Personality Disorders

a.

For which characteristics will the nurse look when assessing a client suspected of having antisocial personality disorder? a. Deceitfulness, impulsiveness, and lack of empathy b. Perfectionism, preoccupation with detail, and verbosity c. Avoidance of interpersonal contact and preoccupation with being criticized d. A need for others to assume responsibility for decision-making and nurture-seeking

a. "You seem concerned about how you are being treated here on this unit." This response gives the patient an opportunity to respond and communicates that you are listening.

Gale tells another nurse on the unit, "You are the only decent person here. You really care, and my nurse is really cold." This nurse is new to the unit and does not know how to answer. What would be your best response to Gale if you were in this position? a. "You seem concerned about how you are being treated here on this unit." b. "You have just not learned to trust people; your nurse is a good person." c. "Your personality disorder is causing you to be angry and distrustful." d. "You need to understand that all the staff here are very caring."

c Anorexia nervosa and substance use disorders are often comorbidities for clients diagnosed with narcissistic personality disorder; therefore, it is important for the nurse to assess the client's nutritional status, because these disorders compromise this.

A client has been diagnosed with narcissistic personality disorder. Which aspect of the nursing assessment is most important? a. Pain rating b. Level of anxiety c. Nutritional status d. Attention span and hyperactivity

Ineffective coping

Crisis, high levels of anxiety - nursing diagnosis

blaming

Genuinely unaware that their personality traits are causing the problems

Personality

How we perceive and interact with the world

a, d, e

Which traits are typically common among avoidant, obsessive-compulsive, and dependent personality disorders? Select all that apply. a. Depressed b. Shallow c. Eccentric d. Fearful e. Tense f. Irrational

c. Histrionic

A client who is dramatic, charming, and seductive has traits of which personality disorder? a. Narcissistic b. Antisocial c. Histrionic d. Borderline

b. Clients diagnosed with paranoid personality disorder are suspicious and believe that others want to exploit, harm, and deceive them. They develop a defense system and try to counterattack the other person and reject the treatment, often behaving rudely. Clients diagnosed with schizoid personality disorder have reduced emotional attachment and depression. In narcissistic personality disorder, clients are extremely worried about their prestige; they feel intense shame and fear of abandonment by others. Clients diagnosed with obsessive-compulsive personality disorder exhibit repetitive behaviors.

A nurse observes that a client behaves rudely to the staff and refuses treatment. On inquiry, the nurse learns that The client says to the nurse, "I think that all staff members are planning to harm and deceive me." Which diagnosis does the nurse expect to see in the client's medical record? a. Schizoid personality disorder b. Paranoid personality disorder c. Narcissistic personality disorder d. Obsessive-compulsive personality disorder

Hopelessness, Risk for suicide, Self-mutilation, Chronic low self-esteem, Spiritual distress

Depression - nursing diagnosis

Ineffective coping, Impaired social interaction, Interrupted family processes, Risk for loneliness

Difficulty in relationships, manipulation - nursing diagnosis

- Have frequent communications among staff members. - Set limits on patient behavior. - All staff should consistently enforce limits.

Discuss how you would use teamwork and collaboration when working with a patient who is extremely manipulative.

Ineffective therapeutic regimen management Noncompliance

Failure to keep medical appointments, late arrival for appointments, failure to follow prescribed medical procedure or medication regimen - nursing diagnosis

d. Introduce yourself, and let Gale know that you will be her nurse during your shift. This response communicates caring and professionalism to Gale and possibly opens further channels of communication.

Gale's medical history (from previous admissions) indicates diagnosis of depressive disorder and BPD. Based on these diagnoses, which of the following will be your best initial intervention as you begin your shift? a. Allow Gale to act out her frustrations since she is newly admitted. b. Immediately set strict limits so that Gale knows who is in control. c. Instruct a mental health technician to monitor Gale on a 15-minute basis. d. Introduce yourself, and let Gale know that you will be her nurse during your shift.

Cognitive-behavioral therapy

Is a form of CBT developed initially for individuals with eating disorders but now used with a range of problems including anxiety, depression, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD) and anger problems.

c

Which behavior is demonstrated by a client who engages in splitting with dichotomous thinking? a. Unconsciously represses undesirable aspects of self b. Places responsibility for behavior outside the self c. Sees things as divided into "all good" or "all bad" d. Demonstrates a lack of personal boundaries

traits

Stylistic peculiarities that all people bring to social relationships

b.

