A nurse is reinforcing teaching about home care with the family of a client who has Alzheimer's disease and wanders at night. Which of the following instructions should the nurse include?

Choice A reason: Response prevention is a technique often used in the treatment of obsessive-compulsive disorder (OCD). This approach involves preventing the client from engaging in the compulsive behavior they typically perform in response to an anxiety-producing obsession. While effective for OCD, this technique is not typically used for treating specific phobias like the fear of elevators.

Choice B reason: Systematic desensitization is an effective behavioral strategy for decreasing anxiety related to specific phobias. This method involves gradually exposing the client to the feared object or situation—in this case, elevators—in a controlled and progressive manner while teaching relaxation techniques. By slowly and systematically confronting the phobia, the client can learn to reduce their anxiety response over time. This approach helps them manage their fear more effectively and builds their confidence in facing the phobic situation.

Choice C reason: Thought stopping is a cognitive-behavioral technique used to interrupt and prevent distressing thoughts. The client is trained to recognize these thoughts and use a specific action or command, such as saying "Stop" out loud, to halt the negative thought process. While this technique can be helpful for managing anxiety and intrusive thoughts, it is not the primary behavioral strategy for treating specific phobias.

Choice D reason: Flooding, also known as exposure therapy, involves exposing the client to the phobic situation in an intense and prolonged manner until their anxiety diminishes. This approach can be effective but is often overwhelming and can cause significant distress. It requires careful supervision and is not typically the first-line treatment for specific phobias due to the potential for causing trauma or exacerbating the fear.

Choice A reason: Encouraging the client to participate in a board game may be helpful for social interaction and engagement, but it is not the most appropriate intervention to address hostile verbal outbursts. Engaging in activities like board games can be beneficial for overall mental health, but the immediate issue of managing aggression requires more direct strategies.

Choice B reason: Touching the client on the shoulder to console them is not advisable in this situation. Physical contact can be misinterpreted by clients with schizophrenia and may escalate their agitation or aggression. It is important to maintain personal boundaries and use verbal communication to convey support and reassurance.

Choice C reason: Bringing a security guard whenever approaching the client can create an atmosphere of fear and mistrust. It is important to establish a therapeutic relationship built on trust and respect. While safety is a priority, using calm communication and de-escalation techniques is preferable to prevent hostile behavior.

Choice D reason: Using a calm, clear tone when speaking to the client is an effective intervention for managing hostile verbal outbursts. Calm communication helps de-escalate the situation and prevents further agitation. It shows the client that the nurse is in control and can provide a stable, reassuring presence, which is essential for building trust and maintaining a therapeutic environment.