Personality Disorders

The nurse is working with a client who has BPD. Prioritize the nurse's interventions: 1. Anticipate and prepare for the first crisis 2. Advocate for and validate client support 3. Maintain a consistent level of contact and support 4. Listen to the client's fears and feelings of anger.

4. Listen to the client's fears and feelings of anger. 3. Maintain a consistent level of contact and support 1. Anticipate and prepare for the first crisis 2. Advocate for and validate client support

A nurse is assessing a client to determine if he has an avoidant personality disorder. What are the most appropriate questions for the nurse to ask the client? select all that apply. a. "Are you worried that people won't like you?" b. "Do you drive yourself pretty hard, and frequently feel that you need to do more?" c. "Are you a perfectionist in the things that you do at home?" d. "Would it be easier for you to lie, or tell the truth?" e. "Are you wary of opening yourself to others because they have hurt you in the past?" f. "Do you carefully select your friends, and prefer just one it two close friends?"

a. "Are you worried that people won't like you?" e. "Are you wary of opening yourself to others because they have hurt you in the past?" f. "Do you carefully select your friends, and prefer just one it two close friends?" People with avoidant personality disorder are timid, sensitive to criticism, and fear not being accepted. They are often hesitant to enter into relationships.

The nurse is assessing a new client who was just admitted to the psychiatric unit. Which assessment questions, by the nurse, would determine if the client has schizotypal personality disorder? Select all that apply a. "Do you often feel that people want to reject you, or think that you're odd?" b. "Does anxiety may you want to hurt or injure yourself?" c. "Do you feel that everyone of the opposite sex finds you extremely attractive?" d. "Have you ever felt that you have special powers or magical influence over others?" e. "Do you tend to stay by yourself, even though you would like to be with others?" f. "Do you feel that other people take advantage of you?"

a. "Do you often feel that people want to reject you, or think that you're odd?" d. "Have you ever felt that you have special powers or magical influence over others?" e. "Do you tend to stay by yourself, even though you would like to be with others?"

A client with dependent personality disorder is working to increase self-esteem. Which statement by the client, shows that teaching was successful? a. "I'm not going to look at the negative things about myself." b. "I'm most concerned about my level of competence and progress." c. "I'm not as envious of other peoples' things as I used to be." d. "I can't stop myself from taking over tasks others should be doing."

a. "I'm not going to look at the negative things about myself." Dependent disorder- clients feel inadequate, fragile, and focus on self- not others

A family member of a client with schizoid personality disorder asks the nurse, "Why doesn't my brother want any contact with his family?" Which responses are accurate? Select all that apply a. A person often struggles with their emotions and can become emotionally detached b. Due to the chaotic relationships in your brother's early life, he has become irresponsible and asocial c. Clients like your brother are very objective, with no room to consider the emotions of others d. Your brother does not obtain pleasure from social encounters e. Your brother gets pleasure from being the center of attention

a. A person often struggles with their emotions and can become emotionally detached d. Your brother does not obtain pleasure from social encounters

A client with avoidant personality disorder is in treatment. What is an appropriate outcome for this client? a. Demonstrates an ability to use constructive criticism b. Participates in impulse control training c. Demonstrates a reduction in clinging, splitting, and manipulation behaviors d. Demonstrates a decrease in attention-seeking behaviors.

a. Demonstrates an ability to use constructive criticism Clients with avoidant personality disorder fear criticism, disapproval, and rejection. They are reluctant to participate in social situations because of these fears.

A client with obsessive-compulsive personality disorder is in the community room. Which behavior pattern would a nurse expect to observe? a. Discussing people who are viewed as superior vs those who are inferior b. Questioning others about their mastery of self-defense skills c. Telling another client about making drugs in the garage d. Ridiculing law enforcement, and saying they are out to get people

a. Discussing people who are viewed as superior vs those who are inferior Clients with obsessive-compulsive disorder are very conscious of a person's rank, and will focus on people who are authority figures

