Chapter 18 Personality Disorders

The nurse is caring for a client diagnosed with antisocial personality disorder. Which of the following characteristics is this client most likely to exhibit? a. A low tolerance for frustration b. An eccentric personality c. Fear of not meeting the expectations of others d. Expressions of guilt regarding antisocial behavior

a. A low tolerance for frustration (Rationale: Clients with an antisocial personality disorder exhibit a low tolerance for frustration, emotional immaturity, and a lack of impulse control. They lack remorse for their actions and disregard the expectations of others. An eccentric personality is more closely associated with a schizotypal disorder.)

Which of the following terms describes the extent to which a person sees himself or herself as an integral part of human society? a. Cooperativeness b. Self-transcendence c. Self-directedness d. Character

a. Cooperativeness (Rationale: Cooperativeness describes the extent to which a person sees himself or herself as an integral part of human society. Character consists of concepts about the self and the external world. Self-directedness is the extent to which a person is responsible, reliable, resourceful, and self-confident. Self-transcendence describes the extent to which a person considered himself or herself to be an integral part of the universe.)

A client describes herself as being "pathologically organized," to the extent that she experiences debilitating anxiety when circumstances are out of her control. What is the nurse's most appropriate intervention for this client? a. Help the client understand that less than perfect results can be acceptable. b. Help the client explore the effects of her behavior on others. c. Affirm the client that she has inherent value as a person. d. Encourage the client to adopt a more chaotic and open-ended pattern of behavior.

a. Help the client understand that less than perfect results can be acceptable. (Rationale: This client likely has an obsessive-compulsive personality disorder. The client would likely benefit from reframing her expectations for her own performance and results. However, urging a chaotic pattern would be extreme and unnecessary. Self-esteem and exploring the effects on others would not be likely priorities.)

A client is beginning treatment for borderline personality disorder. The nurse should expect the assessment to reveal what pattern of behavior? a. Instability in relationships b. Compulsions and rituals c. Difficulty in setting limits with others d. Preoccupation with orderliness

a. Instability in relationships (Rationale: Clients with borderline personality disorder exhibit unstable relationships and impulsivity and may self-mutilate. They rarely exhibit rituals, compulsions, or a propensity toward orderliness. Limit setting is not normally a challenge for these clients, who normally prioritize their own needs and feelings over those of others.)

Assessment of a client reveals a pattern of broken relationships resulting from the client's tendency toward grandiosity and lack of empathy. The nurse should suspect what type of personality disorder? a. Narcissistic b. Obsessive-compulsive c. Histrionic d. Dependent

a. Narcissistic (Rationale: Narcissistic personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and a lack of empathy. Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation. Obsessive-compulsive personality disorder is characterized by a preoccupation with orderliness, perfectionism, and control.)

The nurse is working with a client who has a borderline personality disorder. The nurse is aware that the client is under severe stress as a result of her child's chronic illness and the accompanying financial burden. The nurse should assess the client's risk for which of the following? a. Psychosis b. Acute confusion c. Violent outbursts d. Delirium

a. Psychosis (Rationale: Under stress, clients with borderline personality disorder are at risk of developing transient psychotic symptoms. Violence, confusion, and delirium are atypical.)

A client has a diagnosis of borderline personality disorder and has become very attached to one of the nurses who has been caring for her. She remarks that the other nurses are mean and do not care about her. Which intervention would be most appropriate for the nursing staff to implement? a. Rotate the nurses who are assigned to the client. b. Assign the client's preferred nurse to provide the majority of her care. c. Provide an unstructured environment for the client. d. Ignore the client's behaviors.

a. Rotate the nurses who are assigned to the client. (Rationale: Rotating staff members who work with a client with a borderline personality disorder keeps the client from becoming dependent on any one nurse and reduces the use of splitting and her fear of abandonment. Firm rules and consistency among staff members will her control the client's behavior. Ignoring splitting behaviors can cause the client to increase the behavior by trying to get a response from the staff. Assigning the preferred nurse to provide most of the client's care would reinforce the client's behavior.)

The nurse has begun working with a client who has a schizotypal personality disorder. What goal should the nurse prioritize when beginning to engage with this client? a. Seek to establish a trusting relationship with the client. b. Assess the client's potential for adherence to treatment. c. Limit the client's influence on other clients. d. Educate the client about the implications of his health problem.

a. Seek to establish a trusting relationship with this client. (Rationale: Clients with schizotypal personality disorder are profoundly mistrustful of strangers. Overcoming this mistrust is key to a therapeutic nursing partnership and is a priority over the other listed nursing actions.)

