Chapter 29- Mental Health PrepU

Need for perfection Adherence to a highly structured life Overly moralistic

A nurse is assessing a client diagnosed with obsessive-compulsive personality disorder (OCPD). Which would the nurse expect to find? Select all that apply.

"You seem interested in fitness and helping others"

A nurse has worked for a year with a client with Antisocial Personality Disorder (ASPD). The client offers to provide fitness consultation for the nurse at a gym the client attends. Which is an effective response?

Conduct

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 disorder may have been seen in this client prior to age 18?

Narcissistic personality disorder

A client presents to a mental health clinic. The nurse notes that the client is grandiose and brags that that they earn "a six-figure income" and tells the nurse that they are more well known that the president. Which diagnosis is grandiosity associated with?

"I'll stay here and you can show me what you've tried to do to get the top off"

A client with a dependent personality disorder is receiving treatment on a medical unit. The client asks the nurse for assistance to open the tube of toothpaste so they can brush their teeth. Which is the best response by the nurse?

Intermittent explosive disorder

A nurse in a community mental health clinic receives a client referral for counseling. The nurse reviews the client's medical record and understands the individual has been seeing a psychiatrist for over a year to determine why the person has sudden outbursts of anger. The severity of aggressiveness is out of proportion to the provocation. The psychiatrist has ruled out delirium, dementia, head injury, borderline personality disorder, substance abuse and antisocial personality disorder. Which diagnosis can be considered?

Oppositional defiant disorder

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?

Increased eccentricity

After teaching a group of nurses about different personality disorders, the group leader determines that the education was successful when the nurses identify which characteristic of schizotypal personality disorder?

"Return on time or future restrictions will be imposed."

It is 2000 hrs and a voluntary client with the diagnosis of antisocial personality disorder (ASPD) is out on a leave from the inpatient unit. The leave is supported by the treatment plan. The psychiatrist's order states the client is to return at 2100 hrs. The client calls the unit, speaks with the nurse and states, "2000 hrs doesn't give me enough time." What is the nurse's best response?

Social skills training

The nurse caring for a client with avoidant personality disorder identifies increased self-esteem in social situations as the primary outcome for the plan of care. Which program does the nurse recommend?

Psychological distress

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

Need to be in a position of power in a relationship Suspiciousness and guarded behavior Outwardly argumentative

Which would a nurse assess in a client suspected of having paranoid personality disorder? Select all that apply.

15 years

A client with a diagnosis of antisocial personality disorder would exhibit a history of conduct disorder before which age?

The client was overprotected as a child and independence was discouraged

A client recovering from a medical condition expresses low self-esteem, has difficulty making decisions, minimizes their ability to carry through with interventions to promote recovery and seeks more support than would be expected from the nurse. The nurse determines the client has a personality disorder. What is the probable etiology of the disorder?

Telling the client what to do

A client with a diagnosis of dependent personality disorder is recovering from surgery. The nurse considers the importance of avoiding some interventions that could be therapeutic for another client without a personality disorder. Which intervention will the nurse avoid?

Risk for other directed violence

A client with antisocial personality disorder (ASPD) is admitted to hospital. The nurse identifies which nursing diagnosis as the priority?

Assist the client to identify patterns of behavior and consequences as determined by the team plan.

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?

Borderline personality disorder

A family member of a client asks the nurse a question about personality disorders. The family member asks, "What personality disorder diagnosis makes a client most at risk for self-harm behaviors?" What is the nurse's best response?

The client engages in antisocial behavior only to obtain drugs

A male client addicted to cocaine is interviewed by the nurse in a community outpatient addiction program. The client reveals that he engages in criminal behavior to support his drug habit. When in the pursuit of drugs, the client relies on stealing and prostitution; otherwise, the client does not engage in criminal activity. For what reason does the nurse determine a diagnosis of antisocial personality disorder (ASPD) is not warranted?

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

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 him about the unit rules, he asks, "Well, if I have not done anything bad all day, can I have two cigarettes instead of one?" The most therapeutic nursing response would be which of the following?

Patronizing attitude Snobbish appearance Unrealistic grandiosity

A nurse is assessing a client diagnosed with a narcissistic personality disorder. Which characteristics would the nurse expect to find? Select all that apply.

A child movie actor An only child of a prominent sports celebrity A child of parents with narcissistic personality disorder

A nurse is caring for a variety of children on a psychiatric unit. Which child is at risk to develop narcissistic personality disorder? Select all that apply.

