PERSONALITY DISORDERS TEST #3

A nurse is caring for a pt who has avoidant personality disorder. Which of the following statements is expected from a pt 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 admires me" D. "I sometimes feel better if I cut myself"

A Pt's who have avoidant personality disorder often have a fear of abandonment. This type of statement is expected

A charge nurse is preparing a staff education session on personality disorders. Which of the following personality characteristics associated with all of the personality disorders should the charge nurse include in the teaching? (SATA) 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, C, E Difficulty with social and professional relationships is a personality characteristic that can be seen with all personality disorder types Maladaptive response to stress is a personality characteristics that can be seen with all personality disorder types Difficulty understanding personal boundaries is a personality characteristics that can be seen with all personality disorder types

A 20-year old college student has been brought to the psychiatric hospital by her parents. Her admitting diagnosis is borderline personality disorder. When talking with the parents, which information would the nurse expect to be included in the client's history? Select all that apply. A. Impulsiveness B. Lability of mood C. Ritualistic behavior D. Psychomotor retardation E. Self-destructive behavior

A,B,E

A client with a diagnosis of narcissistic personality disorder has been given a day pass from the psychiatric hospital. The client is due to return at 6pm. At 5pm the client telephones the nurse in charge of the unit and says "6 o'clock is too early. I feel like coming back at 7:30." The nurse would be most therapeutic by telling the client to: A. Return immediately, to demonstrate control B. Return on time or restrictions will be imposed C. Come back at 6:45, as a compromise to set limits D. Come back as soon as possible or the police will be sent

B This sets limits, points out reality, and places responsibility for behavior on the client.

Which of the following conditions is likely to coexist in clients with a diagnosis of borderline personality disorder? A. Avoidance B. Delirium C. Depression D. Disorientation

C Chronic feelings of emptiness and sadness predispose a client to depression. About 40% of the clients with borderline struggle with depression.

Which of the following characteristics is expected for a client with paranoid personality disorder who receives bad news? A. The client is overly dramatic after hearing the facts B. The client focuses on self to not become over-anxious C. The client responds from a rational, objective point of view D. The client doesn't spend time thinking about the information.

C Clients with paranoid personality disorder are effectively restricted, appear unemotional, and appear rational and objective.

A nurse manager is discussing the care of a client who has a personality disorder with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. "I can promote my pt's sense of control by establishing a schedule" B. "I should encourage pt's who have a schizoid personality disorder to increase socialization" C. "I should practice limit-setting to help prevent pt manipulation" D. "I should implement assertiveness training with pt's who have antisocial personality disorder"

C When caring for a pt who has a personality disorder, limit-setting is appropriate to help prevent pt manipulation

A nurse is assisting with a court-ordered evaluation of a pt who has antisocial personality disorder. Which of the following findings should the nurse expect? (SATA) A. Demonstrates extreme anxiety when placed in a social situation B. Has difficulty making even simple decisions C. Attempts to convince other pt's to give him their belongings D. Becomes agitated if his personal area is not neat and orderly E. Blames others for his past and current problems

C, E Exploitation and manipulation of others is an expected finding of antisocial personality disorder Failure to accept personal responsibility is an expected finding of pts who have antisocial personality disorder

A hospitalized client, diagnosed with a borderline personality disorder, consistently breaks the unit's rules. This behavior should be confronted because it will help the client A. Control anger B. Reduce anxiety C. Set realistic goals D. Become more self-aware

D Client's must first become aware of their behavior before they can change it. (3) Occurs after the client is aware of the behavior and has a desire to change the behavior

A nurse notices other clients on the unit avoiding a client diagnosed with antisocial personality disorder. When discussing appropriate behavior in group therapy, which of the following comments is expected about this client by his peers? A. Lack of honesty B. Belief in superstitions C. Show of temper tantrums D. Constant need for attention

A Clients with antisocial personality disorder tend to engage in acts of dishonesty, shown by lying.

In planning care for a client with borderline personality disorder, a nurse must be aware that this client is prone to develop which of the following conditions? A. Binge eating B. Memory loss C. Cult membership D. Delusional thinking

A Clients with borderline personality disorder are likely to develop dysfunctional coping and act out in self-destructive ways such as binge eating.

Which of the following assessment findings is seen in a client diagnosed with borderline personality disorder? A. Abrasions in various healing stages B. Intermittent episodes of hypertension C. Alternating tachycardia and bradycardia D. Mild state of euphoria with disorientation

A Clients with borderline personality disorder tend to self-mutilate and have abrasions in various stages of healing.

A client with borderline personality disorder is admitted to the unit after slashing his wrist. Which of the following goals is most important after promoting safety? A. Establish a therapeutic relationship with the client B. Identify whether splitting is present in the client's thoughts C. Talk about the client's acting out and self-destructive tendencies. D. Encourage the client to understand why he blames others

A After promoting safety, the nurse establishes a rapport with the client to facilitate appropriate expression of feelings. At this time, the client isn't ready to address unhealthy behavior. A therapeutic relationship must be established before the nurse can effectively work with the client on self-destructive tendencies and the issues of splitting.

