PMHN Success 11: Personality Disorders and Impulsive Control Disorders
Which behavior would the nurse expect to observe if a client is diagnosed with paranoid personality disorder? 1. The client sits alone at lunch and states, "Everyone wants to hurt me." 2. The client is irresponsible and exploits other peers in the milieu for cigarettes. 3. The client is shy and refuses to talk to others because of poor self-esteem. 4. The client sits with peers and allows others to make decisions for the entire group.
1. Individuals with paranoid personality disorder would be isolative and believe that others were out to get them. The behavior presented reflects a client diagnosed with this disorder.
A client diagnosed with antisocial personality disorder is caught smuggling cigarettes into the nonsmoking clinical area. Which initial nursing intervention is appropriate? 1. Confront the client about the behavior. 2. Tell the client's primary nurse about the situation. 3. Remind all clients of the no smoking policy in the community meeting. 4. Teach alternative coping mechanisms to assist with anxiety.
1. It is important to address an individual's behavior in a timely manner to set appropriate limits. Limit setting is to be done in a calm, but firm, manner. A client diagnosed with antisocial personality disorder may have no regard for rules or regulations, which necessitates limit setting by the nurse.
Although there are differences among the three personality disorder clusters, there also are some traits common to all individuals diagnosed with personality disorders. Which of the following are common traits? Select all that apply. 1. Failure to accept the consequences of their own behavior. 2. Self-injurious behaviors. 3. Reluctance in taking personal risks. 4. Cope by altering environment instead of self. 5. Lack of insight.
1. A common trait among individuals diagnosed with a personality disorder is the failure to accept the consequences of their own behavior. Although these individuals can identify correct and appropriate behavior, they repeatedly avoid change and cling to patterns that meet their unhealthy needs. 4. A common trait among individuals diagnosed with a personality disorder is their response to stress. When feeling threatened, these individuals cope by attempting to change the environment instead of changing themselves. 5. A common trait among individuals diagnosed with a personality disorder is the lack of insight. These individuals lack understanding of the impact of their behaviors on others.
Which of the following diagnostic criteria describe the characteristics of avoidant personality disorder? Select all that apply. 1. Fearing shame and/or ridicule, does not form intimate relationships. 2. Has difficulty making everyday decisions without reassurance from others. 3. Is unwilling to be involved with people unless certain of being liked. 4. Shows perfectionism that interferes with task completion. 5. Views self as socially inept, unappealing, and inferior.
1. Clients diagnosed with avoidant personality disorder show a pervasive pattern of social inhibitions, feelings of inadequacies, and hypersensitivity to negative evaluation and find it difficult to form intimate relationships. 3. Clients diagnosed with avoidant personality disorder are extremely sensitive to rejection and need strong guarantees of uncritical acceptance. 5. Although there may be a strong desire for companionship, a client with avoidant personality disorder has such a pervasive pattern of inadequacy, social inhibition, and withdrawal from life that the desire for companionship is negated.
A client diagnosed with obsessive-compulsive personality disorder is admitted to a psychiatric unit in a highly agitated state. The physician prescribes a benzodiazepine. Which of the following medications should the nurse expect to administer? Select all that apply. 1. Clonazepam (Klonopin). 2. Lithium carbonate (Lithium). 3. Clozapine (Clozaril). 4. Olanzapine (Zyprexa). 5. Chlordiazepoxide (Librium).
1. Clonazepam (Klonopin) is a benzodiazepine medication. 5. Chlordiazepoxide (Librium) is a benzodiazepine medication.
A client diagnosed with a personality disorder states, "You are the very best nurse on the unit and not at all like that mean nurse who never lets us stay up later than 9 p.m." This statement would be associated with which personality disorder? 1. Borderline personality disorder. 2. Schizoid personality disorder. 3. Dependent personality disorder. 4. Paranoid personality disorder
1. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. Clients diagnosed with borderline personality disorder are characterized by a marked instability in interpersonal relationships, mood, and self-image. Clients with this disorder attempt to pit one individual against another. This is known as "splitting" and is related to an inability to integrate and accept positive and negative feelings. Splitting is a primitive ego defense mechanism that is common in individuals with borderline personality disorder. In the question, the client's statement typifies splitting behavior.
