A nurse is caring for a client who has borderline personality disorder. Which of the following defense mechanisms is commonly used by clients who have this disorder and has the potential to create division amongst the healthcare team?

Splitting

Regression

Denial

Reaction formation

Answer and Explanation

The Correct Answer is A

A. Splitting is a defense mechanism in which the client perceives people or situations as all good or all bad, with no middle ground. This can create conflict and division among healthcare team members, as the client may idealize one staff member while devaluing another, potentially disrupting team cohesion and continuity of care.

B. Regression involves reverting to earlier developmental behaviors (e.g., childish or dependent actions) under stress, but it does not typically cause division among staff.

C. Denial is the refusal to acknowledge reality or facts of a situation. While it can affect treatment adherence, it does not usually create interpersonal conflict among caregivers.

D. Reaction formation is the expression of behavior that is opposite to true feelings (e.g., acting overly friendly toward someone the client dislikes). While it may be confusing, it generally does not have the same divisive effect on the healthcare team as splitting.

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Correct Answer is D

Explanation

A. Tyramine restrictions are associated with MAO inhibitors, not clozapine or other antipsychotics, so dietary counseling about tyramine is unnecessary for this medication.

B. While medication adherence is important for all antipsychotics to prevent relapse of psychosis, clozapine’s teaching priorities focus more on safety monitoring for serious adverse effects rather than adherence alone.

C. Limiting fluid intake is not a standard precaution for clozapine; hydration is generally encouraged unless there are specific comorbidities requiring fluid restriction.

D. Clozapine carries a risk of agranulocytosis, a potentially life-threatening drop in white blood cells that can increase susceptibility to infections. Clients must undergo regular complete blood counts (CBCs) and absolute neutrophil count (ANC) monitoring, initially weekly, then gradually spaced to every 2–4 weeks if stable, to detect hematologic complications early. Educating the client on this requirement is essential to ensure safe, effective, and compliant use of the medication.

A. Fulfill a promise by allowing a client to visit with family members. B. Explain the importance of treatment to a client who speaks a language different from the nurse. C. Use clinical terminology to help a client better understand their diagnosis. D. Minimize contact with a client who is angry.

Correct Answer is A

Explanation

A. Fulfilling promises demonstrates reliability and integrity, which helps build trust and rapport with clients. Allowing a client to visit with family members as promised reinforces the nurse’s dependability.
B. While explaining treatment is important, if the client speaks a different language, the nurse should use an interpreter or appropriate communication tools. Simply explaining without understanding may not build trust.
C. Using clinical terminology can confuse clients and create barriers to effective communication; rapport is better established through clear, understandable language.
D. Minimizing contact with an angry client may worsen feelings of isolation or mistrust; therapeutic engagement and safety-focused interventions are more effective for building rapport.

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A nurse is caring for a client who has borderline personality disorder. Which of the following defense mechanisms is commonly used by clients who have this disorder and has the potential to create division amongst the healthcare team?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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