Borderline Personality Disorder (11 Questions)

1.1 Julien, a 28-year-old male, is hospitalized on the mental health unit with a diagnosis of Borderline Personality Disorder (BPD). He was admitted following a recent crisis involving impulsive behavior and emotional dysregulation.

This morning, during your one-on-one interaction with Julien, he tells you, “You’re the only one who understands me. You actually care. All the other nurses here are rude, cold, and don’t even look at me.” He becomes visibly upset when another staff member enters the room and refuses to speak with them.

Clinical Signs:
*Mood swings and intense emotional reactions
*Strong attachment to the nurse
*Rejection and criticism of other staff
*No signs of psychosis, hallucinations, or delusions

Question:
What do you suspect the patient is likely exhibiting? *
1.2 During a team meeting, the nurses discuss that Julien frequently tells one nurse that she is the only one who understands him, then later complains to another nurse that the first is incompetent and doesn't care. This pattern has caused tension among staff and confusion about how to respond.

Question:
As a nursing team, what is the most appropriate approach to effectively manage Julien’s behavior? *
1.3 During an individual therapy session, he tells the nurse, "My doctor is amazing, but all the nurses here are incompetent." This reflects a pattern of idealizing one caregiver while devaluing others, a behavior previously observed by the care team.

Question:
How should the nurse respond to Julien’s comment to maintain therapeutic communication and support emotional regulation? *
1.4 Today, during a routine interaction, he suddenly says to the nurse, "You were so nice yesterday, but today you're just like everyone else — completely useless."

Question:
What is the most appropriate nursing response to support a therapeutic relationship with Julien? *
2.1 Isabelle Martin, a 28-year-old woman diagnosed with Borderline Personality Disorder (BPD) at the age of 20, presents to the clinic for an urgent evaluation. She has a significant history of self-harm and two previous suicide attempts. At present, she is not taking any prescribed medications and has been inconsistently participating in therapy.

Upon arrival, Isabelle is tearful, visibly anxious, and pacing the room. She reports intense sadness and describes frequent arguments with her partner, expressing an overwhelming fear of abandonment. Her speech is rapid and pressured, and her mood shifts quickly, alternating between despair and a desperate need for reassurance. At one point, she says, “I don’t know who I am anymore,” in a broken, distressed tone.
Isabelle admits to having thoughts of self-harm, but denies any current suicidal intent. However, the nurse observes superficial cuts on her forearm, consistent with recent non-suicidal self-injury.

Question:
Based on the initial assessment, which of the following nursing actions should the nurse prioritize? Choose TWO (2) answers *
2.2 Following an episode of self-harm and suicidal ideation, Isabelle Martin has been admitted to the psychiatric unit for close monitoring and stabilization. During her hospitalization, she begins to develop complex interactions with staff that reflect the interpersonal challenges typical of Borderline Personality Disorder (BPD).

During a routine check-in with Nurse Sophie, Isabelle says,

"You are the only one who understands me. Nurse Claire is cold and doesn't care about me at all. I don't want her to be my nurse anymore. Can you please make sure that she doesn't come near me?"

Later that day, Nurse Claire enters the room to provide care. Isabelle immediately remarks,

"Nurse Sophie told me that you don't like me and that you think I'm just faking my problems. She's so much nicer than you are."

The two nurses later consult with each other and review their notes, confirming that Nurse Sophie never made such a statement, and both are concerned about the emotional volatility and pattern in Isabelle's responses.

Question:
What defense mechanism is Isabelle most likely exhibiting? *
3. You are the evening nurse caring for Mme St-Pierre, a 24-year-old patient admitted for emotional instability and impulsive behavior. During medication rounds, she smiles at you warmly and says, "You are the only nurse who actually cares about me. The day nurse, Isabelle, is absolutely terrible; she ignored me all day and refused to give me an extra blanket. I feel safe only with you. Can you please let me stay up past the unit curfew just for tonight?"

Question:
Which nursing response best addresses the defense mechanism of "splitting" while maintaining professional boundaries? *
4. Mme Gagnon, 29 years old, comes to the nursing station with superficial cuts on her left forearm. She is crying and screaming, "I can't take this pain anymore! Look what you made me do because you wouldn't let me use the phone!" The cuts are bleeding slightly but are not life-threatening.

Medical Order: Cleanse wound and apply dressing daily PRN.

Question:
What is the most appropriate therapeutic approach while attending to her physical wounds? *
5. You have been the primary nurse for Mlle Dubé, 21 years old, for the past three days. You have built a good rapport. It is now Friday afternoon, and you inform her that you are off for the weekend. Mlle Dubé immediately becomes enraged, throws her cup of water on the floor, and screams, "I knew it! You are just like everyone else! You are abandoning me because you hate me! I’m going to kill myself if you leave!"

Question:
How do you interpret this behavior and what is the best response? *
6. M. Tremblay, 30 years old, is diagnosed with BPD and has a history of impulsive substance abuse and angry outbursts. He is currently pacing the hallway, clenching his fists, because his doctor refused to increase his dose of Benzodiazepines. He tells you, "I feel like punching a hole in the wall. I need to get this energy out."

Question:
Using principles from Dialectical Behavior Therapy (DBT), what coaching intervention can you offer? *
7. During the interdisciplinary team meeting, the staff is discussing Mme Lavoie, a patient with severe Borderline Personality Disorder. The discussion becomes heated. One nurse says, "She is impossible! She rings the bell every 5 minutes!" Another nurse argues, "No, she is just misunderstood; you are all being too hard on her, she is actually very sweet." The team is clearly divided.

Question:
What is the priority administrative/clinical intervention for this team? *