A nurse is admitting a client who has borderline personality disorder and is at risk for self-mutilation. Which of the following interventions should the nurse incorporate in the plan of care?

Choice A reason: Providing additional attention to the client can sometimes reinforce negative behaviors in individuals with borderline personality disorder. It is important to balance attention with promoting independence and self-regulation.

Choice B reason: Applying mechanical restraints before administering medication is not a standard practice and can be considered unethical and harmful. Restraints should only be used as a last resort when there is an immediate risk of harm to the client or others.

Choice C reason: Obtaining a verbal contract from the client is a therapeutic intervention that can help manage self-mutilation risks. This contract involves the client agreeing to communicate with staff before engaging in self-harm, which can help in developing trust and promoting safety.

Choice D reason: Limiting staff members who work with the client can help provide consistency and stability, which is beneficial for individuals with borderline personality disorder. However, it is not the primary intervention for preventing self-mutilation.

Choice A reason:

A client with new-onset delirium is experiencing an acute and often fluctuating disturbance in attention and cognition. Delirium is typically caused by an underlying medical condition, substance intoxication, or withdrawal. Assertiveness training would not be appropriate for this client as the primary focus should be on identifying and treating the underlying cause of the delirium.

Choice B reason:

A client experiencing auditory hallucinations is likely dealing with a psychotic disorder such as schizophrenia. The primary treatment for such clients involves antipsychotic medications and psychotherapy aimed at managing symptoms and improving reality orientation. Assertiveness training is not suitable for clients in the acute phase of psychosis as their ability to engage in and benefit from such training is compromised.

Choice C reason:

A client experiencing mania, a state characterized by elevated mood, hyperactivity, and impulsive behavior, is typically seen in bipolar disorder. During a manic episode, the client may have difficulty focusing and controlling their impulses, making it challenging to participate effectively in assertiveness training. The priority for these clients is to stabilize their mood with medication and supportive therapy.

Choice D reason:

A client with somatic symptom disorder experiences excessive thoughts, feelings, and behaviors related to physical symptoms. Assertiveness training can be beneficial for these clients as it helps them express their needs and concerns more effectively, reducing the focus on physical symptoms and improving their overall functioning.