Mental health chapter 18
Emotional regulation skills are taught to those diagnosed with borderline personality disorder to manage what? Impulsive behaviors Psychotic behaviors Physical disability Problem solving
Impulsive behaviors
Avoidant, dependent, and obsessive-compulsive personality disorders are characterized by what? Dramatic or erratic behaviors Odd or eccentric behaviors Manic or withdrawn behaviors Anxious or fearful behaviors
Anxious or fearful behaviors
A client with a personality disorder is upset and calls the nurse a "stupid cow." Which is an effective initial response to this client's behavior? Demonstrate empathy by reaching out to touch the client. Discuss displacement of anger and set limits. Walk away from the client. Report the behavior to the health care provider so that consistency and consequences can be followed.
Discuss displacement of anger and set limits.
When providing care to a client who consistently attempts to manipulate the staff, the nurse can best maintain the therapeutic milieu by doing what? Promoting social ostracism of the client's exhibiting manipulation Scheduling staff one-on-one time with the client Encouraging questions and discussing the client's concerns Instructing the staff to enforce all unit rules consistently
Instructing the staff to enforce all unit rules consistently
When providing care to a client who consistently attempts to manipulate the staff, the nurse can best maintain the therapeutic milieu by doing what? Scheduling staff one-on-one time with the client Instructing the staff to enforce all unit rules consistently Promoting social ostracism of the client's exhibiting manipulation Encouraging questions and discussing the client's concerns
Instructing the staff to enforce all unit rules consistently
The nurse is admitting a client with histrionic personality disorder to the inpatient unit. The nurse would anticipate that this client may exhibit which behavior?
Self-dramatization
When clients diagnosed with borderline personality disorder (BPD) see nurses as either all good or all bad, the client is using which primitive defense? Invalidating Defending Projective identification Splitting
Splitting
Which is considered the etiology of personality disorders? Related to childhood abuse, neglect, and trauma A combination of psychosocial and biologic variables Genetic predetermination Related to substance abuse
A combination of psychosocial and biologic variables
A nurse is reviewing the medical record of a female client diagnosed with borderline personality disorder (BPD). Which would the nurse identify as one of the strongest risk factors for this disorder? History of depression Parental alcohol abuse Abuse as a child Poverty
Abuse as a child
Which personality disorder would be placed in Cluster B? Schizoid Avoidant Borderline Paranoid
Borderline
Into which personality disorder category are individuals placed whose behavior appears odd or eccentric? Cluster B Cluster A Cluster C Cluster D
Cluster A
Clients with borderline personality disorder (BPD) are usually admitted to an inpatient setting because of what? Splitting Medication noncompliance Agitation Threats of self-harm
Threats of self-harm
Personality disorders occur in approximately what percentage of the general population? 25% 30% 15% 40%
15%
Personality disorders occur in approximately what percentage of the general population?
15%
A nurse is assessing a client diagnosed with avoidant personality disorder. Which would the nurse expect to find? Select all that apply. Detail oriented Feelings of inadequacy Shyness Perfectionism Feelings of superiority
-Feelings of inadequacy -Shyness
When conducting a social history with a client diagnosed with a borderline personality disorder (BPD), which question would be most important to ask the client related to impulsivity? "Do you think of yourself as physically attractive?" "Are you pleased with your medications?" "Are you interested in making your partner happy?" "Do you always practice safe sex?"
"Do you always practice safe sex?"
A nurse is assessing a client diagnosed with avoidant personality disorder. Which would the nurse expect to find? Select all that apply. Feelings of inadequacy Shyness Feelings of superiority Perfectionism Detail oriented
-Feelings of inadequacy -Shyness
A nurse is interviewing a client and suspects that the client may have narcissistic personality disorder. Which statement by the client would help support the nurse's suspicions?
"I have a very important position in life; everyone I know wants to be like me."
The nurse is assessing a client who is diagnosed with borderline personality disorder. Which client statement indicates the client is at risk for self-injurious behavior? "I have felt so down lately. I don't enjoy doing anything anymore." "I do what I do because others tell me to do so." "When I feel extremely anxious, it is like my mind goes somewhere else." "It is almost as if as soon as I think of doing something, I immediately do it."
