Question 1

Which statement indicates that a client diagnosed with borderline personality disorder (BPD) is at risk for self-injurious behavior?

Accepted Answer

Self-harm behavior is more likely to occur when the individual with borderline personality disorder is depressed, has highly unstable interpersonal relationships, and is paranoid, hypervigilant, and resentful. The statement about doing what others tell the client to do reflects an unstable self-image. Going somewhere else reflects dissociation. Doing something upon immediately thinking about it reflects impulsivity.

Question 2

The sibling of a client diagnosed with borderline personality disorder asks the nurse to explain why the client engages in wrist cutting. Which response by the nurse would be most appropriate?

Accepted Answer

Clients with borderline personality disorder are impulsive and may respond to stress by harming themselves. Self-harm is an effort to self-soothe by activating endogenous endorphins to provide comfort. The behavior is not sedating or calming, and it is not used to prevent delusional thinking or mood swings.

Question 3

A nurse has explained some of the biologic theories of causation to a client diagnosed with borderline personality disorder. The nurse determines that the explanation has been understood when the client makes which statement?

Accepted Answer

Associated brain dysfunction occurs in the limbic system or frontal lobe and increases impulsive behaviors, parasuicidal behaviors, and mood disturbances. Neurotransmitters, such as serotonin and dopamine, as well as hormones, have not been implicated in the cause.

Question 4

Which assessment would be a priority considering the comorbid conditions associated with borderline personality disorder?

Accepted Answer

Because of the comorbidity of borderline personality disorder and eating disorders and substance abuse, a nutritional assessment may be needed. Individuals with borderline personality disorder are usually able to maintain personal hygiene and physical functioning.

Question 5

A client diagnosed with borderline personality disorder tells the nurse that, "I frequently space out." Which response by the nurse would be most appropriate?

Accepted Answer

To determine a pattern for the client's coping skills, it is important to ask the client what is happening in the environment when dissociation occurs. In addition, this is the only question that is open ended; therefore, it will elicit more information than a closed-ended question would.

Question 6

A client diagnosed with borderline personality disorder tells a 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?

Accepted Answer

The nurse should challenge the client's dysfunctional thinking by encouraging the client to think about the event or situation in a different way which provides the client with a different perspective to consider. Although asking about a previous bad experience may help shed some light on the situation, the client with borderline personality disorder has dysfunctional thinking, and this needs to be addressed first. Telling the client that he or she knows it won't happen or suggesting the client travel by car does not address the client's underlying pattern of thinking.

Question 7

A nurse is observing a client diagnosed with borderline personality disorder on the inpatient unit. Which behavior would the nurse most likely note if the client is also paranoid?

Accepted Answer

Paranoid individuals with borderline personality disorder restrict their relationships to ones in which they feel control. They distance themselves from groups when feeling anxiety (which is most of the time) and rarely use their support systems. They are reluctant to share their feelings. To meet their interpersonal needs, they idealize others and establish intense relationships that violate interpersonal boundaries of others, leading to rejection.

Question 8

A nurse assessing a client diagnosed with borderline personality disorder would most appropriately ask which question to assess the client's level of impulsivity?

Accepted Answer

To assess impulsivity, the nurse would ask the client whether he or she ever felt sorry for acting on the spur of the moment. Asking about things bothering the client provides information about the client's mood. Asking about how the client views other people provides information about the client's cognition and possible dichotomous thinking. Asking about feeling separated from the body provides information about dissociation.

Question 9

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?

Accepted Answer

Self-management skills focus on helping clients learn how to control, manage, or change their behavior, thoughts, or emotional responses to events. Emotion regulation skills are taught to manage intense, labile moods and involve helping the client label and analyze the context of the emotion, as well as developing strategies to reduce emotional vulnerability. Teaching individuals to observe and describe emotions without judging or blocking them helps clients experience emotions without stimulating secondary feelings that may cause more distress. Mindfulness skills are the psychological and behavioral versions of meditation skills usually taught in Eastern spiritual practice; they are used to help the person improve observation, description, and participation skills by learning to focus the mind and awareness on the current moment's activity. Distress tolerance skills involve helping the individual tolerate and accept distress as a part of normal life.

Question 10

Which client statement most accurately reflects the cognitive dysfunction associated with borderline personality disorder (BPD)?

Accepted Answer

People with BPD have dichotomous thinking. Cognitively, they evaluate experiences, people, and objects in terms of mutually exclusive categories (e.g., good or bad, success or failure, trustworthy or deceitful), which results in extreme interpretations of events that would normally be viewed as including both positive and negative aspects. The statement about being a total failure is an example. None of the other options describes this characteristic.

Question 11

A nurse is reviewing the medical record of a client diagnosed with borderline personality disorder (BPD). Which risk factor would the nurse identify for this disorder?

Accepted Answer

Childhood sexual abuse, which more commonly affects girls, is one of the strongest risk factors for BPD. Various studies show that physical and sexual abuse seem to be significant risk factors for BPD. Other studies cite parental loss and separation. Parental alcohol abuse, poverty, and a history of depression have not been linked to BPD.

