A mental health nurse is preparing a client who has chronic anxiety for discharge from the psychiatric unit. Which of the following instructions should the nurse include in the client's discharge plan?

Choice A rationale:

Coercion to take necessary prescribed medications is not an appropriate indication for the use of mechanical restraints. It violates the client's right to autonomy and informed consent.

Forcing a client to take medication against their will can lead to psychological trauma, distrust of healthcare providers, and even legal action.

Alternative interventions, such as patient education, negotiation, and behavioral strategies, should be explored first to encourage medication compliance.

If a client is refusing medication due to a lack of understanding, providing clear and concise information about the medication's purpose, benefits, and potential side effects can help facilitate informed decision-making.

Negotiation strategies can involve exploring the client's concerns and preferences, and working collaboratively to find a solution that addresses those concerns.

Behavioral strategies may include positive reinforcement for medication adherence, or the use of techniques such as distraction or relaxation to reduce anxiety associated with medication administration.

Choice B rationale:

Punishment for verbally abusing other clients is also not an appropriate indication for mechanical restraints.

Restraints should never be used as a form of punishment, as this can be considered abuse and can worsen the client's behavior.

Verbal abuse is often a symptom of underlying mental health issues, and it's important to address the root cause of the behavior rather than simply trying to suppress it through restraints.

Alternative interventions for verbal abuse might include de-escalation techniques, conflict resolution strategies, and individual or group therapy to address underlying emotional or behavioral issues.

Choice C rationale:

Discipline for throwing objects at staff in the nursing station is not an appropriate indication for mechanical restraints. Restraints should only be used as a last resort to protect the client or others from imminent harm.

Throwing objects may be a sign of agitation, frustration, or anger, and it's important to address the underlying cause of these behaviors.

Alternative interventions could include de-escalation techniques, providing a safe space for the client to calm down, medication to manage agitation, or behavioral therapy to teach coping skills.

Choice D rationale:

Self-destructive behavior after all previous alternative interventions have been unsuccessful is the only appropriate indication for mechanical restraints among the choices provided.

When a client is at risk of seriously harming themselves, and other interventions have failed to protect them, restraints may be necessary to prevent injury or death.

However, it's crucial to use restraints only as a temporary measure and to continuously monitor the client's condition and behavior.

As soon as the client is no longer at risk of self-harm, the restraints should be removed.

The correct answer is choiceAandE.

Choice A rationale:

Monitoring the client’s weight daily is crucial in managing anorexia nervosa.It helps track the client’s progress and ensures that any significant weight changes are promptly addressed.

Choice B rationale:

Allowing the client to choose their meals can be counterproductive.Clients with anorexia nervosa may make choices that do not support their nutritional needs, potentially exacerbating their condition.

Choice C rationale:

Allowing the client to practice strenuous exercises is not advisable.Strenuous exercise can further deplete the client’s already low energy reserves and exacerbate malnutrition.

Choice D rationale:

Staying with the client during meals and for 2 hours after meals is incorrect.The recommended practice is to stay with the client for 30 minutes after meals to monitor for any purging behaviors.

Choice E rationale:

Providing the client with small meals frequently is beneficial. It helps in managing their nutritional intake without overwhelming them, which can be more acceptable and manageable for clients with anorexia nervosa.