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Difficulty: MediumMental Health Concepts

While completing evening rounds, the nurse is approached by a client with borderline personality disorder. The client states, "You are the only person working here who actually understands me. The day shift nurse was completely heartless and refused to let me make a phone call." Which of the following is the most appropriate response by the nurse?

  1. A
    I am sorry the day staff upset you; I will grant you extra time on the phone this evening.
  2. B
    Why do you believe the day shift nurse was being heartless toward you?
  3. The unit policy allows telephone access between 1900 and 2100. Let's review the schedule together.Answer
  4. D
    The staff members on this unit are highly qualified and would not intentionally ignore you.

Answer

The most appropriate response is to state the established unit rules regarding telephone privileges and review the schedule with the client.
The correct response sets firm, objective limits by redirecting the client to established unit policies. Clients with borderline personality disorder often use splitting (idealizing one person while devaluing another) to manipulate staff and test boundaries. A neutral, factual response that references universal rules prevents the client from successfully dividing the team and reinforces a safe, consistent therapeutic environment.

Step-by-Step Solution

1
Identify the psychiatric concept being demonstrated by the client.
The client, diagnosed with borderline personality disorder, is exhibiting 'splitting' by idealizing the current nurse while devaluing the previous nurse.
Recognizing this classic behavioral pattern is necessary to select a therapeutic and safe intervention.
2
Determine the primary nursing goal when managing splitting behavior.
The primary goal is to maintain consistent unit rules, avoid taking sides, and present a unified, objective staff approach.
Inconsistency or subjectivity allows the client to manipulate boundaries, which is detrimental to the therapeutic milieu.
3
Evaluate the given communication options against psychiatric nursing standards.
Redirecting the client to established unit policies maintains strict boundaries in a neutral, non-judgmental manner.
Alternative responses that defend staff, ask 'why', or grant special privileges are non-therapeutic and actively undermine the collaborative treatment plan.

Key Concept

Therapeutic Communication and Milieu Management for Splitting Behavior
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Topics

Mental Health Concepts

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