Age Specific Care Competency

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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 client has been admitted with disorganized type schizophrenia. The nurse observes blunted affect and social isolation. The client occasionally curses or calls another client a 'jerk' without provocation. The nurse asks the client how he is feeling, and he responds, 'Everybody picks on me. They frobitz me.' The best response for the nurse to make would be:

  • A. That's really too bad.'
  • B. Who do you mean when you say 'everybody'?'
  • C. What difference does frobitzing make?'
  • D. Why do they frobitz?'
Correct Answer: B

Rationale: The correct answer is B: "Who do you mean when you say 'everybody'?" This response is the best because it acknowledges the client's feelings and seeks clarification. By asking for specifics, the nurse can gain a better understanding of the client's perceptions and experiences, which can help in providing appropriate care and support.

Choice A: "That's really too bad." This response lacks empathy and does not address the client's concerns directly.

Choice C: "What difference does frobitzing make?" This response is dismissive and does not focus on the client's feelings or experiences.

Choice D: "Why do they frobitz?" This response is confrontational and may make the client feel defensive, hindering effective communication and rapport-building.

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).

In most anxiety disorders, the person's distress is

  • A. focused on a specific situation
  • B. related to ordinary life stresses
  • C. greatly out of proportion to the situation
  • D. based on a physical cause
Correct Answer: C

Rationale: Anxiety disorders feature exaggerated distress disproportionate to the trigger, unlike normal stress.

A nurse is caring for a patient diagnosed with anorexia nervosa. What is the most important intervention during the refeeding phase?

  • A. Monitor weight gain and provide a structured meal plan.
  • B. Encourage the patient to eat independently without supervision.
  • C. Focus on psychological therapy to address emotional issues.
  • D. Offer the patient high-calorie, high-fat foods to increase intake.
Correct Answer: A

Rationale: The correct answer is A because during the refeeding phase of anorexia nervosa, monitoring weight gain and providing a structured meal plan are crucial to prevent refeeding syndrome and ensure a safe and gradual increase in caloric intake. This approach helps prevent complications such as electrolyte imbalances and organ dysfunction. Encouraging the patient to eat independently without supervision (B) can be harmful as they may not consume adequate or balanced nutrition. Psychological therapy (C) is important but not the most crucial during the refeeding phase. Offering high-calorie, high-fat foods (D) can lead to rapid weight gain and further complications.

An elderly patient with dementia paces the hallway and often engages in wandering. The nurse documents that the patient is exhibiting which type of behavior that is characteristic of dementia?

  • A. Passive behavior
  • B. Functionally impaired behavior
  • C. Involuntary psychomotor behavior
  • D. Nonaggressive psychomotor behavior
Correct Answer: D

Rationale: The correct answer is D: Nonaggressive psychomotor behavior. In dementia, wandering and pacing are common behaviors due to cognitive impairment. Nonaggressive behavior refers to actions that do not involve harm or aggression towards others. The patient's behavior is voluntary and purposeless, indicating psychomotor involvement. Choices A, B, and C do not accurately describe the behavior exhibited by the patient with dementia. Passive behavior implies lack of engagement, functionally impaired behavior suggests difficulty performing activities of daily living, and involuntary psychomotor behavior implies actions beyond the patient's control, which are not the case in this scenario.

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