The clients on a mental health unit go on a supervised day trip to a baseball game. When returning to the bus, a client with a narcissistic personality disorder insists on leaving the group to get an autograph from a player. What is the most appropriate response by the nurse?

Hold the client by the arm to prevent leaving the group.

Instruct the client with a loud voice to get in the bus so the group can go home.

Inform the client in a matter-of-fact tone that everyone must remain with the group.

Tell the client that the baseball player will not be permitted to give anyone an autograph.

Answer and Explanation

The Correct Answer is C

Narcissistic personality disorder (NPD) is marked by an exaggerated sense of self-importance, an excessive need for admiration, and a lack of empathy for others. Individuals with NPD often believe that normal rules or expectations do not apply to them and may act entitled or superior. They seek attention and recognition to maintain their inflated self-image. Nursing management focuses on setting firm, consistent limits while maintaining a calm, professional, and non-confrontational approach to prevent escalation or humiliation, which these clients cannot tolerate.

Rationale for correct answer

C. Informing the client in a matter-of-fact tone that everyone must stay with the group establishes clear boundaries without confrontation. This approach reinforces rules consistently while minimizing attention to the client’s attention-seeking behavior. It models respectful authority, maintains group safety, and reduces the likelihood of power struggles, which could reinforce the client’s need for control or superiority.

Rationale for incorrect answers

A. Physically restraining the client without cause is inappropriate unless there is immediate danger. This action could provoke anger, increase resistance, and damage trust, escalating the situation unnecessarily.

B. Using a loud or authoritative tone draws attention to the client, reinforcing their need for admiration and control. It can also embarrass or provoke the client, leading to defiance or aggression.

D. Telling the client the player will not give autographs introduces unnecessary information and may lead to argument or denial. It also fails to address the behavioral issue—following group expectations and respecting boundaries.

Take Home Points

Clients with narcissistic personality disorder require firm, consistent, and calm limit setting.
Avoid emotional or confrontational responses that feed attention-seeking behaviors.
Matter-of-fact communication maintains boundaries while preserving dignity and safety.
The goal is to promote compliance with rules without reinforcing entitlement or superiority.

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Free Nursing Study Resources

Correct Answer is ["C","D","G"]

Explanation

Therapeutic communication is a structured, patient-centered approach used to support emotional regulation, insight, and behavioral change. It emphasizes empathy, active listening, and nonjudgmental engagement to promote self-awareness, reduce distress, and foster coping skills. In psychiatric and behavioral settings, therapeutic communication is essential for de-escalating agitation, preventing aggression, and reinforcing adaptive responses to frustration. It avoids punitive or authoritarian tones and instead encourages reflection, problem-solving, and emotional validation.

Rationale for correct answers

C. Helping the patient operate the device demonstrates empathy and problem-solving, reducing frustration by addressing the root cause. It models supportive behavior and reinforces trust in the caregiver-patient relationship.

D. Exploring the patient’s feelings promotes emotional insight, allowing the patient to verbalize internal states rather than act out. This intervention fosters self-regulation and helps identify triggers for future prevention.

G. Encouraging recognition of tension and seeking help builds coping capacity and emotional literacy. It teaches proactive strategies for managing distress and reinforces autonomy in self-regulation.

Rationale for incorrect answers

A. Seclusion is a restrictive intervention reserved for imminent danger. Using it prematurely undermines therapeutic rapport and may escalate feelings of isolation or punishment.

B. Threatening loss of privileges is a punitive approach that increases defensiveness and shame. It lacks supportiveness and does not teach alternative coping mechanisms.

E. Pointing out consequences without emotional processing is confrontational. It may provoke resistance and fails to address underlying emotional dysregulation or skill deficits.

F. Avoiding frustration entirely delays skill development. Exposure with support is necessary for building resilience and adaptive functioning in real-world settings.

Take Home Points

Therapeutic communication prioritizes empathy, emotional insight, and skill-building over punishment or avoidance.
Seclusion and threats should only be used when safety is compromised, not for frustration or emotional dysregulation.
Emotional processing and tension recognition are foundational for teaching self-regulation and preventing future outbursts.
Avoidance of frustration delays coping development; supported exposure fosters resilience and behavioral growth.

A. Establish clear boundaries. B. Explore job possibilities with the nurse. C. Initiate discussion of feelings of being victimized. D. Spend one hour twice a day discussing problems with the nurse.

Correct Answer is A

Explanation

Borderline personality disorder (BPD) is characterized by pervasive instability in relationships, self-image, and affect, often accompanied by impulsive behaviors and fear of abandonment. Clients with BPD typically struggle with emotional regulation and boundaries, frequently oscillating between idealization and devaluation of others. Early in treatment, the therapeutic focus must be on establishing structure, predictability, and safety within the nurse-client relationship to reduce anxiety and maintain behavioral control.

Rationale for correct answer

A. Establishing clear boundaries is the most realistic and essential initial intervention for clients with BPD. Consistent limits help prevent manipulation, splitting, and dependence, while providing a secure framework that promotes trust and emotional containment. Structure allows the nurse to maintain professionalism and avoid enmeshment, supporting the client’s gradual development of internal controls and stability.

Rationale for incorrect answers

B. Exploring job possibilities is premature, as vocational planning requires emotional stability and consistent functioning. Early treatment should focus on safety, boundaries, and basic emotional regulation before addressing long-term goals.

C. Discussing victimization may evoke overwhelming emotions and intensify instability early in therapy. This should occur later, once a trusting and structured therapeutic relationship is established and the client has learned basic coping skills.

D. Spending excessive time with the nurse fosters dependency and reinforces boundary issues, which are central to BPD. Frequent, brief, and predictable contacts are more therapeutic and prevent overattachment or manipulation.

Take Home Points

Initial nursing care for BPD emphasizes structure, consistency, and firm boundaries.
Boundaries promote safety, reduce manipulation, and help stabilize relationships.
Emotional exploration should begin only after trust and control are established.
Excessive nurse availability increases dependency and interferes with therapeutic progress.

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The clients on a mental health unit go on a supervised day trip to a baseball game. When returning to the bus, a client with a narcissistic personality disorder insists on leaving the group to get an autograph from a player. What is the most appropriate response by the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient becomes frustrated and angry when trying to get his MP3 player and headset to function properly and angrily throws it across the room, nearly hitting a peer with it. Which intervention(s) would be the most therapeutic? Select all that apply.

Correct Answer is ["C","D","G"]

Explanation

A client is diagnosed with a borderline personality disorder. What is a realistic initial intervention for this client?

Correct Answer is A

Explanation

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?

A nursing student is learning about narcissistic personality disorder. Which student statement indicates that learning has occurred?

A client diagnosed with a borderline personality disorder is given a nursing diagnosis of disturbed personal identity related to unmet dependency needs as evidenced by the inability to be alone. Which nursing intervention would be appropriate?

A 15-year-old client living in a residential facility has a nursing diagnosis of ineffective coping related to abuse as evidenced by defiant responses to adult rules. Which of the following interventions would address this nursing diagnosis appropriately? Select all that apply.

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

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?

A client with a personality disorder tells a nurse, “I want to tell you something, but you must promise to keep it a secret.” Which response could lead to splitting among the staff?

The clients on a mental health unit go on a supervised day trip to a baseball game. When returning to the bus, a client with a narcissistic personality disorder insists on leaving the group to get an autograph from a player. What is the most appropriate response by the nurse?