Personality Disorders Practice Questions (Test #2, Fall 2020)

Peculiarities of ideation, appearance, and behavior and deficits in interpersonal relationships is to schizotypal personality disorder as a pervasive pattern of excessive emotionality and attention-seeking behavior is to: 1. Borderline personality disorder. 2. Histrionic personality disorder. 3. Paranoid personality disorder. 4. Passive-aggressive personality disorder.

Cluster A describes behaviors that are odd or eccentric, such as schizotypal personality disorder, which is characterized by peculiarities of ideation, appearance, and behavior and deficits in interpersonal relatedness that are not severe enough to meet the criteria for schizophrenia. 1. Borderline personality disorder is characterized by a marked instability in interpersonal relationships, mood, and self-image. 2. Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention-seeking behavior. 3. Paranoid personality disorder is characterized by a pervasive and unwarranted suspiciousness and mistrust of people. 4. Passive-aggressive personality disorder is characterized by a passive resistance to demands for adequate performance in occupational and social functioning. TEST-TAKING HINT: When answering an analogy question, it is important for the test taker to recognize the relationship of subject matter within the question. In this question, peculiarities of ideation, appearance, and behavior are the characteristics of schizotypal personality disorder

When teaching a nursing assistant new to the unit about the principles for the care of a client diagnosed with a personality disorder, the nurse should explain that: 1.The clients are accepted although their behavior may not be. 2.Clients need limits on their behavior. 3.The staff members are the primary ones left to care about these clients. 4.The staff should use minimal humor when working with these clients"

1 The most basic and important idea to convey to a client is that, as a person, he or she is accepted, although his or her behavior may not be. Empathy is conveyed for emotional pain regardless of the client's behavior. Although some clients need limits placed on their behavior, not all clients require limit setting. That the staff members are the primary ones left to care about these clients is not necessarily true, nor is it true that the staff should use very little humor with these clients. Clients who are rigid and perfectionists and who have a restricted affect may need help with displaying humor.

The nurse is talking with a client who has been diagnosed with antisocial personality disorder about how to socialize during activities without being seductive. The nurse should focus the discussion on which of the following areas? 1.Explaining the negative reactions of others toward his behavior. 2.Suggesting he apologize to others for his behavior. 3.Asking him to explain the reasons for his seductive behavior. 4.Discussing his relationship with his mother.

1 The nurse should explain the negative reactions of others toward the client's behaviors to make him aware of the impact of his seductive behaviors on others. Suggesting that the client apologize to others for his behavior is futile because the client cannot feel remorse for wrongdoing. Asking him to explain reasons for his seductive behavior is not helpful because this client is skillful at using projection and rationalization. Discussing his relationship with his mother is not helpful because the focus should be oriented to the present situation and managing his behavior at the present time.

A new client on the psychiatric unit has been diagnosed with depression and obsessive-compulsive personality disorder (OCPD). During visiting hours, her husband states to the nurse that he doesn't understand this OCPD and what can be done about it. What information should the nurse share with the client and her husband? Select all that apply. 1.Perfectionism and overemphasis on tasks usually interfere with friendships and leisure time. 2.It will help to interrupt her tasks and tell her you are going out for the evening. 3.There are medicines, such as clomipramine (Anafranil) or fluoxetine (Prozac) that may help. 4.Remind your wife that it is "OK" to be human and make mistakes. 5.Reinforce with her that she is not allowed to expect the whole family to be perfect too. 6.This disorder typically involves inflexibility and a need to be in control.

1, 3, 4, 6. Inflexibility, need to be in control, perfectionism, overemphasis on work or tasks, and a fear of making mistakes are common symptoms of OCPD. Anafranil and Prozac may help with the obsessive symptoms, Interrupting the client's tasks is likely to increase her anxiety even more. Telling her that she cannot expect the family to be perfect is likely to create a power struggle.

A client diagnosed with paranoid personality disorder is being admitted on an Immediate Detention Order (24-hour hold) after a physical altercation with a police officer who was investigating the client's threatening phone calls to his neighbors. He states that his neighbors are spying on him for the government. "I want them to stop and leave me alone. Now they have you nurses and doctors involved in their conspiracy." Which of the following nursing approaches are most appropriate? Select all that apply. 1.Approach the client in a professional, matter-of-fact manner. 2.Avoid intrusiveness in interactions with the client. 3.Gently present reality to counteract the client's current paranoid beliefs. 4.Develop trust consistently with the client. 5.Do not pressure the client to attend any groups.

1,2,4,5 A professional, matter-of-fact approach and developing trust are the most effective with this client. A friendly approach, intrusiveness, and attempting to counteract the client's beliefs will increase the client's paranoia; he will present more false beliefs to prove he is right about the conspiracy. In groups, questions from peers, confrontations with reality, and the emotionality will increase the client's anxiety.

When developing the plan of care for a client diagnosed with a personality disorder, the nurse plans to assist the client primarily with which of the following? 1.Specific dysfunctional behaviors. 2.Psychopharmacologic compliance. 3.Examination of developmental conflicts. 4.Manipulation of the environment.

1. The nurse should plan to assist the client who has a personality disorder primarily with specific dysfunctional behaviors that are distressing to the client or others. The client with a personality disorder has lifelong, inflexible, and dysfunctional patterns of relating and behaving. The client commonly does not view his behavior as distressful to himself. The client becomes distressed because of others' reactions and behaviors toward him, which cause the client emotional pain and discomfort. Psychopharmacologic compliance is not a primary need because medication does not cure a personality disorder. Medication is prescribed if the client has a severe symptom that interferes with functioning, such as severe anxiety or depression, or if the client has an Axis I disorder. Examination of developmental conflicts usually is not helpful because of the ingrained dysfunctional ways of thinking and behaving. It is more useful to help the client with changing dysfunctional behaviors. Although milieu management is a component of care, the client usually is proficient in manipulation of the environment to meet his needs.

Although there are differences among the three personality disorder clusters, there also are some traits common to all individuals diagnosed with personality disorders. Which of the following are common traits? Select all that apply. 1. Failure to accept the consequences of their own behavior. 2. Self-injurious behaviors. 3. Reluctance in taking personal risks. 4. Copes by altering environment instead of self. 5. Lack of insight.

1. A common trait among individuals diagnosed with a personality disorder is the failure to accept the consequences of their own behavior. Although these individuals can identify correct and appropriate behavior, they repeatedly avoid change and cling to patterns that meet their unhealthy needs. 2. Self-injurious behaviors, such as self-mutilation or cutting, are characteristics specific to borderline personality disorder. This trait is not commonly associated with other disorders. 3. Reluctance in taking personal risks or engaging in any new activities for fear of embarrassment is a particular trait seen in avoidant personality disorders. This trait is not commonly associated with other disorders. 4. A common trait among individuals diagnosed with a personality disorder is their response to stress. When feeling threatened, these individuals cope by attempting to change the environment instead of changing themselves. 5. A common trait among individuals diagnosed with a personality disorder is the lack of insight. These individuals lack understanding of the impact of their behaviors on others. TEST-TAKING HINT: To answer this question correctly, the test taker must note that the essential characteristics of personality disorders are pervasive, maladaptive, and chronic.

Which client situation requires the nurse to prioritize the implementation of limit setting? 1. A client making sexual advances toward a staff member. 2. A client telling a staff member that another staff member allows food in the bedrooms. 3. A client verbally provoking another patient who is paranoid. 4. A client refusing medications to receive secondary gains.

