Assessment 3 N450 Personality disorders

Nurse teachings to PD client

-Be clear and consistent with boundaries, expectation and limits (charts and schedules work) -Teach accountability of language and actions -Teach client to nurture the child within -Set realistic goals -Avoid being to nice or friendly. Instead project a neutral but kind effect -Provide choices -Listen because PD clients especially BPD feel others don't listen to them -Acknowledge and praise appropriate behavior -Stay focused and avoid getting trapped in drama which is the clients way of avoiding feelings

The nurse must maintain ________ when dealing with patient of chronic mental illness

HOPE for improved quality of life w/o imposing our expectation for change based on our own personal goal or timelines

Cluster C: Avoidant Personality Disorder

A pattern of social inhibition, feelings inadequacy, and hypersensitivity to negative evaluation by four more: avoids occupational activities due to fear of criticism, disapproval, or rejection; generally unwilling to get involved with others unless certain of being like; restrained in intimate relationship due to fear or shame you; preoccupied with concerns of rejection and criticism and social situations; inhibited in new situations due to a sense of inadequacy; views self as social inept or inferior; reluctant to take risks or trying to things because of potential embarrassment.

Which statement is descriptive of clients 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 have little difficulty forming satisfying and intimate relationships.

A. They are resistant to behavioral change. Personality disorders are deeply ingrained and pervasive. Clients with personality disorders find it very difficult, if not nearly impossible, to change. Change proceeds very slowly.

A client with histrionic personality disorder winks at an attractive nurse and states, "You and I should be able to turn those resident physicians into jelly if you'd wear your skirts about two inches shorter." The nurse's reply should be based on the understanding that the client's use of seductive behavior is A. a response to stress. B. based on a need to dominate. C. seated in primitive rage. D. callous disregard for others.

A. a response to stress. The histrionic person is impulsive and melodramatic and may act flirtatious or provocative to get the spotlight in an attempt to reduce stress

Personality disorder causes

67-86% etiology of sexual abuse 46-71% etiology of physical abuse

5. Which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with borderline personality disorder? A. Being firm, consistent, and empathic, while addressing specific client behaviors B. Promoting client self-expression by implementing laissez-faire leadership C. Using authoritative leadership to help clients learn to conform to society norms D. Overlooking inappropriate behaviors to avoid providing secondary gains

A The best nursing approach when working with a client diagnosed with borderline personality disorder is to be firm, consistent, and empathetic while addressing specific client behaviors. Individuals with borderline personality disorder always seem to be in a state of crisis and can often have negative patterns of interaction, such as manipulation and splitting.

8. Family members of a client ask the nurse to explain the difference between schizoid and avoidant personality disorders. Which is the appropriate nursing response? A. Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone. B. Clients diagnosed with schizoid personality disorder exhibit delusions and hallucinations, while clients diagnosed with avoidant personality disorder do not. C. Clients diagnosed with avoidant personality disorder are eccentric, and clients diagnosed with schizoid personality disorder are dull and vacant. D. Clients diagnosed with schizoid personality disorder have a history of psychosis, while clients diagnosed with avoidant personality disorder remain based in reality.

A The nurse should educate the family that clients diagnosed with avoidant personality disorder desire intimacy but fear it, while clients diagnosed with schizoid personality disorder prefer to be alone. Schizoid personality disorder is characterized by a profound deficit in the ability to form personal relationships. Clients diagnosed with schizoid personality disorder may exhibit odd and eccentric behaviors but not to the extent of psychosis.

19. Which nursing diagnosis should be prioritized when providing nursing care to a client diagnosed with paranoid personality disorder? A. Risk for violence: directed toward others R/T paranoid thinking B. Risk for suicide R/T altered thought C. Altered sensory perception R/T increased levels of anxiety D. Social isolation R/T inability to relate to others

A The priority nursing diagnosis for a client diagnosed with paranoid personality disorder should be risk for violence: directed toward others R/T paranoid thinking. Clients diagnosed with paranoid personality disorder have a pervasive distrust and suspiciousness of others that result in a constant threat readiness. They are often tense and irritable, which increases the likelihood of violent behavior.

26. Which statements represent positive outcomes for clients diagnosed with narcissistic personality disorder? (Select all that apply.) A. The client will relate one empathetic statement to another client in group by day two. B. The client will identify one personal limitation by day one. C. The client will acknowledge one strength that another client possesses by day two. D. The client will list four personal strengths by day three. E. The client will list two lifetime achievements by discharge.

A,B,C The nurse should determine that appropriate outcomes for a client diagnosed with narcissistic personality disorder include relating empathetic statements to other clients, identifying one personal limitation, and acknowledging one strength in another client. Narcissistic personality disorder is characterized by an exaggerated sense of self-worth, a lack of empathy, and exploitation of others.

28. A client is being assessed for antisocial personality disorder. According to the DSM-5, which of the following symptoms must the client meet in order to be assigned this diagnosis? (Select all that apply.) A. Ego-centrism and goal setting based on personal gratification. B. Incapacity for mutually intimate relationships. C. Frequent feelings of being down miserable and/or hopeless. D. Disregard for and failure to honor financial and other obligations. E, Intense feelings of nervousness, tenseness, or panic.

A,B,D The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. Pathological personality traits of antagonism and disinhibition must occur in order to meet the criteria for the diagnosis of antisocial personality disorder. Frequent feelings of being down, miserable, and/or hopeless and intense feelings of nervousness, tenseness, or panic are characteristics of the pathological personality trait domain of negative affectivity. This domain is listed by the DSM-5 for the diagnosis of borderline personality disorder, not antisocial personality disorder.

27. A nurse is caring for a client diagnosed with antisocial personality disorder. Which factors should the nurse consider when planning this client's care? (Select all that apply.) A. This client has personality traits that are deeply ingrained and difficult to modify. B. This client needs medication to treat the underlying physiological pathology. C. This client uses manipulation, making the implementation of treatment problematic. D. This client has poor impulse control that hinders compliance with a plan of care. E. This client is likely to have secondary diagnoses of substance abuse and depression.

A,C,D,E The nurse should consider that individuals diagnosed with antisocial personality disorders have deeply ingrained personality traits, use manipulation, have poor impulse control, and often have secondary diagnoses of substance abuse or depression.