The nurse is caring for a client with histrionic personality disorder. The client's family member asks, "How do I handle the drama that occurs when she does not get her way?" What information should the nurse provide the family? Select all a. Do not argue or try to rationalize things with the person b. Talk about the trauma to show that you understand c. State your responses in a non-emotional manner d. Sit in the person's visual field but avoid eye contact e. Remember to give positive feedback when possible f. Maintain a serious and personal interest in the person

a. Do not argue or try to rationalize things with the person c. State your responses in a non-emotional manner e. Remember to give positive feedback when possible f. Maintain a serious and personal interest in the person Communication with clients with histrionic disorder needs to be firm and calm, without bargaining or rationalizing with the person. The family member should refrain from engaging in emotional responses

Which questions should the nurse ask to help determine if a client has obsessive compulsive personality disorder? Select all that apply a. Do you tend to drive yourself pretty hard, then frequently feel that you need to do more? b. Is it hard for you to argue with your spouse, because you are worried they will get angry and start to dislike you? c. Does anxiety make you want to self-mutilate? d. Do you keep things to yourself to be sure the wrong people don't get the right information? e. Do you keep lists, or sometimes feel a need to repeatedly check things? f. Do you tend to be a perfectionist?

a. Do you tend to drive yourself pretty hard, then frequently feel that you need to do more? e. Do you keep lists, or sometimes feel a need to repeatedly check things? f. Do you tend to be a perfectionist?

Which nursing intervention is priority while caring for a client with antisocial personality disorder who shows defensive behavior? a. Help the client accept responsibility for his own decisions and behaviors b. Work with the client to feel better about himself by taking care of basic needs c. Teach the client the defense mechanisms used to cope with distress d. Confront the client about the disregard of social rules or the feelings of others.

a. Help the client accept responsibility for his own decisions and behaviors Those with antisocial disorder tend to blame others for their behaviors

Which statement is expected from a client with avoidant personality disorder? a. I am scared you are going to leave me b. I will go to group therapy if you let me smoke c. I need to feel that everyone knows and likes me d. I can sometimes feel better if I cut myself

a. I am scared you are going to leave me Avoidant personality disorder is often associated with the fear of abandonment

A nurse notices that other clients on the unit are avoiding a client diagnosed with antisocial personality disorder. During group therapy, the topic of appropriate behavior is discussed. Which behavior does the group associated with the client who is being avoided? a. Lacks honesty b. Believes in superstitions c. Has frequent temper tantrums d. Constantly craves attention

a. Lacks honesty Clients with antisocial disorder engage in dishonesty.

Which nursing intervention is priority for the client with borderline personality disorder? a. Maintain consistent, realistic limits b. Give instructions for meeting basic self-care needs c. Engage in daytime activities to stimulate wakefulness d. Have the client attend group therapy on daily basis

a. Maintain consistent, realistic limits Clients with BPD are needy, dependent, and manipulative; they don't tend to have difficulty with self-care and wakefulness; they enjoy group therapy because they see the opportunity to be the center of attention

A client with antisocial personality disorder has a high risk for violence directed at others. What is an appropriate goal for the client? a. The client will discuss the desire to hurt others rather and act b. The client will be given something to destroy to displace the anger c. The client will develop a list of resources to use when anger escalates d. The client will understand the difference between anger and physical symptoms

a. The client will discuss the desire to hurt others rather and act Helps the nurse get in touch with the pain associated with the angry feelings.

A client with paranoid personality disorder responds aggressively to another client during a psycho-educational group therapy session. How should the nurse interpret this client behavior? Select all that apply. a. This client prefers individual therapy rather than group therapy b. This client took the statement as a personal criticism c. This client is impulsive and was acting out of frustration. d. This client was attempting to handle emotional distress. e. This client likes the attention received.

a. This client prefers individual therapy rather than group therapy b. This client took the statement as a personal criticism Clients with paranoid personality disorder tend to be hypersensitive and take the comments of others as a personal attack. The client is driven by the suspicion that others will inflict harm. The aim of treatment is to help the person to get rid of feelings of mistrust, resentment, jealousy, and anxiety. Paranoid clients tend to be rigid and guarded. Group sessions along with individual therapy are the best treatment options for paranoid personality symptoms.

