What is the priority nursing diagnosis for a patient diagnosed ...

[karen]

What is the priority nursing diagnosis for a patient diagnosed with antisocial personality disorder who has made threats against staff, ripped art off the walls, and thrown objects?
 
  a. Risk for other-directed violence
  b. Risk for self-directed violence
  c. Impaired social interaction
  d. Ineffective denial

Question 2

One month ago, a patient diagnosed with borderline personality disorder and a history of self-mutilation began dialectical behavior therapy. Today the patient phones to say, I feel empty and want to hurt myself. The nurse should:
 
  a. arrange for emergency inpatient hospitalization.
  b. send the patient to the crisis intervention unit for 8 to 12 hours.
  c. assist the patient to choose coping strategies for triggering situations.
  d. advise the patient to take an anti-anxiety medication to decrease the anxiety level.

[bd5255]

Answer to Question 1

ANS: A
Violence against property, along with threats to harm staff, makes this diagnosis the priority. Patients with antisocial personality disorders have impaired social interactions, but the risk for harming others is a higher priority. They direct violence toward others; not self. When patients with antisocial personality disorders use denial, they use it effectively.

Answer to Question 2

ANS: C
The patient has responded appropriately to the urge for self-harm by calling a helping individual. A component of dialectical behavior therapy is telephone access to the therapist for coaching during crises. The nurse can assist the patient to choose an alternative to self-mutilation. The need for a protective environment may not be necessary if the patient is able to use cognitive strategies to determine a coping strategy that will reduce the urge to mutilate. 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.

[karen]

Excellent

[ktidd]

TYSM