Prepu: Topic 7: Personality Disorders
Clients with borderline personality disorder (BPD) are usually admitted to the inpatient setting because they exhibit what?
Self-harm Explanation: Clients with BPD are usually admitted to the inpatient setting because of threats of self-harm.
It is 2000 hrs and a voluntary client with the diagnosis of antisocial personality disorder is out on a leave from the inpatient unit. The leave is supported by the treatment plan. The psychiatrist's order states the client is to return at 2100 hrs. The client calls the unit, speaks with the nurse and states, "2100 hrs doesn't give me enough time." What is the nurse's best response?
"Return on time or future restrictions will be imposed." Explanation: The client is identified as having voluntary status. Reinforcing the expectation of the treatment plan and pointing out that failure to follow the plan will result in future consequences places the responsibility on the client to return on time. Telling the client to return immediately demonstrates the nurse's power over the client. The loss of client autonomy does not promote healthy decision making. Offering a later time to return gives the message to the client that the nurse is willing to negotiate this part of the treatment plan. It may lead to further efforts from the patient to negotiate flexibility with other unit rules and aspects of the plan of care. Requiring the client to return at an undefined time or the police will be called, is vague and sounds like a threat. This approach does not support client responsibility for actions.
A client with borderline personality disorder has had 21 admissions to the mental health unit, each of which was precipitated by a suicide attempt resulting in superficial cuts. During this admission, the client has developed a relationship with a highly supportive nurse and has progressed to having a pass to spend an afternoon in a nearby shopping mall. Later the day that the client uses the pass, the nurse is shocked when the emergency department calls to say that the client has just been brought in with multiple self-inflicted lacerations. The nurse asks a supervisor, "Everything was going well. How could this happen?" What response by the supervisor reflects an understanding of borderline personality disorder?
"The client's behavior seems personal, but it's really not. Clients with borderline personality disorder act out to relieve anxiety. I suspect having the pass provoked a great deal of anxiety." Explanation: It will be instructive for the more experienced nurse to share with the rationale behind self-inflicted injuries as a feature of borderline personality disorder. Understanding professional boundaries is a vital nursing role. Reinforcing an overhelping relationship or boundary blurring would not be professional or instructive. Berating the client and the client's behaviors would not be professional.
A client with borderline personality disorder tells the nurse: "Everything bad happens to me. It is entirely my fault." What is the best response by the nurse to assist the client to reframe this negative thought?
"What do you mean when you say, bad things?" Explanation: By reframing the belief by the client, the nurse can help the client's self and environmental perceptions. "Why" questions imply criticism and often make clients respond defensively. "Do you believe that you are always at fault?" is a closed question and would not give the client the opportunity to explore the perception. Stating that "Everyone has bad things in life" devaluates the self integrity of the client's perception.
The nurse caring for a client with schizotypal personality disorder continues to assess for validations of the disorder during routine assessments of their interactions. Which client response affirms the nurse's assessment of schizotypal personality disorder?
"You and I have a real bond. I've been listening to all those nice things you've been telling me from the nursing station." Explanation: Clients with schizotypal personality disorder have altered perception and cognition, including ideas of reference. They do not express intense emotions and would seek out getting attention from others. Clients with narcissistic personality disorder demonstrate grandiose and inflated views of themselves, but this is not a characteristic for those with schizotypal personality disorder who are more socially eccentric and odd. A person with schizoid personality disorder is more likely to focus on perseverant thoughts or unusual ideas involving interests in objects or concepts.
A nurse is caring for a variety of children on a psychiatric unit. Which child is at risk to develop narcissistic personality disorder? Select all that apply.
A child movie actor An only child of a prominent sports celebrity A child of parents with narcissistic personality disorder Explanation: Theories about the development of narcissistic personality disorder place emphasis on the developmental environment of the child. Overvaluation and receiving every want places a child who experiences fame and has access to financial resources at higher risk. Growing up in a prominent family may also increase risk. Due to family dynamics, children of parents with narcissistic personality disorder are also at risk. It's more likely that a first- or last-born child in a family would develop the disorder than a middle child. Unless there were unique cultural beliefs that bestow privilege, a child of immigrant parents is not a greater risk of the disorder.
A nurse is caring for a variety of children on a psychiatric unit. Which child is at risk to develop narcissistic personality disorder? Select all that apply.
