Chapter 30: Personality and Borderline Personality Disorder

A client with a dependent personality disorder is receiving treatment on a medical unit. The client asks the nurse for assistance to open the tube of toothpaste so they can brush their teeth. Which is the best response by the nurse?

"I'll stay here and you can show me what you've tried to do to get the top off"

The nurse is talking with a client that is diagnosed with histrionic personality disorder. Which statement made by the client does the nurse identify correlates with this diagnosis?

"No one is paying attention to me and I am so angry!"

The nurse is beginning to work with a client who has a diagnosis of paranoid personality disorder. Which question made by the nurse would be best in the beginning of the conversation?

"What would you like to accomplish today?"

A client with antisocial personality disorder is requesting to use the phone to call the client's spouse, even though it is against the unit rules. The client states, "It is just this once, and my spouse will be so hurt if I don't call." Which is the most appropriate response by the nurse?

"You may not use the phone to call your spouse."

The nurse is caring for a client with a personality disorder. The nurse determines the client is using manipulation to test the staff. Which client statement(s) alerts the nurse to this behavior? Select all that apply.

"You seem like a caring nurse; the one on the evening shift is bad." "The doctor just doesn't get me, but the therapist is good." "I'll just sit this therapy session out; it was okay with the doctor."

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."

Which is considered the etiology of personality disorders?

A combination of psychosocial and biologic variables

Which is the underlying issue in kleptomania?

Act of stealing

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

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

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?

Affective instability

A mental health nurse educator offers information to staff nurses about how to discern various personality disorders. Which is an example of a client with traits of a dependent personality disorder?

An adult client living with parents requiring assistance with planning and carrying out activities

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 nurse suspects that a client may be exhibiting characteristics of narcissistic personality disorder. Which finding would support the nurse's suspicion? Select all that apply.

Arrogance Lack of empathy Grandiosity Preoccupation with fantasy

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 person with temperament traits of high harm avoidance would most likely suffer from which personality disorder?

Avoidant

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

One of the biosocial theories of the etiology of borderline personality disorder involves the role of an invalidating environment, a social situation that negates private emotional responses and communication. The most severe form of invalidation occurs in which of the following situations?

Child sexual abuse

A nurse is assessing a client with borderline personality disorder. During the assessment the nurse notes that the client is using projective identification. Which of the following would support this interpretation?

Client attributes own feelings falsely to others.

Chapter 30: Personality and Borderline Personality Disorder

Cognitive therapy

The nurse is working with a client with paranoid personality disorder to facilitate behavioral change. Which intervention does the nurse employ that will have the greatest impact on successful achievement of outcomes?

Collaborate with the client when establishing treatment outcomes.

The nurse is aware that for some personality disorders, denial of symptoms is common. Which therapeutic approach does the nurse choose to address this denial?

Compassion

A 35-year-old client with a diagnosis of antisocial personality disorder is being seen by a psychiatrist. He has been arrested three times for aggravated battery within the last year. Which disorder may have been seen in this client prior to age 18?

Conduct

To be diagnosed with antisocial personality disorder (APD) as an adult, characteristics of which mental health disorder must be met?

Conduct disorder

An adult female client presents to the mental health clinic and is assessed by the nurse. During the assessment, the nurse observes the client engage warmly with an appropriately variable affect and to be open to share their life story. The story included a pattern of failed intimate relationships, which the client attributes to a mild form of cerebral palsy. The client lives in the parental home. The client's father died when she was in high school and her mother passed away three months prior to the assessment. Interpersonally the client says she works hard to avoid conflict. References are made to being "unlovable" and that she is "engulfed in sadness" to the point of needing a disability income. This is due to the expressed fear of being "unable" to care for everyday needs independently. What disorder does the nurse suspect?

Dependent personality disorder

A client with borderline personality disorder tells the nurse, "Everything bad happens to me. I'm absolutely no good." The nurse interprets this statement as which of the following?

Dichotomous thinking

The nurse completes an intake assessment for a client. Which symptoms are associated with dependent personality disorder? Select all that apply

Difficulty making everyday decisions Withdrawal from adult responsibilities Expresses fears of being unable to manage self-care

The nurse completes an intake assessment for a client. Which symptoms are associated with dependent personality disorder? Select all that apply.

Difficulty making everyday decisions Withdrawal from adult responsibilities Expresses fears of being unable to manage self-care

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.

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

Risk for self-mutilation

The outpatient clinic nurse has taken a referral for a 16-year-old male client who requires assessment for possible conduct disorder. When assessing this client which behavior would the nurse identify as supporting this diagnosis?

Engaging in the destruction of property

The nurse plans care for a client with antisocial personality disorder (ASPD) and concurrent chronic pain. Which assessment finding is anticipated?

Exaggeration of the physical symptoms

Brain dysfunction associated with borderline personality disorder (BPD) occurs in the limbic system and which lobe of the brain?

Frontal

Which personality disorder is diagnosed more often in women?

Histrionic

A 36-year-old client demonstrates a pattern of overexpressiveness with emotions. The client has a relationship history in which the client is attention seeking. The client has recently been experiencing difficulty maintaining appropriate boundaries with colleagues at a new job. The nurse would most likely suspect which disorder?

