Mental Health (Ch. 24 Questions)
a (Finding an approach for helping clients with personality disorders who have overwhelming needs can be challenging 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.)
A nurse who is idealized by a client is at risk for 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 (Clients with antisocial personality act out feelings without consideration for the rights of others. They feel no remorse for their antisocial acts.)
A client arrested for an assault in which he savagely beat a classmate states, "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 (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 diagnosed with obsessive-compulsive personality disorder takes the nurse aside and mentions, "I've observed you interacting with that new patient. 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 the patient." b) "I see you are trying to control that patient's therapy as well as your own." c) "Your eye for perfection extends even to my nursing interventions." d) "That patient's care is really of no concern to you or to other clients."
b (Schizoid personality disorder has the primary feature of emotional detachment. Individuals do not seek out or enjoy close relationships. They are reclusive, avoidant, and uncooperative. They do not do well with resocialization.)
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.
c (Personality patterns persist unmodified over long periods of time. Inflexible and maladaptive responses to stress are characteristic of individuals with a personality disorder.)
A nurse caring for a client who has been diagnosed with a personality disorder should expect that the client will exhibit a) frequent episodes of psychosis. b) constant involvement with the needs of significant others. c) inflexible and maladaptive responses to stress. d) abnormal ego functioning.
b (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.)
Playing one staff member against another is an example of a) devaluation. b) splitting. c) impulsiveness. d) social ineptitude.
b (Individuals with an antisocial personality exhibit a lack of remorse when confronted with the results of their thoughtless, irresponsible behavior toward others.)
Research has indicated that the antisocial personality may be characterized by a) social isolation. b) lack of remorse. c) learning difficulties. d) difficulty with reality testing.
c (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.)
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 (Clients with borderline disorder can decompensate into psychotic states under stress. Hospitalization is needed at these times.)
The client diagnosed with a personality disorder who is most likely to be admitted to a psychiatric unit is one who has a) paranoid personality disorder and is suspicious of his neighbors. b) narcissistic personality disorder and is highly self-important. c) borderline personality disorder and is impulsive. d) dependent personality disorder and clings to her husband.
a (The primary goal of milieu therapy is affect management in a group context.)
The primary goal of milieu therapy for clients diagnosed with personality disorders is a) to manage the effect the behavior has on the entire group. b) to provide one-on-one therapy for each member of the milieu. c) to help the client remain uninvolved with other patients. d) to promote a laissez-faire attitude among the staff members.
c (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.)
The priority nursing intervention for a client diagnosed 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.
a (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.)
When providing care for a client diagnosed 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.
d (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.)
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
b (A primary coping style used by patients with BPD is called splitting. Splitting is the inability to incorporate positive and negative aspects of oneself or others into a whole image. The individual may tend to idealize another person (friend, lover, health care professional) at the start of a new relationship and hope that this person will meet all of his or her needs. At the first disappointment or frustration, however, the individual quickly shifts to devaluation, despising the other person. The other options do not describe splitting, which is a primary coping style of patients with BPD.)
Belinda is a 24-year-old patient with borderline personality disorder (BPD). She is admitted to the inpatient psychiatric unit following a suicide attempt. You are caring for Belinda. Which of the following statements by Belinda illustrates a primary coping style of persons with BPD? a) "My provider says I might get out of here tomorrow. Do you think I'm ready to go?" b) "Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." c) "I will never again speak to any of my messed up family members. I know that this will help me be more functional." d) "I promise I am not feeling suicidal. I won't hurt myself."
c (Narcissistic clients give the impression of being invulnerable and superior to others to protect their fragile self-esteem.)
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.
a (Antisocial clients have no conscience. Their sense of right and wrong is impaired, and they tend to do whatever serves them best without consideration for the rights or feelings of others.)
Characteristics the nurse will assess in the client diagnosed with antisocial personality disorder are a) deceitfulness, impulsiveness, and lack of empathy. b) perfectionism, preoccupation with detail, and verbosit. c) avoidance of interpersonal contact and preoccupation with being criticized. d) a need for others to assume responsibility for decision making and seeking nurture.
c (For a client who has difficulty in relationships and is very manipulative, the nursing diagnosis of impaired social interaction would be used.)
Clients demonstrating characacteristics of 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.
lability
Patients with borderline personality disorder (BPD) exhibit negative effect, which includes emotional _____________, described as rapidly moving from one emotional extreme to another.
d (The main traits that describe STPD are psychoticism such as eccentricity, odd or unusual beliefs and thought processes, and social detachment by preferring to be socially isolated, as well as being overly suspicious or anxious. In obsessive-compulsive personality disorder the main pathological personality traits are rigidity and inflexible standards of self and others, along with persistence of goals long after they are necessary, even if they are self-defeating or negatively affect relationships. People with narcissistic personality disorder come across as arrogant, with an inflated view of their self-importance. They have a need for constant admiration, along with a lack of empathy for others, a factor that strains most relationships over time. Traits of avoidant personality disorder include low self-esteem, feelings of inferiority compared with peers, and a reluctance to engage in unfamiliar activities involving new people.)
Mary Alice is a 37-year-old patient referred to the mental health clinic with a suspected personality disorder. She is withdrawn and suspicious and states she has always preferred to be alone. She describes herself as having "special powers" and states that she is thinking of opening a business where she gives "readings" to people about their future. She states, "I believe we can all read each other's thoughts at times." Based on this presentation, you suspect: a) obsessive-compulsive personality disorder. b) narcissistic personality disorder. c) avoidant personality disorder. d) schizotypal personality disorder (STPD).
a (At this time in the United States, there are no specifically FDA-approved medications for treating personality disorders. Prescribers are using the medications "off- label" until evidence-based pharmacotherapies are proven to be safe and effective. There is evidence that mood stabilizers, antidepressants, and atypical antipsychotics are helpful in specific personality disorders. Pharmacologic evidence is lacking for the treatment of persons with narcissistic and obsessive-compulsive personality disorders. Although patients with personality disorders usually do not like taking medicine unless it calms them down and are fearful about taking something over which they have no control, providers do attempt to mediate symptoms with psychotropic agents for improved quality of life.)
Which is true of pharmacological therapies for treatment of personality disorders? a) Although there are no FDA-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident. b) Research has shown that currently available psychotropic drugs have not been shown to be effective in treating personality disorders. c) Patients with narcissistic personality disorder and obsessive-compulsive personality disorder have shown the most benefit from the use of antianxiety medications along with use of selective serotonin reuptake inhibitors. d) Patients with personality disorders have been shown to be resistant to accepting medication, and as a result most providers do not prescribe psychotropic drugs to these patients.
d e g (APD is the most studied and researched personality disorder. Rigidity and inflexible standards describe obsessive-compulsive personality disorder. Magical thinking describes schizotypal personality disorder. People with APD usually present with depression or because of the consequences of their behaviors, not because they care about the effects of their actions on others. )
Which of the following are true of antisocial personality disorder (APD)? (select all that apply): a) It is the least studied of the personality disorders. b) It is characterized by rigidity and inflexible standards of self and others. c) Persons with APD display magical thinking. d) Persons with APD are concerned with personal pleasure and power. e) It is characterized by deceitfulness, disregard for others, and manipulation. f) Persons with APD usually present for treatment because of awareness of how their behavior is affecting others. g) Frontal lobe dysfunction is a brain change identified in APD.
a (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.)
Which statement is descriptive of clients with a personality disorder? 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.
