MH - Final Exam - Module 7

*paranoid personality disorder* Distrust of others Constantly on guard Hypervigilant- Ready to react to any threat (real or imagined) Insensitive to the feeling of others Tense and irritable Feels others are trying to take advantage of them Attribute their shortcomings to others Do not take responsibility for their own behavior Envious and hostile to others who are successful Can become aggressive and violent (with outbursts)

*Cluster A (odd or eccentric traits):* ▪ characterized by distrust and suspiciousness toward others based on unfounded beliefs that others want to harm, exploit, or deceive the person ATI Ch 16, Mod 7 Lesson Content

*schizoid personality disorder* Inability to form personal relationships Inability to respond to others in emotional manner Prefer to work in isolation Display discomfort in human interaction Cold and aloof Inappropriately serious about everything No Spontaneity Affect is bland

*Cluster A (odd or eccentric traits):* ▪ characterized by emotional detachment, disinterest in close relationships, and indifference to praise or criticism; often uncooperative ATI Ch 16, Mod 7 Lesson Content

*schizotypal personality disorder* Aloof and isolative Live in their own world May by psychotic under stress Distorted thinking Magical thinking Illusion Ideas of reference

*Cluster A (odd or eccentric traits):* ▪ characterized by odd beliefs leading to interpersonal difficulties, an eccentric appearance, and magical thinking or perceptual distortions that are not clear delusions or hallucinations ATI Ch 16, Mod 7 Lesson Content

narcissistic personality disorder Self-centered Lack of empathy Exploit others to fulfill own desires Fragile self-esteem Feel superior, thus entitled to special rights and privileges Exaggerated sense of self- worth

*Cluster B (dramatic, emotional, or erratic traits):* ▪ characterized by arrogance, grandiose views of self-importance, the need for consistent admiration, and a lack of empathy for others that strains most relationships; often sensitive to criticism ATI Ch 16, Mod 7 Lesson Content

antisocial personality disorder Exploit and manipulate others Disregard the law Disregard the rights of others Difficulty establishing stable relationships Experience no guilt and no remorse

*Cluster B (dramatic, emotional, or erratic traits):* ▪ characterized by disregard for others with exploitation, lack of empathy, repeated unlawful actions, deceit, failure to accept personal responsibility; evidence of conduct disorder before age 15, sense of entitlement, manipulative, impulsive, and seductive behaviors; nonadherence to traditional morals and values; verbally charming and engaging. ATI Ch 16, Mod 7 Lesson Content

histrionic personality disorder *priority intervention: promote appropriate behavior*

*Cluster B (dramatic, emotional, or erratic traits):* ▪ characterized by emotional attention-seeking behavior, in which the person needs to be the center of attention; often seductive and flirtatious ATI Ch 16

borderline personality disorder Lack a clear sense of identity Tense and chaotic relationships Always in a state of crisis Affective instability Fluctuating attitudes towards others

*Cluster B (dramatic, emotional, or erratic traits):* ▪ characterized by instability of affect, identity, and relationships, as well as splitting behaviors, manipulation, impulsiveness, and fear of abandonment; often self-injurious and potentially suicidal; ideas of reference are common; often accompanied by impulsivity ATI Ch 16, Mod 7 Lesson Content

dependent personality disorder Lack of self-confidence Submissive/passive Feel helpless when alone Have excess need to be taken care of Allow others to make decisions for them Often tolerate mistreatment by others Have feelings of low self-worth Easily hurt by criticism/disapproval

*Cluster C (anxious or fearful traits; insecurity and inadequacy)* ▪ characterized by extreme dependency in a close relationship with an urgent search to find a replacement when one relationship ends ATI Ch 16, Mod 7 Lesson Content

obsessive-compulsive disorder Overly disciplined Perfectionistic Preoccupied with rules Fear making mistakes Inflexible-lack spontaneity Serious/formal

*Cluster C (anxious or fearful traits; insecurity and inadequacy)* ▪ characterized by indecisiveness and perfectionism with a focus on orderliness and control to the extent that the individual might not be able to accomplish a given task ATI Ch 16, Mod 7 Lesson Content

*avoidant personality disorder* Sensitive to rejection Lead a socially withdrawn life Awkward and uncomfortable in social situations Lonely- express feelings of being unwanted View others as critical betraying

*Cluster C (anxious or fearful traits; insecurity and inadequacy)* ▪ characterized by social inhibition and avoidance of all situations that require interpersonal contact, despite wanting close relationships, due to extreme fear of rejections; have feelings of inadequacy and are anxious in social situations ATI Ch 16, Mod 7 Lesson Content

