A nurse is discussing borderline personality disorder and the risk for self-harm with a newly licensed nurse. Which of the following situations should the nurse identify as the highest risk for self-harm?

Correct Answer: C

Rationale: In this scenario, the correct answer is C) When discharged from the hospital. Borderline personality disorder (BPD) is characterized by unstable moods, behavior, and relationships, often leading to impulsivity and self-harm behaviors. When a person with BPD is discharged from the hospital, they may experience a sudden change in their environment and support system, which can trigger feelings of abandonment, loneliness, and distress, increasing the risk of self-harm. Option A) When getting married does not inherently pose a higher risk for self-harm in individuals with BPD. While relationship stressors can be triggers for self-harm, marriage alone does not indicate a higher risk. Option B) When attending narrative therapy is not typically associated with a higher risk of self-harm. Narrative therapy focuses on helping individuals reframe their life stories and experiences, which can actually be beneficial in managing BPD symptoms. Option D) When attending dialectical behavior therapy (DBT) is also not the highest risk for self-harm. DBT is a highly effective therapy specifically designed for individuals with BPD to learn skills to regulate emotions, improve relationships, and reduce self-harming behaviors. Educationally, understanding the triggers and risk factors for self-harm in individuals with BPD is crucial for nurses working in behavioral health settings. Recognizing the vulnerable periods, such as discharge from the hospital, allows for proactive interventions and support to reduce the likelihood of self-harm behaviors and promote the well-being of the individual.

Correct Answer: D

Rationale: In this scenario, the nurse should suspect that the client has used hallucinogens. Hallucinogens such as LSD, psilocybin, or PCP can cause symptoms like paranoia, hallucinations, disorientation, and erratic behavior, which align with the client's presentation. These substances can lead to altered perceptions of reality and severe psychological distress, explaining the client's behavior of yelling, paranoia, and gesturing at unseen entities. Regarding the other options: A) Anabolic steroids: Anabolic steroids do not typically cause the acute behavioral symptoms described in the client. They are more associated with physical effects like muscle growth. B) Opioids: While opioids can cause altered mental status, they are more likely to result in sedation, respiratory depression, and pinpoint pupils rather than the hallucinatory symptoms exhibited by the client. C) Stimulants: Stimulants like cocaine or amphetamines can induce paranoia and agitation, but they are less likely to cause the vivid hallucinations and perceptual disturbances observed in this case. Understanding the effects of different substances on behavior is crucial for nurses in emergency settings to provide appropriate and timely care. Recognizing the signs of hallucinogen use can guide the nurse in managing the client's safety, addressing their psychological distress, and ensuring proper medical intervention. This knowledge aids in conducting a thorough assessment, implementing relevant interventions, and promoting a safe and supportive environment for individuals experiencing substance-related issues.

Correct Answer: C

Rationale: In this scenario, the nurse's priority should be option C: Awareness of potential for self-harm. Borderline personality disorder is characterized by impulsivity, emotional instability, and a high risk of self-harm or suicide. By educating the family about the potential for self-harm, the nurse is addressing a critical safety concern and helping the family understand the seriousness of the diagnosis. This information empowers the family to provide a safe environment and intervene effectively in case of a crisis. Option A, providing resources for group therapy, is important for long-term management of borderline personality disorder, but safety concerns must be addressed first. Option B, medication compliance, is relevant but not as immediate as addressing the risk of self-harm. Option D, information about insurance coverage, is important but is not as urgent or critical as ensuring the safety of the client. In an educational context, understanding the priority of addressing immediate safety concerns in clients with borderline personality disorder is crucial for nurses providing care in behavioral health settings. Emphasizing the importance of assessing and managing the risk of self-harm is fundamental to ensuring the well-being of clients with this condition.

Correct Answer: A

Rationale: In clients with dependent personality disorder, the correct finding is that they are fearful of making decisions (Option A). This is because individuals with this disorder typically have an excessive need to be taken care of, which leads to a lack of confidence in their abilities to make decisions independently. This fear of making decisions can manifest in various aspects of their lives, from daily choices to significant life decisions. Options B, C, and D are incorrect for clients with dependent personality disorder. Option B, erratic behaviors, is more commonly associated with conditions like borderline personality disorder or certain mood disorders. Option C, dramatic behaviors, are characteristic of histrionic personality disorder. Option D, easily expressing disagreement with others, is not typical for individuals with dependent personality disorder, as they often avoid conflict and seek approval from others to maintain their sense of security and reliance. Educationally, understanding the specific characteristics and common findings associated with different personality disorders is crucial for nurses in planning effective care. By recognizing these distinctions, nurses can tailor interventions and support strategies to meet the unique needs of clients with various personality disorders, promoting better outcomes and enhancing the therapeutic relationship.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Alzheimer's disease. Cortical thinning is a characteristic feature of Alzheimer's disease, a type of dementia that primarily affects areas of the brain responsible for memory, thinking, and language. This thinning is due to the degeneration and loss of nerve cells in the cerebral cortex over time. Option A) Prion disease is characterized by the accumulation of abnormal prion proteins in the brain, leading to rapid neurological deterioration, but it does not typically present with cortical thinning as seen in Alzheimer's disease. Option C) Substance use disorder primarily affects brain function through the effects of substances on neurotransmitter systems and neural pathways, rather than cortical thinning. Option D) HIV infection can lead to neurocognitive disorders, but cortical thinning is not a typical feature of HIV-related brain changes. Educationally, understanding the specific brain changes associated with different types of dementia is crucial for nurses caring for patients with cognitive impairments. Recognizing cortical thinning as a hallmark of Alzheimer's disease can aid in early detection, appropriate care planning, and effective communication with the healthcare team and family members.