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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.
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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 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.
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.
The nurse is caring for a client diagnosed with borderline personality disorder. The nurse has instructed the client about using the communication triad. The nurse determines that the client has understood this technique when he states which of the following?
- A. I should start by stating my feelings as an ?I? statement.
- B. Maybe I should start by describing the situation that has me upset.
- C. I should first tell the other person what I?d like to be different about the situation.
- D. I should begin by telling the other person what has triggered my emotion.
Correct Answer: A
Rationale: The communication triad in BPD therapy involves using ?I? statements to express feelings, describing the situation, and stating desired changes. Starting with an ?I? statement (A) initiates effective communication. Describing the situation (B), desired changes (C), or triggers (D) follows but does not begin the triad.
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.