A nurse is reinforcing discharge teaching with a client who has borderline personality disorder. The client reports being a single parent caring for two toddlers. Which of the following actions should the nurse take?

A. Increased cheerfulness, increased energy, helping other nurses on the shift. While mood changes can sometimes indicate a problem, increased cheerfulness and willingness to help others are not specific red flags for substance use disorder. Substance use is more commonly associated with erratic behavior, frequent absences, or medication discrepancies.
B. Increased irritability towards supervisors, outspokenness regarding work issues, increased attendance at staff meetings. Frustration with workplace issues and increased engagement in staff meetings do not necessarily indicate substance use disorder. Behavioral concerns related to substance use often include impaired judgment, frequent errors, or missing narcotics.
C. Volunteering for overtime on a continual basis, avoiding having a witness to wasting narcotics, needing to be alone in the medication room when preparing medications. Consistently seeking extra shifts, avoiding witnesses when handling narcotics, and needing to be alone while preparing medications suggest possible drug diversion. These behaviors align with common patterns seen in healthcare professionals struggling with substance use disorders.
D. Crying, sharing personal details of relationship problems, monopolizing conversations. Emotional distress and oversharing personal issues may indicate stress or burnout rather than substance use disorder. Substance use concerns are more closely tied to inconsistent work performance, medication discrepancies, and altered behavior related to drug access.

A. "Provide reassurance and comfort ensuring the client is safe." Clients with schizophrenia experiencing confusion and thought distortions require reassurance and safety measures first. Confusion can increase the risk of self-harm or agitation, making safety a priority. Comforting the client and providing a structured environment can help reduce anxiety. Ensuring a calm and safe setting supports symptom management and overall well-being.
B. "Ensure the client goes to group activities as planned." While group activities can promote socialization, a client experiencing confusion and thought distortions may struggle to participate. Forcing group engagement without addressing immediate needs can increase distress. Individualized interventions should be prioritized before encouraging group involvement. Ensuring safety and reducing anxiety are more immediate concerns.
C. "Give PRN medications to treat increased hallucinations." PRN medications may help manage symptoms but are not the first priority. Assessing and ensuring safety takes precedence before administering medications. The nurse should first provide reassurance and evaluate the severity of symptoms. Medication is important, but nonpharmacological interventions should be attempted first when possible. Ensuring safety remains the immediate concern in managing schizophrenia-related confusion.
D. "Use distraction such as the television or music." While distraction techniques can be beneficial, they do not directly address confusion or distorted thinking. The client may require more structured interventions to reorient them and provide reassurance. Music or television might help in stable periods but may not be effective in acute distress. Ensuring the client’s safety and reducing distress are higher priorities in immediate care.