25. A nurse is admitting a client with a new diagnosis of a personality disorder. Which of the following would make the nurse question this diagnosis? (Select all that apply.) A. The client has been diagnosed with sickle cell anemia. B. The client has an inflated self-appraisal and feels a sense of entitlement. C. The client has a history of a substance use disorder. D. The client is odd and eccentric but not delusional. E. The client has an intellectual developmental disorder.

A,C,E The DSM-5 states that impairments in personality functioning and the individual's personality trait expression are not better understood as normative for the individual's developmental stage or sociocultural environment. The impairments in personality functioning and the individual's personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma). The nurse would question the diagnosis of a personality disorder in a client with sickle cell anemia, substance use disorder, or an intellectual developmental disorder.

A client with obsessive-compulsive personality disorder takes the nurse aside and mentions "I've observed you interacting with Mr. D. You are not approaching him properly. You should be more forceful with him." The best response for the nurse would be A. "I will be continuing to follow the care plan for Mr. D." B. "I see you are trying to control Mr. D's therapy as well as your own." C. "Your eye for perfection extends even to my nursing interventions." D. "Mr. D's care is really of no concern to you or to other clients."

A. "I will be continuing to follow the care plan for Mr. D." Obsessive-compulsive personality disorder has the key factor of perfectionism with a focus on orderliness and control. These individuals get so preoccupied with details and rules that they may not be able to accomplish the tasks. Guard against engaging in power struggles with a client with obsessive-compulsive disorder.

A client has been diagnosed with dependent personality disorder. Which behavior descriptions can the nurse expect to assess? A. Anxious, fearful B. Odd, eccentric C. Dramatic, emotional, erratic D. Disoriented, disorganized

A. Anxious, fearful Dependent personality disorder has a primary feature of extreme dependency in a close relationship, with an urgent search to find a replacement when one relationship ends. These individuals have difficulty making independent decisions and are constantly seeking reassurance. They have deeply held convictions of personal incompetence, with the fear that they cannot survive on their own. They frequently seek treatment for anxiety or mood disorders related to a loss.

A 16-year-old has stolen money from his invalid grandmother, uses drugs and alcohol, and frequently beats up acquaintances who disagree with him. Arrested for an assault in which he beat a classmate and caused brain damage, he stated in court "The guy deserved everything he got." The behaviors described are most consistent with the clinical picture of A. antisocial personality disorder. B. borderline personality disorder. C. schizotypal personality disorder. D. narcissistic personality disorder.

A. antisocial personality disorder. Clients with antisocial personality act out feelings without consideration for the rights of others. They feel no remorse for their antisocial acts.

A danger of working with a client who idealizes the nurse is: A. becoming overinvolved and being protective and indulgent. B. becoming indecisive about planned interventions. C. developing a prejudicial, blaming orientation. D. stringent enforcement of boundaries and limits.

A. becoming overinvolved and being protective and indulgent. Finding an approach for helping clients with personality disorders who have overwhelming needs can be overwhelming for caregivers. For example, a borderline female client may briefly idealize her male nurse on the inpatient unit, telling staff and clients alike that she is "the luckiest client because she has the best nurse in the hospital." The rest of the team initially realizes that this behavior is an exaggeration, and they have a neutral response. But after days of constant dramatic praise, some members of the team may start to feel inadequate and jealous of the nurse. They begin to make critical remarks about minor events to prove that the nurse is not perfect. Open communication in staff meetings and ongoing clinical supervision are important aspects of self-care for the nurse working with these clients to maintain objectivity.

The primary goal of milieu therapy for clients with personality disorders is A. manage the affect behavior has on the entire group. B. one-on-one therapy. C. to help the client remain uninvolved with other patients. D. a laissez faire attitude.

A. manage the affect behavior has on the entire group.The primary goal of milieu therapy is affect management in a group context

A nurse is assigned to work with a client with borderline personality disorder. The nurse will need to consider strategies for dealing with the client's A. mood shifts, impulsivity, and splitting. B. grief, anger, and social isolation. C. altered sensory perceptions and suspicion. D. perfectionism and preoccupation with detail.

A. mood shifts, impulsivity, and splitting. Borderline personality disorder has the central characteristic of instability in affect, identity, and relationships. Borderline individuals desperately seek relationships to avoid feeling abandoned. But they often drive others away with excessive demands, impulsive behavior, or uncontrolled anger. Their frequent use of the defense of splitting strains personal relationships and creates turmoil in health care settings.

30. Which nursing statement reflects a common characteristic of a client diagnosed with paranoid personality disorder? A. "This client consistently criticizes care and has difficulty getting along with others." B. "This client is shy and fades into the background." C. "This client expects special treatment, and setting limits will be necessary." D. "This client is expressive during group and is very pleased with self."

ANS: A A client diagnosed with paranoid personality disorder has a pervasive distrust and suspiciousness of others. Anticipating humiliation and betrayal, the paranoid individual characteristically learns to attack first.

26. When a client on an acute care psychiatric unit demonstrates behaviors and verbalizations indicating a lack of guilt feelings, which nursing intervention would help the client to meet desired outcomes? A. Provide external limits on client behavior. B. Foster discussions of rationales for behavioral change. C. Implement interventions consistently by only one staff member. D. Encourage the client to involve self in care.

ANS: A Because the client, due to a lack of guilt, cannot or will not impose personal limits on maladaptive behaviors, these limits must be delineated and enforced by staff.

27. Which characteristics should a nurse recognize as being exhibited by individuals diagnosed with any personality disorder? A. These clients accept and are comfortable with their altered behaviors. B. These clients understand that their altered behaviors result from anxiety. C. These clients seek treatment to avoid interpersonal discomfort. D. These clients avoid relationships due to past negative experiences.

ANS: A Clients who are diagnosed with personality disorders accept and are comfortable with their altered behaviors. Personalities that develop in a disordered pattern remain somewhat unstable and unpredictable throughout the lifetime.

34. A nurse is caring for a group of clients within the DSM-5 Cluster B category of personality disorders. Which factors should the nurse consider when planning client care? Select all that apply. A. These clients have personality traits that are deeply ingrained and difficult to modify. B. These clients need medications to treat the underlying physiological pathology. C. These clients use manipulation, making the implementation of treatment problematic. D. These clients have poor impulse control that hinders compliance with a plan of care. E. These clients commonly have secondary diagnoses of substance abuse and depression.

