NU245- Chapter 18: Personality Disorders

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?

"Do you always practice safe sex?"

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?

"Grossly disrespectful behaviors are better ignored."

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?

"I feel uncomfortable with what you said. My role is to support you in recovery."

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."

A 43-year-old female client is observed walking and dancing around the unit dressed in red high heels and a provocative style of dress. The client is seen sitting on the lap of a male client on the unit, and they are laughing. Which is the most therapeutic nursing intervention?

"I need for you to get off his lap, this behavior is not appropriate."

A nurse is caring for a client diagnosed with borderline personality disorder. The nurse has instructed the client about using the communication triad. The nurse determines that the client has understood this technique when stating what?

"I should start by stating my feelings as an 'I' statement."

A client asks the nurse to go to lunch with the client one day next week after the client is discharged. Which statement is the most therapeutic response?

"My role here is to help you recover. Let's talk about what else you can be doing after discharge."

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."

A nursing instructor is teaching about the importance of bonding and how an easy temperament can serve as a protective factor against psychopathology. Which statement made by a student demonstrates a need for further instruction?

"Temperament is not changeable."

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?

18 years

Which is considered the etiology of personality disorders?

A combination of psychosocial and biologic variables

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?

Affective instability

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?

Antisocial personality disorder

Avoidant, dependent, and obsessive-compulsive personality disorders are characterized by what?

Anxious or fearful behaviors

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

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

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

Impulsivity and difficulty controlling anger are characteristic of which mental health diagnosis?

Borderline personality disorder

Into which personality disorder category are individuals placed whose behavior appears odd or eccentric?

Cluster A

Which cluster of disorders corresponds to symptoms of being dramatic and emotional?

Cluster B

Which cluster of personality disorders is represented by individuals who appear anxious or fearful?

Cluster C

When assessing a client with borderline personality disorder (BPD), which would a nurse expect to assess? Select all that apply.

Control necessary for a relationship Fear of rejection Self-injurious behavior

A nurse is developing a plan of care for a client diagnosed with an antisocial personality disorder who has been admitted to the inpatient psychiatric unit. Which would the nurse likely include? Select all that apply.

Developing a therapeutic relationship Holding the client responsible for behavior

Based on psychological theories, which is believed to be critical to understanding personality disorders?

Difficult temperament

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.

A client diagnosed with schizoid personality disorder is described by family members as what?

Eccentric and a loner

A nurse is preparing a teaching plan for a client with antisocial disorder. Which would the nurse most likely employ to promote successful education?

Engaging the client in a discussion to direct the topic to the client.

Which personality disorder is diagnosed more often in women?

Histrionic

Emotional regulation skills are taught to those diagnosed with borderline personality disorder to manage what?

Impulsive behaviors

Gambling, binge eating, and engaging in unsafe sex are examples of what?

Impulsivity

After reviewing information about different personality disorders, a group of nursing students demonstrates understanding when they identify which as associated with schizoid personality disorder?

Introverted

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?

Maladaptive expression of emotions

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

A client admitted on the inpatient mental health unit has been suspicious of other clients on the unit. This client is often angry at others' comments, and carries a grudge against a roommate for accidentally using the client's bath towel. Which personality disorder is most likely the client's diagnosis?

Paranoid

A psychiatric-mental health nurse is reviewing information about the possible theories associated with narcissitic personality disorder. The nurse demonstrates understanding of the information by identifying which concept as being associated with the development of this personality disorder?

Parental overindulgence of a child

Which personality disorder is characterized by an alteration between hostile self-assertion, such as stubbornness, and excessive dependence?

Passive-aggressive

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

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

Which would be the priority nursing diagnosis for a client diagnosed with borderline personality disorder (BPD)?

Risk for self-mutilation

Clients with borderline personality disorder (BPD) are usually admitted to the inpatient setting because they exhibit what?

Self-harm

The most serious consequence of behaviors seen in borderline personality disorder includes what?

Self-injury

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?

Setting limits

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.

Sleep Nutrition Self-harm

The nurse-therapist is conducting a group therapy session in which one of the participants is an adult who has been diagnosed with narcissistic personality disorder. The nurse recognizes the significance of childhood experiences in the etiology of personality disorders, which for this client may have included what pattern?

The client's parent catered to the client's every need and the client used temper tantrums to successfully get the client's way.

Which is a technique used to help the client with borderline personality disorder gain control over self-critical thoughts?