"I have felt so down lately. I don't enjoy doing anything anymore."
nurse is caring for a client diagnosed with borderline personality disorder. The nurse has instructed the client about using the communication triad. The nurse determines that the client has understood this technique when stating what? "I should start by stating my feelings as an 'I' statement." "I should first tell the other person what I'd like to be different about the situation." "Maybe I should start by describing the situation that has me upset." "I should begin by telling the other person what has triggered my emotion."
"I should start by stating my feelings as an 'I' statement."
A nurse is developing a nurse-client relationship with a client diagnosed with borderline personality disorder (BPD). Which statement by the nurse demonstrates that the nurse understands the client's fears of abandonment and intimacy?
"I will be seeing you during the daytime this week."
The adult children of a client with narcissistic personality disorder meet with the therapist as part of their parent's treatment. The nurse is aware that which statement by the daughter is consistent with behavior typically associated with this personality disorder? "My parent was constantly threatening to commit suicide." "My parent never had any family or friends over to the house." "My parent was always timid and fearful." "My parent never really seemed to see me as a person with my own thoughts and problems."
"My parent never really seemed to see me as a person with my own thoughts and problems."
A client asks the nurse to go to lunch with the client one day next week after the client is discharged. Which statement is the most therapeutic response? "My role here is to help you recover. Let's talk about what else you can be doing after discharge." "I'm sorry, it is not within my role to have any affiliation with you after your discharge." "That sounds good. Call the unit when you decide which day, and we can set it up." "I'd love to do that, but I'm on vacation next week."
"My role here is to help you recover. Let's talk about what else you can be doing after discharge."
A mental health nurse is working with a client with antisocial personality disorder. The nurse has just reviewed the unit rule of one cigarette per break. While telling the client about the unit rules, the client asks, "Well, if I have not done anything bad all day, can I have two cigarettes instead of one?" Which would be the most therapeutic nursing response? "Well, that's a good question. I need to check with the team." "No, only one cigarette is allowed per break time." "It depends on whether or not we can make that exception that day." "This is a good example of trying to push your limits."
"No, only one cigarette is allowed per break time."
A client with borderline personality disorder has been admitted to the inpatient unit because the client has been engaging in wrist cutting. The client's sibling is visiting, and the sibling asks the nurse to explain why the client sometimes does this. Which response by the nurse would be most appropriate? "Sometimes they do it to avoid the onslaught of delusional thinking." "Self-injurious behavior often calms and sedates people with this diagnosis." "Sometimes the self-injurious behavior is undertaken to relieve stress." "The self-mutilation often slows the mood swings your sibling experiences."
"Sometimes the self-injurious behavior is undertaken to relieve stress."
A nursing instructor is teaching about the importance of bonding and how an easy temperament can serve as a protective factor against psychopathology. Which statement made by a student demonstrates a need for further instruction? "Temperament is not changeable." "Temperamental differences among children can be observed very early in life." "Temperament is malleable." "Temperament seen in infancy is often seen later in life."
"Temperament is not changeable."
A psychiatric-mental health nurse is preparing an education plan about antisocial personality disorder for a class of community health nurses. Which would the nurse include as a term often used to describe the behaviors associated with this condition? Select all that apply.
-Psychopath -Sociopath
A client is diagnosed with avoidant personality disorder. When assessing the client, which would be evident? Select all that apply. Sensitivity to negative comments Fear of rejection Overly outgoing nature Timidity Absence of decision-making ability
-Timidity -Sensitivity to negative comments -Fear of rejection
Which statement by a client with borderline personality disorder (BPD) is an example of catastrophizing? "This is the most awful thing that has ever happened to me." "No one ever listens to me." "I never get what I want." "If I had not made him mad, he wouldn't have hit me."
"This is the most awful thing that has ever happened to me."
When reviewing the history of a client with antisocial personality disorder, which would the nurse expect to find? Select all that apply.
