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The nurse is assessing a client who has borderline personality disorder. Which of the following would be a priority?
- A. Nutrition patterns
- B. Personal hygiene practices
- C. Physical functioning
- D. Somatic complaints
Correct Answer: C
Rationale: Physical functioning (C) is a priority in BPD assessment due to the risk of self-harm or impulsivity affecting safety and health. Nutrition (A), hygiene (B), and somatic complaints (D) are important but secondary, as they are less immediately tied to life-threatening risks like self-injury.
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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.
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.
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 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.