The nurse is assessing the degree to which a client considers himself to be an integral part of the universe. The nurse is addressing what aspect of trait of character? a. Self-transcendence b. Self-directedness c. Vitality d. Cooperativeness

a. Self-transcendence (Rationale: Self-transcendence describes the extent to which a person considers himself or herself to be an integral part of the universe. Cooperativeness refers to the extent to which a person sees himself or herself as an integral part of human society. Self-directedness is the extent to which a person is responsible, reliable, resourceful, goal oriented, and self-confident. Vitality is not identified as a character trait.)

A nurse established a trusting and therapeutic relationship with a client, but the client has suddenly begun to express mistrust and hostility toward the nurse. The nurse should recognize what phenomenon? a. Splitting b. Catastrophizing c. Depersonalization d. Thought stopping

a. Splitting (Rationale: In cases of splitting, clients tend to adore and idealize other people even after a brief acquaintance but then quickly devalue them if these others do not meet their expectations in some way. Thought stopping is a technique to alter the process of negative or self-critical thought patterns. This sudden change in the client's appraisal of someone is not characterized as depersonalization or catastrophizing.)

A client with paranoid personality disorder is receiving care at an outpatient psychiatric facility. Which statement by the nurse would best establish rapport and encourage the client to confide in the nurse? a. "It bothers me when I think people are talking about me." b. "I get upset once in a while, too." c. "I know how you feel. I'd feel the same way in your situation." d. "It's normal not to trust anyone."

b. "I get upset once in a while, too." (Rationale: Sharing a benign, nonthreatening, personal fact or feeling helps the nurse establish rapport and encourages the client to confide in the nurse. The nurse cannot know how the client feels. Telling the client otherwise would justify the suspicions of a paranoid client; furthermore, the client relies on the nurse to interpret reality.)

The nurse formulates a nursing diagnosis of impaired social interaction related to disorganized thinking for a client with schizotypal personality disorder. What is the priority nursing intervention for this nursing diagnosis? a. Exploring the effects of the client's behavior on his or her relationships. b. Establishing a one-on-one relationship with the client. c. Helping the client to participate with the client. d. Developing a schedule for the client's participation in therapeutic activities.

b. Establishing a one-on-one relationship with the client. (Rationale: Establishing therapeutic communication is the priority. The other interventions can be completed after the therapeutic relationship has been initiated.)

A client with a borderline personality disorder is adamant that a work colleague is solely to blame for his own negative performance review. What is the nurse's most appropriate intervention? a. Help the client to block thoughts in order to prevent violent outbursts. b. Help the client take responsibility for his actions and behaviors. c. Teach the client how to manage conflict appropriately. d. Teach the client how to improve his work performance.

b. Help the client take responsibility for his actions and behaviors. (Rationale: Clients with a borderline personality disorder have difficulty accepting responsibility for meeting needs outside a relationship. They see life's problems and failures as a result of others' shortcomings. The nurse should aim to help the client take ownership of his or her behavior. The nurse should focus on the client's thinking, not encourage a conflict. Violence is unlikely.)

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. Inappropriate self-disclosure d. Acute confusion

b. Paranoid thoughts (Rationale: A schizotypal client would have paranoid thoughts in social situations. The client is likely to experience acute discomfort in social situations and have cognitive or perceptual distortions. The client is highly unlikely to self-disclosure and will not tend toward perfectionism. Acute confusion is unlikely, though the client may experience some distortions in cognition.)

The nurse is planning the care for an outpatient who has recently received a diagnosis of avoidant personality disorder. What intervention should the nurse prioritize in the care for this client? a. Help the client to explore the feelings of others. b. Set firm limits around the client's social interactions. c. Affirm the client's positive personality traits. d. Educate the client about the consequences of his or her actions.

c. Affirm the client's positive personality traits. (Rationale: Clients with avoidant personality disorder require much support and reassurance from the nurse. In the nonthreatening context of the relationship, the nurse can help them to explore positive self-aspects, positive responses from others, and possible reasons for self-criticism. These clients are not likely to lack empathy or to overstep boundaries in relationships.)

The nurse is providing care in a prison. The nurse should anticipate a high prevalence of what personality disorder? a. Obsessive-compulsive b. Avoidant c. Antisocial d. Borderline

c. Antisocial (Rationale: In prison populations, approximately 50% are diagnosed with antisocial personality disorder. This exceeds the prevalence of other types of personality disorders.)

A client has a documented history of seeking medical care for vague subjective symptoms that are not attributable to a pathologic process. What personality disorder is suggested by this behavior? a. Schizotypal b. Paranoid c. Histrionic d. Antisocial

c. Histrionic (Rationale: Histrionic personality disorder is characterized by attention seeking, which often takes the form of health complaints. This behavior is not typical of clients who have paranoid, antisocial, and schizotypal personality disorders.)

