videbeck ch.18 prep u
Which personality disorder is diagnosed more often in women? Histrionic Schizoid Antisocial Narcissistic
Histrionic Explanation: Borderline and histrionic personality disorders are diagnosed more often in women.
Emotional regulation skills are taught to those diagnosed with borderline personality disorder to manage what? Problem solving Impulsive behaviors Physical disability Psychotic behaviors
Impulsive behaviors Explanation: Emotional regulation skills are taught to manage intense, labile moods which can lead to engaging in impulsive behaviors. These skills involve helping the client label and analyze the content of the emotion and develop strategies to reduce emotional vulnerability and the desire to act impulsively.
Emotional regulation skills are taught to those diagnosed with borderline personality disorder to manage what? Problem solving Impulsive behaviors Physical disability Psychotic behaviors
Impulsive behaviors Explanation: Emotional regulation skills are taught to manage intense, labile moods which can lead to engaging in impulsive behaviors. These skills involve helping the client label and analyze the content of the emotion and develop strategies to reduce emotional vulnerability and the desire to act impulsively.
Which would be the priority nursing diagnosis for a client diagnosed with borderline personality disorder (BPD)? Disturbed thought process Ineffective coping Personal identity disturbance Risk for self-mutilation
Risk for self-mutilation Explanation: One of the first diagnoses to consider is risk for self-mutilation because protection of the client from self-injury is always a priority. Disturbed thought process, ineffective coping, and personal identity disturbance are all potential nursing diagnoses, but they would not be the priority.
Which would be the priority nursing diagnosis for a client diagnosed with borderline personality disorder (BPD)? Risk for self-mutilation Ineffective coping Disturbed thought process Chronic low self-esteem
Risk for self-mutilation Explanation: One of the first diagnoses to consider with this client population is risk for self-mutilation, because protection of the client from self-injury is always a priority. The other diagnoses may be appropriate for the client, but risk for self-mutilation would be the priority.
When conducting a social history with a client diagnosed with a borderline personality disorder (BPD), which question would be most important to ask the client related to impulsivity? "Do you always practice safe sex?" "Are you pleased with your medications?" "Do you think of yourself as physically attractive?" "Are you interested in making your partner happy?"
"Do you always practice safe sex?" Explanation: BPD results in impulsive behavior and often sexual promiscuity; therefore, the most relevant question the psychiatric nurse can ask is whether the client always practices safe sex. Satisfaction with medications, physical attractiveness, or making the partner happy are unrelated to impulsivity.
A nursing instructor is teaching about using behavioral interventions when caring for clients with borderline personality disorder. Which statement by a student indicates a need for further instruction? "Sometimes it is best to just ignore a client's irritating behaviors." "Sometimes it is best to confront a client about irritating behaviors." "Grossly disrespectful behaviors are better ignored." "In some instances, negative responses can be viewed as positive reinforcement."
"Grossly disrespectful behaviors are better ignored." Explanation: Nurses must decide how to respond to particular behaviors. In some instances, if the behavior is irritating but not harmful, it is best to ignore rather than focus on it. Grossly inappropriate behaviors, however, require confrontation.
A nurse is interviewing a client and suspects that the client may have narcissistic personality disorder. Which statement by the client would help support the nurse's suspicions? "I have a very important position in life; everyone I know wants to be like me." "My spouse is poisoning my food to get rid of me and marry my spouse's boss." "I like to work alone because then I can let my thoughts wander." "I'm always the life of the party, making new friends all the time."
"I have a very important position in life; everyone I know wants to be like me." Explanation: Individuals with narcissistic personality disorder are grandiose, have an inexhaustible need for admiration, and lack empathy. These individuals believe that they are superior, special, or unique and that others should recognize them in this way. The statement about having a very important position in life and everyone wanting to be like the client reflects this personality trait. The statement about poisoning the food reflects a paranoid personality trait. The statement about working alone suggests a schizoid personality trait. The statement about being the life of the party suggests a histrionic personality trait.
A nurse is assessing a client and suspects that the client may have obsessive-compulsive personality disorder based on which statement? "I need to have everything perfect. My life is organized down to the second." "I don't have any friends and I don't like to do anything socially." "I can't trust anybody that I meet, no matter where it is or who they are." "I am better than everyone and they should emulate me."
"I need to have everything perfect. My life is organized down to the second." Explanation: Behaviorally, individuals with obsessive-compulsive personality disorder are perfectionists, maintaining a regulated, highly structured, strictly organized life. A need to control others and situations is common in their personal and work lives. Therefore, the statement about everything being perfect and life being organized reflects this characteristic. The statement about not having any friends and no social interaction reflects a schizoid personality disorder manifested by introversion and reclusiveness, difficulty making friends, and lack of interest in social activity. The statement about not trusting anyone reflects a paranoid personality disorder. The statement about being better than anyone else reflects a narcissistic personality disorder, characterized by grandiosity and an inexhaustible need for admiration. Individuals are benignly arrogant and feel themselves to be above the conventions of their cultural group.
