Psych Chapter 18: Personality Disorders
A 43-year-old female client is observed walking and dancing around the unit dressed in red high heels and a provocative style of dress. The client is seen sitting on the lap of a male client on the unit, and they are laughing. Which is the most therapeutic nursing intervention? "You need to go to your room because you are engaging in sexually provocative behavior again!" "I need for you to get off his lap, this behavior is not appropriate." "Why are you sitting on the nurse's lap?" "Why don't we go play a game of ping-pong?"
"I need for you to get off his lap, this behavior is not appropriate."
A client asks the nurse to go to lunch with the client one day next week after the client is discharged. Which statement is the most therapeutic response? "I'm sorry, it is not within my role to have any affiliation with you after your discharge." "I'd love to do that, but I'm on vacation next week." "My role here is to help you recover. Let's talk about what else you can be doing after discharge." "That sounds good. Call the unit when you decide which day, and we can set it up."
"My role here is to help you recover. Let's talk about what else you can be doing after discharge."
Personality disorders occur in approximately what percentage of the general population? 40% 15% 25% 30%
15%
Treatment approaches for clients with personality disorders generally rely on which modality? Cognitive-behavioral therapy A combination of approaches Pharmacotherapy Individual therapy
A combination of approaches
Which is considered the etiology of personality disorders? Related to substance abuse Related to childhood abuse, neglect, and trauma Genetic predetermination A combination of psychosocial and biologic variables
A combination of psychosocial and biologic variables
A group of nursing students is reviewing information about antisocial personality disorder. The students demonstrate understanding of this disorder when they state what? An individual must be at least 18 years of age to be diagnosed with the disorder. Alcohol abuse disorder rarely accompanies this disorder. The disorder is found primarily in Asian individuals. The disorder occurs more frequently in women.
An individual must be at least 18 years of age to be diagnosed with the disorder.
Avoidant, dependent, and obsessive-compulsive personality disorders are characterized by what? Dramatic or erratic behaviors Manic or withdrawn behaviors Anxious or fearful behaviors Odd or eccentric behaviors
Anxious or fearful behaviors
A client is admitted to the mental health unit after the client's spouse brings the client to the emergency department. Upon arrival, the spouse explained that the client had been crying all weekend and stating that the client wanted to die. Upon further assessment, the spouse reports that the client always has difficulty controlling anger and frequently worries that the spouse will leave the client. Recently, the client has been getting drunk every night, which the client never used to do. What diagnosis should the nurse suspect applies to this client? Borderline personality disorder Bipolar disorder Depression Mania
BPD
A nurse is conducting a review class on borderline personality disorder. When describing the characteristics associated with this disorder, which would the nurse most likely include? Select all that apply. Thinking that is based on delusions Impulsive behavior Problems with interpersonal relationships Overinflated self-identity Difficulty regulating moods
Difficulty regulating moods Problems with interpersonal relationships Impulsive behavior
A nurse is preparing a teaching plan for a client with antisocial disorder. Which would the nurse most likely employ to promote successful education? Engaging the client in a discussion to direct the topic to the client. Establishing general goals for teaching. Allowing the client to guide the teaching to other topics. Using a lecture approach to provide information.
Engaging the client in a discussion to direct the topic to the client.
Which personality disorder is diagnosed more often in women? Schizoid Histrionic Antisocial Narcissistic
Histronic
When providing care to a client who consistently attempts to manipulate the staff, the nurse can best maintain the therapeutic milieu by doing what? Promoting social ostracism of the client's exhibiting manipulation Instructing the staff to enforce all unit rules consistently Scheduling staff one-on-one time with the client Encouraging questions and discussing the client's concerns
Instructing the staff to enforce all unit rules consistently
The nurse is conducting an education group for women at risk for self-mutilation. What is the most important goal for this group? Discussing feelings about self-harm Learning problem solving Learning strategies to refrain from self-harm Expressing angry feelings
Learning strategies to refrain from self-harm
A client attends an outpatient mental health clinic accompanied by the client's spouse for an assessment. The client's spouse reports the client is easily irritated if the home is not maintained in a specific order and when the client is unable to complete a "to do" list on time. The client has a serious and formal demeanor. Which personality disorder best describes this client? Avoidant personality disorder Narcissistic personality disorder Paranoid personality disorder Obsessive-compulsive personality disorder
OCD
The nurse working with women who have borderline personality disorder can do which to help clients build social skills and self-esteem? Select all that apply. Offer cognitive restructuring classes. Offer women's health issues classes. Offer cooking classes. Offer assertiveness classes.