Histrionic personality disorder

The nurse completes an assessment for a female client in an outpatient clinic. In addition to her medical issues, the client shares that she has a personality disorder. The client wears heavy makeup and demonstrates strong emotional intensity. Which personality disorder does the nurse identify based on the assessment findings?

Histrionic personality disorder

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

Impulsive behaviors

After teaching a group of nurses about different personality disorders, the group leader determines that the education was successful when the nurses identify which characteristic of schizotypal personality disorder?

Increased eccentricity

A nurse working in an inner city youth support program identifies that antisocial personality disorder (ASPD) can develop in those who have dysfunctional attachments. Which are risks for developing dysfunctional attachments? Select all that apply

Losing of a parent through death Experiencing physical or sexual abuse Experiencing parental abandonment or neglect

A client with narcissistic personality disorder and co-occurring hypomania is admitted to an acute mental health unit. Which is a priority nursing intervention?

Managing the client's hypomania

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

When the nurse is not informed of developmental and cultural issues related to the client's background, which of the following may be expected?

Normal patterns of behavior may be labeled as deviant, immoral, or insane.

The school nurse is observing children in a classroom at the teacher's request. The teacher has concerns that one child is continuously disruptive. The nurse observes that the child sits alone without an obvious friend. The child goes to a group of classmates using building blocks. The child knocks down the tower and blames another child for the mishap. The teacher intervenes and the child is immediately argumentative with the teacher. The child has an angry outburst and kicks the blocks while walking away. Which disorder does the nurse identify from the child's behavior?

Oppositional defiant disorder

The nurse is planning the care of a client undergoing therapy for borderline personality disorder and explains to the client that therapy is a long process. Which is a realistic outcome to assign to the client?

Outcomes that focus on change in behavior

Which defense mechanism is used by people diagnosed with borderline personality disorder to protect their fragmented self-image?

Projective identification

A nurse working in a facility where clients with antisocial personality disorder (ASPD) receive care. Which interventions support client self-responsibility? Select all that apply.

Providing detailed feedback when self-responsibility is noted Describing the benefits of choosing responsible behavior

The nurse provides care to clients who have a tendency toward antisocial and criminal behavior. Which term was used in the past to describe people with this disorder?

Psychopath

A nurse is educating a client with borderline personality disorder to reshape thinking patterns. Which cognitive restructuring technique that would be helpful for this client will the nurse educate the client about?

Recognize negative thoughts and replace them with positive ones.

During neighborhood scans, a nurse working in a community outreach program has identified an individual staying in a local shelter. The person has not engaged with the program. During the day, the client can be observed sweeping the pavement in a particular alley with a broom. There is no obvious purpose to the behavior. The individual is dressed in winter clothing even though it is summer. The client mutters expressions that are audible but cannot be understood. Based on the observations, which disorder does the nurse consider?

Schizotypal personality disorder

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

Self-harm

Which thought process would cause a client with antisocial personality disorder to want to do everything for the self?

Sense of mistrust of others

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

The nurse provides care for a male client with a skin infection. The client also has a diagnosis of paranoid personality disorder. The client removes the peripheral intravenous device, expresses suspicion that the antibiotics are "poisoning" him and that others in the health care system are exerting control over his life. The client is hypervigilant and looks worried. What is the nurse's priority intervention?

State awareness of client's concern and gently offer an alternative perspective

A school-age child has a diagnosis of disruptive behavior disorder. The school nurse conducts an education session to help the parents understand the diagnosis and to teach skills that the parents can implement to help address disruptive behavior. What can parents do to help? Select all that apply.

Teach problem-solving skills Use time out for disruptive behavior Make behavioral expectations clear and consistently enforce them

The nurse is involved in the care of a client with antisocial personality disorder. Which purpose does the nurse identify as a priority when participating in a periodic team meeting when caring for this client?

Team consistency is important to prevent manipulation by the client.

The nurse is preparing a plan of care for a client with dependent personality disorder and assigns an outcome to increase problem-solving skills. Which client behavior would indicate progress toward meeting that outcome?

The client is asking questions to gain information.

Which is a characteristic(s) of intermittent explosive disorder (IED)? Select all that apply.

The episode may occur with seemingly no warning. The episode usually lasts less than 30 minutes. It involves repeated episodes of impulsive, aggressive, violent behavior, and angry verbal outbursts.

A nurse is careful to provide a quiet, comfortable, safe environment when conducting an assessment interview. What is the reason this is particularly important when working with a client believed to be exhibiting characteristics of a personality disorder?

This disorder produces defensive, guarded, and impulsive behavior that is easily provoked into anger when the client feels threatened.

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

Thought stopping

Mnemonic for remembering the clusters: A, B, and C

Weird, Wild, and Worried

A 21-year-old client is being evaluated in the clinic for anger management. The client describes experiencing repeated episodes lasting 20 to 30 minutes of aggressive behavior with angry verbal outbursts when feeling angry. Which diagnosis should the nurse assess for?

intermittent explosive disorder (IED)

The nurse seeks to establish trust while assessing the social history of a client with antisocial personality disorder (ASPD). Which finding(s) demonstrate the client's relationship challenges? Select all that apply.

relationships end suddenly a pattern of failed relationships persistent pattern of disregard for others