1. Although limit setting is needed, this situation does not pose a threat, and immediate limiting setting would not be indicated. 2. The client in this situation is attempting to "split" the staff. Although the nurse needs to set limits on the client's manipulative behavior, there is no potential physical threat, so limit setting in this situation does not take priority. 3. A paranoid client has the potential to strike out defensively if provoked. Because safety is the nurse's first concern, and this situation poses a physical threat, this situation takes priority and needs immediate intervention by the nurse. 4. Attention-seeking by refusing medications is a secondary gain that the nurse may want to address with the client. This situation presents no physical threat, however, and is not the nurse's immediate concern. TEST-TAKING HINT: When the word "prioritize" is used in a question, the test taker must pay

Which intervention describes an important component in the treatment of clients diagnosed with personality disorders? 1. Psychotropic medications are prescribed to reduce hospitalizations. 2. Self-awareness by the nurse is necessary to ensure a therapeutic relationship. 3. Group therapy, not individual therapy, is the preferred approach. 4. Addressing comorbid issues is not indicated

1. Although medications may be used to treat symptoms that clients diagnosed with personality disorders may experience, such as anxiety and depression, there are no specific medications that treat the disorders themselves. 2. Individuals diagnosed with personality disorders attempt to get their needs met in any way possible, including manipulation. It is critical for nurses working with clients diagnosed with personality disorders to be aware of and discuss their frustrations in order to be therapeutic with these clients. 3. Individual therapy assists clients diagnosed with personality disorders to recognize their underlying feelings and work toward being more aware of the effects of their behaviors. Manipulation may occur during group therapy, and this would need to be monitored closely. 4. If there is a comorbid issue, it is important to work with the individual holistically, addressing all concerns to get to the source of all problems. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that nurses working with clients diagnosed with personality disorders must be aware of their own feelings

A client newly admitted to an in-patient psychiatric unit is diagnosed with schizotypal personality disorder. The client states, "I can't believe you are not afraid of the monsters coming after us all." Which is the most appropriate nursing response? 1. "I don't know what monsters you are talking about." 2. "The monsters? Can you please tell me more about that?" 3. "I was wondering if you want to come to group to talk about that." 4. "I can see your thoughts are bothersome. How can I help?"

1. Although the nurse may want to assess the "monsters" further, the nurse would not ask a question that supports the monsters' existence. It is important for the nurse to make it clear that the monsters are not real before assessing further. 2. Asking the client to elaborate about the "monsters" allows the client to continue with the delusional thinking. The nurse would want to ask specific questions and then move on to assisting the client to deal with the uncomfortable feelings. 3. Asking the client to come to group to talk further about the "monsters" does not support the client's feelings and encourages the client to continue to talk about the delusion. 4. Acknowledging the client's feelings about the delusion is an important response. The nurse supports the client's feelings, but not the delusion. At the same time, the nurse explores ways to help the client feel comfortable. TEST-TAKING HINTS: To answer this question correctly, the test taker must remember that when a client is experiencing delusions or hallucinations it is important for the nurse to be empathetic about the feelings that occur because of altered thought processes. The nurse never wants to make statements that reinforce the delusions, however real they may be to the client.

A diabetic client admitted to a medical floor for medication stabilization has a history of antisocial personality disorder. Which documented behaviors would support this Axis II diagnosis? 1. "Labile mood and affect and old scars noted on wrists bilaterally." 2. "Appears younger than stated age with flamboyant hair and makeup." 3. "Began cursing when confronted with drug-seeking behaviors." 4. "Demands foods prepared by personal chef to be delivered to room."

1. Borderline personality disorder, not antisocial personality disorder, is characterized by a marked instability in interpersonal relationships, mood, and self-image. These clients also exhibit self-destructive behaviors, such as cutting. 2. Histrionic personality disorder, not antisocial personality disorder, is characterized by a pervasive pattern of excessive emotionality and attention-seeking behavior. In their attempt to be the center of attention, these clients also exhibit inappropriate sexual, seductive, or provocative behavior. 3. Antisocial personality disorder is characterized by a pattern of socially irresponsible, exploitive, and guiltless behavior. These clients disregard the rights of others and frequently fail to conform to social norms with respect to lawful behaviors. They are also deceitful, impulsive, irritable, and aggressive. 4. Narcissistic personality disorder, not antisocial personality disorder, is characterized by a constant need for attention; grandiose sense of self-importance; and preoccupations with fantasies of success, power, brilliance, and beauty. These clients have a sense of entitlement and unreasonable expectations of special treatment. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize characteristic behaviors that reflect various personality disorders.

A client diagnosed with a narcissistic personality disorder has a grandiose sense of self importance and entitlement. When confronted, the client states, "Contrary to what everyone believes, I do not think that the whole world owes me a living." This client is using what defense mechanism? 1. Minimization. 2. Denial. 3. Rationalization. 4. Projection.

1. Clients diagnosed with a narcissistic personality disorder may attempt to minimize problems brought about by their effect on others, but the situation described is not reflective of this defense mechanism. 2. Denial is used when a client refuses to acknowledge the existence of a real situation or associated feelings. When the client states, "I don't think the whole world owes me a living," denial is being used to avoid facing others' perceptions. 3. Rationalization is an attempt to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors. Clients diagnosed with narcissistic personality disorder often use this defense, but the situation described is not reflective of this defense mechanism. 4. When a client attributes unacceptable feelings or impulses to another person, the client is using the defense mechanism of projection. Clients diagnosed with narcissistic personality disorder often use this defense, but the situation described is not reflective of this defense mechanism. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand that although narcissistic individuals may use any effective defense mechanism, the client in this question is refusing to recognize others' perceptions. The test taker needs to study and recognize examples of the defense mechanism of denial. 5. Ego def

According to the DSM-IV-TR, which of the following diagnostic criteria define avoidant personality disorder? Select all that apply. 1. Does not form intimate relationships because of fear of being shamed or ridiculed. 2. Has difficulty making everyday decisions without reassurance from others. 3. Is unwilling to be involved with people unless certain of being liked. 4. Shows perfectionism that interferes with task completion. 5. Views self as socially inept, unappealing, and inferior.

1. Clients diagnosed with avoidant personality disorder show a pervasive pattern of social inhibitions, feelings of inadequacies, and hypersensitivity to negative evaluation, and find it difficult to form intimate relationships. 2. Clients diagnosed with dependent, not avoidant, personality disorder are unable to assume the responsibility for making decisions. They have problems with doing things on their own and have difficulties initiating projects. 3. Clients diagnosed with avoidant personality disorder are extremely sensitive to rejection and need strong guarantees of uncritical acceptance. 4. Clients diagnosed with obsessive-compulsive, not avoidant, personality disorder display a pervasive pattern of preoccupation with orderliness and perfectionism. The tendency to be rigid and unbending about rules and procedures often makes task completion a problem. 5. Although there may be a strong desire for companionship, a client with avoidant personality disorder has such a pervasive pattern of inadequacy, social inhibition, and withdrawal from life that the desire for companionship is negated. TEST-TAKING HINT: To answer this question correctly, the test taker should note that an individual diagnosed with an avoidant personality disorder is generally unwilling to get involved with another person unless certain of being liked.

A client diagnosed with borderline personality disorder is admitted to a psychiatric unit with recent self-inflicted cuts to both arms. Which of the following would explain this behavior? Select all that apply. 1. Self-mutilation is a manipulative gesture designed to elicit a rescue response. 2. Self-mutilation is often attempted when a "safety" plan has been established. 3. Self-mutilation proposes that feeling pain is better than feeling nothing. 4. Self-mutilation results from feelings of abandonment following separation from significant others. 5. Self-mutilation is attempted when voices tell the client to do self-harm

1. Clients diagnosed with borderline personality disorder often manipulate to attain desired goals. Self-mutilation can be a form of manipulation as well as an expression of underlying emotional pain. 2. Clients diagnosed with borderline personality disorder often build in a "safety" plan when attempting self-mutilation, such as superficial cutting and then asking the nurse for first aid. This is evidence that self-mutilation is not always an actual suicide attempt. 3. Clients diagnosed with borderline personality disorder often use self-mutilation in an attempt to feel physical rather than emotional pain. These clients describe the pain felt on self-mutilation as a relief and a release of emotional pain. 4. Clients diagnosed with borderline personality disorder fear abandonment, which is frequently part of their past history. The pain of being abandoned is intolerable, and the client seeks relief by experiencing the physical pain of self-mutilation. 5. Clients diagnosed with a borderline personality disorder do not hear voices unless diagnosed with a comorbid thought disorder, such as schizophrenia. Nothing in the question indicates this client is diagnosed with a comorbid illness. TEST-TAKING HINT: To answer this question correctly, the test taker must link the behavior noted in the question with characteristics of borderline personality disorder.

