Nokea
A nurse is assessing a client with borderline personality disorder. Which question would be most appropriate to assess the client?s level of impulsivity?
- A. What things bother you and make you feel happy?
- B. Have you ever felt sorry after acting as you did on the spur of the moment?
- C. How do you view other people around you?
- D. Have you ever felt like you were separated from your body?
Correct Answer: B
Rationale: Asking about regret after spontaneous actions (B) directly assesses impulsivity, a core BPD trait. Questions about emotions (A), perceptions of others (C), or dissociation (D) are less specific to impulsivity.
You may also like to solve these questions
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.
A group of nursing students is reviewing possible risk factors for development of borderline personality disorder. The students demonstrate understanding of the information when they identify which of the following as a risk factor? Select all that apply.
- A. Childhood sexual abuse
- B. Parental loss
- C. Substance abuse
- D. Family history
- E. Genetics
Correct Answer: A,B,D,E
Rationale: Risk factors for BPD include childhood sexual abuse (A), parental loss (B), family history (D), and genetics (E), reflecting environmental and hereditary influences. Substance abuse (C) is a common comorbidity but not a primary risk factor for developing BPD.
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.
A nurse is engaged in role-playing with a client with borderline personality disorder to assist the client in learning how to communicate effectively. Which of the following would the nurse encourage the client to use? Select all that apply.
- A. Me statements
- B. Validating perceptions with others
- C. Paraphrasing before responding
- D. Listening passively
- E. Compromising
Correct Answer: B,C,E
Rationale: Effective communication in BPD includes validating others? perceptions (B), paraphrasing before responding (C), and compromising (E) to foster mutual understanding. ?Me? statements (A) are less specific than ?I? statements, and passive listening (D) is less effective than active engagement.
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.