RN Nursing · Personality Disorders · Practice question
A client with borderline personality disorder has been hospitalized several times after self-injurious behavior and suicide attempts. The client has entered cognitive behavior therapy on an outpatient basis. During therapy, the nurse has been counseling her regarding self-harm behavior management. Today the client called the nurse and reported "feeling empty and anxious". Which response by the nurse would best help in this situation?
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"I'm glad you called me. You should take an anxiolytic, then go to sleep.
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"I'm glad you called me. Let's talk about what coping strategies you've learned in therapy that you can use right now when you feel empty and anxious."
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"I'm glad you called me. Let's call your doctor for him to order an emergency admission to an inpatient unit."
Answer & explanation
Correct: "I'm glad you called me. Let's talk about what coping strategies you've learned in therapy that you can use right now when you feel empty and anxious."
For a client with borderline personality disorder (BPD) receiving cognitive behavioral therapy (CBT) for self-harm behavior, the therapeutic goal during outpatient treatment is to reinforce the use of coping skills the client has already been taught rather than resorting to medication or immediate hospitalization. When the client calls reporting feelings of emptiness and anxiety — both core features of BPD — the most therapeutically appropriate response is to acknowledge the call positively and collaboratively explore the coping strategies developed during therapy. This reinforces self-efficacy, maintains the therapeutic alliance, and directly applies the CBT framework. Advising the client to take an anxiolytic and go to sleep bypasses skill-building entirely and could contribute to medication misuse in a population at elevated risk; it also dismisses the emotional content of the call. Immediately arranging emergency admission escalates the situation beyond what the clinical picture warrants and can inadvertently reinforce maladaptive help-seeking patterns in BPD by rewarding crisis behavior with hospitalization rather than building independent coping. The nurse's role here is to be a supportive presence while actively guiding the client toward the skills that empower her to manage distress independently.
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