-Episodes involving scams for personal gain -Repeated incidents involving assaults -Lack of remorse for actions
A nurse is preparing a presentation for a group of staff nurses on personality disorders. When describing antisocial personality disorders (ASPD), the nurse would explain that for a person to be diagnosed with the disorder, the person must be at least which age? 15 years 18 years 25 years 21 years
18 years
Treatment approaches for clients with personality disorders generally rely on which modality? Individual therapy Cognitive-behavioral therapy A combination of approaches Pharmacotherapy
A combination of approaches
After teaching a group of nurses about borderline personality disorder, the leader determines that the education was successful when the group identifies that symptoms typically begin in which age group? Young adulthood Middle-age individuals Adolescence Late adulthood
Adolescence
A client comes to the clinic for a follow-up visit. Despite being warm and friendly with the nurse on a previous visit, today the client presents with anger and sarcastic undertones with the same nurse. The client is presenting which behavior commonly seen in borderline personality disorder? Depression Dichotomous thinking Affective instability Identity diffusion
Affective instability
While shopping in a grocery store, a client with borderline personality disorder (BPD) greets the sibling of a neighbor with a great big hug. Then about 5 minutes later, the client walks past the sibling and ignores the sibling. The client is demonstrating what? Dichotomous thinking Affective instability Dissociation Identity diffusion
Affective instability
A group of nursing students is reviewing information about antisocial personality disorder. The students demonstrate understanding of this disorder when they state what? a. An individual must be at least 18 years of age to be diagnosed with the disorder. b.The disorder occurs more frequently in women. c.Alcohol abuse disorder rarely accompanies this disorder. d.The disorder is found primarily in Asian individuals.
An individual must be at least 18 years of age to be diagnosed with the disorder.
When describing the different clusters of personality disorders, the nurse includes which type as being characterized by dramatic or erratic behavior? Select all that apply. Obsessive-compulsive Borderline Paranoid Antisocial
Antisocial Borderline
The nurse is interviewing a client with a history of violence. The client boasts that the client "put a kid in a wheelchair" once when the client was younger and has maimed others. The client states, "Who cares? Life's tough." Violence and insensitivity are associated with which personality disorder? Antisocial personality disorder Borderline personality disorder Histrionic personality disorder Schizoid personality disorder
Antisocial personality disorder
The nurse is interviewing a client with a history of violence. The client boasts that the client "put a kid in a wheelchair" once when the client was younger and has maimed others. The client states, "Who cares? Life's tough." Violence and insensitivity are associated with which personality disorder? Antisocial personality disorder Schizoid personality disorder Histrionic personality disorder Borderline personality disorder
Antisocial personality disorder
Avoidant, dependent, and obsessive-compulsive personality disorders are characterized by what? Manic or withdrawn behaviors Odd or eccentric behaviors Anxious or fearful behaviors Dramatic or erratic behaviors
Anxious or fearful behaviors
A client has a diagnosis of borderline personality disorder and lives at home with the client's parents. The client has been in the psychiatric unit for 2 weeks and is scheduled to be discharged tomorrow. Which would be most therapeutic when the client's parents come in to discuss discharge plans? Ask the parents how they have coped with the client's behaviors over the years Attempt to discuss placing the client into an assisted living environment Encourage the parents to discuss the possibility of the client going into a day-care program when the client goes home Ask the parents to keep a written schedule of activities for each day for the client
Ask the parents to keep a written schedule of activities for each day for the client
Which personality disorder would be placed in Cluster B**? Borderline Avoidant Schizoid Paranoid
Borderline**
A nurse is providing care to a client with borderline personality disorder. When providing for the client's biopsychosocial needs, the nurse would address which in the biologic domain? Assisting with problem solving Establishing boundaries Assisting with sleep measures Establishing a therapeutic relationship
Assisting with sleep measures
A nurse is providing care to a client with borderline personality disorder. When providing for the client's biopsychosocial needs, the nurse would address which in the biologic domain? Establishing boundaries Assisting with sleep measures Establishing a therapeutic relationship Assisting with problem solving
Assisting with sleep measures
Which personality disorder is most commonly found in clinical settings? Antisocial personality Narcissistic personality Histrionic personality Borderline personality
Borderline personality
Which personality disorder is most commonly found in clinical settings? Narcissistic personality Borderline personality Antisocial personality Histrionic personality
Borderline personality
Which occurs when thinking, feeling, or behaviors occur outside a person's awareness? Dissociation Dichotomous thinking Affective instability Impulsivity
Dissociation
A 30-year-old client who has not paid rent in 4 months is being evicted from an apartment. The client is brought to the hospital after the client uses a kitchen knife to cut the client's wrist in response to the stress of the eviction. The client's behavior is consistent with what? Paranoid personality disorder Borderline personality disorder Antisocial personality disorder Schizotypal personality disorder