Offer cognitive restructuring classes. Offer assertiveness classes. Offer women's health issues classes.
How does personality disorder differ from personality traits? Personality traits usually cause the person a great deal of difficulty but only sporadically. Personality disorder is usually evident earlier in the person's development than are traits. Personality disorder is usually more long term than are traits. Personality disorder causes impairment in social and occupational functioning, whereas traits do not.
Personality disorder causes impairment in social and occupational functioning, whereas traits do not.
Into which personality disorder category are individuals placed whose behavior appears odd or eccentric? Cluster B Cluster D Cluster C Cluster A
cluster A
A client with borderline personality disorder (BPD) who evaluates experiences, people, and objects in terms of mutually exclusive categories (e.g., good or bad, success or failure) is demonstrating which type of thinking? Splitting Systems-oriented thinking Logical thinking Impulsive thinking
splitting
Which occurs when a client tends to adore and idealize other people even after a brief acquaintance but then quickly leaves them if these others do not meet the client's expectations in some way? Decatastrophizing Thought stopping Positive self-talk Splitting
splitting
Which is a technique used to help the client with borderline personality disorder gain control over self-critical thoughts? Communication triad Thought stopping Affective instability Delay gratification
though stopping
Which addresses the psychological domain of biopsychosocial interventions for a client with borderline personality disorder? Withdrawing attention as much as possible Environmental management Prevention of self-harm Communication skills
withdrawing attention as much as possible
A nurse is describing histrionic personality disorder to a group of new nurses. Which term would the nurse most likely use? Psychopath Attention seeking Lacking empathy Sociopath
attention seeking
Which personality disorder is most often treated within the inpatient psychiatric setting? Borderline Schizotypal Antisocial Dependent
borderline
Which personality disorder would be placed in Cluster B? Schizoid Borderline Avoidant Paranoid
borderline
A nurse working with a client with borderline personality disorder could establish which as outcome criteria? Act out neediness. Display anger more frequently. Filter concerns and insecurities through the nurse. Tolerate stress without self-mutilation.
Tolerate stress without self-mutilation.
Which occurs when thinking, feeling, or behaviors occur outside a person's awareness? Dichotomous thinking Affective instability Impulsivity Dissociation
dissociation
Which occurs when thinking, feeling, or behaviors occur outside a person's awareness? Impulsivity Dichotomous thinking Dissociation Affective instability
dissociation
The nurse is admitting a client with histrionic personality disorder to the inpatient unit. The nurse would anticipate that this client may exhibit which behavior? Manipulation Self-dramatization Distrust Perfection
self-dramatization
A client in the emergency department has self-inflicted wounds on both arms. Assessment reveals that the client was diagnosed with borderline personality disorder 6 months ago, for which the client has been receiving outpatient treatment. The client tells the nurse that the client recently found out the client's therapist is moving and will no longer be able to work with the client. What is the priority nursing diagnosis for this client? Stress Loneliness Anxiety Self-mutilation
self-mutilation
A client on an inpatient psychiatric unit has features of borderline personality disorder. The client is frequently angry, has an unstable sense of self, and is highly impulsive. The client can be verbally abusive to staff, who feel manipulated by the client's behaviors. Which intervention does the nurse determine as priority? Increased recreational therapy Setting limits Stress management techniques Social skills training
setting limits
A nurse is caring for a client with schizoid personality trait. When developing a plan of care for the client, which would a nurse most likely include? Coping skills training Anger management training Relaxation techniques Social skills training
social skills training
When conducting a social history with a client diagnosed with a borderline personality disorder (BPD), which question would be most important to ask the client related to impulsivity? "Are you pleased with your medications?" "Do you think of yourself as physically attractive?" "Do you always practice safe sex?" "Are you interested in making your partner happy?"
"Do you always practice safe sex?"
A nursing instructor is teaching about using behavioral interventions when caring for clients with borderline personality disorder. Which statement by a student indicates a need for further instruction? "Sometimes it is best to confront a client about irritating behaviors." "Grossly disrespectful behaviors are better ignored." "Sometimes it is best to just ignore a client's irritating behaviors." "In some instances, negative responses can be viewed as positive reinforcement."
"Grossly disrespectful behaviors are better ignored."
