A mental health nurse is reviewing the medical record of a client who self-harms.
Which of the following pieces of information should the nurse identify as placing the client at risk for self-harm behaviors?
The client has a history of bulimia nervosa.
The client has a parent who has dependent personality disorder.
The client recently received a promotion at work.
The client has borderline personality disorder.
The Correct Answer is D
Choice A: History of bulimia nervosa: While eating disorders can be comorbid with self-harm, bulimia nervosa specifically is not a strong independent risk factor for self-harm. The focus of bulimia nervosa lies on purging behaviors to counteract weight gain, and while self-harm can co-occur, it's not directly linked to the core symptoms of the eating disorder.
Choice B: Parent with dependent personality disorder: Personality disorders in family members can create complex family dynamics and contribute to emotional distress, but inheriting a personality disorder is not possible.
Additionally, dependent personality disorder specifically is characterized by excessive reliance on others, not behaviors associated with increased risk for self-harm.
Choice C: Recent promotion at work: Positive life events like a promotion are unlikely to directly increase the risk of self-harm. In fact, achieving goals and milestones can be protective factors for mental health.
Choice D: Borderline personality disorder: Borderline personality disorder (BPD) is a well-established risk factor for self-harm. Individuals with BPD often experience emotional dysregulation, impulsivity, and fear of abandonment, which can lead to self-injurious behaviors as a coping mechanism. The intense emotions and unstable interpersonal relationships associated with BPD make individuals more vulnerable to engaging in self-harm to manage overwhelming distress.
Further Explanation:
BPD is characterized by a pattern of five or more of the following symptoms:
Fear of abandonment: Frantic efforts to avoid real or imagined abandonment.
Unstable relationships: Intense and unstable relationships with a pattern of idealization and devaluation. Identity disturbance: Markedly unstable sense of self-image or self-worth.
Impulsivity: In at least two areas that are potentially damaging (e.g., spending, unsafe sex, substance abuse). Suicidality: Recurrent suicidal threats, gestures, or attempts, or self-mutilating behavior.
Affective instability: Marked mood swings (e.g., intense episodes of anger, dysphoria, anxiety, or despair lasting a few hours and up to a few days).
Chronic emptiness: Feelings of emptiness or boredom.
Dissociation: Transient, stress-related episodes of derealization or depersonalization.
Research indicates that individuals with BPD have a significantly higher risk of self-harm compared to the general population, with estimates ranging from 70% to 90%. This increased risk is attributed to several factors associated with BPD, such as:
Emotional dysregulation: Difficulty managing intense emotions, leading to self-harm as a way to cope with overwhelming distress.
Impulsivity: Engaging in harmful behaviors without considering the consequences, including self-harm.
Fear of abandonment: Self-harm can be used as a way to punish oneself or manipulate others to prevent perceived abandonment.
Negative self-image: Low self-esteem and feelings of worthlessness can contribute to self-harming behaviors as a form of self-punishment.
Conclusion:
While other factors may contribute to self-harm risk, borderline personality disorder remains a significant and well- established risk factor. A mental health nurse reviewing a client's medical record should prioritize identifying BPD as a potential indicator of increased risk for self-harm behaviors.
Choice A: History of bulimia nervosa: While eating disorders can be comorbid with self-harm, bulimia nervosa specifically is not a strong independent risk factor for self-harm. The focus of bulimia nervosa lies on purging behaviors to counteract weight gain, and while self-harm can co-occur, it's not directly linked to the core symptoms of the eating disorder.
Choice B: Parent with dependent personality disorder: Personality disorders in family members can create complex family dynamics and contribute to emotional distress, but inheriting a personality disorder is not possible.
Additionally, dependent personality disorder specifically is characterized by excessive reliance on others, not behaviors associated with increased risk for self-harm.
Choice C: Recent promotion at work: Positive life events like a promotion are unlikely to directly increase the risk of self-harm. In fact, achieving goals and milestones can be protective factors for mental health.
Choice D: Borderline personality disorder: Borderline personality disorder (BPD) is a well-established risk factor for self-harm. Individuals with BPD often experience emotional dysregulation, impulsivity, and fear of abandonment, which can lead to self-injurious behaviors as a coping mechanism. The intense emotions and unstable interpersonal relationships associated with BPD make individuals more vulnerable to engaging in self-harm to manage overwhelming distress.
Further Explanation:
BPD is characterized by a pattern of five or more of the following symptoms:
Fear of abandonment: Frantic efforts to avoid real or imagined abandonment.