What action should the nurse take when helping a client who is displaying manipulative behaviors? a. Maintain client confidentiality from other staff members. b. Set boundaries and enforce consequences. c. Self-disclose relevant personal information. d. Offer to do special favors for the client.

Social isolation

Withdrawal - nursing diagnosis

b

An adult diagnosed with antisocial personality disorder begins a program at the community mental health center. Which is an appropriate outcome for this client? a. Do not engage in self-mutilation. b. Listen attentively as others share their feelings. c. Limit time spent engaging in compulsive behaviors. d. Attend the program dressed in seasonally appropriate clothing.

a.

An adult was caught shoplifting merchandise from a community thrift shop. When confronted, the individual replies, "All this stuff was donated, so I can take it." This comment suggests features of which personality disorder? a. Antisocial b. Histrionic c. Borderline d. Schizotypal

Risk for other-directed violence, Ineffective coping, Impaired parenting, Disabled family coping

Anger and aggression; child, elder, or spouse abuse - nursing diagnosis

A. "I can promote my client's sense of control by establishing a schedule."

A nurse manager is discussing the care of a client who has a personality disorder with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching? A. "I can promote my client's sense of control by establishing a schedule." B. "Self-assessment will help me cope with emotional reactions to client care." C. "I should practice limit-setting to help prevent client manipulation." D. "Maintaining professional boundaries is a priority of client care."

c. Histrionic personality disorder

A nurse notices that a client behaves in a melodramatic way and acts flirtatiously. With which personality disorder does the nurse expect the client to be diagnosed? a. Paranoid personality disorder b. Schizoid personality disorder c. Histrionic personality disorder d. Narcissistic personality disorder

b. Lack of remorse

Research has indicated that an individual diagnosed with an antisocial personality may present with which characteristic? Multiple choice question a. Social isolation b. Lack of remorse c. Learning difficulties d. Difficulty with reality testing

a

What is the primary goal of milieu therapy for clients diagnosed with personality disorders? a. Managing the affect of the entire group b. Providing one-on-one therapy for each member of the milieu c. Helping the client remain uninvolved with other clients d. Promoting a laissez-faire attitude among the staff members

b. Splitting Splitting is the inability to integrate both the positive and the negative qualities of an individual into a whole. The individual using this defense tends to think in extremes.

What term is used to identify the inability to view both positive and negative aspects of others as part of a whole? a. Devaluation b. Splitting c. Impulsiveness d. Social ineffectiveness

a. Selective serotonin reuptake inhibitor (SSRI) This client meets the diagnostic criteria for borderline personality disorder. SSRIs can help clients with borderline personality disorder who have co-occurrence with panic attacks. Benzodiazepines are not appropriate because of the risk of overdose. An anticonvulsant or lithium may be useful in borderline personality disorder but do not address the panic attacks.

A 22-year-old client is anxious and irritable during the initial assessment. Following a physical altercation with her former significant other, she has had suicidal ideation and panic attacks. The nurse finds she also has a history of childhood sexual abuse. What medication would be most helpful for this client to address the underlying personality disorder and recent panic attacks? a. Selective serotonin reuptake inhibitor (SSRI) b. Benzodiazepine c. Anticonvulsant d. Lithium

d

A 30-year-old client has a history of self-mutilation and multiple citations for driving under the influence of alcohol. He says to the nurse, "I know it's not good for me to cut or drive drunk. It actually scares me when I think about some of the stupid things I've done and what could have happened to me." What is the nurse's most therapeutic response? a. "I believe that once we address your alcohol abuse, you'll find you won't engage in risky behaviors anymore." b. "You need to have better self-control. It's one thing to cut yourself, but you're putting the lives of others at risk when you drink and drive." c. "It's good that you feel scared. You can remember that feeling the next time you're about to do something impulsive." d. "When you think back on the risks you've taken, can you identify anything that those situations had in common?"

a, c, e

A charge nurse is preparing a staff education session on PD. Which of the following should be included as personality characteristics associated with all of the personality disorders? (SATA) A. Difficult in getting along with other members of a group B. Belief in the ability to become invisible during times of stress C. Display of defense mechanisms when routines are changed D. Claiming to be more important than other persons E. Difficulty understanding why is it inappropriate to have a personal relationship with staff

a. Clients diagnosed with antisocial personality act out feelings without consideration for the rights of others. They feel no remorse for their antisocial acts. This lack of remorse for such behavior is not typical of borderline, schizotypal, or narcissistic personality disorders.