Borderline personality disorder
A client is admitted to the mental health unit after the client's spouse brings the client to the emergency department. Upon arrival, the spouse explained that the client had been crying all weekend and stating that the client wanted to die. Upon further assessment, the spouse reports that the client always has difficulty controlling anger and frequently worries that the spouse will leave the client. Recently, the client has been getting drunk every night, which the client never used to do. What diagnosis should the nurse suspect applies to this client? Borderline personality disorder Mania Depression Bipolar disorder
Borderline personality disorder
Impulsivity and difficulty controlling anger are characteristic of which mental health diagnosis? Depression Schizophrenia Posttraumatic stress disorder Borderline personality disorder
Borderline personality disorder
The nurse is in the process of planning the care of a psychiatric-mental health client and has specified the following outcome: The client will be free from self-inflicted harm. What is this client's most likely diagnosis? Dependent personality disorder Borderline personality disorder Antisocial personality disorder Schizoid personality disorder
Borderline personality disorder
The nurse is in the process of planning the care of a psychiatric-mental health client and has specified the following outcome: The client will be free from self-inflicted harm. What is this client's most likely diagnosis? Schizoid personality disorder Dependent personality disorder Antisocial personality disorder Borderline personality disorder
Borderline personality disorder
Which cluster of personality disorders is represented by individuals who appear anxious or fearful? Cluster C Cluster B Cluster D Cluster A
Cluster C
A 70-year-old client comes to the clinic with the client's daughter for group therapy. The client wants the daughter to do everything with the client, is afraid to be left alone, and is having difficulty making any individual decisions. Interventions for this client would center around the diagnosis of which personality disorder? Schizoid Dependent Antisocial Narcissistic
Dependent
When teaching a client with antisocial personality disorder (ASPD), which approach would be most appropriate for the nurse to use? Negotiation Challenging Lecturing Direct
Direct
Borderline personality disorder (BPD) can be diagnosed beginning in which period?
Early adulthood
A nurse is preparing a teaching plan for a client with antisocial disorder. Which would the nurse most likely employ to promote successful education? Allowing the client to guide the teaching to other topics. Engaging the client in a discussion to direct the topic to the client. Using a lecture approach to provide information. Establishing general goals for teaching.
Engaging the client in a discussion to direct the topic to the client.
Which is considered a part of the social domain of the biopsychosocial interventions for the client diagnosed with borderline personality disorder (BPD)? Self-harm prevention Nutritional management Medication administration Establishing boundaries
Establishing boundaries
The nurse in charge of an inpatient psychiatric unit is frustrated and angry with a client who has borderline personality disorder. Which steps should the nurse take? Confront the client firmly but compassionately about how the client's behavior makes the nurse feel. Ignore the feelings and move on from the client. Examine the nurse's own feelings to discover the source of the nurse's anger. Direct the client to another staff member when the client tries to interact.
Examine the nurse's own feelings to discover the source of the nurse's anger.
Which personality disorder is diagnosed more often in women?
Histrionic
When documenting observations of the behaviors exhibited by a client diagnosed with borderline personality disorder, the nurse can correctly use which terms? Impulsive, self-destructive, unstable Impulsive, aggressive, and manipulative Emotional, dramatic, and theatrical Perfectionistic, rigid, and controlling
Impulsive, self-destructive, unstable
In reviewing the history of a client with borderline personality disorder, the nurse would expect to find which clinical manifestation? Lethargy Unlawful behavior Hallucinations Impulsivity
Impulsivity
A nurse caring for a client with borderline personality disorder (BPD) consistently informs the client of the length of the relationship and routinely prepares the client for termination and the end of hospitalization. Which is the nurse trying to prevent? Maladaptive expression of emotions Mania Depression Poor social skills
Maladaptive expression of emotions
Which personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and a lack of empathy? Narcissistic Obsessive-compulsive Dependent Histrionic
Narcissistic
Which personality disorder is categorized as a Cluster B disorder?
Narcissistic personality disorder
A nurse is preparing an inservice program for a group of mental health nurses on the topic of borderline personality disorder. When discussing the need for hospitalization, which would the nurse include as the most likely reason for inpatient hospitalization? Identity diffusion Nonsuicidal self-injury Dichotomous thinking Affective instability
Nonsuicidal self-injury
A client is diagnosed with a personality disorder manifested by odd, eccentric behavior. Which personality disorder would be associated with this manifestation? Obsessive-compulsive Dependent Avoidant Paranoid
Paranoid
Which personality disorder is characterized by an alteration between hostile self-assertion, such as stubbornness, and excessive dependence?