Which behavior patterns would a nurse expect to observe in a patient with schizoid personality disorder? a. emotional coldness and flattened affect b. submissive and clinging c. impulsive and unstable emotionally d. cheerful and carefree

a. emotional coldness and flattened affect

What behaviors would a nurse expect to see in a client who has an obsessive compulsive personality disorder? Select all a. meticulous in their work area b. unresponsive to social cues c. refuses to bend the rules d. have a strong job loyalty e. tries to hide anger

a. meticulous in their work area c. refuses to bend the rules d. have a strong job loyalty e. tries to hide anger

A nurse is assessing a client with a narcissistic personality disorder. Which characteristics would define the client's personality? a. pleasant and encouraging b. submissive and clinging to peers c. impulsive and emotional in groups d provocative and seductive to visitors

a. pleasant and encouraging Although clients with narcissistic personality disorder are grandiose and display a sense of entitlement, they are usually optimistic, cheerful, and pleasant to others

What information should be shared with a new nurse regarding care for a client with borderline personality disorder? a. when problems emerge, calmly review the treatment goals b. try to prevent or decrease the amount of time that the client is manipulative c. remain neutral and avoid engaging in power struggles d. respect the client's need for social isolation and privacy

a. when problems emerge, calmly review the treatment goals

Which response would best facilitate communication with a client who has a personality disorder? a. "What would you like to do today after you have finished your breakfast?" b. "After you attend the morning community meeting, you may work on your homework." c. "You remind me of a friend that I was very close to in high school." d. "We may get comfortable on the unit before you do your therapy homework."

b. "After you attend the morning community meeting, you may work on your homework." This response is a firm yet supportive approach. Answers A and D leave the nurse open for manipulation from the client.

A client with antisocial personality disorder says, "I always want to blow things off." Which response by the nurse is most appropriate? a. "Try to focus on what needs to be done and just do it." b. "Let's work on considering some options and strategies." c. "Procrastinating is a part of your illness that we'll work on." d. "The best thing to do is decide on some useful goals to accomplish."

b. "Let's work on considering some options and strategies."

The nurse is teaching a client with paranoid personality disorder about ways to address behaviors that negatively affect relationships. Which statement, made by the client, best demonstrates that teaching has been effective? a. "I won't abide by social rules as long as I live." b. "Sometimes, I can see what causes my relationship problems." c. "I will learn from other's problems so that I won't repeat them." d. "I have never had problems with social relationships."

b. "Sometimes, I can see what causes my relationship problems." Clients with paranoid personality disorder tend to have impaired social relationships and are very uncomfortable in social settings. Clients struggle to understand and express their feelings about social rules.

Which personality disorder cluster would be the most challenging for the nurse to manage? a. Cluster A b. Cluster B c. Cluster C d. Cluster D

b. Cluster B these clients are very labile emotionally and are quite dramatic

The nurse is assessing a client for narcissistic personality disorder. What questions should the nurse ask the client? Select all that apply a. Do you frequently feel let down by other people? b. Do you find that most other people aren't up to your standards? c. Do you feel that others take advantage of you? d. Do you find that people often have tendency to be disloyal and dishonest? e. If people give you a hard time, do you tend to quickly put them in their place? f. Are you a very special person?

b. Do you find that most other people aren't up to your standards? e. If people give you a hard time, do you tend to quickly put them in their place? f. Are you a very special person? Narcissists feel they are very special people

A client with avoidant personality disorder tells the nurse, "There is not a person in this world who likes me, and I don't know what to do." What is the nurse's most appropriate intervention? a. Discuss ways to think of others instead of focusing on personal needs b. Explore the client's personal feelings about relationship distress c. Discuss ways to form peer relationships that are warm and empathetic d. Identify ways the client seeks immediate gratification despite the consequences

b. Explore the client's personal feelings about relationship distress Clients with avoidant personality disorder fear criticism, disapproval, and rejection

