When developing a care plan for a patient with borderline personality disorder, which intervention should be included to address self-harm behaviors?

Correct Answer: D

Rationale: The correct answer is D, developing a safety plan with the patient. This intervention is crucial for addressing self-harm behaviors in patients with borderline personality disorder. A safety plan helps the patient identify triggers, warning signs, coping strategies, and support networks to prevent self-harm. It also outlines specific steps to take in a crisis situation. This intervention is more direct and practical compared to the other options. A: Keeping a journal may be helpful for self-reflection but may not provide immediate strategies to prevent self-harm. B: Setting boundaries is important but may not directly address self-harm behaviors. C: Providing coping skills is beneficial, but a safety plan is more specific and tailored to managing self-harm risks. In summary, developing a safety plan is the most effective intervention for addressing self-harm behaviors in patients with borderline personality disorder.

Correct Answer: B

Rationale: The correct answer is B: Providing a low-stimulation environment. This is effective because it helps reduce excessive sensory input which can trigger or exacerbate manic symptoms. Manic patients are often sensitive to stimuli, so a calm and quiet environment can help in de-escalating their agitation and hyperactivity. A: Encouraging group activities can be overwhelming for a manic patient due to the increased stimulation and potential for overstimulation. C: Allowing free movement may lead to risky behaviors or agitation, as the patient may not be able to self-regulate effectively. D: Engaging in competitive games can escalate the manic symptoms and potentially lead to aggressive or impulsive behaviors. In summary, providing a low-stimulation environment is the most effective intervention as it helps manage manic symptoms by reducing triggers and promoting a sense of calm.

Correct Answer: B

Rationale: The correct answer is B: Teaching the patient grounding techniques. Grounding techniques help individuals with PTSD manage flashbacks by bringing their focus back to the present moment and reality. This can include techniques like deep breathing, mindfulness, and using the five senses to connect with the environment. Encouraging the patient to confront the trauma directly (A) can be overwhelming and retraumatizing. Relaxation techniques (C) may not be effective during a flashback when the individual is in a hyperaroused state. Developing a safety plan (D) is important but is more focused on preventing future crises rather than managing flashbacks in the moment.

Correct Answer: C

Rationale: The correct answer is C: Difficulty sleeping. This finding is most concerning because it can indicate severe depression or potential suicidal ideation. Insomnia is a common symptom of major depressive disorder and can exacerbate the patient's condition. It is important to address sleep disturbances promptly to prevent further deterioration. Rationale for why other choices are incorrect: A: Decreased interest in activities is a common symptom of major depressive disorder but may not necessarily indicate immediate risk. B: Feelings of worthlessness are also common in depression but may not be as urgent as sleep disturbances. D: Changes in appetite can be a symptom of depression, but difficulty sleeping poses a more immediate concern for potential harm to the patient's well-being.

Correct Answer: A

Rationale: The correct answer is A: Aged cheese. MAOIs interact with tyramine in certain foods like aged cheese, leading to dangerous hypertensive crisis. Aged cheese contains high levels of tyramine, which can cause a sudden increase in blood pressure when combined with MAOIs. Fresh vegetables (B), grilled chicken (C), and fruit juices (D) do not have high levels of tyramine and can be safely consumed with MAOIs. It is crucial for patients taking MAOIs to avoid foods rich in tyramine to prevent adverse reactions.

Correct Answer: A

Rationale: The correct answer is A: To help the patient confront and process traumatic memories. In EMDR for PTSD, the primary goal is to facilitate the processing of traumatic memories to reduce their emotional charge and associated distress. By confronting and processing these memories, the patient can reprocess them in a healthier way, leading to symptom reduction and improved functioning. Other choices are incorrect because EMDR does not solely focus on changing negative thought patterns (B), developing relaxation techniques (C), or avoiding triggers (D) as its primary goal. The essence of EMDR lies in the desensitization and reprocessing of traumatic memories to promote healing and recovery from PTSD symptoms.

Correct Answer: B

Rationale: The correct answer is B: Allowing the patient to wash hands at specified times. This option acknowledges the patient's need for hand washing while also setting boundaries. By allowing the patient to wash hands at specified times, the nurse can help establish a routine and gradually reduce the excessive hand washing behavior. Encouraging the patient to stop washing hands (A) may increase anxiety and resistance. Ignoring the behavior (C) can reinforce it. Setting strict limits (D) may cause distress and worsen the OCD symptoms. Option B strikes a balance between addressing the patient's needs and promoting healthier behaviors.

Correct Answer: A

Rationale: The correct answer is A because clozapine can suppress the immune system, increasing the risk of infections. Reporting signs of infection promptly can help prevent serious complications. Choice B is incorrect because stopping clozapine abruptly can lead to withdrawal symptoms or a relapse of symptoms. Choice C is incorrect because clozapine should be taken with food to reduce gastrointestinal side effects. Choice D is incorrect because alcohol can interact with clozapine, leading to increased sedation and potentially dangerous side effects.

Correct Answer: C

Rationale: The correct answer is C because the primary goal of cognitive processing therapy in PTSD is to help the patient understand the impact of trauma on their current thoughts and behaviors. This involves identifying and challenging maladaptive beliefs and cognitive distortions related to the trauma. By gaining insight into how the trauma has influenced their thoughts and behaviors, the patient can work towards changing these patterns and improving their psychological well-being. Choice A is incorrect because while processing the trauma and reducing avoidance behaviors are important aspects of therapy, they are not the primary goal in cognitive processing therapy. Choice B is incorrect as it focuses solely on confronting and processing the trauma, missing the crucial component of understanding its impact on thoughts and behaviors. Choice D is incorrect because avoidance of triggers is not the primary goal; rather, it is about addressing and modifying the cognitive responses to those triggers.