Week 3 Boyd Questions (chapters 27 & 28)

The adult children of a client with narcissistic personality disorder meet with the therapist as part of their parent's treatment. The nurse is aware that which statement by the daughter is consistent with behavior typically associated with this personality disorder? "My parent never really seemed to see me as a person with my own thoughts and problems." "My parent was always timid and fearful." "My parent never had any family or friends over to the house." "My parent was constantly threatening to commit suicide."

"My parent never really seemed to see me as a person with my own thoughts and problems."

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? "No, only one cigarette is allowed per break time." "Well, that's a good question. I need to check with the team." "It depends on whether or not we can make that exception that day." "This is a good example of trying to push your limits."

"No, only one cigarette is allowed per break time."

The nurse is talking to a client with schizoid personality disorder about finding a job. Which of the following suggestions by the nurse would be most helpful? "Being a loner really limits your employment opportunities." "Maybe your friend could see if there is a night position available at the convenience store." "Perhaps working part-time at a fast-food restaurant would be something you could do." "There is a job posting at the hospital for a file clerk in medical records."

"There is a job posting at the hospital for a file clerk in medical records." *Clients with schizoid disorder often work well in jobs with minimal interpersonal demands. Answer A is not a positive suggestion for this client. Answer B does not promote independence in finding a job. Answer C would not be correct because these clients exhibit marked detachment from others; working in a fast-food restaurant would involve the use of many interpersonal skills.

Which statement by a client with borderline personality disorder (BPD) is an example of catastrophizing? "This is the most awful thing that has ever happened to me." "No one ever listens to me." "I never get what I want." "If I had not made him mad, he wouldn't have hit me."

"This is the most awful thing that has ever happened to me." *Examples of dichotomizing statements include, "No one ever listens to me" and "I never get what I want." A statement in which a self-attribution error has occurred is "if I had not made him mad, he wouldn't have hit me

Which is a psychosocial explanation for the development of personality disorders? -Self-transcendence contributes to self-consciousness and materialism. -Failure to complete a developmental task jeopardizes future personality development. -Highly self-directed people reflect uncooperativeness and intolerance. -Cooperative people become increasingly helpless over time.

-Failure to complete a developmental task jeopardizes future personality development.

Which of the following behavioral patterns noted in clients diagnosed with borderline personality disorder (BPD) is associated with learned helplessness? Self-invalidation Apparent competence Emotional vulnerability Active passivity

Active passivity *Active passivity occurs when a person fails to engage actively in solving his or her own life problems, but actively seeks problem solving from others in the environment; it is learned helplessness and hopelessness. Emotional vulnerability occurs when a person has difficulty regulating negative emotions. Self-invalidation occurs when a person fails to recognize his or her own emotional responses, thoughts, beliefs, and behaviors and sets unrealistically high standards and expectations for him- or herself. Apparent competence is the tendency of an individual to appear deceptively more competent than he or she actually is.

What does the nurse recognize as the most likely explanation for the self-mutilating behaviors that occur with borderline personality disorder? An expression of intense anger or helplessness in order to block emotional pain The result of an inherited disorder that manifests itself as an incapacity to tolerate stress A constitutional inability to regulate affect that predisposes clients to psychic disorganization Use of projective identification to reduce anxiety

An expression of intense anger or helplessness in order to block emotional pain *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.

A client with borderline personality disorder is prescribed pharmacotherapy. The nurse understands that this treatment aims to control which of the following? Select all that apply. Emotional dysregulation Physical disability Anxiety Cognitive disturbances Impulsive aggression

Anxiety Cognitive disturbances Emotional dysregulation Impulsive aggression

A client with antisocial personality disorder uses manipulation to try leaving the unit with another client's family members after visiting hours. Which of the following interventions is best to deal with the manipulative behavior? Allow the client's nurse to determine how to deal with the client since the client has never attempted to escape before. Assist the client to identify patterns of behavior and consequences as determined by the team plan. Remind the client that he could be discharged for inappropriate behavior. Restrict the client from all unit activities to provide time for reflection on his behavior.

Assist the client to identify patterns of behavior and consequences as determined by the team plan. *Following the team plan ensures consistency of response to the client's manipulative behavior. Learning the relationship between behavior and consequences is a positive outcome for the client. Answers A, C, and D are not appropriate interventions for the client exhibiting manipulative behavior.