A client with borderline personality disorder starts flirting with the nurse, saying the client dreams about the nurse at night and wants to kiss the nurse. What would be the best response by the nurse? "I feel flattered that you think that much of me, but nurses don't date clients." "I feel uncomfortable with what you said. My role is to support you in recovery." "That is very sweet of you to say." "Let's talk about something else now."
"I feel uncomfortable with what you said. My role is to support you in recovery."
A nurse is assessing a client and suspects that the client may have obsessive-compulsive personality disorder based on which statement? "I don't have any friends and I don't like to do anything socially." "I am better than everyone and they should emulate me." "I need to have everything perfect. My life is organized down to the second." "I can't trust anybody that I meet, no matter where it is or who they are."
"I need to have everything perfect. My life is organized down to the second."
A nurse is caring for a client diagnosed with borderline personality disorder. The nurse has instructed the client about using the communication triad. The nurse determines that the client has understood this technique when stating what? "Maybe I should start by describing the situation that has me upset." "I should first tell the other person what I'd like to be different about the situation." "I should start by stating my feelings as an 'I' statement." "I should begin by telling the other person what has triggered my emotion."
"I should start by stating my feelings as an 'I' statement."
A mental health nurse is working with a client with antisocial personality disorder. The nurse has just reviewed the unit rule of one cigarette per break. While telling the client about the unit rules, the client asks, "Well, if I have not done anything bad all day, can I have two cigarettes instead of one?" Which would be the most therapeutic nursing response? "It depends on whether or not we can make that exception that day." "This is a good example of trying to push your limits." "No, only one cigarette is allowed per break time." "Well, that's a good question. I need to check with the team."
"No, only one cigarette is allowed per break time."
A client with borderline personality disorder has had 21 admissions to the mental health unit, each of which was precipitated by a suicide attempt resulting in superficial cuts. During this admission, the client has developed a relationship with a highly supportive nurse and has progressed to having a pass to spend an afternoon in a nearby shopping mall. Later the day that the client uses the pass, the nurse is shocked when the emergency department calls to say that the client has just been brought in with multiple self-inflicted lacerations. The nurse asks a supervisor, "Everything was going well. How could this happen?" What response by the supervisor reflects an understanding of borderline personality disorder? "I could have told you this would happen. Clients like these always get you in the end. I hope this will teach you not to get so involved." "I know what you mean. You put a lot of energy into working with this client. It must be disappointing for something like this to happen." "The client's behavior seems personal, but it's really not. Clients with borderline personality disorder act out to relieve anxiety. I suspect having the pass provoked a great deal of anxiety." "I wonder if all this could have been avoided if I'd clued you in on the client. This is a usual pattern. The client burned me once, too, when I first worked here."
"The client's behavior seems personal, but it's really not. Clients with borderline personality disorder act out to relieve anxiety. I suspect having the pass provoked a great deal of anxiety."
The nurse is caring for a client with antisocial personality disorder. Which statement is mostappropriate for the nurse to make when explaining unit rules and expectations to the client? "Please try to attend group therapy each day." "You'll find your condition will improve much faster if you attend group therapy each day." "I and other members of the health care team would like you to attend group therapy each day." "You'll be expected to attend group therapy each day."
"You'll be expected to attend group therapy each day."
The nurse is interviewing a client with a history of violence. The client boasts that the client "put a kid in a wheelchair" once when the client was younger and has maimed others. The client states, "Who cares? Life's tough." Violence and insensitivity are associated with which personality disorder? Schizoid personality disorder Antisocial personality disorder Histrionic personality disorder Borderline personality disorder
Antisocial PD
A client has a diagnosis of borderline personality disorder and lives at home with the client's parents. The client has been in the psychiatric unit for 2 weeks and is scheduled to be discharged tomorrow. Which would be most therapeutic when the client's parents come in to discuss discharge plans? Attempt to discuss placing the client into an assisted living environment Ask the parents to keep a written schedule of activities for each day for the client Ask the parents how they have coped with the client's behaviors over the years Encourage the parents to discuss the possibility of the client going into a day-care program when the client goes home
Ask the parents to keep a written schedule of activities for each day for the client
Impulsivity and difficulty controlling anger are characteristic of which mental health diagnosis? Schizophrenia Posttraumatic stress disorder Depression Borderline personality disorder
BPD
The nurse is in the process of planning the care of a psychiatric-mental health client and has specified the following outcome: The client will be free from self-inflicted harm. What is this client's most likely diagnosis? Schizoid personality disorder Dependent personality disorder Antisocial personality disorder Borderline personality disorder
BPD
When assessing a client with borderline personality disorder (BPD), which would a nurse expect to assess? Select all that apply. Self-injurious behavior Fear of rejection Free sharing of feelings with others Exaggerated sense of self Control necessary for a relationship
Control necessary for a relationship Fear of rejection Self-injurious behavior
A client with a personality disorder is upset and calls the nurse a "stupid cow." Which is an effective initial response to this client's behavior? Report the behavior to the health care provider so that consistency and consequences can be followed. Discuss displacement of anger and set limits. Demonstrate empathy by reaching out to touch the client. Walk away from the client.
