MH HESI: Personality Disorders

Which of the following interventions is important for a client with paranoid personality disorder taking olanzapine (Zyprexa)? 1. Explain effects of serotonin syndrome 2. Teach the client to watch for extrapyramidal adverse reactions 3. Explain that the drug is less effective if the client smokes 4. Discuss the need to report paradoxical effects such as euphoria.

3. Explain that the drug is less effective if the client smokes. Olanzapine (Zyprexa) is less effective for clients who smoke cigarettes. Olanzapine doesn't cause euphoria (damn), and extrapyramidal side effects aren't a problem. However, the client should be aware of adverse effects such as tardive dyskinesia.

personality disorders are described as:

-various inflexible maladaptive behavior patterns or traits that may impair functioning and relationships -The client usually remains in touch with reality and typically has a lack of insight on his or her behavior -stress exacerbates manifestations of the 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: 1. Control anger 2. Reduce anxiety 3. Set realistic goals 4. Become more self-aware

4. Become more self-aware. Client's must first become aware of their behavior before they can change it. Occurs after the client is aware of the behavior and has a desire to change the behavior.

A nurse is performing an assessment on a client admitted to the mental health unit. The nurse notes that the client's diagnosis is documented as obsessive-compulsive disorder. The nurse plans care knowing that the client is most likely to experience which type of compulsive behavior? A. Fears B. Actions C. Illusions D. Thoughts

B. Actions A compulsion is a repetitive act. The client with a phobia is likely to experience repetitive fears. Illusions are characteristic of schizophrenia. An obsession is a repetitive thought.

Research has indicated that antisocial personality may be characterized by: A. social isolation. B. lack of remorse. C. learning difficulties. D. difficulty with reality testing.

B. lack of remorse. The antisocial personality exhibits a lack of remorse when confronted with the results of their thoughtless, irresponsible behavior towards others.

A newly admitted client has an axis II diagnosis of schizoid personality disorder. The nursing intervention of highest priority will be to A. set firm limits on behavior. B. respect need for social isolation. C. encourage expression of feelings. D. involve in milieu and group activities.

B. respect need for social isolation. Schizoid personality disorder has the primary feature of emotional detachment. The person does not seek out or enjoy close relationships. They are reclusive, avoidant, and uncooperative. They do not do well with resocialization

Playing one staff member against another is an example of A. devaluation. B. splitting. C. impulsiveness. D. social ineptitude.

B. splitting. Splitting involves setting up individuals or groups to disagree. While the two parties are busy disagreeing, they are too busy to maintain consistent limits for the manipulative client. The client can enjoy the spectacle and do as he or she pleases.

Which client with a personality disorder is most likely to be admitted to a psychiatric unit? A. Mr. A, with paranoid personality disorder who is suspicious of his neighbors B. Mr. B, with narcissistic personality disorder who is highly self-important C. Ms. C, with borderline personality disorder who is impulsive D. Mrs. D, with dependent personality disorder who clings to her husband

C. Ms. C, with borderline personality disorder who is impulsive Clients with borderline disorder can decompensate into psychotic states under stress. Hospitalization is needed at these times.

Cluster B personality disorders

antisocial, borderline, histrionic, narcissistic

narcissistic personality disorder characteristics

dramatic, flamboyant, needs to be the center of attention

antisocial personality disorder characteristics

feelings of self-importance and entitlement; may exploit others to get own needs met

Cluster A personality disorders

schizoid, schizotypal and paranoid

avoidant personality disorder Characteristics

Needy, always in crisis, self-mutilating, unable to sustain relationships, splitting behaviors

Which behavior would be inconsistent with defining characteristics for the nursing diagnosis of ineffective coping? A. Difficulty in relationships B. High levels of anxiety C. Manipulation D. Interdependence

D. Interdependence The characteristics for the diagnosis of ineffective coping include crisis, high levels of anxiety, anger and aggression; child, elder, or spouse abuse; and difficulty in relationships and manipulation. Interdependence would not be considered a symptom for ineffective coping.

Borderline Personality Disorder characteristics

Orderly, rigid

Which of the following assessment findings is seen in a client diagnosed with borderline personality disorder? 1. Abrasions in various healing stages 2. Intermittent episodes of hypertension 3. Alternating tachycardia and bradycardia 4. Mild state of euphoria with disorientation

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

Which of the following information must be included for the family of a client diagnosed with dependent personality disorder? 1. Address coping skills 2. Explore panic attacks 3. Promote exercise programs 4. Decrease aggressive outbursts

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

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? 1. Binge eating 2. Memory loss 3. Cult membership 4. Delusional thinking

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

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? 1. Establish a therapeutic relationship with the client 2. Identify whether splitting is present in the client's thoughts 3. Talk about the client's acting out and self-destructive tendencies. 4. Encourage the client to understand why he blames others

1. Establish a therapeutic relationship with the client. 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 the 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.