Interpersonal Theory - Harry Stack Sullivan

*Name this Personality Disorder Theory:* ▪ Emphasized the fact that early relationships with the parenting figure is crucial for personality development. ▪ All human beings are driven for the need for interaction. The purpose of all behavior is to get needs met through interpersonal interactions and reduce anxiety. Mod 7 Lesson Content

Object constancy

*Name this Personality Disorder Theory:* ▪ It basically means having the ability to still have a positive emotional bond with someone when you are also feeling angry, hurt, or disappointed with them. It also means being able to feel emotionally connected to that person when they are not physically around you. ▪ People with Borderline Personality Disorder and Narcissistic Personality Disorder *LACK* this. Mod 7 Lesson Content

Theory of Psychosocial Development - Erik Erikson

*Name this Personality Disorder Theory:* ▪ a person's personality continued to evolve throughout the life span. The successful or unsuccessful completion of each stage affects the person moving to the next phase. Mod 7 Lesson Content

personalization

*Name this cognitive distortion:* ▪ "Everyone always stares at me." ▪ "Don't pretend like you don't know how fat I am." Mod 7 Lesson Content

emotional reasoning

*Name this cognitive distortion:* ▪ "I know I look bad because I feel bloated" Mod 7 Lesson Content

all-or-nothing thinking

*Name this cognitive distortion:* ▪ "If I eat this dessert, I won't be thin." Mod 7 Lesson Content

catastrophizing

*Name this cognitive distortion:* ▪ "If I gain weight, I will die." ▪ "Life isn't worth living if I gain weight." Mod 7 Lesson Content

overgeneralization

*Name this cognitive distortion:* ▪ "No one likes me because I am fat." ▪ "If I could be skinny, I know I'd be popular." Mod 7 Lesson Content

Milieu/Group Therapy

*Name this treatment modality for personality disorders:* Appropriate for others who respond more adaptively to support and feedback from peers. Mod 7 Lesson Content

psychoanalytical psychotherapy

*Name this treatment modality for personality disorders:* Focuses on unconscious motivation/need for seeking total satisfaction from others. Mod 7 Lesson Content

interpersonal psychotherapy (IPT)

*Name this treatment modality for personality disorders:* May require long-term therapy to understand and modify maladaptive behaviors. Mod 7 Lesson Content

cognitive-behavioral therapy (CBT)

*Name this treatment modality for personality disorders:* This therapy helps the client recognize and correct internal mental schemata. Mod 7 Lesson Content

dialectal behavior therapy *it is the most effective*

*Name this treatment modality for personality disorders:* This therapy was developed by Marsha Linehan as treatment for the chronic, self-injurious behavior of clients with a borderline personality disorder. Mod 7 Lesson Content

restricting type of anorexia nervosa

*Name this type of Anorexia Nervosa:* The individual drastically restricts food intake and does not binge or purge. Mod 7 Lesson Content

binge-eating/purging type of anorexia

*Name this type of Anorexia Nervosa:* The individual engages in binge eating and purging behaviors in addition to restricting food intake.???? Mod 7 Lesson Content

non-purging type bulimia

*Name this type of bulimia nervosa:* The client can compensate for binge eating through other means, such as excessive exercise and the misuse of laxatives, diuretics, and/or enemas. Mod 7 Lesson Content

purging type bulimia nervosa

*Name this type of bulimia nervosa:* The client uses self-induced vomiting, laxatives, diuretics and/or enemas to lose or maintain weight. Mod 7 Lesson Content

b. Imbalanced nutrition: Less than body requirements.

A 14-year-old client has just been admitted to the psychiatric unit for anorexia nervosa. She is emaciated and refuses to eat. What is the priority nursing diagnosis for this client? a. Complicated grieving b. Imbalanced nutrition: Less than body requirements. c. Interrupted family processes d. Anxiety (severe) Ch 30 Questions

A. Difficulty in getting along with other members of a group C. Display of defense mechanisms when routines are changed E. Difficulty understanding why it is inappropriate to have a personal relationship with staff

A charge nurse is preparing a staff education session on personality disorders. Which of the following should be included as personality characteristics associated with all of the personality disorders? (Select all that apply.) A. Difficulty in getting along with other members of a group B. Belief in the ability to become invisible during times of stress C. Display of defense mechanisms when routines are changed D. Claiming to be more important than other persons E. Difficulty understanding why it is inappropriate to have a personal relationship with staff ATI Ch 16 Application Exercises

a. Refusal to stay in a room alone, stating, "It's so lonely."

