Mental Health Practice test - Personality and Impulse-Control Disorders

When working on an in patient adolescent mental health unit, staff may be able to maintain safety and a calm environment when they interact with patients using: a. High expressed emotion "You must stop that immediately!" using a stern voice b. Strict rule adherence "There are no snack after 10m. No expectations!" using a authoritarian tone c. Suppressed emotion "Hey, let's just talk about something else that doesn't upset you!" using a light, friendly tone d. Low expressed emotion "Please go to your room for quiet time now" using a neutral, calm tone

Low expressed emotion "Please go to your room for quiet time now" using a neutral, calm tone

Impulse control is part of a plan for a client with borderline personality disorder. Which of the following is particularly important to include? A) Identify triggers and patterns of behaviors. B) Manage emotions. C) No harm contract. D) Identify support sources.

No harm contract

A nurse is observing a client diagnosed with borderline personality disorder on the inpatient unit. Which of the following would the nurse most likely note? A) Actively participating in several different groups B) Openly verbalizing feelings C) Participating in relationships in which the client has control D) Adhering to the personal boundaries of others

Participating in relationships in which the client has control

Which assessment would a nurse be most likely to make when working with a patient with a personality disorder? A. Patient behavior demonstrates similarity to cultural norms for behavior. B. Patient behavior causes little distress to self or others. C. Patient behavior is inflexibly dysfunctional. D. Patient seeks an intense relationship with nurse.

Patient behavior is inflexibly dysfunctional

Which of the following would the nurse analyze as indicating improvement in a patient with a diagnosis of high risk for self-mutilation related to feelings of abandonment and impulsivity? A. Patient controls self-destructive impulses when feeling empty or upset. B. Patient vows never to get involved in a close relationship again. C. Patient expresses deep rage at the ending of a relationship. D. Patient suppresses feelings of abandonment

Patient controls self-destructive impulses when feeling empty or upset

A nurse is assisting a client with borderline personality disorder in how to manage transient psychotic episodes that involve auditory hallucinations. The teaching is planned for times when the client is free of these symptoms. Which of the following would the nurse instruct the client to do first? A) Use skills to tolerate painful feelings. B) Practice deep abdominal breathing. C) Identify early internal cues of distress. D) Refer to cards listing potential symptoms.

Practice deep abdominal breathing

A client with borderline personality disorder has difficulty maintaining boundaries of the professional relationship. Which of the following would be most effective for the nurse to do? Select all that apply A) Punish the client with seclusion for violating established boundaries. B) Respond to the client's arrogance in a neutral, nonconfrontational manner. C) Discuss the purpose of the limits in the therapeutic relationship. D) State the parameters of the limits and boundaries clearly E) Ensure that any established limits are maintained consistently.

Respond to the client's arrogance in a neutral, nonconfrontational manner. Discuss the purpose of the limits in the therapeutic relationship. State the parameters of the limits and boundaries clearly Ensure that any established limits are maintained consistently.

Which would be most characteristic of the way a person with an antisocial personality disorder would perceive his "self"? A) Exploited, unappreciated, undervalued B) Assertive, sensitive, warm, fair-minded C) Competitive, flexible, interdependent, empathetic D) Self-sufficient, powerful, superior

Self-sufficient, powerful, superior

Which nursing diagnosis is most appropriate for clients with personality disorders (Paranoid, Schizoid, Schizotypal)? A) Social isolation related to inadequate social skills, craving of solitude. B) High risk for violence, self directed related to poor impulse control. C) Fear related to feelings of abandonment. D) Ineffective individual coping related to high dependency needs.

Social isolation related to inadequate social skills, craving of solitude

A woman with borderline personality disorder has been admitted to the inpatient unit because she has been engaging in wrist cutting. The client's sister is visiting, and the sister asks the nurse to explain why her sister sometimes does this to herself. Which response by the nurse would be most appropriate? A) ​Sometimes the self-injurious behavior is undertaken to relieve stress.​ B) ​Self-injurious behavior often calms and sedates people with this diagnosis.​ C) ​Sometimes they do it to avoid the onslaught of delusional thinking.​ D) The self-mutilation often slows the mood swings your sister experiences.​

Sometimes the self-injurious behavior is undertaken to relieve stress.​

A nurse is working with a client who is a perfectionist. What is important for the client and nurse to discuss? A) The need for medication. B) The effect of anger on perfectionism. C) The need to feel superior. D) The link between anxiety and perfectionism.