A psychiatrist prescribes an anti-obsessional agent for a client who is using ritualistic behavior. A common anti-anxiety medication used for this type of client would be: 1. Fluvoxamine (Luvox) 2. Benztropine (Cogentin) 3. Amantadine (Symmetrel) 4. Diphenhydramine (Benadryl)

1. Fluvoxamine (Luvox). This drug blocks the uptake of serotonin.

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. 1. Impulsiveness 2. Lability of mood 3. Ritualistic behavior 4. psychomotor retardation 5. Self-destructive behavior

1. Impulsiveness 2. Lability of mood 5. Self-destructive behavior

The nursing diagnosis that would be most appropriate for a 22-year old client who uses ritualistic behavior would be: 1. Ineffective coping 2. Impaired adjustment 3. Personal identity disturbance 4. Sensory/perceptual alterations

1. Ineffective coping. Ineffective coping is the impairment of a person's adaptive behaviors and problem-solving abilities in meeting life's demands; ritualistic behavior fits under this category as a defining characteristic.

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? 1. Lack of honesty 2. Belief in superstitions 3. Show of temper tantrums 4. Constant need for attention

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

Which of the following nursing interventions has priority for a client with borderline personality disorder? 1. Maintain consistent and realistic limits 2. Give instructions for meeting basic self-care needs 3. Engage in daytime activities to stimulate wakefulness 4. Have the client attend group therapy on a daily basis

1. Maintain consistent and realistic limits. 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 don't tend to have sleeping difficulties. They enjoy attending group therapy because they often attempt to use the opportunity to become the center of attention

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: 1. Splitting 2. Ambivalence 3. Passive aggression 4. Reaction formation

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

A client with avoidant personality disorder says occupational therapy is boring and doesn't want to go. Which action would be best? 1. State firmly that you'll escort him to OT. 2. Arrange with OT for the client to do a project on the unit. 3. Ask the client to talk about why OT is boring 4. Arrange for the client not to attend OT until he is feeling better

1. State firmly that you'll escort him to OT. If given the chance, a client with avoidant personality disorder typically elects to remain immobilized. The nurse should insist that the client participates in OT. Arranging for the client to do a project on the unit validates and reinforces the client's desire to avoid getting to OT. Addressing an invalid issue such as the client's perceived boredom avoids the real issue: the client's need for therapy.

When assessing a client diagnosed with impulse control disorder, the nurse observes violent, aggressive, and assaultive behavior. Which of the following assessment data is the nurse also likely to find? Select all that apply. 1. The client functions well in other areas of his life. 2. The degree of aggressiveness is out of proportion to the stressor. 3. The violent behavior is most often justified by the stressor. 4. The client has a history of parental alcoholism and chaotic, abusive family life. 5. The client has no remorse about the inability to control his anger.

1. The client functions well in other areas of his life. 2. The degree of aggressiveness is out of proportion to the stressor. 5. The client has no remorse about the inability to control his anger. A client with an impulse control disorder who displays violent, aggressive, and assaultive behavior generally functions well in other areas of his life. The degree of aggressiveness is typically out of proportion with the stressor. Option E: Such a client commonly has a history of parental alcoholism and a chaotic family life, and often verbalizes sincere remorse and guilt for the aggressive behavior. Such a client commonly has a history of parental alcoholism and a chaotic family life, and often verbalizes sincere remorse and guilt for the aggressive behavior.

Which of the following statements is expected from a client with borderline personality disorder with a history of dysfunctional relationships? 1. "I won't get involved in another relationship." 2. "I'm determined to look for the perfect partner." 3. "I've decided to use better communication skills." 4. "I'm going to be an equal partner in a relationship."

2. "I'm determined to look for the perfect partner." 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. Because they tend to blame others for problems, it's unlikely they would express a desire to learn communication skills.