ANS: A, C, D, E The nurse should consider that individuals diagnosed with cluster B-type personality disorders have deeply ingrained personality traits, use manipulation, have poor impulse control, and often have secondary diagnoses of substance abuse and/or depression. This cluster includes antisocial, borderline, histrionic, and narcissistic personality disorders.

29. While improving, a client demands to have a phone installed in the intensive care unit (ICU) room. When a nurse states, "This is not allowed; it is a unit rule," the client angrily demands to see the doctor. Which approach should the nurse use in this situation? A. Provide an explanation for the necessity of the unit rule. B. Assist the client to discuss anger and frustrations. C. Call the physician and relay the request. D. Arrange for a phone to be installed in the client's unit room.

ANS: B Clients who demand special privileges may be diagnosed with narcissistic personality disorder. The best approach in this situation is for the nurse to identify the function that anger, frustration, and rage serve for the client. The verbalization of feelings may help the client to gain insight into his or her behavior.

A client diagnosed with Cluster C traits sits alone and ignores other's attempts to converse. When ask to join a group the client states, "No, thanks." In this situation, which should the nurse assign as an initial nursing diagnosis? A. Fear R/T hospitalization B. Social isolation R/T poor self-esteem C. Risk for suicide R/T to hopelessness D. Powerlessness R/T dependence issues

ANS: B Clients diagnosed with Cluster C traits are described as anxious and fearful. The DSM-5 divides Cluster C personality disorders into three categories: avoidant, dependent, and obsessive-compulsive. Anxiety and fear contribute to social isolation.

24. The nurse should recognize which factors that distinguish personality disorders from psychosis? A. Functioning is more limited in personality disorders than in psychosis. B. Major disturbances of thought are absent in personality disorders. C. Personality disordered clients require hospitalization more frequently. D. Personality disorders do not affect family relationships as much as psychosis.

ANS: B Major disturbances of thought are absent in personality disorders and are a classic symptom of psychosis.

21. Which client is a nurse most likely to admit to an inpatient facility for self-destructive behaviors? A. A client diagnosed with antisocial personality disorder B. A client diagnosed with borderline personality disorder C. A client diagnosed with schizoid personality disorder D. A client diagnosed with paranoid personality disorder

ANS: B The nurse should expect that a client diagnosed with borderline personality disorder would be most likely to be admitted to an inpatient facility for self-destructive behaviors. Clients diagnosed with this disorder often exhibit repetitive, self-mutilative behaviors. Most gestures are designed to evoke a rescue response.

28. A nurse would expect a client diagnosed with schizotypal personality disorder to exhibit which characteristic? A. The client has many friends and associates but prefers to interact in small groups. B. The client has many brief but intense relationships. C. The client experiences incorrect interpretations of external events. D. The client exhibits lack of tender feelings toward others

ANS: C Clients who are diagnosed with schizotypal personality disorder experience odd beliefs or magical thinking that influences behavior and is inconsistent with cultural norms. This results in incorrect interpretations of external events.

4. A highly emotional client presents at an outpatient clinic appointment wearing flamboyant attire, spiked heels, and theatrical makeup. Which personality disorder should a nurse associate with this assessment data? A. Compulsive personality disorder B. Schizotypal personality disorder C. Histrionic personality disorder D. Manic personality disorder

ANS: C The nurse should associate histrionic personality disorder with this assessment data. Individuals diagnosed with histrionic personality disorder tend to be self-dramatizing, attention seeking, overly gregarious, and seductive. They often use manipulation and exhibitionism as a means of gaining attention.

20. Which client symptoms should lead a nurse to suspect a diagnosis of obsessive-compulsive personality disorder? A. The client experiences unwanted, intrusive, and persistent thoughts. B. The client experiences unwanted, repetitive behavior patterns. C. The client experiences inflexibility and lack of spontaneity when dealing with others. D. The client experiences obsessive thoughts that are externally imposed.

ANS: C The nurse should suspect a diagnosis of obsessive-compulsive personality disorder when a client experiences inflexibility and lack of spontaneity. Individuals diagnosed with this disorder are very serious and formal and have difficulty expressing emotions. They are perfectionistic and preoccupied with rules.

22. When planning care for clients diagnosed with personality disorders, what should be the anticipated treatment outcome? A. To stabilize pathology with the correct combination of medications B. To change the characteristics of the dysfunctional personality C. To reduce inflexibility of personality traits that interfere with functioning and relationships D. To decrease the prevalence of neurotransmitters at receptor sites

ANS: C The outcome of treatment for clients diagnosed with personality disorders should be to reduce inflexibility of personality traits that interfere with functioning and relationships. Personality disorders are often difficult and, in some cases, seem impossible to treat.

25. Which client statement would demonstrate a common characteristic of Cluster "B" personality disorder? A. "I wish someone would make that decision for me." B. "I built this building by using materials from outer space." C. "I'm afraid to go to group because it is crowded with people." D. "I didn't have the money for the ring, so I just took it."

ANS: D Antisocial personality disorder is included in the Cluster "B" personality disorders. In this disorder there is a pervasive pattern of disregard for and violation of the rights of others.

31. A client exhibits dependency on staff and peers and expresses fear of abandonment. Using Mahler's theory of object relations, which should the nurse expect to note in this client's childhood? A. Lack of fulfillment of basic needs by parental figures B. Absence of the client's maternal figure during symbiosis C. Difficulty establishing trust with the maternal figure D. Inconsistency by the maternal figure during individuation

ANS: D During phase 3 (5 to 36 months) of Margaret Mahler's individuation theory, there should be a strengthening of the ego and an acceptance of "self" with independent ego boundaries. Inconsistency by the maternal figure during individuation may in later years result in feelings of helplessness when the client is alone because of exaggerated fears of being unable to care for self.

23. The nurse plans to confront a client about secondary gains related to extreme dependency on her spouse. Which nursing statement would be most appropriate? A. "Do you believe dependency issues have been a lifelong concern for you?" B. "Have you noticed any anxiety during times when your husband makes decisions?" C. "What do you know about individuals who depend on others for direction?" D. "How have the specifics of your relationship with your spouse benefited you?"

ANS: D When a client goes to excessive lengths to obtain nurturance and support from others, the client is seeking secondary gains. Secondary gains provide clients the support and attention that they might not otherwise receive.

Cluster C

Anxious and fearful behavior- they generally feel insecure or inadequate. They depend on others for reassurance or they isolate themselves for fear of rejection.