A client diagnosed with borderline personality disorder manipulates the staff in an effort to fulfill her own desires. All of the following may be examples of manipulative behaviors in the borderline patient except: a. Refusal to stay in a room alone, stating, "It's so lonely." b. Asking the nurse for cigarettes after 30 minutes, knowing the assigned nurse has explained she must wait 1 hour. c. Stating to the nurse, "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. Ch 31 Questions

b. "Some medications and psychological treatments have demonstrated effectiveness in reducing binge eating behaviors."

A client has sought help for his concern that he is binge eating and feels like it has "gotten out of control." He asks the nurse what can be done to help him. Which of the following is the most accurate response? a. "Nothing can be done." b. "Some medications and psychological treatments have demonstrated effectiveness in reducing binge eating behaviors." c. "The primary problem is obesity. I can help you set up a calorie-restricted diet." d. "Medications can help with weight loss, but there are no medications effective for reducing binge eating." Ch 30 Questions

d) Imbalanced nutrition, less than body requirements Rationale: This client is malnourished and underweight due to self-induced vomiting and laxative abuse. Nutritional status is compromised, and this problem must be prioritized to establish physiological integrity.

A client is 5′8″ tall and weighs 105 pounds. The client has been taking laxatives daily, and self-induces vomiting after eating. Which is the priority nursing diagnosis for this client? a) Ineffective denial b) Disturbed body image c) Low self-esteem d) Imbalanced nutrition, less than body requirements Eating Disorder PP

b. Binging, purging, normal weight, hypokalemia

A client is hospitalized on the psychiatric unit with a history and current diagnosis of bulimia nervosa. Which of the following symptoms would be congruent with this client's diagnosis? a. Binging, purging, obesity, hyperkalemia b. Binging, purging, normal weight, hypokalemia c. Binging, laxative abuse, amenorrhea, severe weight loss d. Binging, purging, severe weight loss, hyperkalemia Ch 30 Questions

a. Lack of guilt for wrongdoing

A client on the psychiatric unit has a diagnosis of antisocial personality disorder. Which of the following characteristics is consistent with this diagnosis? a. Lack of guilt for wrongdoing b. Insight into his own behavior c. Ability to learn from past experiences d. Compliance with authority Ch 31 Questions

a. Parotid glands appear enlarged. b. Teeth have a "moth-eaten" pattern of tooth decay. c. Client reports that she takes laxatives daily. d. Client's weight is within the expected range.

A client presents in the emergency department with complaints of suicidal ideation. The following information is collected by the nurse. Which of these assessment findings suggests that bulimia nervosa might be a health problem? (Select all that apply.) a. Parotid glands appear enlarged. b. Teeth have a "moth-eaten" pattern of tooth decay. c. Client reports that she takes laxatives daily. d. Client's weight is within the expected range. Ch 30 Questions

C. Inspect the cuts for debris.

A client who has bipolar disorder approaches the nurse and reveals fresh, self-inflicted, superficial cuts going up and down his right arm. Which of the following actions should the nurse take first? A. Implement the client's behavioral modification plan. B. Document the size and location of the cuts. C. Inspect the cuts for debris. D. Administer a tetanus antitoxin. Mod 7 Practice Questions

c. Assess her pain in more detail.

A client with BPD reports to the nurse that she is having abdominal pain and is requesting pain medication. Which action by the nurse is a priority? a. Explore alternative pain management strategies. b. Confront the client about her manipulation to try to get drugs. c. Assess her pain in more detail. d. Set limits on her attempts to cling to the nurse. Ch 31 Questions

d. Rotate staff members who work with the client so that she will learn to relate to more than one person.

A client with a diagnosis of borderline personality disorder exhibits alternating clinging and distancing behaviors with the nurse who has been assigned to her care. The most appropriate nursing intervention with this type of behavior would be to: a. Encourage the client to establish trust in one staff person, with whom all therapeutic interaction should take place. b. Secure a verbal contract from the client that she will discontinue these behaviors. c. Withdraw attention if these behaviors continue. d. Rotate staff members who work with the client so that she will learn to relate to more than one person. Ch 31 Questions

c. "I understand that you are concerned about your weight, and we will talk about the importance of good nutrition, but for now I want you to tell me about your recent invitation to join the National Honor Society. That's quite an accomplishment."

A hospitalized client with bulimia nervosa has stopped vomiting in the hospital and tells the nurse she is afraid she is going to gain weight. Which is the most appropriate response by the nurse? a. "Don't worry. The dietitian will ensure you don't get too many calories in your diet." b. "Don't worry about your weight. We are going to work on other problems while you are in the hospital." c. "I understand that you are concerned about your weight, and we will talk about the importance of good nutrition, but for now I want you to tell me about your recent invitation to join the National Honor Society. That's quite an accomplishment." d. "You are not fat, and the staff will ensure that you do not gain weight while you are in the hospital, because we know that is important to you." Ch 30 Questions

b. Reinforce the rules of the treatment program that all clients are expected to follow.

