Psych Exam 3 - Chapter 28

A nurse is assessing a client and suspects that the client may have obsessive-compulsive personality disorder based on which statement? a. "I need to have everything perfect. My life is organized down to the second." b. "I don't have any friends and I don't like to do anything socially." c. "I can't trust anybody that I meet, no matter where it is or who they are." d. "I am better than everyone and they should emulate me."

a. "I need to have everything perfect. My life is organized down to the second."

A client with borderline personality disorder says to the nurse, "I feel so comfortable talking with you. You seem to have a special way about you that really helps me." Which would be the most appropriate response by the nurse? a. "I'm here to help you just as all the staff members are." b. "I cannot be your friend. We need to be clear on that." c. "I'm glad you feel comfortable with me." d. "You feel others don't understand you?"

a. "I'm here to help you just as all the staff members are."

A client who has a diagnosis of histrionic personality disorder is admitted to an inpatient mental health unit. The client leaves the unit briefly without notifying the nurse or other members of the health care team. The client's nurse uses confrontation to remind the client of the rules of coming and going from the unit. The client has responded, "But those rules are more for the schizophrenics and crazy people, right?" How should the nurse respond? a. "Your safety is the priority while you are admitted to this unit. Please ensure you notify your nurse prior to leaving." b. "If you want an exemption, I can ask the psychiatrist but there are no guarantees." c. "Even though there's no real safety risk in your case, I'd appreciate it if you tried to remember next time." d. "What would make you think that? You're supposed to behave the same as anyone else here."

a. "Your safety is the priority while you are admitted to this unit. Please ensure you notify your nurse prior to leaving."

A client with borderline personality disorder is receiving dialectical behavior therapy. The nurse understands that this therapy includes which intervention? Select all that apply. a. Contingency management b. Symptom identification c. Relaxation techniques d. Skills training e. Problem-solving techniques

a. Contingency management d. Skills training e. Problem-solving techniques

The client is a 29-year-old who is having a great deal of difficulty with a new job. The client has been unable to make decisions individually and feels overwhelmed when the client needs to begin a new project. The client often relies on one of her coworkers to help with decisions and projects. Which would describe the client correctly? a. Dependent personality b. Schizotypal personality c. Histrionic personality d. Narcissistic personality

a. Dependent personality

A client with a personality disorder is upset and calls the nurse a "stupid cow." Which is an effective initial response to this client's behavior? a. Discuss displacement of anger and set limits. b. Walk away from the client. c. Report the behavior to the health care provider so that consistency and consequences can be followed. d. Demonstrate empathy by reaching out to touch the client.

a. Discuss displacement of anger and set limits.

Extrapyramidal side effects are characterized by a triad of symptoms, including what? a. Dystonia, akathisia, and pseudoparkinsonism b. Shuffling gait, cogwheeling, and drooling c. Sadness, flattened affect, and anxious behavior d. Dystonia, flat affect, and cogwheeling

a. Dystonia, akathisia, and pseudoparkinsonism

A client with borderline personality disorder is prescribed pharmacotherapy. The nurse understands that this treatment aims to control which of the following? Select all that apply. a. Emotional dysregulation b. Cognitive disturbances c. Physical disability d. Anxiety e. Impulsive aggression

a. Emotional dysregulation b. Cognitive disturbances d. Anxiety e. Impulsive aggression

Which would the nurse expect to assess in a client with narcissistic personality disorder? a. Grandiose and superior self-concept b. Mistrust of others c. Dependence on others for decision making d. Genuine concern for others

a. Grandiose and superior self-concept

The nurse is conducting an education group for women at risk for self-mutilation. What is the most important goal for this group? a. Learning strategies to refrain from self-harm b. Learning problem solving c. Discussing feelings about self-harm d. Expressing angry feelings

a. Learning strategies to refrain from self-harm

After teaching a group of nurses about problems commonly experienced by clients with borderline personality disorder (BPD), the nurse determines teaching was effective when the group identifies which problem? Select all that apply. a. Living within the law b. Keeping a job c. Inflated self-esteem d. Maintaining intimate relationships