A personality disorder is defined as a collection of traits that do what? Cause behavioral dysfunction and inner distress Lead to withdrawn and antisocial behavior Are malleable and poorly defined Lead to aggression and violence

Cause behavioral dysfunction and inner distress

One of the biosocial theories of the etiology of borderline personality disorder involves the role of an invalidating environment, a social situation that negates private emotional responses and communication. The most severe form of invalidation occurs in which of the following situations? Marriage Divorce Child sexual abuse Death of family member

Child sexual abuse *The most severe form of invalidation occurs in situations of child sexual abuse. Often, the abusing adult has told the child that this is a "special secret" between them. The child experiences feelings of fear, pain, and sadness, yet this trusted adult continuously dismisses the child's true feelings and tells the child what he or she should feel. Divorce, marriage, and death of a family member are not the most severe forms of invalidation.

Dialectical behavior therapy (DBT) combines behavior therapy with which type of therapy? Occupational therapy Milieu therapy Psychotherapy Cognitive therapy

Cognitive therapy

When facilitating change in the behavior of a client diagnosed with a personality disorder, the nurse knows which intervention will have the greatest impact on success? Evaluating the client's understanding of the etiology of the prescribed medications Conducting regular assessments so the treatment can be changed when necessary Educating the client to the importance of complying with treatment interventions Collaborating with the client when establishing treatment goals

Collaborating with the client when establishing treatment goals *Because clients with personality disorders need to feel in control, it is important to involve them in formulating their care plan. The nurse asks what the client would like to accomplish in concrete terms, such as minimizing problems at work, or getting along with others. Clients are more likely to engage in the therapeutic process if they believe they have something to gain. When planning interventions with a client who has a personality disorder, it is important to recognize that the person has disturbed values that do not reflect the views held by the general population. Because of these disturbances, the nurse needs to collaborate with the client regarding the goals that are identified during treatment. The remaining options although appropriate will not be attainable if the client does not recognize the interventions as being useful and personally applicable.

In response to a client's manipulative behavior, the nurse should provide ... Feedback about behavior Reasonable punishment Relaxation exercises Consistent limits

Consistent limits

Which is considered a part of the social domain of the biopsychosocial interventions for the client diagnosed with borderline personality disorder (BPD)? Self-harm prevention Establishing boundaries Nutritional management Medication administration

Establishing boundaries

Clients with borderline personality disorder commonly exhibit which of the following symptoms? Select all that apply. Pattern of getting along well with diverse groups of people Constant need for reassurance Fear of abandonment History of unstable, insecure attachments Extreme feelings of being loved and valued

Fear of abandonment Constant need for reassurance History of unstable, insecure attachments

Brain dysfunction associated with borderline personality disorder (BPD) occurs in the limbic system and which lobe of the brain? Parietal Frontal Occipital Temporal

Frontal *Biologic abnormalities are associated with three BPD characteristics: affective instability; transient psychotic episodes; and impulsive, aggressive, and suicidal behavior. Associated brain dysfunction occurs in the limbic system and frontal lobe and increases the behaviors of impulsiveness, parasuicide, and mood disturbance. Brain dysfunction of the temporal, parietal, and occipital lobes is not associated with BPD.

Which of the following occurs when self-definition is poorly developed? Dissociation Affective instability Identity diffusion Dichotomous thinking

Identity diffusion *Identity diffusion occurs when a person lacks aspects of personal identity, or when personal identity is poorly developed. Affective instability is evidenced by erratic emotional responses to situations and intense sensitivity to criticism or perceived slights. Dichotomous thinking occurs when a person evaluates experiences, people, and objects in terms of mutually exclusive categories. Dissociation occurs in instances when thinking, feelings, or behaviors occur outside a person's awareness.

Emotional regulation skills are taught to those diagnosed with borderline personality disorder to manage what? Physical disability Problem solving Psychotic behaviors Impulsive behaviors

Impulsive behaviors *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.

Gambling, binge eating, and engaging in unsafe sex are examples of what? Identity diffusion Dissociation Impulsivity Affective instability

Impulsivity *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.

