A nurse on a mental health unit is caring for a client.

Exhibits

The nurse is contributing to the plan of care for the client. Which of the following actions should the nurse recommend? (Select all that apply.)

Establish consequences for unacceptable behaviors.

Encourage the client to verbalize their feelings.

Provide clear boundaries for behavior toward peers and staff members.

Determine if the client is having thoughts of harming themselves or others.

Bargain with the client when setting behavioral expectations.

Instruct the client on coping mechanisms and relaxation techniques.

Answer and Explanation

Correct Answer : A,B,C,D,F

A. Establish consequences for unacceptable behaviors: This approach helps the client understand the impact of their actions and encourages accountability, which is important for behavior management in borderline personality disorder.
B. Encourage the client to verbalize their feelings: Encouraging the expression of feelings helps the client develop better emotional awareness and communication skills, which are essential for managing their emotions and interpersonal relationships.
C. Provide clear boundaries for behavior toward peers and staff members: Setting clear boundaries is crucial for maintaining a safe environment and helps the client understand acceptable behavior, promoting healthier interactions with others.
D. Determine if the client is having thoughts of harming themselves or others: Regular assessment of self-harm and harm to others is essential, especially given the client's history of self-injury and a recent suicide attempt. This ensures the client's safety and allows for timely intervention if needed.
E. Instruct the client on coping mechanisms and relaxation techniques: Teaching coping strategies and relaxation techniques equips the client with tools to manage anxiety and emotional distress, which are common in borderline personality disorder.
F. Bargain with the client when setting behavioral expectations: Bargaining may reinforce manipulative behaviors and does not provide the structure that clients with borderline personality disorder often need. Instead, establishing firm and consistent expectations without negotiation is more beneficial for their treatment.

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Correct Answer is C

Explanation

A. To ensure the client participates in a walk with staff on a daily basis: While regular physical activity can be beneficial, this goal focuses more on physical activity rather than addressing the underlying issues related to medication adherence and relapse prevention.
B. To keep the client's environment calm and with minimal daily stimuli: Creating a calm environment can help manage symptoms, but it is a more immediate concern rather than a long-term goal focused on the client's overall management and understanding of their condition.
C. To develop and acknowledge understanding of a relapse plan prior to discharge: This goal is crucial for the client's long-term recovery and management of their condition. By understanding their relapse plan, the client can identify triggers, recognize early warning signs of relapse, and engage in proactive strategies to maintain their mental health after discharge.
D. To be reoriented to their current environment as needed: While reorientation may be necessary for managing acute symptoms, it does not address long-term strategies for preventing relapse or promoting the client's overall well-being. This goal is more focused on immediate needs rather than long-term outcomes.

A. Antisocial personality disorder B. Schizotypal personality disorder C. Narcissistic personality disorder D. Histrionic personality disorder

Correct Answer is A

Explanation

A. Antisocial personality disorder: This disorder is characterized by a disregard for societal rules and the rights of others. Clients with antisocial personality disorder may refuse to follow instructions and demonstrate a lack of respect for rules, indicating a pattern of behavior consistent with this diagnosis.
B. Schizotypal personality disorder: Individuals with schizotypal personality disorder typically exhibit eccentric behaviors, social anxiety, and odd beliefs but are not primarily characterized by a blatant disregard for rules or authority. Their behavior is more focused on social discomfort than defiance of rules.
C. Narcissistic personality disorder: While clients with narcissistic personality disorder may believe they are above the rules and display entitlement, their behavior is often driven by a need for admiration and self-importance rather than outright defiance of rules.
D. Histrionic personality disorder: Individuals with histrionic personality disorder typically seek attention and may be dramatic in their expressions. However, their behaviors are more focused on emotionality and attention-seeking rather than a direct refusal to follow rules or instructions.

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A nurse on a mental health unit is caring for a client. Exhibits The nurse is contributing to the plan of care for the client. Which of the following actions should the nurse recommend? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who was recently re-admitted for relapse of psychosis symptoms due to not taking their medications. Which of the follow should be a long-term goal for this client?

Correct Answer is C

Explanation

A nurse on a mental health unit is caring for a client who refuses to follow instructions and states that the unit rules do not apply to them. The nurse should identify that these findings are manifestations of which of the following personality disorders?

Correct Answer is A

Explanation

A nurse on a mental health unit is assisting with the care of a client. Exhibits The nurse is continuing to assist with the care of the client. Select the four actions the nurse should take.

A nurse is planning care for several clients. The nurse knows that which of the following findings are common in clients who have dependent personality disorder?

A nurse is reviewing the DSM-5 diagnostic criteria for schizophrenia. Which of the following symptoms must be present for a client to be diagnosed with schizophrenia? (Select all that apply).

A nurse is caring for a client who is experiencing manifestations of opiate withdrawal. Which of the following medications should the nurse anticipate the provider to prescribe?

A nurse is discussing borderline personality disorder and the risk for self-harm with a newly licensed nurse. Which of the following situations should the nurse identify as the highest risk for self-harm?

A nurse is meeting with a new client at a substance use disorder clinic. During the meeting, the client states that they have been using cocaine at least once daily for the past 6 months. The nurse is collecting which of the following types of data from the client's account?

A nurse should identify that which of the following factors is a protective factor that prevents adults from developing addictions?

A nurse is caring for a client who has borderline personality disorder. Which of the following defense mechanisms is commonly used by clients who have this disorder and has the potential to create division amongst the healthcare team?

A nurse on a mental health unit is caring for a client.

Exhibits

The nurse is contributing to the plan of care for the client. Which of the following actions should the nurse recommend? (Select all that apply.)