The link between anxiety and perfectionism

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

Validating perceptions with others Paraphrasing before responding Compromising

A client with borderline personality disorder tells the nurse, ​I'm afraid to get on a train because we'll probably get into a wreck.​ Which response by the nurse would be most appropriate? A) Have you had a bad experience riding a train?​ B) ​What are the chances of that actually happening? ​C) ​Now you know that won't happen.​ D) ​Have you thought about going by automobile?​

What are the chances of that actually happening?

A client diagnosed with borderline personality disorder tells the nurse that she ​frequently spaces out.​ Which response by the nurse would be most appropriate? A) ​Do you feel stressed most of the time?​ B) Does this frighten you when it happens?​ C) What's happening around you when this occurs?​ D) ​Do you feel as if you are out of your body?​

What's happening around you when this occurs?​

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

a client diagnosed with borderline personality disorder Rationale: 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.

a nurse is reading a journal article about the various theories associated with the development of antisocial personality disorder. the article mentions difficult temperament as a possible theory. the nurse demonstrates understanding of this concept when identifying which of the following as a key behavior associated with a difficult temperament? select all that apply. a. aggression b. inattention c. hyperactivity d. impulsivity e. depression f. paranoia

aggression inattention hyperactivity impulsivity

a mental health nurse assesses a patient diagnosed with an antisocial personality disorder. which comormid problem is most important for the nurse to include in the assessment? a. generalized weakness b. alcohol use and abuse c. compulsions and phobias d. dysfunctional sleep patterns

alcohol use and abuse

the nurse is preparing to assess a client with a paranoid personality trait. the nurse integrates knowledge of this condition, anticipating that the client's affect and behavior will most likely be which of the following? a. angry and hostile b. flirtatious and seductive c. fearful and anxious d. friendly and open

angry and hostile

a person shoplifts merchandise from a community cancer thrift shop. when confronted, the thief replied, "all this stuff was donated, so I can take it." this comments suggests features of which personality disorder? a. antisocial b. histrionic c. borderline d. schizotypal

antisocial

A patient admitted for psychiatric examination ordered by the court following arrest for embezzlement from his workplace has a history of blaming others for his problems and becoming defensive and angry when criticized. He expresses no remorse for his actions, but claims his actions were justified because his company did not pay him what he is worth. The nurse would correctly determine that this patient displays symptoms most closely associated with: A. avoidant personality disorder. B. schizotypal personality disorder. C. antisocial personality disorder. D. borderline personality disorder.

antisocial personality disorder Rationale: Patients with antisocial personality disorder typically show no remorse and justify their actions as being right for them, despite being socially unacceptable. 1. Such a person would have difficulties with interactions. 2. This person behaves bizarrely and has few interactions with others. 4. This person has intense, angry relationships, is impulsive, and may self-mutilate.

Which client situation should a nurse identify as reflective of 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."

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." Rationale: The client who states, "I cut myself because you are leaving me" reflects impulsive behavior that is commonly associated with the diagnosis of borderline personality disorder. Repetitive, self-mutilative behaviors are common and are generated by feelings of abandonment following separation from significant others.

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.

assist the client to discuss anger and frustrations Rationale: 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 group of nursing students is reviewing information about schizoid personality trait. the students demonstrate understanding of the information when they identify which disorder as the most common comormid disorder? a. depression b. substance abuse c. avoidant personality disorder d. anxiety

avoidant personality disorder

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 promoting secondary gains

being firm, consistent, and empathetic, while addressing specific client behaviors Rationale: 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 diagnosed 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.

a nurse is working with the family of a client who has been diagnosed with antisocial personality disorder. which of the following would be most important for the nurse to focus on when teaching the family about this disorder? a. anger management b. boundary setting c. medication therapy d. self-responsibility

boundary setting

A group of nursing students is reviewing possible risk factors for development of borderline personality disorder. The students demonstrate understanding of the information when they identify which of the following as a risk factor? Select all that apply. A) childhood sexual abuse B) parental loss C) substance abuse D) family history E) genetics

childhood sexual abuse parental loss

When caring for a patient with dependent personality disorder, the behavior the nurse would positively reinforce would be: A. choosing which outfit to wear. B. asking another patient for advice. C. sitting next to the nurse at community meeting. D. concealing anger with a member of the family.

choosing which outfit to wear Rationale: Dependent patients find it difficult to make even simple decisions. They often ask advice; thus independently choosing her own attire is a behavior to be reinforced. The other options are behaviors that reflect dependent needs and are not desirable.

