Personality Disorder Adaptive Quizzing

Which response would the nurse make to a client with borderline personality disorder who receives the wrong tray for lunch and becomes upset at the dietary staff regarding this mistake? 1. "Getting angry is wrong; your behavior must stop." 2. "Yelling is unacceptable and will only get you placed in seclusion." 3. "You have to eat the first tray of food; then I'll get another tray for you." 4. "It must be frustrating to get the wrong tray. I'll order another tray for you."

"It must be frustrating to get the wrong tray. I'll order another tray for you."

Which best response would the nurse make to a client with antisocial personality disorder who asks, "Can I have your phone number so I can call you for a date"? 1. "We are not permitted to date clients." 2. "It is against my professional ethics to date clients." 3. "I'm glad you like me, but I can't give out my phone number." 4. "Our relationship is professional; therefore, I will not see you socially."

"Our relationship is professional; therefore, I will not see you socially."

Which discharge instructions would the nurse include in teaching parents how to respond to their child with antisocial personality disorder who has unruly behavior? 1. "Discuss the behavior with your child and encourage the development of self-control." 2. "Avoid setting expectations for behavior and react to each situation as it arises." 3. "Help your child find new friends and encourage finding a job and assuming personal responsibility." 4. "Set clear limits, explain the consequences if your child disregards them, and firmly and consistently apply them."

"Set clear limits, explain the consequences if your child disregards them, and firmly and consistently apply them."

Which response would the nurse expect from a client with antisocial personality disorder? 1. "I need a lot of help with my troubles." 2. "Society makes people follow rules that don't apply to me." 3. "This might help me straighten out my life." 4. "I don't like to be around other people for long periods of time."

"Society makes people follow rules that don't apply to me." The antisocial client is incapable of accepting responsibility for self-created problems and blames society for the behavior. An admission that the client needs a lot of help or that the therapy may help the client straighten out demonstrates insight, and these individuals rarely develop insight into their problems. An antisocial personality disorder does not mean the client doesn't like being around other people; it means the client does not like society's rules and laws (antisocial) and these rules and laws do not apply to him or her.

Which response would the nurse make to a client with antisocial personality disorder who kisses the nurse and shouts, "I like you"? 1. "Thank you. I like you, too." 2. "I wish you wouldn't do that." 3. "Don't ever touch me like that again. I don't like it." 4. "Your behavior is inappropriate. Don't do that again."

"Your behavior is inappropriate. Don't do that again." Telling the client that this behavior is inappropriate and instructing the client not to do it again accepts the client while rejecting and setting limits on the behavior the client is using. Thanking the client encourages this type of behavior instead of setting limits. Saying that the nurse wishes the client wouldn't do that or telling the client not to touch the nurse like that again makes it appear that it is the nurse's preference, not the client's behavior, that is the issue.

Which personality traits are exhibited in a client who has a diagnosis of borderline personality disorder? Select all that apply. One, some, or all responses may be correct. 1. Engaging 2. Indecisive 3. Withdrawn 4. Manipulative 5. Perfectionistic

1. Engaging 4. Manipulative Clients with borderline personality disorders initially tend to be engaging and to establish intense relationships. They may be manipulative because they are opinionated and want people to conform to their agendas. These clients are often decisive and opinionated, have a pronounced intolerance for being alone, and are usually quite social. These clients are not perfectionists.

Which factors would the nurse find in the client history of a young college student with borderline personality disorder? Select all that apply. One, some, or all responses may be correct. 1. Impulsiveness 2. Lability of mood 3. Ritualistic behavior 4. Psychomotor retardation 5. Self-destructive behavior

1. Impulsiveness 2. Lability of mood 5. Self-destructive behavior

Which behavior would the nurse identify that a client with histrionic personality disorder is displaying when after being refused a sleeping pill, the client throws a book at the nurse? 1. Exploitive 2. Acting out 3. Manipulative 4. Reaction formation

Acting out The client is acting out. Acting out is the process of expressing feelings behaviorally. The action is not exploitive, because no evidence is provided to demonstrate that anyone has been used to get what the client wants. The action is not manipulative, because no evidence is provided to demonstrate that anyone has been influenced against his or her wishes. The action is not disguising unacceptable feelings by expressing opposite emotions (reaction formation).

