A nurse is planning overall strategies to address problems for a client who has borderline personality disorder. Which of the following strategies is the priority for the nurse to incorporate in the plan of care?

Implement measures to prevent intentional self-inflicted injury.

Discuss the appropriate use of assertive behavior with the client.

Encourage the client to attend weekly support group meetings.

Assist the client to maintain awareness of her thoughts and feelings.

Answer and Explanation

The Correct Answer is A

A. Implement measures to prevent intentional self-inflicted injury:
This choice is the priority. Individuals with borderline personality disorder are at an increased risk of self-harm and suicidal behaviors. Implementing measures to prevent intentional self-inflicted injury, such as close monitoring, removing potentially harmful objects, and creating a safe environment, is crucial to ensuring the client's safety and well-being.

B. Discuss the appropriate use of assertive behavior with the client:
Teaching assertive behavior is an important aspect of therapy for individuals with borderline personality disorder. Learning to express emotions and needs in a healthy, assertive manner can improve their interpersonal skills and relationships. However, this choice is secondary to ensuring the client's safety. Safety concerns need to be addressed before moving on to other therapeutic interventions.

C. Encourage the client to attend weekly support group meetings:
Support group meetings can provide valuable social support and a sense of belonging for individuals with borderline personality disorder. Being part of a supportive community can offer understanding and coping strategies. While this is a beneficial intervention, it is not the priority. Safety concerns and addressing self-harm risk take precedence.

D. Assist the client to maintain awareness of her thoughts and feelings:
Developing self-awareness and emotional regulation skills is essential in managing borderline personality disorder. Techniques such as mindfulness and dialectical behavior therapy (DBT) can help individuals become more aware of their thoughts and emotions. While important for long-term management, this intervention is not the priority when immediate safety concerns are present. Safety should always be the first focus of care.

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Correct Answer is B

Explanation

A. Takes advantage of others for her own benefit:
This behavior is not specific to paranoid personality disorder. Instead, it may be seen in individuals with antisocial personality disorder, who disregard the rights of others and exploit them for personal gain. People with paranoid personality disorder are more characterized by a pervasive distrust of others and a belief that others are out to harm or deceive them.

B. Believes that others are deceiving her:
This is a hallmark symptom of paranoid personality disorder. Individuals with this disorder often exhibit extreme distrust and suspicion, believing that others have hidden motives or are deliberately trying to deceive, harm, or manipulate them. This suspiciousness and belief in the untrustworthiness of others are key features of paranoid personality disorder.

C. Shows exaggerated expression of emotions:
Exaggerated expression of emotions is not a defining characteristic of paranoid personality disorder. People with this disorder tend to display a guarded and suspicious demeanor rather than exaggerated emotional expressions. Their interpersonal interactions are often marked by skepticism and wariness.

D. Demonstrates detachment from others:
Detachment from others is more characteristic of schizoid personality disorder, not paranoid personality disorder. Individuals with schizoid personality disorder tend to be emotionally detached and have limited interest in social interactions. In contrast, individuals with paranoid personality disorder are highly suspicious and tend to assume that others are hostile or malevolent, leading to interpersonal difficulties rooted in their intense distrust.

A. Increased time sleeping B. Inability to express empathy C. Auditory hallucinations D. Difficulty concentrating

Correct Answer is D

Explanation

A. Increased time sleeping:
Increased time sleeping alone is not a specific or direct indicator of PTSD. However, changes in sleep patterns are common in individuals with PTSD, with symptoms like nightmares, insomnia, and disturbances in sleep. These disturbances can lead to increased time in bed, but this alone is not a definitive sign of PTSD.

B. Inability to express empathy:
Inability to express empathy is a complex issue and could be related to various emotional or psychological factors. While people with PTSD can experience difficulties in interpersonal relationships, including issues with empathy, this alone is not a specific indicator of the disorder. PTSD primarily involves symptoms related to re-experiencing trauma, avoidance, negative mood changes, and arousal symptoms.
C. Auditory hallucinations:
Auditory hallucinations, which involve hearing voices or sounds that others do not, are not typically associated with PTSD. This symptom is more commonly linked to conditions like schizophrenia or other psychotic disorders, but it is not specific to PTSD.

D. Difficulty concentrating:
Difficulty concentrating is a common and well-recognized symptom of PTSD. Individuals with PTSD often struggle with focus, memory, and attention due to the intrusion of traumatic thoughts and memories. This symptom can significantly impact their daily functioning and is one of the hallmark features of the disorder.

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A nurse is planning overall strategies to address problems for a client who has borderline personality disorder. Which of the following strategies is the priority for the nurse to incorporate in the plan of care?

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Correct Answer is D

Explanation

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