Family members of a client ask a nurse to explain the difference between schizoid and avoidant personality disorders. Which is the appropriate nursing reply? 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 odd, bizarre, and eccentric behavior, 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 psychotic thought processes, while clients diagnosed with avoidant personality disorder remain based in reality."

clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone Rationale: 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. Avoidant personality disorder is characterized by an extreme sensitivity to rejection which leads to social isolation. Schizoid personality disorder is characterized by a profound deficit in the ability to form personal relationships.

From a behavioral perspective, which nursing intervention is most 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 antianxiety medications to improve medication compliance. D. Encourage the client to journal feelings to improve awareness of abandonment issues.

contract with the client to reinforce positive behaviors with unit privileges Rationale: 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.

The distinguishing characteristic the nurse is likely to assess in a patient with antisocial personality disorder that is absent in most other personality disorders is: A. exhibiting guilt and remorse. B. responding well to neuroleptics. C. disregarding the rights of others. D. responding to kindly, gentle suggestions

disregarding the rights of others Rationale: Individuals with antisocial personality disorders have no concern for what is right or wrong or for the rights of others. They frequently violate others' rights and frequently break laws in their "Me first " thinking. These individuals exhibit no guilt or remorse, show no improvement from neuroleptics, and walk all over anyone who is not able to set firm limits.

a nurse is working with a client who is a compulsive gambler. which of the following would the nurse emphasize as crucial for relapse prevention? select all that apply. a. medication therapy b. family involvement c. identification of triggers d. anger management e. milieu management

family involvement identification of triggers

The nurse caring for an individual with schizoid personality disorder would expect to assess: A. impulsive, restless, aggressive behavior. B. magical thinking and suspicious, odd behavior. C. distrustful, cold, often angry behaviors. D. few interactions with others and little verbalization

few interactions with others and little verbalization Rationale: Individuals with schizoid personality disorder do not want to be involved in relationships. They are shy and introverted, speak little, and prefer fantasy and daydreaming to being involved with real people.

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

histrionic personality disorder Rationale: 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.

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

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

a nursing instructor is describing depressive and negativistic personality traits to a group of nursing students. the instructor determines that the teaching was successful when the students identify which of the following as characteristic of negativistic personality traits? select all the apply. a. anhedonia b. hostility c. pessimism d. oppositionality e. guilt

hostility oppositionality guilt

A nursing diagnosis appropriate to consider for a patient with any of the personality disorders is: A. noncompliance. B. impaired social interaction. C. disturbed personal identity. D. disturbed sensory perception

impaired social interaction

a nurse plans care for a patient diagnosed with borderline personality disorder. Which nursing diagnosis is most likely to apply to this patient? a. ineffective relationships related to frequent splitting b. social isolation related to fear of embarrassment or rejection c. ineffective impulse control related to violence as evidenced by cruelty to animals d. disturbed thought process related to recurrent suspiciousness of people and situations

ineffective relationships related to frequent splitting

A nursing instructor is preparing a class discussion on personality disorders and characteristics. Which term would the instructor include to differentiate personality disorders from normal personality? Select all that apply. A) inflexible B) short term C) pervasive D) unstable over time E) distressing

inflexible pervasive unstable over time distressing

the nurse assesses a new patient suspected of having schizotypal personality disorder. which assessment question is this patient most likely to answer affirmatively? a. do some types of situations frighten you? b. do you often have episodes of prolonged crying? c. is anyone in your family diagnosed with a mental illness? d. is it ever very important for you to do everything correctly?

is anyone in your family diagnosed with a mental illness

a nurse is providing care to a client with antisocial personality disorder. as part of the plan of care, the client is to participate in a problem-solving group. the nurse understands that this intervention is effective based on which rationale? a. it requires the client to develop attachments b. it sets up specific boundaries for the client c. it helps reinforce self-responsibility d. it avoids confrontation about dysfunctional patterns

it helps reinforce self-responsibility

a client is brought into the emergency department because of complaints from the neighbors that the client was acting strangely. the nurse assesses the client and suspects schizotypal personality disorder based on assessment of which of the following? select all that apply. a. magical beliefs b. hallucinations c. paranoia d. avoidance of eye contact e. meticulous dress

magical beliefs paranoia avoidance of eye contact

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.

