A nurse is reviewing the medical record of a young adult client who has a new diagnosis of borderline personality disorder. Which of the following findings should the nurse identify as risk factors for this disorder? (Select all that apply.)

The client follows a strict routine of daily activities.

The client reports having a substance use disorder.

The client is a twin

The client's mother abandoned him as a child.

The client's father has an impulse control disorder.

Answer and Explanation

Correct Answer : B,D,E

A. The client follows a strict routine of daily activities:
This choice is less likely to be a risk factor for borderline personality disorder. BPD is characterized by impulsivity and difficulties in maintaining stable routines or relationships. Individuals with BPD often struggle with adhering to strict routines due to impulsive behaviors and emotional dysregulation.

B. The client reports having a substance use disorder:
Individuals with borderline personality disorder often struggle with impulse control and emotional regulation. Substance use can be a way for them to cope with intense emotions and mood swings. The presence of a substance use disorder can indicate a higher risk for borderline personality disorder due to these coping mechanisms.

C. The client is a twin:
Being a twin, in itself, is not a direct risk factor for borderline personality disorder. However, if there are genetic or environmental factors contributing to the disorder, both twins might be at risk due to shared genetic material and upbringing. It's essential to consider the specific familial and environmental context when assessing the risk in twins.

D. The client's mother abandoned him as a child:
Early childhood experiences play a significant role in the development of personality disorders, including borderline personality disorder. Abandonment, neglect, or other forms of trauma can disrupt a child's sense of security and trust, leading to difficulties in regulating emotions and forming stable relationships later in life.

E. The client's father has an impulse control disorder:
Growing up in an environment where a parent has an impulse control disorder can create an unstable living situation. Inconsistent parenting and unpredictable behaviors can contribute to emotional instability and difficulties in regulating impulses, which are hallmark features of borderline personality disorder.

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Correct Answer is C

Explanation

A. Long-term isolation: Long-term isolation, or social isolation, can lead to feelings of loneliness and depression. While prolonged isolation can contribute to mental health issues, it is not a direct risk factor for violent behavior. People who are socially isolated might suffer from emotional distress, but it doesn't necessarily make them violent.

B. Dysthymic disorder: Dysthymic disorder, also known as persistent depressive disorder, is a type of chronic depression. While individuals with dysthymic disorder may experience low moods and a lack of interest in activities, it doesn't inherently make them prone to violence. Depression is more likely to cause self-directed harm (such as self-harm or suicide) rather than violent behavior towards others.

C. Alcohol intoxication: Alcohol is a substance that impairs judgment and reduces inhibitions. When a person is intoxicated, they may act aggressively or violently, even in situations where they wouldn't normally do so. Alcohol intoxication can lead to a loss of control, impaired decision-making, and aggressive behavior, making it a significant risk factor for violent actions.

D. Schizoid personality disorder: Schizoid personality disorder is characterized by a lack of interest in social relationships, emotional coldness, and detachment. While individuals with this disorder may prefer to be alone and avoid social interactions, they are not necessarily prone to violent behavior. Schizoid personality disorder primarily affects social functioning rather than predisposing someone to violence.

A. The nurse maintains confidentiality unless the client's safety is compromised. B. The nurse seeks to spend extra time specifically with the client each day. C. The client sees the nurse as an authority figure. D. The client regards the nurse as a friend.

Correct Answer is A

Explanation

A. The nurse maintains confidentiality unless the client's safety is compromised:
Explanation: Maintaining confidentiality is a fundamental principle in nursing practice. Nurses are ethically and legally obligated to keep client information confidential, ensuring that the client's privacy is respected. Confidentiality builds trust between the nurse and the client, encouraging open communication. However, confidentiality can be breached if the client's safety is at risk, such as if they express suicidal or homicidal thoughts, indicating the need for intervention to ensure their well-being.

B. The nurse seeks to spend extra time specifically with the client each day:
Explanation: While it's important for nurses to spend adequate time with each client, seeking to spend extra time specifically with one client may create imbalances in care distribution. Nurses should strive to provide equitable care to all clients, addressing their needs based on assessments and care plans. Special attention to one client could lead to feelings of favoritism or neglect among other clients, affecting the therapeutic environment.

C. The client sees the nurse as an authority figure:
Explanation: Clients often view nurses as authority figures due to their expertise and role in healthcare. This perception can facilitate a therapeutic relationship, as clients may trust the nurse's guidance and care. However, this should be balanced with empathy and understanding to create a supportive and therapeutic environment.

D. The client regards the nurse as a friend:
Explanation: While a therapeutic nurse-client relationship aims for trust and rapport, it is not a friendship. The nurse maintains professional boundaries to provide objective care without personal bias. Friendship implies a level of personal involvement that can compromise the nurse's ability to make objective clinical decisions. A therapeutic relationship is built on trust, respect, empathy, and clear professional boundaries.

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A nurse is reviewing the medical record of a young adult client who has a new diagnosis of borderline personality disorder. Which of the following findings should the nurse identify as risk factors for this disorder? (Select all that apply.)

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