Identity diffusion occurs in clients diagnosed with borderline personality disorder. Which description would the nurse most commonly associate with identity diffusion in these clients? Select all that apply Inconsistency Self-image instability Deeply insightful thinking Connectedness of thoughts Feelings of emptiness

Inconsistency Self-image instability Feelings of emptiness *Unstable self-image is often manifested as an identity disturbance or identity diffusion, a loss of the capacity for self-definition and commitment to values, goals, or relationships. The nurse can recognize identity diffusion if the patient reports an ongoing "emptiness" or contradictory behavior. The person's thoughts and behavior will seem fragmented and superficial.

When assessing a client with borderline personality disorder (BPD), which behaviors would the nurse expect to find? Select all that apply. Intense personal awareness Learned helplessness Self-directed anger Deceptive competence Repeated, frequent crisis episodes

Learned helplessness Self-directed anger Deceptive competence Repeated, frequent crisis episodes

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? Depression Maladaptive expression of emotions Poor social skills Mania

Maladaptive expression of emotions

A nurse is assessing a client with borderline personality disorder. Which response pattern would the nurse most likely assess? Select all that apply. Mood lability Suicide ideation Fear of abandonment Anger issues Impulsive behavior

Mood lability Anger issues Impulsive behavior Fear of abandonment

A client with borderline personality disorder (BPD) usually is treated with multiple medications. They can include which of the following types? Select all that apply. Hypnotics Antidepressants Mood stabilizers Anti-seizure medications Anxiolytics

Mood stabilizers Antidepressants Anxiolytics

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? Affective instability Identity diffusion Dichotomous thinking Nonsuicidal self-injury

Nonsuicidal self-injury

The nurse working with women who have borderline personality disorder can do which to help clients build social skills and self-esteem? Select all that apply. Offer women's health issues classes. Offer assertiveness classes. Offer cooking classes. Offer cognitive restructuring classes.

Offer cognitive restructuring classes. Offer assertiveness classes. Offer women's health issues classes.

A client is admitted with a diagnosis of schizotypal personality disorder. Which characteristic would this client exhibit during social situations? Paranoid thoughts Perfectionism Trusting behaviors Dependency needs

Paranoid thoughts

A nurse is educating a client with borderline personality disorder (BPD) on the four-square method of breathing. This client also dissociates. The nurse determines that the education was successful when the client states that he will do which of the following first? Take a deep abdominal breath to a count of 4 Exhale a breath to a count of 4 Hold a breath for a count of 4 Plant both feet firmly on the ground

Plant both feet firmly on the ground The four-square method of breathing involves planting both feet firmly on the floor and then taking a deep abdominal breath to the count of 4, holding it to the count of 4, exhaling to the count of 4, and then holding it to the count of 4.

Which defense mechanism is used by people diagnosed with borderline personality disorder to protect their fragmented self-image? Regression Projective identification Compensation Repression

Projective identification

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 Impulse control Working on self-esteem Protection from self-mutilation

Protection from self-mutilation *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.

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 *The nurse introduces the use of limit setting when clients engage in manipulative, acting-out, dependent, or similar inappropriate behaviors.

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. Self-harm Pain Nutrition Hydration Sleep Self-care

Sleep Nutrition Self-harm

Which is a technique used to help the client with borderline personality disorder gain control over self-critical thoughts? Affective instability Thought stopping Communication triad Delay gratification

Thought stopping

Which addresses the psychological domain of biospychosocial interventions for a client with borderline personality disorder? Prevention of self-harm Communication skills Withdrawing attention as much as possible Environmental management

Withdrawing attention as much as possible **Biopsychosocial interventions involving the psychological domain include measures to establish personal boundaries and limits. Withdrawing attention as much as possible while ensuring the client's safety from self-harm tends to decrease acting out behaviors. Environmental management and communication skills address the social domain. Prevention of self-harm addresses the biologic domain.

It has been hypothesized that an increase in which neurotransmitter may be responsible for psychotic states seen in borderline personality disorder? Epinephrine Dopamine Serotonin Acetylcholine

dopamine

The nurse is conducting an education group for women at risk for self-mutilation. What is the most important goal for this group? Learning problem solving Discussing feelings about self-harm Learning strategies to refrain from self-harm Expressing angry feelings

Learning strategies to refrain from self-harm *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.

