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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.
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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.
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.
A nursing instructor is preparing a class discussion on personality disorders and characteristics. Which term would the instructor include to differentiate personality disorders from normal personality? Select all that apply.
- A. Inflexible
- B. Short term
- C. Pervasive
- D. Unstable over time
- E. Distressing
Correct Answer: A,C,E
Rationale: Personality disorders are characterized by inflexible (A), pervasive (C), and distressing (E) patterns of behavior that deviate from normal personality traits. They are not short-term (B) but enduring, and while unstable relationships or emotions may occur, ?unstable over time? (D) is not a defining feature of the disorder itself.
The nurse is assessing a client who is diagnosed with borderline personality disorder. Which client statement indicates the client is at risk for self-injurious behavior?
- A. I have felt so down lately. I don?t enjoy doing anything anymore.
- B. I do what I do because others tell me to do so.
- C. When I feel extremely anxious, it is like my mind goes somewhere else.
- D. It is almost as if as soon as I think of doing something, I immediately do it.
Correct Answer: C
Rationale: The statement about the mind going somewhere else during extreme anxiety (C) suggests dissociation, a common precursor to self-injurious behavior in borderline personality disorder (BPD) as a way to cope with intense emotions. Feeling down (A) indicates depression, following others (B) suggests suggestibility, and impulsivity (D) is a risk but less directly linked to self-injury than dissociation.
A client with borderline personality disorder has difficulty maintaining boundaries of the professional relationship. Which of the following would be most effective for the nurse to do? Select all that apply.
- A. Punish the client with seclusion for violating established boundaries.
- B. Respond to the client?s arrogance in a neutral, nonconfrontational manner.
- C. Discuss the purpose of the limits in the therapeutic relationship.
- D. State the parameters of the limits and boundaries clearly.
- E. Ensure that any established limits are maintained consistently.
Correct Answer: B,C,D,E
Rationale: Effective strategies for managing boundary issues in BPD include responding neutrally to arrogance (B), discussing the purpose of limits (C), clearly stating boundaries (D), and maintaining consistency (E). Punishment via seclusion (A) is inappropriate and non-therapeutic.