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A nurse is observing a client diagnosed with borderline personality disorder on the inpatient unit. Which of the following would the nurse most likely note?
- A. Actively participating in several different groups
- B. Openly verbalizing feelings
- C. Participating in relationships in which the client has control
- D. Adhering to the personal boundaries of others
Correct Answer: C
Rationale: Clients with BPD often seek control in relationships (C) due to fears of abandonment and emotional instability. Active group participation (A), open verbalization (B), and boundary adherence (D) are less likely due to impulsivity and interpersonal difficulties.
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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.
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 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.
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.