305 Exam 2
The nurse is educating the parents of a client with a personality disorder. They are concerned that their 22-year-old son has never shown an interest in a romantic relationship, has no real hobbies or friends, and is happy being the only guard in a factory on the night shift. Which of the following potential comments by the nurse is accurate? a) "People with antisocial personality disorder, which your son has, tend to be lifelong loners." b) "People with dependent personality disorder, which your son has, tend to be lifelong loners." c) "People with histrionic personality disorder, which your son has, tend to be lifelong loners." d) "People with schizoid personality disorder, which your son has, tend to be lifelong loners."
"People with schizoid personality disorder, which your son has, tend to be lifelong loners." Explanation: Clients with schizoid personality disorder show an indifference to social relationships, a flattened affectivity, and a cold, unsociable, seclusive demeanor. They take pleasure in few, if any, activities. People with this disorder usually never marry, have little interest in exploring their sexuality, and frequently live as adult children with their parents or other first-degree relatives. Because they are lifelong loners, they often succeed at solitary jobs others would find intolerable.
A client who has been admitted to the hospital after a suicide attempt has been diagnosed with major depression and the client's care team has recommended ECT. Which of the following teaching points should the nurse include in client education before the procedure? a) "After their ECT, most clients say that the pain they experienced was very manageable." b) "I'll teach you some techniques to help you remain calm and focused during the procedure." c) "You'll be required to fast from solid food for 24 hours before your ECT procedure." d) "You might feel a bit confused or disoriented after your treatment, but this will pass."
"You might feel a bit confused or disoriented after your treatment, but this will pass." Explanation: The confusion and disorientation that may accompany the immediate recovery period after ECT are temporary and resolve spontaneously. The client is unconscious during the procedure and is NPO for 8 hours prior. ECT is painless.
The nurse recognizes that the client most likely experiencing generalized anxiety disorder (GAD) is a ... a) 70-year-old whose spouse died 1 year ago who has "no desire to leave my house" and reports severe fatigue b) 30-year-old business executive who reports being anxious about attending the meetings and social events that are his job responsibilities c) 40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months d) 22-year-old soldier who served in the Middle East who "cannot sleep" and is facing criminal charges for hurting someone in a barroom brawl.
40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months Explanation: The nurse recognizes that the client most likely experiencing generalized anxiety disorder (GAD) is a 40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months. The other options provided do not describe conditions of GAD.
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? a) "I can see that you're angry. Let's look at better ways to express it." b) "I can understand your anger, but you can't disrupt the classroom." c) "Perhaps it would be helpful if you let your dad know you're angry." d) "If you can get rid of your anger, perhaps your stomach ache will go away."
"I can see that you're angry. Let's look at better ways to express it." Explanation: 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 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? a) "I'm glad you feel comfortable with me." b) "I'm here to help you just as all the staff members are." c) "You feel others don't understand you?" d) "I cannot be your friend. We need to be clear on that."
"I'm here to help you just as all the staff members are." Explanation: 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.
The nurse is assigned to care for a client with dependent personality disorder. Which intervention should the nurse include in this client's care plan to promote independence? a) Spending long periods of unscheduled time with the client b) Avoiding discussing the client's feelings of helplessness c) Scheduling competitive activities so the client can test skills d) Helping the client identify preferences, such as choosing which clothing item to wear
Helping the client identify preferences, such as choosing which clothing item to wear Explanation: Helping the client identify preferences promotes development of independent decision-making skills, which the client with dependent personality disorder lacks. To demonstrate that the nurse is available during set times in a structured relationship, the nurse should spend scheduled, not unscheduled, time with the client and should set limits on the amount of time spent. Activities in which the client can succeed would be more appropriate than competitive ones, which this client would find too threatening. To promote rapport and convey empathy, the nurse should acknowledge the client's helpless feelings, not avoid discussing them.