Which behavioral pattern is a characteristic of individuals with histrionic personality disorder? a. Berating themselves and their abilities b. Overreacting to frustrations and annoyances c. Suspicious and mistrustful of others d. Social withdraw, and distant in relationships

b. Overreacting to frustrations and annoyances

A nurse is monitoring a client who appears to be hallucinating. The nurse notes paranoid content in the client's speech, and increasing agitation. The client is gesturing at a figure on the TV. Which interventions are appropriate? Select all a. In a firm voice; instruct the client to stop the behavior b. Reinforce that the client is not in any danger c. Acknowledge the presence of the hallucinations d. Instruct the other team members to ignore the client's behavior e. Immediately implement physical restraint procedures f. Use a calm voice and simple commands

b. Reinforce that the client is not in any danger c. Acknowledge the presence of the hallucinations f. Use a calm voice and simple commands

The healthcare provider is preparing to write a plan of care for a client with BPD. Which medication would the nurse anticipate for the client? a. MAOIs work best because the effects are felt very quickly b. SSRI, along with an atypical antipsychotic, are used to treat, mood instability and impulsivity c. Antipsychotics, along with antidepressants, will treat illusions, ideas of reference, paranoid thinking, anxiety, and hostility d. Anxiolytics will reduce anxiety and cognitive distortions

b. SSRI, along with an atypical antipsychotic, are used to treat, mood instability and impulsivity Best choice for BPD

Which client behaviors should the nurse anticipate from a client with a personality disorder? Select all that apply a. Compliance with the rules of the unit b. Tendency to provoke interpersonal conflict c. Inflexibility toward unit change d. Maladaptive responses to stress e. Trouble in social and professional relationships f. Blurred personal boundaries

b. Tendency to provoke interpersonal conflict c. Inflexibility toward unit change d. Maladaptive responses to stress e. Trouble in social and professional relationships f. Blurred personal boundaries

The sibling of a client with schizoid personality disorder does not understand why his brother does not care about him or want to be his friend. Which statement explains this behavior? a. Someday your brother will become your best friend. b. Your brother does not enjoy having relationships with others c. When your brother is able to trust, then he will be your friend. d. After his medications start to work, then he will become your brother again.

b. Your brother does not enjoy having relationships with others

Which client should the nurse see first? a. a divorced client with a dependent personality disorder who is seeking care from another client b. a client with BPD disorder who continues to talk about wanting to cut her arms c. a client with an avoidant personality disorder who refuses to go to groups on the unit d. a client with paranoid personality disorder who refuses to attend a community morning meeting

b. a client with BPD disorder who continues to talk about wanting to cut her arms

A nurse is caring for a client with schizotypal personality disorder. How should the nurse approach care for this client? a. expect the client to participate in all classes offered on the unit b. allow the client to work on assigned work sheets in her room c. ask the client to conduct the daily community meeting d. have the client assist the instructor of a group medication class.

b. allow the client to work on assigned work sheets in her room

A nurse is providing care for a client with obsessive compulsive personality disorder. What is the priority nursing intervention? a. use a friendly, gentle, reassuring approach b. avoid engaging in a power struggle because their need for control is very high c. be aware that clients with this disorder can instill guilt when they are not getting what they want d. use teaching and role model assertiveness

b. avoid engaging in a power struggle because their need for control is very high

What assessment information, gathered from the family, might explain the client's narcissistic personality disorder? Select all that apply a. family history of autism b. very demanding pattern c. delayed language development d. overly critical caregivers e. limited financial resources f. being overly-indulged in childhood

b. very demanding pattern d. overly critical caregivers f. being overly-indulged in childhood

A client with antisocial personality disorder is trying to convince the nurse that he deserves special privileges, and that an exception to the rules should be made for him. What is the nurse's best response to the client's requests? a. "I believe we need to sit down and talk about this." b. "Don't you know better than to try and bend the rules?" c. "Your requests are unacceptable." d. "Let's discuss your request at the community meeting tomorrow."

c. "Your requests are unacceptable." Clients with antisocial personality disorder often try to manipulate the nurse to gain special privileges. By directly informing the client these actions are unacceptable, the nurse helps the client learn to control these behaviors by setting limits. Do not offer to discuss- suggests that rules are negotiable.