Which of the following nursing interventions has priority for a client with borderline personality disorder? A. Maintain consistent and realistic limits B. Give instructions for meeting basic self-care needs C. Engage in daytime activities to stimulate wakefulness D. Have the client attend group therapy on a daily basis

A Clients with borderline who are needy, dependent, and manipulative will benefit greatly from maintaining consistent and realistic limits. They don't tend to have difficulty meeting their self-care needs. They enjoy attending group therapy because they often attempt to use the opportunity to become the center of attention. They don't tend to have sleeping difficulties.

A client with a diagnosis of borderline personality disorder has negative feelings toward the other clients on the unit and considers them all to be "bad." The nurse understands this defense is known as: A. Splitting B. Ambivalence C. Passive Aggression D. Reaction Formation

A Splitting is the compartmentalization of opposite-affect states and failure to integrate the positive and negative aspects of self or others

A pt is unwilling to go to his church because his ex-girlfriend goes there and he feels that she will laugh at him if she sees him. Because of this hypersensitivity to a reaction from her, the pt remains homebound. The home care nurse develops a plan of care that addresses which personality disorder? A. Avoidant B. Borderline C. Schizotypal D. Obsessive-compulsive

A The avoidant personality disorder is characterized by social withdrawal and extreme sensitivity to potential rejection. The person retreats to social isolation

Which of the following information must be included for the family of a client diagnosed with dependent personality disorder? A. Address coping skills B. Explore panic attacks C. Promote exercise programs D. Decrease aggressive outbursts

A The family needs information about coping skills to help the client learn to handle stress. Clients with dependent personality disorder don't have aggressive outbursts; they tend to be passive and submit to others. They don't tend to have panic attacks. Exercise is a health promotion activity for all clients. Clients with dependent personality disorder wouldn't need exercise promoted more than other people.

Which of the following statements is expected from a client with borderline personality disorder with a history of dysfunctional relationships? A. "I won't get involved in another relationship." B. "I'm determined to look for the perfect partner." C. "I've decided to use better communication skills." D. "I'm going to be an equal partner in a relationship."

B Clients with borderline personality disorder would decide to look for a perfect partner. This characteristic is a result of the dichotomous manner in which these clients view the world. They go from relationship to relationship without taking responsibility for their behavior. It's unlikely that an unsuccessful relationship will cause clients to make a change. They tend to be demanding and impulsive in relationships. There's no thought given to what one wants or needs from a relationship. Because they tend to blame others for problems, it's unlikely they would express a desire to learn communication skills.

The nurse is caring for a pt diagnosed with paranoid personality disorder who is experiencing disturbed thought processes. In formulating a nursing plan of care, which BEST intervention should the nurse include? A. Increase socialization of the pt with peers B. Avoid using a whisper voice in front of the pt C. Begin to educate the pt about social supports in the community D. Have the pt sign a release of information to appropriate parties for assessment purposes

B Disturbed thought process related to paranoid personality disorder is the pt's problem, and the plan of care must address this problem. The members of the health care team need to establish a rapport and trust with the pt.

The client with antisocial personality disorder: A. Suffers from a great deal of anxiety B. Is generally unable to postpone gratification C. Rapidly learns by experience and punishment D. Has a great sense of responsibility toward others

B Individuals with this disorder tend to be self-centered and impulsive. They lack judgment and self-control and do not profit from their mistakes.

A nurse is caring for a pt who has borderline personality disorder. The pt says, "the nurse on the evening shift is always nice! You are the meanest nurse ever!" The nurse should recognize the pt's statement as an example of which of the following defense mechanisms? A. Regression B. Splitting C. Undoing D. Identification

B Splitting occurs when a person is unable to see both positive and negative qualities at the same time. The pt who has borderline personality disorder tends to see a person as all bad one time and all good another time

Which of the following behaviors by a client with dependent personality disorder shows the client has made progress toward the goal of increasing problem solving skills? A. The client is courteous B. The client asks questions C. The client stops acting out D. The client controls emotions

B The client with dependent personality disorder is passive and tries to please others. By asking questions, the client is beginning to gather information, the first step of decision making.

A person with antisocial personality disorder has difficulty relating to others because of never having learned to: A. Count on others B. Empathize with others C. Be dependent on others D. Communicate with others socially

B The lack of superego control allows the ego and the id to control the behavior. Self-motivation and self-satisfaction are of paramount concern.

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? A. Passive-aggressive personality disorder. B. Schizoid personality disorder. C. Schizotypal personality disorder. D. Borderline personality disorder.

C 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.

Which of the following types of behavior is expected from a client diagnosed with a paranoid personality disorder? A. Eccentric B. Exploitative C. Hypersensitive D. Seductive

C People with paranoid personality disorders are hypersensitive to perceived threats. Schizotypal personalities appear eccentric and engage in activities others find perplexing. Clients with narcissistic personality disorder are interpersonally exploitative to enhance themselves or indulge in their own desires. A client with histrionic personality disorder can be extremely seductive when in search of stimulation and approval.