A person with antisocial personality disorder has difficulty relating to others because of never having learned to: 1. Count on others 2. Empathize with others 3. Be dependent on others 4. Communicate with others socially

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

The client with antisocial personality disorder: 1. Suffers from a great deal of anxiety 2. Is generally unable to postpone gratification 3. Rapidly learns by experience and punishment 4. Has a great sense of responsibility toward others

2. Is generally unable to postpone gratification. 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 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: 1. Return immediately, to demonstrate control 2. Return on time or restrictions will be imposed 3. Come back at 6:45, as a compromise to set limits 4. Come back as soon as possible or the police will be sent

2. Return on time or restrictions will be imposed. This sets limits, points out reality, and places responsibility for behavior on the client.

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? 1. The client is courteous 2. The client asks questions 3. The client stops acting out 4. The client controls emotions

2. The client asks questions. The client with a 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.

The nurse is planning activities for a client diagnosed with bipolar disorder with aggressive social behavior. Which activity would be most appropriate for this client? 1. Chess 2. Writing 3. Ping pong 4. Basketball

2. Writing Solitary activities that require a short attention span with mild physical exertion are the most appropriate activities for a client who is exhibiting aggressive behavior. Writing, walks with staff, and finger painting are activities that minimize stimuli and provide a constructive release for tension. The remaining options have a competitive element to them should be avoided because they can stimulate aggression and increase psychomotor activity.

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: 1. "We are not permitted to date clients." 2. "No, you are a client and I am a nurse." 3. "I like you, but our relationship is professional." 4. "It's against my professional ethics to date clients."

3. "I like you, but our relationship is professional." 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.

Which of the following statements is typical for a client diagnosed with a personality disorder? 1. "I understand you're the one to blame." 2. "I must be seen first; it's not negotiable." 3. "I see nothing humorous in this situation." 4. "I wish someone would select the outfit for me."

3. "I see nothing humorous in this situation." Clients with paranoid personality disorder tend to be extremely serious and lack a sense of humor.

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? 1. "I believe we need to sit down and talk about this." 2. "Don't you know better than to try to bend the rules?" 3. "What you're asking me to do is unacceptable." 4. "Why don't you bring this request to the community meeting?"

3. "What you're asking me to do is unacceptable." 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.

Which of the following characteristics or client histories substantiates a diagnosis of antisocial personality disorder? 1. Delusional thinking 2. Feelings of inferiority 3. Disorganized thinking 4. Multiple criminal charges

4. Multiple criminal charges. Clients with antisocial personality disorder are often sent for treatment by the court after multiple crimes or for the use of illegal substances.

A nurse discusses job possibilities with a client with schizoid personality disorder. Which suggestion by the nurse would be helpful? 1. "You can work in a family restaurant part-time on the weekend and holidays." 2. "Maybe your friend could get you that customer service job where you work only on the weekends." 3. "Your idea of applying for the position of filing and organizing records is worth pursuing." 4. "Being an introvert limits the employment opportunities you can pursue."

3. "Your idea of applying for the position of filing and organizing records is worth pursuing." Clients with schizoid personality disorder prefer solitary activities, such as filing, to working with others. Working as a cashier or in customer service would involve interacting with many people.

Which of the following conditions is likely to coexist in clients with a diagnosis of borderline personality disorder? 1. Avoidance 2. Delirium 3. Depression 4. Disorientation

3. Depression. 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 types of behavior is expected from a client diagnosed with a paranoid personality disorder? 1. Eccentric 2. Exploitative 3. Hypersensitive 4. Seductive

3. Hypersensitive. 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 a 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? 1. Antisocial behavior 2. Suspicious behavior 3. Relationship problems 4. Auditory hallucinations

3. Relationship problems. 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: 1. Set limits on manipulative behavior 2. Encourage participation in group therapy 3. Respect the client's needs for social isolation 4. Understand that seductive behavior is expected.

3. Respect the client's needs for social isolation. 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.

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: 1. Promptly notify the attending physician 2. Immediately initiate suicide precautions 3. Sit quietly with the client until nausea and vomiting subsides 4. Assess the client's vital signs and administer syrup of ipecac

3. Sit quietly with the client until nausea and vomiting subside. This intervention demonstrates the nurse's caring presence which is vital for this client. Although the treatment team does need to know about the event, notification is not the immediate concern. Suicide precautions are premature and it reinforces the client's predisposition to manipulative behavior. Ipecac 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: 1. Suggest that the client requesting attention speak with another staff member 2. Leave the new client and talk with the other client to avoid precipitating acting out behavior 3. Tell the interrupting client to sit down and be patient, stating, "I'll be back as soon as possible." 4. Introduce the two clients and suggest that the client join the new client and the nurse on the tour

3. Tell the interrupting client to sit down and be patient, stating, "I'll be back as soon as possible." This sets realistic limits on behavior without rejecting the client

Which of the following characteristics is expected for a client with paranoid personality disorder who receives bad news? 1. The client is overly dramatic after hearing the facts 2. The client focuses on self to not become over-anxious 3. The client responds from a rational, objective point of view 4. The client doesn't spend time thinking about the information.

