Chapter 18
Which would be the priority nursing diagnosis for a client diagnosed with borderline personality disorder (BPD)? Disturbed thought process Ineffective coping Personal identity disturbance Risk for self-mutilation
Risk for self-mutilation p343-344
Which would be the priority nursing diagnosis for a client diagnosed with borderline personality disorder (BPD)? Risk for self-mutilation Ineffective coping Disturbed thought process Chronic low self-esteem
Risk for self-mutilation p343-344
A nurse is reviewing the biologic theories associated with borderlline personalilty disorder. The nurse demonstrates understanding of the information by identifying which areas as being associated with brain dysfunction tied to borderline personality disorder? Select all that apply. Temporal lobe Frontal lobe Cerebellum Limbic system Hypothalamus
Frontal lobe Limbic system p329
In reviewing the history of a client with borderline personality disorder, the nurse would expect to find which clinical manifestation? Unlawful behavior Impulsivity Hallucinations Lethargy
Impulsivity p331
When providing care to a client who consistently attempts to manipulate the staff, the nurse can best maintain the therapeutic milieu by doing what? Instructing the staff to enforce all unit rules consistently Encouraging questions and discussing the client's concerns Promoting social ostracism of the client's exhibiting manipulation Scheduling staff one-on-one time with the client
Instructing the staff to enforce all unit rules consistently p343
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 Overly friendly Highly social Exuberant
Introverted p333
A nurse is providing care to a client with antisocial personality disorder. As part of the plan of care, the client is to participate in a problem-solving group. The nurse understands that this intervention is effective based on which rationale? It requires the client to develop attachments. It sets up specific boundaries for the client. It helps to reinforce self-responsibility. It avoids confrontation about dysfunctional patterns.
It helps to reinforce self-responsibility. p337
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 Learning problem solving Discussing feelings about self-harm Expressing angry feelings
Learning strategies to refrain from self-harm p343-344
Which personality disorder is most often treated within the inpatient psychiatric setting? Antisocial Schizotypal Borderline Dependent
Borderline p328
Which personality disorder is most commonly found in clinical settings? Borderline personality Antisocial personality Histrionic personality Narcissistic personality
Borderline personality p340
Into which personality disorder category are individuals placed whose behavior appears odd or eccentric? Cluster A Cluster B Cluster C Cluster D
Cluster A p328
Which cluster of disorders corresponds to symptoms of being dramatic and emotional? Cluster A Cluster B Cluster C Cluster D
Cluster B p328
A nurse working with a client with borderline personality disorder could establish which as outcome criteria? Display anger more frequently. Act out neediness. Filter concerns and insecurities through the nurse. Tolerate stress without self-mutilation.
Tolerate stress without self-mutilation. p329
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? "Do you always practice safe sex?" "Are you pleased with your medications?" "Do you think of yourself as physically attractive?" "Are you interested in making your partner happy?"
"Do you always practice safe sex?" p.341
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." "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 begin by telling the other person what has triggered my emotion."
"I should start by stating my feelings as an 'I' statement." p345
The adult children of a client with narcissistic personality disorder meet with the therapist as part of their parent's treatment. The nurse is aware that which statement by the daughter is consistent with behavior typically associated with this personality disorder? "My parent was always timid and fearful." "My parent never had any family or friends over to the house." "My parent was constantly threatening to commit suicide." "My parent never really seemed to see me as a person with my own thoughts and problems."
"My parent never really seemed to see me as a person with my own thoughts and problems." p347
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? "Well, that's a good question. I need to check with the team." "No, only one cigarette is allowed per break time." "This is a good example of trying to push your limits." "It depends on whether or not we can make that exception that day."
"No, only one cigarette is allowed per break time." p336
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." "Self-injurious behavior often calms and sedates people with this diagnosis." "Sometimes they do it to avoid the onslaught of delusional thinking." "The self-mutilation often slows the mood swings your sibling experiences."
"Sometimes the self-injurious behavior is undertaken to relieve stress." p329
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 malleable." "Temperament is not changeable." "Temperament seen in infancy is often seen later in life." "Temperamental differences among children can be observed very early in life."
"Temperament is not changeable." p329
Which statement by a client with borderline personality disorder (BPD) is an example of catastrophizing? "This is the most awful thing that has ever happened to me." "No one ever listens to me." "I never get what I want." "If I had not made him mad, he wouldn't have hit me."
"This is the most awful thing that has ever happened to me." p345-346
A client with borderline personality disorder tells a nurse, "I'm afraid to get on a train because we'll probably get into a wreck." Which response by the nurse would be most appropriate? "Have you had a bad experience riding a train?" "What are the chances of that actually happening?" "Now you know that won't happen." "Have you thought about going by automobile?"
"What are the chances of that actually happening?" p345
The nurse is caring for a client with antisocial personality disorder. Which statement is most appropriate for the nurse to make when explaining unit rules and expectations to the client? "You'll be expected to 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 find your condition will improve much faster if you attend group therapy each day." "Please try to attend group therapy each day."