A nurse is caring for a client diagnosed with borderline personality disorder. The nurse has instructed the client about using the communication triad. The nurse determines that the client has understood this technique when stating what? "I should start by stating my feelings as an 'I' statement." "Maybe I should start by describing the situation that has me upset." "I should first tell the other person what I'd like to be different about the situation." "I should begin by telling the other person what has triggered my emotion."
"I should start by stating my feelings as an 'I' statement." Explanation: The client should begin with an "I" statement and the identification of feelings. Many want to begin with the condition. If the client begins with the condition, the statement becomes accusatory and is likely to evoke defensiveness. The "I" statement is followed by a nonjudgmental statement of the emotional trigger, then followed by what the person would like differently or what would restore comfort to the situation.
A nurse is developing a nurse-client relationship with a client diagnosed with borderline personality disorder (BPD). Which statement by the nurse demonstrates that the nurse understands the client's fears of abandonment and intimacy? "I'm here to help you for as long as I can." "I will be seeing you during the daytime this week." "We will work on things until your physician says you can go home." "Let's see how things go first and then how long you need me."
"I will be seeing you during the daytime this week." Explanation: A key to helping clients with BPD is recognizing their fears of both abandonment and intimacy as they relate to the nurse-client relationship. Informing the client of the length of this relationship allows the client to engage in, and prepare for, termination with minimal pain of abandonment. Therefore the statement about seeing the client during the daytime for a week demonstrates understanding of this concept. The other statements are open ended and do not address the length of the relationship.
A client asks the nurse to go to lunch with the client one day next week after the client is discharged. Which statement is the most therapeutic response? "My role here is to help you recover. Let's talk about what else you can be doing after discharge." "That sounds good. Call the unit when you decide which day, and we can set it up." "I'd love to do that, but I'm on vacation next week." "I'm sorry, it is not within my role to have any affiliation with you after your discharge."
"My role here is to help you recover. Let's talk about what else you can be doing after discharge." Explanation: Clients with borderline personality disorder may display negative behaviors that can interfere with therapy. The nurse will have to confront clients about their behaviors and set appropriate limits.
A nurse is conducting a review class on borderline personality disorder. When describing the characteristics associated with this disorder, which would the nurse most likely include? Select all that apply. Difficulty regulating moods Overinflated self-identity Problems with interpersonal relationships Thinking that is based on delusions Impulsive behavior
- Difficulty regulating moods - Problems with interpersonal relationships - Impulsive behavior Explanation: People with BPD have problems regulating their moods, developing a self-identity, maintaining interpersonal relationships, maintaining reality-based thinking, and avoiding impulsive or destructive behavior.
A mental health nurse is working with a client with antisocial personality disorder. The nurse has just reviewed the unit rule of one cigarette per break. While telling the client about the unit rules, the client asks, "Well, if I have not done anything bad all day, can I have two cigarettes instead of one?" Which would be the most therapeutic nursing response? "Well, that's a good question. I need to check with the team." "No, only one cigarette is allowed per break time." "This is a good example of trying to push your limits." "It depends on whether or not we can make that exception that day."
"No, only one cigarette is allowed per break time." Explanation: The client is trying to manipulate the nurse in order to gratify the immediate need for a cigarette. In responding to manipulative behavior, the most therapeutic intervention is to maintain the limits that have been set and not to change the rules or make concessions for the client. The correct answer is the only option that is clear and assertive and maintains the rules.
For a person to be diagnosed with antisocial personality disorder, the individual must be a minimum of what age? 7 years 13 years 18 years 21 years
18 years Explanation: Antisocial personality disorder diagnosis is given to individuals 18 years of age or older who fail to follow society's rules—that is they do not believe that society's rules are made for them and are consistently irresponsible.
A client with borderline personality disorder has been admitted to the inpatient unit because the client has been engaging in wrist cutting. The client's sibling is visiting, and the sibling asks the nurse to explain why the client sometimes does this. Which response by the nurse would be most appropriate? "Sometimes the self-injurious behavior is undertaken to relieve stress." "Self-injurious behavior often calms and sedates people with this diagnosis." "Sometimes they do it to avoid the onslaught of delusional thinking." "The self-mutilation often slows the mood swings your sibling experiences."
"Sometimes the self-injurious behavior is undertaken to relieve stress." Explanation: Clients with borderline personality disorder are impulsive and may respond to stress by harming themselves. Self-harm is an effort to self-soothe by activating endogenous endorphins to provide comfort. The behavior is not sedating or calming, and it is not used to prevent delusional thinking or mood swings.
A nurse is preparing a presentation for a group of staff nurses on personality disorders. When describing antisocial personality disorders (ASPD), the nurse would explain that for a person to be diagnosed with the disorder, the person must be at least which age? 15 years 18 years 21 years 25 years
18 years Explanation: To be diagnosed with ASPD, the individual must be at least 18 years old and must have exhibited one or more childhood behavioral characteristics of conduct disorder before the age of 15 years, such as aggression to people or animals, destruction of property, deceitfulness or theft, or serious violation of rules.