A nurse encourages an angry client to attend group therapy. Knowing that the client has been diagnosed with a cluster B personality disorder, which client response might the nurse expect? 1. Sarcastically states, "That group is only for crazy people with problems." 2. Scornfully states, "No, can't you see that I'm having a séance with my mom?" 3. Suspiciously states, "No, that room has been bugged." 4. Hesitantly states, "OK, but only if I can sit next to you."
1. In the question, the client's statement would represent a typical response from someone who was diagnosed with an antisocial personality disorder. These clients also display patterns of socially irresponsible, exploitive, and guiltless behaviors that reflect a disregard for the rights of others. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. Clients diagnosed with cluster B personality disorders exhibit behaviors that are dramatic, emotional, or erratic.
A client diagnosed with borderline personality disorder superficially cut both wrists, is disruptive in group, and is "splitting" staff. Which nursing diagnosis would take priority? 1. Risk for self-mutilation R/T need for attention. 2. Ineffective coping R/T inability to deal directly with feelings. 3. Anxiety R/T fear of abandonment AEB "splitting" staff. 4. Risk for suicide R/T past suicide attempt.
1. Repetitive, self-mutilating behaviors are classic manifestations of borderline personality disorder. These individuals seek attention by self-mutilating until pain is felt in an effort to counteract feelings of emptiness. Some clients reported that "to feel pain is better than to feel nothing." Because these clients often inflict injury on themselves, this diagnosis must be prioritized to ensure client safety.
A 15 year-old client living in a residential facility has a nursing diagnosis of ineffective coping R/T abuse AEB defiant responses to adult rules. Which of the following interventions would address this nursing diagnosis appropriately? Select all that apply. 1. Set limits on manipulative behavior. 2. Refuse to engage in controversial and argumentative encounters. 3. Obtain an order for tranquilizing medications. 4. Encourage the discussion of angry feelings. 5. Remove all dangerous objects from the client's environment.
1. Setting limits on manipulative behaviors is an appropriate intervention to discourage dysfunctional coping, such as oppositional and defiant behaviors. It is important to convey to the client that inappropriate behaviors are not tolerated. 2. By refusing to engage in debate, argument, rationalization, or bargaining with a client, the nurse has intervened effectively to decrease manipulative behaviors and has decreased the opportunity for oppositional and defiant behaviors. 4. Dealing with feelings honestly and directly discourages ineffective coping. The client may cope with anger inappropriately by displacing this anger onto others.
A client is diagnosed with intermittent explosive disorder. The clinic nurse should anticipate potentially teaching about which of the following medications? Select all that apply. 1. Sertraline (Zoloft). 2. Paliperidone (Invega). 3. Buspirone (BuSpar). 4. Phenelzine (Nardil). 5. Valproate sodium (Depakote)
2. An antipsychotic medication like paliperidone (Invega) can be prescribed for intermittent explosive disorder. 5. A mood stabilizing medication like valproate sodium (Depakote) can be prescribed for intermittent explosive disorder.
Using interpersonal theory, which statement is true regarding development of paranoid personality disorder? 1. Studies have revealed a higher incidence of paranoid personality disorder among relatives of clients with schizophrenia. 2. Clients diagnosed with paranoid personality disorder frequently have been family scapegoats and subjected to parental antagonism and harassment. 3. There is an alteration in the ego development so that the ego is unable to balance the id and superego. 4. During the anal stage of development, the client diagnosed with paranoid personality disorder has problems with control within his or her environment.
2. An example of an interpersonal theory of development might involve a client whose background reflects parental emotional abuse to the extent that paranoid personality disorder eventually will be diagnosed.
A client diagnosed with a personality disorder insists that a grandmother, through reincarnation, has come back to life as a pet kitten. The thought process described is reflective of which personality disorder? 1. Obsessive-compulsive personality disorder. 2. Schizotypal personality disorder. 3. Borderline personality disorder. 4. Schizoid personality disorder.
2. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. Clients diagnosed with schizotypal personality disorder are characterized by peculiarities of ideation, appearance, and behavior; magical thinking; and deficits in interpersonal relatedness that are not severe enough to meet the criteria for schizophrenia. In the question, this client's statement reflects ideations of magical thinking.
