Chapter 24: Personality Disorders Evolve Q's
A client diagnosed with obsessive-compulsive personality disorder takes the nurse aside and mentions, "I've observed you interacting with that new patient. You are not approaching him properly. You should be more forceful with him." What response should the nurse provide to address the client's comment? "I will be continuing to follow the care plan for the patient." "I see you are trying to control that patient's therapy as well as your own." "Your eye for perfection extends even to my nursing interventions." "That patient's care is really of no concern to you or to other clients."
"I will be continuing to follow the care plan for the patient." Obsessive-compulsive personality disorder has the key factor of perfectionism with a focus on orderliness and control. These individuals get so preoccupied with details and rules that they may not be able to accomplish the tasks. Guard against engaging in power struggles with a client with obsessive-compulsive disorder.
A 24-year-old patient diagnosed with borderline personality disorder (BPD) is admitted to the inpatient psychiatric unit following a suicide attempt. Which client statements illustrate a primary coping style of persons with BPD? "My provider says I might get out of here tomorrow. Do you think I'm ready to go?" "Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." "I will never again speak to any of my messed up family members. I know that this will help me to be more functional." "I promise I am not feeling suicidal. I won't hurt myself."
"Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." A primary coping style used by patients with BPD is called splitting. Splitting is the inability to incorporate positive and negative aspects of oneself or others into a whole image. The individual may tend to idealize another person (friend, lover, health care professional) at the start of a new relationship and hope that this person will meet all of his or her needs. At the first disappointment or frustration, however, the individual quickly shifts to devaluation, despising the other person.
Which statement is true regarding antisocial personality disorder (APD)? Select all that apply. A. It is the least studied of the personality disorders. B. It is characterized by rigidity and inflexible standards of self and others. C. Persons with APD display magical thinking. D. Persons with APD are concerned with personal pleasure and power. E. It is characterized by deceitfulness, disregard for others, and manipulation. F. Persons with APD usually present for treatment because of awareness of how their behavior is affecting others. G. Frontal lobe dysfunction is a brain change identified in APD.
D, E, G APD is the most studied and researched personality disorder. Rigidity and inflexible standards describe obsessive-compulsive personality disorder. Magical thinking describes STPD. People with APD usually present with depression because of the consequences of their behaviors, not because they care about the effects of their actions on others.
Which characteristics will the nurse assess in the client diagnosed with antisocial personality? Deceitfulness, impulsiveness, and lack of empathy Perfectionism, preoccupation with detail, and verbosity Avoidance of interpersonal contact and preoccupation with being criticized A need for others to assume responsibility for decision making and seeking nurture
Deceitfulness, impulsiveness, and lack of empathy Antisocial clients have no conscience. Their sense of right and wrong is impaired, and they tend to do whatever serves them best without consideration for the rights or feelings of others.
What characteristic behaviors will the nurse assess in the narcissistic client? Dramatic expression of emotion, being easily led Perfectionism and preoccupation with detail Grandiose, exploitive, and rage-filled behavior Angry, highly suspicious, aloof, withdrawn behavior
Grandiose, exploitive, and rage-filled behavior Narcissistic clients give the impression of being invulnerable and superior to others to protect their fragile self-esteem.
Clients demonstrating characteristics of personality disorders have various self-defeating behaviors and interpersonal problems despite having near-normal ego functioning and intact reality testing. Which nursing diagnosis best addresses this sort of interpersonal dysfunction? Spiritual distress Defensive coping Impaired social interaction Disturbed sensory perception
Impaired social interaction For a client who has difficulty in relationships and is very manipulative, the nursing diagnosis of impaired social interaction would be used.
A nurse caring for a client who has been diagnosed with a personality disorder should expect that the client will exhibit which behaviors? Frequent episodes of psychosis Constant involvement with the needs of significant others Inflexible and maladaptive responses to stress Abnormal ego functioning
Inflexible and maladaptive responses to stress Personality patterns persist unmodified over long periods of time. Inflexible and maladaptive responses to stress are characteristic of individuals with a personality disorder.
Patients diagnosed with BPD exhibit negative effect, which includes rapidly moving from one emotional extreme to another. What term is used to describe this characteristic? Lability Impulsivity Splitting Denial
Lability One of pathological personality traits seen in persons with BPD is negative effect, which is characterized by emotional lability, that is, rapidly shifting emotions from one extreme to another. Patients exhibiting this trait are often documented as being labile.
Research has indicated that the antisocial personality may be characterized by what behavior? Social isolation Lack of remorse Learning difficulties Difficulty with reality testing
Lack of remorse Individuals with an antisocial personality exhibit a lack of remorse when confronted with the results of their thoughtless, irresponsible behavior toward others.
A newly admitted client has a diagnosis of schizoid personality disorder. The nursing intervention of highest priority will be directed toward which classic client need? Set firm limits on behavior. Respect need for social isolation. Encourage expression of feelings. Involve in milieu and group activities.
