A nurse is admitting a client who has borderline personality disorder and is at risk for self-mutilation. Which of the following interventions should the nurse incorporate in the plan of care?

Provide additional attention to the client.

Apply mechanical restraints before administering medication.

Obtain a verbal contract from the client.

Limit staff members who work with the client.

Answer and Explanation

The Correct Answer is C

Choice A reason: Providing additional attention to the client can sometimes reinforce negative behaviors in individuals with borderline personality disorder. It is important to balance attention with promoting independence and self-regulation.

Choice B reason: Applying mechanical restraints before administering medication is not a standard practice and can be considered unethical and harmful. Restraints should only be used as a last resort when there is an immediate risk of harm to the client or others.

Choice C reason: Obtaining a verbal contract from the client is a therapeutic intervention that can help manage self-mutilation risks. This contract involves the client agreeing to communicate with staff before engaging in self-harm, which can help in developing trust and promoting safety.

Choice D reason: Limiting staff members who work with the client can help provide consistency and stability, which is beneficial for individuals with borderline personality disorder. However, it is not the primary intervention for preventing self-mutilation.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is A

Explanation

Choice A reason:

An unintentional tort occurs when a healthcare provider’s actions or inactions cause harm to a patient without intent to harm. In this scenario, the nurse’s failure to clarify a difficult-to-read prescription, resulting in a medication error, is an example of negligence, which is an unintentional tort.

Choice B reason:

Posting private information about a client on social media is a breach of confidentiality and an intentional tort. This action is deliberate and violates the client’s right to privacy.

Choice C reason:

Placing a client in mechanical restraints without obtaining a prescription, resulting in injury, is an intentional tort. This action involves a deliberate decision to restrain the client without proper authorization, leading to harm.

Choice D reason:

Threatening a client with physical harm is an example of assault, which is an intentional tort. This involves a deliberate act to cause the client to fear imminent harm.

A. Illusion B. Hallucination C. Attention-seeking behavior D. Self-mutilation

Correct Answer is D

Explanation

Choice A reason:

An illusion is a misinterpretation of a real external stimulus. The client’s statement does not indicate a misinterpretation of reality but rather a direct expression of intent to harm themselves.

Choice B reason:

A hallucination is a perception of something that is not present, such as hearing voices or seeing things that are not there. The client’s statement does not suggest they are experiencing a hallucination but rather expressing a desire to self-harm.

Choice C reason:

Attention-seeking behavior involves actions taken to gain attention from others. While the client’s statement may draw attention, it is more indicative of a serious risk of self-harm rather than merely seeking attention.

Choice D reason:

Self-mutilation refers to deliberate self-injury without suicidal intent. The client’s statement about using a pen to cut the pain out of their chest indicates a risk of self-harm, which requires immediate intervention to ensure their safety.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse is admitting a client who has borderline personality disorder and is at risk for self-mutilation. Which of the following interventions should the nurse incorporate in the plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A charge nurse is planning an in-service for newly licensed nurses on tort law in mental health care. Which of the following scenarios should the charge nurse provide as an example of an unintentional tort?

Correct Answer is A

Explanation

A nurse is caring for a client who has bipolar disorder. The client says to the nurse, “Give me your pen to cut the pain out of my chest.” The nurse should identify that the client is at risk for which of the following?

Correct Answer is D

Explanation

A nurse is caring for a client who has a history of suicide attempts. Which of the following findings places the client at risk for another suicide attempt? (Select all that apply.)

A nurse is admitting a client who has borderline personality disorder and is at risk for self-mutilation. Which of the following interventions should the nurse incorporate in the plan of care?

A nurse is providing teaching to the caretakers of a client who has Alzheimer’s disease with mild cognitive decline. The client is beginning to experience sleep disturbances. Which of the following instructions should the nurse include?

A nurse is preparing to teach a client who has major depressive disorder and is scheduled to undergo electroconvulsive therapy (ECT). Which of the following statements should the nurse include in the teaching?

A home health nurse is caring for a client who reports feeling tired and being unable to grocery shop. Which of the following responses by the nurse is an example of therapeutic communication?

A charge nurse is providing education to a group of newly licensed nurses about the rights of clients who are involuntarily admitted. Which of the following responses indicates understanding of the teaching?

A nurse is caring for a client who exhibits excessive attention-seeking behaviors, including acting flirtatious and seductive. The nurse should identify these behaviors as manifestations of which of the following personality disorders?

A nurse in an urgent-care clinic is caring for a school-age child who has several visible bruises. The child’s parent states, “My partner got fired today and came home angry. I don’t think this will happen again.” Which of the following responses should the nurse make?