When confronted, a client diagnosed with narcissistic personality disorder states, "Contrary to what everyone believes, I do not think that the whole world owes me a living." This client is using what defense mechanism? 1. Minimization. 2. Denial. 3. Rationalization. 4. Projection.
2. Denial is used when a client refuses to acknowledge the existence of a real situation or associated feelings. When the client states, "I don't think the whole world owes me a living," denial is being used to avoid facing others' perceptions.
A client exhibiting passive-aggressive personality traits continuously complains to the marriage counselor about a nagging husband who criticizes her indecisiveness. Which nursing diagnosis reflects this client's problem? 1. Social isolation R/T decreased self-esteem. 2. Impaired social interaction R/T inability to express feelings openly. 3. Powerlessness R/T spousal abuse. 4. Self-esteem disturbance R/T unrealistic expectations of husband.
2. Impaired social interaction is defined as the insufficient or excessive quantity or ineffective quality of social exchange. When the client in the question complains about a nagging husband who criticizes her indecisiveness, she is passively expressing covert aggression. This negative expression impedes her ability to interact appropriately and to express feelings openly, which leads to the correct nursing diagnosis, impaired social interaction.
A nursing student is studying the historical aspects of personality disorder. Which entry on the examination indicates that learning has occurred? 1. Zeus, in the 3rd century B.C., identified, described, and applied the theory of object relations. 2. Hippocrates, in the 4th century B.C., identified four fundamental personality styles. 3. Narcissus, in 923 A.D., introduced the word "personality" from the Greek term "persona." 4. Achilles, in 866 A.D., described the pathology of personality as a complex behavioral phenomenon.
2. In the 4th century B.C., Hippocrates, also known as the father of medicine, identified four fundamental personality styles that he concluded stemmed from excesses in the four humors: the irritable and hostile choleric (yellow bile), the pessimistic melancholic (black bile), the overly optimistic and extroverted sanguine (blood), and the apathetic phlegmatic (phlegm).
A client diagnosed with borderline personality disorder coyly requests diazepam (Valium). When the physician refuses, the client becomes angry and demands to see another physician. What defense mechanism is the client using? 1. Undoing. 2. Splitting. 3. Altruism. 4. Reaction formation.
2. The client in the question is using the defense mechanism of splitting. An individual diagnosed with borderline personality disorder sees things as either "all good" or "all bad." In the question, when the client's manipulative charm does not work in obtaining the drug from the "good" physician, the client determines that the physician is now "bad" and seeks another physician to meet his or her needs.
A suicidal client is diagnosed with borderline personality disorder. Which correctly written short-term outcome is most beneficial for the client? 1. The client will be free from self-injurious behavior. 2. The client will express feelings without inflicting self-injury by discharge. 3. The client will socialize with peers in the milieu by day 3. 4. The client will acknowledge his or her role in altered interpersonal relationships.
2. The client's being able to express feelings without inflicting self-injury by discharge is an outcome that reinforces the priority for client safety, is measurable, and has a time frame.
After being treated in the ED for self-inflicted lacerations to wrists and arms, a client with a diagnosis of borderline personality disorder is admitted to the psychiatric unit. Which nursing intervention takes priority? 1. Administer tranquilizing drugs. 2. Observe client frequently. 3. Encourage client to verbalize hostile feelings. 4. Explore alternative ways of handling frustration.
2. The priority nursing intervention is to observe the client's behavior frequently. The nurse should do this through routine activities and interactions to avoid appearing watchful and suspicious. Close observation is required so that immediate interventions can be implemented as needed.
Which of the following diagnostic criteria describe the characteristics of borderline personality disorder? Select all that apply. 1.. Arrogant, haughty behaviors or attitudes. 2. Frantic efforts to avoid real or imagined abandonment. 3. Recurrent suicidal and self-mutilating behaviors. 4. Unrealistic preoccupation with fears of being left to take care of self. 5. Chronic feelings of emptiness.
