Ch. 29 Antisocial, Disruptive, Impulse, Conduct DOs
When teaching a client with antisocial personality disorder (ASPD), which approach would be most appropriate for the nurse to use? Direct Confrontational Challenging Lecture
Direct
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? "Tell me why you feel you can't do it yourself" "Let me open that for you" "I'll stay here and you can show me what you've tried to do to get the top off" "I feel you can get your family to help you with this when they come in"
"I'll stay here and you can show me what you've tried to do to get the top off"
At 2200 hrs a client diagnosed with antisocial personality disorder (ASPD) demands to phone a lawyer to argue his involuntary status in a psychiatric facility. The unit follows a policy that prohibits the use of the phone after 2200 hrs. What is the nurse's best response? "It is after the 2200 hrs phone curfew. You will be able to call tomorrow." "Go ahead and use the phone. I know this is stressful." "That's an important decision that can wait until you've had a good sleep." "You know the rules. I'm surprised. You've been respectful up to this point."
"It is after the 2200 hrs phone curfew. You will be able to call tomorrow."
An attractive and engaging client with antisocial personality disorder (ASPD) asks a nurse providing inpatient care to go out on a date. Which is the nurse's best response? "We can discuss that later, closer to discharge." "No, my code of ethics prohibits me from dating clients." "I like you, but I can't. Unit policy prohibits it." "I'm just going to ignore that request."
"No, my code of ethics prohibits me from dating clients."
A mental health nurse is working with a client with antisocial personality disorder. The nurse has just reviewed the unit rule of one cigarette per break. While telling the client about the unit rules, the client asks, "Well, if I have not done anything bad all day, can I have two cigarettes instead of one?" Which would be the most therapeutic nursing response? "It depends on whether or not we can make that exception that day." "No, only one cigarette is allowed per break time." "This is a good example of trying to push your limits." "Well, that's a good question. I need to check with the team."
"No, only one cigarette is allowed per break time."
It is 2000 hrs and a voluntary client with the diagnosis of antisocial personality disorder (ASPD) is out on a leave from the inpatient unit. The leave is supported by the treatment plan. The psychiatrist's order states the client is to return at 2100 hrs. The client calls the unit, speaks with the nurse and states, "2000 hrs doesn't give me enough time." What is the nurse's bestresponse? "Come back ASAP or the police will be sent." "Return immediately." "That's fine, come back at 2030 hrs." "Return on time or future restrictions will be imposed."
"Return on time or future restrictions will be imposed."
A nurse providing care to a client with avoidant personality disorder establishes the underlying cause of problematic behavior. The client states, "I've pushed all my friends away and I hardly ever get out to have fun." Which is the nurse's best response? "You fear being a failure." "You have a fear of being rejected by others." "You feel inferior to others." "You are afraid of having a panic attack."
"You have a fear of being rejected by others."
A client with a diagnosis of antisocial personality disorder would exhibit a history of conduct disorder before which age? 12 years 7 years 15 years 10 years
15 years
A nurse is preparing a presentation for a group of staff nurses on personality disorders. When describing antisocial personality disorders (ASPD), the nurse would explain that for a person to be diagnosed with the disorder, the person must be at least which age? 15 years 18 years 25 years 21 years
18 years
For a person to be diagnosed with antisocial personality disorder, the individual must be a minimum of what age? 21 years 13 years 7 years 18 years
18 years
The nurse provides education about antisocial personality disorder (ASPD) to a group of vocational support workers involved with former inmates entering the workforce. Which description outlines how ASPD is defined? Unstable employment history and a pattern of being fired from jobs A pattern of disregard for and violation of the rights of others Ongoing experiences of transient psychosis The number of and the seriousness of crimes
A pattern of disregard for and violation of the rights of others
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 who openly shares about powers of influence, wealth and to be known by famous people An adult client who has an inflexible manner and depends on rules to guide behavior An adult client living with parents requiring assistance with planning and carrying out activities An adult client living alone with preoccupations about being monitored by cameras
An adult client living with parents requiring assistance with planning and carrying out activities
A client with antisocial personality disorder uses manipulation to try leaving the unit with another client's family members after visiting hours. Which of the following interventions is best to deal with the manipulative behavior? Allow the client's nurse to determine how to deal with the client since the client has never attempted to escape before. Assist the client to identify patterns of behavior and consequences as determined by the team plan. Remind the client that he could be discharged for inappropriate behavior. Restrict the client from all unit activities to provide time for reflection on his behavior.