Cluster C: Obsessive-Compulsive

Are perfectionist, detail oriented; Has need for control; are inflexible and rigid; preoccupied with details; highly critical of self and others. They Have a belief in an absolute correct solution and experience indecision.

1. During an assessment interview, a client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions. Which is the appropriate nursing response to this behavior? A. "You are very disrespectful. You need to learn to control yourself." B. "I understand that you are angry, but this behavior will not be tolerated." C. "What behaviors could you modify to improve this situation?" D. "What anti-personality disorder medications have helped you in the past?"

B The appropriate nursing response is to reflect the client's feeling while setting firm limits on behavior. Clients diagnosed with antisocial personality disorder have a low tolerance for frustration, see themselves as victims, and use projection as a primary ego defense mechanism.

7. A client expresses low self-worth, has much difficulty making decisions, avoids positions of responsibility, and has a behavioral pattern of "suffering" in silence. Which statement best explains the etiology of this client's personality disorder? A. Childhood nurturance was provided from many sources, and independent behaviors were encouraged. B. Childhood nurturance was provided exclusively from one source, and independent behaviors were discouraged. C. Childhood nurturance was provided exclusively from one source, and independent behaviors were encouraged. D. Childhood nurturance was provided from many sources, and independent behaviors were discouraged.

B The behaviors presented in the question represent symptoms of dependent personality disorder. Nurturance provided from one source and discouragement of independent behaviors can contribute to the development of this personality disorder. Dependent behaviors may be rewarded by a parent who is overprotective and discourages autonomy.

22. A nursing instructor is teaching students about clients diagnosed with histrionic personality disorder and the quality of their relationships. Which student statement indicates that learning has occurred? A. "Their dramatic style tends to make their interpersonal relationships quite interesting and fulfilling." B. "Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs." C. "They tend to develop few relationships because they are strongly independent but generally maintain deep affection." D. "They pay particular attention to details, which can interfere with the development of relationships."

B The instructor should evaluate that learning has occurred when the student describes clients diagnosed with histrionic personality disorder as having relationships that are shallow and fleeting. These types of relationships tend to serve their dependency needs.

20. From a behavioral perspective, which nursing intervention is appropriate when caring for a client diagnosed with borderline personality disorder? A. Seclude the client when inappropriate behaviors are exhibited. B. Contract with the client to reinforce positive behaviors with unit privileges. C. Teach the purpose of anti-anxiety medications to improve medication compliance. D. Encourage the client to journal feelings to improve awareness of abandonment issues.

B The most appropriate nursing intervention from a behavioral perspective is to contract with the client to reinforce positive behaviors with unit privileges. Behavioral strategies offer reinforcement for positive change.

21. A highly emotional client presents at an outpatient clinic appointment and states, "My dead husband returned to me during a séance." Which personality disorder should a nurse associate with this behavior? A. Obsessive-compulsive personality disorder B. Schizotypal personality disorder C. Narcissistic personality disorder D. Borderline personality disorder

B The nurse should associate schizotypal personality disorder with this behavior. The behaviors of people diagnosed with schizotypal personality disorder are odd and eccentric but do not decompensate to the level of schizophrenia.

11. When planning care for a client diagnosed with borderline personality disorder, which self-harm behavior should a nurse expect the client to exhibit? A. The use of highly lethal methods to commit suicide B. The use of suicidal gestures to elicit a rescue response from others C. The use of isolation and starvation as suicidal methods D. The use of self-mutilation to decrease endorphins in the body

B The nurse should expect that a client diagnosed with borderline personality disorder may use suicidal gestures to elicit a rescue response from others. Repetitive, self-mutilating behaviors are common in borderline personality disorders that result from feelings of abandonment following separation from significant others.

16. Which client is a nurse most likely to admit to an inpatient facility for self-destructive behaviors? A. A client diagnosed with antisocial personality disorder B. A client diagnosed with borderline personality disorder C. A client diagnosed with schizoid personality disorder D. A client diagnosed with paranoid personality disorder

B The nurse should expect that a client diagnosed with borderline personality disorder would be most likely to be admitted to an inpatient facility for self-destructive behaviors. Clients diagnosed with this disorder often exhibit repetitive, self-mutilating behaviors. Most gestures are designed to elicit a rescue response.

4. A client diagnosed with borderline personality disorder brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the nursing staff best handle this situation? A. Allow the clients to apply the democratic process when developing unit rules. B. Maintain consistency of care by open communication to avoid staff manipulation. C. Allow the client spokesman to verbalize concerns during a unit staff meeting. D. Maintain unit order by the application of autocratic leadership.

B The nursing staff can best handle this situation by maintaining consistency of care by open communication to avoid staff manipulation. Clients with borderline personality disorder can exhibit negative patterns of interaction, such as clinging and distancing, splitting, manipulation, and self-destructive behaviors.

A newly admitted client has an axis II diagnosis of schizoid personality disorder. The nursing intervention of highest priority will be to A. set firm limits on behavior. B. respect need for social isolation. C. encourage expression of feelings. D. involve in milieu and group activities.

B. respect need for social isolation. Schizoid personality disorder has the primary feature of emotional detachment. The person does not seek out or enjoy close relationships. They are reclusive, avoidant, and uncooperative. They do not do well with resocialization

Playing one staff member against another is an example of A. devaluation. B. splitting. C. impulsiveness. D. social ineptitude.

B. splitting. Splitting involves setting up individuals or groups to disagree. While the two parties are busy disagreeing, they are too busy to maintain consistent limits for the manipulative client. The client can enjoy the spectacle and do as he or she pleases.

Nurse needs to beware of ________ when assessing a PD client

Beware of counter transference reactions Ex. - refers to the nurse's behavioral and emotional response to the client- responses may be related to unresolved feelings toward significant others from the nurse's past- may be generated in response to transference feelings on the part of the client - nurse over identifies with the client's feelings as they remind him or her of problems from the nurse's past or present - the nurse promotes and encourages client's dependence - nurse defends the clients behavior to other staff members - nurse is bored and apathetic in sessions with the client - the nurse's anger engenders feelings of disgust toward the client

Which factors differentiate a client diagnosed with social phobia from a client diagnosed with schizoid personality disorder? A. Clients diagnosed with social phobia are treated with cognitive behavioral therapy, whereas clients diagnosed with schizoid personality disorder need medications. B. Clients diagnosed with schizoid personality disorder experience anxiety only in social settings, whereas clients diagnosed with social phobia experience generalized anxiety. C. Clients diagnosed with social phobia avoid attending birthday parties, whereas clients diagnosed with schizoid personality disorder would isolate self on a continual basis. D. Clients diagnosed with schizoid personality disorder avoid attending birthday parties, whereas clients diagnosed with social phobia would isolate self on a continual basis.