2. This criterion describes borderline personality disorder, which is characterized by a pervasive pattern of instability of interpersonal relationships. Having real or imagined feelings of abandonment is the first criterion of this disorder. 3. Recurrent suicidal and self-mutilating behavior is a diagnostic criterion that describes borderline personality disorder. 5. Having chronic feelings of emptiness is a diagnostic criterion that describes borderline personality disorder.
A client has been diagnosed with a cluster A personality disorder. Which of the following client statements would reflect cluster A characteristics? Select all that apply. 1. "I'm the best chef on the East Coast." 2. "My dinner has been poisoned." 3. "I have to wash my hands 10 times before eating." 4. "I just can't eat when I'm alone." 5. "When my mom died, her spirit entered my cat."
2. This statement might be voiced by a client diagnosed with paranoid personality disorder. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. This cluster's characteristic behaviors are odd or eccentric and include patterns of suspiciousness and mistrust. 5. This statement might be voiced by a client diagnosed with schizotypal personality disorder. This cluster's characteristic behaviors are odd or eccentric and include patterns of suspiciousness and mistrust.
A client diagnosed with paranoid personality disorder needs information regarding medications. Which nursing intervention would best assist this client in understanding prescribed medications? 1. Ask the client to join the medication education group. 2. Provide one-on-one teaching in the client's room. 3. During rounds, have the physician ask if the client has any questions. 4. Let the client read the medication information handout.
2. When a client is diagnosed with paranoid personality disorder, one-on-one teaching in a client's room would decrease the client's paranoia, support a trusting relationship, and allow the client to ask questions. The nurse also would be able to evaluate the effectiveness of medication teaching.
Which client situation requires the nurse to prioritize the implementation of limit setting? 1. A client making sexual advances toward a staff member. 2. A client telling staff that another staff member allows food in the bedrooms. 3. A client verbally provoking another client who is paranoid. 4. A client refusing medications to receive secondary gains.
3. A paranoid client has the potential to strike out defensively if provoked. Because safety is the nurse's first concern, and this situation poses a physical threat, this situation takes priority and needs immediate intervention by the nurse.
A diabetic client admitted to a medical floor for medication stabilization has a history of antisocial personality disorder. Which documented behaviors would support this diagnosis? Select all that apply. 1. "Labile mood and affect and old scars noted on wrists bilaterally." 2. "Appears younger than stated age with flamboyant hair and makeup." 3. "Began cursing when confronted with drug-seeking behaviors." 4. "Demands foods prepared by personal chef to be delivered to room." 5. "Attempted to use insincere flattery to obtain extra snacks."
3. Antisocial personality disorder is characterized by a pattern of socially irresponsible, exploitive, and guiltless behavior. These clients disregard the rights of others and frequently fail to conform to social norms with respect to lawful behaviors. They are also deceitful, impulsive, irritable, and aggressive. 5. Antisocial personality disorder is characterized by a pattern of socially irresponsible, exploitive, and guiltless behavior. These clients disregard rules, authority, and social norms. They will frequently use insincere flattery and manipulation for their own gain.
A client tells the nurse, "When I was a waiter I used to spit in the dinners of annoying customers." This statement would be associated with which personality trait? 1. Paranoid personality trait. 2. Schizoid personality trait. 3. Passive-aggressive personality trait. 4. Antisocial personality trait.
3. Clients exhibiting passive-aggressive personality traits are characterized by a passive resistance to demands for adequate performance in occupational and social functioning. The client in the question is demonstrating passive-aggressive traits toward customers that he or she finds annoying.
Irresponsible, guiltless behavior is to a client diagnosed with cluster B personality disorder as avoidant, dependent behavior is to a client diagnosed with a: 1. Cluster A personality disorder. 2. Cluster B personality disorder. 3. Cluster C personality disorder. 4. Cluster D personality disorder
3. Cluster C categorizes behaviors that are anxious or fearful, and it comprises the following disorders: (1) avoidant personality disorder, which is characterized by social withdrawal brought about by extreme sensitivity to rejection; (2) dependent personality disorder, which is characterized by allowing others to assume responsibility for major areas of life because of one's inability to function independently; and (3) obsessive-compulsive personality disorder, which is characterized by a pervasive pattern of perfectionism and inflexibility.