A male client with antisocial personality disorder was found in a female patient's room on her bed. When instructed to leave the room, the client states, "I'm sick of you telling me what I can or can't do. If I want to carry on a relationship with a female patient, it's my right. I'll do exactly as I please!" Which of these actions by the nurse is a priority at this point? a. Reassure the client that he will have plenty of opportunities with women after he is discharged. b. Reinforce the rules of the treatment program that all clients are expected to follow. c. Escort the client to seclusion. d. Establish a trusting relationship by telling the client that you will make an exception just this once. Ch 31 Questions

C. Plan the client's schedule to allow time for rituals.

A nurse in a mental health facility is planning care for a client who has obsessive-compulsive disorder (OCD) and is newly admitted to the unit. Which of the following actions should the nurse plan to take regarding the client's compulsive behaviors? A. Isolate the client for a period of time. B. Confront the client about the senseless nature of the repetitive behaviors. C. Plan the client's schedule to allow time for rituals. D. Set strict limits on the behaviors so that the client can conform to the unit rules and schedules. Mod 7 Practice Questions

A. Identify the client's nutritional status.

A nurse is admitting a client who has experienced a weight loss of 11 kg (25 lb) in the past 3 months. The client weighs 40 kg (88 lb) and believes she is fat. Which of the following aspects of care should the nurse consider the first priority for this client? A. Identify the client's nutritional status. B. Request a mental health consult. C. Plan a therapeutic diet for the client. D. Provide a structured environment for the client. Mod 7 Practice Questions

C. Attempts to convince other clients to give him their belongings E. Blames others for his past and current problems

A nurse is assisting with a court-ordered evaluation of a client who has antisocial personality disorder. When assessing this client, which of the following are expected findings? (Select all that apply.) A. Demonstrates extreme anxiety when placed in a social situation B. Has difficulty making even simple decisions C. Attempts to convince other clients to give him their belongings D. Becomes agitated if his personal area is not neat and orderly E. Blames others for his past and current problems ATI Ch 16 Application Exercises

A. "I'm scared that you're going to leave me."

A nurse is caring for a client who has avoidant personality disorder. Which of the following statements is expected from a client who has this type of personality disorder? A. "I'm scared that you're going to leave me." B. "I'll go to group therapy if you'll let me smoke." C. "I need to feel that everyone admires me." D. "I sometimes feel better if I cut myself." ATI Ch 16 Application Exercises

D. Decrease anxiety to a tolerable level.

A nurse is caring for a client who has been diagnosed with obsessive compulsive disorder (OCD) and is constantly picking up after others in the day room. The nurse should recognize that the client uses this behavior to do which of the following? A. Limit the amount of time available to interact with others. B. Focus attention on meaningful tasks. C. Manipulate and control others' behaviors. D. Decrease anxiety to a tolerable level. Mod 7 Practice Questions

*B. "I don't like it when you address me with that tone of voice"* Rationale: BPD is described as an emotionally unstable personality. Clients who have BPD might show a wide range of impulsive behaviors in all aspects of their lives, including self-destructive behaviors. The client in this situation has overstepped a limit by addressing the nurse in a less-than-respectful tone of voice. This therapeutic response calls to the client's attention the inappropriate behavior and sets appropriate limits for further communication. This is the best approach to continue communication with this client.

A nurse is caring for a client who has borderline personality disorder (BPD). As part of the client's plan of care, the nurse reviews the day's schedule with the client each morning. As the nurse begins to review the schedule with the client, the client says, "Why don't you shut up already? I can read it myself, you know!" Which of the following responses should the nurse give the client? A. "We do this every day. Why are you so angry with me this morning?" B. "I don't like it when you address me with that tone of voice." C. "I know you can, but are you going to read it or not?" D. "Fine. Here is the schedule, and I will expect you to be on time to your therapies." Mod 7 Practice Questions

B. Splitting

A nurse is caring for a client who has borderline personality disorder. The client says, "The nurse on the evening shift is always nice! You are the meanest nurse ever!" The nurse should recognize the client's statement as an example of which of the following defense mechanisms? A. Regression B. Splitting C. Undoing D. Identification ATI Ch 16 Application Exercises

