During an assessment interview, a client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions. Which is the appropriate nursing response to this behavior?
1. "You are very disrespectful. You need to learn to control yourself."
2. "I understand that you are angry, but this behavior will not be tolerated."
3. "What behaviors could you modify to improve this situation?"
4. "What anti-personality disorder medications
have helped you in the past?"
"I understand that you are angry, but this behavior will not be tolerated."
The appropriate nursing response is to reflect the client's feeling while setting firm limits on behavior. Clients diagnosed with antisocial personality disorder have a low tolerance for frustration, see themselves as victims, and use projection as a primary ego defense mechanism.
At 11 p.m. a client
diagnosed with antisocial personality disorder demands to phone a lawyer to file for a divorce. Unit rules state that no phone calls are permitted after 10 p.m. Which nursing response is most appropriate?
1. "Go ahead and use the phone. I know this pending divorce is stressful."
2. "You know better than to break the rules. I'm surprised at you."
3. "It is after the 10 p.m. phone curfew. You will be able to call tomorrow."
4. "A divorce shouldn't be considered until you have had a
good night's sleep."
"It is after the 10 p.m. phone curfew. You will be able to call tomorrow."
The most appropriate response by the staff is to restate the unit rules in a calm, assertive manner. The nurse can encourage the client to verbalize frustration while maintaining an accepting attitude. The nurse may also help the client to identify the true source of frustration.
A client diagnosed with paranoid
personality disorder becomes violent on a unit. Which nursing intervention is most appropriate?
1. Provide objective evidence that reasons for violence are unwarranted.
2. Initially restrain the client to maintain safety.
3. Use clear, calm statements and a confident physical stance.
4. Empathize with the client's paranoid perceptions.
Use clear, calm statements and a confident physical stance.
The most appropriate nursing intervention is to use clear, calm statements and to assume a confident physical stance. A calm attitude provides the client with a feeling of safety and security.
A client diagnosed with borderline personality disorder brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the nursing staff best handle this situation?
1. Allow the clients to apply the democratic
process when developing unit rules.
2. Maintain consistency of care by open communication to avoid staff manipulation.
3. Allow the client spokesman to verbalize concerns during a unit staff meeting.
4. Maintain unit order by the application of autocratic leadership.
Maintain consistency of care by open communication to avoid staff manipulation.
The nursing staff can best handle this situation by maintaining consistency of care by open communication to avoid staff manipulation. Clients with borderline personality disorder can exhibit negative patterns of interaction, such as clinging and distancing, splitting, manipulation, and self-destructive behaviors.
Which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with borderline personality disorder [BPD]?
1. Being firm, consistent, and empathic, while addressing specific client
behaviors
2. Promoting client self-expression by implementing laissez-faire leadership
3. Using authoritative leadership to help clients learn to conform to society norms
4. Overlooking inappropriate behaviors to avoid providing secondary gains
Being firm, consistent, and empathic, while addressing specific client behaviors
The best nursing approach when working with a client diagnosed with borderline personality disorder is to be firm, consistent, and empathetic while addressing specific client behaviors. Individuals with borderline personality disorder always seem to be in a state of crisis and can often have negative patterns of interaction, such as manipulation and splitting.
Which adult client should a nurse identify as exhibiting the characteristics of a dependent personality disorder?
1. A physically healthy client who is dependent on meeting social needs by contact with 15
cats.
2. A physically healthy client who has a history of depending on intense relationships to meet basic needs.
3. A physically healthy client who lives with parents and depends on public transportation.
4. A physically healthy client who is serious, inflexible, perfectionistic, lacks spontaneity, and depends on rules to provide security.
A physically healthy client who lives with parents and depends on public transportation.
A physically healthy adult client who lives with parents and depends on public transportation exhibits signs of dependent personality disorder. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behaviors.
A client expresses low self-worth, has much difficulty making decisions, avoids positions of responsibility, and has a behavioral pattern of "suffering" in silence. Which
statement best explains the etiology of this client's personality disorder?
