Personality and Mood Disorders Q 26
A client with borderline personality disorder is admitted to the unit after slashing his wrist. Which of the following goals is most important after promoting safety?
A. Establish a therapeutic relationship with the client.
B. Identify whether splitting is present in the client’s thoughts.
C. Talk about the client’s acting out and self-destructive tendencies.
D. Encourage the client to understand why he blames others.
Correct Answer: A. Establish a therapeutic relationship with the client.
After promoting safety, the nurse establishes a rapport with the client to facilitate appropriate expression of feelings. At this time, the client isn’t ready to address the unhealthy behavior. A therapeutic relationship must be established before the nurse can effectively work with the client on self-destructive tendencies and the issues of splitting.
Option B: Identify feelings experienced before and around the act of self-mutilation. Feelings are a guideline for future intervention (e.g., rage at feeling left out or abandoned). Explore with the client what these feelings might mean.
Option C: Work out a plan identifying alternatives to self-mutilating behaviors. Anticipate certain situations that might lead to increased stress (e.g., tension or rage). Identify actions that might modify the intensity of such situations.
Option D: Set and maintain limits on acceptable behavior and make clear client’s responsibilities. If the client is hospitalized at the time, be clear regarding the unit rules. Clear and non-punitive limit setting is essential for decreasing negative behaviors.