An appropriate outcome for a patient with a personality disorder ...

[TVarnum]

An appropriate outcome for a patient with a personality disorder and a nursing diagnosis of Ineffective coping as evidenced by use of manipulation would be that the patient will: _______.
 
  a. refrain from manipulative behavior at all times
  b. use manipulation only to get legitimate needs met
  c. acknowledge manipulative behavior when it is pointed out
  d. identify when he is experiencing feelings of anger

Question 2

Which nursing strategy leads patients to respond more positivity to limit setting?
 
  a. Confront the patient with the inappropriateness of the behavior.
  b. Explore with the patient the underlying dynamics of the behavior.
  c. Reflect back to the patient an understanding of the patient's distress.
  d. State clear disapproval of the behavior, and support its consequences.

[31809pancho]

Answer to Question 1

C
People who are manipulative tend to use manipulation so regularly that it becomes almost an automatic, unconscious response. Being able to recognize or acknowledge when their behavior is manipulative is the first step to replacing manipulation with more adaptive ways of meeting one's needs, paving the way for taking greater responsibility for controlling manipulative behavior. Most people are at least occasionally manipulative, so a complete absence of manipulative behavior would be an unrealistic outcome expectation. Manipulation is maladaptive whether used to meet legitimate needs or illegitimate needs. Identifying anger would be helpful for managing maladaptive responses to that emotion but not for manipulation.

Answer to Question 2

C
Setting limits is better accepted by patients if staff first use empathetic mirroring without making a value judgment. Confrontation, while sometimes an appropriate nursing response, does not enhance the effectiveness of limit setting; neither does exploring the underlying causes of maladaptive behavior. Conveying disapproval is rarely therapeutic in general and does not enhance limit setting; it would tend instead to increase patient resistance and impede the therapeutic relationship.