When reviewing the history of a client with antisocial personality disorder, which would the nurse expect to find? Select all that apply. Repeated incidents involving assaults Consistent regular work history Lack of remorse for actions Episodes involving scams for personal gain Detailed plans for future actions
- Repeated incidents involving assaults - Lack of remorse for actions - Episodes involving scams for personal gain Explanation: A client with antisocial personality disorder shows a pervasive pattern of disregard for and violation of the rights of others. History may reveal repeated incidents of physical fights or assaults demonstrating irritability and aggressiveness, repeated failure to sustain consistent work behavior or honor financial obligations, lack of remorse for actions, conning others for personal profit or pleasure, and impulsivity or failing to plan ahead.
A nurse is assessing a client diagnosed with avoidant personality disorder. Which would the nurse expect to find? Select all that apply. Shyness Feelings of inadequacy Feelings of superiority Perfectionism Detail oriented
- Shyness - Feelings of inadequacy Explanation: Individuals with avoidant personality disorder appear timid, shy, and hesitant; fear criticism; and feel inadequate and inferior. These individuals are extremely sensitive to negative comments and disapproval and appraise situations more negatively than others do. Individuals with obsessive-compulsive personality disorder exhibit perfectionism and an intense involvement in details such that they have difficulty making decisions and completing tasks.
When developing the plan of care for a client with borderline personality disorder (BPD), which areas would the nurse identify as likely problematic? Select all that apply. Hydration Self-care Pain Sleep Nutrition Self-harm
- Sleep - Nutrition - Self-harm Explanation: Usually, clients with BPD are managing hydration, self-care, and pain well. Problem areas include sleep, nutrition, and self-harm.
Treatment approaches for clients with personality disorders generally rely on which modality? Pharmacotherapy Cognitive-behavioral therapy Individual therapy A combination of approaches
A combination of approaches Explanation: Clients with personality disorders are likely to benefit from individual psychotherapy. Group therapy provides psychoeducational experiences and teaches assertiveness skills, positive coping skills, relaxation techniques, and nonchemical coping. Clients with borderline, dependent, histrionic, and avoidant personality disorders may benefit from family treatment approaches. Pharmacologic agents such as antidepressants, lithium carbonate, or atypical antipsychotic medications are sometimes used for certain clients.
A nurse is reviewing the medical record of a female client diagnosed with borderline personality disorder (BPD). Which would the nurse identify as one of the strongest risk factors for this disorder? Abuse as a child Parental alcohol abuse Poverty History of depression
Abuse as a child Explanation: Childhood sexual abuse, which more commonly affects girls, is one of the strongest risk factors for BPD. Various studies show that physical and sexual abuse seem to be significant risk factors for BPD. Other studies cite parental loss and separation. Parental alcohol abuse, poverty, and a history of depression have not been linked to BPD.
After teaching a group of nurses about borderline personality disorder, the leader determines that the education was successful when the group identifies that symptoms typically begin in which age group? Adolescence Young adulthood Middle-age individuals Late adulthood
Adolescence Explanation: Many children and adolescents show symptoms similar to those of BPD, such as moodiness, self-destruction, impulsiveness, lack of temper control, and rejection sensitivity. Because symptoms of BPD begin in adolescence, it makes sense that some of the children and adolescents would meet the criteria for BPD even though it is not diagnosed before young adulthood.
While shopping in a grocery store, a client with borderline personality disorder (BPD) greets the sibling of a neighbor with a great big hug. Then about 5 minutes later, the client walks past the sibling and ignores the sibling. The client is demonstrating what? Dichotomous thinking Affective instability Dissociation Identity diffusion
Affective instability Explanation: Affective instability (rapid and extreme shift in mood) is a core characteristic of BPD and is evidenced by erratic emotional responses to situations and intense sensitivity to criticism or perceived slights. For example, a person may greet a casual acquaintance with intense affection, yet later be aloof with the same acquaintance. Dichotomous thinking involves evaluating experiences, people, and objects in terms of mutually exclusive categories (e.g., good or bad, success or failure, trustworthy or deceitful), which informs extreme interpretations of events that would normally be viewed as including both positive and negative aspects. Dissociation refers to times when thinking, feelings, or behaviors occur outside a person's awareness. Identity diffusion occurs when a person lacks aspects of personal identity or when personal identity is poorly developed.
A client comes to the clinic for a follow-up visit. Despite being warm and friendly with the nurse on a previous visit, today the client presents with anger and sarcastic undertones with the same nurse. The client is presenting which behavior commonly seen in borderline personality disorder? Depression Identity diffusion Affective instability Dichotomous thinking
Affective instability Explanation: Affective instability is a rapid and extreme shift in mood and a core characteristic of borderline personality disorder. It is evidenced by erratic emotional responses to situations and intense sensitivity to criticism, perceived slights, or both.