Respect need for social isolation. Schizoid personality disorder has the primary feature of emotional detachment. Individuals do not seek out or enjoy close relationships. They are reclusive, avoidant, and uncooperative.
A 37-year-old patient, referred to the mental health clinic with a suspected personality disorder, is withdrawn and suspicious and states, "I've always preferred to be alone" and then adds, "I can read your thoughts whenever I want to." This presentation supports which psychiatric diagnosis? Obsessive-compulsive personality disorder Narcissistic personality disorder Avoidant personality disorder Schizotypal personality disorder (STPD)
Schizotypal personality disorder (STPD) The main traits that describe STPD are psychoticism such as eccentricity, odd or unusual beliefs and thought processes, and social detachment by preferring to be socially isolated, as well as being overly suspicious or anxious.
Splitting is a process in which the client demonstrates what behavior? Unconsciously represses undesirable aspects of self Places responsibility for his or her behavior outside the self Sees things as divided into "all good" or "all bad" Evidences lack of personal boundaries
Sees things as divided into "all good" or "all bad" Splitting demonstrates the failure to integrate the positive and negative into a cohesive whole. An individual is not seen as a person with good and bad traits, but rather as all good or all bad.
Playing one staff member against another is an example of what defense mechanism? Devaluation Splitting Impulsiveness Social ineptitude
Splitting Splitting involves setting up individuals or groups to disagree. While the two parties are busy disagreeing, they are too busy to maintain consistent limits for the manipulative client. The client can enjoy the spectacle and do as he or she pleases.
Which statement is descriptive of clients with a personality disorder? They are resistant to behavioral change. They have an ability to tolerate frustration and pain. They usually seek help to change maladaptive behaviors. They have little difficulty with cognitive functioning.
They are resistant to behavioral change. Personality disorders are deeply ingrained and pervasive. Clients with personality disorders find it very difficult, if not nearly impossible, to change. Change proceeds very slowly.
The client, diagnosed with which personality disorder, will most likely require admission to a psychiatric unit? Paranoid personality disorder Narcissistic personality disorder Borderline personality disorder Dependent personality disorder
Borderline personality disorder Clients with borderline disorder can decompensate into psychotic states under stress.
Which statement is true of pharmacological therapies associated with the treatment of personality disorders? Although there are no FDA-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident. Research has shown that currently available psychotropic drugs have not been shown to be effective in treating personality disorders. Patients with narcissistic personality disorder and obsessive-compulsive personality disorder have shown the most benefit from the use of antianxiety medications along with use of selective serotonin reuptake inhibitors. Patients with personality disorders have been shown to be resistant to accepting medication, and as a result most providers do not prescribe psychotropic drugs to these patients.
Although there are no FDA-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident. At this time in the United States, there are no specifically FDA-approved medications for treating personality disorders. Prescribers are using the medications "off-label" until evidence-based pharmacotherapies are proven to be safe and effective. There is evidence that mood stabilizers, antidepressants, and atypical antipsychotics are helpful in specific personality disorders. Pharmacologic evidence is lacking for the treatment of persons with narcissistic and obsessive-compulsive personality disorders. Although patients with personality disorders usually do not like taking medicine unless it calms them down and are fearful about taking something over which they have no control, providers do attempt to mediate symptoms with psychotropic agents for improved quality of life.
A client arrested for an assault in which he savagely beat a classmate states, "The guy deserved everything he got." The behaviors described are most consistent with the clinical picture of which disorder? Antisocial personality disorder Borderline personality disorder Schizotypal personality disorder Narcissistic personality disorder
Antisocial personality disorder Clients with antisocial personality act out feelings without consideration for the rights of others. They feel no remorse for their antisocial acts.
What is the priority nursing intervention for a client diagnosed with borderline personality disorder? Protect other clients from manipulation. Respect the client's need for attention. Assess for suicidal and self-mutilating behaviors. Provide clear, consistent limits and boundaries.
Assess for suicidal and self-mutilating behaviors. One of the primary nursing guidelines/interventions for clients with a personality disorder is to assess for suicidal and self-mutilating behaviors, especially during times of stress.
When providing care for a client diagnosed with borderline personality disorder, the nurse will need to consider strategies for dealing with which of the client's classic characteristics? Mood shifts, impulsivity, and splitting Grief, anger, and social isolation Altered sensory perceptions and suspicion Perfectionism and preoccupation with detail
Mood shifts, impulsivity, and splitting Borderline personality disorder has the central characteristic of instability in affect, identity, and relationships. Borderline individuals desperately seek relationships to avoid feeling abandoned, but they often drive others away with excessive demands, impulsive behavior, or uncontrolled anger. Their frequent use of the defense of splitting strains personal relationships and creates turmoil in health care settings.