A client diagnosed with antisocial personality disorder states, "My kids are so busy at home and school, they don't miss me or even know I'm gone." Which nursing diagnosis applies to this client? 1. Risk for injury. 2. Risk for violence: self-directed. 3. Ineffective denial. 4. Powerlessness.
3. Ineffective denial is defined as the conscious or unconscious attempt to disavow knowledge or meaning of an event to reduce anxiety or fear. The client presented in the question is denying his or her children's need for parental support by turning the situation around and making himself or herself sound like the victim who is not needed.
A nursing instructor is teaching about personality disorder characteristics. Which student statement indicates that learning has occurred? 1. "Clients diagnosed with personality disorders need frequent hospitalizations." 2. "Clients perceive their behaviors as uncomfortable and disorganized." 3. "Personality disorders cannot be cured or controlled successfully with medication." 4. "Practitioners have a good understanding about the etiology of personality disorders."
3. It is important for nurses to understand that for individuals diagnosed with personality disorders, no prescribed medications are available to cure or control these disorders. Clients' inappropriate behaviors and skewed perceptions often lead to anxiety or depression or both; therefore, anxiolytics, antidepressants, and antipsychotics sometimes are prescribed.
The nurse is assessing a client diagnosed with borderline personality disorder. According to Mahler's theory of object relations, which describes the client's unmet developmental need? 1. The need for survival and comfort. 2. The need for awareness of an external source for fulfillment. 3. The need for awareness of separateness of self. 4. The need for internalization of a sustained image of a love object/person.
3. Phase 3 (5 to 36 months) is the separationindividuation phase. The main task of this phase is the primary recognition of separateness from the mother figure. According to Mahler's theory, fixation in this phase may predispose the child to borderline personality.
A client diagnosed with a dependent personality disorder has a nursing diagnosis of social isolation R/T parental abandonment AEB fear of involvement with individuals not in the immediate family. Which nursing intervention would be appropriate? 1. Address inappropriate interactions during group therapy. 2. Recognize when client is playing one staff member against another. 3. Role-model positive relationships. 4. Encourage client to discuss conflicts evident within the family system.
3. Role-modeling positive relationships would provide a motivation to initiate interactions with others outside the client's family. This is an appropriate intervention for the nursing diagnosis of social isolation.
A client diagnosed with paranoid personality disorder is prescribed risperidone (Risperdal). The client is noted to have restlessness and weakness in the lower extremities and is drooling. Which nursing intervention would be most important? 1. Hold the next dose of risperidone and document the findings. 2. Monitor vital signs and encourage the client to rest in his or her room. 3. Give the ordered prn dose of trihexyphenidyl (Artane). 4. Get a fasting blood sugar measurement because of potential hyperglycemia.
3. The symptoms noted are EPS caused by antipsychotic medications. These can be corrected by using anticholinergic medications, such as trihexyphenidyl (Artane), benztropine (Cogentin), or diphenhydramine (Benadryl).
A client diagnosed with dependent personality disorder has a nursing diagnosis of altered sleep pattern R/T impending divorce. The client is prescribed oxazepam (Serax) prn. Which is an appropriate correctly written outcome for this nursing diagnosis? 1. The client verbalizes a decrease in tension and racing thoughts. 2. The client expresses understanding about the medication side effects by day 2. 3. The client sleeps 4 to 6 hours a night by day 3. 4. The client notifies the nurse when the medication is needed.
3. This outcome relates directly to the stated nursing diagnosis (altered sleep pattern), is measurable (sleeps 4 to 6 hours a night), and has a time frame (by day 3).
A client diagnosed with an avoidant personality disorder has the nursing diagnosis of social isolation R/T severe malformation of the spine AEB "I can't be around people, looking like this." Which correctly written short-term outcome is appropriate for this client's problem? 1. The client will see self as straight and tall by the time of discharge. 2. The client will see self as valuable after attending assertiveness training courses. 3. The client will be able to participate in one therapy group by end of shift. 4. The client will join in a charade game to decrease social isolation.
3. This short-term outcome is stated in observable and measurable terms. This outcome sets a specific time for achievement (by end of shift). It is short and specific (one therapy group), and it is written in positive terms, all of which should contribute to the final goal of the client having increased social interaction.