What does the nurse recognize as the most likely explanation for the self-mutilating behaviors that occur with borderline personality disorder? The result of an inherited disorder that manifests itself as an incapacity to tolerate stress An expression of intense anger or helplessness in order to block emotional pain Use of projective identification to reduce anxiety A constitutional inability to regulate affect that predisposes clients to psychic disorganization
An expression of intense anger or helplessness in order to block emotional pain Explanation: The client does not have an inherited disorder manifesting as an inability to manage stress and does not exhibit projective identification. Borderline personality pathology is not a constitutional inability to regulate affect; rather, it consists of maladaptive behavior patterns that usually present at times of stress or perceived threat (e.g., regarding fears of rejection, abandonment, and failure). Clients who engage in self-mutilation secondary to borderline personality disorder typically use self mutilation as a cry for help, an expression of intense anger or helplessness, or a form of self punishment with the aim to block emotional pain.
Which diagnosis is associated with a pervasive disregard for and violation of the rights of others? Antisocial personality Borderline personality Passive-aggressive personality Schizoid personality
Antisocial personality Explanation: Antisocial personality disorder is characterized by a disregard for and violation of the rights of others. Antisocial personality disorder is a common diagnosis for those in prison and jails.
The nurse is interviewing a client with a history of violence. The client boasts that the client "put a kid in a wheelchair" once when the client was younger and has maimed others. The client states, "Who cares? Life's tough." Violence and insensitivity are associated with which personality disorder? Schizoid personality disorder Antisocial personality disorder Histrionic personality disorder Borderline personality disorder
Antisocial personality disorder Explanation: Those with antisocial personality disorder display aggressive, irresponsible behavior that often leads to conflicts with society and subsequent involvement in the criminal justice system. People with this disorder commonly display behaviors such as fighting, lying, stealing, abusing children and spouses, abusing substances, and participating in confidence schemes. These people, while often superficially charming, lack genuine warmth.
Avoidant, dependent, and obsessive-compulsive personality disorders are characterized by what? Odd or eccentric behaviors Dramatic or erratic behaviors Anxious or fearful behaviors Manic or withdrawn behaviors
Anxious or fearful behaviors Explanation: Clients with Cluster C personality disorders—which include avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder—are often anxious, tense, and fearful.
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? Attempt to discuss placing the client into an assisted living environment Ask the parents how they have coped with the client's behaviors over the years Ask the parents to keep a written schedule of activities for each day for the client Encourage the parents to discuss the possibility of the client going into a day-care program when the client goes home
Ask the parents to keep a written schedule of activities for each day for the client 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.
A nurse is providing care to a client with borderline personality disorder. When providing for the client's biopsychosocial needs, the nurse would address which in the biologic domain? Establishing a therapeutic relationship Assisting with problem solving Establishing boundaries Assisting with sleep measures
Assisting with sleep measures Explanation: Assisting with sleep measures reflects a biopsychosocial intervention in the biologic domain. Establishing a therapeutic relationship, assisting with problem solving, and establishing boundaries would be interventions in the psychological domain.
A nurse is describing histrionic personality disorder to a group of new nurses. Which term would the nurse most likely use? Attention seeking Psychopath Sociopath Lacking empathy
Attention seeking Explanation: A person with a histrionic personality disorder is often described as "attention seeking," "excitable," and "emotional." Psychopath and sociopath are terms used to describe the behavior of a person with antisocial personality disorder. Lacking empathy describes a person with a narcissistic personality disorder.
Which personality disorder is most often treated within the inpatient psychiatric setting? Antisocial Schizotypal Borderline Dependent
Borderline Explanation: People with borderline personality disorder are believed to be the most frequent recipients of psychiatric care in both inpatient and outpatient settings due to the frequency of engaging in self-destructive behaviors.
A client is admitted to the mental health unit after the client's spouse brings the client to the emergency department. Upon arrival, the spouse explained that the client had been crying all weekend and stating that the client wanted to die. Upon further assessment, the spouse reports that the client always has difficulty controlling anger and frequently worries that the spouse will leave the client. Recently, the client has been getting drunk every night, which the client never used to do. What diagnosis should the nurse suspect applies to this client? Bipolar disorder Borderline personality disorder Depression Mania
Borderline personality disorder Explanation: Borderline personality disorder is characterized by a disruptive pattern of instability related to self-identity, interpersonal relationships, and affect combined with marked impulsivity and destructive behavior.
A 30-year-old client who has not paid rent in 4 months is being evicted from an apartment. The client is brought to the hospital after the client uses a kitchen knife to cut the client's wrist in response to the stress of the eviction. The client's behavior is consistent with what? Paranoid personality disorder Borderline personality disorder Schizotypal personality disorder Antisocial personality disorder
Borderline personality disorder Explanation: A person with borderline personality disorder almost always appears to be in a state of crisis and tends to have an exaggerated response to stressors. This exaggeration of emotional response is not typical of paranoid, schizotypal, or antisocial personality disorders.