A client diagnosed with a personality disorder tells the nurse, "When I was a waiter I use to spit in the dinners of annoying customers." This statement would be associated with which personality disorder? 1. Paranoid personality disorder. 2. Schizoid personality disorder. 3. Passive-aggressive personality disorder. 4. Antisocial personality disorder.

1. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Clients diagnosed with paranoid personality disorder are characterized by a pervasive and unwarranted suspiciousness and mistrust of people. The characteristics of this disorder are not reflected in the question. 2. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Clients diagnosed with schizoid personality disorder are characterized by an inability to form close, personal relationships. The characteristics of this disorder are not reflected in the question. 3. Cluster C includes dependent, avoidant, obsessive-compulsive, and passive aggressive personality disorders. Clients diagnosed with passive-aggressive personality disorder are characterized by a passive resistance to demands for adequate performance in occupational and social functioning. The client in the question is demonstrating passive-aggressive characteristics toward customers the client finds annoying. 4. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. Clients diagnosed with antisocial personality disorder are characterized by a pattern of socially irresponsible, exploitive, and guiltless behaviors. The characteristics of this disorder are not reflected in the question. TEST-TAKING HINT: To answer this question correctly, the test taker must be able to link the behaviors noted in the question with the correct personality disorder.

A client diagnosed with a personality disorder states, "You are the very best nurse on the unit and not at all like that mean nurse who never lets us stay up later than 9 p.m." This statement would be associated with which personality disorder? 1. Borderline personality disorder. 2. Schizoid personality disorder. 3. Passive-aggressive personality disorder. 4. Paranoid personality disorder

1. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. Clients diagnosed with borderline personality disorder are characterized by a marked instability in interpersonal relationships, mood, and self-image. Clients with this disorder attempt to pit one individual against another. This is known as "splitting" and is related to an inability to integrate and accept positive and negative feelings. Splitting is a primitive ego defense mechanism that is common in individuals with borderline personality disorder. In the question, the client's statement typifies splitting behavior. 2. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Clients diagnosed with schizoid personality disorder are characterized by an inability to form close, personal relationships. The behaviors exhibited by the client presented are not associated with this personality disorder. 3. Cluster C includes dependent, avoidant, obsessive-compulsive, and passive-aggressive personality disorders. Clients diagnosed with passive-aggressive personality disorder are characterized by a passive resistance to demands for adequate performance in occupational and social functioning. This client is not displaying any features of a Cluster C disorder. 4. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Clients diagnosed with paranoid personality disorder are characterized by a pervasive and unwarranted suspiciousness and mistrust of people. The behaviors exhibited by the client described are not associated with this personality disorder. TEST-TAKING HINT: To answer this question correctly, the test taker first must recognize the behaviors in the question as splitting behaviors. Next, the test taker must understand that splitting behaviors are commonly seen in clients diagnosed with borderline personality disorder.

Personality disorders are grouped in clusters according to their behavioral characteristics. In which cluster are the disorders correctly matched with their behavioral characteristics? 1. Cluster C: antisocial, borderline, histrionic, narcissistic disorders; anxious or fearful characteristic behaviors. 2. Cluster A: avoidant, dependent, obsessive-compulsive disorders; odd or eccentric characteristic behaviors. 3. Cluster A: antisocial, borderline, histrionic, narcissistic disorders; dramatic, emotional, or erratic characteristic behaviors. 4. Cluster C: avoidant, dependent, obsessive-compulsive disorders; anxious or fearful characteristic behaviors.

1. Cluster B, not cluster C, consists of antisocial, borderline, histrionic, and narcissistic personality disorders. Being anxious or fearful is the correct description for clients diagnosed with a cluster C personality disorder. 2. Cluster C, not cluster A, includes avoidant, dependent, and obsessive-compulsive personality disorders. Cluster A consists of paranoid, schizoid, and schizotypal personality disorders, with characteristic behaviors described as odd or eccentric. 3. Cluster B, not cluster A, consists of antisocial, borderline, histrionic, and narcissistic personality disorders. These disorders are correctly described as dramatic, emotional, or erratic. 4. Cluster C includes avoidant, dependent, and obsessive-compulsive personality disorders. Some practitioners also include passive-aggressive personality disorder with cluster C. Anxious or fearful is the correct description for clients diagnosed with a cluster C personality disorder. TEST-TAKING HINT: To answer this question correctly, the test taker must review which personality disorders make up clusters A, B, and C and then the characteristic behaviors of clients diagnosed with these disorders. The test taker also must understand that when one part of the answer choice is incorrect, the whole answer choice is incorrect

After being treated in the ED for self-inflicted lacerations to wrists and arms, a client with a diagnosis of borderline personality disorder is admitted to the psychiatric unit. Which nursing intervention takes priority? 1. Administer tranquilizing drugs. 2. Observe client frequently. 3. Encourage client to verbalize hostile feelings. 4. Explore alternative ways of handling frustration.

1. Giving the client tranquilizing medications, such as anxiolytics or antipsychotics, may have a calming affect and reduce aggressive behavior, but it does not address the client's priority safety issue. Tranquilizing medications are considered a chemical restraint and would be used only when all other, less restrictive measures have been attempted. 2. The priority nursing intervention is to observe the client's behavior frequently. The nurse should do this through routine activities and interactions to avoid appearing watchful and suspicious. Close observation is required so that immediate interventions can be implemented as needed. 3. Encouraging the client to verbalize hostile feelings may help the client to come to terms with unresolved issues, but it does not address the client's priority safety need. 4. It is important to explore alternative ways of handling frustration, such as physical activities. Although this may relieve pent-up frustration, it does not address the client's priority safety need. TEST-TAKING HINT: To answer this question correctly, the test taker must note important words in the question, such as "priority." Physical safety

According to the DSM-IV-TR, which diagnostic criterion describes schizotypal personality disorder? 1. Neither desires nor enjoys close relationships, including being part of a family. 2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates. 3. Considers relationships to be more intimate than they actually are. 4. Exhibits behavior or appearance that is odd, eccentric, or peculiar.

1. Having no close relationship with either friends or family is described as a criterion for schizoid, not schizotypal, personality disorder. 2. Unjustified doubts and suspicions are often a principal aberration associated with paranoid, not schizotypal, personality disorder and is one of the seven DSM-IV-TR criteria for that disorder. Individuals with paranoid personality disorder are extremely oversensitive and tend to misinterpret even minute cues within the environment, magnifying and distorting them into thoughts of trickery and deception. Paranoid behaviors are not commonly associated with individuals diagnosed with schizotypal personality disorders. 3. Individuals diagnosed with histrionic, not schizotypal, personality disorder have a tendency to be self-dramatizing, attentionseeking, overly gregarious, and seductive. Because they have difficulty maintaining long-lasting relationships, they tend to exaggerate the intimacy of a relationship. In contrast, individuals diagnosed with schizotypal personality disorders are aloof and isolated and behave in a bland and apathetic manner. 4. Magical thinking and odd beliefs that influence behavior and are inconsistent with subcultural norms are defined as criteria for schizotypal personality disorder, which is often described as "latent schizophrenia." Clients with this diagnosis are odd and eccentric, but do not decompensate to the level of schizophrenia. TEST-TAKING HINT: To differentiate between schizotypal and schizoid personality disorders, the test taker should remember that clients diagnosed with schizotypal personality disorder typically are odd and eccentric, and clients diagnosed with schizoid personality disorder are void of close relationships.