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

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.

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

For which of the following behaviors would it be most essential for the nurse to use limit setting? A. Dependence B. Avoidance C. Suspicion D. Manipulation

manipulation Rationale: Manipulation involves getting one's needs met at the expense of others. Because manipulation violates the rights of others, limit setting is absolutely necessary. Limit setting may be used with dependent and avoidant behavior, occasionally, but other therapeutic techniques are also useful.

The nurse working with a patient who has borderline personality disorder must consider in advance strategies for intervening in: A. grief and social isolation. B. withdrawal and social avoidance. C. mood shifts, impulsivity, and manipulation. D. thought disorder, grandiosity, and overreaction

mood shifts, impulsivity, and manipulation Rationale: Characteristic behaviors of individuals with borderline personality disorder include rapid mood shifts, impulsive acting out, manipulation of others, as well as problems with identity, dependency, self-mutilation, and unstable, intense interpersonal relationships.

The nurse is assessing a client who has borderline personality disorder. Which of the following would be a priority? A) nutrition patterns B) personal hygiene practices C) physical functioning D) somatic complaints

nutrition patterns

A patient with a personality disorder told the nurse during the interview that he believes that people in general do not like him, and may even wish to harm him. This thinking can be assessed as showing evidence of the use of A. projection. B. conversion. C. intellectualization. D. introjection

projection Rationale: The patient with paranoid personality disorder may unconsciously use the defense mechanism projection to keep anxiety under control. The use of projection allows the individual to disown his own unacceptable feelings, attitudes, or ideas by attributing them to others.

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.

provide external limits on client behavior Rationale: 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.

When a patient demonstrates behaviors and verbalization's indicating a lack of guilt feelings, desired outcomes will be facilitated by interventions that: A. provide external limits on patient behavior. B. foster discussion of rationales for behavior. C. encourage interactions with vulnerable patients. D. require participation in activities therapies.

provide external limits on patient behavior Rationale: When patients are unable to determine appropriate behavioral limits, staff must set clear limits and enforce them. This ensures the safety of the patient and others. The other options are either inappropriate (2 and 3) or unrelated to the topic (4).

a nursing instructor is preparing a teaching plan for a class of nursing students about antisocial personality disorder. which of the following would the nurse include as a term often used to describe the behaviors associated with this condition? select all that apply. a. psychopath b. manipulator c. criminality d. sociopath e. psychotic

psychopath sociopath

the nurse is reviewing the medical record of a client diagnosed with antisocial personality disorder. the nurse notes that the client has had numerous episodes involving irritability, aggressiveness, and impulsivity, and has exhibited callousness toward others. based on this information, which nursing diagnosis would the nurse most likely identify as a priority? a. risk for other-directed violence b. risk for self-injury c. risk for suicide d. risk for self-directed violence

risk for other-directed violence

A client is diagnosed with intermittent explosive disorder. The clinic nurse should anticipate teaching about which medication? A. Citalopram (Celexa) B. Risperidone (Risperdal) C. Fluvoxamine (Luvox) D. Isocarboxazid (Marplan)

risperidone (risperdal) Rationale: An antipsychotic like Risperdal can be prescribed for intermittent explosive disorder. An antidepressant is not the usual drug of choice for this disorder.