3. The client responds from a rational, objective point of view. Clients with paranoid personality disorder are affectively restricted, appear unemotional, and appear rational and objective.

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? 1. Admonish the client for not using the bathroom 2. Firmly tell the client that her behavior is unacceptable 3. Ask the client if she's ready to get cleaned up now 4. Help the client to the shower, and change the bedclothes.

4. Help the client to the shower, and change the bedclothes. 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.

A nurse is assessing a client diagnosed with dependent personality disorder. Which of the following characteristics is a major component to this disorder? 1. Abrasive to others 2. Indifferent to others 3. Manipulative of others 4. Over-reliance on others

4. Over-reliance on others. 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.

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? 1. Antisocial 2. Avoidant 3. Borderline 4. Paranoid

4. Paranoid. 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.

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: 1. Controlling anxiety 2. Terminating the session on time 3. Accepting the psychiatric diagnosis 4. Setting mutual goals for the relationship

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

A client with obsessive-compulsive personality disorder takes the nurse aside and mentions "I've observed you interacting with Mr. D. You are not approaching him properly. You should be more forceful with him." The best response for the nurse would be A. "I will be continuing to follow the care plan for Mr. D." B. "I see you are trying to control Mr. D's therapy as well as your own." C. "Your eye for perfection extends even to my nursing interventions." D. "Mr. D's care is really of no concern to you or to other clients."

A. "I will be continuing to follow the care plan for Mr. D." Obsessive-compulsive personality disorder has the key factor of perfectionism with a focus on orderliness and control. These individuals get so preoccupied with details and rules that they may not be able to accomplish the tasks. Guard against engaging in power struggles with a client with obsessive-compulsive disorder.

A nurse is planning care for a group of clients on a mental health unit. The nurse notes that most of the assigned clients require interventions commonly used to treat anxiety disorders. Such antianxiety interventions would be appropriate for which clients? Select all that apply. A. A client with panic disorder B. Generalized anxiety disorder C. A client with multiple personality disorder D. A client with post-traumatic stress disorder (PTSD) E. A client with obsessive-compulsive disorder (OCD)

A. A client with panic disorder B. Generalized anxiety disorder D. A client with post-traumatic stress disorder (PTSD) E. A client with obsessive-compulsive disorder (OCD) Multiple personality disorder is considered to be a dissociative disorder rather than an anxiety disorder. Anxiety is a characteristic of panic disorder, generalized anxiety disorder, PTSD, and OCD.

A client has been diagnosed with dependent personality disorder. Which behavior descriptions can the nurse expect to assess? A. Anxious, fearful B. Odd, eccentric C. Dramatic, emotional, erratic D. Disoriented, disorganized

A. Anxious, fearful Dependent personality disorder has a primary feature of extreme dependency in a close relationship, with an urgent search to find a replacement when one relationship ends. These individuals have difficulty making independent decisions and are constantly seeking reassurance. They have deeply held convictions of personal incompetence, with the fear that they cannot survive on their own. They frequently seek treatment for anxiety or mood disorders related to a loss.

A client 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 client 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. Avoidant The avoidant personality disorder is characterized by social withdrawal and extreme sensitivity to potential rejection. The person retreats to social isolation. Borderline personality disorder is characterized by unstable mood and self-image and impulsive and unpredictable behavior. Schizotypal personality disorder is characterized by the display of abnormal thoughts, perceptions, speech, and behaviors. Obsessive-compulsive personality disorder is characterized by perfectionism, the need to control others, and a devotion to work.

A nurse assists a client with a diagnosis of obsessive-compulsive disorder (OCD) in his preparations for bedtime. One hour later the client calls the nurse and says that he is feeling anxious; he asks the nurse to sit and talk for a while. Which is the appropriate initial nursing action? A. Sit and talk with the client. B. Ask the unlicensed assistive personnel to sit with the client. C. Administer the prescribed as-needed antianxiety medication. D. Tell the client that it is time for sleep and that you will talk with him tomorrow.