Which of the following would be consistent with the use of the Five Senses Exercise to help a client with borderline personality disorder (BPD) avoid self-destructive behaviors? Light a scented candle. Drink a beer. Read a horror novel. Watch an action movie.

Light a scented candle.

A client who exhibits mild symptoms of a personality disorder will experience an increase in the intensity of the symptoms when which of the following conditions is present? Losing the job he's had for 6 years Experiencing the hormonal changes of puberty A chronic case of psoriasis flairs up Preparing for retirement

Losing the job he's had for 6 years

Which personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and a lack of empathy? Narcissistic Histrionic Dependent Obsessive-compulsive

Narcissistic *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.

When the nurse is not informed of developmental and cultural issues related to the client's background, which of the following may be expected? The nurse should request a change of assignment. The nurse should rely on personal values and standards. Normal patterns of behavior may be labeled as deviant, immoral, or insane. The meaning of the client's behavior can be derived from conventional wisdom.

Normal patterns of behavior may be labeled as deviant, immoral, or insane.

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 Paranoid personality disorder Narcissistic personality disorder

Obsessive-compulsive personality disorder

When establishing a relationship with a client who has borderline personality disorder, which is most important for the nurse to do? Tell the client the relationship will last as long as the client wishes Aggressively confront the client about boundary violations. Respect the client's boundaries at all times. Limit interactions to 10 minutes at a time.

Respect the client's boundaries at all times. *Clients with borderline personality disorder have issues with boundaries; by respecting the client's boundaries, the nurse can assist the client to develop better boundary control and directly address the most significant characteristic of this personality disorder. Aggression by the nurse is never appropriate or necessary. Ensuring brief interactions has no particular benefit for the client; prolonged engagement can better facilitate rapport. The nurse-client relationship does not carry on after the client's current treatment is complete.

Which would be the priority nursing diagnosis for a client diagnosed with borderline personality disorder (BPD)? Disturbed thought process Chronic low self-esteem Ineffective coping Risk for self-mutilation

Risk for self-mutilation

After educating a group of nursing students on comorbidities associated with borderline personality disorder, the instructor determines a need for additional education when the students identify which of the following as a common comorbid condition? Eating disorder Substance abuse disorder Schizophrenia Mood disorder

Schizophrenia

The nurse is admitting a client with histrionic personality disorder to the inpatient unit. The nurse would anticipate that this client may exhibit which behavior? Self-dramatization Perfection Distrust Manipulation

Self-dramatization

Clients with borderline personality disorder (BPD) are usually admitted to the inpatient setting because they exhibit what? Impulsivity Self-harm Aggression Splitting

Self-harm

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? Inability to delay gratification Sense of mistrust of others Belief in his own self-worth Rewards for competitive behavior

Sense of mistrust of others *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? Accept the client's behavior Assist the client to eliminate passive behavior Set limits on attention-seeking behavior Try to meet the client's needs for attention

Set limits on attention-seeking behavior *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.

When clients diagnosed with borderline personality disorder (BPD) see nurses as either all good or all bad, the client is using which primitive defense? Defending Invalidating Splitting Projective identification

Splitting *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 is the main reason why the periodic team meetings are important when caring for a client with antisocial personality? Staff frustrations in caring for the client need to be processed. Team consistency is important to prevent manipulation by the client. The team needs to consider updating treatment recommendations as the client improves. Rotating team members need to be apprised of the care planned for the client.

Team consistency is important to prevent manipulation by the client. *It is important to be consistent and firm with the care plan and not to make independent changes in rules or consequences. Any change should be made by the staff as a group and conveyed to all staff members working with this client. Consistency is essential and may require team dialogue. If the client can find just one person to make independent changes, any plan will become ineffective. Care providers must be kept up to date on the components of the client's treatment plan, but this can be accomplished without meetings. Similarly, updates can be communicated or documented in different ways. Staff's frustrations must be dealt with appropriately, but the primary focus for all treatment planning should be centered on meeting the client's needs.