As part of a client's treatment plan for borderline personality disorder, the client is engaged in dialectical behavior therapy. As part of the therapy, the client is learning how to control and change behavior in response to events. The nurse identifies the client as learning which type of skills? A) emotion regualtion skills B) mindfulness skills C) distress tolerance skills D) self-management skills

self-management skills

a nurse is assessing a client diagnosed with avoidant personality disorder. which of the following would the nurse most likely expect to find? select all that apply. a. shyness b. feelings of inadequacy c. feelings of superiority d. perfectionism e. detail oriented

shyness feelings of inadequacy

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

social isolation R/T inability to relate to others Rationale: 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 unsociable.

the nurse is caring for a client with schizoid personality trait. when developing the plan of care for the client, which of the following would the nurse most likely include? a. social skills training b. anger management training c. relaxation techniques d. coping skills training

social skills training

a nurse is caring for a client who has borderline personality disorder, the client says, "the nurse on the evening shift is always nice! you are the meanest nurse ever." the nurse should recognize the clients statement as an example of which of the following defense mechanisms? a. regression b. splitting c. undoing d. identification

splitting

Blake is a 15 yr old patient admitted for emergency observation after stealing a car and being pulled over by the police for reckless driving. He also as a history of pyromania. Which of the following is the priority assessment? a. Illegal behaviors in the past 6 months b. Assessment of childhood development and family interactions c. Suicide risk d. Feelings of remorse

suicide risk

a nurse is developing a teaching plan for a client with an impulse-control disorder. the nurse is planning to explain the emotional aspects associated with the behavior as part of the plan. Which of the following would the nurse describe as occurring first before the individual commits the act? a. remorse b. tension c. regret d. pleasure

tension

A nurse would expect a client diagnosed with schizotypal personality disorder to exhibit which characteristic? A. The client keeps to self and has few, if any relationships. 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.

the client experiences incorrect interpretations of external events Rationale: 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.

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.

the client experiences inflexibility and lack of spontaneity when dealing with others Rationale: 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, formal, and have difficulty expressing emotions. They are perfectionistic and preoccupied with rules.

a group of nursing students is reviewing information about antisocial personality disorder. the students demonstrate understanding of this disorder when they state which of the following? a. the disorder occurs more frequently in women b. the individual must be at least 18 years of age c. the disorder is found primarily in Asian individuals d. alcohol abuse disorder rarely accompanies this disorder

the individual must be at least 18 years of age

The problem that is most likely to occur when a nurse sets unrealistically high goals for an antisocial patient is A. the nurse becomes frustrated and angry with the patient when goals are not met. B. the nurse adopts various acting out behaviors used by the patient. C. the patient's acting out behaviors intensify in response to frustration over inability to meet the expectations of others. D. the patient experiences anger and directs it inward

the nurse becomes frustrated and angry with the patient when goals are not met Rationale: Change comes slowly even when appropriate goals are set with the patient. When goals are unattainable, staff become discouraged or frustrated with lack of progress. Regarding option 2, when a nurse adopts the behaviors used by an antisocial patient, it is not related to lack of progress toward goals. Regarding option 3, the antisocial patient is usually uncaring about the opinions of others. Regarding option 4, antisocial patients act out feelings, instead of turning them inward.

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 evoke 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

the use of suicidal gestures to evoke a rescue response from others Rationale: The nurse should expect that a client diagnosed with borderline personality disorder might use suicidal gestures to evoke a rescue response from others. Repetitive, self-mutilative behaviors are common in clients diagnosed with borderline personality disorders. These behaviors are generated by feelings of abandonment following separation from significant others.

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 frustrate the development of relationships."

their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs Rationale: The instructor should evaluate that learning has occurred when the student describes clients diagnosed with histrionic personality disorder as having shallow, fleeting interpersonal relationships that serve their dependency needs. Histrionic personality disorder is characterized by colorful, dramatic, and extroverted behavior. These individuals also have difficulty maintaining long-lasting relationships.

Which characteristics should a nurse recognize as being exhibited by individuals diagnosed with any personality disorders? 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.

these clients accept and are comfortable with their altered behaviors Rationale: 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.

