The nurse in the mental health clinic is caring for a 23-year-old female
Item 1 of 1
- Nurses' Notes
1545 – Client presented to establish care with psychiatry and was recommended by a few of her professors to seek counseling regarding her attitude. She stated, "I just want to get checked out because they insist something is wrong, but I feel fine." The client did report that she has gone through a few breakups over the past year and states that "guys suck, all they want is to be with you for a short time, and then they leave you. I cannot handle it when someone leaves me." Since her most recent breakup, she reports hanging out with several guys and having indiscriminate sex but is "keeping her distance." The client reports obtaining psychiatric care one year ago but abandoned treatment because "the psychiatrist just didn't get me; he was totally awful." The client reports no psychiatric hospitalizations but two previous suicide attempts when she was a teenager using a butter knife, stating, "I wasn't trying to kill myself; I just wanted my parents to listen to me." On assessment, the client is alert, completely oriented, and has a mood described as "whatever" she appears somewhat hostile during the assessment, and her affect is labile, ranging from euthymic to angry at certain portions of the interview. She denies any hallucinations. She is dressed in normal attire; her hair is well-kept, and she has a slender appearance.
Complete the sentences below from the list of options
Complete the sentences below from the list of options
The client is exhibiting manifestations consistent with
personality disorder.
The nurse should prioritize assessing the client for
When developing a plan of care for this client, it is strongly recommended that the nurse obtain a prescription for
Statistics
Subject/Lesson
Subject
Mental Health
Lesson
Mental Health
Client Need
Test Plan
Psychosocial Integrity
Related Topic
Mental Health Concepts
Item Type
Item Type
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Explanation
- The client's clinical picture is strongly suggestive of borderline personality disorder.
- BPD has a defense mechanism of splitting where they may view an individual(s) as all good or all bad. This is demonstrated in the client's view of the male gender.
- The client stated she sought psychiatric care previously and then devalued her previous psychiatrist.
- Devaluation, splitting, denial, and projection are common defense mechanisms used in this disorder.
- The client reports two previous parasuicide attempts with the intent to get attention; this is consistent with BPD as they seek attention even by engaging in self-mutilation
- The client engaging in indiscriminate sex with others is a finding stemming from the impulsivity found in this disorder.
- It is unlikely that this client has antisocial personality disorder because no evidence of illegal behavior, or lack of empathy, was in the client's history.
- Narcissism is not likely because individuals with this PD have a self-inflated view of themselves that is not necessarily unstable. Nor is parasuicide common in this disorder.
- This client is quite social and expressed no disinterest in others; this is not found in schizoid personality disorder.
- This client must be assessed for suicide. Suicide is a priority assessment for any client, and considering the client's previous attempts, it is even more critical to evaluate the client for any thoughts of self-harm. The other assessments are not a priority because a client suicide assessment is directly linked to the client's safety.
- No medication is approved to treat personality disorders. Instead, therapy is the cornerstone treatment.
- For clients with BPD, dialectical behavioral therapy (DBT) is used, which focuses on emotional regulation and mature defense mechanisms.
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2 Key Topics
Personality Disorders
32.3 Major Psychiatric Disorders
Additional Info
✓ A borderline personality disorder is about five times more common in first-degree biological relatives with the same disorder compared with the general population
✓ This disorder is characterized by the individual having an unstable self-image, fear of rejection, impulsivity, and emotional dysregulation
✓ A key intervention for a client with BPD is to assess for suicidality
✓ Parasuicide is common with this personality disorder; however, it is essential to keep this client safe
✓ Defense mechanisms commonly seen in this personality disorder include splitting, projective identification, and denial
✓ Treatment is therapy, specifically dialectal behavioral therapy, which focuses on emotional regulation and strategies to respond to stressors in a mature way
✓ No medication is approved to treat any personality disorder
