A patient with borderline personality disorder and a history of ...

[ap345]

A patient with borderline personality disorder and a history of self-mutilation has now begun dialectical behavior therapy on an outpatient basis. Counseling focuses on self-harm behavior management. Today the patient telephones to say,
 
  I'm feeling empty and want to cut myself. The nurse should:
 
  a. arrange for emergency inpatient hospitalization.
  b. send the patient to the crisis intervention unit for 8 to 12 hours.
  c. assist the patient to identify the trigger situation and choose a coping strategy.
  d. advise the patient to take an antianxiety medication to decrease the anxiety level.

Question 2

The most challenging nursing intervention with patients with personality disorders who use manipulation to get their needs met is:
 
  a. supporting behavioral change.
  b. monitoring suicide attempts.
  c. maintaining consistent limits.
  d. using aversive therapy.

[Kdiggy]

Answer to Question 1

ANS: C
The patient has responded appropriately to the urge for self-harm by calling a helping individual. A component of dialectical behavior therapy is telephone access to the therapist for coaching during crises. The nurse can assist the patient to choose an alternative to self-mutilation. The need for a protective environment may not be necessary if the patient is able to use cognitive strategies to determine a coping strategy that reduces the urge to mutilate. Taking a sedative and going to sleep should not be the first-line intervention; sedation may reduce the patient's ability to weigh alternatives to mutilating behavior.

Answer to Question 2

ANS: C
Maintaining consistent limits is by far the most difficult intervention because of the patient's superior skills at manipulation. Supporting behavioral change and monitoring patient safety are less difficult tasks. Aversive therapy would probably not be part of the care plan; positive reinforcement strategies for acceptable behavior are more effective than aversive techniques.