A child movie actor An only child of a prominent sports celebrity A child of parents with narcissistic personality disorder Explanation: Theories about the development of narcissistic personality disorder place emphasis on the developmental environment of the child. Overvaluation and receiving every want places a child who experiences fame and has access to financial resources at higher risk. Growing up in a prominent family may also increase risk. Due to family dynamics, children of parents with narcissistic personality disorder are also at risk. It's more likely that a first- or last-born child in a family would develop the disorder than a middle child. Unless there were unique cultural beliefs that bestow privilege, a child of immigrant parents is not a greater risk of the disorder.
Which is considered the etiology of personality disorders?
A combination of psychosocial and biologic variables Explanation: A combination of psychosocial and biologic factors is believed to be responsible for the formation of personality itself and personality disorders.
The nurse provides education to the parent of a child diagnosed with intermittent explosive disorder. In addition to medication, what additional therapy does the nurse recommend?
Anger management Explanation: Anger management is warranted for clients diagnosed with intermittent explosive disorder. These individuals are at risk for substantial personal and social consequences for their outbursts including legal issues. Anger management in tandem with pharmacotherapy can be beneficial. The onset of this disorder can occur in childhood to mid-adulthood. Play therapy is not identified as an intervention to treat individuals with this disorder. Acute or long-term hospitalizations are not identified as effective treatment strategies for these individuals. Suicidal risk needs to be assessed and hospitalization may be warranted if suicide risk is identified.
Into which personality disorder category are individuals whose behavior appears odd or eccentric?
Cluster A Explanation: Cluster A includes individuals whose behavior appears odd or eccentric, such as paranoid or schizoid personality disorder.
The nurse assesses a client diagnosed with narcissistic personality disorder. What other diagnoses share common symptoms with this personality disorder? Select all that apply
Antisocial personality disorder Borderline personality disorder Explanation: Narcissistic personality disorder is categorized in the B Cluster in DSM-5. Its symptoms are more closely associated with other B Cluster personality disorders, including antisocial personality disorder and borderline personality disorder. Psychosis is not a common symptom of narcissistic personality disorder. Clients with narcissistic personality disorder are more likely to present with symptoms of hypomania or mania. These are not associated with major depressive disorder or the anxiety and worry associated with generalized anxiety disorder.
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 to keep a written schedule of activities for each day for the client Explanation: When providing family and client education upon discharge, it is important for the nurse to ask the parents to keep a written schedule of daily activities for the client in order to keep a fixed routine with the aim of preventing chronic boredom and emptiness that is often associated with borderline personality disorder.
The psychiatric nurse shows an understanding of the possible risks manifested by the personality disorders contained in Cluster B when
Assessing the client for suicidal ideations Explanation: Cluster B includes clinical symptoms of emotional, erratic, or dramatic behavior; Cluster B personality disorders also carry the highest suicide risk. It is Cluster A, not B, that contains disorders that present with psychotic thinking and distorted speech patterns, and it is Cluster C, not B, that contains disorders that present with anxious and/or fearful behaviors.
Personality disorder is listed on which axis of the DSM-IV-tR?
Axis II Explanation: Axis II of the DSM-IV-TR includes personality disorders and intellectual disabilities.
Which personality disorder would be placed in Cluster B?
Borderline Explanation: Borderline personality disorder is placed in Cluster B. Avoidant personality is in Cluster C. Paranoid and schizoid personalities are in Cluster A.
Which personality disorder is most commonly found in clinical settings?
Borderline personality Explanation: Borderline personality disorder is the most common personality disorder found in clinical settings. It is three times more common in women than in men.
Personality disorders are diagnosed when personality traits become inflexible and maladapative and significantly interfere with how a person functions in society or cause the person emotional distress. Which personality disorder is most commonly found in clinical settings?
Borderline personality Explanation: Borderline personality disorder is the most common personality disorder found in clinical settings. It is three times more common in women than in men.
A family member of a client asks the nurse a question about personality disorders. The family member asks, "What personality disorder diagnosis makes a client most at risk for self-harm behaviors?" What is the nurse's best response?
Borderline personality disorder Explanation: A client with borderline personality disorder is most likely to be at risk for self-harm behaviors. Clients with antisocial personality disorder have increased risk for violence directed toward others but self-harm is not a risk. Clients with antisocial personality disorder who are facing legal action or who have experienced significant social losses may be at risk of suicide. Clients with Cluster A disorders including schizoid and paranoid personality disorders are not at significant risk for self-harm unless there are other co-occurring disorders.
A nurse is assessing a client with borderline personality disorder. During the assessment the nurse notes that the client is using projective identification. Which of the following would support this interpretation?
