A nurse on a mental health unit caring for a client. Exhibits The nurse is planning care for the client. Which of the following actions should the nurse plan to take? (Select all that apply)

A. The client’s recent suicide attempt and history of self-injury, as noted in the DSM-5 criteria for borderline personality disorder (BPD), indicate a high risk for recurrent suicidal behavior. Assessing for current thoughts of self-harm or harm to others is essential to ensure safety, directly addressing Maslow’s physiological and safety needs. B. The client’s anxiety, restlessness, and difficulty focusing reflect affective dysregulation, a hallmark of BPD per DSM-5. Encouraging verbalization of feelings helps the client process emotions, reducing impulsive behaviors like outbursts, and supports emotional stability. C. Establishing consequences for behaviors like yelling may escalate emotional instability in BPD clients, as DSM-5 notes their sensitivity to perceived rejection. This approach risks increasing impulsivity or self-harm, making it inappropriate for the client’s care plan. D. Teaching coping mechanisms like relaxation techniques addresses the client’s reported anxiety and sleep difficulties, aligning with DSM-5’s focus on emotional instability in BPD. These strategies meet Maslow’s physiological need for rest and help manage distress. E. Bargaining with the client when setting expectations undermines the consistent boundaries needed for BPD management, per DSM-5. It may reinforce manipulative behaviors, as seen in the client’s impulsive outburst and remorse, and is not therapeutic. F. The client’s unstable interpersonal interactions, such as yelling at staff and subsequent panic, align with DSM-5 BPD criteria of volatile relationships. Clear boundaries provide structure, promote safety, and support a therapeutic environment for the client and others.