Author Question: A client with borderline personality disorder has had 21 admissions to the mental health unit, each ... (Read 48 times)

KWilfred · **on:** Jul 19, 2018

A client with borderline personality disorder has had 21 admissions to the mental health unit, each
precipitated by a suicide attempt, usually resulting in superficial cuts on the arm.

On this admission
the client has developed a relationship with a highly supportive nurse. The client has progressed to
having a pass to spend an afternoon in a nearby shopping mall. The nurse is shocked when the
emergency department calls to say that the client had just been brought in with multiple self-inflicted
lacerations. The nurse asks a peer, Why? Everything was going well. How could she do this to
me? What response by the other nurse reflects understanding of the client's borderline disorder?
a. I know what you mean. You put a lot of energy into working with this client. It
must be disappointing to have her do something like this..
b. I could have told you this would happen. A client like this always gets you in the
end. I hope this will teach you not to get so involved..
c. I know the client's behavior seems personal, but it's really not. Clients with
borderline disorder act out to relieve anxiety, and I suspect having the pass
provoked a great deal of anxiety..
d. I wonder if all this could have been avoided if I'd clued you in on the client. This
is a usual pattern for her. She burned me once, too, when I first worked here..

Question 2

The intervention by a psychiatric nurse that implements the ethical principle of autonomy is when
the nurse

a. explores alternative solutions with the client, who later chooses one alternative.
b. stays with a client who is demonstrating a high level of anxiety.
c. intervenes when a self-mutilating client attempts to slash her wrists.
d. suggests that two clients who were fighting be restricted to the unit.

bpool94 · **Reply #1 on:** Jul 19, 2018

Answer to Question 1

C
This is the only statement that addresses what would be the priority nursing diagnosis, risk for
self-directed violence, and gives a possible reason for the client's acting out. The other statements
are countertransference reactions.

Answer to Question 2

ANS: A
Autonomy is the right to self-determination, that is, to make one's own decisions. By exploring
alternatives with the client, the client is better equipped to make an informed, autonomous decision.
Options B and C: These actions demonstrate beneficence and fidelity. Option D demonstrates the
principles of fidelity and justice.