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. *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 working with a client who has been diagnosed with borderline personality disorder to help manage her feelings using the communication triad. Which of the following would the nurse encourage the client to do first? Use an "I" statement to identify the current feeling. Determine what the client would like. Identify the situation or condition responsible for the feeling. Identify what would help promote comfort with the situation.

Use an "I" statement to identify the current feeling. The communication triad provides a specific syntax and order for clients to identify and express their feelings and seek relief. The "sentence" consists of three parts: (1) an "I" statement to identify the prevailing feeling; (2) a nonjudgmental statement of the emotional trigger; (3) what the client would like differently or what would restore comfort to the situation. The nurse must emphasize with clients that they begin with the "I" statement and the identification of feelings, although many want to begin with the condition. If the client begins with the condition, the statement becomes accusatory and is likely to evoke defensiveness. Beginning with "I" allows the client to identify and express the feeling first and take full ownership.

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 Anxiety Loneliness Stress

self-mutilation

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 ... Dialectical behavior Dissociation Manipulation Splitting

splitting *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.

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? "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?"

"Do you always practice safe sex? *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 students about borderline personality disorder (BPD) and identifies a need for further instruction when a student makes which statement? "People with BPD can add to the chaos of an already chaotic family." "People with BPD are usually part of an already chaotic family." "Family members feel the need to disagree with the client with BPD to help make them resilient." "When a family member of a client with BPD withdraws, it can lead to more fears on the part of the client."

"Family members feel the need to disagree with the client with BPD to help make them resilient."

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? "In some instances, negative responses can be viewed as positive reinforcement." "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."

"Grossly disrespectful behaviors are better ignored." *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 17-year-old client comes to the community crisis clinic with multiple superficial cuts on the wrist. The client is crying uncontrollably and states that the client's romantic partner has left and the client doesn't want to live without the partner. What would be the most therapeutic initial nursing response? "There's plenty of fish in the sea. Don't worry, at your age you will find someone else." "Let's set some boundaries on your behavior here." "Many partners change their minds about relationships, this is really quite normal." "I can see that you are feeling anxious. I will stay with you until you feel better."

"I can see that you are feeling anxious. I will stay with you until you feel better."

An 11-year-old child talks to the school nurse about a single episode of disruptive behavior in class. The child states, "I had a stomach ache and felt like vomiting. I couldn't help it. I was just so mad at my dad." Which would be the most appropriate response by the nurse? "I can see that you're angry. Let's look at better ways to express it." "Perhaps it would be helpful if you let your dad know you're angry." "If you can get rid of your anger, perhaps your stomach ache will go away." "I can understand your anger, but you can't disrupt the classroom."

"I can see that you're angry. Let's look at better ways to express it." *A child at this age may have difficulty expressing negative or intense emotions verbally; the nurse's response helps teach the child appropriate expressions of anger.

A client with borderline personality disorder starts flirting with the nurse, saying the client dreams about the nurse at night and wants to kiss the nurse. What would be the best response by the nurse? "That is very sweet of you to say." "Let's talk about something else now." "I feel flattered that you think that much of me, but nurses don't date clients." "I feel uncomfortable with what you said. My role is to support you in recovery."

"I feel uncomfortable with what you said. My role is to support you in recovery." *When a client violates boundaries, it is important to respond right away. If a client flirts with the nurse, the nurse should reply that this is not professional and out of place. The nurse should not encourage, dismiss, acknowledge, or ignore the behavior.

A client with paranoid personality disorder is admitted to a psychiatric facility. Which statement by the nurse would best establish rapport and encourage the client to confide in the nurse? "I get upset once in a while, too." "It bothers me when I think people are talking about me." "It's normal not to trust anyone." "I know how you feel. I'd feel the same way in your situation."

"I get upset once in a while, too." *Sharing a benign, nonthreatening, personal fact or feeling helps the nurse establish rapport and encourages the client to confide in the nurse. The nurse cannot know how the client feels. Telling the client otherwise would justify the suspicions of a paranoid client; furthermore, the client relies on the nurse to interpret reality.

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? "Let's see how things go first and then how long you need me." "We will work on things until your physician says you can go home." "I'm here to help you for as long as I can." "I will be seeing you during the daytime this week."

