The nurse is caring for a client with bipolar disorder. The client has been manipulating some of the staff and other clients in order to get her way. Which actions by the nurse are appropriate in managing this client?

Select all that apply.
  1. giving support when the client exhibits positive behaviors
  2. setting clear limits and communicating expected behaviors
  3. role playing with the client to demonstrate appropriate behaviors
  4. treating the client more like a friend in order to show respect for her as a person
  5. giving the client small gifts, such as extra dessert, in order to encourage appropriate behavior
Numbers 1, 2, and 3 are correct.
Rationale: The nurse can best manage the behavior of the client by showing support when the client exhibits positive behaviors. The nurse should set clear, enforceable limits and communicate expectations to the client. The client should also be informed of consequences of not complying. Role playing demonstrates appropriate behaviors to the client and allows her to practice best responses before a situation arises. Treating the client more like a friend is inappropriate; the nurse should maintain a professional relationship with the client and not try to be her friend. This only confuses the client; it also makes the situation worse for other staff members and can lead to infighting among staff. Giving small gifts to encourage desired behavior is a form of bribery. The nurse should not try to bribe or manipulate the client, nor should the nurse accept gifts from the client. Consistent treatment by all staff members gives the client a stable and safe environment in which to work on her behavior.