Question

A client with borderline personality disorder tells the nurse, You're the only nurse who really understands me. The others are mean. The client then asks the nurse for an extra dose of antianxiety medication because of increased anxiety. How should the nurse respond?

1. I'll talk to the physician right away. I don't think they give you enough medicine.
2. I'll have to discuss your request with the team. Can we talk about how you're feeling right now?
3. I don't want to hear you say negative things about the other nurses.
4. You know you can't have extra medication. Why do you keep asking?

Answer 1

The nurse should respond by acknowledging the client's feelings but also adhere to the treatment plan by discussing the medication request with the team, and redirect the conversation to how the client is currently feeling.

Step-by-step explanation:

When dealing with a client who has borderline personality disorder (BPD), it's important to maintain professional boundaries while providing compassionate care. A client's idealization of certain staff members, as well as devaluation of others, is a common behavior in BPD known as 'splitting'. When the client requests an extra dose of antianxiety medication, the appropriate response as a nurse should be centered on maintaining the therapeutic relationship and ensuring the safety and well-being of the client, which includes adhering to the prescribed medication plan.

The nurse should respond by validating the client's feelings, stating the importance of discussing the medication request with the treatment team, and focusing on the client's current emotional state. Therefore, the best response would be: "I'll have to discuss your request with the team. Can we talk about how you're feeling right now?" This approach respects the client's feelings, supports a multidisciplinary approach to care, while also setting appropriate boundaries on medication administration.