Ch 18 - prepU Personality Disorders

Impulsivity and difficulty controlling anger are characteristic of which mental health diagnosis?

Borderline personality disorder

Which diagnosis is associated with a pervasive disregard for and violation of the rights of others?

Antisocial personality

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?

"My role here is to help you recover. Let's talk about what else you can be doing after discharge."

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 uncomfortable with what you said. My role is to support you in recovery."

A nurse is interviewing a client and suspects that the client may have narcissistic personality disorder. Which statement by the client would help support the nurse's suspicions?

"I have a very important position in life; everyone I know wants to be like me."

A nurse is developing a nurse-client relationship with a client diagnosed with borderline personality disorder (BPD). Which statement by the nurse demonstrates that the nurse understands the client's fears of abandonment and intimacy?

"I will be seeing you during the daytime this week."

After reviewing information about different personality disorders, a group of nursing students demonstrates understanding when they identify which as associated with schizoid personality disorder?

Introverted

A client diagnosed with schizoid personality disorder is described by family members as what?

Eccentric and a loner

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?

Abuse as a child

A client is admitted with a diagnosis of schizotypal personality disorder. Which characteristic would this client exhibit during social situations?

Paranoid thoughts

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?

"I should start by stating my feelings as an 'I' statement." The client should begin with an "I" statement and the identification of feelings. Many want to begin with the condition. If the client begins with the condition, the statement becomes accusatory and is likely to evoke defensiveness. The "I" statement is followed by a nonjudgmental statement of the emotional trigger, then followed by what the person would like differently or what would restore comfort to the situation.

A client with borderline personality disorder has been admitted to the inpatient unit because the client has been engaging in wrist cutting. The client's sibling is visiting, and the sibling asks the nurse to explain why the client sometimes does this. Which response by the nurse would be most appropriate?

"Sometimes the self-injurious behavior is undertaken to relieve stress."

A nursing instructor is teaching about the importance of bonding and how an easy temperament can serve as a protective factor against psychopathology. Which statement made by a student demonstrates a need for further instruction?

"Temperament is not changeable." Temperament has a major influence on the chances that a child may experience psychological problems. Temperament is not unchangeable--environmental influences can change or modify a child's emotional style. Temperamental differences can be observed early in life. The patterns of temperament seen in infancy often extend into childhood and later in life.

For a person to be diagnosed with antisocial personality disorder, the individual must be a minimum of what age?

18 years

What does the nurse recognize as the most likely explanation for the self-mutilating behaviors that occur with borderline personality disorder?

An expression of intense anger or helplessness in order to block emotional pain

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?

Ask the parents to keep a written schedule of activities for each day for the client

A nurse is providing care to a client with borderline personality disorder. When providing for the client's biopsychosocial needs, the nurse would address which in the biologic domain?

Assisting with sleep measures

A nurse is describing histrionic personality disorder to a group of new nurses. Which term would the nurse most likely use?

Attention seeking

Which personality disorder is most often treated within the inpatient psychiatric setting?

Borderline

A 30-year-old client who has not paid rent in 4 months is being evicted from an apartment. The client is brought to the hospital after the client uses a kitchen knife to cut the client's wrist in response to the stress of the eviction. The client's behavior is consistent with what?

Borderline personality disorder

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 Borderline personality disorder is characterized by a disruptive pattern of instability related to self-identity, interpersonal relationships, and affect combined with marked impulsivity and destructive behavior.

Into which personality disorder category are individuals placed whose behavior appears odd or eccentric?

Cluster A

Which cluster of disorders corresponds to symptoms of being dramatic and emotional?

Cluster B

The client is a 29-year-old who is having a great deal of difficulty with a new job. The client has been unable to make decisions individually and feels overwhelmed when the client needs to begin a new project. The client often relies on one of her coworkers to help with decisions and projects. Which would describe the client correctly?

Dependent personality

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?

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?

Discuss the feelings with a colleague to promote coping.

Emotional regulation skills are taught to those diagnosed with borderline personality disorder to manage what?

Impulsive behaviors

Gambling, binge eating, and engaging in unsafe sex are examples of what?