A client arrested for an assault in which the client savagely beat a classmate states, "The guy deserved everything he got." The behaviors described are most consistent with which personality disorder? a. Antisocial b. Borderline c. Schizotypal d. Narcissistic

b. The scenario describes splitting of staff and impulsivity associated with self-mutilation. These are common behaviors among clients diagnosed with borderline personality disorder. Clients diagnosed with narcissistic personality disorder are exploitive, grandiose, and disparaging. Clients diagnosed with avoidant personality disorder are excessively anxious in social situations and hypersensitive to negative evaluation. Clients diagnosed with histrionic personality disorder are seductive, flamboyant, attention-seeking, and shallow.

A client at the mental health center says to the nurse, "The other staff members do not care about me, but you are different. You understand my problems." When the nurse tells this client about an upcoming career change, the client becomes very angry. An hour later, the client loudly announces, "I'm going to cut my wrists." Given this scenario, which personality disorder does the client most likely have? a. Narcissistic b. Borderline c. Avoidant d. Histrionic

a, e

A client becomes anxious in group activities and is hypersensitive to negative evaluation. Which interventions should the nurse perform while caring for this client? Select all that apply. a. Taking a friendly approach toward the client b. Assigning the client to another group activity c. Insisting that the client participate in group activities d. Adopting a firm, matter-of-fact approach with the client e. Accepting the client's request to not be involved in group activities

c, d, e

A client diagnosed with antisocial personality disorder becomes frustrated and angry when unable to connect to the internet. The client then curses loudly, disrupting, frightening, and disturbing others. Which nursing actions are therapeutic? Select all that apply. a. Seclude the client for one hour to allow for de-escalation. b. Say to the client, "Step aside and I will get you connected to the Internet." c. Ask the client, "How were you feeling when you were having this difficulty?" d. Encourage the client to recognize signs of mounting tension and seek assistance. e. Tell the client, "Further outbursts will result in suspension of your computer privileges."

c

After a power outage, a facility must serve a dinner of sandwiches and fruit to clients. Which comment is most likely from a client diagnosed with a narcissistic personality disorder? a. "These sandwiches are probably contaminated with bacteria." b. "I suppose it's the best we can hope for under these circumstances." c. "You should have ordered a to-go meal from a local restaurant for me." d. "I would rather wait to eat until the dietary department can prepare a meal."

c. The client plays a leading role in a group activity assigned by the nurse. A client diagnosed with antisocial personality disorder shows impaired social interaction and defensive coping. A client who plays a leading role in a group activity indicates improvement of the symptoms, which may be the result of effective treatment. The client declaring the government to be responsible still indicates disruptive thought processes. A request to be excused from a therapy task doesn't indicate progress or effective treatment. Psychotherapy aims to help the client interact with others and develop sensitivity toward others. Ridiculing another client shows that the client with antisocial personality disorder is not sensitive and does not show empathy for others.

A client diagnosed with antisocial personality disorder participates in psychotherapy. Which response by the client most indicates to the nurse the treatment has been effective? a. The client declares the government to be responsible for his or her condition. b. The client requests the nurse to be excused from a particular task. c. The client plays a leading role in a group activity assigned by the nurse. d. The client ridicules a client experiencing acute mania.

c. Dialectical behavior therapy Dialectical behavior therapy is an advanced practice intervention used in clients with borderline personality disorder who have chronic suicidal intentions. This therapy includes cognitive and behavioral techniques like mindfulness and emotion regulation to improve interpersonal effectiveness skills in clients.

A client diagnosed with borderline personality disorder has suicidal intentions. The nurse plans to teach mindfulness and emotion regulation to improve the client's interpersonal effectiveness skills and support which type of therapy? a. Family therapy b. Schema-focused therapy c. Dialectical behavior therapy d. Supportive psychotherapy

a.

A client diagnosed with obsessive-compulsive personality disorder takes the nurse aside and says, "I saw you interacting with that new client. Your approach is not correct. You should be more forceful and directive." Select the nurse's best response. a. "I will continue to follow the care plan for the client." b. "I see you are trying to control that client's therapy as well as your own." c. "Your eye for perfection extends even to my nursing interventions." d. "That client's care is really of no concern to you or to other clients."

b. People diagnosed with schizotypal personality disorder have severe social and interpersonal deficits. They experience anxiety in social situations. They may have some intellectual and perceptual distortions but can be made aware of reality, unlike those with schizophrenia. Schizoid personality disorder can be a precursor to schizophrenia or delusional disorder. People diagnosed with this disorder are emotionally detached loners who do not seek out or enjoy close relationships. People diagnosed with paranoid personality disorder tend to be afraid that others will harm or deceive them, so they are hostile and view others with suspicion. People diagnosed with obsessive-compulsive disorder have a fear of imminent catastrophe. They tend to rehearse over and over how they will respond in a social circumstance.

