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A client diagnosed with borderline personality disorder tells the nurse that she frequently spaces out. Which response by the nurse would be most appropriate?
- A. Do you feel stressed most of the time?
- B. Does this frighten you when it happens?
- C. What?s happening around you when this occurs?
- D. Do you feel as if you are out of your body?
Correct Answer: D
Rationale: The client?s description of ?spacing out? suggests dissociation, common in BPD. Asking if she feels out of her body (D) directly assesses the nature of this dissociative experience. Asking about stress (A), fear (B), or external events (C) is less specific to confirming dissociation.
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A client with borderline personality disorder tells the nurse, I?m afraid to get on a train because we?ll probably get into a wreck. Which response by the nurse would be most appropriate?
- A. Have you had a bad experience riding a train?
- B. What are the chances of that actually happening?
- C. Now you know that won?t happen.
- D. Have you thought about going by automobile?
Correct Answer: B
Rationale: Challenging the irrational fear by asking about the likelihood of a train wreck (B) gently encourages reality-testing without dismissing the client?s anxiety, a therapeutic approach in BPD. Asking about past experiences (A) may reinforce fear, dismissing the fear (C) is invalidating, and suggesting alternatives (D) avoids addressing the fear.
As part of a client?s treatment plan for borderline personality disorder, the client is engaged in dialectical behavior therapy. As part of the therapy, the client is learning how to control and change behavior in response to events. The nurse identifies the client as learning which type of skills?
- A. Emotion regulation skills
- B. Mindfulness skills
- C. Distress tolerance skills
- D. Self-management skills
Correct Answer: A
Rationale: Dialectical behavior therapy (DBT) for BPD emphasizes emotion regulation skills (A) to help clients manage intense emotions and modify behaviors in response to triggers. Mindfulness (B) focuses on awareness, distress tolerance (C) on enduring crises, and self-management (D) is not a DBT-specific term.
The nurse has explained some of the biologic theories of causation to a client diagnosed with borderline personality disorder and his family. The nurse determines that the client and family have understood the instructions when they state which of the following?
- A. The disorder may be caused by increased serotonin activity.
- B. The disorder is caused by decreased dopamine activity in my brain.
- C. A frontal lobe dysfunction may be causing this condition.
- D. A decrease in hormonal substances increases the risk for this illness.
Correct Answer: C
Rationale: Frontal lobe dysfunction (C), particularly in areas like the prefrontal cortex, is implicated in BPD due to its role in emotional regulation and impulsivity. Increased serotonin activity (A) is not typically associated, decreased dopamine (B) is more relevant to other disorders, and hormonal decreases (D) lack specific evidence in BPD causation.
A nurse is assisting a client with borderline personality disorder in how to manage transient psychotic episodes that involve auditory hallucinations. The teaching is planned for times when the client is free of these symptoms. Which of the following would the nurse instruct the client to do first?
- A. Use skills to tolerate painful feelings.
- B. Practice deep abdominal breathing.
- C. Identify early internal cues of distress.
- D. Refer to cards listing potential symptoms.
Correct Answer: C
Rationale: Identifying early internal cues of distress (C) is the first step in managing transient psychotic episodes in BPD, enabling proactive intervention before hallucinations escalate. Tolerating feelings (A), breathing (B), or using cards (D) are subsequent steps after recognizing cues.
The nurse is caring for a client diagnosed with borderline personality disorder. The nurse has instructed the client about using the communication triad. The nurse determines that the client has understood this technique when he states which of the following?
- A. I should start by stating my feelings as an ?I? statement.
- B. Maybe I should start by describing the situation that has me upset.
- C. I should first tell the other person what I?d like to be different about the situation.
- D. I should begin by telling the other person what has triggered my emotion.
Correct Answer: A
Rationale: The communication triad in BPD therapy involves using ?I? statements to express feelings, describing the situation, and stating desired changes. Starting with an ?I? statement (A) initiates effective communication. Describing the situation (B), desired changes (C), or triggers (D) follows but does not begin the triad.