A client diagnosed with antisocial personality disorder demands, at midnight, to speak to the ethics committee about the involuntary commitment process. Which nursing statement is appropriate? 1. "I realize you're upset; however, this is not the appropriate time to explore your concerns." 2. "Let me give you a sleeping pill to help put your mind at ease." 3. "It's midnight, and you are disturbing the other clients." 4. "I will document your concerns in your chart for the morning shift to discuss with the ethics committee."

1. In this situation, the nurse empathizes with the client's concerns and then sets limits on inappropriate behaviors in a matter-of-fact manner. 2. Offering a sleeping pill in this situation avoids the client's frustrations and the need to set limits on inappropriate behaviors. 3. "It's midnight and you are disturbing the other clients" is a judgmental response and does not deal with the client's concerns or the inappropriate behavior. 4. Documenting the client's concerns in the chart placates the client and avoids addressing the client's concerns directly. Here, the nurse is transferring responsibility to other staff members' versus dealing with the immediate situation. This interaction allows the client to split staff. TEST-TAKING HINT: To answer this question correctly, the test taker must remember that when setting limits on manipulative behaviors, the nurse always should give reasons for the limits and deal with the situation in a timely manner.

Which predisposing factor would be implicated in the etiology of paranoid personality disorder? 1. The individual may have been subjected to parental demands, criticism, and perfectionistic expectations. 2. The individual may have been subjected to parental indifference, impassivity, or formality. 3. The individual may have been subjected to parental bleak and unfeeling coldness. 4. The individual may have been subjected to parental antagonism and harassment

1. Individuals diagnosed with narcissistic, not paranoid, personality disorder most likely would be subjected to parental demands, criticism, and perfectionistic expectations. 2. Individuals diagnosed with schizotypal, not paranoid, personality disorder most likely would be subjected to parental indifference, impassivity, or formality. 3. Individuals diagnosed with schizoid, not paranoid, personality disorder most likely would be subjected to parental bleak and unfeeling coldness. 4. Individuals diagnosed with paranoid personality disorder most likely would be subjected to parental antagonism and harassment. These individuals likely served as scapegoats for displaced parental aggression and gradually relinquished all hope of affection and approval. They learned to perceive the world as harsh and unkind, a place calling for protective vigilance and mistrust. TEST-TAKING HINT: To answer this question, the test taker must study and understand the predisposing factors involved in personality disorders. The test taker also needs to understand that although personality disorders are diagnosed in adulthood, they usually begin in childhood and adolescence and often are rooted in parental behaviors and attitudes

Which scenario would the nurse expect to observe if the client were diagnosed with paranoid personality disorder? 1. The client sits alone at lunch and states, "Everyone wants to hurt me." 2. The client is irresponsible and exploits other peers in the milieu for cigarettes. 3. The client is shy and refuses to talk to others because of poor self-esteem. 4. The client sits with peers and allows others to make decisions for the entire group.

1. Individuals with paranoid personality disorder would be isolative and believe that others were out to get them. The scenario presented reflects a client diagnosed with this disorder. 2. Individuals with antisocial personality disorder, not paranoid personality disorder, would be irresponsible and try to exploit others in the milieu. 3. Individuals with avoidant, not paranoid, personality disorder would be shy and refuse to talk with others because of poor self-esteem. 4. Individuals with dependent, not paranoid, personality disorder would sit with peers and allow others to make decisions for the entire group. TEST-TAKING HINT: To answer this question correctly, the test taker needs to review the signs and symptoms of the different personality disorders and be able to recognize them in various scenarios.

A client diagnosed with antisocial personality disorder is observed smoking in a nonsmoking area. Which initial nursing intervention is appropriate? 1. Confront the client about the behavior. 2. Tell the client's primary nurse about the situation. 3. Remind all clients of the no smoking policy in the community meeting. 4. Teach alternative coping mechanisms to assist with anxiety.

1. It is important to address an individual's behavior in a timely manner to set appropriate limits. Limit setting is to be done in a calm, but firm, manner. A client diagnosed with antisocial personality disorder may have no regard for rules or regulations, which necessitates limit setting by the nurse. 2. Limit setting needs to be applied immediately, by all staff members, to avoid client manipulation and encourage responsible and appropriate behaviors. 3. Although the nurse may want to remind all clients about unit rules, the word "initial" makes this answer incorrect. Initially, the nurse needs to confront the behavior. 4. The word "initial" makes this answer incorrect. Addressing inappropriate or testing behaviors must be a priority to bring into the client's awareness the consequences of inappropriate actions. The nurse should follow-up limit setting at a later time with constructive discussions regarding the cause and effects of inappropriate behaviors. TEST-TAKING HINT: The test taker must note important keywords in the question, such as "initial," "priority," or "most important." These words assist the test taker to determine the correct answer.

A nurse is discharging a client diagnosed with narcissistic personality disorder. Which employment opportunity is most likely to be recommended by the treatment team? 1. Home construction. 2. Air traffic controller. 3. Night watchman at the zoo. 4. Prison warden.

1. The flexibility and mobility of construction work, which uses physical versus interpersonal skills, may be best suited for a client diagnosed with antisocial personality disorder. These clients tend to exploit and manipulate others, and construction work would provide less opportunity for the client to exhibit these behaviors. A client diagnosed with narcissistic personality disorder would not be suited for this job. 2. Individuals with obsessive-compulsive personality disorder are inflexible and lack spontaneity. They are meticulous and work diligently and patiently at tasks that require accuracy and discipline. They are especially concerned with matters of organization and efficiency and tend to be rigid and unbending about rules and procedures, making them, and not the client described in the question, good candidates for the job of air traffic controller. 3. Clients diagnosed with schizoid personality disorder are unable to form close, personal relationships. These clients are comfortable with animal companionship, making a night watchman job at the zoo an ideal occupation. A client diagnosed with narcissistic personality disorder would not be suited for this job. 4. Individuals diagnosed with narcissistic personality disorder have an exaggerated sense of self-worth and believe they have an inalienable right to receive special consideration. They tend to exploit others to fulfill their own desires. Because they view themselves as "superior" beings, they believe they are entitled to special rights and privileges. Because of the need to control others inherent in the job of prison warden, this would be an appropriate job choice for client diagnosed with narcissistic personality disorder. TEST-TAKING HINT: To answer this question correctly, the test taker must be familiar with the characteristics of the various personality disorders and how these traits would affect employment situations

According to the DSM-IV-TR, which of the following diagnostic criteria define borderline personality disorder? Select all that apply. 1. Arrogant, haughty behaviors or attitudes 2. Frantic efforts to avoid real or imagined abandonment. 3. Recurrent suicidal and self-mutilating behaviors. 4. Unrealistic preoccupation with fears of being left to take care of self. 5. Chronic feelings of emptiness.

1. This criterion describes narcissistic, not borderline, personality disorder, which is characterized by a pervasive pattern of grandiosity (in fantasy or behavior), a need for admiration, and a lack of empathy for others. 2. This criterion describes borderline personality disorder, which is characterized by a pervasive pattern of instability of interpersonal relationships. Real or imagined feelings of abandonment are the first criterion of this disorder. 3. Recurrent suicidal and self-mutilating behavior is the fifth DSM-IV-TR diagnostic criterion that describes borderline personality disorder. 4. This criterion describes dependent, not borderline, personality disorder, which is characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior. 5. Chronic feelings of emptiness are the seventh DSM-IV-TR diagnostic criterion that describes borderline personality disorder. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that all four disorders in cluster B may have many characteristics that overlap; however, each cluster has at least one defining characteristic. In the case of borderline personality, feelings of abandonment, self-mutilating behavior, and feelings of emptiness are the key components of this disorder.