18 years

A nurse is preparing a presentation for a group of staff nurses on personality disorders. When describing antisocial personality disorders (ASPD), the nurse would explain that for a person to be diagnosed with the disorder, the person must be at least which age?

Confronting the ASPD client to explain the roommate's family cannot support this person living at the client's home

A nurse on an orthopedic unit is caring for a client with antisocial personality disorder (ASPD) who sustained a fracture. It's brought to the nurse's attention that the client has pressured the client's current roommate to stay at the roommate's home on discharge. How does the nurse respond?

The client is likely to have a concurrent diagnose of substance abuse The client has poor impulse control that hinders compliance with a plan of care The client has personality traits that are deeply ingrained and difficult to modify The client lacks insight and commitment, making the treatment adherence a challenge

A nurse provides care for a client recovering from orthopedic surgery. The client also has a diagnosis of antisocial personality disorder (ASPD). What factors related to the personality disorder does the nurse consider when planning care? Select all that apply.

Angry outbursts Blaming others for problems Disobedience

A nurse suspects that a child has oppositional defiant disorder. When reviewing the child's history, which would support this suspicion? Select all that apply.

Cystic fibrosis

A nurse working in a children's hospital is mindful of those at greatest risk of developing dependent personality disorder as adults. A child with which diagnosis is at highest risk of developing this disorder?

Losing of a parent through death Experiencing physical or sexual abuse Experiencing parental abandonment or neglect

A nurse working in an inner city youth support program identifies that antisocial personality disorder (ASPD) can develop in those who have dysfunctional attachments. Which are risks for developing dysfunctional attachments? Select all that apply.

Limited social skills Reluctance to join group activities Limited expressions of feelings and emotions

A nurse working in an outpatient recovery program for clients with serious mental illness receives a referral to accept a client with a co-occurring schizoid personality disorder. The nurse establishes that this new client would have some challenges with group-based therapy in the program. Which are characteristics expected with the client? Select all that apply.

Teach problem-solving skills Use time out for disruptive behavior Make behavioral expectations clear and consistently enforce them

A school-age child has a diagnosis of disruptive behavior disorder. The school nurse conducts an education session to help the parents understand the diagnosis and to teach skills that the parents can implement to help address disruptive behavior. What can parents do to help? Select all that apply.

Dependent personality disorder

An adult female client presents to the mental health clinic and is assessed by the nurse. During the assessment, the nurse observes the client engage warmly with an appropriately variable affect and to be open to share their life story. The story included a pattern of failed intimate relationships, which the client attributes to a mild form of cerebral palsy. The client lives in the parental home. The client's father died when she was in high school and her mother passed away three months prior to the assessment. Interpersonally the client says she works hard to avoid conflict. References are made to being "unlovable" and that she is "engulfed in sadness" to the point of needing a disability income. This is due to the expressed fear of being "unable" to care for everyday needs independently. What disorder does the nurse suspect?

"No, my code of ethics prohibits me from dating clients."

An attractive and engaging client with antisocial personality disorder (ASPD) asks a nurse providing inpatient care to go out on a date. Which is the nurse's best response?

Groundskeeper in a park

An outreach nurse in a mental health clinic assists a client with schizoid personality disorder. The client expresses a desire to work part time. Which position is most likely to suit the client?

Schizotypal personality disorder

During neighborhood scans, a nurse working in a community outreach program has identified an individual staying in a local shelter. The person has not engaged with the program. During the day, the client can be observed sweeping the pavement in a particular alley with a broom. There is no obvious purpose to the behavior. The individual is dressed in winter clothing even though it is summer. The client mutters expressions that are audible but cannot be understood. Based on the observations, which disorder does the nurse consider?

Demonstration of seductive behavior

The nurse in a medical setting provides care for a client with histrionic personality disorder concurrent with their medical challenges. During the initial assessment with the client, the nurse identifies an altered expression of sexuality. To guide further assessment, what factor does the nurse anticipate from the client?

Conduct disorder

The client was brought to the clinic after breaking out several windows. The nurse questions the client regarding this action. Further assessment reveals that the client has been involved with vandalism, conning others, running away from home, verbal bullying and intimidation, drinking alcohol, and sexual promiscuity. Which disorder woudl teh nurse most likely suspect?

Histrionic personality disorder

The nurse completes an assessment for a female client in an outpatient clinic. In addition to her medical issues, the client shares that she has a personality disorder. The client wears heavy makeup and demonstrates strong emotional intensity. Which personality disorder does the nurse identify based on the assessment findings?

