A patient with borderline personality disorder who is to be discharged soon threatens to "dosomething" to herself if discharged. Which of the following actions by the nurse would be most important?

Appeared in: SJH Nursing Officer - 2019

Explanation

The immediate priority and first step in managing a patient's threat of self-harm is always assessment.
Discussing the statement directly with the patient allows the nurse to gather critical information about suicidal intent, plan, and means.
This action aligns with the nursing process (Assessment, Diagnosis, Planning, Implementation, Evaluation), which dictates that assessment must precede intervention.
Even with a diagnosis of BPD, where manipulation can be a feature, all suicidal or self-harm ideation must be taken seriously to ensure patient safety.

Why Other Options Were Wrong

Option A: This is an intervention, not an assessment. It is a step that might be taken as part of a safety plan, but only after the immediate risk has been evaluated.
Option C: This is a significant intervention that should only be implemented after a thorough risk assessment confirms it is necessary. Requesting an extension without assessment is a premature action.
Option D: Ignoring any threat of self-harm is negligent, unsafe, and a serious breach of the nurse's duty of care. It could have fatal consequences.

Related Visual

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing management of self-harm threats in a patient with Borderline Personality Disorder (BPD) to guide bedside assessment, documentation, and the next nursing action.
Patients with Borderline Personality Disorder have a significantly high rate of both suicide attempts and completed suicides. Therefore, all expressions of self-harm must be treated as genuine until a thorough assessment proves otherwise.
Accurate and detailed documentation is critical. The nurse must document the patient's exact words, the full suicide risk assessment, all interventions taken, and the patient's response.
What if? If the patient had already made a superficial cut on her wrist while making the statement, the nurse's immediate priority would be to ensure physical safety (e.g., applying pressure to the wound, removing the sharp object) while simultaneously beginning the verbal risk assessment. The action becomes a dual priority of physical first aid and psychiatric assessment.

How to Approach the Question

First, identify the question as a priority-setting problem within a clinical scenario. The keywords 'most important' signal that you must choose the highest priority action.
Analyze the core clinical issue: A patient is threatening self-harm. The diagnosis of BPD is a key detail, suggesting a potential conflict between perceived manipulation and genuine risk.
Recall the fundamental principle of the nursing process: Assessment always precedes Planning and Intervention (ADPIE).
Evaluate each option through the lens of the nursing process:
Option A (ask family to stay) is an intervention.
Option B (discuss the statement) is an assessment.

Concept Tested & Keywords

Concept Tested: Nursing management of self-harm threats in a patient with Borderline Personality Disorder (BPD).
Stem keywords: borderline personality disorder, discharged, threatens, do something to herself
Lead-in keywords: most important
Clinical cues: Patient has borderline personality disorder, which is associated with both manipulative behavior and a high risk of suicide.
Clinical cues: The threat is linked to discharge, a common stressor for patients that can increase feelings of abandonment and suicidality.

Question ID

Q7hTeIwiAbZ18UZadZQ4G4

Reference Book

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 9173-9175, 9171-9173, 9172-9174

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