Which action would the nurse take for a client with borderline personality disorder? 1. Provide an unstructured environment to promote self-expression. 2. Be firm, consistent, and understanding while focusing on specific target behaviors. 3. Use an authoritarian approach, because this type of client needs to learn to conform to the rules of society. 4. Record but ignore marked shifts in mood, suicidal threats, and temper displays because these are attention-seeking behaviors.

Be firm, consistent, and understanding while focusing on specific target behaviors. The nurse would be firm, consistent, and understanding while focusing on specific target behaviors. Consistency, limit-setting, and supportive confrontation are essential nursing interventions designed to provide a secure, therapeutic environment for clients with borderline personality disorder. To be therapeutic, the environment needs structure, and the staff must help the client set short-term goals for behavioral changes. The use of an authoritarian approach will increase anxiety in this type of client, resulting in feelings of rejection and withdrawal. Ignoring the client's behavior is nontherapeutic and may reinforce underlying fears of abandonment.

A client with a personality disorder alternately clings to the nurse and then distances him- or herself. Which interpretation would the nurse make about the client's fears? 1. Client fears embarrassment and shame 2. Client fears losing self-esteem and respect 3. Client fears abandonment and rejection 4. Client fears interdependence and connection

Client fears abandonment and rejection

Which assessment finding would the nurse observe in a client who has schizoid personality disorder? 1. Rigid and controlling 2. Dependent and submissive 3. Detached and socially distant 4. Superstitious and socially anxious

Detached and socially distant

Which behavior would indicate a client with antisocial personality disorder who is facing criminal charges for stealing money from work is meeting treatment outcomes? 1. Expression of feelings of resentment toward the employer 2. Discussion of plans for each of the possible outcomes of a trial 3. Expression of resignation about difficult relationships with coworkers 4. Discussion of the decision to file a grievance against the employer after discharge from the hospital

Discussion of plans for each of the possible outcomes of a trial A behavior that the client is meeting treatment outcomes is the discussion of plans for each of the possible outcomes of a trial. If the client can realistically examine the possible outcomes of the trial, then some benefit has been gained from the therapy. Expressing resentment toward the employer does not indicate the client is meeting treatment outcomes. Expressing resignation about difficult relationships with coworkers does not show improvement or insight. Deciding to file a grievance indicates unrealistic planning and does not demonstrate the development of insight or the ability to meet treatment outcomes. The client is still blaming other for mistakes and decisions made by the client.

Which behavior is typical for antisocial personality disorder? 1. Sexual acting out 2. Disregard for others 3. Loss of contact with reality 4. Compulsive, repetitive behaviors

Disregard for others Clients with antisocial personality disorder usually have a history of interpersonal difficulties. They are unable to engage in the give-and-take a relationship requires because of their consistent disregard for and exploitation of others. There is no direct relationship between antisocial personality disorders and sexual acting out. Loss of contact with reality is not characteristic for the personality disorders. Compulsive behaviors are associated with obsessive-compulsive disorder.

Which behavior would the nurse expect from a client with borderline personality disorder? 1. Act out to intimidate others. 2. Cooperate with the staff to gain praise. 3. Divide the staff into opposing factions to gain self-esteem. 4. Remain removed from others to avoid interacting with them.

Divide the staff into opposing factions to gain self-esteem. The nurse would expect the client to divide the staff into opposing factions to gain self-esteem. Attempts at dividing the staff are expected, because the resulting effect creates a feeling of power and control. These individuals usually act out to discharge anxiety rather than to intimidate others. Usually they comply or cooperate to prevent a feeling of abandonment rather than to gain praise. Although these clients may occasionally withdraw from others, they cannot remain removed from others because of their impulsiveness and manipulation. They like the intense interaction

Which intervention is best for a client who has a borderline personality disorder? 1. Establishing clear boundaries 2. Exploring vocational possibilities 3. Discussing feelings of being victimized 4. Spending 1 to 2 hours per day with the client

Establishing clear boundaries

Which approach would the nurse take when a client with borderline personality disorder states that the nurse is uncaring after the nurse sets limits? 1. Help the client identify feelings. 2. Increase the client's limits on privileges. 3. Avoid the client until the hostility is resolved. 4. Advise the client how to approach people differently.

Help the client identify feelings.