A client diagnosed with obsessive-compulsive disorder (OCD) is attempting to resist a compulsion. Based on this finding, the nurse should assess the client for ... a) Feelings of failure b) Excessive fear c) Increased anxiety d) Depression
Increased anxiety Explanation: A client with obsessive-compulsive disorder who attempts to resist the compulsion must be evaluated for increased anxiety. A compulsion is a repetitive, intentional behavior that the client performs in response to a certain obsession; it is aimed at neutralizing or decreasing anxiety. Resisting the compulsion may increase the client's anxiety. Although a client with OCD may have feelings of failure, depression, and excessive fear, these are not responses to resisting the compulsion.
After teaching a group of nursing students about different personality disorders, the instructor determines that the education was successful when the students identify which of the following as characteristic of schizotypal personality disorder? a) Normal mannerisms b) Increased eccentricity c) Flatness d) Neatly dressed appearance
Increased eccentricity Explanation: Individuals with schizotypal personality disorder are more dramatically eccentric than those with schizoid personality disorder, who are characteristically flat, colorless, and dull (Millon, 2011). These individuals are perceived as strikingly odd or strange in appearance and behavior, even to laypersons. They may have unusual mannerisms, an unkempt manner of dress that does not quite "fit together," and inattention to usual social conventions (e.g., avoiding eye contact, wearing clothes that are stained or ill-fitting, and being unable to join in the give-and-take banter of coworkers).
What is electroconvulsive therapy the most effective treatment available for? a) Personality disorders b) Schizophrenia that has not responded to medication c) Major depression that has not responded to medication d) Bipolar disorder
Major depression that has not responded to medication Explanation: Electroconvulsive therapy is the most effective treatment available for refractory major depression (i.e., depression that recurs and does not respond to other modalities).
A client is undergoing ECT. The nurse would be correct to inform the client of which aspect prior to the ECT? a) There will be mild to moderate pain. b) The client will be awake during the procedure. c) NPO will be employed 8 hours prior to the procedure. d) The procedure is done with a full bladder.
NPO will be employed 8 hours prior to the procedure. Explanation: Prior to the ECT procedure, the client is NPO for 8 hours. The client will empty his bladder just before or after vital signs are taken prior to the ECT. The client will not be harmed or feel any pain. The client will be asleep during the procedure.
After reviewing information about the various impulse control disorders, a nurse demonstrates understanding of the information by identifying which disorder as involving a persistent pattern of disobedience and argumentativeness? a) Oppositional defiant disorder b) Conduct disorder c) Kleptomania d) Pyromania
Oppositional defiant disorder Explanation: Oppositional defiant disorder is characterized by a persistent pattern of disobedience, argumentativeness, angry outbursts, low tolerance for frustration, and tendency to blame others for misfortunes, large and small. Conduct disorder is characterized by more serious violations of social norms, including aggressive behavior, destruction of property, and cruelty to animals. In kleptomania, individuals cannot resist the urge to steal, and they independently steal items that they could easily afford. Irresistible impulses to start fires characterize pyromania: repeated fire setting with tension or arousal before setting fires; fascination or attraction to the fires; and gratification when setting, witnessing, or participating in the aftermath of fire.
A nurse is working with an adolescent diagnosed with conduct disorder. The nurse is engaged in social skills training. If successful, which outcome would the nurse expect? a) Enhanced thinking about consequences of choices b) Ability to examine responses after an emotional conflict c) Recognition of how actions affect others d) Ability to identify alternative solutions to a problem
Recognition of how actions affect others Explanation: Social skills training teaches adolescents with these behavior disorders to recognize the ways in which their actions affect others. Problem-solving skills training teaches these children to generate alternative solutions to social situations; sharpen thinking concerning the consequences of those choices; and evaluate responses after interpersonal conflicts.
A nurse is teaching a client with borderline personality disorder to reshape thinking patterns. Which is an example of a cognitive restructuring technique that would be helpful for this client? a) Recognize negative thoughts and replace them with positive ones. b) When negative thoughts begin, tell yourself "stop." c) Express needs using "I" statements. d) Learn to look at situations realistically rather than assuming the worst.
