Psychiatric care technicians (PCTs) are unlicensed assistive personnel that are an integral part of the acute care mental healthcare team. Which of the following choices would be an example(s) of overdelegation by the nurse to a PCT? The nurse directs the PCT to (Select All that Apply):

Choice A Reason:

Stable and satisfactory relationships. This statement is incorrect. Individuals with borderline personality disorder (BPD) often struggle with maintaining stable and satisfactory relationships. They may experience intense and unstable relationships characterized by extreme fluctuations between idealization and devaluation of others. This instability is a hallmark of BPD and can lead to significant interpersonal difficulties.

Choice B Reason:

Little tolerance for being alone. This statement is correct. One of the defining characteristics of BPD is a profound fear of abandonment and an intense need for companionship. Individuals with BPD often have little tolerance for being alone and may go to great lengths to avoid real or imagined abandonment. This fear can lead to frantic efforts to maintain relationships, even if they are unhealthy or abusive.

Choice C Reason:

Predictability. This statement is incorrect. People with BPD typically exhibit unpredictable and impulsive behaviors. Their emotional responses can be intense and rapidly changing, making their behavior difficult to predict. This unpredictability can further complicate their relationships and daily functioning.

Choice D Reason:

Controlled anger. This statement is incorrect. Individuals with BPD often struggle with controlling their anger. They may experience intense and inappropriate anger, which can be difficult to manage and may result in aggressive or self-destructive behaviors. This difficulty in controlling anger is another key feature of BPD.

Choice A Reason: Is not responding to other clients on the unit.

While a lack of response to other clients can indicate social withdrawal and isolation, which are common in depressive episodes, it does not necessarily indicate an immediate risk to the client’s safety. This behavior is concerning but does not require the highest priority intervention compared to other behaviors that may indicate a risk of self-harm or suicidal ideation.

Choice B Reason: Is refusing to take their prescribed mood stabilizer.

Refusing medication is a significant concern as it can lead to worsening of symptoms and destabilization of the client’s condition. However, this behavior does not indicate an immediate risk to the client’s safety. The nurse should address this issue promptly, but it is not the highest priority compared to behaviors that suggest suicidal ideation.

Choice C Reason: Angrily argues with another client stating, “God is dead.”

This behavior indicates agitation and potential conflict with others, which can be problematic in a clinical setting. However, it does not directly suggest an immediate risk to the client’s safety. The nurse should intervene to de-escalate the situation and provide support, but this is not the highest priority compared to signs of suicidal ideation.

Choice D Reason: States, “There is no future when you feel so depressed.”

This statement is highly concerning as it indicates feelings of hopelessness and potential suicidal ideation. Expressions of hopelessness and statements about the future being bleak are significant risk factors for suicide. The nurse should prioritize this behavior for immediate intervention to assess the client’s risk of self-harm and provide appropriate support and safety measures.