A client diagnosed with borderline personality disorder (BPD) brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. Which approach is best for the nursing staff to implement?

Correct Answer: B

Rationale: The correct approach is B: Maintain consistency of care by open communication to avoid staff manipulation. In this scenario, the client with BPD is exhibiting manipulative behavior by rallying other clients to unreasonably demand rule modifications. By maintaining consistency in care and open communication, staff can address the conflict effectively without succumbing to manipulation. This approach also promotes a therapeutic environment and upholds boundaries. Choice A: Allowing clients to apply the democratic process may further enable manipulation and chaos rather than resolving the conflict effectively. Choice C: Allowing only the client spokesperson to verbalize concerns may not address the underlying issue of manipulation and could potentially reinforce the behavior. Choice D: Applying autocratic leadership may lead to a power struggle and exacerbate the conflict, rather than promoting a collaborative resolution.

Correct Answer: D

Rationale: The correct answer is D because it directly addresses the concept of secondary gains related to extreme dependency on the spouse. By asking about the specific benefits gained from the relationship, the nurse can uncover underlying motivations for the dependency. A: This choice focuses on a broad question about lifelong concerns, not specifically targeting the secondary gains of dependency. B: This choice asks about anxiety related to decision-making, which is not directly addressing the benefits gained from dependency. C: This choice is too general and does not directly address the issue of secondary gains in the context of dependency.

Correct Answer: B

Rationale: The correct answer is B: Social isolation R/T poor self-esteem. This choice is correct because the client's behavior of sitting alone and ignoring others' attempts to converse indicates a pattern of social withdrawal, which aligns with social isolation. Poor self-esteem is a cluster C trait often associated with social isolation. The other choices are incorrect because there is no evidence of fear related to hospitalization, no indication of suicidal ideation or hopelessness, and no clear link to powerlessness due to dependence issues in the scenario provided.

Correct Answer: D

Rationale: The correct answer is D because clients with moderate intellectual disabilities typically struggle with academic tasks, making it unlikely for them to successfully complete elementary school without significant support. This indicates a need for further instruction on understanding the developmental characteristics of clients with moderate ID. A: This choice is incorrect because clients with moderate ID can often work in a sheltered workshop setting with appropriate accommodations and support. B: This choice is incorrect because clients with moderate ID can usually perform some personal care activities independently or with assistance. C: This choice is incorrect because clients with moderate ID may indeed have difficulty relating to peers due to social and communication challenges associated with their disability.

Correct Answer: D

Rationale: The correct answer is D: An 8-year-old boy. Boys are around four times more likely to be diagnosed with Autism Spectrum Disorder (ASD) compared to girls. Additionally, ASD is typically diagnosed in early childhood, with symptoms manifesting around the age of 2-3 years old. By the age of 8, a child would have likely shown clear signs of ASD if they have it. Choices A, B, and C (young girls) are less likely to be diagnosed with ASD based on prevalence and age of onset.