C A client diagnosed with schizoid personality disorder exhibits a profound deficit in the ability to form personal relationships. Clients diagnosed with schizoid personality disorder prefer being alone to being with others and avoid social situations, social contacts, and activities.

Which adult client should a nurse identify as exhibiting the characteristics of a dependent personality disorder? A. A physically healthy client who is dependent on meeting social needs by contact with 15 cat B. A physically healthy client who has a history of depending on intense relationships to meet basic needs C. A physically healthy client who lives with parents and depends on public transportation D. A physically healthy client who is serious, inflexible, perfectionistic, lacks spontaneity, and depends on rules to provide security

C A physically healthy adult client who lives with parents and depends on public transportation exhibits signs of dependent personality disorder. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behaviors.

17. When planning care for clients diagnosed with personality disorders, what should be the goal of treatment? A. To stabilize the client's pathology by using the correct combination of psychotropic medications B. To change the characteristics of the dysfunctional personality C. To reduce personality trait inflexibility that interferes with functioning and relationships D. To decrease the prevalence of neurotransmitters at receptor sites

C The goal of treatment for clients diagnosed with personality disorders should be to reduce inflexibility of personality traits that interfere with functioning and relationships. Personality disorders are often difficult and, in some cases, seem impossible to treat. There are no psychotropic medications approved specifically for the treatment of personality disorders.

A client diagnosed with paranoid personality disorder becomes violent on a unit. Which nursing intervention is most appropriate? A. Provide objective evidence that reasons for violence are unwarranted. B. Initially restrain the client to maintain safety. C. Use clear, calm statements and a confident physical stance. D. Empathize with the client's paranoid perceptions.

C The most appropriate nursing intervention is to use clear, calm statements and to assume a confident physical stance. A calm attitude provides the client with a feeling of safety and security. It may also be beneficial to have sufficient staff on hand to present a show of strength.

At 11:00 p.m. a client diagnosed with antisocial personality disorder demands to phone a lawyer to file for a divorce. Unit rules state that no phone calls are permitted after 10:00 p.m. Which nursing response is most appropriate? A. "Go ahead and use the phone. I know this pending divorce is stressful." B. "You know better than to break the rules. I'm surprised at you." C. "It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow." D. "A divorce shouldn't be considered until you have had a good night's sleep."

C The most appropriate response by the staff is to restate the unit rules in a calm, assertive manner. The nurse can encourage the client to verbalize frustration while maintaining an accepting attitude. The nurse may also help the client to identify the true source of frustration.

13. Which reaction to a compliment from another client should a nurse identify as a typical response from a client diagnosed with avoidant personality disorder? A. Interpreting the compliment as a secret code used to increase personal power B. Feeling the compliment was well deserved C. Being grateful for the compliment but fearing later rejection and humiliation D. Wondering what deep meaning and purpose is attached to the compliment

C The nurse should identify that a client diagnosed with avoidant personality disorder would be grateful for the compliment but would fear later rejection and humiliation. Individuals diagnosed with avoidant personality disorder are extremely sensitive to rejection and are often awkward and uncomfortable in social situations.

10. Looking at a slightly bleeding paper cut, the client screams, "Somebody help me quick! I'm bleeding. Call 911!" A nurse should identify this behavior as characteristic of which personality disorder? A. Schizoid personality disorder B. Obsessive-compulsive personality disorder C. Histrionic personality disorder D. Paranoid personality disorder

C The nurse should identify this behavior as characteristic of histrionic personality disorder. Individuals with this disorder tend to be self-dramatizing, attention seeking, over gregarious, and seductive.

15. Which client symptoms should lead a nurse to suspect a diagnosis of obsessive-compulsive personality disorder? A. The client experiences unwanted, intrusive, and persistent thoughts. B. The client experiences unwanted, repetitive behavior patterns. C. The client experiences inflexibility and lack of spontaneity when dealing with others. D. The client experiences obsessive thoughts that are externally imposed.

C The nurse should suspect a diagnosis of obsessive-compulsive personality disorder when a client experiences inflexibility and lack of spontaneity. Individuals with this disorder are very serious, formal, and have difficulty expressing emotions. They are perfectionistic and preoccupied with rules.

A client with dependent personality disorder who had been living with her newly married son was admitted a week ago for treatment of depression, which began after her son suggested that she move out. Which remark by the client would the nurse evaluate as showing improvement in the client's condition? A. "My son's suggestion hurt me greatly." B. "My son is less at fault than my daughter-in-law." C. "I'm going to need help to afford to rent an apartment." D. "How will I ever live alone with no one to look after my affairs?"

C. "I'm going to need help to afford to rent an apartment." Dependent personality disorder has a primary feature of extreme dependency in a close relationship, with an urgent search to find a replacement when one relationship ends. Clients have a deeply held conviction of personal incompetence, with the fear that they cannot survive on their won. Self reflection on the possibility of moving into an apartment shows improvement.

Which client with a personality disorder is most likely to be admitted to a psychiatric unit? A. Mr. A, with paranoid personality disorder who is suspicious of his neighbors B. Mr. B, with narcissistic personality disorder who is highly self-important C. Ms. C, with borderline personality disorder who is impulsive D. Mrs. D, with dependent personality disorder who clings to her husband

C. Ms. C, with borderline personality disorder who is impulsiveClients with borderline disorder can decompensate into psychotic states under stress. Hospitalization is needed at these times.

The priority nursing intervention for a client with borderline personality disorder is to A. protect other clients from manipulation. B. respect the client's need for social isolation. C. assess for suicidal and self-mutilating behaviors. D. provide clear, consistent limits and boundaries.

C. assess for suicidal and self-mutilating behaviors. One of the primary nursing guidelines/interventions for clients with a personality disorder is to assess for suicidal and self-mutilating behaviors, especially during times of stress.

Characteristic behaviors the nurse will assess in the narcissistic client are A. dramatic expression of emotion, being easily led. B. perfectionism and preoccupation with detail. C. grandiose, exploitive, and rage-filled behavior. D. angry, highly suspicious, aloof, withdrawn behavior.