Recognize negative thoughts and replace them with positive ones. Explanation: Cognitive restructuring is a technique useful in changing patterns of thinking by helping clients to recognize negative thoughts and feelings and to replace them with positive patterns of thinking. Thought stopping is a technique to alter the process of negative or self-critical thought patterns. When the thoughts begin, the client may actually say "Stop!" in a loud voice to stop the negative thoughts. Decatastrophizing is a technique that involves learning to assess situations realistically rather than always assuming a catastrophe will happen. Assertive communication involves using "I" statements.
When establishing a relationship with a client who has borderline personality disorder, which is most important for the nurse to do? a) Respect the client's boundaries at all times. b) Limit interactions to 10 minutes at a time. c) Aggressively confront the client about boundary violations. d) Tell the client the relationship will last as long as the client wishes.
Respect the client's boundaries at all times. Explanation: 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.
Which thought process would cause a client with antisocial personality disorder to want to do everything for himself? a) Inability to delay gratification b) Belief in his own self-worth c) Rewards for competitive behavior d) Sense of mistrust of others
Sense of mistrust of others Explanation: Clients believe others are just like them, that is, ready to exploit and use others for their own gain. These clients are devoid of personal emotions, and actually the self is quite shallow and empty. These clients view relationships as serving their needs and pursue others only for personal gain. There is no competition because these clients believe they are only taking care of themselves because no one else will.
Which of the following interventions should the nurse include in a plan of care for a client with histrionic personality disorder? a) Accept the client's behavior b) Assist the client to eliminate passive behavior c) Set limits on attention-seeking behavior d) Try to meet the client's needs for attention
Set limits on attention-seeking behavior Explanation: Setting limits on attention-seeking behavior, and discussing alternatives for appropriate behavior, will promote growth. Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. Acceptance of the behavior will cause the behavior to be intensified. These clients are not passive in nature. Answer D is an inappropriate intervention since these clients are already seeking attention.
Eight months ago, a client was in a hotel fire and was the last person to be rescued from the roof. She watched her husband burn to death from the helicopter. She continues to have nightmares and is fearful that she will die in a fire. An appropriate nursing diagnosis for the client is what? a) Sleep pattern disturbance related to recurrent nightmares b) Unrealistic fear of fire related to conversion reaction c) Anxiety related to illusions d) Ego disintegration related to severe anxiety
Sleep pattern disturbance related to recurrent nightmares Explanation: The appropriate nursing diagnosis is sleep pattern disturbance. The client is not having illusions, nor is her fear of the fire unrealistic. She is not experiencing ego disintegration.
Disturbances in affect
The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision, defines schizophrenia as a disturbance in multiple psychological processes that affects thought content and form, perception, affect, sense of self, volition, relationship to the external world, and psychomotor behavior. Multiple personalities occur in dissociative identity disorder.
A client is taking phenelzine (Nardil), an MAOI medication for depression. The mental health nurse instructs him to avoid aged foods, such as wine and cheese, because of what? a) They cause GI distress, which may provoke ulceration of the gastric mucosa. b) They contain tyramine, which may provoke hypertensive crisis. c) They contain amylase, an enzyme known to reduce liver perfusion. d) They cause CNS depression, which could lead to coma and/or death.
They contain tyramine, which may provoke hypertensive crisis. Explanation: The MAOI antidepressants contain tyramine, which can trigger hypertensive crisis. The client must be instructed to avoid all aged foods.
Which of the following statements about the assessment of persons with anxiety and anxiety disorders is most accurate? a) Panic attacks are the most common late-life anxiety disorders. b) When an elder person has an onset of anxiety for the first time in his or her life, it is possible that the anxiety is associated with another condition. c) An elder person with anxiety may be experiencing ruminative thoughts. d) Agoraphobia that occurs in late life may be related to trauma experienced or anticipated.