. A client newly admitted to an in-patient psychiatric unit is diagnosed with schizotypal personality disorder. The client states, "I envision my future death by fire." Which is the most appropriate nursing response? 1. "I don't know what you mean by envisioning your future death." 2. "Your future death? Can you please tell me more about that?" 3. "I was wondering if you want to come to group to talk about that." 4. "I can see your thoughts are bothersome. How can I help?"
4. Acknowledging the client's feelings about the altered thoughts is an important response. The nurse supports the client's feelings but not the altered thoughts. At the same time, the nurse explores ways to help the client feel comfortable.
When assessing a client diagnosed with histrionic personality disorder, the nurse might identify which characteristic behavior? 1. Odd beliefs and magical thinking. 2. Grandiose sense of self-importance. 3. Preoccupation with orderliness and perfection. 4. Attention-seeking flamboyance.
4. Clients diagnosed with histrionic personality disorder have a pervasive pattern of excessive emotionality and attentionseeking behaviors. These individuals are uncomfortable in situations in which they are not the center of attention and have a style of speech that is excessively impressionistic and lacking in detail.
A client diagnosed with schizoid personality disorder chooses solitary activities, lacks close friends, and appears indifferent to criticism. Which nursing diagnosis would be appropriate for this client's problem? 1. Anxiety R/T poor self-esteem AEB lack of close friends. 2. Ineffective coping R/T inability to communicate AEB indifference to criticism. 3. Altered sensory perception R/T threat to self-concept AEB magical thinking. 4. Social isolation R/T discomfort with human interaction AEB avoiding others.
4. Clients diagnosed with schizoid personality disorder are unsociable and prefer to work in isolation. These individuals are characterized primarily by a profound defect in the ability to form personal relationships or to respond to others in any meaningful or emotional way. They display a lifelong pattern of social withdrawal, and their discomfort with human interaction is very apparent. This client is choosing solitary activities and lacks friends. The nursing diagnosis of social isolation is appropriate in addressing this client's problem.
When assessing a client exhibiting passive-aggressive personality traits, which characteristic behavior might the nurse identify? 1. The client exhibits behaviors that attempt to "split" the staff. 2. The client shows reckless disregard for the safety of self or others. 3. The client has unjustified doubts about the trustworthiness of friends. 4. The client seeks subtle retribution when feeling others have wronged him or her
4. Clients exhibiting passive-aggressive traits believe another individual has wronged them, and they may go to great lengths to seek retribution or "get even." This is done in a subtle and passive manner, rather than by discussing their feelings with the offending individual.
A male client diagnosed with a personality disorder boasts to the nurse that he has to fight off female attention and is the highest paid in his company. These statements are reflective of which personality disorder? 1. Obsessive-compulsive personality disorder. 2. Avoidant personality disorder. 3. Schizotypal personality disorder. 4. Narcissistic personality disorder.
4. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. Clients diagnosed with narcissistic personality disorder are characterized by a constant need for attention, a grandiose sense of self-importance, and preoccupations with fantasies of success, power, brilliance, and beauty, all of which this client is displaying.
Personality disorders are grouped in clusters according to their behavioral characteristics. In which cluster are the disorders correctly matched with their behavioral characteristics? 1. Cluster C: antisocial, borderline, histrionic, narcissistic disorders; anxious or fearful characteristic behaviors. 2. Cluster A: avoidant, dependent, obsessive-compulsive disorders; odd or eccentric characteristic behaviors. 3. Cluster A: antisocial, borderline, histrionic, narcissistic disorders; dramatic, emotional, or erratic characteristic behaviors. 4. Cluster C: avoidant, dependent, obsessive-compulsive disorders; anxious or fearful characteristic behaviors.
4. Cluster C includes avoidant, dependent, and obsessive-compulsive personality disorders. Anxious or fearful is the correct description for clients diagnosed with a cluster C personality disorder.
A nurse is discharging a client diagnosed with narcissistic personality disorder. Which employment opportunity is most likely to be recommended by the treatment team? 1. Home construction. 2. Air traffic controller. 3. Night watchman at the zoo. 4. Prison warden.