C. "I understand you have concerns about your weight, but first, let's talk about your recent accomplishments."

A nurse is caring for a client who has bulimia nervosa and has stopped purging behavior. The client tells the nurse about fears of gaining weight. Which of the following responses should the nurse make? A. "Many clients are concerned about their weight. However, the dietician will ensure that you don't get too many calories in your diet." B. "Instead of worrying about your weight, try to focus on other problems at this time." C. "I understand you have concerns about your weight, but first, let's talk about your recent accomplishments." D. "You are not overweight, and the staff will ensure that you do not gain weight while you are in the hospital. We know that is important to you." ATI Ch 19 Application Exercises

A. Believes that others are deceiving him E. Persistently holds onto grudges

A nurse is caring for a client who has paranoid personality disorder. Which of the following findings should the nurse expect? (Select all that apply) A. Believes that others are deceiving him B. Desires to be the center of attention C. Views himself as inferior to others D. Demonstrates a grandiose sense of self-importance E. Persistently holds onto grudges Mod 7 Practice Questions

A. "Life isn't worth living if I gain weight."

A nurse is caring for an adolescent client who has anorexia nervosa with recent rapid weight loss and a current weight of 90 lb. Which of the following statements indicates the client is experiencing the cognitive distortion of catastrophizing? A. "Life isn't worth living if I gain weight." B. "Don't pretend like you don't know how fat I am." C. "If I could be skinny, I know I'd be popular." D. "When I look in the mirror, I see myself as obese." ATI Ch 19 Application Exercises

D. Integrity vs. despair

A nurse is caring for several clients who are at various developmental stages. The nurse should explain that, according to Erikson, acceptance of death is a primary task of which of the following stages of psychosocial development? A. Autonomy vs. shame and doubt B. Generativity vs. stagnation C. Identity vs. role diffusion D. Integrity vs. despair Mod 7 Practice Questions

A. "What is your relationship like with your family?" C. "Would you describe your current eating habits?" E. "Can you discuss your feelings about your appearance?"

A nurse is obtaining a nursing history from a client who has a new diagnosis of anorexia nervosa. Which of the following questions should the nurse include in the assessment? (SATA). A. "What is your relationship like with your family?" B. "Why do you want to lose weight?" C. "Would you describe your current eating habits?" D. "At what weight do you believe you will look better?" E. "Can you discuss your feelings about your appearance?" ATI Ch 19 Application Exercises

B. Hypokalemia D. Slightly elevated body weight

A nurse is performing an admission assessment of a client who has bulimia nervosa with purging behavior. Which of the following is an expected finding? (SATA) A. Amenorrhea B. Hypokalemia C. Yellowing of the skin D. Slightly elevated body weight E. Presence of lanugo on the face ATI Ch 19 Application Exercises

C. Institute consequences for manipulative behavior.

A nurse is planning care for a client who demonstrates manipulative behavior. Which of the following interventions should be included in the plan of care? A. Allow manipulation so as to not raise the client's anxiety. B. Avoid discussing past behaviors with the client. C. Institute consequences for manipulative behavior. D. Bargain with the client to discourage manipulative behavior Mod 7 Practice Questions

D. Implement one-to-one observation during meal times.

A nurse is planning care for a client who has anorexia nervosa with binge-eating and purging behavior. Which of the following actions should the nurse include in the client's plan of care? A. Allow the client to select preferred meal times. B. Establish consequences for purging behavior C. Provide the client with a high-fat diet at the start of treatment D. Implement one-to-one observation during meal times. ATI Ch 19 Application Exercises

A. Dialectical behavior therapy

A nurse is planning discharge for a client who has borderline personality disorder. Which of the following interventions should be included for this client? A. Dialectical behavior therapy B. Behavioral contract C. Bibliotherapy D. Safety plan Mod 7 Practice Questions

A. The client has borderline personality disorder.

A nurse is reviewing the medical record of a client who performs self-injury. Which of the following information should the nurse identify as placing the client at risk for self-harm behaviors? A. The client has borderline personality disorder. B. The client has a parent who has dependent personality disorder. C. The client has a history of bulimia nervosa. D. The client recently received a promotion at work. Mod 7 Practice Questions

C. "I should practice limit-setting to help prevent client manipulation."

A nurse manager is discussing the care of a client who has a personality disorder with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching? A. "I can promote my client's sense of control by establishing a schedule." B. "Self-assessment will help me cope with emotional reactions to client care." C. "I should practice limit-setting to help prevent client manipulation." D. "Maintaining professional boundaries is a priority of client care." ATI Ch 16 Application Exercises

b. Characterizing staff members as either all good or all bad.

