodiazepine overdose is the correct answer. Restraints are contraindicated for this client because they could cause physical harm. After a benzodiazepine overdose, the client may experience symptoms such as drowsiness, confusion, and impaired coordination. Restraints could increase the risk of injury, particularly if the client becomes agitated or tries to remove them. In addition, restraints could potentially interfere with medical treatment for the overdose.