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

to reduce inflexibility of personality traits that interfere with functioning and relationships Rationale: 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.

a nurse is reading an article about a young girl who developed gastrointestinal symptoms from a hair ball because of a ritual that she engaged in. the girl would pull out hair over several hours to relieve tension an anxiety and then eat her hair. the nurse most likely is reading an article about which of the following? a. kleptomania b. trichtotillomania c. pyromania d. intermittent explosive disorder

trichotillomania

after a power outage, a facility must serve a dinner of sandwiches and fruit to patients. which comment is most likely from a patient diagnosed with a narcissistic personality disorder? a. these sandwiches are probably contaminated with bacteria b. I suppose its the best we can hope for under these circumstances c. you should have ordered a to go meal from a local restaurant for me d. I would rather wait to eat until the dietary department can prepare a meal

you should have ordered a to go meal from a local restaurant for me

The nurse is caring for a client diagnosed with borderline personality disorder. The nurse has instructed the client about using the communication triad. The nurse determines that the client has understood this technique when he states which of the following? A) ​I should start by stating my feelings as an 'I' statement.​ B) Maybe I should start by describing the situation that has me upset.​ C) ​I should first tell the other person what I'd like to be different about the situation.​ D) ​I should begin by telling the other person what has triggered my emotion.​

​I should start by stating my feelings as an 'I' statement.​

Alicia, a 31 yr old pt, is flirting with a peer. She is overheard asking him to convince staff to giver her privileges to leave the unit. Later she offer you a backrub in exchange for a Xanax. Which responses are most therapeutic. Select all that apply a. Label the behaviorr as undesirable, and explore with Alicia more effective ways to meet her needs b. By role-playing, ,demonstrate other approaches Alicia could use to meet her needs c. Advise the other pts that Alicia is being manipulative and that they should ignore her when she behaves this way d. Bargain with Alicia to determine a reasonable compromise regarding how much of such behavior is acceptable before she crosses the line e. Explain that such behavior is unacceptable, and give her specific examples of consequences f. Ignore the behavior for the time being so Alicia will find it unrewarding and in turn seek other, and hopefully more adaptive, ways to meet her needs

-Label the behavior as undesirable, and explore with Alicia more effective ways to meet her needs -By role-playing, ,demonstrate other approaches Alicia could use to meet her needs -Explain that such behavior is unacceptable, and give her specific examples of consequences

A patient becomes frustrated and angry when trying to get is dvd player and headset to function properly and angrily throws it across the room, nearly hitting a peer with it. Which interventions would be the most therapeutic? Select all that apply a. Place the pt in seclusion for 1 hour to allow him to deescalate b. Tall the pt that any further outbursts will result in a loss of privileges c. Offer to help the pt learn how to operate his music player and headset d. Explore with the pt how he was feeling as he worked with the music player e. Point out the consequence of such behavior and not that is cannot be tolerated f. Limit the pts exposure to frustrating experiences until he attains improved coping skills g. Encourage the pt to recognize signs of mounting tension and seek assistance

-Place the pt in seclusion for 1 hour to allow him to deescalate -Explore with the pt how he was feeling as he worked with the music player -Point out the consequence of such behavior and not that is cannot be tolerated -Encourage the pt to recognize signs of mounting tension and seek assistance

Which statements represent positive outcomes for clients diagnosed with narcissistic personality disorder? (Select all that apply.) A. The client will relate one empathetic statement toward another client in group by day 2. B. The client will identify one personal limitation by day 1. C. The client will acknowledge one strength that another client possesses by day 2. D. The client will list four personal strengths by day 3. E. The client will list two lifetime achievements by discharge.

-The client will relate one empathetic statement toward another client in group by day 2. -The client will identify one personal limitation by day 1 -The client will acknowledge one strength that another client possesses by day 2. Rationale: 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. An exaggerated sense of self-worth, a lack of empathy, and exploitation of others are characteristics of narcissistic personality disorder.

a nurse is assisting with a court ordered evaluation of a client who has antisocial personality disorder. which of the following findings should the nurse expect? select all that apply. a. demonstrates extreme anxiety when placed in a social situation b. has difficulty making even simple decisions c. attempts to convince other clients to give him their belongings d. becomes agitated if his personal area is not neat and orderly e. blames others for his past and current problems

-attempts to convince other clients to give him their belongings -blames others for his past and current problems

a nurse is developing a plan of care for a client diagnosed with an antisocial personality disorder who has been admitted to the inpatient psychiatric unit. which of the following would the nurse most likely include? select all that apply. a. developing a therapeutic relationship b. bargaining about the unit rules c. holding the client responsible for behavior d. discouraging client from discussing thoughts e. using a firm, lecture-like approach for teaching