Impulsivity and difficulty controlling anger are characteristic of which mental health diagnosis? Depression Schizophrenia Posttraumatic stress disorder Borderline personality disorder
Borderline personality disorder Explanation: Impulsivity and difficulty controlling anger are characteristic of borderline personality disorder
The nurse is in the process of planning the care of a psychiatric-mental health client and has specified the following outcome: The client will be free from self-inflicted harm. What is this client's most likely diagnosis? Dependent personality disorder Borderline personality disorder Antisocial personality disorder Schizoid personality disorder
Borderline personality disorder Explanation: Self-mutilation is frequently performed by individuals who have borderline personality disorder. Persons with dependent personality disorder, antisocial personality disorder, or schizoid personality disorder are not prone to self-mutilation and the accompanying attention that it provides.
A personality disorder is defined as a collection of traits that do what? Cause behavioral dysfunction and inner distress Are malleable and poorly defined Lead to aggression and violence Lead to withdrawn and antisocial behavior
Cause behavioral dysfunction and inner distress Explanation: A personality disorder can be defined as a collection of personality traits that have become fixed and rigid to the point that the person experiences inner distress and behavioral dysfunction. A personality disorder also can be considered a lifelong pattern of behavior that affects many areas of the person's life, causes problems, and is not produced by another disorder or illness.
A personality disorder is defined as a collection of traits that do what? Cause behavioral dysfunction and inner distress Are malleable and poorly defined Lead to aggression and violence Lead to withdrawn and antisocial behavior
Cause behavioral dysfunction and inner distress Explanation: A personality disorder can be defined as a collection of personality traits that have become fixed and rigid to the point that the person experiences inner distress and behavioral dysfunction. A personality disorder also can be considered a lifelong pattern of behavior that affects many areas of the person's life, causes problems, and is not produced by another disorder or illness.
Into which personality disorder category are individuals placed whose behavior appears odd or eccentric? Cluster A Cluster B Cluster C Cluster D
Cluster A Explanation: Cluster A includes individuals whose behavior appears odd or eccentric, such as paranoid or schizoid personality disorder.
Which cluster of disorders corresponds to symptoms of being dramatic and emotional? Cluster A Cluster B Cluster C Cluster D
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.
A 70-year-old client comes to the clinic with the client's daughter for group therapy. The client wants the daughter to do everything with the client, is afraid to be left alone, and is having difficulty making any individual decisions. Interventions for this client would center around the diagnosis of which personality disorder? Narcissistic Dependent Antisocial Schizoid
Dependent Explanation: Dependent personalities lack self-confidence and are unable to function in an independent role. Clients go to great lengths to seek nurturance and support from others. They experience difficulty in making everyday decisions and are preoccupied with fears of being left alone to care for themselves.
The client is a 29-year-old who is having a great deal of difficulty with a new job. The client has been unable to make decisions individually and feels overwhelmed when the client needs to begin a new project. The client often relies on one of her coworkers to help with decisions and projects. Which would describe the client correctly? Narcissistic personality Dependent personality Schizotypal personality Histrionic personality
Dependent personality Explanation: Clients with dependent personality have a pervasive and excessive need to be taken care of, leading to submissive and clinging behavior and fears of separation. In addition, they need so much approval from others that they have tremendous difficulty making independent decisions or starting projects. In effect, they do not trust their own judgment and often believe that others have better ideas.
The nurse is conducting an admission assessment of a 41-year-old client. Each time that the nurse asks the client a question, the client defers to the client's spouse to answer the question. Such behavior is consistent with which personality disorder? Borderline personality disorder Histrionic personality disorder Dependent personality disorder Antisocial personality disorder
Dependent personality disorder Explanation: Persons with dependent personality disorder are polite and compliant but unable to function in an independent role or an assertive manner. Persons with borderline, histrionic, or antisocial personality disorders are more apt to overemphasize their own needs, priorities, and opinions.
A client with a personality disorder is upset and calls the nurse a "stupid cow." Which is an effective initial response to this client's behavior? Demonstrate empathy by reaching out to touch the client. Discuss displacement of anger and set limits. Report the behavior to the health care provider so that consistency and consequences can be followed. Walk away from the client.
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.
The nurse in charge of an inpatient psychiatric unit is irritated with a client who has borderline personality disorder. Which step should the nurse take? Confront the client firmly about how the client's behavior makes the nurse feel. Direct the client to another staff member when the client tries to interact. Discuss the feelings with a colleague to promote coping. Arrange for the client to be transferred to another unit.
Discuss the feelings with a colleague to promote coping. Explanation: Clients often test the nurse for a response, and nurses must decide how to respond to particular behaviors. This can be tricky because even negative responses can be viewed as positive reinforcement for the client. Discussing feelings with a colleague can promote the nurse's adaptive coping with the stress of working with a client diagnosed with a personality disorder. Grossly inappropriate and disrespectful behaviors require confrontation. There is no need to direct the client to another staff member or arrange for a transfer.