Which client behavior would support the nurse's conclusion that actions directed toward modifying the behavior of a client with antisocial personality disorder has been successful? 1. Promises never to take drugs again 2. States will only steal if out of money 3. Recognizes the need to socialize more 4. Identifies feelings underlying acting-out behavior

Identifies feelings underlying acting-out behavior

Which behavior is most typical for clients with borderline personality disorder? 1. Arrogant 2. Eccentric 3. Impulsive 4. Dependent

Impulsive Impulsive, potentially self-damaging behaviors are typical of clients with this personality disorder. Arrogance is associated with a narcissistic personality disorder. Eccentric behavior is more typical of the client with a schizotypal personality disorder.

Which approach would the nurse use for a client with a narcissistic personality disorder who insists on leaving the group to get an autograph from a baseball player after the game? 1. Holding the client by the arm to keep the client from leaving the group 2. Instructing the client in a loud voice to get on the bus so the group can go home 3. Informing the client in a matter-of-fact tone that everyone must remain with the group 4. Telling the client that the baseball player will not be permitted to give anyone an autograph

Informing the client in a matter-of-fact tone that everyone must remain with the group

Which characteristic would the nurse observe in an adult who has schizotypal personality disorder? 1. Rigid and controlling 2. Submissive and immature 3. Arrogant and attention seeking 4. Introverted and emotionally withdrawn

Introverted and emotionally withdrawn A client with schizotypal personality disorder is introverted and emotionally withdrawn. These clients usually display social inadequacy and lack of emotional contact with others. Rigid and controlling behaviors reflect an obsessive-compulsive personality disorder. Submissive and immature behaviors reflect a dependent personality disorder. Arrogant and attention-seeking behaviors reflect a narcissistic personality disorder.

For a client with the diagnosis of borderline personality disorder, which problem is most likely to underlie angry or hostile behavior? 1. Low self-esteem 2. Inability to test reality 3. Reaction to command hallucination 4. Ineffective verbal communication

Low self-esteem The client has low self-esteem and reacts by using hostile behavior. People with borderline personality disorder often have identity disturbances. Reality testing and hallucinations are psychotic features that do not accompany personality disorders. Impaired verbal communication can be related to organic causes, such as stroke or dementia, or to thought disturbances, such as schizophrenia.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), which behaviors describe an individual with a cluster A personality disorder? 1. Odd and eccentric 2. Anxious and fearful 3. Dramatic and erratic 4. Hostile and impulsive

Odd and eccentric Cluster A includes paranoid, schizoid, and schizotypal personality disorders. These clients are odd and eccentric and use strange speech and have impaired relationships. Cluster C includes avoidant, dependent, and obsessive-compulsive personality disorders. These clients are anxious, fearful, tense, and rigid. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. These clients are dramatic, erratic, labile, impulsive, hostile, and manipulative

Which parameter would the nurse assess for in a client with borderline personality disorder and possible depression who has a history of self-abusive, acting-out behavior? 1. Degree of anger 2. Potential for suicide 3. Level of intelligence 4. Ability to test reality

Potential for suicide

Which nursing intervention would be essential for a client with antisocial personality disorder who is admitted to the mental health hospital? 1. Encouraging interactions with others 2. Presenting a united, consistent staff approach 3. Assuming a nurturing, forgiving tone in disputes 4. Using seclusion when manipulative behaviors are exhibited

Presenting a united, consistent staff approach The essential nursing intervention is to present a united, consistent staff approach. Clients with an antisocial personality disorder are experts in manipulation and exploitation; they may ignore rules and divide staff members. These clients do not need to be encouraged to interact with other people, because they are forward in their approach to others. A nurturing, forgiving tone will foster and worsen manipulation, not decrease it. Seclusion is an overreaction to manipulative behaviors; it implies punishment, which is not productive. Seclusion is used only when the client may injure the self or others.

Which nursing intervention would be most important for a client who has the diagnosis of antisocial personality disorder? 1. Teaching and modeling assertiveness 2. Using a gentle and reassuring approach 3. Providing clear boundaries and consequences 4. Presenting an empathetic and democratic approach

Providing clear boundaries and consequences

Which personality disorder would the nurse suspect in a client telling a rambling, lengthy, unclear, and overly detailed story about their dog, who they say is the president? Select all that apply. One, some, or all responses may be correct. 1. Schizoid 2. Paranoid 3. Histrionic 4. Borderline 5. Narcissistic 6. Schizotypal

Schizotypal

A client with the diagnosis of borderline personality disorder has a history of suicidal behavior and self-mutilation. Which rationale best explains the self-mutilation? 1. The client uses self-mutilation to control others. 2. Self-mutilation is an expression of anger or frustration. 3. The client is trying to convey feelings of autonomy. 4. The behavior is used to manipulate family and friends.

