A client with a diagnosis of antisocial personality disorder is being discharged from the hospital. The client asks the nurse, “Can I have your phone number so that I can call you for a date?” What is the nurse’s best response?
“We are not permitted to date clients.”
“It is against my professional ethics to date clients.”
“Our relationship is professional; therefore, I will not see you socially.”
“I’m glad you like me; however, I cannot give out my phone number.”
The Correct Answer is C
Antisocial personality disorder is marked by a pervasive pattern of disregard for others’ rights, lack of empathy, and manipulative or exploitative behavior. These individuals often violate social norms, show impulsivity, and may engage in deceit or aggression. They typically lack remorse and may attempt to charm or manipulate authority figures for personal gain. Therapeutic boundaries are essential in managing interactions with such clients to prevent exploitation and maintain professional integrity.
Rationale for correct answer
C. Professional boundaries must be maintained with clients diagnosed with antisocial personality disorder due to their manipulative tendencies. This response clearly defines the therapeutic relationship and prevents personal entanglement. It avoids emotional engagement and reinforces the nurse’s role, protecting both parties from inappropriate dynamics.
Rationale for incorrect answers
A. The word permitted implies that dating clients is a rule violation rather than a professional boundary issue. This response lacks the therapeutic clarity needed to reinforce the nurse-client relationship and may invite further negotiation.
B. The term ethics is vague and may provoke debate or challenge from a client with antisocial traits. It does not firmly establish the therapeutic boundary and may be interpreted as a personal moral stance rather than a professional standard.
D. The word glad introduces emotional engagement, which is inappropriate in this context. It may reinforce the client’s manipulative behavior and blur professional boundaries, making the nurse appear personally invested.
Take Home Points
- Antisocial personality disorder requires firm, clear boundaries due to manipulative and exploitative behaviors.
- Therapeutic relationships must remain professional and emotionally neutral to prevent boundary violations.
- Responses to inappropriate client advances should reinforce the nurse’s role and avoid emotional language.
- Differentiate antisocial personality disorder from borderline personality disorder, which involves emotional instability and fear of abandonment rather than calculated manipulation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Histrionic personality disorder is marked by excessive emotionality, attention-seeking, and dramatic behavior. Clients often display exaggerated expressions, are highly extroverted, and may use physical appearance or provocative behavior to gain attention. They are uncomfortable when not the center of attention and may rapidly shift emotions. Relationships are often perceived as more intimate than they are. Unlike narcissistic or antisocial traits, histrionic features are rooted in emotional expressiveness and social approval-seeking rather than manipulation or grandiosity.
Rationale for correct answer
C. The client’s extroverted and dramatic presentation aligns with the core features of histrionic personality disorder. These individuals thrive on attention and often exaggerate emotions to maintain social engagement and approval.
Rationale for incorrect answers
A. The egotistical and boastful traits are more consistent with narcissistic personality disorder, where self-importance and entitlement dominate, rather than emotional expressiveness.
B. Perfectionistic and rigid behaviors are hallmarks of obsessive-compulsive personality disorder. These clients are focused on control and order, not emotional display or attention-seeking.
D. Manipulative and aggressive traits are more typical of antisocial personality disorder, where rule-breaking and exploitation are central. Histrionic clients may be suggestible but not overtly aggressive.
Take Home Points
- Histrionic personality disorder involves exaggerated emotionality and a strong need to be the center of attention.
- It must be differentiated from narcissistic traits, which focus on grandiosity and entitlement.
- Obsessive-compulsive personality disorder centers on control and perfectionism, not emotional expressiveness.
- Antisocial personality disorder features manipulation and aggression, unlike the socially engaging nature of histrionic traits.
Correct Answer is A
Explanation
Borderline personality disorder is characterized by pervasive instability in relationships, self-image, and affect, often accompanied by impulsivity and intense fear of abandonment. Clients may exhibit splitting, emotional lability, and manipulative behaviors to test boundaries or avoid perceived rejection. They often struggle with identity disturbance and chronic feelings of emptiness. Therapeutic approaches require firm, consistent limits, validation of emotions, and avoidance of reinforcing maladaptive behaviors. Safety concerns may arise due to self-harm or suicidal gestures, but behavioral interventions are prioritized over physical restraints.
Rationale for correct answer
A. Clients with borderline traits often engage in manipulative behaviors such as splitting staff or testing boundaries. Setting firm, consistent limits helps reduce chaos and reinforces therapeutic structure. Limit-setting is essential to maintain safety, reduce emotional dysregulation, and prevent staff burnout. It also models healthy interpersonal boundaries and supports emotional containment.
Rationale for incorrect answers
B. Allowing the client to set limits undermines therapeutic structure and may reinforce maladaptive control-seeking behaviors. These clients often lack internal regulation and benefit from external consistency.
C. Restraints are not a routine intervention for borderline personality disorder. They are reserved for acute safety threats and may escalate distress or reinforce feelings of abandonment and punishment.
D. Acting-out behavior should never be encouraged. It reflects poor impulse control and emotional dysregulation. Reinforcing such behavior increases risk of harm and undermines therapeutic goals.
Take Home Points
- Borderline personality disorder requires firm, consistent limit-setting to manage manipulative and impulsive behaviors.
- Emotional dysregulation and fear of abandonment are core features that drive interpersonal instability.
- Physical restraints are reserved for acute safety concerns and should be used cautiously.
- Encouraging acting-out behaviors worsens emotional instability and undermines therapeutic progress.
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