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.".
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.
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