Client attributes own feelings falsely to others. Explanation: Clients falsely attributing to others their own unacceptable feelings, impulses, or thoughts is termed projective identification. Lacking a definitive sense of self reflects issues with separation-individuation. Misinterpreting environmental stimuli reflects cognitive schema. The inability to control emotional reactions in social situations reflects emotional dysregulation.
Which observation by the nurse is supportive of a diagnosis of avoidant personality disorder?
Client fears criticism from others, including staff. Explanation: Symptoms suggesting an avoidant personality disorder include fear of rejection, avoidance of relationships, and censorship of expression of thoughts and feelings because of fear of a negative reaction. Borderline personality disorder presents with unstable interpersonal relationships, labile affect, and complaints of emptiness. Clients with histrionic personality disorder are overly dramatic, manipulative, and attention-seeking. Clients with schizoid personality disorder are indifferent to and lack concern for interpersonal contacts.
Which cluster of disorders corresponds to symptoms of being dramatic and emotional?
Cluster B Explanation: Cluster B includes individuals who appear dramatic, emotional, or erratic. Cluster C includes clients who appear anxious or fearful, such as avoidant, dependent, and obsessive-compulsive. Cluster A includes individuals whose behavior appears odd or eccentric. There is currently no Cluster D in the DSM-5.
Which cluster of personality disorders includes people who appear dramatic, emotional, or erratic?
Cluster B Explanation: Cluster B includes individuals who appear dramatic, emotional, or erratic. Cluster C includes clients who appear anxious or fearful, such as avoidant, dependent, and obsessive-compulsive. Cluster A includes individuals whose behavior appears odd or eccentric. There is currently no Cluster D in the DSM-IV-TR.
Dialectical behavior therapy (DBT) combines behavior therapy with which type of therapy?
Cognitive therapy Explanation: DBT combines cognitive and behavior therapy strategies. Clinicians partner with clients and focus on many interconnected behaviors.
A client with antisocial personality disorder (ASPD) is seen in the emergency department (ED) following threats of taking an overdose. The suicidality was prompted by fraud and the client being barred from living with family. During the assessment the nursing diagnosis of dysfunctional family processes was identified. What is the outcome for this session?
Communicate to the client's family that the client is safe Explanation: For a client with ASPD, treatment outcomes should address short-term targets and be directly connected to an identified problem. Having communicated a message to a family member in this situation is a reasonable outcome. Establishing long-term outcomes related to a stable living situation or improved coping require more intensive interventions over time, and this is beyond the scope of the nurse in the ED. Remaining safe from self-harm is a priority outcome but it does not relate to nursing diagnosis of dysfunctional family processes.
A 35-year-old client with a diagnosis of antisocial personality disorder is being seen by a psychiatrist. He has been arrested three times for aggravated battery within the last year. Which disorder may have been seen in this client prior to age 18?
Conduct Explanation: Antisocial behavior is usually seen in clients between the ages of 15 and 40 years. The diagnosis of conduct disorder is given to clients who exhibit clinical symptoms before the age of 18 years.
In response to a client's manipulative behavior, the nurse should provide ...
Consistent limits Explanation: Limit setting is the most effective way of dealing with manipulative behavior.
The nurse in a medical setting provides care for a client with histrionic personality disorder concurrent with their medical challenges. During the initial assessment with the client, the nurse identifies an altered expression of sexuality. To guide further assessment, what factor does the nurse anticipate from the client?
Demonstration of seductive behavior Explanation: The presentation of histrionic personality disorder in women typically includes an element of seductive dress and interpersonal communication. These qualities are overt and there is typically little or no restraint in terms of expression. Many clients struggle to maintain long-term relationships. Clients may experience sexual intimacy yet express unmet needs of social intimacy and belonging.
The nurse completes an intake assessment for a client. Which symptoms are associated with dependent personality disorder? Select all that apply.
Difficulty making everyday decisions Withdrawal from adult responsibilities Expresses fears of being unable to manage self-care Explanation: Individuals with dependent personality disorder can struggle with planning without seeking advice or direction from others. They have a tendency to avoid taking on responsibilities associated with adulthood. Individuals have a level of concern about being able to manage their personal needs which exceeds logical explanation. There is no clear association between opiate addiction or diabetes and dependent personality disorder.
The nurse completes an intake assessment for a client. Which symptoms are associated with dependent personality disorder? Select all that apply.
