The nurse is caring for a person displaying associative looseness. Which of the following would be the best strategy for the nurse to respond to associative looseness?

Place difficulty in understanding on yourself: “I’m having trouble following you.”

Let the patient think you understand to minimize the patient’s anxiety.

Use reality testing to help the patient clarify their statements.

Tell the patient they are not making any sense in order to set clear expectations.

Answer and Explanation

The Correct Answer is A

A: Placing the difficulty in understanding on yourself by saying, “I’m having trouble following you,” is a therapeutic communication technique. It helps to reduce the patient’s anxiety and encourages them to clarify their thoughts without feeling judged. This approach fosters a supportive environment and can help the patient organize their thoughts better.

B: Letting the patient think you understand to minimize their anxiety is not an effective strategy. It can lead to further confusion and does not help the patient improve their communication. Honesty and clarity are important in therapeutic interactions.

C: Using reality testing to help the patient clarify their statements can be useful, but it may not be the best initial approach. It requires the patient to have some level of insight and ability to engage in reality testing, which may not be possible in severe cases of associative looseness.

D: Telling the patient they are not making any sense can be perceived as judgmental and may increase the patient’s anxiety and frustration. It is not a supportive or therapeutic approach and can hinder effective communication.

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Correct Answer is B

Explanation

A: Impulsivity refers to acting on urges without considering consequences, which is a feature of borderline personality disorder but not the best description of the scenario.
B: Emotional lability, or rapid and intense mood swings, accurately describes the client’s behavior in the scenario.
C: Reaction formation involves behaving in a way that is opposite to one’s true feelings, which is not depicted in the scenario.
D: Splitting involves viewing people or situations as all good or all bad, which can be a feature of borderline personality disorder but is not the primary feature shown in the scenario.

A. Encourages clients to participate in various activities on the unit B. Allows the client to skip mandatory programming as a reward for good behavior C. Ignores a client’s attention-seeking behavior of screaming in their bedroom D. Removes a client from group after they become disruptive, per unit policy

Correct Answer is B

Explanation

A: Encouraging clients to participate in various activities is a positive approach that helps engage them in the program and develop new skills.

B: Allowing the client to skip mandatory programming as a reward for good behavior is inappropriate because it undermines the structure and consistency of the program. Mandatory programming is essential for therapeutic progress and should not be used as a reward or punishment.

C: Ignoring attention-seeking behavior, such as screaming, can be an appropriate strategy to avoid reinforcing negative behaviors, provided it is done within the context of a behavior management plan.

D: Removing a client from group after they become disruptive, per unit policy, is an appropriate action to maintain the therapeutic environment and ensure the safety and well-being of all clients.

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