A nurse is planning care for a client who demonstrates manipulative behavior. Which of the following interventions should be included in the plan of care?

Avoid discussing past behaviors with the client.

Institute consequences for manipulative behavior.

Allow manipulation so as to not raise the client's anxiety.

Bargain with the client to discourage manipulative behavior.

Answer and Explanation

The Correct Answer is B

Rationale:

Choice A: Avoid discussing past behaviors with the client is incorrect. While avoiding dwelling on the past is important, discussing past manipulative behaviors in a safe and therapeutic environment can help the client gain insight into their patterns and triggers. This awareness is crucial for developing future coping mechanisms and preventing further manipulation.

Choice C: Allow manipulation so as to not raise the client's anxiety is incorrect. Allowing manipulation reinforces the behavior and undermines the client's well-being. It also sets a dangerous precedent for interactions with others.

While addressing anxiety is important, it should not be at the cost of condoning manipulation.

Choice D: Bargain with the client to discourage manipulative behavior is incorrect. Bargaining implies making concessions in exchange for the client stopping their manipulation. This approach can be ineffective and even reinforce the manipulative behavior as the client learns to negotiate for desired outcomes. Instead, clear boundaries and consistent consequences are more effective in addressing manipulation.

Rationale for Choice B:

Instituting consequences for manipulative behavior provides a clear and consistent response to the client's actions. This can help to limit the behavior and encourage the client to develop alternative coping mechanisms.

Consequences should be:

Fair and proportional: The consequence should be related to the specific manipulative behavior and not be overly harsh or punitive.

Consistent: The same consequence should be applied each time the manipulative behavior occurs. This predictability helps the client understand the cause-and-effect relationship between their actions and the consequences.

Enforceable: The consequence should be something that can be realistically implemented and followed through on. While implementing consequences, it's important to:

Maintain a therapeutic relationship: Address the behavior in a calm and professional manner, focusing on the behavior itself and not personal attacks.

Communicate clearly: Explain the consequences to the client in advance and ensure they understand the connection between their actions and the outcome.

Provide alternative coping mechanisms: Offer the client support and guidance in developing healthier ways to express their needs and manage their emotions.

By setting clear boundaries and consistently implementing consequences, nurses can help clients with manipulative behaviors learn to interact in a more positive and productive way. This ultimately benefits the client, their relationships, and their overall well-being.

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Correct Answer is A

Explanation

Choice A rationale:

The client’s reported behavior of using laxatives and inducing vomiting after eating can lead to a condition known as hypomagnesemia. Hypomagnesemia is a condition characterized by low levels of magnesium in the blood. This condition can be caused by poor intake, excessive loss, or movement of magnesium from the blood into less accessible locations. The use of laxatives can lead to excessive loss of magnesium through increased bowel movements. Similarly, self-induced vomiting can also result in a loss of magnesium. Therefore, the client’s behavior puts them at risk for developing hypomagnesemia.

Choice B rationale:

Renal failure, also known as kidney failure, occurs when the kidneys lose their ability to filter waste products from the blood. While the use of laxatives and self-induced vomiting can lead to dehydration, which can strain the kidneys, these behaviors are not directly associated with renal failure. Therefore, while it’s possible for the client to develop kidney problems, it’s less likely compared to hypomagnesemia.

Choice C rationale:

Heart failure occurs when the heart muscle doesn’t pump blood as well as it should. This condition can cause symptoms like shortness of breath, swelling, fatigue, and other symptoms. While severe electrolyte imbalances, such as those that might result from the use of laxatives and self-induced vomiting, can affect heart function, they would typically result in arrhythmias (irregular heartbeats) rather than heart failure. Therefore, it’s less likely for the client to develop heart failure based on the behaviors described.

Choice D rationale:

Hyperthyroidism is a condition where the thyroid gland produces and releases too much thyroid hormone. This condition can cause symptoms like rapid heartbeat, weight loss, and anxiety. The client’s behaviors of using laxatives and inducing vomiting after eating do not directly influence the production of thyroid hormones. Therefore, it’s less likely for the client to develop hyperthyroidism based on the behaviors described.

A. Potassium level B. Temperature C. ECG report D. BUN level E. BMI.

Correct Answer is ["A","C","E"]

Explanation

Choice A rationale: Potassium level A therapeutic response to the treatment plan for anorexia nervosa would be indicated by a normal potassium level. Anorexia nervosa often leads to electrolyte imbalances, including low potassium levels, due to inadequate food intake and, in some cases, purging behaviors. Therefore, a normal potassium level can indicate that the client is responding well to the treatment plan, as it suggests they are maintaining a more balanced diet and managing their symptoms effectively.

Choice B rationale: Temperature While body temperature can be affected by severe malnutrition, it is not a specific indicator of a therapeutic response to the treatment plan for anorexia nervosa. Therefore, while it’s important to monitor, it is not a definitive sign of improvement or recovery.

Choice C rationale: ECG report An ECG report can indicate a therapeutic response to the treatment plan for anorexia nervosa. This is because anorexia nervosa can lead to heart problems such as abnormal heart rhythms. Therefore, a normal ECG report can suggest that the client’s heart health is improving, which can be a sign that they are responding well to the treatment plan.

Choice D rationale: BUN level While the BUN (Blood Urea Nitrogen) level can provide information about hydration status and kidney function, it is not a specific indicator of a therapeutic response to the treatment plan for anorexia nervosa. Therefore, while it’s important to monitor, it is not a definitive sign of improvement or recovery.

Choice E rationale: BMI BMI (Body Mass Index) is a key indicator of a therapeutic response to the treatment plan for anorexia nervosa. Anorexia nervosa is characterized by a significantly low body weight, and one of the main goals of treatment is weight restoration. Therefore, an increase in BMI can indicate that the client is gaining weight and responding well to the treatment plan.

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A nurse is planning care for a client who demonstrates manipulative behavior. Which of the following interventions should be included in the plan of care?

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Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

A nurse in an outpatient mental health clinic is caring for a client who has anorexia nervosa. The nurse is assessing the client during a follow-up visit.Which of the following findings indicate a therapeutic response to the treatment plan? (Select all that apply.)

Correct Answer is ["A","C","E"]

Explanation

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