"I will be seeing you during the daytime this week." *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 with borderline personality disorder says to the nurse, "I feel so comfortable talking with you. You seem to have a special way about you that really helps me." Which would be the most appropriate response by the nurse? "You feel others don't understand you?" "I'm here to help you just as all the staff members are." "I cannot be your friend. We need to be clear on that." "I'm glad you feel comfortable with me."

"I'm here to help you just as all the staff members are." *For the borderline personality disorder client, personal boundaries are unclear, and clients often have unrealistic expectations. Clients easily can misinterpret the nurse's genuine interest and caring as a personal friendship, and the nurse may feel flattered by a client's compliments. The nurse must be quite clear about establishing the boundaries of the therapeutic relationship to ensure that neither the client's nor the nurse's boundaries are violated. Stating that the nurse's role is no different from that of the other staff denies that the nurse is somehow "special" to the client. The nurse should not implicitly validate the client's view by thanking him or her or by exploring the lesser role of other staff with the client. Stating "I'm glad you feel comfortable with me" misses an opportunity to reinforce healthy boundaries. Conversely, stating "I cannot be your friend" is unnecessarily direct and is not empathic; such a response may jeopardize therapeutic rapport with the client. Redirection is preferred over confrontation.

A client with conduct disorder starts yelling at another client and calling the client insulting names. Which is the most appropriate response by the nurse? "How would you feel if someone yelled at you like that?" "Yelling at others is unacceptable. You need to let staff know you're upset." "What's the matter with you? Don't you know any better?" "You're still having problems controlling your anger."

"Yelling at others is unacceptable. You need to let staff know you're upset." *The nurse must show acceptance of clients as worthwhile persons even if their behavior is unacceptable. This means that the nurse must be matter of fact about setting limits and must not make judgmental statements about clients. He or she must focus only on the behavior.

Personality disorders occur in approximately what percentage of the general population? 40% 30% 10% 20%

10%

For a person to be diagnosed with antisocial personality disorder, the individual must be a minimum of what age? 13 years 7 years 21 years 18 years

18 years

Which is considered the etiology of personality disorders? A combination of psychosocial and biologic variables Related to childhood abuse, neglect, and trauma Genetic predetermination Related to substance abuse

A combination of psychosocial and biologic variables

The nurse is assessing the mood of a client with borderline personality disorder. Which area would the nurse most likely assess to gather the best information? Select all that apply. Blood pressure Activity level Appearance Evidence of self harm Adherence to medication therapy

Activity level Appearance Evidence of self harm

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? Middle-age individuals Young adulthood Late adulthood Adolescence

Adolescence *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.

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? Middle-age individuals Young adulthood Late adulthood Adolescence

Adolescence *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.

Which of the following primary characteristics of borderline personality disorder is evidenced by erratic emotional responses to situations with intense sensitivity to criticism? Dissociation Self-harm Affective instability Identity diffusion

Affective instability *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.

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? Identity diffusion Dissociation Affective instability Dichotomous thinking

Affective instability *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? Affective instability Dichotomous thinking Identity diffusion Depression

Affective instability *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.

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 Ask the parents how they have coped with the client's behaviors over the years Attempt to discuss placing the client into an assisted living environment Encourage the parents to discuss the possibility of the client going into a day-care program when the client goes home

Ask the parents to keep a written schedule of activities for each day for the client *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? Assisting with sleep measures Establishing a therapeutic relationship Assisting with problem solving Establishing boundaries

Assisting with sleep measures

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? Demands excessive attention from others whenever in a group situation Tends to exaggerate the potential dangers of ordinary situations Perceives personal behavior to be embarrassing Believes he or she is incapable of functioning independently

Believes he or she is incapable of functioning independently *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.

People who are impulse-driven and have difficulty delaying gratification frequently participate in which of the following behaviors? Select all that apply. Binge eating Abusing alcohol Gambling Shopping beyond their means Fasting on religious holidays

Binge eating Abusing alcohol Gambling Shopping beyond their means

When describing the different clusters of personality disorders, the nurse includes which type as being characterized by dramatic or erratic behavior? Select all that apply. Paranoid Borderline Avoidant Obsessive-compulsive Antisocial

Borderline Antisocial *Cluster B personality disorders are described by dramatic, emotional, or erratic behavior and include antisocial, borderline, histrionic, and narcissistic personality disorders. Paranoid personality disorder is categorized as Cluster A, characterized by odd or eccentric behavior. Avoidant and obsessive-compulsive personality disorders are categorized as Cluster C, characterized by anxious or fearful behavior.

