A client diagnosed with a borderline personality disorder is given a nursing diagnosis of disturbed personal identity related to unmet dependency needs as evidenced by the inability to be alone. Which nursing intervention would be appropriate?

Ask the client directly, “Have you thought about killing yourself?”

Maintain a low level of stimuli in the client’s environment.

Frequently orient the client to reality and surroundings.

Help the client identify values and beliefs.

Answer and Explanation

The Correct Answer is D

Disturbed personal identity, or identity disturbance, occurs when an individual has a fragmented or unstable sense of self, often resulting from unmet dependency and attachment issues. In borderline personality disorder, this manifests as chronic feelings of emptiness, identity confusion, and reliance on others to define one’s worth. Clients often experience intense fear of abandonment and difficulty maintaining a consistent self-concept. Nursing interventions focus on helping clients establish internal values and beliefs that promote self-awareness and identity stability.

Rationale for correct answer

D. Helping the client identify values and beliefs promotes self-concept development and personal identity formation. This intervention encourages introspection and assists the client in distinguishing their own feelings, opinions, and preferences from those of others, reducing dependency behaviors. It supports long-term psychological growth and fosters autonomy essential for recovery.

Rationale for incorrect answers

A. Asking directly about suicidal thoughts is appropriate when assessing safety, but it does not address issues of identity or dependency. While suicide risk must always be monitored, this intervention is unrelated to the specific nursing diagnosis of disturbed personal identity.

B. Maintaining a low level of stimuli is a strategy for anxiety or agitation, not identity disturbance. This action may help calm the client temporarily but does not promote self-awareness or personal growth.

C. Frequent orientation to reality is indicated for psychosis or confusion, not borderline personality disorder. Clients with BPD are typically reality-oriented but struggle with emotional instability and self-perception, making this intervention irrelevant.

Take Home Points

Disturbed personal identity in borderline personality disorder arises from unmet dependency and a fragile sense of self.
Supporting value clarification helps clients define their own beliefs and develop stable identity boundaries.
Identity-focused interventions promote autonomy and reduce reliance on external validation.
Orientation or environmental control techniques are not effective for identity disturbances without perceptual impairment.

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Correct Answer is C

Explanation

Antisocial personality disorder (ASPD) is characterized by a pervasive pattern of disregard for and violation of the rights of others, impulsivity, and lack of remorse. Individuals often manipulate, deceive, or exploit others for personal gain. They frequently ignore rules, show little empathy, and fail to learn from negative experiences. Nursing management focuses on establishing structure and consistent boundaries, as these clients respect authority only when clear consequences are enforced.

Rationale for correct answer

C. Providing clear boundaries and consequences is the most important intervention for clients with antisocial personality disorder. This approach ensures safety and prevents manipulation by maintaining structure and predictability. Firm limit-setting helps the client recognize that behaviors have consequences and that privileges are earned through acceptable conduct. Consistency among staff is essential to prevent manipulation and maintain therapeutic control.

Rationale for incorrect answers

A. Teaching and role-modeling assertiveness are appropriate for clients who lack confidence or have difficulty expressing needs, such as those with dependent or avoidant disorders, not for manipulative antisocial clients.

B. Using a gentle and reassuring approach can be misinterpreted as weakness, encouraging manipulation or exploitation. Clients with ASPD often test limits and may take advantage of overly permissive staff.

D. A democratic and overly empathetic style is not effective with antisocial clients. These individuals require firm, direct communication and consistent enforcement of rules rather than negotiation or shared decision-making, which they may manipulate.

Take Home Points

Antisocial personality disorder requires firm boundaries and consistent consequences to reduce manipulation.
A structured environment promotes safety and accountability.
Overly gentle or permissive approaches increase the risk of exploitation.
Consistency among staff prevents manipulation and reinforces behavioral control.

