A client with borderline personality disorder has been hospitalized several times after self-mutilating
episodes and suicide attempts. The client has entered dialectical behavior therapy on an outpatient
basis.
During therapy, the advanced practice nurse has been counseling her regarding self-harm
behavior management. Today the client called the nurse and reported that she is "feeling empty and
anxious" and wants to cut her arms. The nurse should
a. arrange for emergency in-patient hospitalization.
b. send her to the crisis intervention unit for 8 to 12 hours.
c. assist the client to identify the trigger situation and choose a coping strategy.
d. advise the client to take an anxiolytic to decrease anxiety level and go to sleep.
C
The client has responded appropriately to the urge to harm herself 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 client to choose an alternative to self-mutilation. Options A and B:
The need for a protective environment may not be necessary if the client is able to use cognitive
strategies to determine a coping strategy that will reduce the urge to mutilate. Option D: Taking a
sedative and going to sleep should not be the first-line intervention because sedation may reduce the
client's ability to weigh alternatives to mutilating behavior.
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