A client experiences extreme anxiety in social situations and seems to have some intellectual and perceptual distortions but can be made aware of the misinterpretations of reality. With which disorder does the nurse expect the client to be diagnosed? a. Schizoid personality disorder b. Schizotypal personality disorder c. Paranoid personality disorder d. Obsessive-compulsive personality disorder

d. The main traits that describe schizotypal personality disorder 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. In obsessive-compulsive personality disorder the main pathological personality traits are rigidity and inflexible standards of self and others, along with persistence to goals long after it is necessary, even if it is self-defeating or negatively affects relationships. People with narcissistic personality disorder come across as arrogant, with an inflated view of their self-importance. They have a need for constant admiration, along with a lack of empathy for others, a factor that strains most relationships over time. Traits of avoidant personality disorder include low self-esteem, feelings of inferiority compared with peers, and a reluctance to engage in unfamiliar activities involving new people.

A client is withdrawn and suspicious and states, "I always prefer to be alone." The client also states, "I have special powers and read other's thoughts at times." Based on this presentation, the nurse suspects which personality disorder? a. Obsessive-compulsive b. Narcissistic c. Avoidant d. Schizotypal

b.

A mental health nurse assesses a client diagnosed with antisocial personality disorder. Which co-morbid problem is most important for the nurse to include in the assessment? a. Generalized anxiety b. Alcohol use and abuse c. Compulsions and phobias d. Dysfunctional sleep patterns

c, e

A nurse is assisting with a court-ordered evaluation of a client who has antisocial personality disorder. When assessing this client, which of the following are expected findings? (SATA) A. Demonstrates extreme anxiety when placed in a social situation B. Has difficulty making even simple decisions C. Attempts to convince other clients to give him their belongings D. Becomes agitates if his personal area is not neat and orderly E. Blames others for his past and current problems

A. "I'm scared that you're going to leave me."

A nurse is caring for a client who has avoidant personality disorder. Which of the following statements is expected from a client who has this type of personality disorder? A. "I'm scared that you're going to leave me." B. "I'll go to group therapy if you'll let me smoke." C. "I need to feel that everyone admires me." D. "I sometimes feel better if I cut myself."

B. Splitting

A nurse is caring for a client who has borderline PD. The client says, "The nurse on the evening shift is always nice! You are the meanest nurse ever!" The nurse should recognize the clients statement as an example of which of the following defense mechanisms? A. Regression B. Splitting C. Undoing D. Identification

b.

A nurse is managing the care of an individual diagnosed with avoidant personality disorder. What is the appropriate outcome for this client? a. The client will refrain from aggressive behavior toward others within 5 days. b. The client will demonstrate use of assertive communication within 3 months. c. The client will establish an intimate relationship with another adult within 2 weeks. d. The client will make a permanent commitment never to self-mutilate within 1 week.

d.

How can the nurse manager address the needs of a nursing staff who cares primarily for clients diagnosed with personality disorders? a. Schedule monthly in-services on the management of this client population. b. Design schedules to provide staff with 3 consecutive days off each period. c. Require that nursing staff rotate to another nursing unit for 6 months every 24 months. d. Hold a daily meeting to focus on communication between nursing and supervisory staff.

- Patient's problems can overwhelm health care professionals. - Intense feelings evoked in a nurse often mirror the feelings of a patient: For example, a patient might tell a nurse, "You're inadequate and incompetent!" - Health care professionals may feel confused, helpless, angry, and frustrated. - Patients are abusive of authority and successful in splitting staff in an attempt to defend against the patient's own feelings of frustration and powerlessness. - When staff members are split, the result is conflict. - Untrained staff members may become vengeful in response to a sense of entitlement, manipulation, dependency, ingratitude, impulsivity, and rage. - Nurses and other health care professionals should practice self-health management, which includes acknowledging and accepting their own emotional responses. - Health care professionals should ensure personal well-being.

Identify some disconcerting feelings health care professionals experience when working with individuals with personality disorders.