Impulsivity

The nurse is conducting an education group for women at risk for self-mutilation. What is the most important goal for this group?

Learning strategies to refrain from self-harm

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?

Maladaptive expression of emotions

Which personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and a lack of empathy?

Narcissistic

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?

Nonsuicidal self-injury

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?

Obsessive-compulsive personality disorder

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 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 catered to the client's every need and the client used temper tantrums to successfully get the client's way.

Which is a technique used to help the client with borderline personality disorder gain control over self-critical thoughts?

Thought stopping

Clients with borderline personality disorder (BPD) are usually admitted to an inpatient setting because of what?

Threats of self-harm

A client is diagnosed with avoidant personality disorder. When assessing the client, which would be evident? Select all that apply.

Timidity Sensitivity to negative comments Fear of rejection

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?

Splitting

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?

"I need for you to get off his lap, this behavior is not appropriate."

Which is considered the etiology of personality disorders?

A combination of psychosocial and biologic variables

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?

Adolescence Many children and adolescents show symptoms similar to those of BPD, such as moodiness, self-destruction, impulsiveness, lack of temper control, and rejection sensitivity. Because symptoms of BPD begin in adolescence, it makes sense that some of the children and adolescents would meet the criteria for BPD even though it is not diagnosed before young adulthood.

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?

Affective instability

Which personality disorder would be placed in Cluster B?

Borderline

Which occurs when thinking, feeling, or behaviors occur outside a person's awareness?

Dissociation A cognitive dysfunction seen in BPD is dissociation, or times when thinking, feeling, or behaviors occur outside a person's awareness. Affective instability is evidenced by erratic emotional responses to situations and intense sensitivity to criticism or perceived slights. Impulsivity occurs when there is difficulty delaying gratification or thinking through the consequences before acting on feelings, leading to unpredictable actions. Cognitively, people with BPD have dichotomous thinking. They evaluate experiences, people, and objects in terms of mutually exclusive categories, which informs extreme interpretations of events that would normally be viewed as including both positive and negative aspects.

A client is diagnosed with a personality disorder manifested by odd, eccentric behavior. Which personality disorder would be associated with this manifestation?

Paranoid Paranoid, schizoid, and schizotypal personality disorders are characterized by behavior that is odd or eccentric. Avoidant, dependent, and obsessive-compulsive personality disorders are characterized by anxiety and fearfulness.

A psychiatric-mental health nurse is reviewing information about the possible theories associated with narcissitic personality disorder. The nurse demonstrates understanding of the information by identifying which concept as being associated with the development of this personality disorder?

Parental overindulgence of a child

Which statement accurately reflects the prognosis for a client with a personality disorder?

Prognosis varies based on the degree of functional impairment and the client's motivation to change.

A client with borderline personality disorder has been admitted to the inpatient unit after being found in the client's parents' bedroom, burning the client's arm with an iron. This injury required a brief stay in the hospital's burn unit prior to transfer to your psychiatric unit. Which is the nursing care priority for this client during the first 24 hours of admission?

Protection from self-mutilation

A nurse is reviewing the medical record of a client diagnosed with antisocial personality disorder. The nurse notes that the client has had numerous episodes involving irritability, aggressiveness, and impulsivity and has exhibited callousness toward others. Based on this information, which nursing diagnosis would the nurse identify as a priority?

Risk for other-directed violence

Which would be the priority nursing diagnosis for a client diagnosed with borderline personality disorder (BPD)?

Risk for self-mutilation

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?

Self-dramatization

Clients with borderline personality disorder (BPD) are usually admitted to the inpatient setting because they exhibit what?

Self-harm

The most serious consequence of behaviors seen in borderline personality disorder includes what?

Self-injury

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 behavior in response to events. The nurse identifies the client as learning which type of skills?

Self-management skills

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?

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?

Setting limits

A nurse is assessing a client diagnosed with avoidant personality disorder. Which would the nurse expect to find? Select all that apply.

Shyness Feelings of inadequacy

= When clients diagnosed with borderline personality disorder (BPD) see nurses as either all good or all bad, the client is using which primitive defense?

Splitting