Using interpersonal theory, which statement is true regarding development of paranoid personality disorder? 1. Studies have revealed a higher incidence of paranoid personality disorder among relatives of clients with schizophrenia. 2. Clients diagnosed with paranoid personality disorder frequently have been family scapegoats and subjected to parental antagonism and harassment. 3. There is an alteration in the ego development so that the ego is unable to balance the id and superego. 4. During the anal stage of development, the client diagnosed with paranoid personality disorder has problems with control within his or her environment.

2 1. Biological, not interpersonal, theory attributes a higher incidence of paranoid personality disorder to relatives of clients with schizophrenia. 2. An example of an interpersonal theory of development might involve a client whose background reflects parental emotional abuse to the extent that paranoid personality disorder eventually will be diagnosed. 3. Intrapersonal, not interpersonal, theory would discuss the alteration in the ego development and the inability to balance the id and superego. 4. Intrapersonal, not interpersonal, theory would discuss alterations in the anal stage of development. TEST-TAKING HINT: "Intrapersonal" theory and "interpersonal" theory are sometimes confused. To answer this question correctly, the test taker can best differentiate these terms by thinking of the comparison between "interpersonal" and "interstate" (an "interstate" is a road between states, and "interpersonal" is between two persons). "Intrapersonal" means existing or occurring within one person's mind or self.

A client diagnosed with borderline personality disorder ingratiatingly requests diazepam (Valium). When the emergency department physician refuses, the client becomes angry and demands to see another physician. What defense mechanism is the client using? 1. Undoing. 2. Splitting. 3. Altruism. 4. Reaction formation.

2 Ego defenses are either adaptive or pathological. They can be grouped into the following four categories: mature defenses, neurotic defenses, immature defenses, and psychotic defenses. 1. The defense mechanism of undoing is the symbolic negation or cancellation of thoughts or experiences that one finds intolerable. The only thing that the manipulative client in the question finds intolerable is the physician who refuses to give the requested drug. 2. The client in the question is using the defense mechanism of splitting. An individual diagnosed with borderline personality disorder sees things as either "all good" or "all bad." In the question, when the client's manipulative charm does not work in obtaining the drug from the "good" physician, the client determines that the physician is now "bad" and seeks another physician to meet his or her needs. 3. The defense mechanism of altruism is considered a mature defense and is used when emotional conflicts and stressors are dealt with by meeting the needs of others. The client in the question is meeting no one else's needs but his or her own. 4. The defense mechanism of reaction formation prevents unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating the opposite thoughts or types of behaviors. The client in the question does not perceive his or her thoughts or behaviors as either unacceptable or problematic and is not exaggerating the opposite behavior. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize the behavior in the question as pathological. In understanding this, the test taker can eliminate answer "3" immediately.

The nurse assesses a client to be at risk for self-mutilation and implements a safety contract with the client. Which of the following client behaviors indicate that the contract is working? 1.The client withdraws to his room when feeling overwhelmed. 2.The client notifies staff when anxiety is increasing. 3.The client suppresses his feelings when angry. 4.The client displaces his feelings onto the primary health care provider.

2 For the client who is at risk for self-mutilation, the nurse develops a contract to assist the client with assuming responsibility for his behavior and to help the client develop adaptive methods of coping with feelings. Self-mutilation is usually an expression of intense anxiety, anger, helplessness, or guilt or a means to block psychological pain by inducing physical pain. A typical contract helpful to the client would have the client notify staff when anxiety is increasing. Withdrawing to his room when feeling overwhelmed, suppressing feelings when angry, or displacing feelings onto the primary health care provider is not an adaptive method to help the client deal with his feelings and could still result in self-mutilation.

The client with diagnosed borderline personality disorder tells the nurse, "You're the best nurse here. I can talk to you and you listen. You're the only one here that can help me." Which of the following responses by the nurse is most therapeutic? 1."Thank you; you're a good person." "All of the nurses here provide good care." 3."Other clients have told me that too." 4."Mary and Sam are good nurses too.

2 The most therapeutic response is, "All of the nurses here provide good care." This statement corrects the client's unrealistic and exaggerated perception. "Splitting," defined as the inability to integrate good and bad aspects of an individual and the self, is a hallmark behavior of a client with borderline personality disorder. The client sees himself and others as all good or all bad. Components of "splitting" include behaviors that idealize and devalue others. It is a defense that allows the client to avoid pain and feelings associated with past abuse or a current situation involving the threat of rejection or abandonment. The other statements promote the client's idealistic view and do nothing to help correct the client's distortion.

A client with an Axis II diagnosis of antisocial personality disorder has a potential for violence and aggressive behavior. Which of the following client outcomes to be accomplished in the short term is most appropriate for the nurse to include in the plan of care? 1.Use humor when expressing anger. 2.Discuss feelings of anger with staff. 3.Ask the nurse for medication when upset. 4.Use indirect behaviors to express anger.

2 The nurse assists the client with identifying and putting feelings into words during one-to-one interactions. This helps the client express her feelings in a nonthreatening setting and avoid directing anger toward other clients. A client with an antisocial personality disorder needs to understand how others feel and react to her behaviors and why they react the way they do. The client also needs to understand the consequences of her behaviors. Using humor or indirect behaviors to express anger is a passive-aggressive method that will not help the client learn how to express her anger appropriately. Asking the nurse for medication when upset is a way to avoid dealing with feelings and is not helpful. However, medication may be necessary if talking and engaging in a physical activity have not been effective in lowering anxiety or if the client is about to lose control of her behavior.

Which of the following approaches is most appropriate to use with a client diagnosed with a narcissistic personality disorder when discrepancies exist between what the client states and what actually exists? 1.Limit setting. 2.Supportive confrontation. 3.Consistency. 4.Rationalization.

2 The nurse would specifically use supportive confrontation with the client to point out discrepancies between what the client states and what actually exists to increase responsibility for self. Limit setting and consistency also may be used. However, limit setting helps the client control unacceptable behavior and consistency helps reduce the frequency of negative behaviors; they do not point out discrepancies. Rationalization is typically used by the client, not the nurse, to blame others, make excuses, and provide alibis for self-centered behaviors

A client diagnosed with paranoid personality disorder is hospitalized for physically threatening his wife because he suspects her of having an affair with a coworker. Which of the following approaches should the nurse employ with this client? 1.Authoritarian. 2.Parental. 3.Matter-of-fact. 4.Controlling.

3 For this client, the nurse needs to use a calm, matter-of-fact approach to create a nonthreatening and secure environment because the client is experiencing problems with suspiciousness and trust. Use of "I" statements and responses would be therapeutic to reduce the client's suspiciousness and increase his trust in the staff and the environment. An authoritarian approach is nontherapeutic and inappropriate because the client may perceive this approach as an attack, subsequently responding with anger and threatening behavior. A parental or controlling approach may be perceived as authoritarian, and the client may become defensive and angry.

The client who has a history of using angry outbursts when frustrated begins to curse at the nurse during an appointment after being informed that she will have to wait to have her medication refilled. Which of the following responses by the nurse is most appropriate? "1."You're being very childish." 2."I'm sorry if you can't wait." 3."I will not continue to talk with you if you curse." 4."Come back tomorrow and your medication will be ready."

