Nokea
A patient with borderline personality disorder cut her wrists while out on a pass. For future planning, staff should consider that the reason for the self-mutilation is probably related to:
- A. an inherited disorder that manifests itself as an incapacity to tolerate stress.
- B. fear of abandonment associated with relationships or increasing autonomy.
- C. use of projective identification and splitting to bring anxiety to manageable levels.
- D. a constitutional inability to regulate affect, predisposing to psychic disorganization.
Correct Answer: B
Rationale: Correct Answer: B
Rationale:
1. Borderline personality disorder is characterized by fear of abandonment.
2. Self-mutilation can be a maladaptive coping mechanism to alleviate this fear.
3. The behavior is often triggered by perceived threats to relationships or autonomy.
4. Therefore, considering fear of abandonment in future planning is crucial.
Summary of other choices:
A: Inherited disorder is not the primary reason for self-mutilation in borderline personality disorder.
C: Projective identification and splitting are defense mechanisms, not primary reasons for self-mutilation.
D: Constitutional inability to regulate affect may contribute, but fear of abandonment is more central in borderline personality disorder.
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A salesman has had difficulty holding a job because he accuses co-workers of conspiring to take his sales. Today, he argued with several office mates and threatened to kill one of them. The police were called, and he was brought to the mental health center for evaluation. He has had previous admissions to the unit for stabilization of paranoid schizophrenia. When the nurse meets him, he points at staff in the nursing station and states loudly, 'They're all plotting to destroy me. Isn't that true?' Which would be the most appropriate response?
- A. No, that is not true. People here are trying to help you if you will let them.'
- B. Let's think about it: what reason would people have to want to destroy you?'
- C. Thinking that people want to destroy you must be very frightening.'
- D. That doesn't make sense; staff are health care workers, not murderers.'
Correct Answer: C
Rationale: The correct answer is C because it demonstrates empathy and validates the patient's feelings without agreeing with the delusion. By acknowledging the patient's fear, the nurse can establish trust and rapport, which are crucial in therapeutic communication. This response shows understanding and compassion, helping to de-escalate the situation and provide a supportive environment for the patient.
Choice A is incorrect as it denies the patient's belief and may lead to increased agitation. Choice B is incorrect as it challenges the patient's delusion, which can worsen the situation and lead to further confrontation. Choice D is incorrect as it dismisses the patient's feelings and may cause the patient to become defensive or feel misunderstood.
A client with moderate to severe dementia does not remember her son's name. The son repeatedly questions the mother when he visits the dementia facility, asking, 'Do you know my name?' The mother invariably becomes agitated. The nurse can most effectively intervene by explaining to the son:
- A. Your mother is angry with you and is punishing you by 'forgetting' who you are. Be patient and she'll get over it.'
- B. I know it is difficult for you, but your mother's dementia is severe and she cannot retain information even for short periods of time. She senses your distress and becomes agitated.'
- C. Although it's a strain for you, you will need to reorient your mother as often as you can, during the time you are with her. With repetition, she may be able to understand and recall what you are saying.'
- D. Because you become so distressed, it might be better if you come to see your mother only once a week and stay for only a short time.'
Correct Answer: B
Rationale: Rationale:
1. Correct Answer (B): Explains the son's mother's inability to retain information due to severe dementia, causing agitation. Validates son's feelings and provides insight into the mother's behavior.
2. Incorrect Answer (A): Falsely suggests the mother is punishing the son by forgetting, potentially causing misunderstanding and blame.
3. Incorrect Answer (C): Implies the son should solely focus on reorienting the mother, overlooking the emotional impact and distress caused by repetitive questioning.
4. Incorrect Answer (D): Suggests limiting visits based on the son's distress, rather than addressing the root cause of agitation caused by the mother's dementia.
A patient who has been taking fluoxetine (Prozac) 60 mg daily for the past 6 months tells the nurse at the medication follow-up clinic that he is considering stopping the Prozac. He states his mood is fine, and now that he is living normally, his wife is concerned that he has no sex drive. Which response would be best?
- A. Without the medicine the depression will likely return; you and your wife will need to adjust to the sexual side effects.
- B. If we switch your medication time to the morning, the sexual side effects will be worn off in time for evening sexual activity.
- C. The problem is not likely due to the medicine. Often the depression itself, even after it improves, continues to dampen sex drive.
- D. Without an antidepressant, the depression is more likely to reoccur, but there are other medications that do not interfere so much with sex.
Correct Answer: D
Rationale: Step-by-step rationale for why answer D is correct:
1. Correctly acknowledges the patient's concern about sexual side effects.
2. Highlights the importance of managing depression to prevent recurrence.
3. Offers a solution by mentioning alternative medications with less impact on sex drive.
4. Empowers the patient by providing information and options for treatment.
5. Addresses both the patient's current situation and long-term mental health needs.
Summary of why other choices are incorrect:
A: Overlooks the patient's valid concern about sexual side effects and lacks a proactive solution.
B: Focuses on timing of medication without addressing the underlying issue of sexual side effects.
C: Dismisses the patient's concern and fails to provide a solution or alternative options.
Sensory experiences that occur in the absence of a stimulus are called
- A. illusions
- B. hallucinations
- C. delusions
- D. affect episodes
Correct Answer: B
Rationale: Hallucinations are perceptions without stimuli, distinct from illusions (misinterpretations).
Which of the following procedures can be used to identify Down Syndrome pre-natally?
- A. Amniocentesis
- B. Amnioprolaxis
- C. Amniophalaxi
- D. Amniocalesis
Correct Answer: A
Rationale: Amniocentesis: A procedure extracting and analyzing amniotic fluid to identify Down Syndrome pre-natally in high-risk parents.