C. grandiose, exploitive, and rage-filled behavior. Narcissistic clients give the impression of being invulnerable and superior to others to protect their fragile self-esteem.

Clients with personality disorders have various self-defeating behaviors and interpersonal problems despite having near-normal ego functioning and intact reality testing. A nursing diagnosis that addresses this sort of interpersonal dysfunction is A. spiritual distress. B. defensive coping. C. impaired social interaction. D. disturbed sensory perception.

C. impaired social interaction. For a client who has difficulty in relationships and is very manipulative, the nursing diagnosis of impaired social interaction would be used.

Splitting is a process in which the client A. unconsciously represses undesirable aspects of self. B. places responsibility for his or her behavior outside the self. C. sees things as divided into "all good" or "all bad." D. evidences lack of personal boundaries.

C. sees things as divided into "all good" or "all bad." Splitting demonstrates the failure to integrate the positive and negative into a cohesive whole. An individual is not seen as a person with good and bad traits, but rather as all good or all bad.

Working with clients with personality disorders needs to be perceived as a ________ rather than a burden.

Challenge- this allows the nurse to sharpen skills in patience, self awareness, creativity and non judgment

Cluster B- Narcissistic

Characteristics: exploitive, grandiose, disparaging, filled with rage, very sensitive to rejection, criticism, cannot show empathy, handles aging poorly

Cluster C: Dependent Personality Disorder

Characterized by a pervasive and excessive need to be taken care of that results in submissive and clinging behaviors, difficulty making decisions, and fears of separation as evidenced by five or more: difficulty making decisions without advice and reassurance from others; needs others to assume responsibility for most major areas; have difficulty expressing disagreement due to fear of loss of approval; difficulty doing things on their own; excessive attempts to obtain support from others; Uncomfortable when alone due to not being self-sufficient; urgently seeks a new relationship when a close relationship ends; preoccupied with fears of being left alone

Chronicity of Mental illness is defined as:

Continuation of a health disruption until it has a possible permanent impact on the overall identity and lifestyle of the person. This results in changes in ones world view, habits of relating, view of self, and ability to carry out self care fx

9. Which nursing diagnosis should a nurse identify as appropriate when working with a client diagnosed with schizoid personality disorder? A. Altered thought processes R/T increased stress B. Risk for suicide R/T loneliness C. Risk for violence: directed toward others R/T paranoid thinking D. Social isolation R/T inability to relate to others

D An appropriate nursing diagnosis when working with a client diagnosed with schizoid personality disorder is social isolation R/T inability to relate to others. Clients diagnosed with schizoid personality disorder appear cold, aloof, and indifferent to others. They prefer to work in isolation and are not sociable.

18. Which client situation would reflect the impulsive behavior that is commonly associated with borderline personality disorder? A. As the day-shift nurse leaves the unit, the client suddenly hugs the nurse's arm and whispers, "The night nurse is evil. You have to stay." B. As the day-shift nurse leaves the unit, the client suddenly hugs the nurse's arm and states, "I will be up all night if you don't stay with me." C. As the day-shift nurse leaves the unit, the client suddenly hugs the nurse's arm, yelling, "Please don't go! I can't sleep without you being here." D. As the day-shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, "I cut myself because you are leaving me."

D The client who states, "I cut myself because you are leaving me" reflects impulsive behavior that is commonly associated with borderline personality disorder. Repetitive, self-mutilating behaviors are common in clients diagnosed with borderline personality disorders that result from feelings of abandonment following separation from significant others.

23. During an interview, which client statement should indicate to a nurse a potential diagnosis of schizotypal personality disorder? A. "I don't have a problem. My family is inflexible, and relatives are out to get me." B. "I am so excited about working with you. Have you noticed my new nail polish, 'Ruby Red Roses'?" C. "I spend all my time tending my bees. I know a whole lot of information about bees." D. "I am getting a message from the beyond that we have been involved with each other in a previous life."

D The nurse should assess that a client who states that he or she is getting a message from beyond indicates a potential diagnosis of schizotypal personality disorder. Individuals with schizotypal personality disorder are aloof and isolated and behave in a bland and apathetic manner. The person experiences magical thinking, ideas of reference, illusions, and depersonalization as part of daily life.

12. A nurse tells a client that the nursing staff will start alternating weekend shifts. Which response should a nurse identify as characteristic of clients diagnosed with obsessive-compulsive personality disorder? A. "You really don't have to go by that schedule. I'd just stay home sick." B. "There has got to be a hidden agenda behind this schedule change." C. "Who do you think you are? I expect to interact with the same nurse every Saturday." D. "You can't make these kinds of changes! Isn't there a rule that governs this decision?"

D The nurse should identify that a client with obsessive-compulsive personality disorder would have a difficult time accepting changes. This disorder is characterized by inflexibility and lack of spontaneity. Individuals with this disorder are very serious, formal, over-disciplined, perfectionistic, and preoccupied with rules.

24. Which nursing diagnosis should be prioritized when providing nursing care to a client diagnosed with avoidant personality disorder? A. Risk for violence: directed toward others R/T paranoid thinking B. Risk for suicide R/T altered thought C. Altered sensory perception R/T increased levels of anxiety D. Social isolation R/T inability to relate to others

D The priority nursing diagnosis for a client diagnosed with avoidant personality disorder should be social isolation R/T inability to relate to others. These clients avoid close or romantic relationships, interpersonal attachments, and intimate sexual relationships.

Which behavior would be inconsistent with defining characteristics for the nursing diagnosis of ineffective coping? A. Difficulty in relationships B. High levels of anxiety C. Manipulation D. Interdependence

D. Interdependence The characteristics for the diagnosis of ineffective coping include crisis, high levels of anxiety, anger and aggression; child, elder, or spouse abuse; and difficulty in relationships and manipulation. Interdependence would not be considered a symptom for ineffective coping.

The nurse should warn the patient about any changes or side effect when administering medications to ______

Establish their trust

Cluster B

Dramatic/emotional/erratic- these clients seek out relationships but can not maintain them because of their excessive demands & instability. Their main goal is to use others to meet their own needs.

Cluster B- Borderline Personality Disorder

Individual has a difficulty regulating emotion (affective instability) and has extreme fears of abandonment leading to dysfunctional relationships which often leads to individual engaging in self-injury/harm (SI). They have intense and short lived relationships because they can not tolerate intimacy due to the extreme feelings of idealization and devaluation. They have identity disturbances, are impulsive and carry chronic feelings of emptiness.