Discuss displacement of anger and set limits.
The nurse in charge of an inpatient psychiatric unit is irritated with a client who has borderline personality disorder. Which step should the nurse take? Confront the client firmly about how the client's behavior makes the nurse feel. Arrange for the client to be transferred to another unit. Direct the client to another staff member when the client tries to interact. Discuss the feelings with a colleague to promote coping.
Discuss the feelings with a colleague to promote coping.
The nurse in charge of an inpatient psychiatric unit is frustrated and angry with a client who has borderline personality disorder. Which steps should the nurse take? Examine the nurse's own feelings to discover the source of the nurse's anger. Direct the client to another staff member when the client tries to interact. Confront the client firmly but compassionately about how the client's behavior makes the nurse feel. Ignore the feelings and move on from the client.
Examine the nurse's own feelings to discover the source of the nurse's anger.
Which personality disorder is categorized as a Cluster B disorder? Narcissistic personality disorder Obsessive-compulsive personality disorder Paranoid personality disorder Schizoid personality disorder
Narcissistic personality disorder
Which statement accurately reflects the prognosis for a client with a personality disorder? Clients with personality disorders have a fairly good prognosis even without therapy. Prognosis varies based on the degree of functional impairment and the client's motivation to change. Clients make the most improvement with short-term insight-oriented therapy. The prognosis for personality disorders is poor, even with very long-term therapy.
Prognosis varies based on the degree of functional impairment and the client's motivation to change.
When reviewing the history of a client with antisocial personality disorder, which would the nurse expect to find? Select all that apply. Lack of remorse for actions Repeated incidents involving assaults Detailed plans for future actions Consistent regular work history Episodes involving scams for personal gain
Repeated incidents involving assaults Lack of remorse for actions Episodes involving scams for personal gain
When reviewing the history of a client with antisocial personality disorder, which would the nurse expect to find? Select all that apply. Repeated incidents involving assaults Lack of remorse for actions Episodes involving scams for personal gain Consistent regular work history Detailed plans for future actions
Repeated incidents involving assaults Lack of remorse for actions Episodes involving scams for personal gain
The nurse is counseling a 28-year-old client with avoidant personality disorder. Despite being employed, the client verbalizes having low quality of life due to anxiety and isolation. Which therapeutic goals does the nurse establish as priority? The client will be able to accept a job promotion. The client will engage in less risk-taking behavior The client will form a romantic relationship. The client will experience increased self-esteem.
The client will experience increased self-esteem.
The nurse-therapist is conducting a group therapy session in which one of the participants is an adult who has been diagnosed with narcissistic personality disorder. The nurse recognizes the significance of childhood experiences in the etiology of personality disorders, which for this client may have included what pattern? The client's parent was in a constant state of crisis and depended heavily on the client for emotional support. The client's parent catered to the client's every need and the client used temper tantrums to successfully get the client's way. The client's parent was a rigid disciplinarian who demanded complete subservience from both the client and the client's other parent. The client's parents had excessively high performance expectations of the client and failure was met with severe sanctions.
The client's parent catered to the client's every need and the client used temper tantrums to successfully get the client's way.
