The nurse is talking with a client that grew up in a home where both parents were alcoholics. Which behavior(s) does the nurse identify when assessing this client that correlate with this home life? (Select all that apply)

Choice A reason: Stating that depressive disorders are the 4th leading cause of years lost due to disability is factually inaccurate. According to the World Health Organization (WHO) and the Global Burden of Disease data, major depressive disorder is 1 of the leading contributors to disability worldwide and is ranked among the top causes of years lived with disability (YLD), not merely the 4th. Some data rank it as the single leading cause of disability globally when measured in YLD. Presenting it as the 4th leading cause misrepresents its global public health significance and would therefore not constitute a true statement for nursing education purposes.

Choice B reason: The monoamine hypothesis of depression, which implicates dysregulation of the neurotransmitters norepinephrine, dopamine, and serotonin in the pathophysiology of depressive disorders, is a well-established and widely accepted neuroscientific framework. Evidence supporting this hypothesis comes from multiple sources, including the clinical efficacy of pharmacological agents that enhance monoaminergic neurotransmission, such as SSRIs, SNRIs, MAOIs, and tricyclic antidepressants, as well as neurobiological research demonstrating altered monoamine receptor density and function in individuals with depression. While the monoamine hypothesis has been refined and expanded to include neuroendocrine, neuroplasticity, and inflammatory mechanisms, the fundamental role of these 3 neurotransmitters remains an established and clinically relevant true statement.

Choice C reason: The assertion that depression in older adults is easier to diagnose is factually incorrect. Depression in geriatric populations is notoriously difficult to diagnose for multiple reasons: older adults often present with atypical symptoms such as somatic complaints, cognitive impairment (depressive pseudodementia), anhedonia rather than overt sadness, and medical comorbidities that mask or mimic depressive features. Additionally, both patients and providers may attribute depressive symptoms to normal aging. Depression in older adults is frequently underdiagnosed and undertreated due to these diagnostic challenges, making this statement demonstrably false and clinically misleading.

Choice D reason: The assertion that depressive disorders are more prevalent in males than females contradicts robust epidemiological evidence. Consistently across cross-cultural, national, and international studies, major depressive disorder and dysthymic disorder are approximately 2 times more prevalent in females than in males throughout the lifespan, particularly from adolescence through menopause. Hormonal factors, including estrogen and progesterone fluctuations, as well as psychosocial contributors such as higher rates of trauma exposure and socioeconomic disadvantage, are implicated in the higher female prevalence. Stating that depression is more prevalent in males is factually inaccurate and inconsistent with global epidemiological data.

Choice A reason: The statement "I just don't trust anyone and I don't believe what my partner tells me" reflects pervasive suspiciousness and interpersonal mistrust, which are the defining characteristics of paranoid personality disorder, not narcissistic personality disorder. Paranoid personality disorder is categorized under Cluster A and involves a pervasive pattern of unwarranted suspicion, hypervigilance, and misinterpretation of others' motives as malevolent. While narcissistic clients may exhibit some distrust in specific contexts, the global pervasive suspiciousness described in this statement is not consistent with the core diagnostic criteria of narcissistic personality disorder.

Choice B reason: The statement "My partner says I am too dependent and can do anything for myself" reflects excessive reliance on others and difficulty functioning independently, which are the core features of dependent personality disorder (DPD). DPD is a Cluster C disorder characterized by pervasive and excessive psychological dependence on others, difficulty making decisions without reassurance, submissive behavior, and intense fear of separation. This client statement points toward dependency and inadequacy in self-management rather than grandiosity or entitlement, clearly differentiating it from the core features of narcissistic personality disorder.

Choice C reason: The statement "My partner says I care for others more than I care for them" suggests altruism and other-centeredness, which are characteristics inconsistent with narcissistic personality disorder. NPD is defined in part by a marked lack of empathy and a pattern of exploiting others for personal gain. A client with NPD would be unlikely to be perceived by a partner as excessively caring for others. This statement more closely reflects attributes that might be associated with codependent behavior or, paradoxically, with manipulative self-presentation aimed at appearing selfless, but it does not reflect the grandiosity and entitlement central to NPD.

Choice D reason: The statement "I won't be alone long; everyone wants to be with me because I am beautiful" is a direct and textbook manifestation of the grandiosity, sense of entitlement, and inflated self-importance that define narcissistic personality disorder. This statement reflects the client's belief in their own special attractiveness and desirability, an expectation that others will pursue them based on their perceived superiority, and an absence of distress about the loss of the relationship because of an entrenched belief in their own exceptional worth. This attitude reflects the NPD core feature of grandiose self-image and is highly consistent with the relationship problems that arise due to entitlement and lack of empathy in NPD clients.