Page | 1
NSG 526 EXAM 3 QUESTIONS WITH
ANSWERS.
Safety Interventions - correct answer -Clients with BPD are
usually admitted to the inpatient setting because of threats of self-
injury. Clients with BPD should be continuously assessed for self-
injurious behavior or suicide attempts. It is important to ask the
client about specific self-abusive behaviors, such as cutting,
scratching, or swallowing. The client may wear long sleeves to
hide injury on the arms. Specifically asking about thoughts of
hurting oneself when experiencing a major upset provides an
opportunity for prevention and for coaching the client toward
alternative self-soothing measures.
Remembering that self-injury is an effort to - correct answer -self-
sooth by activating endogenous endorphins, the advance practice
psychiatric/mental health nurse can assist the client to find more
productive and enduring ways to find comfort. Five Senses
Exercise
Pharmacologic Interventions for bpd - correct answer -Less
medication is better for people with BPD. Clients with BPD may
be taking several medications, particularly if they have a comorbid
disorder, such as a mood disorder or substance abuse.
Pharmacotherapy is used to control emotional dysregulation,
, Page | 2
impulsive aggression, cognitive disturbances, and anxiety as an
adjunct to psychotherapy
Sleep Enhancement - correct answer -Facilitation of regular
sleep-wake cycles may be needed because of disturbed sleep
patterns. Conservative approaches should be exhausted before
recommending medication. Establishing a regular bedtime
routine, monitoring bedtime snacks and drinks, and avoiding
foods and drinks that interfere with sleep should be tried. If
relaxation exercises are used, they should be adapted to the
tolerance of the individual. Moderate exercises (e.g., brisk
walking) 3 to 4 hours before bedtime activates both serotonin and
endorphins, thereby enhancing calmness and a sense of well-
being before bedtime. For clients who have difficulty falling asleep
and experience interrupted sleep, it helps to establish some basic
sleeping routines. The bedroom should be reserved for only two
activities: sleep and sex. Therefore, the client should remove the
television, computer, and exercise equipment from the bedroom.
If the client is not asleep within 15 minutes, he or she should get
out of bed and go to another room to read, watch television, or
listen to soft music. If the client is not asleep in 15 minutes, the
same process should be repeated. Special consideration must be
made for clients who have been physically and sexually abused
and who may be unable to put themselves in a vulnerable
position, such as lying down in a room with other people or
closing their eyes. These clients may need additional safeguards
to help them sleep, such as a night light or repositioning the
furniture to afford easy exit.
, Page | 3
Establishing Personal Boundaries and Limitations - correct
answer -Personal boundaries are highly context specific; for
example, stroking the hair of a stranger on the bus would be
inappropriate, but stroking the hair and face of one's intimate
partner while sitting together would be appropriate. Our personal
physical space needs or boundaries are distinct from behavioral
and emotional limits we have.
Testing limits - correct answer -s a natural way of identifying
where the boundaries are and how strong they are. Therefore, it
is necessary to state clearly the enduring limits (e.g., the written
rules or contract) and the consequences of violating them. The
limits must then be consistently maintained. Clarifying limits
requires making explicit what is usually implicit. Despite the
clinical setting (e.g., hospital, day-treatment setting, outpatient
clinic), the PMH-APRN must clearly state the day, time, and
duration of each contact with the client and remain consistent in
those expectations.
additional strategies for establishing the boundaries of the
relationship include - correct answer -Documenting in the client
chart the agreed-on appointment expectations
Sharing the treatment plan with the client
Confronting violations of the agreement in a non-punitive way
, Page | 4
Discussing the purpose of limits in the therapeutic relationship
and applicability to other relationships.
Behavioral Interventions - correct answer -goal of behavioral
interventions is to replace the dysfunctional behaviors with
positive ones
helping clients control emotions and behavior - correct answer -by
acknowledging and validating desired behaviors and ignoring or
confronting undesired behaviors. if the behavior is irritating but not
harmful or demeaning, it is best to ignore rather than focus on it.
However, grossly inappropriate and disrespectful behaviors
require confrontation. this incident can be used to help the client
understand why such behavior is inappropriate and how it can be
changed. The PMH-APRN should explore with the client what
happened, what events led up to the behavior, what were the
consequences, and what feelings were aroused.
Cognitive Therapeutic Interventions - correct answer -the major
goal of cognitive therapeutic interventions is emotional regulation
- recognizing and controlling the expression of feelings. Clients
often fail even to recognize their feelings; instead, they respond
quickly without thinking about the consequences. Remember, the
time needed for taking action is shorter than the time needed for
thinking before acting. Pausing makes up for the momentary lag
NSG 526 EXAM 3 QUESTIONS WITH
ANSWERS.