A nurse on the psychiatric unit documents that the client was attempting to use "splitting" behaviors with staff. This should be interpreted to mean that the client is: a. Trying to keep staff away from other patients. b. Characterizing staff members as either all good or all bad. c. Having brief psychotic episodes. d. Manifesting two or more distinct subpersonalities when communicating with staff. Ch 31 Questions

d. "Our relationship is strictly professional. It is not appropriate for us to have that kind of discussion."

A patient diagnosed with antisocial personality disorder approaches the nurse and says, "You're so cute, are you married?" Which of these is the most appropriate response by the nurse? a. "I'm married, but that's none of your business." b. "Let's talk about your love life instead." c. "Thank you so much for the compliment but I'm married." d. "Our relationship is strictly professional. It is not appropriate for us to have that kind of discussion." Ch 31 Questions

d. Early childhood trauma

According to researchers, which of the following is a common theme in the health history of the client with BPD? a. Autism b. Attention deficit-hyperactivity disorder c. Positive and fulfilling interpersonal relationships d. Early childhood trauma Ch 31 Questions

▪ A pervasive pattern of disregard for and violation of the rights of others. ▪ Failure to conform to social norms with respect to lawful behavior. ▪ Deceitfulness ▪ Impulsivity ▪ Irritability and aggressiveness ▪ Reckless disregard for the safety of self and others ▪ Consistent irresponsibility ▪ Lack of remorse

Criteria: *Antisocial Personality Disorder* Mod 7 Lesson Content

▪ Frantic efforts to avoid real or imagined abandonment. ▪ A pattern of unstable and intense interpersonal relationships (alternating between idealization and devaluation). ▪ Markedly and persistently unstable self-image. ▪ Impulsivity in at least two areas (spending, sex, substance abuse, reckless driving, binge eating). ▪ Recurred suicidal behavior, gestures, threats or self-mutilation. ▪ Affective instability. ▪ Chronic feelings of emptiness. ▪ Inappropriate, intense anger or difficulty controlling anger. ▪ Transient, stress-related paranoia ideations.

Criteria: *Borderline Personality Disorder* Mod 7 Lesson Content

for acute treatment: weight loss greater than 30% of body weight over 6 months a body weight that is less than 85% of expected normal weight

Criteria: Anorexia nervosa ATI Ch 19

at least once per week for 3 months

Criteria: Binge eating disorder ATI Ch 19

*splitting* This refers to the inability to view both positive and negative aspects of others as part of a whole.

Defense mechanism used frequently by a patient with Borderline Personality Disorder Mod 7 Lesson Content

2 to 3lb/week is medically acceptable

For anorexia treatment, how much weight should they be adding on per week? ATI Ch 19

▪ emotional lability ▪ impulsivity ▪ splitting ▪ dichotomous thinking ▪ idolizing others ▪ devaluation when disappointed ▪ self-mutilation (cutting)

Name some common traits of Borderline Personality Disorder Mod 7 Lesson Content

▪ Theory of Object Constancy ▪ Interpersonal Theory - Henry Stack Sullivan ▪ Theory of Psychosocial Development - Erik Erikson

Name the 3 Personality Disorder Theories Mod 7 Lesson Content

*Familial Factors* ▪ More common in families who have a history of eating disorders. ▪ Influenced by parental pressure to succeed. *Environmental Factors* ▪ Media influence and pressure from society to have the slim, trim "perfect body." *Temperamental Factors* ▪ Anxiety traits in childhood ▪ Obsessive traits in childhood *Biological Factors* ▪ Lesions in appetite and satiety centers in the hypothalamus ▪ Low levels of serotonin ▪ Higher levels of cortisol

Name the factors that contribute to binge eating disorder Mod 7 Lesson Content

*Stage 1: Infancy (0 -1.5 yr)Trust vs. Mistrust* ▪ Develops sound basis for relating to and trusting others. *Stage 2: Early Childhood (1.5 - 3 yr)Autonomy vs. shame and doubt* ▪ Develops a sense of self-control and adequacy. *Stage 3: Preschool (3-6 yr)Initiative vs. shame and doubt* ▪ Develops the ability to initiate one's own activities and has a sense of purpose. *Stage 4: School Age (6-12 yr)Industry vs. inferiority* ▪ Developing social, physical and school skills. ▪ Develops competence and ability to work. *Stage 5: Adolescence (12-20 yr)Identity vs. role confusion* ▪ Develops a sense of personal identity *Stage 6: Early Adulthood (20-35 yr)Intimacy vs. isolation* ▪ Develops an ability to love deeply and commit. *Stage 7: Middle Adulthood (35-65 yr)Generativity vs. self-absorption* ▪ Develops an ability to give and care for others. *Stage 8: Later years (65-death)Integrity vs. despair* ▪ Has a sense of integrity and fulfillment

