Psych Exam 4 - Ch. 24 (Personality Disorders)

A patient diagnosed with obsessive-compulsive personality disorder takes the nurse aside and mentions, "I've observed you interacting with that new patient. You are not approaching him properly. You should be more forceful with him." The best response for the nurse would be,

"I will be continuing to follow the care plan for the patient." Obsessive-compulsive personality disorder has the key factor of perfectionism, with a focus on orderliness and control. These individuals get so preoccupied with details and rules that they may not be able to accomplish the tasks. Guard against engaging in power struggles with a patient with obsessive-compulsive disorder. p. 462

A patient diagnosed with a borderline personality disorder shows the nurse multiple new, shallow self-inflicted cuts. Select the nurse's therapeutic response.

"I will care for your wounds, and then you should write down what you were thinking and feeling when this happened. We will discuss it later." An approach useful for patients with borderline personality disorder relates to responses to superficial self-destructive behaviors. The nurse should remain neutral and provide wound care in a matter-of-fact manner. Then the patient is instructed to write down the sequence of events leading up to the injury, as well as the consequences, before staff will discuss the event. This cognitive exercise encourages the patient to think independently about his or her behavior instead of merely ventilating feelings. It facilitates the discussion with staff about alternative actions. It is not therapeutic to deny the seriousness of the wounds or confront the patient with the behavior. Instituting suicide precautions reinforces the behavior. pp. 464, 470, 471, 476, Table 24.2

A patient diagnosed with borderline personality disorder is hospitalized after an attempted suicide. The healthcare practitioner orders naltrexone. What does the nurse tell the patient to explain why he or she is receiving this medication?

"The medication will reduce the risk self-harm." Naltrexone is an opioid receptor antagonist that has been found to reduce self-injurious behavior in patients with borderline personality disorder. There are no medications approved to treat borderline personality disorder itself. Psychotropic medications are used to maintain the patients' cognitive function, symptom relief, and improve the quality of life, while selective serotonin reuptake inhibitors, anticonvulsants, and lithium are used to stabilize the patient's mood. Second-generation antipsychotics may be used to help control anger. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question. p. 469

Which patient statement supports the diagnosis of histrionic personality disorder? (SATA)

-"I like being the center of attention." -"My husband left because he said I flirt way too much." -"I'm here because I got so depressed after my last divorce." Histrionic personality disorder is characterized by emotional attention-seeking behaviors including self-centeredness, low frustration tolerance, and excessive emotionality. The person with histrionic personality disorder often is impulsive and melodramatic and may act flirtatious or provocative. Relationships do not last, because the partner often feels smothered or reacts to the insensitivity of the histrionic person. The individual with histrionic personality disorder does not have insight into his or her role in breaking up relationships and may seek treatment for depression or other comorbid condition. p. 456

Which patient statement supports the diagnosis of dependent personality disorder? (SATA)

-"It's hard but I pay for the rent, all the utilities, and all the food." -"My mother didn't like it so I never spent the night at a friend's house." -"I was sick a lot as a child and so my family was always there for me." Persons with dependent personality disorder have a high need to be taken care of, which can lead to patterns of submissiveness with fears of separation and abandonment by others. This may create problems for the person by leaving them more vulnerable to exploitation by others because of their passive and submissive nature. Persons with dependent personality disorder are thought to have early and profound learning experiences during childhood in which disordered attachment and dependency develop on the caretaker. Dependent personality disorder may be the result of chronic physical illness or punishment of independent behavior in childhood. Moving back to the family home and expressing how difficult separation has been are not statements that are supportive of a dependent personality disorder. pp. 457-458

Which behavior would be consistent with defining characteristics for the nursing diagnosis of ineffective coping? (SATA)

-Manipulation -Aggressiveness -High levels of anxiety -Difficulty in relationships The characteristics for the diagnosis of ineffective coping include crisis; high levels of anxiety, anger, and aggression; child, elder, or spouse abuse; and difficulty in relationships and manipulation. Interdependence would not be considered a symptom for ineffective coping. p. 475

Screening for which personality disorder should be focused on the male population? (SATA)

-Paranoid -Antisocial -Schizotypal Statistically more men than women are diagnosed with antisocial, paranoid, and schizotypal personality disorders. More women than men are diagnosed with borderline and dependent personality disorders. pp. 454, 455, 459

The nurse is caring for a patient with borderline personality disorder who has impaired social interaction. What symptoms does the nurse find in the patient? (SATA)

-The patient feels rejected. -The patient has unstable relationships. -The patient reports to have intense relationships. A patient with borderline personality disorder feels rejected because of differences in opinions and feelings from others. The patient has intense relationships as a result of extreme emotional responses. The patient has unstable relationships because the partner is unable to understand the perceptions of the patient. The patient avoids engaging in social activities because he or she does not feel accepted by the dominant cultural group as a result of negative evaluation. Such patients show extreme emotional responses. p. 464