Self-mutilation is an expression of anger or frustration. Typically, recurrent self-mutilation is an expression of intense anger, helplessness, or guilt or is a form of self-punishment. Self-mutilation is used not to control others, but rather for self-validation; also, it is a means of blocking psychological pain by inducing physical pain. Expression of autonomy and manipulation are not the purposes of self-destructive behaviors.

Which intervention will the nurse use for a client diagnosed with borderline personality disorder to develop healthier coping mechanisms? 1. Provide a stress-free environment. 2. Encourage healthy relationships with peers. 3. Allow the client to take responsibility for decisions. 4. Set realistic limits on maladaptive behavior.

Set realistic limits on maladaptive behavior.

Which intervention would be important when caring for a client who was admitted yesterday with borderline personality disorder (BPD)? 1. Setting limits 2. Offering advice 3. Being an attentive listener 4. Encouraging group activities

Setting limits

A client, diagnosed with borderline personality disorder, declares that the whole staff is "bad" after being disappointed by one staff member. Which defense mechanism is the client using? 1. Splitting 2. Rationalization 3. Undoing 4. Reaction formation

Splitting Splitting is the compartmentalization of opposite-affect states and failure to integrate the positive and negative aspects of self or others. Rationalization is justifying an illogical behavior by creating a plausible explanation. Undoing is making up for an action. Reaction formation is the expression of unacceptable desires by adopting opposite behaviors in an exaggerated way.

Which response would the nurse make to a client with a borderline personality disorder who cries bitterly and pounds the bed in frustration after a conference with the primary health care provider? 1. Leave the client for a short period and wait until the client regains control. 2. Pat the client reassuringly on the back and say, "I know that it's hard to bear." 3. Ask about the client's troubles and answer, "Other people also have problems." 4. Stay with the client and listen attentively if the client wishes to talk about the problem.

Stay with the client and listen attentively if the client wishes to talk about the problem. The nurse would stay with the client and listen attentively if the client wishes to talk about the problem. Sitting with the client indicates acceptance and demonstrates that the nurse believes the client is worthy of the nurse's time. It is better to stay with the client quietly until control is regained; staying prevents the outburst from escalating. Patting the client reassuringly on the back and saying, "I know that it's hard to bear" provides little comfort for the client; touching should be used judiciously in this instance. Asking about the client's troubles and answering, "Other people also have problems" may close off further communication and belittles the client's problems

Which characteristic would the nurse observe in a client with antisocial personality disorder? 1. Suffers from extreme anxiety 2. Rapidly learns by experience if punished 3. Usually is unable to postpone gratification 4. HAs a great sense of responsibility toward others

Usually is unable to postpone gratification Clients with antisocial personality disorder lack judgment and self-control and are unable to postpone gratification. These individuals tend to be self-centered and impulsive. They do not suffer from anxiety. These individuals believe that the rules do not apply to them, and they do not profit from their mistakes or from punishment. These people are too self-centered to have a sense of responsibility to anyone but themselves.

Which consistent approach would the nurse use for a client with an antisocial personality disorder? 1. Warm and firm without being punitive 2. Indifferent and detached but nonjudgmental 3. Conditionally acquiescent to client demands 4. Clearly communicative of personal disapproval

Warm and firm without being punitive The nurse would be warm and firm without being punitive. The client needs positive relationships with other adults, but clear, consistent limits must be presented to minimize attempts at manipulation. Acting indifferent and detached but nonjudgmental is not a therapeutic approach. Being indifferent and detached gives the impression that the nurse does not care. Being conditionally acquiescent to client demands is not a therapeutic approach because clear, consistent limits are necessary to prevent manipulation. Being clearly communicative of personal disapproval is a judgmental attitude that should be avoided.