Which occurs when thinking, feeling, or behaviors occur outside a person's awareness? Affective instability Impulsivity Dissociation Dichotomous thinking
Dissociation Explanation: A cognitive dysfunction seen in BPD is dissociation, or times when thinking, feeling, or behaviors occur outside a person's awareness. Affective instability is evidenced by erratic emotional responses to situations and intense sensitivity to criticism or perceived slights. Impulsivity occurs when there is difficulty delaying gratification or thinking through the consequences before acting on feelings, leading to unpredictable actions. Cognitively, people with BPD have dichotomous thinking. They evaluate experiences, people, and objects in terms of mutually exclusive categories, which informs extreme interpretations of events that would normally be viewed as including both positive and negative aspects.
A client diagnosed with schizoid personality disorder is described by family members as what? Eccentric and a loner Dramatic and emotional Nervous and fearful Tired and sad
Eccentric and a loner Explanation: A client diagnosed with schizoid personality disorder is described by family members as being eccentric and a loner, not dramatic and emotional, nervous and fearful, or tired and sad.
A nurse is preparing a teaching plan for a client with antisocial disorder. Which would the nurse most likely employ to promote successful education? Using a lecture approach to provide information. Engaging the client in a discussion to direct the topic to the client. Establishing general goals for teaching. Allowing the client to guide the teaching to other topics.
Engaging the client in a discussion to direct the topic to the client. Explanation: Client education efforts have to be creative and thought provoking. In teaching a person with antisocial disorder, a direct approach is best, but the nurse must avoid "lecturing," which the client will resent. In teaching the client about positive health care practices, impulse control, and anger management, the best approach is to engage the client in a discussion about the issue and then direct the topic to the major educational points. These clients often take great delight in arguing or showing how the rules of life do not apply to them. A sense of humor is important, as are clear teaching goals and avoiding being sidetracked.
Which is considered a part of the social domain of the biopsychosocial interventions for the client diagnosed with borderline personality disorder (BPD)? Medication administration Establishing boundaries Self-harm prevention Nutritional management
Establishing boundaries Explanation: The social domain includes establishing boundaries as clients with BPD have difficulty maintaining satisfying interpersonal relationships. Medications, prevention of harm to self and others, and encouraging adequate nutrition are part of the biologic domain.
The nurse in charge of an inpatient psychiatric unit is frustrated and angry with a client who has borderline personality disorder. Which steps should the nurse take? Confront the client firmly but compassionately about how the client's behavior makes the nurse feel. Direct the client to another staff member when the client tries to interact. Examine the nurse's own feelings to discover the source of the nurse's anger. Ignore the feelings and move on from the client.
Examine the nurse's own feelings to discover the source of the nurse's anger. Explanation: Working with clients who have personality disorders is difficult. For this reason, nurses may find it helpful to discuss their emotional reactions to clients who have personality disorders with knowledgeable and trusted nurse colleagues. Doing so can facilitate nurses working through negative countertransferences, resulting in their tolerating and accepting feelings of irritation and anger as natural reactions to clients with personality disorders. This realization can increase the nurse's own self-awareness and sense of emotional control.
When documenting observations of the behaviors exhibited by a client diagnosed with borderline personality disorder, the nurse can correctly use which terms? Impulsive, self-destructive, unstable Impulsive, aggressive, and manipulative Perfectionistic, rigid, and controlling Emotional, dramatic, and theatrical
Impulsive, self-destructive, unstable Explanation: Borderline personality behavior is characteristically impulsive, self-destructive, and unstable. It is antisocial, not borderline personality, behavior that is characteristically impulsive, aggressive, and manipulative. Obsessive-compulsive, not borderline personality, behavior is characteristically perfectionistic, rigid, and controlling, whereas histrionic personality, not borderline behavior, is characteristically emotional, dramatic, and theatrical.
Gambling, binge eating, and engaging in unsafe sex are examples of what? Identity diffusion Dissociation Affective instability Impulsivity
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.
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 Encouraging questions and discussing the client's concerns Promoting social ostracism of the client's exhibiting manipulation Scheduling staff one-on-one time with the client
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.
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? Poor social skills Depression Mania Maladaptive expression of emotions
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.
Which personality disorder is categorized as a Cluster B disorder? Paranoid personality disorder Obsessive-compulsive personality disorder Schizoid personality disorder Narcissistic personality disorder
Narcissistic personality disorder Explanation: Clients with Cluster B disorders display dramatic, emotional, and attention-seeking behaviors. These include antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder.
A nurse is preparing an inservice program for a group of mental health nurses on the topic of borderline personality disorder. When discussing the need for hospitalization, which would the nurse include as the most likely reason for inpatient hospitalization? Dichotomous thinking Identity diffusion Affective instability Nonsuicidal self-injury
Nonsuicidal self-injury Explanation: Hospitalization is necessary during acute episodes involving nonsuicidal self-injury, but once this is controlled, the client is discharged. Dichotomous thinking, identity diffusion and affective instability characterize borderline personality disorder. Unless these are acute and lead to parasuicidal behavior, the client is treated in outpatient or day treatment settings.