Cluster B- Histrionic

Individual has exaggerated liability (characterized by emotions that are easily aroused or freely expressed, and that tend to alter quickly and spontaneously; emotionally unstable) and shallow expression of emotions. They need constant approval, seductiveness, and have concerns about owns attractiveness. They are attention seeking and are discomforted when not the center of attention. Overvaluation of relationships.

Cluster A

Odd/Eccentric- results in person becoming alienated from others Paranoia (suspicious pattern)-distrusting, feels threatened, aggressive, pacing, speaking loudly, glaring, clenching fists and jaws Schizoid (asocial patter)- restricted emotional expression, voluntary withdrawal, avoidance, poor occupational fx Scizotypal (eccentric)- magical thinking, odd beliefs, perceptual distortions

What kind of communication is needed between nurses when dealing with a client with PD especially cluster B clients, or else the unit may turn into chaos?

Open communication

Theory of symbolic interactionism (Sociocultural Approach)

Persistent mental illness is a set of behaviors representing a role created by society as a result of observations of individuals exhibiting behaviors of troublesome to the society in which they are then labeled as mentally deviant. The individuals character is only seen in the context of their mental illness thus healthier aspects are ignored. Person is born healthy ----> Stressors exposed ------> Mentally ill behaviors expressed ------> Therapeutic environment -----> Person returns back to society -------> If society treats the person as if still mentally ill, the cycle continues -----> tough to assume healthy identity ------> expectations are internalized

The nurse needs to focus on _______

Positive goals of developing new functional behaviors w/o directly addressing the dysfunctional ones. *It is best to accept the individual with their dysfunctions, learn overall nature and patterns of the behavior associated with the dysfunction, then gently help the client incorporate more functional habits of living* The client needs to set a goal as better than his current state of functioning

Research has indicated that antisocial personality may be characterized by: A. social isolation. B. lack of remorse. C. learning difficulties. D. difficulty with reality testing. B. lack of remorse.

The antisocial personality exhibits a lack of remorse when confronted with the results of their thoughtless, irresponsible behavior towards others.

During a team meeting the RN who is experiencing a countertransference reaction to a patient would state: a. "He reminds me so much of my sweet uncle." b. "That patient asked me out to dinner." c. "I think the team needs to discuss how best to manage the patient's manipulative behaviors." d. "I believe it's okay to cry."

a rationale: Countertransference usually consists of feelings related to persons other than the patient but transferred to the patient. This range of both positive and negative feelings may interfere with the ability to be therapeutic. Reporting a patient's attempt at arranging a social interaction or the need to manage a patient's maladaptive behavior are appropriate occurrences to report to the team but do not demonstrate countertransference. Crying is not associated with countertransference.

A nurse therapist finds herself feeling sad after sessions with a client. The client's passiveness reminds her of a family member who led a very unhappy life. What is the term for this emotional dynamic? a) Countertransference b) Reaction formation c) Free association d) Transference

a) Countertransference

Jodie is an RN whose client reminds her of her sister, with whom she has a close and positive relationship. This phenomenon is best characterized by which term? a) Countertransference b) Transference c) Reaction formation d) Free association a) Countertransference

a) Countertransference

When focusing on the primary goal of crisis therapy, a psychiatric nurse counsels a single mother who is recovering from a suicide attempt to a) Help regain confidence in her pervious ability to cope with the stress of being a single parent b) Help her identify reliable, affordable help with her childcare needs c) Comply with her prescribed therapies including the use of an antidepressant. d) Rely more on her extended family's offer to act as a support system

a) Help regain confidence in her pervious ability to cope with the stress of being a single parent

The nurse will probably spend more time on the orientation phase of the nurse-patient relations with which patient? a. The highly distrustful teenager who ran away from an abusive home situation b. The young mother who wants to return home to her young children c. The older adult who is admitted for 3 days for adjustments to his medication regime d. The middle-aged adult who voluntarily admitted himself for drug detox treatment

a. rationale: The nurse concentrates on nursing approaches in a particular phase, depending on the status and needs of individual patients. For example, approaches used in the orientation phase have priority when the patient is highly suspicious, because a need exists to develop trust with the patient. The distrustful patient will require additional interventions associated with the orientation phase. For the patient with good insight and motivation such as the young mother and the middle-aged adult, approaches in the working phase are most important because they concentrate on problem solving and change. If the patient is to be admitted for only 3 days, then approaches used in the termination phase are critical because of the need for formalizing plans for follow-up care and referrals to other services along the continuum of care.

A mother completes treatment for an addiction to prescription pain medications. As part of the mother's therapy, the family participates in a family therapy program. According to family systems theory, this is because of what? a) The family needs to learn signs of relapse if the mother begins taking pills again. b) The dynamics of the entire family have and will continue to shift to accommodate a change. c) The family needs to focus on helping the mother until equilibrium is regained. d) The family has unresolved issues toward the mother.

b) The dynamics of the entire family have and will continue to shift to accommodate a change.

The nurse practicing with therapeutic intentions versus social ones will: a. offer to visit the patient following discharge. b. assess the patient's needs following discharge. c. ignore the patient's requests for a date while on the unit. d. feel sadness and cry in response to the patient's depression.

b, rationale: The establishment and maintenance of objectivity and goal-directedness is crucial in therapeutic relationships. Assessing patient needs in preparation for discharge demonstrates therapeutic intentions. Offering to visit the patient following discharge is an example of blurring boundaries and the risk of unprofessional conduct that may come as a result. Inappropriate social requests should not be ignored but should be discussed with the team for decision-making purposes. Crying and feeling sad in response to a patient's condition may suggest a potential for a boundary violation as an example of countertransference.

Which statement made by the nurse best demonstrates the technique of self-disclosure when discussing a depressed patient? a. "Depression runs in my family. Does any family member of yours have depression too?" b. "Feeling lonely can make me depressed. What kinds of things make you feel depressed?" c. "Medication helped me when I was depressed. Have you ever been prescribed an antidepressant medication?" d. "I was so depressed once, I actually thought about suicide. Have you ever thought about hurting yourself?"

b. rationale: A self-disclosure should be planned, patient-centered, and goal-directed. The disclosure guides the conversation toward the exploration of patient problems, issues, and needs. Such disclosures help the patient clarify issues and feel less vulnerable and more normal. Therapeutic self-disclosure facilitates comfort, honesty, openness, and risk taking but never burdens patients with the nurse's problems. Directing the conversation to possible triggers is the best example of self-disclosure, since it opens the topic and divulges very general personal information. Sharing a family history of depression, the fact that the nurse was once prescribed antidepressant medication, and that suicide was once considered constitute personal information that is inappropriate to share and burdensome to the patient.