"You'll be expected to attend group therapy each day." p336
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 Parental alcohol abuse Poverty History of depression
Abuse as a child p340
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 Young adulthood Middle-age individuals Late adulthood
Adolescence p340
When teaching a client with antisocial personality disorder (ASPD), which approach would be most appropriate for the nurse to use? Direct Lecture Challenging Confrontational
Direct p336
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 personality disorder p335
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 how they have coped with the client's behaviors over the years Ask the parents to keep a written schedule of activities for each day for the client 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 p343
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? Establishing a therapeutic relationship Assisting with problem solving Establishing boundaries Assisting with sleep measures
Assisting with sleep measures p341
Impulsivity and difficulty controlling anger are characteristic of which mental health diagnosis? Depression Schizophrenia Posttraumatic stress disorder Borderline personality disorder
Borderline personality disorder p329
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? Paranoid personality disorder Borderline personality disorder Schizotypal personality disorder Antisocial personality disorder
Borderline personality disorder p340
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? Dependent personality disorder Borderline personality disorder Antisocial personality disorder Schizoid personality disorder
Borderline personality disorder p343
A personality disorder is defined as a collection of traits that do what? Cause behavioral dysfunction and inner distress Are malleable and poorly defined Lead to aggression and violence Lead to withdrawn and antisocial behavior
Cause behavioral dysfunction and inner distress p327
Which cluster of personality disorders is represented by individuals who appear anxious or fearful? Cluster A Cluster B Cluster C Cluster D
Cluster C p328
A nurse is developing a plan of care for a client diagnosed with an antisocial personality disorder who has been admitted to the inpatient psychiatric unit. Which would the nurse likely include? Select all that apply. Developing a therapeutic relationship Bargaining about the unit rules Holding the client responsible for behavior Discouraging client from discussing thoughts Using a firm, lecture-like approach for teaching
Developing a therapeutic relationship Holding the client responsible for behavior p338
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. Difficulty regulating moods Overinflated self-identity Problems with interpersonal relationships Thinking that is based on delusions Impulsive behavior
Difficulty regulating moods Problems with interpersonal relationships Impulsive behavior p340
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. Direct the client to another staff member when the client tries to interact. Discuss the feelings with a colleague to promote coping. Arrange for the client to be transferred to another unit.
Discuss the feelings with a colleague to promote coping. p351
Which occurs when thinking, feeling, or behaviors occur outside a person's awareness? Affective instability Impulsivity Dissociation Dichotomous thinking
Dissociation p345
A client diagnosed with schizoid personality disorder is described by family members as what? Eccentric and a loner Dramatic and emotional Nervous and fearful Tired and sad
Eccentric and a loner p333
Which is considered a part of the social domain of the biopsychosocial interventions for the client diagnosed with borderline personality disorder (BPD)? Medication administration Establishing boundaries Self-harm prevention Nutritional management
Establishing boundaries p345
Which personality disorder is diagnosed more often in women? Histrionic Schizoid Antisocial Narcissistic
Histrionic p346
When documenting observations of the behaviors exhibited by a client diagnosed with borderline personality disorder, the nurse can correctly use which terms? Impulsive, self-destructive, unstable Impulsive, aggressive, and manipulative Perfectionistic, rigid, and controlling Emotional, dramatic, and theatrical
Impulsive, self-destructive, unstable p329
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 Depression Mania Maladaptive expression of emotions
Maladaptive expression of emotions p345
Which personality disorder is categorized as a Cluster B disorder? Paranoid personality disorder Obsessive-compulsive personality disorder Schizoid personality disorder Narcissistic personality disorder
Narcissistic personality disorder p347
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? Dichotomous thinking Identity diffusion Affective instability Nonsuicidal self-injury
Nonsuicidal self-injury p340
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 cooking classes. Offer assertiveness classes. Offer women's health issues classes.
Offer cognitive restructuring classes. Offer assertiveness classes. Offer women's health issues classes. p345
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 most likely the client's diagnosis? Antisocial Borderline Paranoid Histrionic
Paranoid p332
A client is diagnosed with a personality disorder manifested by odd, eccentric behavior. Which personality disorder would be associated with this manifestation? Avoidant Dependent Obsessive-compulsive Paranoid
Paranoid p332
Which personality disorder is characterized by mistrust and suspiciousness of others? Paranoid Dependent Histrionic Narcissistic
Paranoid p332
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? Suicidal assessment Working on self-esteem Impulse control Protection from self-mutilation
Protection from self-mutilation p.340
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 Consistent regular work history Lack of remorse for actions Episodes involving scams for personal gain Detailed plans for future actions
Repeated incidents involving assaults Lack of remorse for actions Episodes involving scams for personal gain p339
When assessing a client with borderline personality disorder (BPD), which behaviors would the nurse expect to find? Select all that apply. Repeated, frequent crisis episodes Self-directed anger Intense personal awareness Learned helplessness Deceptive competence
Repeated, frequent crisis episodes Self-directed anger Learned helplessness Deceptive competence p329
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 Distrust Perfection Self-dramatization
Self-dramatization p346
The most serious consequence of behaviors seen in borderline personality disorder includes what? Identity diffusion Impulsivity Self-injury Dissociation
Self-injury p340
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? Emotion regulation skills Mindfulness skills Distress tolerance skills Self-management skills
Self-management skills p345
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? Anxiety Self-mutilation Loneliness Stress
Self-mutilation p343
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? Social skills training Anger management training Relaxation techniques Coping skills training
Social skills training p334
A client with borderline personality disorder (BPD) tells the nurse, "You are good but the nurse on the afternoon shift is bad. The doctor is bad, too, but the therapist is good." The nurse interprets this statement as reflecting what? Splitting Identity diffusion Dissociation Cognitive schema
Splitting p341
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 Defending Invalidating Projective identification
Splitting p341
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 Thought stopping Decatastrophizing Positive self-talk
Splitting p341
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 experience increased self-esteem. The client will engage in less risk-taking behavior The client will form a romantic relationship.
The client will experience increased self-esteem. p348
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. The client's parents had excessively high performance expectations of the client and failure was met with severe sanctions. 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 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. p347-348
A group of nursing students is reviewing information about antisocial personality disorder. The students demonstrate understanding of this disorder when they state what? The disorder occurs more frequently in women. The individual must be at least 18 years of age. The disorder is found primarily in Asian individuals. Alcohol abuse disorder rarely accompanies this disorder.
The individual must be at least 18 years of age. p335