-developing a therapeutic relationship -holding the client responsible for behavior

a charge nurse is preparing a staff education session on personality disorders. which of the following personality characteristics associated with all of the personality disorders should the charge nurse include in the teaching? select all that apply. a. difficulty in getting along with other members of a group b. belief in the ability to become invisible during times of stress c. display of defense mechanisms when routines are changed d. claiming to be more important than other persons e. difficulty understanding why it is inappropriate to have a personal relationship with staff

-difficulty in getting along with other members of a group -display of defense mechanisms when routines are changed -difficulty understanding why it is inappropriate to have a personal relationship with staff

Which individual would most likely be diagnosed with intermittent explosive disorder? A. A client diagnosed with antisocial personality disorder who attacks the nursing staff B. A client diagnosed with diabetes mellitus who has a history of multiple severe assaultive acts C. A client diagnosed with schizophrenia who sets fires because of command hallucinations D. A client diagnosed with alcohol dependence who severely beats wife while intoxicated

A client diagnosed with diabetes mellitus who has a history of multiple severe assaultive acts

The nurse has explained some of the biologic theories of causation to a client diagnosed with borderline personality disorder and his family. The nurse determines that the client and family have understood the instructions when they state which of the following? A) ​The disorder may be caused by increased serotonin activity.​ B) ​The disorder is caused by decreased dopamine activity in my brain.​ C) ​A frontal lobe dysfunction may be causing this condition.​ D) A decrease in hormonal substances increases the risk for this illness.​

A frontal lobe dysfunction may be causing this condition.​

When planning limit setting for a manipulative patient, which of the following steps would be omitted: A. Establishing realistic limits B. Making sure limits are enforceable C. Making patient aware of limits and consequences of violating limits D. Allowing staff to use own judgment in event the patient exceeds limits

Allowing staff to use own judgment in event the patient exceeds limits Rationale: When a plan for limit setting is established, all staff must be committed to follow the plan implicitly.

Which of the following behaviors would the nurse expect to observe while interacting with a 43-year-old woman diagnosed with narcissistic personality disorder? A. Attention seeking B. Empathy towards others C. Lack of trust in others D. Labile affect

Attention seeking Rationale: Patients with narcissistic personality disorder are grandiose and display a constant need for admiration from others. 2. Patients with narcissistic personality disorder display little empathy. 3. It is patients with schizoid personality disorder for whom trust is a major issue. 4. Labile affect is more prominent in patients with borderline personality disorder.

A client has unsuccessful relationships that are very intense and then they end. The client finds being alone unbearable. The client describes all of this in dramatic terms and indicates that relationships end in some dramatic event. What type of personality disorder does this client likely exhibit? A)Antisocial personality disorder. B)Schizoid personality disorder. C)Borderline personality disorder. D)Narcissistic personality disorder.

Borderline personality disorder

Which statement is most accurate about describing personality disorders? A) People with personality disorders are unable to experience painful feelings. B) Behavior is sporadic with no particular pattern. C) These disorders usually develop during the toddler stage. D) Clients view their problems as separate from themselves.

Clients view their problems as separate from themselves

A nurse wishing to assess a patient's interpersonal relationships would obtain most data by asking: A. "How would you describe yourself?" B. "Describe your relationship with friends." C. "Do you have any persistent worries?" D. "Tell me about any strange or unusual things that have ever happened to you."

Describe your relationship with friends

A nurse is assessing a client with borderline personality disorder. Which question would be most appropriate to assess the client's level of impulsivity? A) ​What things bother you and make you feel happy? ​B) Have you ever felt sorry after acting as you did on the spur of the moment?​ C) ​How do you view other people around you? ​D) ​Have you ever felt like you were separated from your body?​

Have you ever felt sorry after acting as you did on the spur of the moment?​

During an interview, which client statement indicates to a nurse that a potential diagnosis of schizotypal personality disorder should be considered? A. "I really don't have a problem. My family is inflexible, and every relative is 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."

I am getting a message from the beyond that we have been involved with each other in a previous life Rationale: The nurse should assess that a client who states that he or she is getting a message from the 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 individual experiences magical thinking, ideas of reference, illusions, and depersonalization as part of daily life.