a. Living within the law b. Keeping a job d. Maintaining intimate relationships

The nurse is assessing a client who has borderline personality disorder. Which would be the priority considering the comorbid conditions associated with this disorder? a. Nutrition patterns b. Somatic complaints c. Personal hygiene practices d. Physical functioning

a. Nutrition patterns

A client with borderline personality disorder has been admitted to the inpatient unit after being found in the client's parents' bedroom, burning the client's arm with an iron. This injury required a brief stay in the hospital's burn unit prior to transfer to your psychiatric unit. Which is the nursing care priority for this client during the first 24 hours of admission? a. Protection from self-mutilation b. Working on self-esteem c. Impulse control d. Suicidal assessment

a. Protection from self-mutilation

When assessing a client with borderline personality disorder (BPD), which would a nurse expect to assess? Select all that apply. a. Self-injurious behavior b. Fear of rejection c. Exaggerated sense of self d. Free sharing of feelings with others e. Control necessary for a relationship

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

Clients with borderline personality disorder (BPD) are usually admitted to an inpatient setting because of what? a. Threats of self-harm b. Splitting c. Agitation d. Medication noncompliance

a. Threats of self-harm

The nurse is assessing a client who is diagnosed with borderline personality disorder. Which client statement indicates the client is at risk for self-injurious behavior? a. "When I feel extremely anxious, it is like my mind goes somewhere else." b. "I have felt so down lately. I don't enjoy doing anything anymore." c. "I do what I do because others tell me to do so." d. "It is almost as if as soon as I think of doing something, I immediately do it."

b. "I have felt so down lately. I don't enjoy doing anything anymore."

Which statement by a client with borderline personality disorder (BPD) is an example of catastrophizing? a. "If I had not made him mad, he wouldn't have hit me." b. "This is the most awful thing that has ever happened to me." c. "I never get what I want." d. "No one ever listens to me."

b. "This is the most awful thing that has ever happened to me."

Which of the following behavioral patterns noted in clients diagnosed with borderline personality disorder (BPD) is associated with learned helplessness? a. Self-invalidation b. Active passivity c. Emotional vulnerability d. Apparent competence

b. Active passivity

A personality disorder is defined as a collection of traits that do what? a. Lead to withdrawn and antisocial behavior b. Cause behavioral dysfunction and inner distress c. Are malleable and poorly defined d. Lead to aggression and violence

b. Cause behavioral dysfunction and inner distress

Which would most likely be a type of behavior that would be manifested by a client who has histrionic personality disorder? a. Insisting that others follow the rules of the unit b. Having a tantrum if not getting enough attention c. Wondering why others are being friendly to the client d. Getting others to make decisions for the client

b. Having a tantrum if not getting enough attention

Which disorder is characterized by pervasive mistrust and suspiciousness of others? a. Histrionic personality disorder b. Paranoid personality disorder c. Dependent personality disorder d. Schizoid personality disorder

b. Paranoid personality disorder

A client is admitted with a diagnosis of schizotypal personality disorder. Which characteristic would this client exhibit during social situations? a. Perfectionism b. Paranoid thoughts c. Trusting behaviors d. Dependency needs

b. Paranoid thoughts

A nurse is engaged in role-playing with a client with borderline personality disorder to assist the client in learning how to communicate effectively. Which of the following would the nurse encourage the client to use? Select all that apply. a. "Me" statements b. Paraphrasing before responding c. Listening passively d. Validating perceptions with others e. Compromising

b. Paraphrasing before responding d. Validating perceptions with others e. Compromising

