A client with borderline personality disorder (BPD) tells the ...

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A client with borderline personality disorder (BPD) tells the nurse, You are good but the nurse on the afternoon shift is bad. The doctor is bad, too, but the therapist is good. The nurse interprets this statement as reflecting which of the fo
 
  A) Splitting
  B) Identity diffusion
  C) Dissociation
  D) Cognitive schema

Question 2

A client with borderline personality disorder has difficulty maintaining boundaries of the therapeutic relationship. Which of the following would be most effective for the nurse to do? Select all that apply.
 
  A) Punish the client with seclusion for violating established boundaries.
  B) Respond to the client's arrogance in a neutral, non-confrontational manner.
  C) Discuss the purpose of the limits in the therapeutic relationship.
  D) State the parameters of the limits and boundaries clearly.
  E) Ensure that any established limits are maintained consistently.

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Answer to Question 1

Ans: A
Persons with BPD view the world in absolutes; nurses and other treatment team members are alternately categorized as all good or all bad. This defense is called splitting, and presents clinicians with a challenge to work openly with each other, as well as the client, until the issue can be resolved through team meetings and clinical supervision. Identity diffusion occurs when a person lacks aspects of personal identity or when personal identity is poorly developed. Dissociation is a cognitive dysfunction reflected as thinking, feeling or behaving outside a person's awareness. Cognitive schema refers to patterns of thoughts that determine how a person interprets events.

Answer to Question 2

Ans: B, C, D, E
When setting limits to maintain boundaries, the nurse must clearly state the limits and consequences for violating them, and ensure that they are consistently maintained. In addition, the nurse must respond to a client's arrogance in a neutral manner that avoids confrontation and a power struggle. The nurse also should discuss the purpose of the limits in the therapeutic relationship and confront violations in a nonpunitive way.

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