Mr Olsen, age 75 years, lives in a nursing home and diagnosed with mild dementia. Occasionally he attempts to get out of bed during the night and is a risk tor falls. What nursing intervention should the practical nurse use to ensure his safety?

Reasoning:

Choice A reason: While voluntary patients have the right to request discharge, this response is premature and ignores the nurse's responsibility to assess the patient's safety. Simply allowing them to leave without a formal process or assessment could lead to self-harm or neglect of necessary psychiatric stabilization.

Choice B reason: This statement is technically inaccurate and paternalistic. In most jurisdictions, a voluntary patient has a legal right to request release forms and initiate the discharge process. The nurse cannot unilaterally block access to these forms based solely on the absence of a doctor’s prior permission.

Choice C reason: This response is too passive and fails to perform a necessary clinical assessment. Before initiating discharge paperwork, the nurse must engage the patient to determine if they are experiencing an acute crisis, a change in mental status, or if they pose a danger to themselves or others.

Choice D reason: This is the best response because it acknowledges the patient's legal right to the forms while fulfilling the nurse's clinical role. It allows for a therapeutic dialogue to explore the patient's reasons for leaving, evaluate their current mental status, and ensure they are safe for discharge.

Reasoning:

Choice A reason: Borderline Personality Disorder is characterized by a pervasive pattern of instability in interpersonal relationships, self-image, and affect. Affective instability, or emotional dysregulation, leads to rapid shifts in mood and "splitting," where others are viewed as either all good or all bad, creating the chaotic relational patterns described in the clinical assessment.

Choice B reason: Avoidant personality disorder involves a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. These individuals typically avoid relationships due to fear of rejection or criticism, rather than engaging in the intense, volatile, and chaotic interpersonal dynamics seen in Cluster B disorders like Borderline Personality Disorder.

Choice C reason: Histrionic personality disorder is marked by excessive emotionality and attention-seeking behavior. While these individuals may have dramatic or shallow relationships, the specific hallmark of "affective instability" paired with "chaotic" and "intense" relationships is more scientifically aligned with the diagnostic criteria for Borderline Personality Disorder according to the DSM-5-TR.

Choice D reason: Antisocial personality disorder is characterized by a disregard for and violation of the rights of others, often involving deceit and lack of remorse. While their relationships are certainly problematic and often exploitative, they do not typically stem from the profound affective instability and fear of abandonment seen in borderline pathology.