A client in the emergency department has self-inflicted wounds on both arms. Assessment reveals that the client was diagnosed with borderline personality disorder 6 months ago, for which the client has been receiving outpatient treatment. The client tells the nurse that the client recently found out the client's therapist is moving and will no longer be able to work with the client. What is the priority nursing diagnosis for this client? a. Stress b. Self-mutilation c. Anxiety d. Loneliness

b. Self-mutilation

A client with borderline personality disorder (BPD) tells the nurse, "You are good but the nurse on the afternoon shift is bad. The doctor is bad, too, but the therapist is good." The nurse interprets this statement as reflecting what? a. Dissociation b. Splitting c. Identity diffusion d. Cognitive schema

b. Splitting

For clients with borderline personality disorder, there is a tendency to see the world as either good or bad. As a result, these clients use the primitive defense of what? a. Regression b. Splitting c. Denial d. Compensation

b. Splitting

A nurse reading an artlcle about borderline personality disorder (BPD) finds that it is more prevalent in women than in men. Which explanation for this higher proportion in women would the nurse identify as a reason? Select all that apply. a. Women are more temperamental than men. b. There is a gender bias in diagnosis. c. Women have more problems with hormone regulations. d. Childhood sexual abuse is more common in girls and a risk factor for BPD. e. It tends to be more socially acceptable for women to seek help.

b. There is a gender bias in diagnosis. d. Childhood sexual abuse is more common in girls and a risk factor for BPD. e. It tends to be more socially acceptable for women to seek help.

A 17-year-old client comes to the community crisis clinic with multiple superficial cuts on the wrist. The client is crying uncontrollably and states that the client's romantic partner has left and the client doesn't want to live without the partner. What would be the most therapeutic initial nursing response? a. "There's plenty of fish in the sea. Don't worry, at your age you will find someone else." b. "Many partners change their minds about relationships, this is really quite normal." c. "I can see that you are feeling anxious. I will stay with you until you feel better." d. "Let's set some boundaries on your behavior here."

c. "I can see that you are feeling anxious. I will stay with you until you feel better."

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? a. "I could have told you this would happen. Clients like these always get you in the end. I hope this will teach you not to get so involved." b. "I wonder if all this could have been avoided if I'd clued you in on the client. This is a usual pattern. The client burned me once, too, when I first worked here." c. "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." d. "I know what you mean. You put a lot of energy into working with this client. It must be disappointing for something like this to happen."

c. "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."

When describing the different clusters of personality disorders, the nurse includes which type as being characterized by dramatic or erratic behavior? Select all that apply. a. Avoidant b. Paranoid c. Borderline d. Antisocial e. Obsessive-compulsive

c. Borderline d. Antisocial

A nurse is interviewing a friend of a client diagnosed with borderline personality disorder and asks the friend to describe the client's affect. Which description would the nurse most likely hear? a. Extremely affectionate b. In touch with feelings c. Intensely moody d. Open to criticism

c. Intensely moody

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? a. Avoidant personality disorder b. Paranoid personality disorder c. Obsessive-compulsive personality disorder d. Narcissistic personality disorder

c. Obsessive-compulsive personality disorder

When establishing a relationship with a client who has borderline personality disorder, which is most important for the nurse to do? a. Aggressively confront the client about boundary violations. b. Tell the client the relationship will last as long as the client wishes. c. Respect the client's boundaries at all times. d. Limit interactions to 10 minutes at a time.

c. Respect the client's boundaries at all times.

Which of the following interventions should the nurse include in a plan of care for a client with histrionic personality disorder? a. Accept the client's behavior b. Assist the client to eliminate passive behavior c. Set limits on attention-seeking behavior d. Try to meet the client's needs for attention

c. Set limits on attention-seeking behavior

A nurse is caring for a client that does not want to participate in group therapy. Which behavior is supportive of a diagnosis of dependent personality disorder? a. tends to exaggerate the potential dangers of ordinary situations b. perceives personal behavior to be embarrassing c. believes he or she is incapable of functioning independently d. demands excessive attention from others whenever in a group situation

c. believes he or she is incapable of functioning independently

The adult children of a client with narcissistic personality disorder meet with the therapist as part of their parent's treatment. The nurse is aware that which statement by the daughter is consistent with behavior typically associated with this personality disorder? a. "My parent was constantly threatening to commit suicide." b. "My parent was always timid and fearful." c. "My parent never had any family or friends over to the house." d. "My parent never really seemed to see me as a person with my own thoughts and problems."

d. "My parent never really seemed to see me as a person with my own thoughts and problems."