A client is enthusiastically positive about his plan of care but consistently "sabotages" the nurse's efforts to implement interventions and to hold the client accountable. The nurse should suspect the presence of what type of personality disorder? a. Histrionic b. Dependent c. Passive-aggressive d. Narcissistic

c. Passive-aggressive (Rationale: Clients diagnosed with passive-aggressive personality disorder have a pervasive pattern of passive resistance to demands, despite outward cooperation. This trait is not characteristic of other types of personality disorders.)

Which of the following describes the extent to which a person is responsible, reliable, resourceful, and self-confident? a. Character b. Cooperativeness c. Self-directedness d. Self-transcendence

c. Self-directedness (Rationale: Self-directedness is the extent to which a person is responsible, reliable, resourceful, and self-confident. Cooperativeness describes the extent to which a person sees himself or herself as an integral part of human society. Self-transcendence describes the extent to which a person considers himself or herself to be an integral part of the universe. Character consists of concepts about the self and the external world.)

The nurse is caring for a client with antisocial personality disorder. Which statement is most appropriate for the nurse to make when explaining unit rules and expectations to the client? a. "You'll find your condition will improve much faster if you attend group therapy on a regular basis." b. "The whole care team is hoping that you will choose to attend group therapy." c. "I and other members of the health-care team would be so pleased if you would attend group therapy." d. "You'll be expected to attend group therapy each day."

d. "You'll be expected to attend group therapy each day." (Rationale: Rules and explanations must be brief, clear, and leave little room for misinterpretation. A client with antisocial personality disorder tends to disregard rules and authority and be socially irresponsible. The words "You'll be expected to attend..." are concise and concrete and convey precisely what behavior is expected. The other options leave open the interpretation that attendance is suggested but not mandatory.)

Which of the following is the priority nursing intervention for a client diagnosed with depressive personality disorder? a. Foster the client's self-reliance b. Uses a matter-of-fact approach c. Set firm limits with the client d. Assess the client's risk of self-harm

d. Assess the client's risk of self-harm (Rationale: Nursing interventions for the client diagnosed with depressive personality disorder include assessing risk for self-harm, providing factual feedback, and promoting self-esteem. A matter-of-fact approach is used with the narcissistic client. Limit setting is used with the antisocial client. Fostering self-reliance is used with the dependent client.)

The nurse is planning the care for a client who has been diagnosed with avoidant personality disorder. What nursing diagnosis should the nurse prioritize? a. Spiritual distress b. Disturbed body image c. Acute confusion d. Chronic low self-esteem

d. Chronic low self-esteem (Rationale: Clients with avoidant personality disorder typically have very low self-esteem. Spiritual distress and disturbed body image are plausible, but neither is universally present in clients with this diagnosis. Acute confusion is unlikely.)

The nurse is assigned to care for a client with dependent personality disorder. Which intervention should the nurse include in this client's care plan to promote independence? a. Spend long periods of unscheduled time with the client. b. Avoid discussing the client's feelings of helplessness. c. Schedule competitive activities so the client can test his or her skills. d. Help the client identify preferences, such as choosing which clothing item to wear.

d. Help the client identify preferences, such as choosing which clothing item to wear. (Rationale: Helping the client identify preferences promotes development of independent decision-making skills, which the client with dependent personality disorder lacks. To demonstrate that the nurse is available during set times in a structured relationship, the nurse should spend schedules, not unscheduled, time with the client and should set limits on the amount of time spent. Activities in which the client can succeed would be more appropriate than competitive ones, which the client may perceive as threatening. To promote rapport and convey empathy, the nurse should acknowledge the client's helpless feelings, not avoid discussing them.)

The nurse is providing care for a client with a histrionic personality disorder. The nurse should recognize the need to do which of the following actions? a. Hold the client accountable for her actions b. Teach the client to consider the feelings of others c. Reassure the client that she is safe d. Set limits appropriately

d. Set limits appropriately (Rationale: Clients with histrionic personality disorder are characterized by a pervasive pattern of excessive emotionality and attention seeking. It is often necessary to set limits with these clients. This is often a priority over reassuring clients of their safety or teaching interpersonal skills.)

The nurse is assessing a new client who has been diagnosed with a personality disorder. During the health interview, it becomes evident that the client has a persistent inability to set goals. What conclusion should the nurse draw from this observation? a. The client likely has a history of substance misuse. b. The client likely has a history of uncooperativeness. c. The client may have depression rather than a personality disorder. d. The client may have a low level of self-directedness.

d. The client may have a low level of self-directedness. (Rationale: People low in self-directedness are blaming, helpless, irresponsible, and unreliable. They cannot set and pursue meaningful goals. A lack of goal setting does not necessarily suggest the presence of depression or a tendency toward substance misuse. Cooperativeness is a dimension of character that is largely independent of goal setting.)