Population Specific Care

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A patient with borderline personality disorder has been making steady progress but one day gets a phone call from her boyfriend, who breaks off their relationship. Although she has not self-injured in over 2 months, she makes repeated lacerations on her forearm. Which statement about this and most maladaptive behaviors seen in personality disorders is most accurate?

  • A. People with personality disorders rarely achieve lasting improvement.
  • B. However dysfunctional, most behavior is the person's best effort to cope.
  • C. People with personality disorders are at the mercy of others' actions.
  • D. What appears to be improvement can be manipulation instead.
Correct Answer: B

Rationale: The correct answer is B: However dysfunctional, most behavior is the person's best effort to cope.

Rationale:
1. People with borderline personality disorder often struggle with intense emotions and unstable relationships.
2. Self-injury is a maladaptive coping mechanism used to manage overwhelming emotions or distress.
3. In this scenario, the patient resorts to self-injury as a coping strategy after the breakup triggers intense emotional pain.
4. Despite being maladaptive, the behavior serves as a coping mechanism to regulate emotions.
5. Understanding that maladaptive behaviors are often the individual's best attempt to cope helps in providing non-judgmental support and promoting healthier coping strategies.

Summary:
A: Incorrect. People with personality disorders can make progress with appropriate treatment and support.
C: Incorrect. While external factors may trigger behaviors, individuals with personality disorders have agency in their actions.
D: Incorrect. Improvement in behavior should not always be viewed as manipulation; it can indicate genuine progress in coping skills.

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State four (4) negative symptoms of schizophrenia

  • A. Apathy
  • B. Social withdrawal
  • C. Blunted affect
  • D. Poverty of speech
Correct Answer: A

Rationale: Negative symptoms involve diminished function, such as lack of emotion, isolation, flat affect, and reduced verbal output.

A catatonic patient admitted in a stuporous condition begins to demonstrate increased motor activity. During his assessment, the psychiatrist raises the patient's arm above his head and releases it. The patient maintains the position his arm was placed in, immobile in that position for 15 minutes, moving only when the nurse gently lowers his arm. What symptom is demonstrated by this assessment technique?

  • A. Echopraxia
  • B. Waxy flexibility
  • C. Depersonalization
  • D. Thought withdrawal
Correct Answer: B

Rationale: The correct answer is B: Waxy flexibility. This symptom is demonstrated by the patient's ability to maintain the position his arm was placed in, immobile, for an extended period of time. This is characteristic of catatonia, where individuals exhibit increased motor activity and abnormal posturing. Waxy flexibility refers to the tendency of catatonic patients to maintain positions that they are placed in by others, almost as if their limbs are made of wax and can be molded into different positions.

Explanation for other choices:
A: Echopraxia involves mimicking the movements of others, which is not demonstrated in this scenario.
C: Depersonalization refers to feeling detached from oneself, which is not evident in the patient's behavior during the assessment.
D: Thought withdrawal is a symptom of schizophrenia where thoughts are believed to be removed from one's mind by an external force, which is not relevant to the patient's motor behavior in this case.

A widow, aged 72 years, lives alone and is visited weekly by her son. She takes digoxin, hydrochlorothiazide, and an antihypertensive drug. She also has a prescription for diazepam (Valium) as needed for moderate to severe anxiety. When the son visited today, he found his mother confused and disoriented, with an unsteady gait. The nurse assessed the patient as having several cognitive problems, including memory and attention deficits and fluctuating levels of orientation. The nurse confirms that the patient's symptoms developed:

  • A. Over the past few days.
  • B. Over the past few weeks.
  • C. Over the past few months.
  • D. None of the above.
Correct Answer: A

Rationale: The correct answer is A: Over the past few days. The sudden onset of confusion, disorientation, and cognitive deficits in the elderly patient suggests an acute change in her condition. This acute change is more indicative of a recent event or medication-related issue rather than a gradual decline over weeks or months. The sudden onset could be due to factors such as medication interactions, overdose, or underlying medical conditions. It is crucial to investigate recent changes in medications, lab results, or any other potential triggers that might have led to this acute cognitive decline. Choices B, C, and D are incorrect because they imply a gradual decline over weeks, months, or no specific timeframe, which does not align with the sudden onset observed in the patient.

Which of the following are considered red flags for a communication disorder?

  • A. Speech onset at 24 months, lack of pointing to indicate needs, and poor eye contact
  • B. Short attention, odd intonation of speech, and poor pretend play
  • C. Lack of pointing to show interests or needs, poor eye contact, and reduced joint attention
  • D. Weak vocabulary, reduced joint attention, and poor interaction with peers
Correct Answer: C

Rationale: Red flags for communication disorders include lack of pointing to show interests/needs, poor eye contact, and reduced joint attention, as these indicate deficits in social communication, per developmental guidelines.

A history reveals that a patient virtually stopped eating 5 months ago and lost 25% of body weight. The nurse says, "Describe what you think about your present weight and how you look." Which response would be most consistent with anorexia nervosa?

  • A. "I'm fat and ugly."
  • B. "What I think about myself is my business."
  • C. "I'm grossly underweight, but I cover it well."
  • D. "I'm a few pounds overweight, but I can live with it."
Correct Answer: A

Rationale: The correct answer is A because the response indicates a distorted body image, a common characteristic of anorexia nervosa. Anorexia nervosa is characterized by an intense fear of gaining weight and a distorted perception of body image, leading individuals to see themselves as overweight despite being underweight. In this case, the patient's response of "I'm fat and ugly" demonstrates a negative perception of their weight and appearance, which aligns with the distorted body image seen in anorexia nervosa.

Choices B, C, and D are incorrect:
B: "What I think about myself is my business" - This response does not indicate a distorted body image or negative perception of weight and appearance, which are key features of anorexia nervosa.
C: "I'm grossly underweight, but I cover it well" - While this response acknowledges being underweight, it does not reflect the distorted body image commonly seen in anorexia nervosa.
D: "I'm a

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