A patient experiencing a loss of reality believes in the angry voices in her head. The nurse will respond to a newly admited patient who is experiencing auditory hallucinations. The nurse initially makes which response? a. "There are no voices in your head." b. "Try to ignore them by listening to your favorite music ." c."I am not hearing those voices, but I understand that you do." d. "Just listen to my voice to distract yourself."

c rationale: Initially the nurse acknowledges and respects the patient's experience while presenting reality and avoiding reinforcement of the hallucinations. Stating that there are no voices discounts and minimizes the patient's experience. It is nontherapeutic and may be argumentative. More teaching and support of the patient will be required before distraction can be implemented, and even then it may not be possible or realistic for the patient.

What is the initial intervention when a patient acknowledges to the nurse that he is hearing voices? a. Minimizing stimulation by moving the patient to an area that is quiet and dimly lighted b. Seating the patient in front of the television so the program can serve as a distraction from the voices c. sking the patient to describe what the voices are saying d. Reassuring the patient that the staff will keep him safe

c. rationale: If the patient acknowledges hearing something that the nurse cannot hear, the nurse can then ask, "Tell me what you hear." Moving the patient to a low-stimuli area will not serve to help control the voices. The voices from the television are not likely to serve as a distraction. Reassuring the patient that staff will keep him safe is not necessarily inappropriate, but the need for safety cannot be determined until it is known what the patient is hearing. *need to ask about voices in case they try to harm themselves you can take control

A newly admitted patient is depressed and fears her husband will ask for a divorce. She begins to cry during the initial assessment interview. An effective nursing strategy would be to: a. postpone the assessment for later. b. avoid comment on her tears, and continue the assessment. c. stop and offer her a tissue. d. ask her why her husband wants to divorce her.

c. rationale: Stopping to offer the patient a tissue allows the patient (and the nurse) to pause, think, and collect herself. Assessment initially may not be postponed; data forms the basis for the plan of care, and the nurse-patient interaction initiates or establishes the therapeutic relationship. Making the observation is therapeutic and validates support of the patient. "Why" questions are considered nontherapeutic and could engender anger and/or defensiveness.

The new RN is experiencing difficulty knowing how to terminate a relationship with a patient. The preceptor states: a. "If the relationship has been short, termination may not be necessary." b. "Just say good-bye and good luck." c. "Thank the patient for working with you, and say how you valued the experience." d. "Try to move through the termination phase as quickly as possible."

c. rationale: Thanking the patient and acknowledging the value of the experience offers respect and support to the patient while validating the importance of the relational opportunity for the nurse. Termination is always appropriate and necessary therapeutically. Wishing the patient "good luck" is not therapeutic but instead is casual and informal. Termination should not be rushed, and—depending upon the length of time in the relationship—planning and discussion of termination for the patient and nurse are important.

Which statement made by the nurse indicates a need for additional instructions concerning the nursing role in promoting a change in a patient's behavior? a. "How long do you think it will take for you to stop smoking?" b. "You should be very proud of the way you handled your anger today." c. "I think you will be much happier when you leave your abusive partner." d. "What do you think you can do to avoid the triggers that cause you to abuse alcohol?"

c. rationale: he nurse should not give the patient advice to leave but rather help the patient solve her own problems. The nurse encourages short-term, realistic, and achievable goals that have been made by the patient. Asking the patient to consider timelines, praising the patient for positive changes, and helping with the identification of triggers are all appropriate nursing interventions that focus on the promoting of change. *telling her to do something instead of giving therapy

A female client with borderline personality disorder is admitted to the psychiatric unit. Initial nursing assessment reveals that the client's wrists are scratched from a recent suicide attempt. Based on this finding, the nurse Lenny should formulate a nursing diagnosis of: a.Ineffective individual coping related to feelings of guilt b.Situational low self-esteem related to feelings of loss of control c.Risk for violence: Self-directed related to impulsive mutilating acts d.Risk for violence: Directed toward others related to verbal threats

c.Risk for violence: Self-directed related to impulsive mutilating acts The predominant behavioral characteristic of the client with borderline personality disorder is impulsiveness, especially of a physically self-destructive sort. The observation that the client has scratched wrists doesn't substantiate the other options.

While working with an older male client, the nurse begins to think that the client reminds her of her grandfather, and responds as if she was the granddaughter. The nurse is developing which of the following? a) Empathy b) Modeling c) Transference d) Countertransference

d) Countertransference

Which statement demonstrates empathy on the part of the nurse responding to a patient who is angry about the death of her child? a. "I lost a child too, so I know how you feel." b. "It is a pity that someone so young was taken from you." c. "You have a right to be angry, losing a child is so unfair." d. "It's normal to be angry, but let's talk about how to handle that anger."

d. rationale: Empathy is an objective understanding of the way in which patients see their situation. It can also convey hope for improvement. Sympathy, by contrast, is the nurse having the same feelings as the patient, and objectivity is therefore lost. Sympathy often leads to comforting, reassuring, or pitying patients.

A newly admitted patient continually touches the nursing staff members and makes sexual innuendoes when interactions are attempted. The initial therapeutic manner of managing such behavior is to: a. avoid the patient until the behaviors cease. b. demand firmly that the patient cease all inappropriate touching. c. ask the patient to explain why the sexual innuendoes occur. d. explain that the behavior is inappropriate and must stop

d: rationale: Patients generally stop these behaviors when asked and should be reminded that these actions are inappropriate. The nurse then discusses the underlying need. If the behaviors continue, then setting limits can be stronger. Avoiding the patient without an explanation is incongruent with professionalism. Demands are ineffective and disrespectful. While a discussion concerning the behavior is appropriate, it is not the initial response.

Cluster B- Antisocial

individual does not want to conform to social rules/norms and are reckless to being safe with self and others. They are manipulative and deceitfulness (repeatedly lying), lack ability to learn from experience, and are selfish and don't feel any remorse.