A nurse is reinforcing discharge teaching with a client who has borderline personality disorder. The client reports being a single parent caring for two toddlers. Which of the following actions should the nurse take?

A. School-age: Schizophrenia is rare in children, and early-onset cases before adolescence are uncommon. Symptoms that resemble schizophrenia in children often require further evaluation for other neurodevelopmental disorders.
B. Young adulthood: Schizophrenia typically manifests between late adolescence and early adulthood, usually between ages 18 and 25 in men and slightly later in women. This period is when individuals experience their first psychotic episode.
C. Preschooler: Schizophrenia is extremely rare in preschool-aged children. Symptoms such as hallucinations or disorganized behavior at this age are more likely related to other developmental disorders or trauma.
D. Older adulthood: Late-onset schizophrenia is rare, and when psychotic symptoms emerge in older adults, they are often due to conditions such as dementia, delirium, or medication effects rather than primary schizophrenia.

A. Increased cheerfulness, increased energy, helping other nurses on the shift. While mood changes can sometimes indicate a problem, increased cheerfulness and willingness to help others are not specific red flags for substance use disorder. Substance use is more commonly associated with erratic behavior, frequent absences, or medication discrepancies.
B. Increased irritability towards supervisors, outspokenness regarding work issues, increased attendance at staff meetings. Frustration with workplace issues and increased engagement in staff meetings do not necessarily indicate substance use disorder. Behavioral concerns related to substance use often include impaired judgment, frequent errors, or missing narcotics.
C. Volunteering for overtime on a continual basis, avoiding having a witness to wasting narcotics, needing to be alone in the medication room when preparing medications. Consistently seeking extra shifts, avoiding witnesses when handling narcotics, and needing to be alone while preparing medications suggest possible drug diversion. These behaviors align with common patterns seen in healthcare professionals struggling with substance use disorders.
D. Crying, sharing personal details of relationship problems, monopolizing conversations. Emotional distress and oversharing personal issues may indicate stress or burnout rather than substance use disorder. Substance use concerns are more closely tied to inconsistent work performance, medication discrepancies, and altered behavior related to drug access.