Behavioral PrepU Chapter 24: Personality & Impulse-Control Disorders

A nurse is developing a nurse-client relationship with a client diagnosed with borderline personality disorder (BPD). Which statement by the nurse demonstrates that the nurse understands the client's fears of abandonment and intimacy?

"I will be seeing you during the daytime this week."

A client with a dependent personality disorder is receiving treatment on a medical unit. The client asks the nurse for assistance to open the tube of toothpaste so they can brush their teeth. Which is the best response by the nurse?

"I'll stay here and you can show me what you've tried to do to get the top off"

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 is the most appropriate response by the nurse?

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

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?

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

The facilitator of a social skills training program contacts a mental health nurse about a client diagnosed with histrionic personality disorder attending the program. The facilitator feels the client has well-developed social skills and does not need assertiveness training. How does the nurse respond?

"Their interpersonal relationships tend to be shallow and their self-esteem is low. Having success interacting with others in group will help the client."

The nurse observes a client with a diagnosis of obsessive-compulsive personality disorder becoming distressed when unable to complete a puzzle. Which response(s) demonstrates effective use of the cognitive restructuring technique? Select all that apply. -"Why don't you take a break and try to finish later?" -"If you are unable to finish the puzzle, what is the worst that can happen?" -"I think it is beautiful the way it is." -"How might your best friend see this situation?" -"Consider that it is only a puzzle and not important."

-"Why don't you take a break and try to finish later?" -"If you are unable to finish the puzzle, what is the worst that can happen?" -"How might your best friend see this situation?"

The nurse understands the importance of establishing boundaries and limitations when working with clients who have borderline personality disorder (BPD). Which strategy would be most useful for for establishing boundaries? Select all that apply. -Document in the client's chart agreed-upon appointment expectations. -Confront the patient directly and in a stern matter. -Share the treatment plan with the client. -Confront violations of the agreement in a non-punitive way. -Offer personal information to the client.

-Document in the client's chart agreed-upon appointment expectations -Share the treatment plan with the client -Confront violations of the agreement in a non-punitive way

A nurse is working with clients diagnosed with personality disorders. Which technique(s) would be most important for the nurse to use to effectively deal with the frustration in providing care to this group of clients? Select all that apply. -Solve the problems of the client. -Employ ongoing communication with team members. -Identify that behavior changes in the clients can occur quickly. -Discuss feelings of anger or frustration with colleagues. -Consider the client to be a personal friend.

-Employ ongoing communication with team members -Discuss feelings of anger or frustration with colleagues

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. -Cerebellum -Hypothalamus -Frontal lobe -Temporal lobe -Limbic system

-Frontal lobe -Limbic system

A nurse working in an outpatient recovery program for clients with serious mental illness receives a referral to accept a client with a co-occurring schizoid personality disorder. The nurse establishes that this new client would have some challenges with group-based therapy in the program. Which are characteristics expected with the client? Select all that apply. -Limited expressions of feelings and emotions -Behavior intended to please the nurse -Limited social skills -Grandiose and self-inflated expressions -Reluctance to join group activities

-Limited expressions of feelings and emotions -Limited social skills -Reluctance to join group activities

A nurse working in an inner city youth support program identifies that antisocial personality disorder (ASPD) can develop in those who have dysfunctional attachments. Which are risks for developing dysfunctional attachments? Select all that apply. -ing dysfunctional attachments? Select all that apply. -Losing of a parent through death -Experiencing parental abandonment or neglect -Having same-sex parents -Being the middle child -Experiencing physical or sexual abuse

-Losing a parent through death -Experiencing parental abandonment or neglect -Experiencing physical or sexual abuse

A client with borderline personality disorder (BPD) usually is treated with multiple medications. They can include which of the following types? Select all that apply. -Mood stabilizers -Anxiolytics -Antidepressants -Anti-seizure medications -Hypnotics

-Mood stabilizers -Anxiolytitcs -Antidepressants

When reviewing the history of a client with antisocial personality disorder, which would the nurse expect to find? Select all that apply. -Repeated incidents involving assaults -Consistent regular work history -Lack of remorse for actions -Detailed plans for future actions -Episodes involving scams for personal gain

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

People who are impulse-driven and have difficulty delaying gratification frequently participate in which of the following behaviors? Select all that apply. -Shopping beyond their means -Gambling -Fasting on religious holidays -Binge eating -Abusing alcohol

