hard · NCLEX-RN Psychosocial Integrity

The nurse is prioritizing clinical hypotheses to guide Tessa's care plan. Which concern has the highest clinical priority? Apply the response specifically to this case: inpatient client with borderline personality disorder using splitting and self-injury threats, requiring unified limits, validation, safety assessment, and adaptive-skill reinforcement.

  1. High risk for self-injury secondary to acute emotional dysregulation and poor impulse control.
  2. Impaired staff relationships related to client-initiated splitting of floor nurses, for this client.
  3. Disrupted unit schedule participation related to phone privilege demands.
  4. Inability to maintain a stable therapeutic alliance due to chronic trust deficits, for this client.

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