What is the nurse's priority assessment for a patient with borderline personality disorder?
Suicidal or homicidal ideations
Sleep patern changes
Impulsive behaviours
Only support systems
The Correct Answer is A
Borderline personality disorder is a serious mental illness characterized by instability in mood, behaviour, and self-image. Patients with borderline personality disorder are at a high risk of self-harm, suicide, and impulsive behaviours. Therefore, the nurse's priority assessment should be to identify any suicidal or homicidal ideations, as these can be life-threatening emergencies. Once identified, appropriate interventions should be initiated, such as suicide precautions, crisis management, and referral to mental health professionals for further evaluation and treatment.
While sleep patern changes, impulsive behaviours, and support systems are also important aspects to assess in patients with borderline personality disorder, they are not the priority when compared to suicidal or homicidal ideations.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
This statement by the patient suggests that they may be projecting their feelings, thoughts, and attitudes toward their parents and uncle onto the therapist. This projection is a common phenomenon in therapy and is known as transference. Transference occurs when a patient transfers emotions, desires, and expectations from one person to another, usually the therapist. It can be positive or negative and can affect the therapeutic relationship.
Therefore, the statement "Talking to you feels like talking to my parents and uncle" is a clear indication of transference and should be carefully considered by the therapist in the ongoing therapy sessions. The therapist should explore the patient's feelings and experiences with their parents and uncle to better understand the nature of the transference and how it may be affecting the therapeutic process.
Correct Answer is C
Explanation
A systolic blood pressure of 62 mm Hg indicates severe hypotension and is a medical emergency. This is a life-threatening situation that requires immediate hospitalization for stabilization and treatment. Clients with eating disorders are at risk of electrolyte imbalances, cardiac complications, and other medical complications due to malnutrition and dehydration. While the other options are also abnormal findings, they are not as severe as the critically low blood pressure measurement. Therefore, the priority for hospitalization would be the client with severe hypotension.
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