A. Offer to remain with the client during initial interactions with others on the unit. B. Encourage self-awareness through critical examination of feelings and behaviors. C. Recognize when the client is “splitting” staff by playing one staff member against another. D. Allow the client to take on responsibility for his or her own self-care practices.

Correct Answer is B

Explanation

Self-esteem disturbance in individuals with antisocial personality disorder (ASPD) is characterized by a fragile and inflated self-image that compensates for deep feelings of inadequacy. Clients may demonstrate arrogance, manipulation, and a lack of empathy as defenses against internal insecurity. These behaviors often arise from chronic deprivation, neglect, or failure to meet basic psychological needs, leading to distorted self-perception and poor emotional insight. Effective nursing care focuses on developing self-awareness, accountability, and empathy to foster genuine self-esteem rather than superficial grandiosity.

Rationale for correct answer

B. Encouraging self-awareness through critical examination of feelings and behaviors helps the client gain insight into maladaptive coping patterns and the underlying feelings of inferiority masked by boasting or manipulation. This process promotes internal reflection, responsibility, and authentic self-esteem development. It shifts focus from external validation to personal accountability, which is central to managing antisocial traits.

Rationale for incorrect answers

A. Offering to remain with the client during initial interactions is useful for those with anxiety or social withdrawal, not for antisocial personality disorder. These clients often display excessive confidence and do not require supportive presence for social engagement.

C. Recognizing “splitting” staff is crucial in borderline personality disorder, not antisocial. ASPD clients manipulate others for personal gain but do not typically engage in splitting behavior characterized by idealization and devaluation of staff members.

D. Allowing the client to take responsibility for self-care is appropriate for promoting independence, but in this case, it does not address the self-esteem disturbance or the psychological mechanisms sustaining the client’s grandiosity. The focus should be on self-reflection and emotional understanding first.

Take Home Points

Antisocial personality disorder involves inflated self-image masking deep insecurity and lack of empathy.
Encouraging self-awareness and emotional insight is key to improving genuine self-esteem.
“Splitting” behaviors are typical of borderline, not antisocial, personality disorders.
Long-term therapeutic goals focus on accountability, empathy development, and recognition of consequences.

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A client diagnosed with a borderline personality disorder is given a nursing diagnosis of disturbed personal identity related to unmet dependency needs as evidenced by the inability to be alone. Which nursing intervention would be appropriate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which nursing intervention is most important for a client who has the diagnosis of antisocial personality disorder?

Correct Answer is C

Explanation

A client diagnosed with an antisocial personality disorder is given a nursing diagnosis of self-esteem disturbance related to extreme poverty as evidenced by continual boasting and grandiosity. Which nursing intervention would be appropriate?

Correct Answer is B

Explanation

A client diagnosed with a borderline personality disorder is given a nursing diagnosis of disturbed personal identity related to unmet dependency needs as evidenced by the inability to be alone. Which nursing intervention would be appropriate?

After being treated in the ED for self-inflicted lacerations to the wrists and arms, a client with a diagnosis of borderline personality disorder is admitted to the psychiatric unit. Which nursing intervention takes priority?

A client is diagnosed with a borderline personality disorder. What is a realistic initial intervention for this client?

A client with a personality disorder tells a nurse, “I want to tell you something, but you must promise to keep it a secret.” Which response could lead to splitting among the staff?

A 15-year-old client living in a residential facility has a nursing diagnosis of ineffective coping related to abuse as evidenced by defiant responses to adult rules. Which of the following interventions would address this nursing diagnosis appropriately? Select all that apply.

The clients on a mental health unit go on a supervised day trip to a baseball game. When returning to the bus, a client with a narcissistic personality disorder insists on leaving the group to get an autograph from a player. What is the most appropriate response by the nurse?

A client with a diagnosis of borderline personality disorder has negative feelings toward the other clients on the unit and considers them all to be “bad.” Which defense was the client using when this statement was made?

A nursing student is learning about narcissistic personality disorder. Which student statement indicates that learning has occurred?