Fear Disturbed: sensory perception, thought processes, coping

Paranoia - nursing diagnosis

c. Schizotypal personality disorder is more common in families with a history of schizophrenia, so the client is most likely to answer "yes" to this question. Affirmative answers to the other questions are representative of characteristics of other disorders.

The nurse assesses a new client suspected of having a schizotypal personality disorder. Which assessment question is this client most likely to answer affirmatively? a. "Do some types of situations frighten you?" b. "Do you often have episodes of prolonged crying?" c. "Is anyone in your family diagnosed with a mental illness?" d. "Is it ever extremely important for you to do everything correctly?"

b

The nurse is assessing a client diagnosed with narcissistic personality disorder. Which behavior is the nurse most likely to find in this client? a. Aggression toward others b. Exploitation of others c. Hypervigilance of others d. Submission to others

c. Reluctance to answer any questions

The nurse is assessing a client for a possible personality disorder. Which finding does the nurse identify as feature of paranoid personality disorder? a. Dichotomous thinking b. Excessive emotionality c. Reluctance to answer any questions d. Deferring questions to a family member

b

The nurse is caring for a client diagnosed with borderline personality disorder. Which behavior does the nurse expect find in the client? a. The client is always calm and depressed. b. The client shows extreme fluctuating emotions. c. The client abuses peers and hospital staff. d. The client feels uncomfortable with the nurse's attention.

c, e

The nurse is caring for a client who previously attempted suicide. The nurse reads in the client's medical history that he or she has been diagnosed with histrionic personality disorder. Which characteristics does the nurse expect to observe in the client? Select all that apply. a. The client is relaxed and calm. b. The client is in a long-term relationship. c. The client wants the best of everything. d. The client does not have attachment to his or her parents. e. The client feels comfortable when given complete attention.

b

What are individuals displaying when they believe they have a right to hurt others, take what they want, and treat others unfairly? a. Splitting b. Entitlement c. Impulsivity d. Manipulation

a. Behaviors in people with OCD can fluctuate at different times; behaviors in people with OCPD are consistent over time. Since OCPD is a personality disorder, these clients' behaviors and personality traits do not fluctuate. The intensity of the obsessive-compulsive behaviors in people with OCD can fluctuate at different times. Many people with OCPD seem to be high functioning, with no difficulty in functioning. People with OCD often have disruption in their ability to function in all areas of their lives. People with OCPD do not display unwanted obsessions or compulsive ritualistic behavior. Making a diagnosis between these two disorders can cause confusion in the clinical setting.

What is a key difference between obsessive-compulsive personality disorder (OCPD) and obsessive-compulsive disorder (OCD)? a. Behaviors in people with OCD can fluctuate at different times; behaviors in people with OCPD are consistent over time. b. People with OCD tend to be more high functioning in across all areas of their lives than people with OCPD. c. Unwanted obsessions and ritualistic compulsions are well controlled in people with OCPD but not in people with OCD. d. Diagnostic criteria are clearer for OCPD than for OCD, so diagnosing OCPD is easier for clinicians.

c

What is the most helpful strategy for the nursing staff to support self-care among nurses who help clients with personality disorders? a. Whenever possible, assign personality disorder clients to nurses who have less experience and may be more eager to help. b. Encourage clients to use splitting behaviors, so they can be supported by the nurses for whom they have the most respect. c. Implement frequent avenues of communication and continuously available supervision to support the nurses' confidence and effectiveness. d. Provide training to help the nurses learn how to ignore their own feelings about clients and put the clients' well-being first.

b

When providing care for a client diagnosed with borderline personality disorder, the nurse will need to consider strategies for dealing with which characteristic behavior in the client? a. Grief, anger, and social isolation b. Mood shifts, impulsivity, and splitting c. Altered sensory perceptions and suspicion d. Perfectionism and preoccupation with detail

b, c, d

Which abnormalities in brain structure and function have been found to be associated with borderline personality disorder? Select all that apply. a. Gray matter size b. Hippocampus size c. Frontal lobe function d. Amygdala size e. Prefrontal lobe function

a, b, e

Which are typical characteristics of Cluster A disorders? Select all that apply. a. Eccentric behavior b. Suspicious c. Warm d. Gregarious e. Irrational

a, b, d, e

Which assessment questions does the nurse know focus on the characteristic behaviors of a client diagnosed with borderline personality disorder? Select all that apply. a. Does your mood shift dramatically over a few hours? b. Have you ever been told you are sarcastic? c. Do you experience visual or auditory hallucinations? d. How would you describe your romantic relationships? e. How would you describe your romantic relationships?

a.

