Personality Disorders

A nurse is caring for a client who has borderline personality disorder. The client has previously identified another nurse as his favorite, stating, "He's the best nurse ever." When the nurse calls in sick, which of the following statements indicates that the client is using splitting as a method of coping? a. "He's the worst nurse that's ever taken care of me." b. "You're just lying to me. He's not really sick." c. "He's my favorite nurse, and I'm really worried about him." d. "If anyone else tries to take care of me, II'm going to get really upset."

a. "He's the worst nurse that's ever taken care of me."

A nurse is assisting with a court-ordered evaluation of 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 me." b. "I'll go to group therapy if you'll let me smoke." c. "I need to feel that everyone that admires me." d. "I sometimes feel better if I cut myself."

a. "I'm scared that you're going to leave me."

A nurse is caring for a client with obsessive-compulsive disorder (OCD) who has been taking fluoxetine for 3 months. The client states, "This medication isn't working. I want to stop taking it." Which of the following responses should the nurse make? a. "It is best to discontinue the medication slowly over 1 to 2 months." b. "If the medication hasn't helped you in 3 months, it's not going to." c. "You will likely gain weight if you stop taking the medication." d. "This medication is the only treatment available for your condition."

a. "It is best to discontinue the medication slowly over 1 to 2 months."

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 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

a. Difficulty in getting along with other members of a group c. Display of defense mechanisms when routines are changed e. Difficulty understanding why it is inappropriate to have a personal relationship with staff

A nurse is evaluating the plan of care for a client who has antisocial personality disorder. Which of the following actions indicate that the client is making progress with the treatment? (Select all that apply.) a. Helping another client who has depression fill out a menu b. Nominating himself to chair the client government meeting c. Requesting a weekend pass to go home d. Serving as the judge for a unit talent show e. Informing the nurse that the staff provides excellent care to clients

a. Helping another client who has depression fill out a menu c. Requesting a weekend pass to go home

Jack is a new client on the psychiatric unit with a diagnosis of Antisocial Personality Disorder. Which of the following characteristics would you expect to assess in Jack? a. Lack of guilt for wrongdoing b. Insight into his own behavior c. Ability to learn from past experiences d. Compliance with authority

a. Lack of guilt for wrongdoing

A nurse in a mental health facility is admitting a client who has antisocial personality disorder. Which of the following behaviors should the nurse expect the client to exhibit? a. Lack of remorse b. Self-mutiliation c. Delusional behavior d. Splitting

a. Lack of remorse

Which of the following behavioral patterns is a characteristic of individuals with narcissistic personality disorder? a. Overly self-centered and exploitative of others b. Suspicious and mistrustful of others c. Rule conscious and disapproving of change d. Anxious and socially isolated

a. Overly self-centered and exploitative of others

Kim, a client diagnosed with BPD, manipulates the staff in an effort to fulfill her own desires. All of the following may be examples of manipulative behaviors in the borderline client except: a. Refusal to stay in room alone, stating, "It's so lonely." b. Asking Nurse Jones for cigarettes after 30 minutes, knowing the assigned nurse has explained she must wait 1 hour. c. Stating to Nurse Jones, "I really like having you for my nurse. You're the best one around here." d. Cutting arms with razor blade after discussing dismissal plans with physician.

a. Refusal to stay in room alone, stating, "It's so lonely."

A nurse is caring for a client who has borderline personality disorder. Which of the following manifestations should the nurse expect? a. Self-mutilation b. Submission c. Exploitation of others d. Reclusive behavior

a. Self-mutilation

A nurse is observing a client who has histrionic personality disorder. Which of the following behaviors should the nurse expect? a. The client whispers in the provider's ear b. The client refuses to provide her telephone number c. The client has diminished facial expressions d. The client asks if she is doing the right thing 3 times during the appointment

a. The client whispers in the provider's ear

Which of the following behavioral patterns is characteristic of individuals with schizotypal personality disorder? a. Belittling themselves and their abilities b. A lifelong pattern of social withdrawal c. Suspicious and mistrustful of others d. Overreacting inappropriately to minor stimuli

b. A lifelong pattern of social withdrawal

"Splitting" by the client with BPD denotes: a. Evidence of precocious development b. A primitive defense mechanism in which the client sees objects as all good or all bad c. A brief psychotic episode in which the client loses contact with reality d. Two distinct personalities within the borderline client

b. A primitive defense mechanism in which the client sees objects as all good or all bad