-Shopping beyond their means -Gambling -Binge eating -Abusing alcohol

A school-age child has a diagnosis of disruptive behavior disorder. The school nurse conducts an education session to help the parents understand the diagnosis and to teach skills that the parents can implement to help address disruptive behavior. What can parents do to help? Select all that apply. -Teach problem-solving skills -Use time out for disruptive behavior -Take the child to the police as a scare tactic -Get the child a pet to care for -Make behavioral expectations clear and consistently enforce them

-Teach problem-solving skills -Use time out for disruptive behavior -Make behavioral expectations clear and consistently enforce them

The nurse seeks to establish trust while assessing the social history of a client with antisocial personality disorder (ASPD). Which finding(s) demonstrate the client's relationship challenges? Select all that apply. -perceptive of the needs of others -enduring relationships with family members -persistent pattern of disregard for others -a pattern of failed relationships -relationships end suddenly

-persistent pattern of disregard for others -a pattern of failed relationships -relationships end suddenly

A client with a diagnosis of antisocial personality disorder would exhibit a history of conduct disorder before which age?

15 years

The nurse provides education about antisocial personality disorder (ASPD) to a group of vocational support workers involved with former inmates entering the workforce. Which description outlines how ASPD is defined?

A pattern of disregard for and violation of the rights of others

A client comes to the clinic for a follow-up visit. Despite being warm and friendly with the nurse on a previous visit, today the client presents with anger and sarcastic undertones with the same nurse. The client is presenting which behavior commonly seen in borderline personality disorder?

Affective instability

Which is the underlying issue in kleptomania?

Act of stealing

While shopping in a grocery store, a client with borderline personality disorder (BPD) greets the sibling of a neighbor with a great big hug. Then about 5 minutes later, the client walks past the sibling and ignores the sibling. The client is demonstrating what?

Affective instability

Clients with borderline personality disorder (BPD) usually exhibit which type of thinking?

All or nothing

The nurse provides education to the parent of a child diagnosed with intermittent explosive disorder. In addition to medication, what additional therapy does the nurse recommend?

Anger management

A nurse is providing care to a client with borderline personality disorder. When providing for the client's biopsychosocial needs, the nurse would address which in the biologic domain?

Assisting with sleep measures

A nurse is providing community education regarding adolescents with oppositional defiance disorder (ODD). Which point should the nurse include in the educational session?

Behavior problems can develop when parental figures pay attention to a child's maladaptive behaviors.

A family member of a client asks the nurse a question about personality disorders. The family member asks, "What personality disorder diagnosis makes a client most at risk for self-harm behaviors?" What is the nurse's best response?

Borderline personality disorder

A personality disorder is defined as a collection of traits that do what?

Cause behavioral dysfunction and inner distress

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?

Child sexual abuse

Dialectical behavior therapy (DBT) combines behavior therapy with which type of therapy?

Cognitive therapy

The nurse is aware that for some personality disorders, denial of symptoms is common. Which therapeutic approach does the nurse choose to address this denial?

Compassion

In response to a client's manipulative behavior, the nurse should provide ...

Consistent limits

An adult female client presents to the mental health clinic and is assessed by the nurse. During the assessment, the nurse observes the client engage warmly with an appropriately variable affect and to be open to share their life story. The story included a pattern of failed intimate relationships, which the client attributes to a mild form of cerebral palsy. The client lives in the parental home. The client's father died when she was in high school and her mother passed away three months prior to the assessment. Interpersonally the client says she works hard to avoid conflict. References are made to being "unlovable" and that she is "engulfed in sadness" to the point of needing a disability income. This is due to the expressed fear of being "unable" to care for everyday needs independently. What disorder does the nurse suspect?

Dependent personality disorder

When teaching a client with antisocial personality disorder (ASPD), which approach would be most appropriate for the nurse to use?

Direct

The nurse is talking with a client that is suspected of having an avoidant personality disorder. Which behaviors observed by the nurse correlate with this suspicion?

Does not speak out in group therapy because fears criticism from others.

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

Emotionless and a loner

A client is admitted to the hospital medical unit with an admitting diagnosis of antisocial personality disorder. The client also has a history of alcohol use. What is the nurse's priority intervention for this client?

Ensure the safety of other clients and staff

A nurse prepares an educational program for women during antenatal care. An outcome of the teaching is to lower the risk of antisocial personality disorder (ASPD) in the population who access the program. Which is a priority teaching need?