Thought stopping

no-self-harm contract

a client promises to not engage in self-harm and to report to the nurse when he or she is losing control

positive self-talk

a cognitive-behavioral technique in which the client changes thinking about the self from negative to positive

thought stopping

a cognitive-behavioral technique to alter the process of negative or self-critical thought patterns

The most important short-term goal for the client who tries to manipulate others would be to a.acknowledge own behavior. b.express feelings verbally. c.stop initiating arguments. d.sustain lasting relationships.

a. acknowledge own behavior

The nurse would assess for which characteristics in a client with narcissistic personality disorder? a.Entitlement b.Fear of abandonment c.Hypersensitivity d.Suspiciousness

a. entitlement

A client is admitted to the psychiatric unit with a diagnosis of borderline personality disorder. What finding does the nurse expect the assessment to reveal?

acute discomfort in relationships

limit setting

an effective technique that involves three steps: stating the behavioral limit (describing the unacceptable behavior), identifying the consequences if the limit is exceeded, and identifying the expected or desired behavior

personality

an ingrained, enduring pattern of behaving and relating to self, others, and the environment includes perceptions, attitudes, and emotions

When interviewing any client with a personality disorder, the nurse would assess for which? a.Ability to charm and manipulate people b.Desire for interpersonal relationships c.Disruption in some aspects of his or her life d.Increased need for approval from others

c. disruption in some aspects of his or her life

When working with a client with a narcissistic personality disorder, the nurse would use which approach? a.Cheerful b.Friendly c.Matter-of-fact d.Supportive

c. matter-of-fact

passive-aggressive behavior

characterized by a negative attitude and a pervasive pattern of passive resistance to demands for adequate social and occupational performance

dependent personality disorder

characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation

paranoid personality disorder

characterized by pervasive mistrust and suspiciousness of others

Cognitive restructuring techniques include all of the following, except a.decatastrophizing. b.positive self-talk. c.reframing. d.relaxation.

d. relaxation

personality disorders

diagnosed when personality traits become inflexible and maladaptive and significantly interfere with how a person functions in society or cause the person emotional distress

nonsuicidal self-injury

intentional physical damage to the body, such as cutting or burning results from self-harm urges or thoughts injury is not an attempt at suicide

dysphoric

mood that involves unhappiness, restlessness, and malaise

borderline personality disorder (BPD)

pervasive and enduring pattern of unstable interpersonal relationships, self-image, and affect marked impulsivity frequent self-mutilation behavior

temperament

refers to the biologic processes of sensation, association, and motivation that underlie the integration of skills and habits based on emotion

time-out

retreat to a neutral place to give the opportunity to regain self-control

confrontation

technique designed to highlight the incongruence between a person's verbalizations and actual behavior used to manage manipulative or deceptive behavior

cognitive restructuring

therapy that focuses on changing the way one thinks about or interprets one's self, relationships, and/or environment

A client with borderline personality disorder has had 21 admissions to the mental health unit, each of which was precipitated by a suicide attempt resulting in superficial cuts. During this admission, the client has developed a relationship with a highly supportive nurse and has progressed to having a pass to spend an afternoon in a nearby shopping mall. Later the day that the client uses the pass, the nurse is shocked when the emergency department calls to say that the client has just been brought in with multiple self-inflicted lacerations. The nurse asks a supervisor, "Everything was going well. How could this happen?" What response by the supervisor reflects an understanding of borderline personality disorder?

"The client's behavior seems personal, but it's really not. Clients with borderline personality disorder act out to relieve anxiety. I suspect having the pass provoked a great deal of anxiety."

Transient psychotic symptoms that occur with borderline personality disorder are most likely treated with which type of drug? a.Anticonvulsant mood stabilizers b.Antipsychotics c.Benzodiazepines d.Lithium

b. antipsychotics

The nurse working with a client with antisocial personality disorder would expect which behaviors? a.Compliance with expectations and rules b.Exploitation of other clients c.Seeking special privileges d.Superficial friendliness toward others e.Utilization of rituals to allay anxiety f.Withdrawal from social activities

b. exploitation c. seeking special privileges d. superficial friendliness toward others

Which underlying emotion is commonly seen in an avoidant personality disorder? a.Depression b.Fear c.Guilt d.Insecurity

b. fear

When working with a client with a personality disorder, the nurse would expect to assess which? a.High levels of self-awareness b.Impaired interpersonal relationships c.Inability to empathize with others d.Minimal insight e.Motivation to change f.Poor reality testing

b. impaired interpersonal relationships c. inability to empathize with others d. minimal insight

Clients with a schizotypal personality disorder are most likely to benefit from which nursing intervention? a.Cognitive restructuring techniques b.Improving community functioning c.Providing emotional support d.Teaching social skills

b. improving community functioning

depressive behavior

characterized by a pervasive pattern of depressive cognitions and behaviors in various contexts

schizoid personality disorder

characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings

antisocial personality disorder

characterized by a pervasive pattern of disregard for and violation of the rights of others and with the central characteristics of deceit and manipulation

histrionic personality disorder

characterized by a pervasive pattern of excessive emotionality and attention seeking

narcissistic personality disorder

characterized by a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy

obsessive-compulsive personality disorder

characterized by a pervasive pattern of preoccupation with perfectionism, mental and interpersonal control, and orderliness at the expense of flexibility, openness, and efficiency

schizotypal personality disorder

characterized by a pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions and behavioral eccentricities

avoidant personality disorder

characterized by a pervasive pattern of social discomfort and reticence, low self-esteem, and hypersensitivity to negative evaluation

character

consists of concepts about the self and the external world