Age Specific Considerations in Patient 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. In this scenario, the patient's self-injury following the breakup is a maladaptive coping mechanism to deal with emotional distress. Individuals with personality disorders often engage in maladaptive behaviors as a way to cope with overwhelming emotions or stress. This behavior may not be effective or healthy, but it is their attempt to manage their internal struggles.

A: People with personality disorders rarely achieve lasting improvement - This statement is incorrect as individuals with personality disorders can make progress with therapy and support.

C: People with personality disorders are at the mercy of others' actions - This statement is incorrect as individuals with personality disorders have agency over their behaviors, even if they struggle with emotional regulation.

D: What appears to be improvement can be manipulation instead - This statement is incorrect as improvement in behavior should not be automatically attributed to manipulation; it could genuinely reflect progress in coping skills.

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Individuals with Down Syndrome often have moderate to severe intellectual impairment with a measurable IQ usually between:

  • A. 45-50
  • B. 55-60
  • C. 35-55
  • D. 25-35
Correct Answer: C

Rationale: Down Syndrome: A disorder caused by an extra chromosome 21, characterized by intellectual impairment with IQ typically between 35-55.

The psychiatric-mental health nurse, who is teaching a patient's parents how to use positive reinforcement techniques with the patient, recommends:

  • A. agreeing with the child's statements, whether negative or positive, and simply restating the child's statements without other comment
  • B. controlling the child's behavior, so there is no chance of negative behavior
  • C. removing adverse consequences to produce positive results
  • D. rewarding positive behaviors to promote their recurrence
Correct Answer: D

Rationale: Positive reinforcement rewards desired behaviors, increasing their frequency, a core behavioral strategy.

When thinking about alcohol and drug abuse the clinical officer should be aware that

  • A. Most alcoholics become poly drug abusers
  • B. Addictive individuals tend to use hostile, abusive behavior
  • C. An unhappy childhood is a causative factor in many addictions
  • D. Most poly drug abusers also abuse alcohol
Correct Answer: D

Rationale: Most poly drug abusers also abuse alcohol, as it is a commonly available and socially accepted substance often combined with other drugs.

A teacher comes to the mental health clinic saying a co-worker recently confronted her about behaviors that are annoying to other co-workers. She is now experiencing moderate to severe levels of anxiety. The co-worker told the patient that others find her very difficult because she is a perfectionist and micromanages the tasks of others on the teaching team, always demanding that things should be done according to her plans. The co-worker mentioned that the patient made everyone feel as though everything they tried was inadequate, and they feel frustrated and angry. The patient states she likes her co-workers and only wanted to help them be successful. The nurse realizes the patient's behaviors are most consistent with:

  • A. obsessive-compulsive personality disorder.
  • B. narcissistic personality disorder.
  • C. histrionic personality disorder.
  • D. schizoid personality disorder.
Correct Answer: A

Rationale: The correct answer is A: obsessive-compulsive personality disorder. This is because the patient's behaviors of being a perfectionist, micromanaging tasks, demanding things be done according to her plans, and making others feel inadequate align with the diagnostic criteria for obsessive-compulsive personality disorder. Individuals with this disorder are preoccupied with orderliness, perfectionism, and control.

Choice B: narcissistic personality disorder, is incorrect because the patient's behaviors are not characterized by a sense of grandiosity, a lack of empathy, or a need for admiration, which are hallmark features of narcissistic personality disorder.

Choice C: histrionic personality disorder, is incorrect as individuals with this disorder typically display attention-seeking behavior, emotional instability, and excessive emotionality, none of which are evident in the patient's presentation.

Choice D: schizoid personality disorder, is incorrect as individuals with this disorder tend to be socially detached, have limited emotional expression, and prefer solitary activities, which do not align with the

The experienced nurse assessing a battered woman client uses many open-ended questions during the interview. The rationale for this is that:

  • A. The woman will feel more in charge of the interview
  • B. Such questions allow for simple yes or no answers when the client is upset
  • C. The questions are direct and easily understood by anxious individuals
  • D. Clients can refuse to answer when sensitive information is being probed
Correct Answer: A

Rationale: The correct answer is A because using open-ended questions allows the client to express themselves freely, promoting a sense of control and empowerment. This approach helps build trust and rapport, enabling the client to share their experiences more openly. Choice B is incorrect because closed-ended questions limit the client's ability to fully express themselves. Choice C is incorrect as open-ended questions encourage deeper reflection and discussion, which may not be easily understood by anxious individuals. Choice D is incorrect because while clients can refuse to answer sensitive questions, open-ended questions actually encourage them to share more, rather than withhold information.

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