A client with conduct disorder starts yelling at another client and calling the client insulting names. Which is the most appropriate response by the nurse? a. "What's the matter with you? Don't you know any better?" b. "You're still having problems controlling your anger." c. "How would you feel if someone yelled at you like that?" d. "Yelling at others is unacceptable. You need to let staff know you're upset."

d. "Yelling at others is unacceptable. You need to let staff know you're upset."

One of the biosocial theories of the etiology of borderline personality disorder involves the role of an invalidating environment, a social situation that negates private emotional responses and communication. The most severe form of invalidation occurs in which of the following situations? a. Death of family member b. Marriage c. Divorce d. Child sexual abuse

d. Child sexual abuse

Which observation by the nurse is supportive of a diagnosis of avoidant personality disorder? a. Client talks about three failed marriages. b. Client cries loudly whenever requests are denied. c. Client shows no remorse when accidentally breaking another client's bracelet. d. Client fears criticism from others, including staff.

d. Client fears criticism from others, including staff.

In response to a client's manipulative behavior, the nurse should provide ... a. Relaxation exercises b. Feedback about behavior c. Reasonable punishment d. Consistent limits

d. Consistent limits

Brain dysfunction associated with borderline personality disorder (BPD) occurs in the limbic system and which lobe of the brain? a. Temporal b. Parietal c. Occipital d. Frontal

d. Frontal

When assessing a client with narcissistic personality disorder, the nurse would expect the client to demonstrate which of the following? a. Genuine concern for others b. Dependence on others for decision making c. Mistrust of others d. Grandiose and superior self-concept

d. Grandiose and superior self-concept

Which of the following nursing diagnoses would be least likely to be made when working with a client with personality disorder? a. Ineffective Coping related to maladaptive personality traits b. Noncompliance related to personality disorder c. Risk for Suicide secondary to psychiatric illness d. Ineffective communication related to lack of orientation to reality

d. Ineffective communication related to lack of orientation to reality

A nurse is reviewing the biologic theories associated with borderlline personalilty disorder. The nurse demonstrates understanding of the information by identifying which areas as being associated with brain dysfunction tied to borderline personality disorder? Select all that apply. a. Cerebellum b. Hypothalamus c. Temporal lobe d. Limbic system e. Frontal lobe

d. Limbic system e. Frontal lobe

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. a. Pain b. Hydration c. Self-care d. Nutrition e. Self-harm f. Sleep

d. Nutrition e. Self-harm f. Sleep

Which statement accurately reflects the prognosis for a client with a personality disorder? a. Clients with personality disorders have a fairly good prognosis even without therapy. b. Clients make the most improvement with short-term insight-oriented therapy. c. The prognosis for personality disorders is poor, even with very long-term therapy. d. Prognosis varies based on the degree of functional impairment and the client's motivation to change.

d. Prognosis varies based on the degree of functional impairment and the client's motivation to change.

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? a. Stress management techniques b. Social skills training c. Increased recreational therapy d. Setting limits

d. Setting limits

A client with depression asks a nurse about possible herbal supplements. Which supplement would the nurse identify as being commonly used? a. Valerian b. Melatonin c. Kava d. St. John's wort

d. St. John's wort

A nurse working with a client with borderline personality disorder could establish which as outcome criteria? a. Filter concerns and insecurities through the nurse. b. Display anger more frequently. c. Act out neediness. d. Tolerate stress without self-mutilation.

d. Tolerate stress without self-mutilation.

Clients taking monoamine oxidase inhibitors (MAOIs) for depression must be placed on a diet that is low in: a. fat. b. sodium. c. sugar. d. tyramine.

d. tyramine.