Name the stages of the Theory of Psychosocial Development Mod 7 Lesson Content

▪ Serotonin dysfunction ▪ Abnormalities in the limbic system and prefrontal cortex *childhood abandonment*

Neurobiological causes of Borderline Personality Disorder Mod 7 Lesson Content

▪ Encourage the client to examine behavior. ▪ Help the client realize you are available without reinforcing dependence. ▪ Rotate staff members to avoid client dependence on a particular individual. ▪ Recognize if the client is playing one staff member against another (splitting). ▪ With the client, explore feelings of abandonment (clinging and distancing). ▪ Assist the client to work towards "object constancy" without promoting dependency.

Nursing Interventions: *Borderline Personality Disorder* Mod 7 Lesson Content

▪ Make aware the behaviors that are acceptable and those that are not. Explain the consequences of violation of limits. ▪ Do not try to coax or convince the client to do the right thing. Do not use the words "you should", instead "you are expected to..." ▪ Provide positive feedback for acceptable behaviors in matter-of-fact manner. ▪ Provide milieu that is appropriate environment (specific rules, group therapy with peer feedback) ▪ Discuss past behaviors with outcomes. ▪ Maintain attitude "It is not you, but your behavior that is unacceptable." ▪ Use least restrictive method to control abusive to others behavior ▪ Recognize manipulative behavior and set limits.

Nursing Interventions: Antisocial Personality Disorder Mod 7 Lesson Content

*priority intervention: identify the client's nutritional status* *For Physical Assessment:* ▪ Weigh on schedule - Do not negotiate weight - Client can choose not to look at the scale - Morning weight prior to a meal and in same clothing (underwear) ▪ Measure vital signs TID ▪ Repeat ECC and lab tests until stable ▪ *Place client on continuous cardiac monitoring* *For Eating:* ▪ Observe during meal ▪ Inflexible eating schedules ▪ Small frequent meals ▪ High fiber to prevent constipation ▪ Low sodium to prevent fluid retention ▪ Instruct the client to avoid caffeine ▪ Make a plan of care with client input - Ex. Amount of time for meal (30 min) - Meal selection if possible *For Communication:* ▪ Acknowledge the emotional and physical difficulty the client is experiencing. ▪ Focus on client strengths ▪ Praise the client for positive behaviors ▪ Explain that privileges and restrictions are based on compliance to plan developed with her/him. ▪ Encourage the client to explore feelings and fears related to eating ▪ State matter-of-factly when behaviors are unacceptable ▪ Avoid challenging or bargaining ▪ Discuss ways to control problematic areas in life. ▪ Provide teaching regarding healthy eating. ▪ Use cognitive-behavioral approach and behavior modification.

Nursing Interventions: Eating Disorders Mod 7 Lesson Content ATI Ch 19

▪ patient is cared for in the hospital setting ▪ consult with MD about developing a controlled rate of nutritional support during initial treatment ▪ monitor blood electrolytes ▪ fluids replacement

Nursing Interventions: refeeding syndrome ATI Ch 19

refeeding syndrome

Potentially fatal complication that can occur when fluids, electrolytes, and carbohydrates are introduced to a severely malnourished client ATI Ch 19

15-36 mg/dL

Prealbumin reference range JA Live Lecture

None! Drugs have no effect in the direct treatment of the disorder itself. Medications treat symptomatic relief. *Borderline Personality Disorder:* ▪ Antipsychotics - treat paranoia, illusions, ideas of reference, anxiety, hostility ▪ SSRIs - treat impulsivity and self-destructive acts. ▪ SSRI + SGAs - treat mood instability, impulsivity *Antisocial Personality Disorder:* ▪ lithium + propranolol - treat episodes of violence

Psychopharmacology: *Personality Disorders* Mod 7 Lesson Content

There are no medications specifically for eating disorders. ▪ Medications are to treat the symptoms. ▪ SSRI's and SNRIs - *Fluoxetine (Prozac)* has been administered successfully to treat clients with anorexia nervosa and bulimia nervosa. Dosage is 60mg/day which is 3x that prescribed for depression.