Question 12

A nurse engages in role-playing to assist the client diagnosed with borderline personality disorder in learning how to communicate effectively. Which strategy would the nurse encourage the client to use? Select all that apply.

Accepted Answer

The nurse would teach the client basic communication approaches, such as making "I" statements, paraphrasing what the other party says before responding, checking the accuracy of perceptions with others, compromising, and seeking common ground, listening actively, and offering and accepting reactions.

Question 13

A nurse is conducting a review class on borderline personality disorder. When describing the characteristics associated with this disorder, which would the nurse most likely include? Select all that apply.

Accepted Answer

People with BPD have problems regulating their moods, developing a self-identity, maintaining interpersonal relationships, maintaining reality-based thinking, and avoiding impulsive or destructive behavior.

Question 14

A client diagnosed with borderline personality disorder (BPD), would be expected to demonstrate which behavior? Select all that apply.

Accepted Answer

People diagnosed with BPD have an extreme fear of abandonment as well as a history of unstable, insecure attachments. These individuals, who already are intensely emotional and have a poor sense of self, feel estranged from others and inadequate in the face of perceived social standards. Intense shame and self-hate follow. These feelings often result in self-injurious behaviors, such as wrist cutting, self-burnings, or head banging. People with BPD use elaborate strategies to structure interactions. That is, they restrict their relationships to ones in which they feel in control. They distance themselves from groups when feeling anxious (which is most of the time) and rarely use their social support system. Even if they are married or have a supportive extended family, they are reluctant to share their feelings. They do not want to burden anyone; they fear rejection and assume that people are tired of hearing them repeat the same issues.

Question 15

The assessment of a client diagnosed with borderline personality disorder reveals an unstable self-image and identity diffusion. The nurse would identify this issue based on which findings? Select all that apply.

Accepted Answer

The nurse can recognize identity diffusion if the client reports an ongoing "emptiness" or contradictory behavior. Also, the client's thoughts and behavior will seem fragmented and superficial. Reports of spacing out and an inability to remember events suggest dissociation.

Question 16

A nurse is working with the family of a client who has been diagnosed with antisocial personality disorder. Which factor would be most important for the nurse to focus on when teaching the family about this disorder?

Accepted Answer

Family members of clients with antisocial personality disorder usually need help in establishing boundaries. Because there is a long-term pattern of interaction in which family members feel responsible for the client's antisocial behavior, these patterns need to be interrupted. Anger management and self-responsibility are appropriate for the client, not the family. Medication therapy is usually not prescribed unless the client has another disorder.

Question 17

A group of nursing students is reviewing information about antisocial personality disorder. The students demonstrate understanding of this disorder when they confirm which fact?

Accepted Answer

To be diagnosed with antisocial personality disorder, the individual must be at least 18 years of age and must have exhibited one or more childhood behavioral characteristics of conduct disorder before the age of 15 years. The disorder occurs more frequently in men and crosses all cultures and ethnicities. This personality disorder is strongly associated with alcohol and drug abuse.

Question 18

A nurse is providing care to a client diagnosed with antisocial personality disorder. As part of the plan of care, the client is to participate in a problem-solving group. The nurse understands that this intervention is effective based on which rationale?

Accepted Answer

Problem-solving groups that focus on identifying a problem and developing a variety of alternative solutions are especially helpful for a client with antisocial personality disorder. This is because client self-responsibility is reinforced when clients remind each other of better alternatives. In addition, clients are likely to confront each other with dysfunctional schemas or thinking patterns. Groups that focus on developing empathy would foster attachment. Although groups typically have specific rules and boundaries, this is not the primary focus of problem-solving groups.

Question 19

A nurse is reviewing the medical record a client diagnosed with antisocial personality disorder (ASPD). Which factor would the nurse identify as having increased the client's risk for this condition?

Accepted Answer

There is an increased likelihood of developing adult ASPD if there was an early onset of conduct disorder (before age 10 years) as well as accompanying childhood ADHD. Males with alcohol use disorder and those from substance abuse clinics, prisons, or other forensic settings have the highest rates. In the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions (n = 43,093), the odds of ASPD were greater among Native Americans and lower among Asians, compared with white men and women.

Question 20

A nurse working with a client diagnosed with antisocial personality disorder needs to keep which fact in mind when focusing on a therapeutic relationship?

Accepted Answer

Therapeutic relationships are difficult to establish because these individuals do not attach to others and are often unable to use the relationship to change behavior. The goal of the therapeutic relationship is to identify dysfunctional thinking patterns and develop new problem-solving behaviors. After the first few meetings with these clients, the nurse may believe that the relationship has a good start, but in reality, a superficial alliance is usually formed. Additional sessions reveal the lack of client commitment to the relationship. These clients begin to revisit topics discussed in previous sessions or lose interest in trying to work on problems.

Quiz 30: Personality and Impulse-Control Disorders: Nursing Care of Persons With Personality Andimpulse-Control Disorders