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A client with borderline personality disorder says to the nurse, 'I feel so comfortable talking with you. You seem to have a special way about you that really helps me.' Which would be the most appropriate response by the nurse?
- A. I'm glad you feel comfortable with me.
- B. I'm here to help you just as all the staff are.
- C. Do you feel others don't understand you?
- D. I cannot be your friend; we need to be clear on that.
Correct Answer: B
Rationale: This response reinforces the professional role of the nurse, maintaining boundaries with a client prone to idealization.
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Which techniques are important for nurses caring for clients with personality disorders to use in order to effectively provide care? Select all that apply.
- A. Discuss feelings of anger or frustration with colleagues to help them recognize and cope with their own feelings.
- B. Considering the client to be a personal friend.
- C. Employ ongoing communication with team members to remain firm and consistent about expectations for clients.
- D. Solving the problems of the client.
- E. Understanding that behavior changes in clients with personality disorders can occur quickly.
Correct Answer: A,C
Rationale: Discussing frustrations and maintaining team consistency are key to managing countertransference and preventing manipulation.
Which challenges are posed when working with clients with personality disorders? Select all that apply.
- A. Clients with personality disorders are obviously unable to function more effectively.
- B. It can take a long time to change their behaviors, attitudes, or coping skills.
- C. The nurse can easily but mistakenly believe the client simply lacks motivation or the willingness to make changes.
- D. Clients with personality disorders challenge the ability of therapeutic staff to work as a team.
- E. Team members may have differing opinions about individual clients.
Correct Answer: B,C,D,E
Rationale: Long-term change, perceived lack of motivation, and team dynamics are significant challenges in treating personality disorders.
The nurse is planning the type of approach that will be most effective in developing a therapeutic relationship with the client. The nurse should use a matter-of-fact approach with clients with which types of personality disorders? Select all that apply.
- A. Paranoid
- B. Antisocial
- C. Schizotypal
- D. Narcissistic
- E. Avoidant
Correct Answer: A,B,D
Rationale: A matter-of-fact approach with limit setting is effective for paranoid, antisocial, and narcissistic personalities to maintain boundaries.
Which of the following is a realistic outcome for the care of a person with a personality disorder?
- A. Outcomes that focus on satisfaction with daily life
- B. Outcomes that focus on the client's perception of others
- C. Outcomes that focus on increased client insight
- D. Outcomes that focus on change in behavior
Correct Answer: D
Rationale: Behavioral change is a realistic and primary focus for treatment, as insight or perception changes are less achievable.
When establishing a relationship with a client who has borderline personality disorder, which is most important for the nurse to do?
- A. Aggressively confront the client about boundary violations.
- B. Limit interactions to 10 minutes.
- C. Respect the client's boundaries.
- D. Tell the client the relationship is professional.
Correct Answer: C
Rationale: Respecting the client's boundaries helps model and teach appropriate boundary-setting for those with borderline personality disorder.