A. Sit and talk with the client. The appropriate initial nursing action is to sit and talk with the client if he is expressing anxiety. An unlicensed assistive personnel may not be able to alleviate the client's anxiety. Antianxiety medication may be necessary, but this would not be the initial appropriate nursing action. Option 4 is an inappropriate action and places the client's feelings on hold.

Which statement is descriptive of clients with personality disorders? A. They are resistant to behavioral change. B. They have an ability to tolerate frustration and pain. C. They usually seek help to change maladaptive behaviors. D. They have little difficulty forming satisfying and intimate relationships.

A. They are resistant to behavioral change. Personality disorders are deeply ingrained and pervasive. Clients with personality disorders find it very difficult, if not nearly impossible, to change. Change proceeds very slowly.

A client with histrionic personality disorder winks at an attractive nurse and states, "You and I should be able to turn those resident physicians into jelly if you'd wear your skirts about two inches shorter." The nurse's reply should be based on the understanding that the client's use of seductive behavior is A. a response to stress. B. based on a need to dominate. C. seated in primitive rage. D. callous disregard for others.

A. a response to stress. The histrionic person is impulsive and melodramatic and may act flirtatious or provocative to get the spotlight in an attempt to reduce stress

A 16-year-old has stolen money from his invalid grandmother, uses drugs and alcohol, and frequently beats up acquaintances who disagree with him. Arrested for an assault in which he beat a classmate and caused brain damage, he stated in court "The guy deserved everything he got." The behaviors described are most consistent with the clinical picture of A. antisocial personality disorder. B. borderline personality disorder. C. schizotypal personality disorder. D. narcissistic personality disorder.

A. antisocial personality disorder. Clients with antisocial personality act out feelings without consideration for the rights of others. They feel no remorse for their antisocial acts.

A danger of working with a client who idealizes the nurse is A. becoming over involved and being protective and indulgent. B. becoming indecisive about planned interventions. C. developing a prejudicial, blaming orientation. D. stringent enforcement of boundaries and limits.

A. becoming over involved and being protective and indulgent. Finding an approach for helping clients with personality disorders who have overwhelming needs can be overwhelming for caregivers. For example, a borderline female client may briefly idealize her male nurse on the inpatient unit, telling staff and clients alike that she is "the luckiest client because she has the best nurse in the hospital." The rest of the team initially realizes that this behavior is an exaggeration, and they have a neutral response. But after days of constant dramatic praise, some members of the team may start to feel inadequate and jealous of the nurse. They begin to make critical remarks about minor events to prove that the nurse is not perfect. Open communication in staff meetings and ongoing clinical supervision are important aspects of self-care for the nurse working with these clients to maintain objectivity.

Characteristics the nurse will assess in the client with antisocial personality disorder are A. deceitfulness, impulsiveness, and lack of empathy. B. perfectionism, preoccupation with detail, and verbosity. C. avoidance of interpersonal contact and preoccupation with being criticized. D. need for others to assume responsibility for decision-making and seeks nurture.

A. deceitfulness, impulsiveness, and lack of empathy. Antisocial clients have no conscience. Their sense of right and wrong is impaired, and they tend to do whatever serves them best without consideration for the rights or feelings of others.

The primary goal of milieu therapy for clients with personality disorders is A. manage the affect behavior has on the entire group. B. one-on-one therapy. C. to help the client remain uninvolved with other patients. D. a laissez faire attitude.

A. manage the affect behavior has on the entire group. The primary goal of milieu therapy is affect management in a group context

A nurse is assigned to work with a client with borderline personality disorder. The nurse will need to consider strategies for dealing with the client's A. mood shifts, impulsivity, and splitting. B. grief, anger, and social isolation. C. altered sensory perceptions and suspicion. D. perfectionism and preoccupation with detail.

A. mood shifts, impulsivity, and splitting. Borderline personality disorder has the central characteristic of instability in affect, identity, and relationships. Borderline individuals desperately seek relationships to avoid feeling abandoned. But they often drive others away with excessive demands, impulsive behavior, or uncontrolled anger. Their frequent use of the defense of splitting strains personal relationships and creates turmoil in health care settings.

Characteristic behaviors the nurse will assess in the narcissistic client are A. dramatic expression of emotion, being easily led. B. perfectionism and preoccupation with detail. C. grandiose, exploitive, and rage-filled behavior. D. angry, highly suspicious, aloof, withdrawn behavior.

C. grandiose, exploitive, and rage-filled behavior. Narcissistic clients give the impression of being invulnerable and superior to others to protect their fragile self-esteem.