Which of the following characteristics or situations is indicated when a client with borderline personality disorder has a crisis? A. Antisocial behavior B. Suspicious behavior C. Relationship problems D. Auditory hallucinations

C Relationship problems can precipitate a crisis because they bring up issues of abandonment. Clients with borderline personality disorder aren't usually suspicious; they're more likely to be depressed or highly anxious.

When caring for a client with a diagnosis of schizotypal personality disorder, the nurse should: A. Set limits on manipulative behavior B. Encourage participation in group therapy C. Respect the client's needs for social isolation D. Understand that seductive behavior is expected.

C These clients are withdrawn, aloof, and socially distant; allowing distance and providing support may encourage the eventual development of a therapeutic alliance. Group therapy would increase this client's anxiety; cognitive or behavioral therapy would be more appropriate.

A client with antisocial personality is trying to convince a nurse that he deserves special privileges and that an exception to the rules should be made for him. Which of the following responses is the most appropriate? A. "I believe we need to sit down and talk about this." B. "Don't you know better than to try to bend the rules?" C. "What you're asking me to do is unacceptable." D. "Why don't you bring this request to the community meeting?"

C These clients often try to manipulate the nurse to get special privileges or make exceptions to the rules on their behalf. By informing the client directly when actions are inappropriate, the nurse helps the client learn to control unacceptable behaviors by setting limits. By sitting down to talk about the request, the nurse is telling the client there's room for negotiating when there is none.

A young, handsome man with a diagnosis of antisocial personality disorder is being discharged from the hospital next week. He asks the nurse for her phone number so that he can call her for a date. The nurse's best response would be: A. "We are not permitted to date clients." B. "No, you are a client and I am a nurse." C. "I like you, but our relationship is professional." D. "It's against my professional ethics to date clients."

C This accepts the client as a person of worth rather than being cold or implying rejection. However, the nurse maintains a professional rather than a social role.

An adult client with a borderline personality disorder become nauseated and vomits immediately after drinking after drinking 2 ounces of shampoo as a suicide gesture. The most appropriate initial response by the nurse would be to: A. Promptly notify the attending physician B. Immediately initiate suicide precautions C. Sit quietly with the client until nausea and vomiting subsides D. Assess the client's vital signs and administer syrup of ipecac

C This intervention demonstrates the nurse's caring presence which is vital for this client. (1) Although the treatment team does need to know about the event, notification is not the immediate concern. (2) This is premature and it reinforces the client's predisposition to manipulative behavior. (4) This medication is inappropriate in this situation; vomiting would be expected after the ingestion of shampoo.

A nurse is orienting a new client to the unit when another client rushes down the hallway and asks the nurse to sit down and talk. The client requesting the nurse's attention is extremely manipulative and uses socially acting-out behaviors when demands are unmet. The nurse should: A. Suggest that the client requesting attention speak with another staff member B. Leave the new client and talk with the other client to avoid precipitating acting out behavior C. Tell the interrupting client to sit down and be patient, stating, "I'll be back as soon as possible." D. Introduce the two clients and suggest that the client join the new client and the nurse on the tour

C This sets realistic limits on behavior without rejecting the client

A client with schizotypal personality disorder is sitting in a puddle of urine. She's playing in it, smiling, and softly singing a child's song. Which action would be best? A. Admonish the client for not using the bathroom B. Firmly tell the client that her behavior is unacceptable C. Ask the client if she's ready to get cleaned up now D. Help the client to the shower, and change the bedclothes.

D A client with schizotypal personality disorder can experience high levels of anxiety and regress to childlike behaviors. This client may require help needing self-care needs. The client may not respond to the other options or those options may generate more anxiety.

Which of the following characteristics or client histories substantiates a diagnosis of antisocial personality disorder? A. Delusional thinking B. Feelings of inferiority C. Disorganized thinking D. Multiple criminal charges

D Clients with antisocial personality disorder are often sent for treatment by the court after multiple crimes or for the use of illegal substances

When working with the nurse during the orientation phase of the relationship, a client with a borderline personality disorder would probably have the most difficulty in: A. Controlling anxiety B. Terminating the session on time C. Accepting the psychiatric diagnosis D. Setting mutual goals for the relationship

D Clients with borderline personality disorders frequently demonstrate a pattern of unstable interpersonal relationships, impulsiveness, effective instability, and frantic efforts to avoid abandonment; these behaviors usually create great difficulty in establishing mutual goals.

A nurse is assessing a client diagnosed with dependent personality disorder. Which of the following characteristics is a major component to this disorder? A. Abrasive to others B. Indifferent to others C. Manipulative of others D. Over reliance on others

D Clients with dependent personality disorder are extremely over reliant on others; they aren't abrasive or assertive. They're clinging and demanding of others; they don't manipulate.

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? A. Explore alternative ways of handling frustration. B. Encourage client to verbalize hostile feelings. C. Administer tranquilizing drugs. D. Observe client frequently.

D 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.

A nurse notices that a client is mistrustful and shows hostile behavior. Which of the following types of personality disorder is associated with these characteristics? A. Antisocial B. Avoidant C. Borderline D. Paranoid

D Paranoid individuals have a need to constantly scan the environment for signs of betrayal, deception, and ridicule, appearing mistrustful and hostile. They expect to be tricked or deceived by others

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

D 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.