The nurse is caring for a patient who had attempted suicide. The nurse reports that the patient has histrionic personality disorder. Based on which symptom did the nurse diagnose the patient's behavioral disorder? (SATA)

-The patient wants the best of everything. -The patient feels comfortable when given complete attention. Patients with histrionic personality disorder try to seek attention. They remain uncomfortable unless they become the center of attention. They feel comfortable when lots of attention is given to them. The patient wants the best of everything and becomes angry if the demands are not fulfilled. The patient has low frustration tolerance and is often irritated. Patients don't have long-term relationships because the partner reacts insensitively. The patients have intense attachment only to the opposite-sex parent. The patient develops a fear of attack from the same-sex parent. p. 456

The nurse tells a patient diagnosed with borderline personality disorder, "A new case manager has been assigned to work with you." Which initial reaction is most likely for this patient?

Anger This scenario is likely to cause the patient to feel rejected. Patients diagnosed with borderline personality disorder show separation anxiety and emotional lability (rapidly moving from one emotional extreme to another). Typically, these emotional shifts include responding to situations with emotions that are out of proportion to the circumstances, pathologic fear of separation, and intense sensitivity to perceived personal rejection. Withdrawal and guilt are reactions more likely from a person diagnosed with dependent personality disorder. This patient could be expected to react rather than being silent. pp. 463, 470, Table 24.2

A person diagnosed with obsessive-compulsive personality disorder is consistently late for appointments and says, "I have to check the safety features and fluid levels on my car six times before I leave home." Which nursing diagnosis has the highest priority?

Anxiety Internally, this person is fearful of imminent catastrophe. This fear produces anxiety. Persons diagnosed with obsessive-compulsive personality disorder try to control the environment through perfectionism and orderliness. Traits include compulsivity, oppositionality, lack of emotional expressiveness, and perfectionism. Social interactions, family processes, and role performance for this individual will improve after the anxiety is reduced; therefore, these diagnoses have a lower priority. p. 458

A patient at the mental health center says to the nurse, "Most of the staff does not care about me, but you are different. You understand my problems." When the nurse tells this patient about an upcoming career change, the patient becomes very angry. An hour later, the patient loudly announces, "I'm going to cut my wrists. I need to be hospitalized immediately." Given this scenario, which personality disorder is most likely?

Borderline The scenario describes splitting of staff and impulsivity associated with self-mutilation. These are common behaviors among persons diagnosed with borderline personality disorder. Persons diagnosed with narcissistic personality disorder are exploitive, grandiose, and disparaging. Persons diagnosed with avoidant personality disorder are excessively anxious in social situations and hypersensitive to negative evaluation. Persons diagnosed with histrionic personality disorder are seductive, flamboyant, attention seeking, and shallow. pp. 464, 470, 471, Table 24.2

A nurse manages care for an individual diagnosed with avoidant personality disorder. Select the appropriate outcome for this patient. The patient will

Demonstrate use of assertive communication within 3 months A person diagnosed with avoidant personality disorder is excessively anxious in social situations and hypersensitive to negative evaluation but desires social interaction. Assertiveness training is intended to assist this person in self-expression. Outcome achievement for any of the personality disorders is slow because personality is a deeply ingrained characteristic. It is likely to take months or years to achieve desired outcomes. Persons diagnosed with avoidant personality disorder seldom self-mutilate or demonstrate aggression toward others. p. 457

A patient with borderline personality disorder has suicidal intentions. The nurse plans to teach mindfulness and emotion regulation to improve interpersonal effectiveness skills in the patient. Which therapy does the nurse follow to effectively work with the patient?

Dialectical behavior therapy Dialectical behavior therapy is used in patients with borderline personality disorder who have chronic suicidal intentions. The therapy includes cognitive and behavioral techniques like mindfulness and emotion regulation. It helps to improve interpersonal effectiveness skills in patients. Schema-focused therapy helps patients change their view about themselves. It helps in evaluating the behavior of people in stressful conditions. In supportive psychotherapy, the nurse encourages the patient to participate in activities. It helps to enhance the patient's ability to cope with stressors. In family therapy, the family members of the patient are taught how to assist the patient in handling stress. p. 470

Which behaviors are demonstrated characteristically by a patient diagnosed with narcissism?

