A nurse is planning discharge for a client who has borderline personality disorder. Which of the following interventions should be included for this client?

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.

A. A client who has depression - Correct.

Explanation:

Depression is a significant risk factor for suicide. Individuals with depression may experience feelings of hopelessness, helplessness, and despair, which can contribute to suicidal ideation. It is crucial for the mental health nurse to carefully assess and monitor individuals with depression for any signs of suicidal thoughts or behaviors. Prompt intervention and support are essential to address the underlying issues and mitigate the risk of suicide.

Explanation for other choices:

B. A client whose family visits him every week from out of town.

• Family support is generally considered a protective factor against suicide. Regular family visits can provide emotional support and a sense of connection, reducing the risk.

C. A pregnant female client who is at 8 months gestation.

• Pregnancy alone is not a direct risk factor for suicide. However, mental health issues during pregnancy, such as depression, should be assessed and addressed appropriately.

D. A client who has a lot of friends.

• This scenario does not provide enough information for a clear assessment of suicide risk. Social interactions can be both protective and risk factors, depending on the individual's overall situation and support network. Further assessment would be needed to determine the significance of this factor.