Which behavior would the nurse observe in a client who has a histrionic personality disorder? a. Manipulates others to meet their own needs b. Portrays an attitude of grandiosity c. Demonstrates highly provocative behaviors d. Express feelings of emptiness and boredom

c. Demonstrates highly provocative behaviors

While planning the care of a client with a schizotypal personality disorder, the nurse recognizes that this client has serious difficulty interacting socially. Which is a priority nursing intervention for this client? a. Encourage the client to compose and write a list of social rules. b. Role play a troublesome social dilemma and have the client work through the scenario c. Discuss the client's thoughts and feelings about engagement in peer conversations d. Talk about how and why the client becomes absorbed in negative self-labeling

c. Discuss the client's thoughts and feelings about engagement in peer conversations

A nurse is caring for a client with an avoidant personality disorder. The nurse would like this client to demonstrate her newly acquired social skills in social situations. Which intervention would best facilitate this outcome? a. Discuss the factors that interfere with the client's social interactions b. Identify social skills that client currently performs well c. Go to the hospital cafeteria, purchase lunch, and dine in a group setting d. Complete a work sheet on social skills

c. Go to the hospital cafeteria, purchase lunch, and dine in a group setting

A client with antisocial personality disorder and previous suicide attempt states, "I don't want to be here and I am not following your treatment plan or any of your rules. I am going to tell everyone not to follow the rules." Which statement about the clients condition is most accurate? a. The client is refusing psychotropic drugs used to treat his condition b. The client manipulates others, but not his family c. The client is not motivated to change his behavior or lifestyle d. The client can quickly make behavior changes if motivated.

c. The client is not motivated to change his behavior or lifestyle Clients with antisocial disorder feels nothing is wrong with their behavior and has no desire to change. They attempt to manipulate those around them.

A nurse is caring for a client with schizotypal personality disorder. Which behavior would the nurse anticipate from this client? a. exhibitionism b. impulsiveness c. bodily illusions d. repetitive behaviors

c. bodily illusions Schizotypal = bodily illusions Histrionic = exhibitionism Borderline PD = impulsive OCD = repetitive behaviors

A client with BPD states that he does not how to deal with his impulsive behavior. Which intervention should the nurse implement? a. teach the client that impulse behavior is part of his illness b. explore how depression influences impulsive behaviors c. choose an example of an impulsive situation and explore it d. decrease interactions in which impulsive behavior occurs

c. choose an example of an impulsive situation and explore it

A client with antisocial personality disorder is trying to manipulate the health care team. What is the staff's best strategy? a. focus on teaching the client more effective behaviors to meet basic needs b. help the client verbalize underlying feelings of hopelessness and learn coping skills c. remain calm and don't respond in an emotional manner to the client's manipulative actions d. help the client eliminate the intense desire to have everything in life turn out perfectly

c. remain calm and don't respond in an emotional manner to the client's manipulative actions Antisocial = manipulative

The nurse is reviewing the behaviors of a client with histrionic personality disorder. The nurse determines that a change in behavior may be occurring when the client" a. draws attention to themselves, and dresses provocatively b. becomes easily influenced by others or circumstances c. shows concern about hurting someone else's feelings d. describes intimate relationships with casual acquaintances

c. shows concern about hurting someone else's feelings

Which assessment questions would determine if the client has a histrionic personality disorder? Select all that apply a. "Do you frequently feel let down by people?" b. "If a friend hurts you, do you sometimes feel like hurting yourself?" c. "Do you find that most people aren't quite up to your standards?" d. "Do you think that you would make a good actor?" e. "Compared to other people, do you feel that you are very special person?" f. "Do people of the opposite sex often frequently find you attractive?"

d. "Do you think that you would make a good actor?" f. "Do people of the opposite sex often frequently find you attractive?" Histrionic personality disorder is characterized by a long-standing pattern of attention seeking behavior and extreme emotionality.