A client is admitted to the mental health unit after the client's spouse brings the client to the emergency department. Upon arrival, the spouse explained that the client had been crying all weekend and stating that the client wanted to die. Upon further assessment, the spouse reports that the client always has difficulty controlling anger and frequently worries that the spouse will leave the client. Recently, the client has been getting drunk every night, which the client never used to do. What diagnosis should the nurse suspect applies to this client? Borderline personality disorder Mania Bipolar disorder Depression

Borderline personality disorder

The nurse is counseling a 35-year-old client with a personality disorder. The client states that the client's problems are not the client's fault and that the client is a victim of circumstances and "fate." When experiencing stress, the client has impulsively called friends and family and stating, "It's my last day on earth." This client presentation is best described by which disorder? Histrionic personality disorder Borderline personality disorder Narcissistic personality disorder Antisocial personality disorder

Borderline personality disorder

A client with borderline personality disorder (BPD) who evaluates experiences, people, and objects in terms of mutually exclusive categories (e.g., good or bad, success or failure) is demonstrating which type of thinking? Impulsive thinking Logical thinking Systems-oriented thinking Catastrophizing

Catastrophizing People with BPD use catastrophizing when assessing a stressful situation. Cognitively, 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 nurse reading an artlcle about borderline personality disorder (BPD) finds that it is more prevalent in women than in men. Which explanation for this higher proportion in women would the nurse identify as a reason? Select all that apply. It tends to be more socially acceptable for women to seek help. There is a gender bias in diagnosis. Women are more temperamental than men. Childhood sexual abuse is more common in girls and a risk factor for BPD. Women have more problems with hormone regulations.

Childhood sexual abuse is more common in girls and a risk factor for BPD. It tends to be more socially acceptable for women to seek help. There is a gender bias in diagnosis.

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. Clearly communicate expectations. Be assertive. Independently make all decisions. Let the client make all the decisions. Observe personal limits.

Clearly communicate expectations. Be assertive. Observe personal limits. *The nurse in the therapeutic relationship models self-respect by observing personal limits, being assertive, and clearly communicating expectations.

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 lacks a definitive sense of self Client is unable to control emotional reactions in social situations Client misinterprets environmental stimuli Client attributes own feelings falsely to others

Client attributes own feelings falsely to other *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.

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 Dependent personality disorder Antisocial personality disorder Histrionic personality disorder

Dependent personality disorder *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 nurse is conducting a mental status exam of a client with borderline personality disorder (BPD). The client verbalizes statements that demonstrate a view of things as absolute, with no perception of compromise. The nurse interprets this type of thinking, documenting it as which of the following? Abstract Disorganized Dichotomous Irrational

Dichotomous *Those with BPD usually exhibit dichotomous thinking, or a tendency to view things as absolute: either black or white, good or bad, with no perception of compromise. This type of thought pattern would not be documented as abstract, irrational, or disorganized.

A client with borderline personality disorder tells the nurse, "Everything bad happens to me. I'm absolutely no good." The nurse interprets this statement as which of the following? Impulsivity Dichotomous thinking Affective instability Dissociation

Dichotomous thinking *People with BPD have dichotomous thinking. Cognitively, they evaluate 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 (times when thinking, feeling, or behaviors occur outside a person's awareness) can be conceptualized on a continuum from minor dissociations of daily life (such as daydreaming) to a breakdown in the integrated functions of consciousness, memory, perception of self or the environment, and sensory-motor behavior. 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. Impulsivity reflects actions that the person does on the spur of the moment.

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. *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? Discuss the feelings with a colleague to promote coping. Arrange for the client to be transferred to another unit. 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. *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.

A client with borderline personality was formerly cooperative with the treatment regimen. Suddenly, the client believes the staff is working against the client and is refusing all interaction and participation in treatment. The nurse feels very frustrated by this client's behavior. What is the best action for the nurse to take regarding personal frustration with this client? Set aside the frustration and focus on reassessing the client's needs. Discuss the feelings of frustration with the client in a one-to-one interaction. Discuss the frustration with a colleague or supervisor in a private setting. Research the client's diagnosis further to better understand the client's behaviors.