A nurse is reviewing the medical record of a female client diagnosed with borderline personality disorder (BPD). Which would the nurse identify as one of the strongest risk factors for this disorder? Poverty History of depression Parental alcohol abuse Abuse as a child
abuse as a child
After teaching a group of nurses about borderline personality disorder, the leader determines that the education was successful when the group identifies that symptoms typically begin in which age group? Late adulthood Middle-age individuals Young adulthood Adolescence
adolescence
A client comes to the clinic for a follow-up visit. Despite being warm and friendly with the nurse on a previous visit, today the client presents with anger and sarcastic undertones with the same nurse. The client is presenting which behavior commonly seen in borderline personality disorder? Depression Identity diffusion Affective instability Dichotomous thinking
affective instability
While shopping in a grocery store, a client with borderline personality disorder (BPD) greets the sibling of a neighbor with a great big hug. Then about 5 minutes later, the client walks past the sibling and ignores the sibling. The client is demonstrating what? Dichotomous thinking Dissociation Affective instability Identity diffusion
affective instability
Which diagnosis is associated with a pervasive disregard for and violation of the rights of others? Antisocial personality Passive-aggressive personality Schizoid personality Borderline personality
antisocial personality
The nurse is in the process of planning the care of a psychiatric-mental health client and has specified the following outcome: The client will be free from self-inflicted harm. What is this client's most likely diagnosis? Schizoid personality disorder Antisocial personality disorder Borderline personality disorder Dependent personality disorder
borderline personality disorder
Which personality disorder is most commonly found in clinical settings? Narcissistic personality Borderline personality Antisocial personality Histrionic personality
borderline personality disorder
Which cluster of disorders corresponds to symptoms of being dramatic and emotional? Cluster A Cluster D Cluster C Cluster B
cluster b
As part of a client's treatment plan for borderline personality disorder, the client is engaged in dialectical behavior therapy. As part of the therapy, the client is learning how to control and change extreme behaviors in response to events. The nurse identifies the client as learning which type of skills? Reframing Mindfulness skills Emotion regulation skills Distress tolerance skills
emotion regulation skills
A client diagnosed with schizoid personality disorder is described by family members as what? Nervous and fearful Tired and sad Emotionless and a loner Dramatic and emotional
emotionless and a loner
The nurse is providing care for a client who has been diagnosed with antisocial personality disorder. Which outcome should the nurse prioritize when planning this client's care? The client will be free from self-inflicted harm. The client will use the support system without becoming overly dependent on it. The client will to express anger in an adaptive, nonviolent manner The client will establish an adequate balance of rest, sleep, and activity.
he client will to express anger in an adaptive, nonviolent manner
Emotional regulation skills are taught to those diagnosed with borderline personality disorder to manage what? Physical disability Problem solving Impulsive behaviors Psychotic behaviors
impulsive behaviors
Emotional regulation skills are taught to those diagnosed with borderline personality disorder to manage what? Psychotic behaviors Physical disability Problem solving Impulsive behaviors
impulsive behaviors
Gambling, binge eating, and engaging in unsafe sex are examples of what? Dissociation Identity diffusion Impulsivity Affective instability
impulsivity
After reviewing information about different personality disorders, a group of nursing students demonstrates understanding when they identify which as associated with schizoid personality disorder? Overly friendly Exuberant Highly social Introverted
introverted
A nurse caring for a client with borderline personality disorder (BPD) consistently informs the client of the length of the relationship and routinely prepares the client for termination and the end of hospitalization. Which is the nurse trying to prevent? Poor social skills Maladaptive expression of emotions Depression Mania
maladaptive expression of emotions
A nurse is preparing an inservice program for a group of mental health nurses on the topic of borderline personality disorder. When discussing the need for hospitalization, which would the nurse include as the most likely reason for inpatient hospitalization? Affective instability Identity diffusion Nonsuicidal self-injury Dichotomous thinking
nonsuicidal self-injury
A client admitted on the inpatient mental health unit has been suspicious of other clients on the unit. This client is often angry at others' comments, and carries a grudge against a roommate for accidentally using the client's bath towel. Which personality disorder is mostlikely the client's diagnosis? Paranoid Antisocial Borderline Histrionic
paranoid
A client is admitted with a diagnosis of schizotypal personality disorder. Which characteristic would this client exhibit during social situations? Paranoid thoughts Trusting behaviors Perfectionism Dependency needs
paranoid thoughts
Which would be the priority nursing diagnosis for a client diagnosed with borderline personality disorder (BPD)? Disturbed thought process Ineffective coping Chronic low self-esteem Risk for self-mutilation
risk for self-mutilation
Which would be the priority nursing diagnosis for a client diagnosed with borderline personality disorder (BPD)? Disturbed thought process Ineffective coping Risk for self-mutilation Chronic low self-esteem
risk for self-mutilation
Clients with borderline personality disorder (BPD) are usually admitted to the inpatient setting because they exhibit what? Self-harm Aggression Impulsivity Splitting
self harm