4. Individuals diagnosed with narcissistic personality disorder have an exaggerated sense of self-worth and believe they have an inalienable right to receive special consideration. They tend to exploit others to fulfill their own desires. Because they view themselves as "superior" beings, they believe they are entitled to special rights and privileges. Because of the need to control others inherent in the job of prison warden, this would be an appropriate job choice for a client diagnosed with narcissistic personality disorder.
Which predisposing factor would be implicated in the etiology of paranoid personality disorder? 1. The individual may have been subjected to parental demands, criticism, and perfectionistic expectations. 2. The individual may have been subjected to parental indifference, impassivity, or formality. 3. The individual may have been subjected to parental bleak and unfeeling coldness. 4. The individual may have been subjected to parental antagonism and harassment.
4. Individuals diagnosed with paranoid personality disorder most likely would be subjected to parental antagonism and harassment. These individuals likely served as scapegoats for displaced parental aggression and gradually relinquished all hope of affection and approval. They learned to perceive the world as harsh and unkind, a place calling for protective vigilance and mistrust.
Which diagnostic criterion describes a characteristic of schizotypal personality disorder? 1. Neither desires nor enjoys close relationships, including being part of a family. 2. Is preoccupied with unjustified doubts about the loyalty of friends and associates. 3. Considers relationships to be more intimate than they actually are. 4. Exhibits behavior or appearance that is odd, eccentric, or peculiar.
4. Magical thinking and odd beliefs that influence behavior and are inconsistent with subcultural norms are defined as criteria for schizotypal personality disorder, which is often described as "latent schizophrenia." Clients with this diagnosis are odd and eccentric but do not decompensate to the level of schizophrenia.
A nursing student is learning about narcissistic personality disorder. Which of the following student statements indicate that learning has occurred? Select all that apply. 1. "These clients have peculiarities of ideation." 2. "These clients require constant approval and affirmation." 3. "These clients are impulsive and self-destructive." 4. "These clients express a grandiose sense of self-importance." 5. "These clients have a deep need for admiration."
4. Narcissistic personality disorder is characterized by a grandiose sense of self-importance and preoccupations with fantasies of success, power, brilliance, and beauty. These clients sometimes may exploit others for self-gratification.
A client diagnosed with a borderline personality disorder is given a nursing diagnosis of disturbed personal identity R/T unmet dependency needs AEB the inability to be alone. Which nursing intervention would be appropriate? 1. Ask the client directly, "Have you thought about killing yourself?" 2. Maintain a low level of stimuli in the client's environment. 3. Frequently orient the client to reality and surroundings. 4. Help the client identify values and beliefs.
4. This client has been diagnosed with borderline personality disorder resulting from fixation in an earlier developmental level. This disruption during the establishment of the client's value system has led to disturbed personal identity. When the nurse helps the client to identify internalized values, beliefs, and attitudes, the client begins to distinguish personal identity.
A client diagnosed with an obsessive-compulsive personality disorder has a nursing diagnosis of anxiety R/T interference with hand washing AEB "I'll go crazy if you don't let me do that." Which correctly written short-term outcome is appropriate for this client? 1. During a 3-hour period after admission to the unit, the client will refrain from hand washing. 2. The client will wash hands only at appropriate bathroom and meal intervals. 3. The client will refrain from hand washing throughout the night. 4. Within 72 hours of admission, the client will notify staff when signs and symptoms of anxiety escalate.
4. This short-term outcome is stated in observable and measurable terms. This outcome sets a specific time for achievement (within 72 hours). It is specific (signs and symptoms), and it is written in positive terms. When the client can identify signs and symptoms of increased anxiety, the next step of problem-solving can begin.
A client diagnosed with antisocial personality disorder demands, at midnight, to speak to the ethics committee about the involuntary commitment process. Which nursing statement is appropriate? 1. "I realize you're upset; however, this is not the appropriate time to explore your concerns." 2. "Let me give you a sleeping pill to help put your mind at ease." 3. "It's midnight, and you are disturbing the other clients." 4. "I will document your concerns in your chart for the morning shift to discuss with the ethics committee."
In this situation, the nurse empathizes with the client's concerns and then sets limits on inappropriate behaviors in a matter-of-fact manner.