Difficulty making everyday decisions Withdrawal from adult responsibilities Expresses fears of being unable to manage self-care Explanation: Individuals with dependent personality disorder can struggle with planning without seeking advice or direction from others. They have a tendency to avoid taking on responsibilities associated with adulthood. Individuals have a level of concern about being able to manage their personal needs which exceeds logical explanation. There is no clear association between opiate addiction or diabetes and dependent personality disorder.
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?
Discuss displacement of anger and set limits. Explanation: It is important to maintain open and clear lines of communication. The nurse should calmly set limits for the client's inappropriate expressions of anger. The client may view touch as a threat. Reporting the behavior to the health care provider would not be an initial response to the client's anger. Walking away and leaving the client does not help the client to learn to recognize anger without losing control.
A client diagnosed with schizoid personality disorder is described by family members as what?
Emotionless and a loner Explanation: A client diagnosed with schizoid personality disorder is described by family members as lacking emotion and a loner, not dramatic and emotional, nervous and fearful, or tired and sad.
Trichotillomania involves which of the following activities?
Hair pulling Explanation: Trichotillomania is chronic, self-destructive hair pulling that results in noticeable hair loss, usually in the crown, occipital, or parietal areas, although sometimes of the eyebrows and eyelashes. This disorder does not involve lip smacking, compulsive hand washing, or repetitive eyelid blinking.
The nurse is working in a prison setting with a client diagnosed with Antisocial Personality Disorder (ASPD). The client has identified impulse control issues particularly around urges for sexual intimacy. The client has assaulted people who have interfered with their gratification. What is the priority intervention for the nurse?
Helping to express anger in an adaptive and non-violent manner Explanation: Promoting safety for clients and staff is a priority intervention for clients with ASPD. Other interventions to tolerate distress, improve coping, manage substance abuse and promote adherence to treatment are all relevant yet take a back seat to reduction of risk for aggression or violence.
Gambling, binge eating, and engaging in unsafe sex are examples of what?
Impulsivity Explanation: Impulsivity occurs in people who have difficulty delaying gratification or thinking through the consequences before acting on their feelings. Examples of impulsivity are gambling, spending money irresponsibly, binge eating, engaging in unsafe sex, and abusing substances. Identity diffusion occurs when a person lacks aspects of personal identity or when personal identity is poorly developed. Dissociation occurs when thinking, feeling, or behaviors occur outside a person's awareness.
Which of the following nursing diagnoses would be least likely to be made when working with a client with personality disorder?
Ineffective Communication related to lack of orientation to reality Explanation: Personality disorders are not associated with a lack of orientation to reality. Common nursing diagnoses for persons with personality disorders include Noncompliance related to personality disorder, Ineffective Coping related to entrenched maladaptive personality traits, and Risk for Suicide secondary to psychiatric illness.
When providing care to a client who consistently attempts to manipulate the staff, the nurse can best maintain the therapeutic milieu by doing what?
Instructing the staff to enforce all unit rules consistently Explanation: Being consistent in expectations regarding rules and regulations for all clients will minimize the threat of manipulation. The other options provided are appropriate but do not represent the best way to minimize manipulation.
The nurse is conducting an education group for women at risk for self-mutilation. What is the most important goal for this group?
Learning strategies to refrain from self-harm Explanation: Discussing feelings provides some relief, but avoiding personal harm is the highest priority for clients at risk for self-mutilation. It is helpful to learn problem-solving techniques and how to express anger, but the priority is for the client not to cause personal harm.
A nurse working in an inner city youth support program identifies that antisocial personality disorder (ASPD) can develop in those who have dysfunctional attachments. Which are risks for developing dysfunctional attachments? Select all that apply.
Losing of a parent through death Experiencing physical or sexual abuse Experiencing parental abandonment or neglect Explanation: Significant loss including the death of a parent is associated with attachment challenges. People with a history of physical or sexual abuse are likely to have strained relationship with family and certainly with the perpetrators of the abuse. Neglect or abandonment strains attachment and has been identified as a factor to contribute to ASPD. Birth order and whether the child has same-sex parents are not identified as contributing to risk for dysfunctional attachment.
A nurse working in an inner city youth support program identifies that antisocial personality disorder (ASPD) can develop in those who have dysfunctional attachments. Which are risks for developing dysfunctional attachments? Select all that apply.
