A nurse is teaching a client with borderline personality disorder to reshape thinking patterns. What is an example of a cognitive restructuring technique that would be helpful for this client?

Choice A reason: Increasing age is a recognized risk factor for suicide, particularly among older adults who may face isolation, chronic illness, or loss of loved ones.

Choice B reason: Substance abuse is a major risk factor. Drugs and alcohol impair judgment, increase impulsivity, and worsen psychiatric symptoms, all of which elevate suicide risk.

Choice C reason: Physical illness, especially chronic or terminal conditions, increases suicide risk. Pain, disability, and loss of independence can contribute to hopelessness and suicidal ideation.

Choice D reason: Living with family is generally protective against suicide. Family presence provides social support, monitoring, and connection, which reduce risk. Therefore, it is not considered a risk factor.

Choice A reason: This response shifts the focus to recovery but does not directly enforce the rule. Clients with antisocial personality disorder often manipulate situations, so vague reasoning may invite further argument.

Choice B reason: This response places responsibility on the supervisor rather than the nurse’s authority. It can encourage manipulation by making the nurse appear powerless.

Choice C reason: This is the most appropriate response because it is clear, firm, and enforces unit rules without emotional reasoning. Consistency and limit-setting are essential when managing antisocial personality disorder to prevent manipulation and maintain boundaries.

Choice D reason: Allowing the client to break the rule “just this once” reinforces manipulative behavior and undermines consistency. It teaches the client that rules can be bent through persuasion, which is counterproductive.