Psychopharmacology: Eating Disorders Mod 7 Lesson Content

dichotomous thinking

Seeing things or others as all black or white, bad or good. Mod 7 Lesson Content

*Psychosocial:* ▪ Morbid fear of obesity ▪ Distortion of body image ▪ Preoccupation of food ▪ Refusal to eat *Physiological Symptoms:* ▪ Hypothermia ▪ *Acrocyanosis* (blueness of the extremities) ▪ Carotenemia (yellow skin) ▪ Bradycardia ▪ Hypotension (possible orthostatic hypotension) ▪ Edema ▪ Lanugo (fine soft hair) ▪ Amenorrhea ▪ Metabolic changes

Symptoms of Anorexia Nervosa Mod 7 Lesson Content

▪ Normal to slightly low weight ▪ Dental caries, tooth erosion ▪ *Parotid gland swelling* ▪ Gastric dilation, rupture ▪ Calluses on fingers (*Russell's sign*) ▪ Peripheral edema ▪ Anemia and leukopenia ▪ Muscle weakening ▪ Abnormal laboratory values (hypokalemia, hyponatremia, hypomagnesemia, hypophosphatemia) ▪ Electrolyte imbalances ▪ Cardiomyopathy-cardiac failure

Symptoms of Bulimia Nervosa Mod 7 Lesson Content

TRUE!

T/F: Personality disorders often co-occur with disorders of mood, eating, anxiety and substance abuse Mod 7 Lesson Content

b. "If you continue to refuse to take food orally, you will be fed through a nasogastric tube."

The nurse is caring for a client who has been hospitalized with anorexia nervosa and is severely malnourished. The client continues to refuse to eat. What is the most appropriate response by the nurse? a. "You know that if you don't eat, you will die." b. "If you continue to refuse to take food orally, you will be fed through a nasogastric tube." c. "You might as well leave if you are not going to follow your therapy regimen." d. "You don't have to eat if you don't want to. It is your choice." Ch 30 Questions

*Behavior Modification* ▪ The program cannot "control" the individual with the disorder. The client is able to contract for privileges based on healthy eating and ultimately weight gain. *Individual Therapy* ▪ This therapy can be helpful when the eating disorder is affected by psychological problems. ▪ Unresolved conflicts are explored. *Family Therapy* ▪ Eating disorders are often considered a "family disorder." Support is given to the members of the family as they deal with feelings of guilt and the perception of their role in the illness.

Treatment Modalities: Eating Disorders Mod 7 Lesson Content

▪ Interpersonal Psychotherapy ▪ Psychoanalytical Psychotherapy ▪ Milieu/Group Therapy ▪ Cognitive/Behavioral Therapy ▪ Dialectical Behavior Therapy

Treatment Modalities: Personality Disorders Mod 7 Lesson Content

d) They are within their normal weight range. Rationale: Clients diagnosed with bulimia nervosa are often able to maintain a normal weight by purging after binging.

Which assessment finding would the nurse expect in clients diagnosed with bulimia? a)They are below normal weight. b)They binge when they experience hunger. c)They will be highly motivated to seek help. d)They are within their normal weight range. Eating Disorder PP

b) Body image disturbance Rationale: The distortion in body image by clients diagnosed with anorexia nervosa is manifested by thoughts that they are fat when they are obviously underweight or even emaciated.

Which is characteristic of the diagnosis of anorexia nervosa? a) Obsession with weight gain b) Body image disturbance c) Disregard for the feelings of others d) Healthy family relationships Eating Disorder PP

c. Fluoxetine (Prozac)

Which medication has been used with some success in clients with anorexia nervosa? a. Lorcaserin (Belviq) b. Diazepam (Valium) c. Fluoxetine (Prozac) d. Carbamazepine (Tegretol) Ch 30 Questions

a. Overly self-centered and exploitative of others

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 Ch 31 Questions

b. A lifelong pattern of social withdrawal

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. Suspicious and mistrustful of others d. Overreacting inappropriately to minor stimuli Ch 31 Questions

c. Bradycardia, hypotension, hypothermia

Which of the following physical manifestations would you expect to assess in a client suffering from anorexia nervosa? a. Tachycardia, hypertension, hyperthermia b. Bradycardia, hypertension, hyperthermia c. Bradycardia, hypotension, hypothermia d. Tachycardia, hypotension, hypothermia Ch 30 Questions

Russell's sign

calluses on the knuckles or back of the hand due to repeated self-induced vomiting over long periods of time Eating Disorder PP ATI Ch 19

binge eating disorder

repeated episodes after which they experience significant distress. They generally do not use compensatory behaviors such as vomiting and laxatives. They may be initially normal weight, but inevitably this causes obesity. Mod 7 Lesson Content

bulmia nervosa

repeated episodes of binge eating followed by inappropriate, compensatory behavior such as self-induced vomiting, misuse of laxatives or diuretics, fasting or exercise. Mod 7 Lesson Content

emotional dysregulation

the inability of a person to regulate their emotional response to provocative stimuli. Mod 7 Lesson Content