Safety Interventions - correct answer -Clients with BPD are
usually admitted to the inpatient setting because of threats of self-
injury. Clients with BPD should be continuously assessed for self-
injurious behavior or suicide attempts. It is important to ask the
client about specific self-abusive behaviors, such as cutting,
scratching, or swallowing. The client may wear long sleeves to
hide injury on the arms. Specifically asking about thoughts of
hurting oneself when experiencing a major upset provides an
opportunity for prevention and for coaching the client toward
alternative self-soothing measures.
Remembering that self-injury is an effort to - correct answer -self-
sooth by activating endogenous endorphins, the advance practice
psychiatric/mental health nurse can assist the client to find more
productive and enduring ways to find comfort. Five Senses
Exercise
Pharmacologic Interventions for bpd - correct answer -Less
medication is better for people with BPD. Clients with BPD may
be taking several medications, particularly if they have a comorbid
disorder, such as a mood disorder or substance abuse.
Pharmacotherapy is used to control emotional dysregulation,
, Page | 2
impulsive aggression, cognitive disturbances, and anxiety as an
adjunct to psychotherapy
Sleep Enhancement - correct answer -Facilitation of regular
sleep-wake cycles may be needed because of disturbed sleep
patterns. Conservative approaches should be exhausted before
recommending medication. Establishing a regular bedtime
routine, monitoring bedtime snacks and drinks, and avoiding
foods and drinks that interfere with sleep should be tried. If
relaxation exercises are used, they should be adapted to the
tolerance of the individual. Moderate exercises (e.g., brisk
walking) 3 to 4 hours before bedtime activates both serotonin and
endorphins, thereby enhancing calmness and a sense of well-
being before bedtime. For clients who have difficulty falling asleep
and experience interrupted sleep, it helps to establish some basic
sleeping routines. The bedroom should be reserved for only two
activities: sleep and sex. Therefore, the client should remove the
television, computer, and exercise equipment from the bedroom.
If the client is not asleep within 15 minutes, he or she should get
out of bed and go to another room to read, watch television, or
listen to soft music. If the client is not asleep in 15 minutes, the
same process should be repeated. Special consideration must be
made for clients who have been physically and sexually abused
and who may be unable to put themselves in a vulnerable
position, such as lying down in a room with other people or
closing their eyes. These clients may need additional safeguards
to help them sleep, such as a night light or repositioning the
furniture to afford easy exit.
, Page | 3
Establishing Personal Boundaries and Limitations - correct
answer -Personal boundaries are highly context specific; for
example, stroking the hair of a stranger on the bus would be
inappropriate, but stroking the hair and face of one's intimate
partner while sitting together would be appropriate. Our personal
physical space needs or boundaries are distinct from behavioral
and emotional limits we have.
Testing limits - correct answer -s a natural way of identifying
where the boundaries are and how strong they are. Therefore, it
is necessary to state clearly the enduring limits (e.g., the written
rules or contract) and the consequences of violating them. The
limits must then be consistently maintained. Clarifying limits
requires making explicit what is usually implicit. Despite the
clinical setting (e.g., hospital, day-treatment setting, outpatient
clinic), the PMH-APRN must clearly state the day, time, and
duration of each contact with the client and remain consistent in
those expectations.
additional strategies for establishing the boundaries of the
relationship include - correct answer -Documenting in the client
chart the agreed-on appointment expectations
Sharing the treatment plan with the client
Confronting violations of the agreement in a non-punitive way
, Page | 4
Discussing the purpose of limits in the therapeutic relationship
and applicability to other relationships.
Behavioral Interventions - correct answer -goal of behavioral
interventions is to replace the dysfunctional behaviors with
positive ones
helping clients control emotions and behavior - correct answer -by
acknowledging and validating desired behaviors and ignoring or
confronting undesired behaviors. if the behavior is irritating but not
harmful or demeaning, it is best to ignore rather than focus on it.
However, grossly inappropriate and disrespectful behaviors
require confrontation. this incident can be used to help the client
understand why such behavior is inappropriate and how it can be
changed. The PMH-APRN should explore with the client what
happened, what events led up to the behavior, what were the
consequences, and what feelings were aroused.
Cognitive Therapeutic Interventions - correct answer -the major
goal of cognitive therapeutic interventions is emotional regulation
- recognizing and controlling the expression of feelings. Clients
often fail even to recognize their feelings; instead, they respond
quickly without thinking about the consequences. Remember, the
time needed for taking action is shorter than the time needed for
thinking before acting. Pausing makes up for the momentary lag
