A client with borderline personality has a history of unsuccessful suicidal behavior. After creating a safe environment for this client, the nurse should implement which intervention?
Direct the client to make a personal inventory of his resentful situations.
Have the client work on addressing the source of his pain and anger.
Address with the client how to document problematic conditions as they arise.
Tell the client to verbalize disturbing and disorganized thoughts as they occur.
The Correct Answer is D
Borderline personality disorder is marked by pervasive instability in mood, self-image, and interpersonal relationships, often accompanied by impulsivity and recurrent suicidal behavior. Clients may experience intense emotional dysregulation, fear of abandonment, and transient psychotic symptoms under stress. Verbalization of internal experiences helps externalize distress, reduce impulsive actions, and allows for therapeutic intervention. Safety is prioritized through structured communication and emotional containment.
Rationale for correct answer
D. Encouraging the client to verbalize disturbing thoughts promotes emotional regulation and early intervention. It allows the nurse to assess for escalating risk, validate the client’s experience, and implement safety measures. This approach supports therapeutic alliance and reduces impulsive self-harm.
Rationale for incorrect answers
A. Focusing on resentment may intensify negative affect and reinforce maladaptive rumination. This can escalate emotional dysregulation and does not provide immediate containment or safety for suicidal ideation.
B. Addressing the source of pain is a long-term therapeutic goal, not an acute intervention. In early stabilization, this may overwhelm the client and increase vulnerability to self-harm without adequate coping strategies.
C. Asking the client to document problematic conditions may be cognitively demanding during emotional crises. It lacks immediacy in addressing suicidal ideation and may not provide the emotional support needed in acute phases.
Take Home Points
- Clients with borderline personality disorder benefit from structured, supportive environments that prioritize emotional safety.
- Encouraging verbalization of distress helps prevent impulsive self-harm and builds therapeutic trust.
- Acute interventions should focus on containment, not deep emotional processing or cognitive tasks.
- Long-term therapy may address core issues like abandonment fears, trauma, and interpersonal dysfunction, but not during crisis stabilization.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Narcissistic personality disorder is defined by a pervasive pattern of grandiosity, need for admiration, and lack of empathy. Individuals often display arrogance, exaggerate achievements, and expect special treatment. Beneath this exterior lies a fragile self-esteem, making them vulnerable to criticism. They often exploit others for personal gain and show little regard for others’ feelings. Their interpersonal relationships are superficial, and they may become enraged or dismissive when their inflated self-image is challenged. Unlike borderline or paranoid traits, their core defense is entitlement and superiority, not fear or mistrust.
Rationale for correct answer
A. The hallmark of narcissistic personality disorder is entitlement, where the individual believes they deserve special privileges and admiration without reciprocation. This belief fuels interpersonal conflict, as they expect others to comply with their expectations and may react with rage or disdain when not treated as superior. Entitlement is central to their interpersonal dysfunction and is a key diagnostic feature.
Rationale for incorrect answers
B. Fear of abandonment is characteristic of borderline personality disorder, not narcissistic traits. While narcissistic individuals may react strongly to rejection, it stems from wounded pride rather than abandonment anxiety.
C. Hypersensitivity to rejection is more aligned with avoidant personality disorder. Narcissistic individuals may react to criticism with anger or devaluation, but not due to social inhibition or fear of disapproval.
D. Suspiciousness is a core feature of paranoid personality disorder. Narcissistic individuals may be defensive, but they do not typically exhibit pervasive mistrust or interpret others’ actions as malevolent.
Take Home Points
- Entitlement is a defining feature of narcissistic personality disorder, driving interpersonal conflict and expectations of special treatment.
- Narcissistic individuals may react to criticism with rage or devaluation, but not due to abandonment fears.
- Differentiating narcissistic traits from borderline or avoidant personality disorders requires assessing the motivation behind interpersonal reactions.
- Suspiciousness and mistrust are more consistent with paranoid personality disorder, not narcissistic pathology.
Correct Answer is C
Explanation
Borderline personality disorder is marked by pervasive instability in relationships, affect, and self-image, often accompanied by impulsivity and recurrent self-harming behaviors. Individuals may experience intense emotional reactions to perceived abandonment, leading to suicidal gestures or overdoses. They often have a history of unstable interpersonal relationships and may engage in self-mutilation as a maladaptive coping strategy. These behaviors are not necessarily driven by a desire to die but rather to regulate overwhelming emotions or elicit care. The condition is more prevalent in young women and requires structured, empathetic, and consistent therapeutic approaches.
Rationale for correct answer
C. The combination of impulsive overdose, wrist cutting, and unstable romantic relationships strongly supports borderline personality disorder. These behaviors reflect emotional dysregulation and fear of abandonment, hallmark features of the disorder.
Rationale for incorrect answers
A. Narcissistic personality disorder involves grandiosity and need for admiration, but does not typically present with self-harm or impulsive suicidal behavior following relationship loss.
B. Histrionic personality disorder features attention-seeking and dramatic emotional expression, but lacks the recurrent self-injurious behavior and emotional instability seen in borderline personality disorder.
D. A severe depressive episode may include suicidal ideation, but the pattern of repetition and impulsivity, along with unstable relationships and self-mutilation, points more specifically to a personality disorder rather than a mood episode.
Take Home Points
- Borderline personality disorder often presents with impulsive self-harm and emotional instability triggered by interpersonal stress.
- It must be differentiated from mood disorders and other personality disorders that lack recurrent self-injurious behavior.
- Management includes dialectical behavior therapy, mood stabilizers, and structured therapeutic boundaries.
- Accurate diagnosis is essential to guide appropriate treatment and avoid mislabeling behaviors as purely depressive or manipulative.
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