Ensuring attachment after birth

The nurse completes an assessment for a female client in an outpatient clinic. In addition to her medical issues, the client shares that she has a personality disorder. The client wears heavy makeup and demonstrates strong emotional intensity. Which personality disorder does the nurse identify based on the assessment findings?

Histrionic personality disorder

Which of the following occurs when self-definition is poorly developed?

Identity diffusion

When documenting observations of the behaviors exhibited by a client diagnosed with borderline personality disorder, the nurse can correctly use which terms?

Impulsive, self-destructive, unstable

A high school teacher has referred an adolescent to the school health nurse for repeated episodes of aggressive behavior and verbalizing profanities loudly at other students in the class. The adolescent can sometimes be apologetic. The nurse should suspect which disruptive behavior disorder?

Intermittent explosive disorder

The nurse has a client with antisocial personality disorder to take a time-out in the client's room when challenged by another person instigating an argument. Which explanation to the client will the nurse give for the time-out?

It allows an opportunity for the client to regain control of emotions.

A nurse is preparing an inservice program for a group of mental health nurses on the topic of borderline personality disorder. When discussing the need for hospitalization, which would the nurse include as the most likely reason for inpatient hospitalization?

Nonsuicidal self-injury

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

Paranoid

A client is diagnosed with a personality disorder manifested by odd, eccentric behavior. Which personality disorder would be associated with this manifestation?

Paranoid

Which of the following is likely the etiologic basis of the compulsive patterns seen in people with obsessive-compulsive personality disorder (OCPD)?

Parental overcontrol

Which defense mechanism is used by people diagnosed with borderline personality disorder to protect their fragmented self-image?

Projective identification

The nurse provides care to clients who have a tendency toward antisocial and criminal behavior. Which term was used in the past to describe people with this disorder?

Psychopath

A nurse is working with an adolescent diagnosed with conduct disorder. The nurse is engaged in social skills training. If successful, which outcome would the nurse expect?

Recognition of how actions affect others

A nurse is educating a client with borderline personality disorder to reshape thinking patterns. Which cognitive restructuring technique that would be helpful for this client will the nurse educate the client about?

Recognize negative thoughts and replace them with positive ones.

During neighborhood scans, a nurse working in a community outreach program has identified an individual staying in a local shelter. The person has not engaged with the program. During the day, the client can be observed sweeping the pavement in a particular alley with a broom. There is no obvious purpose to the behavior. The individual is dressed in winter clothing even though it is summer. The client mutters expressions that are audible but cannot be understood. Based on the observations, which disorder does the nurse consider?

Schizotypal personality disorder

Which thought process would cause a client with antisocial personality disorder to want to do everything for the self?

Sense of mistrust of others

Which of the following interventions should the nurse include in a plan of care for a client with histrionic personality disorder?

Set limits on attention-seeking behavior

A client on an inpatient psychiatric unit has features of borderline personality disorder. The client is frequently angry, has an unstable sense of self, and is highly impulsive. The client can be verbally abusive to staff, who feel manipulated by the client's behaviors. Which intervention does the nurse determine as priority?

Setting limits

A client with borderline personality disorder (BPD) who evaluates experiences, people, and objects in terms of mutually exclusive categories (e.g., good or bad, success or failure) is demonstrating which type of thinking?

Splitting

The nurse is involved in the care of a client with antisocial personality disorder. Which purpose does the nurse identify as a priority when participating in a periodic team meeting when caring for this client?

Team consistency is important to prevent manipulation by the client.

A male client addicted to cocaine is interviewed by the nurse in a community outpatient addiction program. The client reveals that he engages in criminal behavior to support his drug habit. When in the pursuit of drugs, the client relies on stealing and prostitution; otherwise, the client does not engage in criminal activity. For what reason does the nurse determine a diagnosis of antisocial personality disorder (ASPD) is not warranted?

The client engages in antisocial behavior only to obtain drugs

The nurse is counseling a 28-year-old client with avoidant personality disorder. Despite being employed, the client verbalizes having low quality of life due to anxiety and isolation. Which therapeutic goals does the nurse establish as priority?

The client will experience increased self-esteem

After teaching a group of nursing students about kleptomania, the instructor determines that the education was successful when the students state what?

The disorder is difficult to detect and treat

Clients with borderline personality disorder (BPD) are usually admitted to an inpatient setting because of what?

Threats of self-harm

A nurse working with a client with borderline personality disorder could establish which as outcome criteria?

Tolerate stress without self-mutilation.