Which behavior is most characteristic of a client diagnosed with antisocial personality disorder? a. Justifying taking another client's dessert by stating, "I deserve two desserts." b. Throwing a book when asked to turn down the volume on the television. c. Insisting that it is necessary to eat only green foods on Thursdays. d. Repeatedly accusing the staff of favoring another client.

b, c, e

Which characteristics are criteria for diagnosing borderline personality disorder? Select all that apply. a. Periods of manic behavior b. Recurrent suicidal behavior c. Chronic feelings of emptiness d. Compulsively performing ritualistic behaviors e. A pattern of unstable and intense personal relationships

a, b, d, e

Which client assessment findings best support the diagnosis of schizoid personality disorder? Select all that apply. a. Has never been married b. Raised in foster care after age 7 after death of parents c. Reports, "I like people but I have only two good friends." d. Is employed as a nightshift janitor at an office complex e. States, "I don't really care whether people are afraid of me."

c, d

Which client statements support the diagnosis of dependent personality disorder? Select all that apply. a. "I've lived alone in the past but moved back home when my mother died." b. "It's hard, but I pay for the rent, all the utilities, and all the food." c. "My mother didn't like it, so I never spent the night at a friend's house." d. "I was sick a lot as a child, and so my family was always there for me." e. "It's been so hard with my spouse out of town so much for work."

a, b, c

Which client statements support the diagnosis of histrionic personality disorder? Select all that apply. a. "I like being the center of attention." b. "My spouse left me because I flirt too much with others." c. "I need to be in the hospital because I got so depressed after my last divorce." d. "I try really hard, but I can never seem to please my spouse." e. "I think I'd feel better if I could just cry and let my spouse know how I feel."

a, b, c, e

Which defining characteristics best apply for the nursing diagnosis of ineffective coping? Select all that apply. a. Difficulty in relationships b. High levels of anxiety c. Manipulation d. Interdependence e. Aggression

d, e

Which interventions by the nurse are best associated specifically with care provided for a client diagnosed with paranoid disorder? Select all that apply. a. Monitoring the client for behaviors associated with psychosis b. Discussing how the client's statements hurt the feelings of others c. Failing to react when the client speaks disrespectfully to the nurse d. Giving the client a copy of the daily routine he or she is expected to follow e. Explaining why the scheduled therapy session will be delayed 30 minutes

c

Which personality disorder is characterized by persistent disregard for and violation of the rights of others with an absence of remorse for hurting others?Multiple choice question a. Borderline b. Schizotypal c. Antisocial d. Narcissistic

b. Borderline personality disorder is considered a Cluster B personality disorder. Avoidant personality disorder is one of the disorders in Cluster C. Paranoid and schizotypal personality disorders are Cluster A personality disorders.

Which personality disorder is considered a Cluster B personality disorder? a. Avoidant personality disorder b. Borderline personality disorder c. Paranoid personality disorder d. Schizotypal personality disorder

b, d, f

Which personality traits are associated with borderline personality disorder? Select all that apply. a. Shyness b. Impulsivity c. Disinhibition d. Hypersensitivity e. Aggressive disregard f. Emotional dysregulation

c. The presence of a personality disorder interferes with or complicates social and interpersonal functioning. Individuals who meet criteria for personality disorders have problems with empathy or intimacy within their relationships. People diagnosed with personality disorders tend not to perceive themselves as having a problem but instead believe their problems are caused by how others behave toward them. While short-term hospitalization may sometimes be necessary when acute problems occur, extended hospitalizations tend to be counterproductive for this population. In the United States, there are no Federal Drug Administration-approved medications specifically for treating personality disorders; however, some health care providers prescribe selected psychotropic medications for off-label use.

Which statement about clients diagnosed with personality disorders is accurate? a. Clients readily recognize their problems and seek professional assistance. b. Extended hospitalization is the best intervention and is commonly needed for stabilization. c. Characteristics of these disorders are most evident in social and interpersonal interactions. d. Research has produced multiple medications that effectively manage symptoms of personality disorders.

d. A primary coping style used by clients diagnosed with BPD is 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 (e.g., a friend, lover, or 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, as illustrated by the statement expressing disappointment in the nurse. Asking about the nurse's opinion on the client's discharge, expressing a plan to never speak to family, and denying suicidal thoughts and feelings do not indicate splitting or BPD.