1. Childhood nurturance was provided from many sources, and independent behaviors were encouraged.
2. Childhood nurturance was provided exclusively from one source, and independent behaviors were discouraged.
3. Childhood nurturance was provided exclusively from one source, and independent behaviors were encouraged.
4. Childhood nurturance was provided from many sources, and independent behaviors were
discouraged.
Childhood nurturance was provided exclusively from one source, and independent behaviors were discouraged.
The behaviors presented in the question represent symptoms of dependent personality disorder. Nurturance provided from one source and discouragement of independent behaviors can contribute to the development of this personality disorder. Dependent behaviors may be rewarded by a parent who is overprotective and discourages autonomy.
Family members of a client ask the nurse to explain the difference between schizoid and avoidant personality disorders. Which is the appropriate nursing response?
1. Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone.
2. Clients diagnosed with schizoid personality disorder exhibit delusions and hallucinations, while clients diagnosed with avoidant
personality disorder do not.
3. Clients diagnosed with avoidant personality disorder are eccentric, and clients diagnosed with schizoid personality disorder are dull and vacant.
4. Clients diagnosed with schizoid personality disorder have a history of psychosis, while clients diagnosed with avoidant personality disorder remain based in reality.
Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone.
The nurse should educate the family that clients diagnosed with avoidant personality disorder desire intimacy but fear it, while clients diagnosed with schizoid personality disorder prefer to be alone.
Which nursing diagnosis should a nurse identify as appropriate when working with a client diagnosed with schizoid personality disorder?
1. Altered thought processes R/T increased stress
2.
Risk for suicide R/T loneliness
3. Risk for violence: directed toward others R/T paranoid thinking
4. Social isolation R/T inability to relate to others
Social isolation R/T inability to relate to others
An appropriate nursing diagnosis when working with a client diagnosed with schizoid personality disorder is social isolation R/T inability to relate to others. Clients diagnosed with schizoid personality disorder appear cold, aloof, and indifferent to others. They prefer to work in isolation and are not sociable.
Looking at a slightly bleeding paper cut, the client screams, "Somebody help me quick! I'm bleeding. Call 911!" A nurse should identify this behavior as characteristic of which personality disorder?
1. Schizoid personality disorder
2. Obsessive-compulsive personality disorder
3. Histrionic personality disorder
4. Paranoid personality disorder
Histrionic personality disorder
The nurse should identify this behavior as characteristic of histrionic personality disorder. Individuals with this disorder tend to be self-dramatizing, attention seeking, over-gregarious, and seductive.
When planning care for a client diagnosed with borderline personality disorder, which self-harm behavior should a nurse expect the client to exhibit?
1. The use of highly lethal methods to commit suicide
2. The use
of suicidal gestures to elicit a rescue response from others
3. The use of isolation and starvation as suicidal methods
4. The use of self-mutilation to decrease endorphins in the body
The use of suicidal gestures to elicit a rescue response from others
The nurse should expect that a client diagnosed with borderline personality disorder may use suicidal gestures to elicit a rescue response from others. Repetitive, self-mutilating behaviors are common in borderline personality disorders that result from feelings of abandonment following separation from significant others.
A nurse tells a client that the nursing staff will start alternating weekend shifts. Which response should a nurse identify as characteristic of clients diagnosed with obsessive-compulsive personality disorder?
1. "You really don't have to go by that schedule. I'd just stay home sick."
2. "There has got to be a hidden
agenda behind this schedule change."
3. "Who do you think you are? I expect to interact with the same nurse every Saturday."
4. "You can't make these kinds of changes! Isn't there a rule that governs this decision?"
"You can't make these kinds of changes! Isn't there a rule that governs this decision?"
The nurse should identify that a client with obsessive-compulsive personality disorder would have a difficult time accepting changes. This disorder is characterized by inflexibility and lack of spontaneity. Individuals with this disorder are very serious, formal, over-disciplined, perfectionistic, and preoccupied with rules.
