An unemployed woman, age 24, seeks help because she feels depressed and abandoned and doesn't know what to do with her life. She says she has quit her last five jobs because her coworkers didn't like her and didn't train her adequately. Last week, her boyfriend broke up with her after she drove his car into a tree after an argument. The client's initial diagnosis is borderline personality disorder. Which nursing observations support this diagnosis?

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Lack of self-esteem, strong dependency needs, and impulsive behavior. These observations align with the diagnostic criteria for borderline personality disorder. Individuals with this disorder often struggle with a poor self-image, intense fear of abandonment leading to dependency on others, and display impulsive behaviors like quitting jobs abruptly or engaging in risky activities. Option A is incorrect because flat affect, social withdrawal, and unusual dress are more indicative of other mental health conditions like depression or schizophrenia. Option B is incorrect as suspiciousness, hypervigilance, and emotional coldness are more characteristic of conditions like paranoid personality disorder or PTSD. Option D is incorrect as insensitivity to others, sexual acting out, and violence are not typical features of borderline personality disorder. Educationally, understanding the specific behavioral and emotional patterns associated with different psychological disorders is crucial for accurate assessment and effective intervention in mental health settings. This rationale provides insight into the nuanced symptoms of borderline personality disorder, aiding in the development of clinical reasoning skills for mental health professionals.

Correct Answer: A

Rationale: In the context of demonstrating mentally healthy behavior, option A is the correct answer. This is because seeing oneself as capable of achieving ideals and meeting demands reflects a sense of self-efficacy and positive self-esteem, which are key components of mental health. This attitude suggests a balanced perception of one's abilities and a sense of optimism about achieving goals. Options B and C are incorrect as they describe behaviors that are indicative of potential mental health challenges. Behaving without considering consequences and aggressively meeting needs at the expense of others' rights can be signs of impulsivity, lack of empathy, and disregard for social norms, which are not aligned with mental well-being. Option D is also incorrect in this context as seeking help from others when assuming responsibility for major areas of one's life can be a positive trait, but it does not specifically indicate the achievement of mentally healthy behavior. Independence and self-reliance are important aspects of mental health, but so is the ability to recognize when support is needed. Educationally, this question helps students understand the nuances of mental health behaviors and how various attitudes and actions can be indicators of a person's mental well-being. It encourages students to critically analyze behaviors and their implications on mental health, promoting a deeper understanding of the biological basis of behavior and mental health principles.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Fulfilling relationships. The patient described is exhibiting symptoms characteristic of borderline personality disorder, which often involves unstable and intense relationships. Developing fulfilling relationships is crucial for individuals with this condition as it can help provide stability, support, and a sense of security, ultimately contributing to improved mental health. Option A) Effectiveness in work does not directly address the relational difficulties the patient is experiencing. While being successful in work can be beneficial for mental health, it is not the primary need in this case. Option B) Communication skills play a role in relationships, but the core issue here is not just about communication but about the patient's pattern of idealizing and devaluing significant others. Option C) Productive activities are important for overall well-being, but they do not specifically address the challenges related to forming and maintaining stable relationships, which is the primary concern for the patient in this scenario. Educationally, this question highlights the importance of understanding the link between mental health and interpersonal relationships. It emphasizes the role of fulfilling relationships in promoting mental well-being and how interventions focused on improving relationship skills can be beneficial for individuals struggling with issues like those seen in borderline personality disorder.

Correct Answer: C

Rationale: In the context of the Biological Basis of Behavior, self-reflection plays a crucial role in the nurse-client relationship. Option C, "helps the nurse-client relationship be open to improvement and change," is the correct answer. Self-reflection allows the nurse to continuously evaluate their interactions with clients, identify areas for personal and professional growth, and adapt their approach to better meet the clients' needs. This openness to improvement and change fosters a therapeutic environment where trust can flourish, leading to better outcomes for the client. Option A, "a guide for professional behavior with clients," is incorrect because while self-reflection does inform professional behavior, its main purpose in this context is to enhance the nurse-client relationship rather than solely guide behavior. Option B, "a guide to encourage the client to disclose their feelings," is incorrect as self-reflection is focused on the nurse's introspection and personal growth rather than directly influencing the client's disclosure of feelings. Option D, "helps the nurse take action on the client's behaviors," is incorrect as self-reflection is more about the nurse understanding their own reactions and behaviors rather than directly addressing the client's behaviors. Educationally, understanding the significance of self-reflection in nursing practice is essential for developing strong therapeutic relationships and providing effective care. By encouraging students to engage in regular self-reflection, educators can help them become more self-aware, empathetic, and responsive nurses, ultimately improving patient outcomes and satisfaction.

Correct Answer: C

Rationale: In this scenario, the best nursing response is option C: "Information is only shared with the health-care team." This response respects the client's confidentiality while also adhering to ethical and legal obligations regarding privacy and disclosure of information. Option A, "You will be closely watched while you are here," is incorrect as it does not address the client's request for confidentiality and may create a sense of mistrust. Option B, "You can trust me; I won't tell anyone," is incorrect because it makes a promise that the nurse may not be able to keep due to legal and ethical obligations to report certain information. Option D, "Of course, I have to tell what you say," is incorrect as it violates the client's right to confidentiality and breaches the trust in the nurse-client relationship. Educationally, this question emphasizes the importance of understanding and upholding confidentiality in healthcare settings. Nurses must navigate complex situations where maintaining patient confidentiality is crucial while also balancing legal and ethical obligations. It highlights the need for clear communication with patients about confidentiality and the boundaries of information sharing.