3 Stating, "I will not continue to talk with you if you curse," sets limits on the client's behavior and points out the negative effects of her behavior. Therefore, this response is most appropriate and therapeutic. The statement, "You're being very childish," reprimands the client, possibly causing the anger to escalate. The statement, "I'm sorry if you can't wait," fails to provide feedback to the client about her behavior. The statement, "Come back tomorrow and your medication will be ready," ignores the client's behavior, failing to provide feedback to the client about the behavior. It also shows poor nursing judgment because the client may need her medication before tomorrow or may not return to the clinic the following day.

A client has been diagnosed with Avoidant Personality Disorder. He reports loneliness, but has fears about making friends. He also reports anxiety about being rejected by others. In designing a long-term treatment plan, in what order, from first to last, should the nurse include the following? 1. Teach the client anxiety management and social skills. 2. Ask the client to join one of his chosen activities with the nurse and two other clients. 3. Talk with the client about his self-esteem and his fears. 4. Help the client make a list of small group activities at the center he would find interesting.

3,1,4,2 The client needs a stepwise plan for developing a social life. He needs to first work on his self-esteem and reduce his fears of rejection before talking about how to decrease his anxiety and learning new social skills. Helping him chose interesting activities is important before suggesting an activity for him. Then he will be ready to try a structured activity with the nurse present for support and role modeling.

A client diagnosed with borderline personality disorder has self-inflicted cuts on her arms. The nurse is assessing the client for the risk of suicide. What should the nurse ask the client first? 1.About medications she has taken recently. 2.If she is taking antidepressants. 3.If she has a suicide plan. 4.Why she cut herself.

3. . The client is at risk for suicide, and the nurse should determine how serious the client is, including if she has a plan and the means to implement the plan. While medication history may be important, the nurse should first attempt to determine suicide risk. Asking the client why she cut herself will likely cause the client to respond with insufficient information to determine suicide risk

When assessing a client diagnosed with histrionic personality disorder, the nurse might identify which characteristic behavior? 1. Odd beliefs and magical thinking. 2. Grandiose sense of self-importance. 3. Preoccupation with orderliness and perfection. 4. Attention-seeking flamboyance.

4 1. Clients diagnosed with schizotypal, not histrionic, personality disorder exhibit odd beliefs and magical thinking that influence behavior and are inconsistent with subcultural norms (e.g., belief in clairvoyance, telepathy, or "sixth sense"). These clients present with a pervasive pattern of social and interpersonal deficits marked by acute discomfort with close relationships. 2. Clients diagnosed with narcissistic, not histrionic, personality disorder are preoccupied with fantasies of unlimited success, brilliance, beauty, or ideal love. Through a grandiose sense of self, this individual expects to be recognized as superior without commensurate achievements. 3. Clients diagnosed with obsessive-compulsive, not histrionic, personality disorder have a pervasive pattern of preoccupation with orderliness, perfection, and mental and interpersonal control at the expense of flexibility, openness, and efficiency. 4. Clients diagnosed with histrionic personality disorder have a pervasive pattern of excessive emotionality and attentionseeking behaviors. These individuals are uncomfortable in situations in which they are not the center of attention and have a style of speech that is excessively impressionistic and lacking in detail. TEST-TAKING HINT: To answer this question correctly, the test taker must pair characteristic behaviors with various personality disorders. For a client diagnosed with histrionic personality disorder, it may assist the test taker to remember, "Life is a stage, and they are the director."

The client diagnosed with borderline personality disorder who is to be discharged soon threatens to "do something" to herself if discharged. The nurse should first: 1.Request that the client's discharge be canceled. 2.Ignore the client's statement because it's a sign of manipulation. 3.Ask a family member to stay with the client at home temporarily. 4.Discuss the meaning of the client's statement with her."

4 Any suicidal statement must be assessed by the nurse. The nurse should discuss the client's statement with her to determine its meaning in terms of suicide, overwhelming feelings of anxiety, abandonment, or other need that the client cannot express appropriately. It is not uncommon for a client with borderline personality disorder to make threatening comments before discharge. Extending the hospital stay is inappropriate because it would encourage dependency and manipulation. Ignoring the client's statement on the assumption that it is a sign of manipulation is an error in judgment. Asking a family member to stay with the client temporarily at home is not appropriate and places the responsibility for the client on the family instead of the client.

28-year-old client with an Axis I diagnosis of major depression and an Axis II diagnosis of dependent personality disorder has been living at home with very supportive parents. The client is thinking about independent living on the recommendation of the treatment team. The client states to the nurse, "I don't know if I can make it in an apartment without my parents." The nurse should respond by saying to the client: 1."You're a 28-year-old adult now, not a child who needs to be cared for." 2."Your parents won't be around forever. After all, they are getting older." 3."Your parents need a break, and you need a break from them." 4."Your parents have been supportive and will continue to be even if you live apart."

4 Some characteristics of a client with a dependent personality are an inability to make daily decisions without advice and reassurance and the preoccupation with fear of being alone to care for oneself. The client needs others to be responsible for important areas of his life. The nurse should respond, "Your parents have been supportive of you and will continue to be supportive even if you live apart," to gently challenge the client's fears and suggest that they may be unwarranted. Stating, "You're a 28-year-old adult now, not a child who needs to be cared for," or "Your parents need a break, and you need a break from them," is reprimanding and would diminish the client's self-worth. Stating, "Your parents won't be around forever; after all they are getting older," may be true, but it is an insensitive response that may increase the client's anxiety

The client tells the nurse at the outpatient clinic that she doesn't need to attend groups because she's "not a regular like these other people here." The nurse should respond to the client by saying: 1."Because you're not a regular client, sit in the hall when the others are in group." 2."Your family wants you to attend, and they will be very disappointed if you don't." 3."I'll have to mark you absent from the clinic today and speak to the doctor about it." 4."You say you're not a regular here, but you're experiencing what others are experiencing."

4 The best response is, "You say you're not a regular here, but you're experiencing what others are experiencing." This statement helps the client to identify factors that precipitate denial by helping her to confront that which inhibits compliance. Denial is used to help a client feel better and more secure when a situation provokes a high level of anxiety and is threatening to the client. The statement, "Because you're not a regular client, sit in the hall when the others are in group," agrees with and promotes denial in the client and interferes with treatment. The statement, "Your family wants you to attend and they will be disappointed if you don't," causes the client to feel guilty and decreases her self-esteem. The statement, "I'll have to mark you absent from the clinic today and speak to the doctor about it," is punitive and threatening to the client, subsequently decreasing her self-esteem.

The client diagnosed with borderline personality disorder is admitted to the unit after having attempted to cut her wrists with a pair of scissors. The client has several scars on both arms from self-mutilation and suicide gestures. A staff member states to the nurse, "It's just attention that she wants, she's not going to kill herself." The nurse should respond to the staff member by saying: 1."She's here now and we have to do our best." 2."She needs to be here until she can control her behavior." 3."I'm ashamed of you; you know better than to say that." 4."Any attempt at self-harm is serious, and safety is a priority."

4 The client with borderline personality disorder is usually in a crisis situation when hospitalized for self-mutilation and suicidal ideation or behavior. The statement, "Any attempt at self-harm is serious and safety is a priority," is the best response because the misperception that self-mutilation is used to gain attention can result in death of the client. The client can accidentally commit suicide. Any form of self-harm is an indication that the client needs treatment. The statement, "She's here now and we have to do our best," is not helpful and does not educate the staff member about the client's needs. The statement, "She needs to be here until she can control her behavior," may be true but does not provide information about the client's priority needs. The statement, "I'm ashamed of you; you know better than to say that," is punitive, diminishes self-worth, and may not be a correct assumption of the staff member's knowledge.

The client with histrionic personality disorder is melodramatic and responds to others and situations in an exaggerated manner. The nurse should recommend which of the following activities for this client? 1.Party planning. 2.Music group. 3.Cooking class. 4.Role-playing.