Grandiose, exploitive, and rage-filled behavior Narcissistic patients give the impression of being invulnerable and superior to others to protect their fragile self-esteem. A dramatic expression of emotion while easily being led, perfectionism and preoccupation with detail, and angry, highly suspicious, aloof, and withdrawn behavior are not generally associated with narcissism. p. 456

A nurse is caring for a patient with antisocial personality disorder. What appropriate interventions should the nurse take to control aggressive behavior of the patient?

Instruct the patient to make a model from clay. The nurse should encourage the patient to do activities like clay modeling and journal-writing. It helps in diverting the anger and tension of the patient. The patient should not be left alone. The nurse should monitor the patient to avoid physical harm to the patient. The nurse should try to reduce the exposure of the patient to frustrating stimuli. Repeated exposure to the stimuli can make the patient aggressive and increases the risk of physical harm. The patient should be restrained only when there is a threat to the safety of the patient or others. pp. 459-460

A nurse is caring for a patient with paranoia and severe social and interpersonal deficits. What interventions should the nurse perform while caring for the patient?

Leave the patient alone when needed. The patient with schizotypal personality disorder has paranoia and severe social and interpersonal deficits. The nurse should leave the patient alone and respect the patient's need for social isolation. The nurse should avoid being overfriendly or nice to the patient because the patient may become manipulative and misinterpret the nurse's behavior. The nurse shouldn't try to increase the socialization of the patient by frequently involving his or her in group tasks. It can make the patient aggressive. The patient must be left alone when needed to help the patient become calm. The nurse should be aware of the suspicious behavior of the patient and should make a note. It helps to follow appropriate interventions in the patient's treatment. pp. 455-456

A primary health care provider is prescribing medications for a patient with borderline personality disorder who shows risk of self-injuring. Which medication would a nurse expect to be prescribed?

Naltrexone Patients with borderline personality disorder are often self-injuring. Naltrexone is an opiod receptor antagonist. It is used to calm the patient who is self-injuring. Diazepam is a benzodiazepine drug. It is used to treat anxiety in patients. Omega-3 supplements are prescribed to treat mood and emotion dysregulation symptoms. Citalopram is a selective serotonin reuptake inhibitor. It is used to treat depression in patients but these drugs are not generally prescribed to patients with borderline personality disorder. p. 469

A nurse observes that a patient with osteoarthritis behaves rudely to the staff and refuses to take treatment. On inquiry, the nurse learns that the patient thinks that all staff members are planning to harm and deceive him or her. What is the patient likely to be suffering from?

Paranoid personality disorder Patients with paranoid personality disorder are suspicious and believe that others want to exploit, harm, and deceive them. They develop a defense system and try to counterattack the other person, and reject the treatment. They behave rudely and develop jealousy toward others. Patients with schizoid personality disorder have reduced emotional attachment and depression. Patients with obsessive-compulsive personality disorder have repetitive behavior. They remain preoccupied with minute details. In narcissistic personality disorder, patients are extremely worried about their prestige. They feel intense shame and fear of abandonment by others. p. 458

The nurse is assessing a patient for a possible personality disorder. What behavior does the nurse identify as feature of paranoid personality disorder?

Reluctance to answer any questions A person with paranoid personality disorder generally views others with suspicion and may be reluctant to answer any questions. People with histrionic personality disorder may exhibit excessive emotionality to the extent of being considered melodramatic. A person with dependent personality disorder may have low self-esteem and may be dependent on others for minor issues. For instance, the person may ask a family member to answer questions during an interview. A person with borderline personality disorder may have dichotomous thinking. This is due to splitting or an inability to view both the positive and negative aspects of a person as a part of the whole. p. 454

What medication order does the nurse anticipate for a patient diagnosed with antisocial personality disorder displaying aggressive behavior?

Valproic acid The nurse can anticipate a medication order for valproic acid, which will help with aggression, depression, and impulsivity. Fluoxetine may be administered to decrease irritability and help with anxiety and depression. Clonazepam is a benzodiazepine that may help with anxiety but should be used with caution because it is an addictive agent. Methylphenidate is used if there is a comorbidity of attention-deficit/hyperactivity disorder p. 461

Which statement is descriptive of patients with a personality disorder?

They are resistant to behavioral change. Personality disorders are deeply ingrained and pervasive. Patients with personality disorders find it very difficult, if not nearly impossible, to change and are not open to changing their behavior. They have difficulty establishing and maintaining intimate relationships that are satisfying. This disorder makes a patient easily frustrated and intolerant of pain. p. 458

A nurse manages care for an individual with a personality disorder. What is the most attainable outcome for this patient?

Within 4 weeks, the patient will describe personal characteristics of reactions to stress. Personality disorders are pervasive, long-standing patterns of behavior. It is unrealistic to expect dramatic changes in a short period of time. Outcomes should be realistic and focused on problem-solving and cognitive reframing. p. 457