Chapter 18

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?

"I'm here to help you just as all the staff members are."

The nurse is talking to a client with schizoid personality disorder about finding a job. Which suggestion by the nurse would be most helpful?

"There is a job posting at the hospital for a file clerk in medical records."

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?

"Yelling at others is unacceptable. You need to let staff know you're upset."

A client with antisocial personality disorder is begging to use the phone to call his wife, even though it is against the unit rules. The client begs, "It is just this once, and she will be so hurt if I don't call her." Which would be the most appropriate response by the nurse?

"You may not use the phone to call your wife."

A client with dependent personality disorder has a goal to increase her problem-solving skills. Which client behavior would indicate progress toward meeting that goal?

Asking questions

Which observation by the nurse is supportive of a diagnosis of avoidant personality disorder?

Client fears criticism from others, including staff

Which techniques are important for nurses caring for clients with personality disorders to use in order to effectively provide care? Select all that apply.

Discuss feelings of anger or frustration with colleagues to help them recognize and cope with their own feelings. Employ ongoing communication with team members to remain firm and consistent about expectations for clients.

A female client with borderline personality was formerly cooperative with the treatment regimen. Suddenly, the client believes the staff is working against her 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?

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

Which of the following is a psychosocial explanation for the development of personality disorders?

Failure to complete a developmental task jeopardizes future personality development.

The client states that decisions that are made by him are superior to everyone else's. Which of the following would the nurse expect to assess in a client with narcissistic personality disorder?

Grandiose and superior self-concept

Which would most likely be a type of behavior that would be manifested by a client who has histrionic personality disorder?

Having a tantrum if not getting enough attention

The nurse teaches an antisocial client to take a time-out in his room when challenged by another person instigating an argument. What is the main reason for the time-out?

It allows an opportunity for the client to regain control of emotions.

Which challenges are posed when working with clients with personality disorders? Select all that apply.

It can take a long time to change their behaviors, attitudes, or coping skills. The nurse can easily but mistakenly believe the client simply lacks motivation or the willingness to make changes. Clients with personality disorders challenge the ability of therapeutic staff to work as a team. Team members may have differing opinions about individual clients.

The nurse is teaching a client with paranoid personality disorder to validate ideas with another person before taking action on him. Which is the best rationale for this intervention?

It will assist the client to start basing decisions and actions on reality.

Upon admission, a client with a personality disorder identified as areas of concern for which the client would like help. The nurse is aware of which of the following will most likely be addressed by the health care team?

Psychological distress

The nurse explains to the client that therapy will be a long process. Which of the following is a realistic outcome for the care of a person with a personality disorder?

Outcomes that focus on change in behavior

Which disorder is characterized by pervasive mistrust and suspiciousness of others?

Paranoid personality disorder

The client often uses attention seeking behaviors. Which of the following nursing interventions are most important in a plan of care for a client with histrionic personality disorder? Select all that apply.

Provide factual feedback about behavior. teach social skills

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?

Recognize negative thoughts and replace them with positive ones.

When establishing a relationship with a client who has borderline personality disorder, which is most important for the nurse to do?

Respect the client's boundaries at all times.

Of the following personality disorders, which are most likely related to lack of caring about others? Select all that apply.

Schizotypal personality disorder Antisocial personality disorder Narcissistic personality disorder

Which is the main reason why the periodic team meetings are important when caring for a client with antisocial personality?

Team consistency is important to prevent manipulation by the client.

The client is talking to staff members individually and attempting to manipulate them. Which of the following are important in the limit-setting technique to deal with manipulative behavior? Select all that apply.

Stating the behavioral limit Identifying the consequences if the limit is exceeded Identifying the expected or desired behavior

The nurse is teaching a client with schizoid personality to function more comfortably with others in the community. Which nursing intervention would be effective to improve the client's social skills?

Teach the client to make necessary requests in writing or over the phone.

A nurse is careful to provide a quiet, comfortable, safe environment when conducting an assessment interview. What is the reason this is particularly important when working with a client believed to be exhibiting characteristics of a personality disorder?

This disorder produces defensive, guarded, and impulsive behavior that is easily provoked into anger when the client feels threatened.

A person with temperament traits of high harm avoidance would most likely suffer from which personality disorder?

avoidant

A nurse is caring for a client that does not want to participate in group therapy. Which behavior is supportive of a diagnosis of dependent personality disorder?

believes he or she is incapable of functioning independently

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?

collaborating with the client when establishing treatment goals

When analyzing the behaviors of a client who meets the criteria for antisocial personality disorder, the nurse recognizes that which nursing diagnoses would be pertinent to the client's care?

ineffective coping

The nurse is planning the type of approach that will be most effective in developing a therapeutic relationship with the client. The nurse should use a matter-of-fact approach with clients with which types of personality disorders? Select all that apply.

paranoid antisocial narcissistic

The staff nurse that has a student assigned to her unit today notices that the nursing student appears to cooperate with the group but does not complete agreed upon tasks at the appropriate time repeatedly and then displays negativity. The nursing student may be showing signs of which of the following personality disorder or behavior?

passive-agressive behavior

While observing the client the nurse notices the client's mood changes rapidly and erratically. When planning care for a client with passive-aggressive personality disorder, the nurse will need to include interventions for which behavior?

procrastination and intentional inefficiency

The nurse is assessing the client who states he is a spiritual healer. Which term describes the extent to which a person considers himself to be an integral part of the universe?

self-transcendence

Which thought process would cause a client with antisocial personality disorder to want to do everything for himself?

sense of mistrust of others