Clients with personality disorders have various self-defeating behaviors and interpersonal problems despite having near-normal ego functioning and intact reality testing. A nursing diagnosis that addresses this sort of interpersonal dysfunction is A. spiritual distress. B. defensive coping. C. impaired social interaction. D. disturbed sensory perception.

C. impaired social interaction. For a client who has difficulty in relationships and is very manipulative, the nursing diagnosis of impaired social interaction would be used.

The nurse is caring for a client 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 client with peers. B. Avoid using a whisper voice in front of the client. C. Begin to educate the client about social supports in the community Have the client sign a release of information to appropriate parties for assessment purposes.

B. Avoid using a whisper voice in front of the client Disturbed thought process related to paranoid personality disorder is the client's problem, and the plan of care must address this problem. The client is distrustful and suspicious of others. The members of the health care team need to establish a rapport and trust with the client. Laughing or whispering in front of the client would be counterproductive. The remaining options ask the client to trust on a multitude of levels. These options are actions that are too intrusive for a client with this disorder.

The priority nursing intervention for a client with borderline personality disorder is to A. protect other clients from manipulation. B. respect the client's need for social isolation. C. assess for suicidal and self-mutilating behaviors. D. provide clear, consistent limits and boundaries.

C. assess for suicidal and self-mutilating behaviors. One of the primary nursing guidelines/interventions for clients with a personality disorder is to assess for suicidal and self-mutilating behaviors, especially during times of stress.

A client with dependent personality disorder who had been living with her newly married son was admitted a week ago for treatment of depression, which began after her son suggested that she move out. Which remark by the client would the nurse evaluate as showing improvement in the client's condition? A. "My son's suggestion hurt me greatly." B. "My son is less at fault than my daughter-in-law." C. "I'm going to need help to afford to rent an apartment." D. "How will I ever live alone with no one to look after my affairs?"

C. "I'm going to need help to afford to rent an apartment." Dependent personality disorder has a primary feature of extreme dependency in a close relationship, with an urgent search to find a replacement when one relationship ends. Clients have a deeply held conviction of personal incompetence, with the fear that they cannot survive on their won. Self reflection on the possibility of moving into an apartment shows improvement.

A nurse caring for a client who has been diagnosed with a personality disorder should expect that the client will exhibit which of the following characteristics? A. Frequent episodes of psychosis B. Constant involvement with the needs of significant others C. Inflexible and maladaptive responses to stress D. Abnormal ego functioning

C. Inflexible and maladaptive responses to stress Personality patterns persist unmodified over long periods of time. Characteristics of inflexible and maladaptive response to stress is one of these characteristics for individuals with personality disorder.

Splitting is a process in which the client A. unconsciously represses undesirable aspects of self. B. places responsibility for his or her behavior outside the self. C. sees things as divided into "all good" or "all bad." D. evidences lack of personal boundaries.

C. sees things as divided into "all good" or "all bad." Splitting demonstrates the failure to integrate the positive and negative into a cohesive whole. An individual is not seen as a person with good and bad traits, but rather as all good or all bad.

A nurse is performing an assessment on a client admitted to the mental health unit. The client tells the nurse that she cannot leave home without checking numerous times that the iron and coffee pot have been shut off. The client states that this activity makes her late for many functions and that she misses engagements on occasion because of it. The nurse would expect to note which anxiety disorder documented in the client's record? A. A phobia B. Generalized anxiety disorder C. Posttraumatic stress disorder (PTSD) D. Obsessive-compulsive disorder (OCD)

D. Obsessive-compulsive disorder (OCD) A repetitive behavior that interferes with activities of daily living and functioning is indicative of OCD. This repetitive behavior is not associated with phobias, generalized anxiety disorder, or PTSD.

A nurse is preparing to admit a client with a diagnosis of obsessive-compulsive disorder (OCD) to the mental health unit. The nurse would expect to note which behaviors in the client? A. Suspicious and hostile B. Flexible and adaptable C. Frightened and delusional D. Rigidness in thought and inflexibility

D. Rigidness in thought and inflexibility Rigid and inflexible behaviors are characteristic of the client with OCD. Clients with this disorder usually are not hostile unless they are prevented from engaging in the obsession or compulsion, because this behavior is what decreases the anxiety. Options A, B, and C are incorrect and are not characteristic of OCD.

Obsessive-Compulsive Personality Disorder Characteristics

Unable to conform to social norms

schizotypal personality disorder Characteristics

Unable to make decisions for self, allows others to assume responsibility for his or her life