Discuss the frustration with a colleague or supervisor in a private setting.

Which occurs when thinking, feeling, or behaviors occur outside a person's awareness? Dissociation Dichotomous thinking Impulsivity Affective instability

Dissociation *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.

The nurse understands the importance of establishing boundaries and limitations when working with clients who have borderline personality disorder (BPD).Which strategy would be most useful for for establishing boundaries? Select all that apply. Offer personal information to the client. Document in the client's chart agreed-upon appointment expectations. Share the treatment plan with the client. Confront violations of the agreement in a non-punitive way. Confront the patient directly and in a stern matter.

Document in the client's chart agreed-upon appointment expectations. Share the treatment plan with the client. Confront violations of the agreement in a non-punitive way. *Some strategies for establishing the boundaries of the relationship include documenting in the chart the agreed-upon appointment expectations, sharing the treatment plan with the client, confronting violations of the agreement in a non-punitive way, and discussing the purpose of limits in the therapeutic relationship and their applicability to other relationships. Confronting in a direct and stern matter and offering personal information are not conducive to a therapeutic relationship.

A nurse is reviewing the biologic theories associated with borderlline personalilty disorder. The nurse demonstrates understanding of the information by identifying which areas as being associated with brain dysfunction tied to borderline personality disorder? Select all that apply. Frontal lobe Limbic system Temporal lobe Hypothalamus Cerebellum

Frontal lobe Limbic system

When assessing a client with narcissistic personality disorder, the nurse would expect the client to demonstrate which of the following? Genuine concern for others Grandiose and superior self-concept Mistrust of others Dependence on others for decision making

Grandiose and superior self-concept

Which would the nurse expect to assess in a client with narcissistic personality disorder? Dependence on others for decision making Genuine concern for others Mistrust of others Grandiose and superior self-concept

Grandiose and superior self-concept

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 *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.

In reviewing the history of a client with borderline personality disorder, the nurse would expect to find which clinical manifestation? Unlawful behavior Hallucinations Lethargy Impulsivity

Impulsivity *Clients with borderline personality disorder exhibit impulsivity that is potentially self-damaging. They have difficulty controlling anger, thereby posing a threat to the safety of others, and they exhibit transient stress-related paranoid behavior. Clients with antisocial personality disorder exhibit lack of respect for lawful behavior. Those with schizophrenia experience hallucinations. Clients with depression tend to experience lethargy.

A client with borderline personality disorder (BPD) who is receiving dialectical behavior therapy as part of his treatment program is participating in a skills group. The client is learning how to be assertive and problem solve. Which type of skills group is the client involved with? Emotional regulation skills Interpersonal effectiveness skills Distress tolerance skills Mindfulness skills

Interpersonal effectiveness skills *Interpersonal effectiveness skills include the development of assertiveness and problem-solving skills within an interpersonal context. 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. Emotion regulation skills are taught to manage intense, labile moods, to help the client label and analyze the context of the emotion, and to develop strategies to reduce emotional vulnerability. Distress tolerance skills involve helping the individual tolerate and accept distress as a part of normal life.

The nurse is teaching a client with paranoid personality disorder to validate ideas with another person before taking action. Which is the best rationale for this intervention? It will teach the client to differentiate when his or her suspicions are true. It will help the client learn to trust other people. It will assist the client to start basing decisions and actions on reality. It will help the client understand the origins of his or her paranoid thinking.

It will assist the client to start basing decisions and actions on reality. One of the most effective interventions with paranoid or suspicious clients is helping clients to learn to validate ideas before taking action; however, this requires the ability to trust and to listen to one person. The rationale for this intervention is that clients can avoid problems if they can refrain from taking action until they have validated their ideas with another person. This helps prevent clients from acting on paranoid ideas or beliefs. It also assists them to start basing decisions and actions on reality. Seeking input from others will not uncover the root causes of the client's disorder, however. Building trust is a possible outcome for this approach but the primary goal is grounding the client's thinking in reality since this most directly addresses the main characteristics of the disorder. Paranoid suspicions are rarely true and it is not therapeutic to validate the fact that they may be true.