After being treated in the ED for self-inflicted lacerations to the wrists and arms, a client with a diagnosis of borderline personality disorder is admitted to the psychiatric unit. Which nursing intervention takes priority?

Administer tranquilizing drugs.

Observe client frequently.

Encourage client to verbalize hostile feelings.

Explore alternative ways of handling frustration.

Answer and Explanation

The Correct Answer is B

Borderline personality disorder (BPD) is a complex mental condition characterized by unstable mood, self-image, and interpersonal relationships. Individuals often experience intense emotional swings, impulsivity, and recurrent self-harming behaviors. The disorder involves impaired emotional regulation and an unstable sense of identity, leading to patterns of fear of abandonment, self-injury, or suicidal ideation. The priority in managing these clients is ensuring safety, as self-harm and impulsive acts pose immediate life-threatening risks.

Rationale for correct answer

B. The most critical nursing action is to ensure safety by frequent observation. Clients with borderline personality disorder are at high risk for self-harm or suicide, particularly following emotional distress or interpersonal conflict. Close observation allows early intervention if the client attempts to injure themselves again, thereby preventing life-threatening behavior. Safety monitoring fulfills the physiological need for survival, which takes precedence over emotional or psychosocial care interventions.

Rationale for incorrect answers

A. Administering tranquilizing drugs is not the first-line action unless the client displays acute agitation or psychosis. Medications may help control mood instability but do not prevent self-injury or suicidal behavior, which is the immediate concern.

C. Encouraging the client to verbalize hostile feelings is therapeutic but not the priority intervention during the acute phase after self-harm. Emotional expression can be explored after the client is physically safe and stabilized.

D. Exploring alternative ways of handling frustration is a rehabilitative approach used in later stages of therapy. Initially, the focus must be on observation and safety to prevent recurrence of self-inflicted injuries.

Take Home Points

The primary nursing priority in borderline personality disorder after self-harm is ensuring client safety through close and continuous observation.
Emotional exploration and coping strategy development are secondary to stabilization.
Medication management may support mood control but is not a substitute for safety monitoring.
Interventions progress from meeting physiological needs to addressing psychological and interpersonal aspects as stability improves.

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Correct Answer is B

Explanation

Self-esteem disturbance in individuals with antisocial personality disorder (ASPD) is characterized by a fragile and inflated self-image that compensates for deep feelings of inadequacy. Clients may demonstrate arrogance, manipulation, and a lack of empathy as defenses against internal insecurity. These behaviors often arise from chronic deprivation, neglect, or failure to meet basic psychological needs, leading to distorted self-perception and poor emotional insight. Effective nursing care focuses on developing self-awareness, accountability, and empathy to foster genuine self-esteem rather than superficial grandiosity.

Rationale for correct answer

B. Encouraging self-awareness through critical examination of feelings and behaviors helps the client gain insight into maladaptive coping patterns and the underlying feelings of inferiority masked by boasting or manipulation. This process promotes internal reflection, responsibility, and authentic self-esteem development. It shifts focus from external validation to personal accountability, which is central to managing antisocial traits.

Rationale for incorrect answers

A. Offering to remain with the client during initial interactions is useful for those with anxiety or social withdrawal, not for antisocial personality disorder. These clients often display excessive confidence and do not require supportive presence for social engagement.

C. Recognizing “splitting” staff is crucial in borderline personality disorder, not antisocial. ASPD clients manipulate others for personal gain but do not typically engage in splitting behavior characterized by idealization and devaluation of staff members.

D. Allowing the client to take responsibility for self-care is appropriate for promoting independence, but in this case, it does not address the self-esteem disturbance or the psychological mechanisms sustaining the client’s grandiosity. The focus should be on self-reflection and emotional understanding first.

Take Home Points

Antisocial personality disorder involves inflated self-image masking deep insecurity and lack of empathy.
Encouraging self-awareness and emotional insight is key to improving genuine self-esteem.
“Splitting” behaviors are typical of borderline, not antisocial, personality disorders.
Long-term therapeutic goals focus on accountability, empathy development, and recognition of consequences.

A. Splitting B. Ambivalence C. Passive aggression D. Reaction formation

Correct Answer is A

Explanation

Splitting is a primitive defense mechanism commonly seen in individuals with borderline personality disorder (BPD). It involves an inability to integrate positive and negative aspects of oneself or others into a cohesive whole. As a result, people are viewed as either entirely good or entirely bad, with no middle ground. This black-and-white thinking often leads to unstable relationships, emotional lability, and frequent shifts in idealization and devaluation. Splitting serves as a way to manage intense anxiety and fear of abandonment by simplifying complex emotional experiences.

Rationale for correct answer

A. The client’s statement that others are all “bad” demonstrates polarization, which defines splitting. This mechanism allows the individual to cope with conflicting feelings by categorizing people or experiences as all good or all bad. In BPD, this arises from difficulty tolerating ambivalence, resulting in unstable interpersonal relationships and intense emotional reactions.

Rationale for incorrect answers

B. Ambivalence refers to simultaneous opposing emotions toward the same person or situation. It reflects emotional conflict but not the rigid separation of good and bad qualities characteristic of splitting.

C. Passive aggression involves indirect expression of hostility, such as procrastination or resistance, rather than overtly labeling others as bad. It is a behavioral response, not a cognitive distortion like splitting.

D. Reaction formation occurs when an individual behaves in a way opposite to their true feelings, such as expressing affection toward someone they actually dislike. This differs from splitting, where individuals categorize people into extremes without emotional reversal.

Take Home Points

Splitting is a hallmark defense mechanism in borderline personality disorder.
It reflects an inability to integrate both positive and negative perceptions of self or others.
This defense contributes to unstable relationships and intense emotional shifts.
Treatment focuses on helping clients recognize and integrate conflicting feelings for healthier emotional regulation.

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After being treated in the ED for self-inflicted lacerations to the wrists and arms, a client with a diagnosis of borderline personality disorder is admitted to the psychiatric unit. Which nursing intervention takes priority?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client diagnosed with an antisocial personality disorder is given a nursing diagnosis of self-esteem disturbance related to extreme poverty as evidenced by continual boasting and grandiosity. Which nursing intervention would be appropriate?

Correct Answer is B

Explanation

A client with a diagnosis of borderline personality disorder has negative feelings toward the other clients on the unit and considers them all to be “bad.” Which defense was the client using when this statement was made?

Correct Answer is A

Explanation

Which nursing intervention is most important for a client who has the diagnosis of antisocial personality disorder?

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After being treated in the ED for self-inflicted lacerations to the wrists and arms, a client with a diagnosis of borderline personality disorder is admitted to the psychiatric unit. Which nursing intervention takes priority?