Unstable relationships: Intense and unstable relationships with a pattern of idealization and devaluation. Identity disturbance: Markedly unstable sense of self-image or self-worth.
Impulsivity: In at least two areas that are potentially damaging (e.g., spending, unsafe sex, substance abuse). Suicidality: Recurrent suicidal threats, gestures, or attempts, or self-mutilating behavior.
Affective instability: Marked mood swings (e.g., intense episodes of anger, dysphoria, anxiety, or despair lasting a few hours and up to a few days).
Chronic emptiness: Feelings of emptiness or boredom.
Dissociation: Transient, stress-related episodes of derealization or depersonalization.
Research indicates that individuals with BPD have a significantly higher risk of self-harm compared to the general population, with estimates ranging from 70% to 90%. This increased risk is attributed to several factors associated with BPD, such as:
Emotional dysregulation: Difficulty managing intense emotions, leading to self-harm as a way to cope with overwhelming distress.
Impulsivity: Engaging in harmful behaviors without considering the consequences, including self-harm.
Fear of abandonment: Self-harm can be used as a way to punish oneself or manipulate others to prevent perceived abandonment.
Negative self-image: Low self-esteem and feelings of worthlessness can contribute to self-harming behaviors as a form of self-punishment.
Conclusion:
While other factors may contribute to self-harm risk, borderline personality disorder remains a significant and well- established risk factor. A mental health nurse reviewing a client's medical record should prioritize identifying BPD as a potential indicator of increased risk for self-harm behaviors.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale: Having the client join a therapy group immediately upon admission might not be the most therapeutic action. The client is experiencing panic-level anxiety, which is characterized by a heightened state of arousal and fear. Introducing the client to a group setting at this time could potentially increase their anxiety levels due to the unfamiliar environment and people.
Choice B rationale: Suggesting that the client rest in bed might seem like a good idea, as rest can help reduce stress and anxiety. However, this action alone might not be the most therapeutic for a client experiencing panic-level anxiety. The client might continue to experience high levels of anxiety while alone in their room, and without the presence of a healthcare professional, they might not have the necessary support to manage their anxiety.
Choice C rationale: Remaining with the client for a while is the most therapeutic action at this time. The presence of the nurse can provide a sense of safety and security for the client, which can help reduce their anxiety levels. The nurse can also use this time to assess the client’s anxiety levels, provide reassurance, and implement appropriate interventions to help manage the client’s anxiety.
Choice D rationale: Medicating the client with a sedative might help reduce the client’s anxiety levels, but it should not be the first action taken. Medication should be considered as part of a comprehensive treatment plan that includes non-pharmacological interventions, such as providing a safe and supportive environment, using therapeutic communication, and teaching the client coping strategies.
Correct Answer is B
Explanation
Choice A rationale:
Planning a therapeutic diet for the client is not the first priority. While a therapeutic diet may be necessary at some point, it is important to first assess the client's nutritional status to determine their individual needs. A diet plan that is not tailored to the client's specific needs could be ineffective or even harmful.
Focusing on diet planning prematurely could also reinforce the client's distorted body image and eating disorder behaviors. It is important to address the underlying psychological issues before implementing dietary interventions.
Choice C rationale:
Requesting a mental health consult is important, but it is not the first priority. The nurse should first gather data about the client's nutritional status to provide the mental health professional with a comprehensive understanding of the client's condition.
A mental health consult can be helpful in addressing the client's distorted body image and underlying psychological issues, but it should not take precedence over assessing and addressing the client's immediate physical needs.
Choice D rationale:
Providing a structured environment for the client can be helpful in managing eating disorders, but it is not the first priority. The client's immediate physical needs, such as nutritional status, should be addressed first.
A structured environment may include regular mealtimes, supervision during meals, and restrictions on activities that could be used to compensate for food intake (such as excessive exercise). However, these interventions are more effective when implemented in conjunction with addressing the client's underlying psychological issues.
Choice B rationale:
Identifying the client's nutritional status is the first priority because it will provide essential information about the severity of the client's malnutrition and any potential medical complications. This information will guide the nurse in developing an appropriate plan of care, including dietary interventions, mental health referrals, and other necessary measures.
A thorough nutritional assessment should include:
A review of the client's dietary intake, including the types and amounts of foods consumed, as well as any restrictions or avoidance of certain foods.
A physical examination to assess for signs of malnutrition, such as muscle wasting, dry skin, hair loss, and edema. Laboratory tests to evaluate electrolyte levels, blood glucose levels, and other nutritional markers.
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