Losing of a parent through death Experiencing physical or sexual abuse Experiencing parental abandonment or neglect Explanation: Significant loss including the death of a parent is associated with attachment challenges. People with a history of physical or sexual abuse are likely to have strained relationship with family and certainly with the perpetrators of the abuse. Neglect or abandonment strains attachment and has been identified as a factor to contribute to ASPD. Birth order and whether the child has same-sex parents are not identified as contributing to risk for dysfunctional attachment.
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 Explanation: Informing the client of the length of the relationship as much as possible allows the client to engage in and prepare for termination with a safe and adaptive expression of the emotions attached to the ending of the relationship.
Cluster B includes people who appear dramatic, emotional, or erratic. Which personality disorder in this cluster is characterized by a pervasive pattern of grandiosity, need for admiration, and a lack of empathy?
Narcissistic Explanation: Narcissistic personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and a lack of empathy. Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation. Obsessive-compulsive personality disorder is characterized by a preoccupation with orderliness, perfectionism, and control.
The nurse working with clients who have borderline personality disorder (BPD) understands that they need help to both recognize genuine respect from others as well as reciprocate that respect for others. How can the nurse model self-respect? Select all that apply.
Observe personal limits. Be assertive. Clearly communicate expectations. Explanation: The nurse in the therapeutic relationship models self-respect by observing personal limits, being assertive, and clearly communicating expectations.
Cluster A includes people whose behavior appears odd or eccentric. Which of the following personality disorders in this cluster is characterized by mistrust and suspiciousness of others?
Paranoid Explanation: Paranoid personality disorder is characterized by mistrust and suspiciousness of others. Dependent personality disorder is characterized by submissive and clinging behavior, with an excessive need to be taken care of. Histrionic personality disorder is characterized by excessive emotionality and attention seeking. Narcissistic personality disorder is characterized by grandiosity and a need for admiration.
A client with antisocial personality disorder (ASPD) is admitted to hospital. The nurse identifies which nursing diagnosis as the priority?
Risk for other directed violence Explanation: Protection of clients and staff is always a priority in care. Clients with ASPD have a high risk for violence, low impulse control and a disregard for others. Their initial presentation can be very engaging, yet when needs are unmet or when provoked by others, there is a risk for violence. This risk for violence supersedes other concerns in the care environment of a hospital. Other needs can be addressed, including problem solving, improved family functioning and social interactions with others, but these are not priorities.
During neighborhood scans, a nurse working in a community outreach program has identified an individual staying in a local shelter. The person has not engaged with the program. During the day, the client can be observed sweeping the pavement in a particular alley with a broom. There is no obvious purpose to the behavior. The individual is dressed in winter clothing even though it is summer. The client mutters expressions that are audible but cannot be understood. Based on the observations, which disorder does the nurse consider?
Schizotypal personality disorder Explanation: The details in the case represent the typical profile of an individual with schizotypal personality disorder. The individual appears socially odd and does not engage in help seeking. They engage in unusual mannerisms and their communication is impaired with some psychotic references. Individuals with paranoid personality disorder have a mindset of suspicion and they tend to be isolative and avoid social contact. People with obsessive compulsive personality disorder have a pattern of rigid thinking and perfectionist qualities. Although the person in this case sweeps for unusually long periods of time in a repetitive way, there is little or no connection with the pattern seen in someone with obsessive compulsive personality disorder.
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 Explanation: The client with histrionic personality disorder uses self-dramatization and emotional exaggeration to draw attention to self. The antisocial personality tends to be manipulative. Paranoid personality disorder causes the client to be suspicious and distrust others. In obsessive-compulsive personality disorder, the client's perfectionism interferes with task completion.
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?
Self-mutilation Explanation: Although all the above are problems for this client, the highest priority nursing diagnosis is self-mutilation. If left untreated, self-mutilation can lead to suicide attempts.
The nurse is working with a client with antisocial personality disorder. This client's desire to do everything for himself is based on which of the following?
Sense of mistrust of others Explanation: Clients believe others are just like them, that is, ready to exploit and use others for their own gain. These clients are devoid of personal emotions and actually the self is quite shallow and empty. These clients view relationships as serving their needs and pursue others only for personal gain. There is no competition because these clients believe they are only taking care of themselves because no one else will.
Which of the following interventions should the nurse include in a plan of care for a client with histrionic personality disorder?
Set limits on attention-seeking behavior Explanation: Setting limits on attention-seeking behavior, and discussing alternatives for appropriate behavior, will promote growth. Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. Acceptance of the behavior will cause the behavior to be intensified. These clients are not passive in nature. Answer D is an inappropriate intervention since these clients are already seeking attention.