A nurse is admitting a client who has antisocial personality disorder to an acute care unit. The client is admitted under a court order following the theft and destruction of a car. Which of the following behaviors should the nurse expect the client to display? a. Relief about finally receiving care b. Anger with the nursing staff for hospitalizing him against his will c. Withdrawal from others due to shame over his recent actions d. Remorse for stealing and destroying the car

b. Anger with the nursing staff for hospitalizing him against his will

A nurse is caring for a client who has antisocial personality disorder. Which of the following actions should the nurse take? a. Encourage the client to attend assertive behavior sessions b. Ensure staff members set limits on the client's behavior c. Tell the client to increase socialization on the unit d. Frequently implement measures to increase the client's self-esteem

b. Ensure staff members set limits on the client's behavior

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 client's statement as an example of which of the following defense mechanisms? a. Regression b. Splitting c. Undoing e. Identification

b. Splitting

Milieu therapy is a good choice for clients with antisocial personality disorder because it: a. provides a system of punishment and rewards for behavior modification b. emulates a social community in which the client may learn to live harmoniously with others c. provides mostly one-to-one interaction between the client and therapist d. provides a very structured setting in which the clients have very little input into the planning of their care

b. emulates a social community in which the client may learn to live harmoniously with others

A nurse manager is discussing the care of a client who has 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 promote my client's 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."

c. "I should practice limit-setting to help prevent client manipulation."

A nurse is caring for a client who has obsessive-compulsive disorder and feels compelled to pace the floor for a specific number of times each day or "something bad will happen." Which of the following responses should the nurse make? a. "Nothing terrible is going to happen to you. Please stop this behavior." b. "Are you seeking attention with this behavior?" c. "It may help if we talked about why you find it necessary to pace the floor." d. "Are you pacing to work off excess energy?"

c. "It may help if we talked about why you find it necessary to pace the floor."

A nurse is caring for a client who has antisocial personality disorder. The client uses manipulation to gain access to a smoking area form which his access has been limited as a behavioral intervention. Which of the following statements should the nurse make? a. "You know you shouldn't use the smoking area." b. "You know that manipulation is not the right thing to do." c. "Let's review the consequences of your actions." d. "I can talk with the provider about reducing your smoking restriction.:

c. "Let's review the consequences of your actions."

A nurse in a long-term mental health facility is caring for a client who has a personality disorder. The client has a broken unit rule, and phone privileges are being revoked consequently. The client asks the nurse, "Can I just make one more phone call?" Which of the following responses should the nurse make? a. "No, you can't. Go sit in your room." b. "Okay, if you promise to obey the rules for the rest of the day.: c. "No you can't. You have broken rules that apply to everyone." d. "You can make a single 5-minute phone call."

c. "No you can't. You have broken rules that apply to everyone."

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. Often engages in magical thinking c. Attempts to convince other clients to relinquish their belongings d. Becomes agitated if personal area is not neat and orderly e. Blames others for personal past and current problems

c. Attempts to convince other clients to relinquish their belongings e. Blames others for personal past and current problems

A nurse is caring for a client who has obsessive-compulsive disorder. Which of the following actions should the nurse take first? a. Encourage the client to verbalize her feelings b. Teach the client relaxation techniques c. Determine the client's anxiety level d. Role-play problem-solving behaviors with the client

c. Determine the client's anxiety level

A nurse is caring for a client with borderline personality disorder who has been engaging in self-mutilation. The nurse should encourage the client to participate in which of the following groups? a. Co-dependents support group b. National Alliance on Mental Illness c. Dialectical behavior treatment group d. Dual diagnosis treatment group

c. Dialectical behavior treatment group

A nurse is creating a plan of care for a client who has borderline personality disorder and exhibits manipulative behaviors. Which of the following interventions should the nurse include to address limit-setting? a. Teach the client to use reaction formation for behavior control b. Recommend the client attend assertiveness training c. Establish and explain consequences for the client's behavior d. Encourage the client to increase socialization