A client attends an outpatient mental health clinic accompanied by the client's spouse for an assessment. The client's spouse reports the client is easily irritated if the home is not maintained in a specific order and when the client is unable to complete a "to do" list on time. The client has a serious and formal demeanor. Which personality disorder best describes this client? Obsessive-compulsive personality disorder Avoidant personality disorder Narcissistic personality disorder Paranoid personality disorder
Obsessive-compulsive personality disorder Explanation: Perfectionism, rigidity, controlling behavior, and extreme orderliness characterize people with obsessive-compulsive personality disorder. Their rigid perfectionism often results in indecisiveness, preoccupation with detail, and an insistence that others do things their way. Resisting authority and insisting that they and they alone are right are common behavioral patterns. Hoarding worthless objects, displaying stinginess, working excessively, showing stubbornness, and moralizing also occur to a high degree in people with this disorder.
A client is diagnosed with a personality disorder manifested by odd, eccentric behavior. Which personality disorder would be associated with this manifestation? Avoidant Dependent Obsessive-compulsive Paranoid
Paranoid Explanation: Paranoid, schizoid, and schizotypal personality disorders are characterized by behavior that is odd or eccentric. Avoidant, dependent, and obsessive-compulsive personality disorders are characterized by anxiety and fearfulness.
A client admitted on the inpatient mental health unit has been suspicious of other clients on the unit. This client is often angry at others' comments, and carries a grudge against a roommate for accidentally using the client's bath towel. Which personality disorder is most likely the client's diagnosis? Antisocial Borderline Paranoid Histrionic
Paranoid Explanation: People with paranoid personality disorder are suspicious and quick to take offense, project negative feelings onto others, have few friends, project hidden meaning into innocent remarks, are guarded, and are quick to react with anger and counterattack in response to imagined character or reputation attacks.
A client with borderline personality disorder has been admitted to the inpatient unit after being found in the client's parents' bedroom, burning the client's arm with an iron. This injury required a brief stay in the hospital's burn unit prior to transfer to your psychiatric unit. Which is the nursing care priority for this client during the first 24 hours of admission? Suicidal assessment Working on self-esteem Impulse control Protection from self-mutilation
Protection from self-mutilation Explanation: Clients with borderline personality disorder become intensely and inappropriately angry if they believe others are ignoring them and consequently may impulsively try to harm or mutilate themselves.
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? Manipulation Distrust Perfection Self-dramatization
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.
Clients with borderline personality disorder (BPD) are usually admitted to the inpatient setting because they exhibit what? Aggression Splitting Self-harm Impulsivity
Self-harm Explanation: Clients with BPD are usually admitted to the inpatient setting because of threats of self-harm.
The most serious consequence of behaviors seen in borderline personality disorder includes what? Identity diffusion Impulsivity Self-injury Dissociation
Self-injury Explanation: The turmoil and unsuccessful interpersonal relationships and social experiences associated with borderline personality disorder may lead the person to undermine the self when a goal is about to be reached. The most serious consequences are suicide attempts and parasuicidal behaviors. Identity diffusion occurs when a person lacks aspects of personal identity or when personal identity is poorly developed. Impulsivity occurs in people who have difficulty delaying gratification or thinking through the consequences before acting on their feelings. Dissociation occurs when thinking, feeling, or behaviors occur outside a person's awareness.
As part of a client's treatment plan for borderline personality disorder, the client is engaged in dialectical behavior therapy. As part of the therapy, the client is learning how to control and change behavior in response to events. The nurse identifies the client as learning which type of skills? Emotion regulation skills Mindfulness skills Distress tolerance skills Self-management skills
Self-management skills Explanation: Self-management skills focus on helping clients learn how to control, manage, or change their behavior, thoughts, or emotional responses to events. Emotion regulation skills are taught to manage intense, labile moods and involve helping the client label and analyze the context of the emotion, as well as developing strategies to reduce emotional vulnerability. Teaching individuals to observe and describe emotions without judging or blocking them helps clients experience emotions without stimulating secondary feelings that may cause more distress. Mindfulness skills are the psychological and behavioral versions of meditation skills usually taught in Eastern spiritual practice; they are used to help the person improve observation, description, and participation skills by learning to focus the mind and awareness on the current moment's activity. Distress tolerance skills involve helping the individual tolerate and accept distress as a part of normal life.
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? Anxiety Self-mutilation Loneliness Stress
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.
A client on an inpatient psychiatric unit has features of borderline personality disorder. The client is frequently angry, has an unstable sense of self, and is highly impulsive. The client can be verbally abusive to staff, who feel manipulated by the client's behaviors. Which intervention does the nurse determine as priority? Social skills training Setting limits Stress management techniques Increased recreational therapy
Setting limits Explanation: The nurse introduces the use of limit setting when clients engage in manipulative, acting-out, dependent, or similar inappropriate behaviors.