The nurse caring for a client with avoidant personality disorder identifies increased self-esteem in social situations as the primary outcome for the plan of care. Which program does the nurse recommend?
Social skills training Explanation: Social skills training is most closely associated with improving the self-esteem for a client with avoidant personality disorder. Social skills improvement will create more opportunities for social successes and this will promote improved self-esteem. Training in anger management or mindfulness may be helpful for a client with needs addressed by these interventions but they are not directly associated with improved self-esteem in social situations. It's unlikely that a client with avoidant personality disorder would require a traditional anger management program. Similarly, recreation therapy would have multiple benefits for a client with avoidant personality disorder, yet the connection to improved self-esteem in social situations is not a primary focus.
Which occurs when a client tends to adore and idealize other people even after a brief acquaintance but then quickly leaves them if these others do not meet the client's expectations in some way?
Splitting Explanation: Splitting occurs in this situation. Thought stopping is a technique to alter the process of negative or self-critical thought patterns such as, "I'm dumb, I'm stupid." Decatastrophizing is a technique that involves learning to assess situations realistically rather than always assuming a catastrophe will happen. In positive self-talk, the client reframes negative thoughts into positive ones.
A student nurse is assessing a client with borderline personality disorder and notes that this client has a tendency to view others and situations with extremes of "bad" or "good." The nurse documents this assessment finding as ...
Splitting Explanation: Splitting is identified when a client views others as all good or all bad. Manipulation occurs when a client attempts to use and reform situations and people for his or her own gain, regardless of the distortion or validity. Dialectical behavioral therapy is a psychosocial approach to the treatment of people with bipolar disorder. Dissociation refers to the separation of objects from their emotional significance.
Which of the following occurs when a client tends to adore and idealize other people even after a brief acquaintance but then quickly leaves them if these others do not met their expectation in some way?
Splitting Explanation: Splitting occurs in this situation. Thought stopping is a technique to alter the process of negative or self-critical thought patterns such as, "I'm dumb, I'm stupid." Decatastrophizing is a technique that involves learning to assess situations realistically rather than always assuming a catastrophe will happen. In positive self-talk, the client reframes negative thoughts into positive ones.
A school-age child has a diagnosis of disruptive behavior disorder. The school nurse conducts an education session to help the parents understand the diagnosis and to teach skills that the parents can implement to help address disruptive behavior. What can parents do to help? Select all that apply.
Teach problem-solving skills Use time out for disruptive behavior Make behavioral expectations clear and consistently enforce them Explanation: Children with disruptive behavior disorder can benefit from improvements in problem solving to generate more perceptive interpretation of others' behavior, generate more thoughtful decisions, and consider the consequences of poor choices. Mild forms of punishment such as time out avoid the tendency for children to associate high levels of parental attention with disruptive behavior. Establishing clear behavioral expectations and reinforcing these consistently is a key strategy for parents and caregivers. Providing a pet to the child does not address the disruptive behavior and could add further stress to a household which is typically strained. Threats and punishments are more likely to generate disruptive behavior. Efforts to praise and reward adaptive behavior are more likely than to expose the child to threats.
The nurse conducts an assessment to rule out antisocial personality disorder (ASPD) in a young adult. What aspect of the client's childhood is the priority assessment?
Temperament Explanation: A child's temperament emerges soon after birth and remains relatively stable. It is understood to have a biological basis. The characteristics of a child's temperament include levels of energy, mood, adaptability to new environments, and intensity. These traits persist into adulthood and are fundamental consideration for personality disorder diagnostic criteria including ASPD. Physiological functioning including bowel patterns, the development of speech and school performance can be relevant assessment areas yet their importance is less significant than for temperament.
A nurse working with a client with borderline personality disorder could establish which as outcome criteria?
Tolerate stress without self-mutilation. Explanation: Clients with borderline personality disorder frequently engage in impulsive acts, particularly self-mutilation. Tolerating stress without self-mutilation indicates a positive outcome for a client with such maladaptive behaviors as the typical impulsivity of self-mutilation.
A nurse is caring for a client that does not want to participate in group therapy. Which behavior is supportive of a diagnosis of dependent personality disorder?
believes he or she is incapable of functioning independently Explanation: Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation. These behaviors are designed to elicit care taking from others. The dependent person must rely on others to make decisions and assume responsibility of major areas of life. Low self-esteem and exaggeration are seen in avoidant personality disorder. Attention seeking is seen in narcissistic personality disorder.
