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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.
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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.
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.
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 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.
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.