Recognize the Disorder
Which four personality disorders belong to Cluster B?
Antisocial, Borderline, Histrionic, and Narcissistic Personality Disorders
What is a therapeutic boundary?
A professional limit that maintains safety, consistency, respect, and an appropriate nurse-patient relationship.
A patient says, ‘You’re the only nurse who cares about me.’ What is a therapeutic boundary?
‘I’m glad you feel comfortable talking with me. Our whole team is here to support your care.’
A patient becomes tearful when a nurse ends a conversation. What cues should be recognized?
Distress, possible fear of abandonment, difficulty with separation, and any indicators of self-harm risk.
A patient demands immediate attention while another patient has an urgent medical need. What should the nurse do?
Prioritize the urgent medical need while acknowledging the other patient’s concerns and giving a realistic follow-up plan.
A patient demonstrates intense fear of abandonment, unstable relationships, and impulsivity. Which disorder is most consistent?
Borderline Personality Disorder
A patient requests your personal phone number. What should you do?
Politely decline and explain that communication must remain through appropriate professional channels.
A patient says, ‘If you leave, I’ll be furious!’ What should the nurse say?
’I hear that you’re upset. I need to leave at the scheduled time, and we can plan when to talk again.’
A patient suddenly begins yelling when a limit is established. What should the nurse assess first?
Immediate risk of harm, escalating agitation, environmental safety, and the patient’s ability to communicate
A patient threatens staff verbally but has not become physically aggressive. What is the priority?
Maintain safety, use calm verbal de-escalation, establish clear limits, and summon assistance as needed.
A patient repeatedly violates others’ rights, deceives others, and shows little remorse. Which disorder is most consistent?
Antisocial Personality Disorder
A patient repeatedly requests extra time after a scheduled session. What is the best response?
Acknowledge the need, reinforce the agreed time limit, and offer an appropriate scheduled opportunity to talk.
A patient says, ‘The other nurse is terrible. You’re better.’ How should you respond?
’It sounds like you’re frustrated. Tell me what happened so we can address your concern together.’
A patient says, ‘Nobody cares about me,’ after a staff change. What is the likely nursing priority?
Assess emotional distress and safety, validate feelings, and maintain predictable communication.
A patient with borderline personality disorder reports an urgent medical need to self-harm. What should the nurse do first?
Immediately assess safety, suicidal intent, plan, means, and need for observation or emergency intervention.
A patient displays grandiosity, a need for admiration, and difficulty empathizing with others. Which disorder is most consistent?
Narcissistic Personality Disorder
A patient asks one nurse to override a limit established by another nurse. What should the team do?
Maintain consistent limits, communicate with one another, and avoid reinforcing staff splitting.
A patient says, ‘You have to make an exception for me.’ What should you say?
’I understand this is important to you. The same safety expectations apply to everyone, and I can help you explore other options.’
A patient repeatedly attempts to turn staff members against each other. What nursing hypothesis should be prioritized?
Inconsistent boundaries may be reinforcing splitting; the team needs a coordinated, therapeutic care plan.
A patient repeatedly crosse boundaries during group therapy. What intervention is best?
Calmly reinforce agreed group rules, redirect the behavior, and maintain consistent expectations.
A patient consistently seeks attention and expresses emotions in a dramatic, rapidly changing manner. Which disorder is most consistent?
Histrionic Personality Disorder
A patient offers an expensive gift in exchange for special treatment. How should the nurse respond?
Decline the gift respectfully, explain professional boundaries, and follow facility policy
A patient say, ‘If you don’t do what I want, I’ll hurt myself.’ What is the response?
’I’m concerned about your safety, and I take what you said seriously. I’m going to stay with you and get the team to help assess and keep you safe.’
After setting a boundary, what indicates that the intervention is effective?
The patient remains safe, understands expectations, uses coping skills, and engages in communication without boundary violations.
A patient is escalating despite verbal de-escalation. What should the nurse prioritize?
Protect patient and staff safety, call for trained assistance, reduce stimulation, and use the least restrictive safe intervention according to policy.