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A woman with borderline personality disorder has been admitted to the inpatient unit because she has been engaging in wrist cutting. The client?s sister is visiting, and the sister asks the nurse to explain why her sister sometimes does this to herself. Which response by the nurse would be most appropriate?
- A. Sometimes the self-injurious behavior is undertaken to relieve stress.
- B. Self-injurious behavior often calms and sedates people with this diagnosis.
- C. Sometimes they do it to avoid the onslaught of delusional thinking.
- D. The self-mutilation often slows the mood swings your sister experiences.
Correct Answer: A
Rationale: Self-injurious behavior in BPD, such as wrist cutting, is often a maladaptive coping mechanism to relieve intense emotional stress or distress (A). It does not typically calm or sedate (B), is unrelated to delusions (C), and does not directly address mood swings (D), which are more characteristic of bipolar disorder.
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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.
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 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 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.