A patient with borderline personality disorder has been hospitalized several times after self-injurious behavior and suicide attempts. The patient has entered dialectical behavior therapy on an outpatient basis
During therapy, the advanced practice nurse has been counseling her regarding self-harm behavior management. Today the patient called the nurse and reported "feeling empty and anxious" and wants to cut herself. Which response would best help in this situation? a. Arrange for an emergency admission to a crisis unit.
b. Arrange for an emergency admission to an inpatient unit.
c. Assist the patient to identify and choose a coping strategy.
d. Advise the patient to take an anxiolytic, then go to sleep.
C
The patient has responded appropriately to the urge to harm herself by calling a helping individual. The nurse can assist the patient to choose an alternative to self-injury. Except when the patient is judged to be at risk of suicide as well, hospital or crisis center admissions are generally discouraged in favor of guiding the patient to use internal controls to manage urges to self-injure. This is designed to minimize dependence on hospitalization for safety and promote independence and adaptive coping. Taking a sedative and going to sleep should not be the first-line intervention, because sedation may reduce the patient's ability to weigh alternatives to mutilating behavior, and using medications to deal with stress (especially in the absence of other adaptive coping alternatives such as relaxation exercises) could increase the risk of drug abuse or dependence.
You might also like to view...
A couple wants to start a family and they are concerned that their child will be at risk for cystic fibrosis because they each have a cousin with cystic fibrosis. What should the nurse practitioner tell them about cystic fibrosis?
A) It is an autosomal dominant disorder. B) It is passed by mitochondrial inheritance. C) It is an X-linked inherited disorder. D) It is an autosomal recessive disorder.
The intensive care nurse plans to test nociception in the patient with a closed-head injury. Which nursing action is indicated?
1. Move an object across the patient's visual field. 2. Place a container of ground coffee close to the patient's nostrils. 3. Ask the patient to squeeze and release the nurse's hand. 4. Press the patient's nail bed.
Which patient(s) would the nurse consider to be at risk for not understanding informed consent information because of health illiteracy? Select all that apply
1. A 50-year-old who works in a manufacturing plant 2. A 23-year-old who works at a fast-food restaurant 3. A 35-year-old immigrant from China 4. A 19-year-old high school graduate 5. A 77-year-old who has long-standing diabetes mellitus
The nurse practices "here and now" focus on problem identification, with an emphasis on quickly understanding the context in which the problem is embedded during which of the following phases of the nurse-client relationship?
a. Orientation b. Preinteraction c. Termination d. Working