Which reaction to a compliment from another client should a nurse identify as a typical response from a client diagnosed with avoidant personality disorder?
1. Interpreting the compliment as a secret code used to increase personal power
2. Feeling the compliment was
well deserved
3. Being grateful for the compliment but fearing later rejection and humiliation
4. Wondering what deep meaning and purpose is attached to the compliment
Being grateful for the compliment but fearing later rejection and humiliation
The nurse should identify that a client diagnosed with avoidant personality disorder would be grateful for the compliment but would fear later rejection and humiliation. Individuals diagnosed with avoidant personality disorder are extremely sensitive to rejection and are often awkward and uncomfortable in social situations.
Which factors differentiate a client diagnosed with social phobia from a client diagnosed with schizoid personality disorder?
1. Clients diagnosed with social phobia are treated with cognitive behavioral therapy, whereas clients diagnosed with schizoid personality disorder need medications.
2. Clients diagnosed with
schizoid personality disorder experience anxiety only in social settings, whereas clients diagnosed with social phobia experience generalized anxiety.
3. Clients diagnosed with social phobia avoid attending birthday parties, whereas clients diagnosed with schizoid personality disorder would isolate self on a continual basis.
4. Clients diagnosed with schizoid personality disorder avoid attending birthday parties, whereas clients diagnosed with social phobia would isolate self on a
continual basis.
Clients diagnosed with social phobia avoid attending birthday parties, whereas clients diagnosed with schizoid personality disorder would isolate self on a continual basis.
A client diagnosed with schizoid personality disorder exhibits a profound deficit in the ability to form personal relationships. Clients diagnosed with schizoid personality disorder prefer being alone to being with others and avoid social situations, social contacts, and activities.
Which client symptoms should lead a nurse to suspect a diagnosis of obsessive-compulsive personality disorder?
1. The client experiences unwanted, intrusive, and persistent thoughts.
2. The client experiences unwanted, repetitive behavior patterns.
3. The client experiences inflexibility and lack of spontaneity when dealing with others.
4. The client experiences obsessive thoughts that are externally
imposed.
The client experiences inflexibility and lack of spontaneity when dealing with others.
The nurse should suspect a diagnosis of obsessive-compulsive personality disorder when a client experiences inflexibility and lack of spontaneity. Individuals with this disorder are very serious, formal, and have difficulty expressing emotions. They are perfectionistic and preoccupied with rules.
Which client is a nurse most
likely to admit to an inpatient facility for self-destructive behaviors?
1. A client diagnosed with antisocial personality disorder.
2. A client diagnosed with borderline personality disorder.
3. A client diagnosed with schizoid personality disorder.
4. A client diagnosed with paranoid personality disorder.
A client diagnosed with borderline personality disorder.
The nurse should expect that a client diagnosed with borderline personality disorder would be most likely to be admitted to an inpatient facility for self-destructive behaviors. Clients diagnosed with this disorder often exhibit repetitive, self-mutilating behaviors. Most gestures are designed to elicit a rescue response.
When planning care for clients diagnosed with personality disorders, what should be the goal of treatment?
1. To stabilize the client's pathology by using the correct combination of psychotropic
medications
2. To change the characteristics of the dysfunctional personality
3. To reduce personality trait inflexibility that interferes with functioning and relationships
4. To decrease the prevalence of neurotransmitters at receptor sites
To reduce personality trait inflexibility that interferes with functioning and relationships
The goal of treatment for clients diagnosed with personality disorders should be to reduce inflexibility of personality traits that interfere with functioning and relationships.
Which client situation would reflect the impulsive behavior that is commonly associated with borderline personality disorder?
1. As the day-shift nurse leaves the unit, the client suddenly hugs the nurse's arm and whispers, "The night nurse is evil. You have to stay."
2. As the day-shift nurse leaves the unit, the client suddenly hugs the nurse's arm and states, "I will
be up all night if you don't stay with me."