A client with antisocial personality disorder talks about personal life changes that need to occur. Which client statement shows that group therapy is having a positive therapeutic effect? a. "I am not doing as bad as I thought I was." b. "I wish I could believe I could change, but it is probably too late." c. "I see all the problems, but I am not sure there are good solutions." d. "I am finally learning to live my life without living on the edge."

d. "I am finally learning to live my life without living on the edge." The patient is aware of their risky behaviors and how problematic they are

A client with a history if social inhibition, agoraphobia, the fear of criticism, feelings of inferiority, and feelings of being extremely unattractive to others has been admitted to the hospital. With which disorder would the nurse associate these behaviors? a. Dependent personality disorder b. Histrionic personality disorder c. Narcissistic personality disorder d. Avoidant personality disorder

d. Avoidant personality disorder

Which assessment questions should the nurse ask to determine if the client has a schizoid personality disorder? Select all a. Do you tend to be a perfectionist? b. Have you found yourself worried that people won't like you? c. Do you enjoy making decisions in your house, or would you prefer others make decisions for you? d. During the course of your life, have you had only one or two friends? e. Over the years, have you been able to physically defend yourself? f. Do you prefer to be alone?

d. During the course of your life, have you had only one or two friends? f. Do you prefer to be alone?

A client with paranoid personality disorder is discussing his current problems with a nurse. Which intervention is most important for the nurse to implement? a. Have the client explore personal sources of frustration b. Have the client focus on ways to interact with others c. Have the client discuss the use of defense mechanisms d. Have the client clarify his thought and beliefs about an event

d. Have the client clarify his thought and beliefs about an event Clients with a paranoid personality disorder often mistrust people, and don't view interacting with others as a way to handle a problem. These clients tend to be aggressive and argumentative rather than frustrated. A paranoid client will focus on defending self rather than acknowledging the use of defense mechanisms

The nurse is developing outcomes for a client with histrionic personality disorder. What is the most appropriate outcome for this client? a. The clients agrees to contracts for safety, and is free of self-inflicted injury b. The client participated in impulse control training c. The client participated in anger management classes d. The client participates in group therapy without being the center of attention

d. The client participates in group therapy without being the center of attention

The nurse is developing long-term goals, for a client with paranoid personality disorder, who is trying to improve peer relationships. What is the most appropriate goal? a. The client will verbalize a realistic view of self b. The client will take steps to address disorganized thinking. c. The client will become appropriately interdependent on others. d. The client will become involved in activities that foster social relationship

d. The client will become involved in activities that foster social relationship

The nurse is caring for a client with an avoidant personality disorder. Which characteristics define the client's behavior? Select all that apply a. Vigilant and suspiciousness b. Distant personal relationships c. Unstable relationships d. View themselves as inferior to others e. Inflexible, rigid, and needs to be in control f. Social phobias

d. View themselves as inferior to others f. Social phobias

A client with dependent personality disorder is working on goals for self-care. Which short-term goal is most important for the client's ADLs? a. complete all self-care activities independently b. establish a schedule for each day of the week c. perform self-care activities in a minimal amount of time d. identify activities that can be performed independently

d. identify activities that can be performed independently

What is the most appropriate short-term goal for a client with paranoid personality disorder and impaired social skills? a. obtain feedback from the other people and staff on the unit b. discuss anxiety-provoking situations and possible solutions c. address positive and negative feelings the client has about self d. identify personal feelings that hinder the client's social interaction

d. identify personal feelings that hinder the client's social interaction

A client with paranoid personality disorder makes an inappropriate and unreasonable report to the nurse. What is the most appropriate intervention by the nurse? a. use logic and a strong rationale to address the client's concerns b. immediately confront the client about the stated misperception c. use nonverbal communication in the group setting to address the issue d. matter-of-factly tell the client that you don't share his interpretation

d. matter-of-factly tell the client that you don't share his interpretation Helps the client differentiate between realistic and emotional thoughts and conclusions. When the nurse uses logic to respond, the nurse risks creating a power struggle. Non-verbal communication can be misinterpreted. It is unwise to confront a paranoid client because they will immediately become defensive

What intervention would be most effective for a client with schizoid personality disorder? a. participates in impulse control training b. participated in anger management classes c. participates in group without being center of attention d. participates in social skills training

d. participates in social skills training Schizoid = detached from others

The nurse is developing outcomes for a client with obsessive compulsive personality disorder. What is the most appropriate outcome for this client? a. participating in training classes b. demonstrating a reduction in manipulative behavior c. demonstrating decreased suspicion and increased security d. participating in recreational therapy on the unit

d. participating in recreational therapy on the unit