The nurse in the outpatient psychiatric clinic is meeting in a room with a client. Without warning, another client diagnosed with antisocial personality disorder comes into the room and sits down. Which of the following responses by the nurse is MOST appropriate? a. "If you sit quietly, you may stay in the room." b. "Is there something that you need?" c. "How do you feel about another client joining us?" d. "I am talking with this client. Please return to the waiting room."

I am talking with this client. please return to the waiting room Rationale: sets limits on behavior in a nonjudgmental way

a nurse is interviewing a client and suspects that the client may have narcissistic personality disorder. which client statement would help support the nurse's suspicions? a. I have a very important position in life; everyone I know wants to be like me. b. my wife is poisoning my food so she can get rid of me and marry her boss c. I like to work alone because then I can let my thoughts wander. d. I'm always the life of the party, making new friends all the time

I have a very important position in life; everyone I know wants to be like me

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

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

The nurse interviews a client about his relationship with his wife. Which statement would be most characteristic of the thinking of an individual with an antisocial personality? A) "I've done some stupid things in my life, but I always learn my lesson." B) "I'm feeling awful about the way I've hurt my family." C) "I have a quick temper, but I can usually keep it under control." D) "I hit her because she nags at me. She deserves it, whenever I beat her up."

I hit her because she nags at me. She deserves it, whenever I beat her up

A family member of a client with a borderline personality disorder tells the nurse, "I am so glad she is finally in treatment. We can get this problem solved." What is the best response for the nurse to make? A) "Yes, getting into treatment is important." B) "I hope the treatment goes well, but these problems are not going away. Adaptation will be critical." C) "After I tell you the problems that are important, I will lay out a treatment plan for you." D) "Medication will make a big difference and in no time you will see big differences."

I hope the treatment goes well, but these problems are not going away. Adaptation will be critical

a nurse manager is discussing the care of a client who has a personality disorder with a newly licensed nurse. which of the following statements by the newly licensed nurse indicates an understanding of the teaching? a. I can promise my clients sense of control by establishing a schedule b. I should encourage clients who have a schizoid personality disorder to increase socialization c. I should practice limit setting to help prevent client manipulation d. I should implement assertiveness training with clients who have antisocial personality disorder

I should practice limit setting to help prevent client manipulation

During an assessment interview, a client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions. Which is the most appropriate nursing statement to address 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?"

I understand that you are angry, but this behavior will not be tolerated Rationale: The appropriate nursing statement 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. Antidepressants and anxiolytics are used for symptom relief; however, there are no specific medications targeted for the diagnosis of a personality disorder.

a nurse is caring for a client who has avoidant personality disorder. which of the following statements is expected from a client who has this type of personality disorder? a. I'm scared that you're going to leave now b. I'll go to group therapy if you'll let me smoke c. I need to feel that everyone admires me d. I sometimes feel better if I cut myself

I'm scared that you're going to leave now

The nurse sets limits in a therapeutic manner by doing which of the following? A) Identifying limits in a clear manner without apologizing B) Negotiating limits appropriate for the individual client C) Providing various reasons that limits are important D) Substituting persuasive statements for specific limits

Identifying limits in a clear manner without apologizing

Which of the following would the nurse expect to observe in a patient diagnosed with schizotypal personality disorder? A. Brief psychotic episodes in response to stress B. Intense, stormy relationships C. Incorrect interpretation of external events D. Lack of tender feelings toward others

Incorrect interpretation of external events Rationale: Incorrect interpretation of external events and a belief that all events refer to the self are typical of patients with schizotypal personality disorder. 1. This is more often seen with schizoid disorder. 2. This is more often seen with borderline personality disorder. 4. This would be seen in paranoid personality disorder.

A client diagnosed with antisocial personality disorder comes to a nurses' station at 11:00 p.m. requesting to phone a lawyer to discuss filing for a divorce. The unit rules state that no phone calls are permitted after 10:00 p.m. Which nursing reply 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. "The decision to divorce should not be considered until you have had a good night's sleep."

It is after the 10:00 pm phone curfew. You will be able to call tomorrow. Rationale: The most appropriate response by the staff is to restate the unit rules in a calm, assertive manner. Because of the probability of manipulative behavior in this client population, it is imperative to maintain consistent application of rules.