The mother of a 2-year-old tells the nurse at the well-child clinic that her child likes to take a blanket wherever he goes. The mother asks if she should take the blanket away from the child. The nurse counsels the mother to allow the child to have the blanket because it reminds him of his mother and comforts him. The basis for this counseling is:

Correct Answer: A

Rationale: The correct answer is A: Mahler's theory of object relations. Mahler emphasizes the importance of transitional objects like a blanket for young children to provide comfort and security as they develop a sense of self and separation from their primary caregiver. This theory aligns with the situation described, where the child's attachment to the blanket symbolizes the bond with the mother. Explanation for why the other choices are incorrect: B: Freud's developmental theory focuses on psychosexual stages and the role of unconscious processes, not specifically on transitional objects. C: Kernberg's conceptualization of object constancy pertains to personality disorders and object relations in adult psychotherapy, not child development. D: Sullivan's theory of 'good me' is about interpersonal relationships and self-esteem, not directly related to transitional objects in child development.

Correct Answer: A

Rationale: The correct answer is A: Plan frequent client-centered staff meetings. This measure is advisable as it promotes open communication, collaboration, and consistency in care. By holding regular meetings, staff can discuss concerns, share observations, and develop strategies to effectively manage individuals with erratic personality disorders. This approach helps in setting clear boundaries, identifying manipulative behaviors, and ensuring a unified team response. Summary: - Choice B: Practice take-down and restraint procedures is incorrect as it focuses on physical control rather than preventive strategies. - Choice C: Institute written or taped change-of-shift reports is incorrect as it lacks real-time communication and immediate response to potential issues. - Choice D: Rotate staff assignments so no one is responsible for the client for a prolonged period of days is incorrect as it may disrupt continuity of care and hinder the establishment of trust and rapport.

Correct Answer: D

Rationale: The correct answer is D: manipulative. The patient is using different strategies to manipulate each nurse's emotions and behavior for personal gain. In the first scenario, the patient is attempting to create a divide between Nurse A and Nurse B by praising Nurse A and implying Nurse B's incompetence. In the second scenario, the patient is trying to instigate conflict between Nurse A and Nurse B by falsely suggesting Nurse A's negative feelings towards Nurse B. In the third scenario, the patient is employing a manipulative tactic by undermining Nurse C's confidence and competence. These behaviors demonstrate a pattern of manipulation aimed at controlling and influencing the nurses' perceptions and actions. Choices A, B, and C do not accurately capture the manipulative intent behind the patient's actions.

Correct Answer: B

Rationale: The correct answer is B: provide care in a matter-of-fact manner. This approach is important in treating patients with borderline personality disorder as it helps maintain boundaries and consistency, which are crucial for managing their condition. By being matter-of-fact, the nurse can prevent potential manipulation or reinforcement of maladaptive behaviors. Encouraging the patient to vent anger (choice A) may escalate the situation. Being overly sympathetic (choice C) can blur professional boundaries. Offering to listen to feelings (choice D) may reinforce the behavior and not address the underlying issues effectively.

Correct Answer: A

Rationale: The correct answer is A: Monitor for signs of electrolyte imbalances and dehydration. This is the priority assessment for a patient with bulimia nervosa who is experiencing frequent purging behaviors because purging can lead to electrolyte imbalances and dehydration, which can result in serious health complications such as cardiac arrhythmias and renal issues. Monitoring electrolyte levels and hydration status is crucial for the patient's safety and well-being. Summary: - Choice B is incorrect because focusing on weight gain and exercise habits is not the priority when dealing with the immediate health risks of electrolyte imbalances and dehydration. - Choice C is incorrect as expressing feelings about food and body image is important for therapy but not the priority in this acute situation. - Choice D is incorrect as monitoring for compulsive eating behaviors and binge episodes is more relevant for patients with binge eating disorder rather than bulimia nervosa with frequent purging behaviors.