4 The nurse should use role playing to teach the client appropriate responses to others in various situations. This client dramatizes events, draws attention to self, and is unaware of and does not deal with feelings. The nurse works to help the client clarify true feelings and learn to express them appropriately. Party planning, music group, and cooking class are therapeutic activities, but will not help the client specifically learn how to respond appropriately to others.

One evening the client takes the nurse aside and whispers, "Don't tell anybody, but I'm going to call in a bomb threat to this hospital tonight." Which of the following actions is the priority? 1.Warning the client that his telephone privileges will be taken away if he abuses them. 2.Offering to disregard the client's plan if he does not go through with it. 3.Notifying the proper authorities after saying nothing until the client has actually completed the call. 4.Explaining to the client that this information will have to be shared immediately with the staff and the primary health care provider."

4 The priority is to explain to the client that this information has to be shared immediately with the staff and the primary health care provider because of its serious nature. Safety of all is crucial regardless of whether the client follows through on his plan. It is possible that the client is asking to be stopped and that he is indirectly pleading for help in a dysfunctional manner. Bargaining with the client, such as warning him that his telephone privileges will be taken away if he abuses them or offering to disregard his plan if he does not go through with it, is inappropriate. Saying nothing to anyone until the client has actually completed the call and then notifying the proper authorities represent serious negligence on the part of the nurse

A 19-year-old client is admitted to a psychiatric unit with an Axis I diagnosis of alcohol abuse and an Axis II diagnosis of personality disorder not otherwise specified. The client's mother states, "He's always in trouble, just like when he was a boy. Now he's just a bigger prankster and out of control." In view of the client's history, which of the following is most important initially? 1.Letting the client know the staff has the authority to subdue him if he gets unruly. 2.Keeping the client isolated from other clients until he is better known by the staff. 3.Emphasizing to the client that he will have to pay for any damage he causes. 4.Closely observing the client's behavior to establish a baseline pattern of functioning."

4. The best initial course of action when admitting a client is to observe him to establish baseline information. This assessment provides valuable information about the client's behavior and forms the basis for the plan of care. Telling the client that the staff has authority to subdue him if he gets unruly or that he will have to pay for any damage he causes is threatening and may incite or provoke trouble. Isolating a client is not recommended unless there is a very good reason for it, such as a very active, combative client who is dangerous to himself and others.

When planning care for a client diagnosed with schizotypal personality disorder, which of the following helps the client become involved with others? 1.Participating solely in group activities. 2.Being involved with primarily one-to-one activities. 3.Leading a sing-along in the afternoon. 4.Attending an activity with the nurse.

4. Attending an activity with the nurse assists the client to become involved with others slowly. The client with a schizotypal personality disorder needs support, kindness, and gentle suggestion to improve social skills and interpersonal relationships. The client commonly has problems in thinking, perceiving, and communicating and appears similar to clients with schizophrenia except that psychotic episodes are infrequent and less severe. Participation solely in group activities or leading a sing-along would be too overwhelming for the client, subsequently increasing the client's anxiety and withdrawal. Engaging primarily in one-to-one activities would not be helpful because of the client's difficulty with social skills and interpersonal relationships. However, activities with the nurse could be used to establish trust. Then the client could proceed to activities with others.

Irresponsible, guiltless behavior is to a client diagnosed with cluster B personality disorder as avoidant, dependent behavior is to a client diagnosed with a: 1. Cluster A personality disorder. 2. Cluster B personality disorder. 3. Cluster C personality disorder. 4. Cluster D personality disorder.

Irresponsible and guiltless behavior is a characteristic of an individual diagnosed with an antisocial personality disorder, which is grouped in the cluster B classification. 1. Cluster A categorizes behaviors that are odd or eccentric, and it comprises the following disorders: (1) paranoid personality disorder, which is characterized by a pervasive and unwarranted suspiciousness and mistrust of people; (2) schizoid personality disorder, which is characterized by an inability to form close, personal relationships; and (3) schizotypal personality disorder, which is characterized by peculiarities of ideation, appearance, behavior, and deficits in interpersonal relatedness that are not severe enough to meet the criteria for schizophrenia. 2. Cluster B categorizes behaviors that are dramatic, emotional, or erratic, and it comprises the following disorders: (1) antisocial personality disorder, which is characterized by a pattern of socially irresponsible, exploitive, and guiltless behavior; (2) borderline personality disorder, which is characterized by a marked instability in interpersonal relationships, mood, and self-image; (3) histrionic personality disorder, which is characterized by a pervasive pattern of excessive emotionality and attention-seeking behavior; and (4) narcissistic personality disorder, which is characterized by a constant need for attention; grandiose sense of self-importance; and preoccupations with fantasies of success, power, brilliance, and beauty. 3. Cluster C categorizes behaviors that are anxious or fearful, and it comprises the following disorders: (1) avoidant personality disorder, which is characterized by social withdrawal brought about by extreme sensitivity to rejection; (2) dependent personality disorder, which is characterized by allowing others to assume responsibility for major areas of life because of one's inability to function independently; (3) obsessive-compulsive personality disorder, which is characterized by a pervasive pattern of perfectionism and inflexibility; and (4) passive-aggressive personality disorder, which is characterized by a passive resistance to demands for adequate performance in occupational and social functioning. 4. There is no DSM-IV-TR cluster D classification. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that there are three clusters of personality disorders, "A," "B," and "C." This eliminates answer choice "4" immediately

A client has been diagnosed with a cluster A personality disorder. Which client statement would reflect cluster A characteristics? 1. "I'm the best chef on the East Coast." 2. "My dinner has been poisoned." 3. "I have to wash my hands 10 times before eating." 4. "I just can't eat when I'm alone."

Paranoid personality disorder is relatively common and occurs more often in men than in women. Within families, it occurs more frequently in oldest children. 1. This statement might be voiced by a client diagnosed with narcissistic personality disorder. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. This cluster's characteristic behaviors are dramatic, emotional, or erratic. 2. This statement might be voiced by a client diagnosed with paranoid personality disorder. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. This cluster's characteristic behaviors are odd or eccentric and include patterns of suspiciousness and mistrust. 3. This statement might be voiced by a client diagnosed with obsessive-compulsive personality disorder. Cluster C includes dependent, avoidant, obsessive-compulsive, and passiveaggressive personality disorders. This cluster's characteristic behaviors are anxious and fearful. 4. This statement might be voiced by a client diagnosed with dependent personality disorder. Cluster C includes dependent, avoidant, obsessive-compulsive, and passive-aggressive personality disorders. This cluster's characteristic behaviors are anxious and fearful. TEST-TAKING HINT: To answer this question correctly, the test taker must be able to link the cluster noted in the question with the appropriate client statement.

Milieu therapy is a good choice for clients with antisocial personality disorder because it a. provides a system of punishment and reward 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

Splitting by the client with borderline personality disorder 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

Which of the following behaviors indicates to the nurse that the client diagnosed with avoidant personality disorder is improving? 1.Interacting with two other clients. 2.Listening to music with headphones. 3.Sitting at a table and painting. 4.Talking on the telephone."

1 The client with avoidant personality disorder is showing signs of improvement when interacting with two other clients. A client with avoidant personality disorder is timid, socially uncomfortable, withdrawn, and hypersensitive to criticism. Social contact with others decreases isolation and withdrawal. Listening to music with headphones, sitting at a table and painting, and talking on the telephone are solitary activities and therefore do not indicate improvement, which is evidenced by social contact.