Which statement best illustrates a primary coping style common for clients diagnosed with borderline personality disorder (BPD)? a. "I promise I am not feeling suicidal. I won't hurt myself." b. "My health care provider says I might get out of here tomorrow. Do you think I'm ready to go?" c. "I will never again speak to any of my messed up family members. I know that this will help me be more functional." d. "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."

b, c, d

Which statement by a nurse providing care for clients diagnosed with personality disorders demonstrates therapeutic management of manipulative client behavior? Select all that apply. a. "Tell me what triggered your angry response to what I said." b. "The staff is responsible for determining unit rules that are fair for all clients." c. "Remember that all clients must follow the rules regarding use of the telephone." d. "Missing group today means that you will not be able to attend the pizza party later." e. "Tell me what you are trying to accomplish by being so rude to the staff and other clients."

a.

Which statement is descriptive of clients diagnosed with personality disorders? a. They are resistant to behavioral change. b. They have an ability to tolerate frustration and pain. c. They usually seek help to change maladaptive behaviors. d. They are able to form satisfying and intimate relationships.

b. "There is nothing good I can say about my mother."

Which statement most demonstrates a common defense mechanism used by clients diagnosed with a borderline personality disorder? a. "I'm so ashamed when I lose my temper." b. "There is nothing good I can say about my mother." c. "I can't go to group therapy unless you go with me." d. "I've attempted suicide on three different occasions."

b, d, e

Which statements are true of antisocial personality disorder (APD)? Select all that apply. a. Clients diagnosed with APD display magical thinking. b. Frontal lobe dysfunction is a brain change identified in APD. c. It is characterized by rigidity and inflexible standards of self and others. d. It is characterized by deceitfulness, disregard for others, and manipulation. e. Clients diagnosed with APD are concerned with personal pleasure and power. f. Clients diagnosed with APD usually present for treatment because of awareness of how their behavior is affecting others.

c. In people diagnosed with personality disorders (PDs), personality traits tend to be inflexible and unpredictable, and coping strategies tend to be more primitive and immature. They often blame others for their difficulties or even deny having a problem. Binge drinking is associated with addiction. Ritualistic behaviors are associated with obsessive compulsive disorder. Difficulty deciding what movie to view is not associated with a personality disorder.

Which stress management behavior is most reflective of personality disorders? a. Binge drinking every weekend b. Demonstrating ritualistic behaviors c. Blaming a spouse for the client's poor performance at work d. Having difficulty making a decision concerning which movie to view

a, c, e

Which symptoms should the nurse assess to identify borderline personality disorder when interviewing clients? Select all that apply. a. Tendency toward intense anxiety b. Inclination toward group activities c. Feelings of emptiness d. Extent of happiness e. Frequency of mood shifts

shyness seductiveness rigidity suspiciousness passive aggressive behaviors

examples of personality traits

Trazodone and venlafaxine

have low toxicity in overdose

Atypical antipsychotics

help with psychotic features in BPD under stress

Psychodynamic psychotherapy

is a form of depth psychology, the primary focus of which is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension. In this way, it is similar to psychoanalysis.

Lithium, anticonvulsants, SSRIs

minimize aggression

a

nurse plans care for a client diagnosed with borderline personality disorder (BPD). Which nursing diagnosis is most likely to apply to this client? a. Ineffective relationships related to frequent splitting b. Social isolation related to fear of embarrassment or rejection c. Ineffective impulse control related to violence as evidenced by cruelty to animals d. Disturbed thought processes related to recurrent suspicion of people and situations

Difficulty accurately perceiving and interpreting the world around them Difficulty with impulse control Inappropriate emotional responses Blaming

personality disorder traits

Medications are not available for the treatment of PDs per se. Treating the *symptoms* is helpful. *Benzodiazepines* (maintenance dosing) for anxiety are not appropriate because of the *potential for abuse* and overdose; they may be used in *emergency situations* Medications with low toxicity are appropriate.

pharmacologic therapies of PDs

Dialectical behavior therapy

provides clients with new skills to manage painful emotions and decrease conflict in relationships

Carbamazepine

targets impulsivity and self-harm

Psychotherapy

the treatment of mental disorder by psychological rather than medical means

Selective serotonin reuptake inhibitors (SSRIs)

treat co-morbid depression and panic attacks