A nurse is assisting in a group therapy meeting and is sharing a humorous story unrelated to anyone in the group.
When the group laughs at the story, a client who has schizophrenia jumps up and runs out while yelling “You are all making fun of me!” Which of the following behaviors is this client displaying?

Choice A rationale:

Medication compliance is crucial in the management of BPD because:

Instability and Impulsivity: Individuals with BPD often struggle with impulsivity and unstable moods, which can lead to inconsistent medication adherence. They may forget to take their medications, take them at the wrong times, or stop taking them altogether when they feel better or worse. This can disrupt the therapeutic effects of the medications and increase the risk of relapse or worsening symptoms.

Multiple Medications: BPD is often treated with a combination of medications, such as mood stabilizers, antidepressants, and antipsychotics. Each medication has its own unique dosing schedule, side effects, and potential for interactions. Monitoring compliance ensures that the client is taking all medications as prescribed, reducing the risk of adverse events and optimizing treatment outcomes.

Mental Health Stigma: Unfortunately, mental health stigma can contribute to medication noncompliance. Individuals with BPD may feel ashamed or embarrassed about their diagnosis, leading them to hide their medication use or avoid taking medications altogether. By openly discussing medication compliance and addressing any concerns, nurses can help reduce stigma and promote adherence.

Therapeutic Relationship: A strong therapeutic relationship between the nurse and client is essential for promoting medication compliance in BPD. Nurses can foster trust and open communication by:

Actively listening to the client's concerns about medications.

Providing clear and concise education about the purpose and benefits of medications.

Collaborating with the client to develop a medication regimen that fits their lifestyle and preferences.

Regularly assessing medication adherence and addressing any barriers to compliance.

Offering support and encouragement to the client throughout the treatment process.

Choice A rationale:

Providing strategies for redirecting violent behavior is a relevant intervention for individuals with borderline personality disorder, as they may exhibit impulsive and aggressive behaviors. However, it is not the priority in this situation. The immediate focus should be on ensuring the client's safety and preventing self-harm.

Strategies for redirecting violent behavior can be implemented once the client's safety is stabilized. These strategies might include:

De-escalation techniques

Distraction techniques

Time-outs

Setting clear boundaries and expectations

Teaching coping skills for managing anger and frustration Choice B rationale:

Exploring reasons for her behavior is important for understanding the underlying issues that contribute to the client's selfharming behaviors. However, it is not the priority in the initial phase of treatment. The focus should be on ensuring the client's immediate safety and preventing harm.

Once the client is stabilized, exploring the reasons for her behavior can be done through individual therapy, group therapy, or other therapeutic modalities. This exploration can help the client gain insight into her patterns of thinking, feeling, and behaving, and develop healthier coping mechanisms.

Choice C rationale:

Encouraging the client to talk about her feelings is a valuable therapeutic intervention, as it can help the client express and process emotions in a healthy way. However, it is not the priority in the context of borderline personality disorder, where the risk of self-harm is high.

Encouraging emotional expression can be beneficial once the client's safety is ensured and appropriate coping skills are in place. This can be done through individual therapy, journaling, or other expressive arts therapies.

Choice D rationale:

Protecting the client from self-harm behavior is the nurse's priority when working with a client who has borderline personality disorder. This is because individuals with this disorder have a high risk of engaging in self-injurious behaviors, such as cutting, burning, or overdosing on medication.

It is important to implement various safety measures to protect the client, including:

Close observation and monitoring

Removal of potentially harmful objects from the environment

Clear communication of expectations and boundaries

Collaboration with the healthcare team to develop a comprehensive safety plan

Regular assessment of suicide risk