Upon hearing the news that the nurse is leaving for vacation in 2 weeks, which response by a client with borderline personality disorder would indicate the client's ability to maintain a more mature relationship has progressed? 1. States, "I need to get well enough by then, so I can leave, too." 2. Wishes the nurse a safe trip and offers thanks for the help received 3. Responds, "I guess you leaving is just another loss I'll have to adjust to." 4. Informs the nurse that there is no sense in waiting and that the relationship can be ended today

Wishes the nurse a safe trip and offers thanks for the help received Wishing the nurse a safe trip and offering thanks for the help received demonstrates the client's acceptance of the professional role of the nurse, as well as the ability to end dependent relationships. The response "I need to get well enough by then, so I can leave, too" shows an inability to relate to other staff members involved with the client's care. The response "I guess you leaving is just another loss I'll have to adjust to" still shows the existence of manipulation on the client's part. Informing the nurse that there is no sense in waiting and that the relationship can be ended today shows a childish need to punish the nurse for leaving and is typical when the client with borderline personality disorder has not progressed.

Which assessment finding would the nurse observe in a client who has been found to have an antisocial personality disorder? 1. Pays great attention to detail and demonstrates a high level of anxiety 2. Has scars from self-mutilation and a history of many negative relationships 3. Displays charm, has an above-average intelligence, and tends to manipulate others 4. Demonstrates suspiciousness, avoids eye contact, and engages in limited conversation

Displays charm, has an above-average intelligence, and tends to manipulate others The nurse would observe charm, above-average intelligence, and manipulation of others. A client with an antisocial personality disorder is charming on first contact, but this charm is a manipulative ploy. These clients usually are bright and use their intelligence for self-gain. Paying great attention to detail and demonstrating a high level of anxiety are traits of an individual with an obsessive-compulsive personality disorder. The client with a borderline personality disorder self-mutilates when under stress; there is a fear of abandonment, so any relationship is better than no relationship. Demonstrating suspiciousness, avoiding eye contact, and engaging in limited conversation resembles the behavior of an individual with a paranoid personality, which includes suspiciousness and lack of trust.

Which characteristic of clients with antisocial personality disorder would the nurse consider when planning care? 1. Engages in many rituals 2. Is a perfectionist 3. Exhibits lack of empathy for others 4. Possesses limited communication skills

Exhibits lack of empathy for others Exhibits lack of empathy for others is a characteristic of clients with antisocial personality disorder. Clients with obsessive-compulsive disorder, not antisocial personality disorder, engage in rituals. Clients with obsessive-compulsive personality disorder are perfectionists. Self-satisfaction is of paramount concern to people with antisocial personality disorder, and they have little or no concern (empathy) for others. Individuals with antisocial personality disorder do not possess limited communication skills. They are usually charming on the surface and can easily con people into doing what they want.

Which behavior would the nurse observe in a client who has a histrionic personality disorder? 1. Boastful and egotistical 2. Rigid and perfectionistic 3. Extroverted and dramatic 4. Aggressive and manipulative

Extroverted and dramatic Clients with a histrionic personality disorder are extroverted and dramatic. Clients with histrionic personality disorder draw attention to themselves, are vain, and demonstrate emotionality and attention-seeking behavior. Boastful and egotistical behaviors are typical of clients with the diagnosis of narcissistic personality disorder. Rigid and perfectionistic behaviors are typical of clients with the diagnosis of obsessive-compulsive personality disorder. Aggressive and manipulative behaviors are typical of clients with the diagnosis of antisocial personality disorder.

Which action would the nurse take for a client with borderline personality disorder who receives the wrong meal tray and angrily states, "The next time I see the dietician, I'm going to throw this tray at her"? 1. Suggest that the client calm down while explaining that sometimes trays get mixed up. 2. Teach the client that the behavior is inappropriate while sending the client out of the dining room. 3. Tell the client that it is frustrating not to get the correct tray but that throwing the tray at the dietician is unacceptable behavior. 4. Inform the client that throwing the tray at the dietician will make matters worse and may result in the client being placed in seclusion.

Tell the client that it is frustrating not to get the correct tray but that throwing the tray at the dietician is unacceptable behavior. The nurse would tell the client that it is frustrating not to get the correct tray but that throwing the tray at the dietician is unacceptable behavior. Validating the client's frustration and correcting the behavior are the most appropriate responses; safety is a priority. Suggesting that the client calm down while explaining that sometimes trays get mixed up does not validate the client's feelings. Sending the client out of the room without offering support and direction is not an appropriate nursing response. Threatening seclusion is an inappropriate nursing intervention; seclusion is always the last resort and should not be used as a threat.