c. Establish and explain consequences for the client's behavior

A nurse is caring for a client with borderline personality disorder (BPD) who exhibits a pattern of behavior of playing a staff member against another. Which of the following actions should the nurse take? a. Have the same staff members work with the client on a long-term basis b. Sit down and listen to the client's feelings about other staff members c. Explore with the client his use of clinging and distancing behaviors d. Arrange for the client to share complaints regarding staff members with the nursing supervisor

c. Explore with the client his use of clinging and distancing behaviors

A nurse is planning care for a client with borderline personality disorder who self-mutilates. Which of the following treatment approaches should the nurse plan to take? a. Restrict participation in group therapy sessions b. Establish consequences for self-mutilation c. Maintain close observation of the client d. Provide an unstructured environment

c. Maintain close observation of the client

In evaluating the progress of Jack, a client diagnosed with antisocial personality disorder, which of the following behaviors would be considered the most significant indication of positive change? a. Jack got angry only once in group this week b. Jack was able to wait a whole hour for a cigarette without verbally abusing the staff c. On his own initiative, Jack sent a note of apology to a man he had injured in a recent fight d. Jack stated that he would no longer start any more fights

c. On his own initiative, Jack sent a note of apology to a man he had injured in a recent fight

A nurse on a mental health unit is caring for a client who has antisocial personality disorder and is becoming increasingly loud and belligerent. Which of the following approaches should the nurse use to manage this client's behavior? a. Confront the client for breaking the rules b. Stand near the client to offer comfort and support c. Speak to the client with clear, calm, caring statements d. Escort the client to the nurses' station

c. Speak to the client with clear, calm, caring statements

A nurse on an acute mental health unit is assessing a client who has obsessive-compulsive disorder (OCD). Which of the following behaviors should the nurse expect? a. Being intentionally dishonest b. Jumping rapidly between topics of conversation c. Tapping 4 sides of a light switch d. Mimicking the movements of another person

c. Tapping 4 sides of a light switch

A nurse is caring for a client who has borderline personality disorder and is expressing a concern about needing prolonged hospitalization. Which of the following responses should the nurse make? a. "You should focus on getting better right now." b. "Why do you think you'll be hospitalized for a long time?" c. "All of your needs will be taken care of while you are in the hospital." d. "Tell me what concerns you the most about being hospitalized."

d. "Tell me what concerns you the most about being hospitalized."

A nurse is preparing to meet with a client who has borderline personality disorder. Which of the following actions should the nurse plan to take during the working phase of the therapeutic relationship? a. Introduce the concept of client confidentiality b. Establish goals with the client c. Define the roles of the nurse and client d. Facilitate a change in the client's behavior

d. Facilitate a change in the client's behavior

A nurse is caring for a client who has borderline personality disorder. The nurse enters the client's room and finds the client cutting into his flesh with a paper clip. After providing first aid, which of the following actions should the nurse perform? a. Encourage the client to discuss feelings about his self-injurious behavior during group therapy b. Fill out an incident report for risk management about the client's self-injurious behavior c. Document the client's self-injurious behavior in his medical record d. Identify the client's feelings that led to self-injurious behavior

d. Identify the client's feelings that led to self-injurious behavior

Kim has a diagnosis of borderline personality disorder. She often exhibits alternating clinging and distancing behaviors. The most appropriate nursing intervention with this type of behavior would be to: a. Encourage Kim to establish trust in one staff person, with whom all therapeutic interaction should take place. b. Secure a verbal contract from Kim that she will discontinue these behaviors. c. Withdraw attention if these behaviors continue. d. Rotate staff members who work with Kim so that she will learn to relate to more than one person.

d. Rotate staff members who work with Kim so that she will learn to relate to more than one person.

A nurse is working with a client who exhibits extreme superstition, elaborate speech patterns, and eccentric behavior. The nurse should identify these features as which of the following personality disorders? a. Paranoid b. Histrionic c. Antisocial d. Schizotypal

d. Schizotypal

Jessica is a nurse who was floated to the psychiatric unit to cover for a staff nurse who called out sick. She encounters a patient who is diagnosed with BPD, and the patient states, "Thank goodness they sent you to the unit. No one else here has taken the time to listen to my concerns." This may be an example of which symptom common in BPD? a. Impulsivity b. Self-harming behaviors c. Dissociation d. Splitting

d. Splitting