A nurse is preparing to administer amantadine 150 mg PO every 12 hr. The available medication is amantadine 50 mg/5 mL syrup.

How many mL should the nurse administer per dose?

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.

Choice A rationale: Agoraphobia is a type of anxiety disorder where the person fears and avoids places or situations that might cause them to panic, feel trapped, or helpless. The goal of treatment for agoraphobia is to help the person feel less anxious and fearful about being in places or situations that they perceive as difficult to escape from. This is often achieved through a combination of cognitive-behavioral therapy (CBT) and medication. In CBT, the person learns to understand and change thought patterns that lead to troublesome feelings, behaviors, and symptoms.

Gradual exposure to the feared situation, under controlled conditions, can help the person gain better control over their anxiety. Therefore, the statement “I plan to sit on a park bench for a few minutes each day” indicates an understanding of the goals of treatment as it suggests a willingness to gradually expose oneself to feared situations.

Choice B rationale: The statement “I can try participating in group therapy every week” does not necessarily indicate an understanding of the goals of treatment for agoraphobia. While group therapy can be beneficial for many mental health conditions, it is not specific to the treatment of agoraphobia. In the context of agoraphobia, the focus of treatment is more on individual cognitive-behavioral therapy and gradual exposure to feared situations.

Choice C rationale: The statement “I will join a book club in my neighborhood” does not necessarily indicate an understanding of the goals of treatment for agoraphobia. Joining a book club could potentially provide social support and a sense of community, which can be beneficial for mental health in general. However, it does not specifically address the fears and avoidance behaviors associated with agoraphobia.

Choice D rationale: The statement “I should avoid entering elevators and other closed spaces” indicates a misunderstanding of the goals of treatment for agoraphobia. Avoidance of feared situations is a common symptom of agoraphobia, and treatment aims to reduce this avoidance behavior, not reinforce it. Therefore, this statement suggests a need for further education about the goals of treatment.