A client diagnosed with borderline personality disorder brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the nursing staff best handle this situation?

Maintain consistency of care by open communication to avoid staff manipulation

Maintain unit order by the application of autocratic leadership

Allow the clients to apply the democratic process when developing unit rules

Allow the client spokesperson to verbalize concerns during a unit staff meeting

Answer and Explanation

The Correct Answer is A

A. Maintain consistency of care by open communication to avoid staff manipulation: This is the correct answer. Borderline personality disorder (BPD) clients may engage in splitting behaviors, which involve polarized views of staff as either all good or all bad. Maintaining consistency of care and open communication can help prevent manipulation and ensure fair and transparent interactions.

B. Maintain unit order by the application of autocratic leadership: Autocratic leadership, characterized by a top-down approach with limited input from others, may not be the most effective strategy in this situation. It may lead to resistance from clients and potentially escalate the conflict.

C. Allow the clients to apply the democratic process when developing unit rules: While democratic processes are generally beneficial, allowing clients to unreasonably demand modifications of unit rules without considering the overall impact on the therapeutic environment may not be appropriate. It's important to balance client involvement with maintaining a structured and therapeutic milieu.

D. Allow the client spokesperson to verbalize concerns during a unit staff meeting: While it's important to provide a platform for clients to express concerns, allowing a spokesperson to verbalize concerns during a staff meeting should be done in a manner that maintains order and follows the therapeutic goals of the unit. It should not involve unreasonably demanding modifications without a careful consideration of the impact on the overall treatment milieu.

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Correct Answer is B

Explanation

A. The client will substitute a productive activity for rituals by day one: This outcome may be challenging to achieve within the first day, and it is important to set realistic goals. Moreover, focusing on substituting a productive activity might not address the immediate need to reduce ritualistic behaviors.

B. The client will refrain from ritualistic behaviors during daylight hours: This is an appropriate initial outcome. It acknowledges the challenge of completely eliminating rituals but sets a realistic goal of refraining from these behaviors during daylight hours. This allows for gradual progress without setting unrealistic expectations.

C. The client will participate in unit activities by day three: While participation in unit activities is a positive goal, it may be too optimistic to expect this within the first three days, especially considering the severity of obsessive-compulsive disorder symptoms.

D. The client will wake early enough to complete rituals prior to breakfast: This goal does not promote a reduction in ritualistic behaviors; instead, it may reinforce and accommodate the rituals. The aim of treatment for obsessive-compulsive disorder is to reduce the impact of these rituals, not to support them.

A. By setting punishments for clients who violate the community rules B. By setting expectations wherein all clients are not treated on an equal basis C. By setting expectations wherein all clients are treated on an equal basis D. By dealing with inappropriate behaviors as they occur

Correct Answer is C

Explanation

A. By setting punishments for clients who violate the community rules: This approach is more authoritarian than democratic. In a democratic milieu, the emphasis is on collaboration, shared decision-making, and equal participation, rather than imposing punishments.

B. By setting expectations wherein all clients are not treated on an equal basis: This approach would be contrary to the principles of a democratic milieu. The democratic model promotes equality, inclusion, and the involvement of all clients in decision-making.

C. By setting expectations wherein all clients are treated on an equal basis: This is the correct answer. In a democratic milieu, all clients are encouraged to participate equally in decision-making processes, express their opinions, and contribute to the therapeutic community. This fosters a sense of empowerment and shared responsibility.

D. By dealing with inappropriate behaviors as they occur: While addressing inappropriate behaviors is important in any therapeutic environment, the emphasis on a democratic form of self-government goes beyond reacting to behaviors. It involves actively engaging clients in the decision-making process and promoting a collaborative and supportive community.

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A client diagnosed with borderline personality disorder brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the nursing staff best handle this situation?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client diagnosed with obsessive-compulsive disorder is admitted to a psychiatric unit. The client has an elaborate routine for toileting activities. Which would be an appropriate initial client outcome during the first week of hospitalization?

Correct Answer is B

Explanation

How does a democratic form of self-government in the milieu contribute to client therapy?

Correct Answer is C

Explanation

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