Difficulty making everyday decisions Withdrawal from adult responsibilities Expresses fears of being unable to manage self-care

The nurse completes an intake assessment for a client. Which symptoms are associated with dependent personality disorder? Select all that apply.

Temperament

The nurse conducts an assessment to rule out antisocial personality disorder (ASPD) in a young adult. What aspect of the client's childhood is the priority assessment?

Kleptomania

The nurse in an outpatient clinic conducts an assessment for a client employed full time as a professional. The client has an unstable mood and feels sad most of the time. The client shares that they were recently charged for shoplifting cosmetics valued under $10. The client has admitted to shoplifting more than five times before this incident. In addition to a mood disorder, what other disorder does the nurse identify?

Reclusive and distant Awkward interpersonal relations

The nurse is assigned to a client with schizoid personality disorder. Which does the nurse anticipate are client characteristics of the disorder? Select all that apply.

Compassion

The nurse is aware that for some personality disorders, denial of symptoms is common. Which therapeutic approach does the nurse choose to address this denial?

"People with schizoid personality disorder, which the client has, tend to be lifelong loners."

The nurse is educating the parents of a client with a personality disorder. They are concerned that their 22-year-old 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 potential comment by the nurse is accurate?

Antisocial personality disorder

The nurse is interviewing a client with a history of violence. The client boasts that the client "put a kid in a wheelchair" once when the client was younger and has maimed others. The client states, "Who cares? Life's tough." Violence and insensitivity are associated with which personality disorder?

Physically abused by a care provider Having a mother sent to jail for five years Receiving inadequate nutrition due to neglect

The nurse is involved in assessing client's risk for developing antisocial personality disorder (ASPD). Which finding places children at risk? Select all that apply.

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

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

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

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

Helping to express anger in an adaptive and non-violent manner

The nurse is working in a prison setting with a client diagnosed with Antisocial Personality Disorder (ASPD). The client has identified impulse control issues particularly around urges for sexual intimacy. The client has assaulted people who have interfered with their gratification. What is the priority intervention for the nurse?

Considering the child's multiple social and family systems Interrupting inconsistent responses to disruptive behavior

The nurse leads a parents' support group of children diagnosed with a conduct disorder. The parents ask questions about family therapy. What interventions are included in family therapy? Select all that apply.

Exaggeration of the physical symptoms

The nurse plans care for a client with antisocial personality disorder (ASPD) and concurrent chronic pain. Which assessment finding is anticipated?

Managing finances Planning a weekly menu Simple meal preparation

The nurse provides a therapy group on skills to a support group of clients with dependent personality disorder. The group identifies the need to addresses the nursing diagnosis of 'Impaired Home Maintenance.' What area does the nurse choose to focus on for these clients to address this nursing diagnosis? Select all that apply.

Psychopath

The nurse provides care to clients who have a tendency toward antisocial and criminal behavior. Which term was used in the past to describe people with this disorder?

A pattern of disregard for and violation of the rights of others

The nurse provides education about antisocial personality disorder (ASPD) to a group of vocational support workers involved with former inmates entering the workforce. Which description outlines how ASPD is defined?

Suicide attempt Periods of destructive behavior

The nurse teaches a group of nursing students about personality disorders and how their diagnoses present with behavior. Emphasis is provided to explain that most clients are treated on an outpatient basis. Which behaviors warrant admission in an inpatient facility for an individual with a personality disorder? Select all that apply.

An 8-year-old with conduct disorder and attention ddeficit hyperactivity disorder (ADHD)

The nurse working in a community outreach setting with children understands risk of developing antisocial personality disorder (ASPD). Which individual is most susceptible to developing ASPD?

Engaging in the destruction of property

The outpatient clinic nurse has taken a referral for a 16-year-old male client who requires assessment for possible conduct disorder. When assessing this client which behavior would the nurse identify as supporting this diagnosis?

Conduct disorder

To be diagnosed with antisocial personality disorder (APD) as an adult, characteristics of which mental health disorder must be met?

ineffective coping

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?

Serotonin Norepinephrine

When describing the etiology of pyromania to group of nurses, which neurotransmitter would the nurse identify as being linked to this disorder. Select all that apply.

a retreat away to regain self-control

When discussing a school-aged child's behavioral contract with the school staff, how should the nurse most effectively explain a time-out?

Repeated incidents involving assaults Lack of remorse for actions Episodes involving scams for personal gain

When reviewing the history of a client with antisocial personality disorder, which would the nurse expect to find? Select all that apply.

Team consistency is important to prevent manipulation by the client.

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