Passive-aggressive
How does personality disorder differ from personality traits? Personality disorder is usually evident earlier in the person's development than are traits. Personality disorder is usually more long term than are traits. Personality disorder causes impairment in social and occupational functioning, whereas traits do not. Personality traits usually cause the person a great deal of difficulty but only sporadically.
Personality disorder causes impairment in social and occupational functioning, whereas traits do not.
A nurse is conducting a review class on borderline personality disorder. When describing the characteristics associated with this disorder, which would the nurse most likely include? Select all that apply. Thinking that is based on delusions Overinflated self-identity Problems with interpersonal relationships Difficulty regulating moods Impulsive behavior
Problems with interpersonal relationships Difficulty regulating moods Impulsive behavior
Which statement accurately reflects the prognosis for a client with a personality disorder?
Prognosis varies based on the degree of functional impairment and the client's motivation to change.
A client with borderline personality disorder has been admitted to the inpatient unit after being found in the client's parents' bedroom, burning the client's arm with an iron. This injury required a brief stay in the hospital's burn unit prior to transfer to your psychiatric unit. Which is the nursing care priority for this client during the first 24 hours of admission? Working on self-esteem Impulse control Suicidal assessment Protection from self-mutilation
Protection from self-mutilation
A nurse is reviewing the medical record of a client diagnosed with antisocial personality disorder. The nurse notes that the client has had numerous episodes involving irritability, aggressiveness, and impulsivity and has exhibited callousness toward others. Based on this information, which nursing diagnosis would the nurse identify as a priority? Risk for self-directed violence Risk for other-directed violence Risk for suicide Risk for self-injury
Risk for other-directed violence
Which would be the priority nursing diagnosis for a client diagnosed with borderline personality disorder (BPD)? Disturbed thought process Ineffective coping Risk for self-mutilation Chronic low self-esteem
Risk for self-mutilation
Which would be the priority nursing diagnosis for a client diagnosed with borderline personality disorder (BPD)? Ineffective coping Risk for self-mutilation Disturbed thought process Chronic low self-esteem
Risk for self-mutilation
The nurse is admitting a client with histrionic personality disorder to the inpatient unit. The nurse would anticipate that this client may exhibit which behavior? Self-dramatization Perfection Distrust Manipulation
Self-dramatization
Clients with borderline personality disorder (BPD) are usually admitted to the inpatient setting because they exhibit what?
Self-harm
A client in the emergency department has self-inflicted wounds on both arms. Assessment reveals that the client was diagnosed with borderline personality disorder 6 months ago, for which the client has been receiving outpatient treatment. The client tells the nurse that the client recently found out the client's therapist is moving and will no longer be able to work with the client. What is the priority nursing diagnosis for this client? Stress Anxiety Self-mutilation Loneliness
Self-mutilation
A client on an inpatient psychiatric unit has features of borderline personality disorder. The client is frequently angry, has an unstable sense of self, and is highly impulsive. The client can be verbally abusive to staff, who feel manipulated by the client's behaviors. Which intervention does the nurse determine as priority? Stress management techniques Setting limits Increased recreational therapy Social skills training
Setting limits
A client with borderline personality disorder (BPD) tells the nurse, "You are good but the nurse on the afternoon shift is bad. The doctor is bad, too, but the therapist is good." The nurse interprets this statement as reflecting what? Identity diffusion Cognitive schema Dissociation Splitting
Splitting
The nurse is providing care for a client who has been diagnosed with antisocial personality disorder. Which outcome should the nurse prioritize when planning this client's care?
The client will to express anger in an adaptive, nonviolent manner
The nurse-therapist is conducting a group therapy session in which one of the participants is an adult who has been diagnosed with narcissistic personality disorder. The nurse recognizes the significance of childhood experiences in the etiology of personality disorders, which for this client may have included what pattern? The client's parent catered to the client's every need and the client used temper tantrums to successfully get the client's way. The client's parent was a rigid disciplinarian who demanded complete subservience from both the client and the client's other parent. The client's parent was in a constant state of crisis and depended heavily on the client for emotional support. The client's parents had excessively high performance expectations of the client and failure was met with severe sanctions.
The client's parent catered to the client's every need and the client used temper tantrums to successfully get the client's way.
Which is a technique used to help the client with borderline personality disorder gain control over self-critical thoughts? Communication triad Delay gratification Thought stopping Affective instability
Thought stopping