3. As the day-shift nurse leaves the unit, the client suddenly hugs the nurse's arm, yelling, "Please don't go! I can't sleep without you being here."
4. As the day-shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, "I cut myself because you are leaving me."
As the day-shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, "I cut myself because you are leaving me."
The client who states, "I cut myself because you are leaving me" reflects impulsive behavior that is commonly associated with borderline personality disorder. Repetitive, self-mutilating behaviors are common in clients diagnosed with borderline personality disorders that result from feelings of abandonment following separation from significant others.
Which nursing diagnosis should be prioritized when providing
nursing care to a client diagnosed with paranoid personality disorder?
1. Risk for violence: directed toward others R/T paranoid thinking
2. Risk for suicide R/T altered thought
3. Altered sensory perception R/T increased levels of anxiety
4. Social isolation R/T inability to relate to others
Risk for violence: directed toward others R/T paranoid thinking
The priority nursing diagnosis for a client diagnosed with paranoid personality disorder should be risk for violence: directed toward others R/T paranoid thinking. Clients diagnosed with paranoid personality disorder have a pervasive distrust and suspiciousness of others that result in a constant threat readiness. They are often tense and irritable, which increases the likelihood of violent behavior.
From a behavioral perspective, which nursing intervention is appropriate when caring for a client diagnosed with borderline
personality disorder?
1. Seclude the client when inappropriate behaviors are exhibited.
2. Contract with the client to reinforce positive behaviors with unit privileges.
3. Teach the purpose of anti-anxiety medications to improve medication compliance.
4. Encourage the client to journal feelings to improve awareness of abandonment issues.
Contract with the client to reinforce positive behaviors with unit privileges.
The most appropriate nursing intervention from a behavioral perspective is to contract with the client to reinforce positive behaviors with unit privileges. Behavioral strategies offer reinforcement for positive change.
A highly emotional client presents at an outpatient clinic appointment and states, "My dead husband returned to me during a séance." Which personality disorder should a nurse associate with this behavior?
1. Obsessive-compulsive personality
disorder
2. Schizotypal personality disorder
3. Narcissistic personality disorder
4. Borderline personality disorder
Schizotypal personality disorder
The nurse should associate schizotypal personality disorder with this behavior. The behaviors of people diagnosed with schizotypal personality disorder are odd and eccentric but do not decompensate to the level of schizophrenia.
A nursing instructor
is teaching students about clients diagnosed with histrionic personality disorder and the quality of their relationships. Which student statement indicates that learning has occurred?
1. "Their dramatic style tends to make their interpersonal relationships quite interesting and fulfilling."
2. "Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs."
3. "They tend to develop few relationships because they are strongly independent but generally
maintain deep affection."
4. "They pay particular attention to details, which can interfere with the development of relationships."
"Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs."
The instructor should evaluate that learning has occurred when the student describes clients diagnosed with histrionic personality disorder as having relationships that are shallow and fleeting. These types of relationships tend to serve their dependency needs.
During an interview, which client statement should indicate to a nurse a potential diagnosis of schizotypal personality disorder?
1. "I don't have a problem. My family is inflexible, and my relatives are out to get me."
2. "I am so excited about working with you. Have you noticed my new nail polish, 'Ruby Red Roses'?"
3. "I spend all my time tending my bees. I know a whole lot of information about
bees."
4. "I am getting a message from the beyond that we have been involved with each other in a previous life."
"I am getting a message from the beyond that we have been involved with each other in a previous life."
The nurse should assess that a client who states that he or she is getting a message from beyond indicates a potential diagnosis of schizotypal personality disorder. Individuals with schizotypal personality disorder are aloof and isolated and behave in a bland and apathetic manner. The person experiences magical thinking, ideas of reference, illusions, and depersonalization as part of daily life.
Which nursing diagnosis should be prioritized when providing nursing care to a client diagnosed with avoidant personality disorder?
