The plan of care for clients with borderline personality should include:
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Solution
Ensuring she adheres to certain restrictions
The client is manipulative. The client must be informed about the policies, expectations, rules and regulation upon admission.
Option A: Limits should be firmly and consistently implemented. Flexibility and bargaining are not therapeutic in dealing with a manipulative client.
Option B: There is no specific medication prescribed for this condition.
Option C: This is not part of the care plan. Interaction with other clients are allowed, but the client should be observed and given limits in her attempt to manipulate and dominate others.
A teenage girl is diagnosed to have borderline personality disorder. Which manifestations support the diagnosis?
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Solution
Lack of self-esteem, strong dependency needs, and impulsive behavior
These are the characteristics of a client with borderline personality.
Option B: This describes the avoidant personality.
Option C: These are the characteristics of a client with paranoid personality.
Option D: This describes the obsessive compulsive personality
The client joins a support group and frequently preaches against abuse, is demonstrating the use of:
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Solution
Reaction formation
Reaction formation is the adoption of behavior or feelings that are exactly opposite of one’s true emotions.
Option A: Denial is a refusal to accept a painful reality.
Option C: Rationalization is attempting to justify one’s behavior by presenting reasons that sound logical.
Option D: Projection is attributing of one’s behaviors and feelings to another person.
A client tends to be insensitive to others, engages in abusive behaviors and does not have a sense of remorse. Which personality disorder is he likely to have?
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Solution
Antisocial
These are the characteristics of an individual with an antisocial personality.
Option A: Narcissistic personality disorder is characterized by grandiosity and a need for constant admiration from others.
Option B: Individuals with paranoid personality demonstrate a pattern of distrust and suspiciousness and interprets others motives as threatening.
Option C: Individuals with histrionic have excessive emotionality and attention-seeking behaviors.
Situation: Clients with personality disorders have difficulties in their social and occupational functions.
Clients with a personality disorder will most likely:
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Solution
Manifest enduring patterns of inflexible behaviors
Personality disorders are characterized by inflexible traits and characteristics that are lifelong.
Options A and D. This disorder is manifested by life-long patterns of behavior. The client with this disorder will not likely present himself for treatment unless something has gone wrong in his life so he may not recover from therapeutic intervention.
Option B: Medications are generally not recommended for personality disorders.
The client jumps up and throws a chair out of the window. He was restrained after his behavior can no longer be controlled by the staff. Which of these documentations indicates the safeguarding of the patient’s rights?
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Solution
The staff carried out less restrictive measures but were unsuccessful.
This documentation indicates that the client has been placed in restraints after the least restrictive measures failed in containing the client’s violent behavior.
The nurse exemplifies an awareness of the rights of a client whose anger is escalating by:
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Solution
Taking a directive role in verbalizing feelings
Taking a directive role in the client’s verbalization of feelings can decrease the client’s anger.
Option B: A confrontational approach can be threatening and adds to the client’s tension.
Options C and D: Use of restraints and isolation may be required if less restrictive interventions are unsuccessful.
The charge nurse of a psychiatric unit is planning the client assignment for the day. The most appropriate staff to be assigned to a client with a potential for violence is which of the following:
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Solution
A mature, experienced nurse
The unstable, aggressive client should be assigned to the most experienced nurse.
Options A, C, and D. A shy, inexperienced, soft-spoken nurse may feel intimidated by the angry patient.
The nurse closely observes the client who has been displaying aggressive behavior. The nurse observes that the client’s anger is escalating. Which approach is least helpful for the client at this time?
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Solution
Initiate confinement measures
The proper procedure for dealing with harmful behavior is to first try to calm patient verbally. When verbal and psychopharmacologic interventions are not adequate to handle the aggressiveness, seclusion or restraints may be applicable.
Options A, B and C are appropriate approaches during the escalation phase of aggression.
Situation: Knowledge and skills in the care of violent clients is vital in the psychiatric unit. A nurse observes that a client with a potential for violence is agitated, pacing up and down the hallway and making aggressive remarks. Which of the following statements is most appropriate to make to this patient?
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Solution
What is causing you to become agitated?
In a non-violent aggressive behavior, help the client identify the stressor or the true object of hostility. This helps reveal unresolved issues so that they may be confronted.
Option B: Pacing is a tension relieving measure for an agitated client.
Option C: This is a threatening statement that can heighten the client’s tension.
Option D: Seclusion is used when less restrictive measures have failed.