When an elder person has an onset of anxiety for the first time in his or her life, it is possible that the anxiety is associated with another condition. Explanation: Anxiety that starts for the first time in late life is frequently associated with another condition such as depression, dementia, physical illness, or medication toxicity or withdrawal. Phobias, particularly agoraphobia, and GAD are the most common late-life anxiety disorders. Most people with late-onset agoraphobia attribute the start of the disorder to the abrupt onset of a physical illness or as a response to a traumatic event such as a fall or mugging. Ruminative thoughts are common in late-life depression and can take the form of obsessions such as contamination fears, pathologic doubt, or fear of harming others.
Choice Multiple question - Select all answer choices that apply. A nurse is conducting an in-service program about personality disorders. When describing dependent personality disorder, which of the following would the nurse include as typical of the person's behavior in interpersonal relationships? Select all that apply. a) Compliant b) Conciliatory c) Overly pleasing d) Disagreeable e) Placating
• Compliant • Conciliatory • Placating • Overly pleasing Explanation: Individuals with dependent personality disorder cling to others in a desperate attempt to keep them close. In interpersonal relationships, they need excessive advice and reassurance. They are compliant, conciliatory, and placating. They rarely disagree with others and are easily persuaded. Friends describe them as gullible. They are warm, tender, and noncompetitive. They timidly avoid social tension and interpersonal conflicts.
A major difference between the atypical antipsychotics (such as Clozapine) and the typical antipsychotics (such as Haldol) is what? a) Atypical antipsychotics block both serotonin and dopaminergic receptors. b) There are no side effects with the typical antipsychotics. c) Typical antipsychotics often lead to weight gain. d) Atypical antipsychotics can cause arrhythmias and kidney failure in rare cases.
Atypical antipsychotics block both serotonin and dopaminergic receptors. Explanation: Typical antipsychotics do have side effects, often lead to weight gain, and, in rare cases, cause dysrhythmias and kidney failure. Thus, option A is the correct answer.
The nurse is aware that a person who repeatedly seeks cosmetic surgery to correct a perceived flaw in his or her appearance may have which of the following disorders? a) Pyromania b) Hoarding disorder c) Body dysmorphic disorder d) Body identity integrity disorder
Body dysmorphic disorder Explanation: Body dysmorphic disorder is a preoccupation with imagined or slight defect in physical appearance that causes significant distress for the individual and interferes with functioning in daily life. Elective cosmetic surgery is sought repeatedly to "fix the flaw," yet after surgery, the person is still dissatisfied or finds another flaw in appearance. It becomes a vicious cycle. Hoarding disorder is a progressive, debilitating, compulsive disorder that involves excessive acquisition of animals or apparently useless things; cluttered living spaces that become uninhabitable; and significant distress or impairment for the individual. Pyromania is the desire to start fires. Body identity integrity disorder is the term given to people who feel alienated from a part of their body and desire amputation.
A personality disorder is defined as a collection of personality traits that is what? a) Causing behavioral dysfunction and inner distress b) Leading to withdrawn and antisocial behavior c) Leading to aggression and violence d) Malleable and poorly defined
Causing 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.
negative symptoms
Common negative symptoms of schizophrenia include alogia, affective blunting, avolition, anhedonia, and attentional impairment.
A 35-year-old client with a diagnosis of antisocial personality disorder is being seen by a psychiatrist. He has been arrested three times for aggravated battery within the last year. Which personality disorder may have been seen in this client prior to age 18? a) Schizoid b) Paranoid c) Avoidant d) Conduct
Conduct Explanation: Antisocial behavior is usually seen in clients between the ages of 15 and 40 years. The diagnosis of conduct disorder is given to clients who exhibit clinical symptoms before the age of 18 years.
To be diagnosed with antisocial personality disorder (APD) as an adult, characteristics of which mental health disorder must be met? a) Histrionic disorder b) Obsessive-compulsive disorder c) Conduct disorder d) Schizophrenia
Conduct disorder Explanation: To be diagnosed with APD, the individual must be at least 18 years old and 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.