1. Risk for violence: directed toward others R/T paranoid thinking
2. Risk for suicide R/T altered thought
3. Altered sensory perception R/T
increased levels of anxiety
4. Social isolation R/T inability to relate to others
Social isolation R/T inability to relate to others
The priority nursing diagnosis for a client diagnosed with avoidant personality disorder should be social isolation R/T inability to relate to others. These clients avoid close or romantic relationships, interpersonal attachments, and intimate sexual relationships.
A nurse
is admitting a client with a new diagnosis of a personality disorder. Which of the following would make the nurse question this diagnosis? [Select all that apply.]
1. The client has been diagnosed with sickle cell anemia.
2. The client has an inflated self-appraisal and feels a sense of entitlement.
3. The client has a history of a substance use disorder.
4. The client is odd and eccentric but not delusional.
5. The client has an intellectual developmental disorder.
-The client has been diagnosed with sickle cell anemia.
-The client has a history of a substance use disorder.
-The client has an intellectual developmental disorder.
The DSM-5 states that impairments in personality functioning and the individual's personality trait expression are not better understood as normative for the individual's developmental stage or sociocultural environment. The impairments in personality functioning and the individual's personality trait
expression are not solely due to the direct physiological effects of a substance [e.g., a drug of abuse, medication] or a general medical condition [e.g., severe head trauma]. The nurse would question the diagnosis of a personality disorder in a client with sickle cell anemia. substance use disorder, and intellectual developmental disorder.
Which statements represent positive outcomes for clients diagnosed with narcissistic personality disorder?
[Select all that apply.]
1. The client will relate one empathetic statement to another client in group by day two.
2. The client will identify one personal limitation by day one.
3. The client will acknowledge one strength that another client possesses by day two.
4. The client will list four personal strengths by day three.
5. The client will list two lifetime achievements by discharge.
-The client will relate one empathetic statement to
another client in group by day two.
-The client will identify one personal limitation by day one.
-The client will acknowledge one strength that another client possesses by day two.
The nurse should determine that appropriate outcomes for a client diagnosed with narcissistic personality disorder include relating empathetic statements to other clients, identifying one personal limitation and acknowledging one strength in another client.
A
nurse is caring for a client diagnosed with antisocial personality disorder. Which factors should the nurse consider when planning this client's care? [Select all that apply.]
1. This client has personality traits that are deeply ingrained and difficult to modify.
2. This client needs medication to treat the underlying physiological pathology.
3. This client uses manipulation, making the implementation of treatment problematic.
4. This client has poor impulse control that hinders
compliance with a plan of care.
5. This client is likely to have secondary diagnoses of substance abuse and depression.
-This client has personality traits that are deeply ingrained and difficult to modify.
-This client uses manipulation, making the implementation of treatment problematic.
-This client has poor impulse control that hinders compliance with a plan of care.
-This client is likely to have secondary diagnoses of substance abuse and
depression.
A client is being assessed for antisocial personality disorder. According to the DSM-5, which of the following symptoms must the client meet in order to be assigned this diagnosis? [Select all that apply.]
1. Ego-centrism and goal setting based on personal gratification.
2. Incapacity for mutually intimate relationships.
3. Frequent feelings of being down, miserable, or hopeless.
4. Disregard for and failure to honor
financial and other obligations.
5. Intense feelings of nervousness, tenseness, or panic.
- Ego-centrism and goal setting based on personal gratification.
- Incapacity for mutually intimate relationships.
- Disregard for and failure to honor financial and other obligations.
_______________________ personality disorder is characterized by a profound defect in the ability to form personal relationships or to respond to others in any meaningful emotional way.
Schizoid
_____________________ personality disorder is characterized by colorful, dramatic, and extroverted behavior in excitable, emotional people.
Histrionic
________________________________ personality disorder is characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation.
Dependent
_____________________ personality disorder is a pervasive distrust and suspiciousness of others, such that their motives are interpreted as malevolent.