A nurse is caring for a client with schizoid personality trait. When developing a plan of care for the client, which would a nurse most likely include? Social skills training Anger management training Relaxation techniques Coping skills training
Social skills training Explanation: Because individuals with schizoid personality trait often lack customary social skills, social skills training is useful in enhancing their ability to relate in interpersonal situations. The primary focus is to increase the client's ability to feel pleasure. The nurse balances interventions between encouraging enough social activity and too much activity, which prevents the individual from retreating to a fantasy world that becomes intolerable. Anger management, relaxation techniques, and coping skills are not appropriate for a client with schizoid personality trait.
For clients with borderline personality disorder, there is a tendency to see the world as either good or bad. As a result, these clients use the primitive defense of what? Regression Denial Splitting Compensation
Splitting Explanation: Because borderline personality disorder clients view the world in absolutes, nurses and other treatment team members are alternatively categorized as all good or all bad. The primitive defense is termed splitting and presents clinicians with a challenge to work openly with each other, as well as the client, until the issue can be resolved through team meetings and clinical supervision. Regression, denial, and compensation are ego defense mechanisms
When clients diagnosed with borderline personality disorder (BPD) see nurses as either all good or all bad, the client is using which primitive defense? Splitting Defending Invalidating Projective identification
Splitting Explanation: Because clients with BPD view the world in absolutes, nurses and other treatment team members are alternately categorized as all good or all bad. This primitive defense is called splitting, and it presents clinicians with a challenge to work openly with each other, as well as the client, until the issue can be resolved through team meetings and clinical supervision. This is not an example of defending, invalidating, or projective identification.
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 Thought stopping Decatastrophizing Positive self-talk
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.
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 Thought stopping Decatastrophizing Positive self-talk
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.
The nurse is counseling a 28-year-old client with avoidant personality disorder. Despite being employed, the client verbalizes having low quality of life due to anxiety and isolation. Which therapeutic goals does the nurse establish as priority? The client will be able to accept a job promotion. The client will experience increased self-esteem. The client will engage in less risk-taking behavior The client will form a romantic relationship.
The client will experience increased self-esteem. Explanation: People with avoidant personality disorder have a pattern of social discomfort, timidity, and fear of negative evaluation. They are preoccupied with what they perceive as their own shortcomings and will form relationships with others only if they believe acceptance is guaranteed. People with this disorder often view themselves as unattractive and inferior to others and are often socially inept. The priority goal should address increasing the client's self-esteem.
The nurse-therapist is conducting a group therapy session in which one of the participants is an adult who has been diagnosed with narcissistic personality disorder. The nurse recognizes the significance of childhood experiences in the etiology of personality disorders, which for this client may have included what pattern? The client's parent catered to the client's every need and the client used temper tantrums to successfully get the client's way. The client's parents had excessively high performance expectations of the client and failure was met with severe sanctions. The client's parent was a rigid disciplinarian who demanded complete subservience from both the client and the client's other parent. The client's parent was in a constant state of crisis and depended heavily on the client for emotional support.
The client's parent catered to the client's every need and the client used temper tantrums to successfully get the client's way. Explanation: Narcissistic personality disorder is characterized by an exaggerated sense of self-importance. It is plausible that a client's high degree of control and entitlement early in life may have contributed to or exacerbated such tendencies. The other patterns of interaction would not tend to promote entitlement or a grandiose self-view.
The nurse-therapist is conducting a group therapy session in which one of the participants is an adult who has been diagnosed with narcissistic personality disorder. The nurse recognizes the significance of childhood experiences in the etiology of personality disorders, which for this client may have included what pattern? The client's parent catered to the client's every need and the client used temper tantrums to successfully get the client's way. The client's parents had excessively high performance expectations of the client and failure was met with severe sanctions. The client's parent was a rigid disciplinarian who demanded complete subservience from both the client and the client's other parent. The client's parent was in a constant state of crisis and depended heavily on the client for emotional support.
The client's parent catered to the client's every need and the client used temper tantrums to successfully get the client's way. Explanation: Narcissistic personality disorder is characterized by an exaggerated sense of self-importance. It is plausible that a client's high degree of control and entitlement early in life may have contributed to or exacerbated such tendencies. The other patterns of interaction would not tend to promote entitlement or a grandiose self-view.
A group of nursing students is reviewing information about antisocial personality disorder. The students demonstrate understanding of this disorder when they state what? The disorder occurs more frequently in women. The individual must be at least 18 years of age. The disorder is found primarily in Asian individuals. Alcohol abuse disorder rarely accompanies this disorder.
The individual must be at least 18 years of age. Explanation: To be diagnosed with antisocial personality disorder, the individual must be at least 18 years of age and must have exhibited one or more childhood behavioral characteristics of conduct disorder before the age of 15 years. The disorder occurs more frequently in men and crosses all cultures and ethnicities. This personality disorder is strongly associated with alcohol and drug abuse.
A nurse working with a client with borderline personality disorder could establish which as outcome criteria? Display anger more frequently. Act out neediness. Filter concerns and insecurities through the nurse. Tolerate stress without self-mutilation.
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.
