Chapter 28: Personality and Borderline Personality Disorder: Management of Emotional Dysregulation and Self Harm

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.

A)I have felt so down lately. I don’t enjoy doing anything anymore.

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

A)Sometimes the self-injurious behavior is undertaken to relieve stress.

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.

C)A frontal lobe dysfunction may be causing this condition.

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

A) Nutrition patterns

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?

C)What’s happening around you when this occurs?

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.

A)I should start by stating my feelings as an ‘I’ statement.

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?

B)What are the chances of that actually happening?

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

A) Inflexible

C) Pervasive

D) Unstable over time

E) Distressing

A group of nursing students is reviewing possible risk factors for development of borderline personality disorder. The students demonstrate understanding of the information when they identify which of the following as a risk factor? Select all that apply.

A) Childhood sexual abuse

B) Parental loss

C) Substance abuse

D) Family history

E) Genetics

A) Childhood sexual abuse

B) Parental loss

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

C) Participating in relationships in which the client has control

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?

B)Have you ever felt sorry after acting as you did on the spur of the moment?

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

D) Self-management skills

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.

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.

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

B) Validating perceptions with others

C) Paraphrasing before responding

E) Compromising

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.

B) Practice deep abdominal breathing.