Paranoid
1. Kim has a diagnosis of BPD. She often exhibits alternating clinging and distancing behaviors. Which of the following is the most appropriate nursing intervention with this type of behavior?
a. Encourage Kim to establish trust in one staff person with whom all therapeutic interaction should take place.
b. Secure a verbal contract from Kim that she will discontinue these behaviors.
c. Withdraw attention if these behaviors continue.
d.Rotate staff members who work with Kim so that she will learn to relate to more than one person.
Rotate staff members who work with Kim so that she will learn to relate to more than one person.
2. Kim, a client diagnosed with BPD, manipulates the staff in an effort to fulfill her own desires. All of the following may be examples of manipulative behaviors in the borderline client except:
a. Refusal to stay in room alone, stating, "It's so lonely."
b. Asking Nurse Jones for cigarettes after 30 minutes, knowing the assigned
nurse has explained she must wait 1 hour.
c.Stating to Nurse Jones, "I really like having you for my nurse. You're the best one around here."
d. Cutting arms with razor blade after discussing dismissal plans with physician.
Refusal to stay in room alone, stating, "It's so lonely.
3. "Splitting" by the client with BPD denotes which of the following?
a. Evidence of precocious development
b. A
primitive defense mechanism in which the client sees objects as all good or all bad
c. A brief psychotic episode in which the client loses contact with reality
d. Two distinct personalities within the borderline client
A primitive defense mechanism in which the client sees objects as all good or all bad
According to Margaret Mahler, predisposition to BPD occurs when developmental tasks go unfulfilled in which of the following phases?
a. Autistic phase, during which the child's needs for security and comfort go unfulfilled
b. Symbiotic phase, during which the child fails to bond with the mother
c. Differentiation phase, during which the child fails to recognize a separateness between self and mother
d. Rapprochement phase, during which the mother withdraws emotional support in response to the child's increasing independence
Rapprochement phase, during which the mother withdraws emotional support in response to the child's increasing independence
5. Jack is a new client on the psychiatric unit with a diagnosis of Antisocial Personality Disorder. Which of the following characteristics would you expect to assess in Jack?
a. Lack of guilt for wrongdoing
b. Insight into his own behavior
c. Ability to learn from past experiences
d. Compliance with authority
Lack of guilt for wrongdoing
6. Milieu therapy is a good choice for clients with antisocial personality disorder because it:
a. Provides a system of punishment and rewards for behavior modification.
b. Emulates a social community in which the client may learn to live harmoniously with others.
c. Provides mostly one-to-one interaction between the client and therapist.
d. Provides a structured setting in
which the client shave very little input into the planning of their care.
Emulates a social community in which the client may learn to live harmoniously with others.
7. In evaluating the progress of Jack, a client diagnosed with Antisocial Personality Disorder, which of the following behaviors would be considered the most significant indication of positive change?
a. Jack got angry only once in group this
week.
b. Jack was able to wait a whole hour for a cigarette without verbally abusing the staff.
c. On his own initiative, Jack sent a note of apology to a man he had injured in a recent fight.
d. Jack stated that he would not start any more fights.
On his own initiative, Jack sent a note of apology to a man he had injured in a recent fight.
8. Which of the following behavioral patterns is characteristic of individuals with narcissistic personality disorder?
a. Overly self-centered and exploitative of others
b. Suspicious and mistrustful of others
c. Rule conscious and disapproving of change
d. Anxious and socially isolated
Overly self-centered and exploitative of others
9. Carol is a nurse who was floated to the psychiatric unit to cover for a staff nurse who called out sick. She encounters a patient who is diagnosed with BPD, and the patient states "Thank goodness they sent you to the unit. No one else here has taken the time to listen to my concerns." This may be an example of which symptom common in BPD?
a. Impulsivity
b. Self-harming behaviors
c. Dissociation
d. Splitting
Splitting
10. Which of the following behavioral patterns is characteristic of individuals with schizotypal personality disorder?
a. Belittling themselves and their abilities
b. A lifelong pattern of social withdrawal
c. Suspiciousness and mistrust of others
d. Overreacting inappropriately to minor stimuli
A lifelong pattern of social withdrawal