A client is complaining to other clients about not being allowed by staff to keep food in her room. The nurse should: 1.Ignore the client's behavior. 2.Set limits on the behavior. 3.Reprimand the client. 4.Allow the snack to be kept in her room

2. The nurse needs to set limits on the client's manipulative behavior to help the client control dysfunctional behavior. The manipulative client bends rules to have her needs met without regard for rules or the needs or rights of others. A consistent approach by the staff is necessary to decrease manipulation. Ignoring the client's behavior reinforces or promotes the continuation of the client's manipulative behavior. Reprimanding the client may be perceived as a threat, resulting in aggressive behavior. Allowing the client to keep a snack in her room reinforces the dysfunctional behavior.

A male client diagnosed with a personality disorder boasts to the nurse that he has to fight off female attention and is the highest paid in his company. These statements are reflective of which personality disorder? 1. Obsessive-compulsive personality disorder. 2. Passive-aggressive personality disorder. 3. Schizotypal personality disorder. 4. Narcissistic personality disorder.

The concept of narcissism has its roots in Greek mythology, where Narcissus drowns himself after falling in love with his watery reflection. It is estimated that this disorder occurs in 2% to 16% of the clinical population and less than 1% of the general population. It is diagnosed more often in men than in women. 1. Cluster C includes dependent, avoidant, obsessive-compulsive, and passive-aggressive personality disorders. Clients diagnosed with obsessive-compulsive personality disorder are characterized by difficulty in expressing emotions, along with a pervasive pattern of perfectionism and inflexibility. Nowhere in the stem does it mention that the client is perfectionistic or inflexible. 2. Cluster C includes dependent, avoidant, obsessive-compulsive, and passive-aggressive personality disorders. Clients diagnosed with passive-aggressive personality disorder are characterized by a passive resistance to demands for adequate performance in occupational and social functioning, which this client does not demonstrate. 3. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Clients diagnosed with schizotypal personality disorder are characterized by peculiarities of ideation, appearance, and behavior and deficits in interpersonal relatedness that are not severe enough to meet the criteria for schizophrenia. Nowhere in the question does this client demonstrate schizotypal behaviors. 4. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. Clients diagnosed with narcissistic personality disorder are characterized by a constant need for attention, grandiose sense of self-importance, and preoccupations with fantasies of success, power, brilliance, and beauty, all of which this client is displaying. TEST-TAKING HINT: To answer this question correctly, the test taker must be able to link the behaviors noted in the question to the appropriate personality disorder.

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

Which of the following behavioral patterns is 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

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

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

A nurse encourages an angry client to attend group therapy. Knowing that the client has been diagnosed with a cluster B personality disorder, which client response might the nurse expect? 1. Sarcastically states, "That group is only for crazy people with problems." 2. Scornfully states, "No, can't you see that I'm having a séance with my mom?" 3. Suspiciously states, "No, that room has been bugged." 4. Hesitantly states, "OK, but only if I can sit next to you."

Clients diagnosed with a cluster B personality disorder do not believe they have any problems and frequently blame others for their behaviors. 1. In the question, the client's statement would represent a typical response from someone who was diagnosed with an antisocial personality disorder. These clients also display patterns of socially irresponsible, exploitive, and guiltless behaviors that reflect a disregard for the rights of others. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. Clients diagnosed with cluster B personality disorders exhibit behaviors that are dramatic, emotional, or erratic. 2. This client statement would represent a typical response from a client diagnosed with schizotypal personality disorder. These clients also are characterized by peculiarities of ideation with odd and eccentric behaviors. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. 3. This client statement would represent a typical response from a client diagnosed with paranoid personality disorder. These clients are characterized by a pervasive and unwarranted suspiciousness and mistrust of people, as portrayed in the question. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. 4. This client statement would represent a typical response from a client diagnosed with dependent personality disorder. These clients are characterized by the inability to function independently and by allowing others to assume responsibility for major areas of life. Cluster C includes dependent, avoidant, obsessive-compulsive, and passive-aggressive personality disorders. TEST-TAKING HINT: To answer this question correctly, the test taker must be able to link the behaviors noted in the question with the appropriate personality disorder. If the test taker understands that clients diagnosed with a cluster A disorder may have suspicious behaviors, answer "3" can be eliminated immediately.

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 suicidal client is diagnosed with borderline personality disorder. Which short-term outcome is most beneficial for the client? 1. The client will be free from self-injurious behavior. 2. The client will express feelings without inflicting self-injury by discharge. 3. The client will socialize with peers in the milieu by day 3. 4. The client will acknowledge the client's role in altered interpersonal relationships.

. 1. Although it is important for the client to be safe and free from self-injurious behaviors, this outcome does not have a timeframe and is incorrectly written. 2. The client's being able to express feelings without inflicting self-injury by discharge is an outcome that reinforces the priority for client safety, is measurable, and has a timeframe. 3. Although it is important for the client to be able to socialize with peers in the milieu, it is not the priority outcome and is incorrect. 4. The ultimate outcome for a client diagnosed with borderline personality disorder is to understand better how specific personal behaviors affect interpersonal skills. Because this outcome does not have a timeframe and does not reinforce the priority of safety, it is incorrect. TEST-TAKING HINT: To answer this question correctly, the test taker needs to review the criteria for outcomes, making sure that all answers are measurable, specific, client-centered, and positive, and have a timeframe. Answers "1" and "4" can be eliminated immediately because they do not have a timeframe.

A client diagnosed with a personality disorder insists that a grandmother, through reincarnation, has come back to life as a pet kitten. The thought process described is reflective of which personality disorder? 1. Passive-aggressive personality disorder. 2. Schizotypal personality disorder. 3. Borderline personality disorder. 4. Schizoid personality disorder.

1. Cluster C includes dependent, avoidant, obsessive-compulsive, and passive-aggressive personality disorders. Clients diagnosed with passive-aggressive personality disorder are characterized by a passive resistance to demands for adequate performance in occupational and social functioning. The characteristics of this disorder are not reflected in the question. 2. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Clients diagnosed with schizotypal personality disorder are characterized by peculiarities of ideation, appearance, and behavior; magical thinking; and deficits in interpersonal relatedness that are not severe enough to meet the criteria for schizophrenia. In the question, this client's statement reflects ideations of magical thinking. 3. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. Clients diagnosed with borderline personality disorder are characterized by a marked instability in interpersonal relationships, mood, and self-image. These behaviors are not described in the question. 4. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Clients diagnosed with schizoid personality disorder are characterized by an inability to form close, personal relationships. In contrast to schizotypal behavior, a client with this disorder would be incapable of establishing any type of personal alliance the way the client presented in the question has established with his or her grandmother. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand the differences between schizoid and schizotypal personality disorders.

The client approaches various staff with numerous requests and needs to the point of disrupting the staff's work with other clients. The nurse meets with the staff to decide on a consistent, therapeutic approach for this client. Which of the following approaches will be most effective? 1.Telling the client to stay in his room until staff approach him. 2.Limiting the client to the dayroom and dining area. 3.Giving the client a list of permissible requests. 4.Having the client address needs to the staff person assigned.

4 For the client with attention-seeking behaviors, the nurse would institute a behavioral contract with the client to help decrease dysfunctional behaviors and promote self-sufficiency. Having the client approach only his assigned staff person sets limits on his attention-seeking behavior. Telling the client to stay in his room until staff approach him, limiting the client to a certain area, or giving the client a list of permissible requests is punitive and does nothing to help the client gain control over the dysfunctional behavior.

Kim, a client diagnosed with Borderline Personality Disorder, 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

Carol is a new nursing graduate being oriented on a medical/surgical unit by the head nurse, Mrs. Carey. When Carol describes a new technique she has learned for positioning immobile clients, Mrs. Carey states, "What are you trying to do . . . tell me how to do my job? We have always done it this way on this unit, and we will continue to do it this way until I say differently!" This is an example of which type of personality characteristic? a. Antisocial b. Paranoid c. Passive-aggressive d. Obsessive-compulsive

d