A client with bipolar disorder is refusing to take mood stabilizers due to weight gain. To increase the patient’s adherence to a medication regimen, what measures could the nurse teach the client? (SELECT ALL THAT APPLY)

d. Interview the client alone and assess for abuse

Explanation of Choices

Choice A Reason: Provide the Daughter and Client with Nutritional Counseling

While nutritional counseling is important, especially given the client’s malnourished state, it is not the immediate priority in this scenario. The client’s reluctance to speak and the daughter’s interruptions suggest that there may be underlying issues that need to be addressed first. Nutritional counseling can be provided later, once the immediate concerns have been resolved.

Choice B Reason: Request a Psychiatric Evaluation for the Client

Requesting a psychiatric evaluation may be necessary if there are signs of mental health issues, but it is not the first step in this situation. The priority is to ensure the client’s safety and well-being by addressing any immediate concerns, such as potential abuse. A psychiatric evaluation can be considered after the initial assessment and intervention.

Choice C Reason: Take the History from the Daughter Because of the Client’s Confusion

Taking the history from the daughter might seem practical due to the client’s confusion, but it is not the best approach in this case. The daughter’s constant interruptions and the client’s reluctance to speak raise concerns about the reliability of the information provided by the daughter. It is crucial to gather information directly from the client whenever possible to ensure an accurate assessment.

Choice D Reason: Interview the Client Alone and Assess for Abuse

Interviewing the client alone and assessing for abuse is the most appropriate intervention. The client’s reluctance to speak and the daughter’s interruptions could indicate that the client is being controlled or intimidated. Conducting a private interview allows the client to speak freely and provides an opportunity to identify any signs of abuse or neglect. Ensuring the client’s safety and addressing any immediate risks is the top priority.

The correct answer is d. Splitting.

Choice A Reason: Denial

Denial is a defense mechanism where an individual refuses to accept reality or facts, blocking external events from awareness. While denial can be present in various mental health conditions, it does not specifically explain the client’s sudden shift from idealizing to devaluing the nurse.

Choice B Reason: Separation-individuation

Separation-individuation refers to a developmental process where an individual differentiates themselves from others, particularly caregivers, and develops a sense of self. This concept is more relevant to early childhood development and does not directly explain the client’s behavior in this context.

Choice C Reason: Reaction formation

Reaction formation is a defense mechanism where an individual expresses feelings or behaviors that are opposite to their true feelings or desires. While this can occur in borderline personality disorder, it does not fully capture the client’s extreme shift in perception from positive to negative.

Choice D Reason: Splitting

Splitting is a hallmark characteristic of borderline personality disorder. It involves viewing people or situations in black-and-white terms, as either all good or all bad, with no middle ground. The client’s outburst, shifting from idealizing the nurse to seeing them as hateful, is a classic example of splitting. This defense mechanism helps individuals with borderline personality disorder manage their intense emotions and fears of abandonment.