Assist the client to identify patterns of behavior and consequences as determined by the team plan.
What is the nurse's treatment intervention for a client with histrionic personality disorder? Address client's requests with priority over other clients Challenge the expectation for others to fulfill their needs Monitor client for symptoms of extrapyramidal side effects (EPS) Monitor weekly blood lithium levels
Challenge the expectation for others to fulfill their needs
A mental health nurse educator receives a call from a hospital nurse requesting clarification about a client admitted to a medical unit. The client is admitted for treatment of pneumonia, and the admitting diagnosis includes avoidant personality disorder traits. The nurse requests information about how to anticipate the client's interpersonal needs. How does the nurse educator respond? Clients desire social interaction but they lack trust Clients are dependent on others and require challenges to these behavioral deficits Clients have a grandiose and over-inflated view of their potentials and avoid therapeutic efforts to generate insight Clients exhibit paranoid delusions and have suspicions of others
Clients desire social interaction but they lack trust
A client with antisocial personality disorder (ASPD) is seen in the emergency department (ED) following threats of taking an overdose. The suicidality was prompted by fraud and the client being barred from living with family. During the assessment the nursing diagnosis of dysfunctional family processes was identified. What is the outcome for this session? Find a stable living situation Remain safe and avoid threats of self-harm Communicate to the client's family that the client is safe Establish a pattern of effective coping
Communicate to the client's family that the client is safe
A nurse working in a children's hospital is mindful of those at greatest risk of developing dependent personality disorder as adults. A child with which diagnosis is at highest risk of developing this disorder? A fractured femur A ruptured appendix Inflamed tonsils Cystic fibrosis
Cystic fibrosis
The nurse in a medical setting provides care for a client with histrionic personality disorder concurrent with their medical challenges. During the initial assessment with the client, the nurse identifies an altered expression of sexuality. To guide further assessment, what factor does the nurse anticipate from the client? Demonstration of seductive behavior Suppression of outward signs of sexual attraction Having success in establishing social intimacy Having one long-term intimate partner
Demonstration of seductive behavior
The nurse is teaching parents of infants about the importance of autonomy and instilling coping skills in children. The nurse explains that these abilities can fail to develop in children whose parents offer high levels of affection as the parents overprotect their children. Which disorder is associated with overprotection in children? Attention deficit hyperactivity disorder Major depressive disorder Schizoid personality disorder Dependent personality disorder
Dependent personality disorder
The nurse completes an intake assessment for a client. Which symptoms are associated with dependent personality disorder? Select all that apply. Drug addiction to opiates Insulin dependent diabetes Difficulty making everyday decisions Expresses fears of being unable to manage self-care Withdrawal from adult responsibilities
Difficulty making everyday decisions Expresses fears of being unable to manage self-care Withdrawal from adult responsibilities
A nurse suspects that a child has oppositional defiant disorder. When reviewing the child's history, which would support this suspicion? Select all that apply. Disobedience Angry outbursts Cruelty to animals Destruction of property Blaming others for problems
Disobedience Angry outbursts Blaming others for problems
A client is admitted to a hospital medical unit. The admitting diagnosis is antisocial personality disorder. The client has alcohol use and also expressed a suicidal plan. What is the nurse's priority intervention for this client? Ensure safety of the client Initiate Clinical Institute Withdrawal Assessment for Alcohol (CIWA) protocol Medicate client immediately Ensure client attends Alcoholics Anonymous (AA) meetings
Ensure safety of the client
A nurse prepares an educational program for women during antenatal care. An outcome of the teaching is to lower the risk of antisocial personality disorder (ASPD) in the population who access the program. Which is a priority teaching need? Getting moderate exercise during pregnancy Receiving vitamin supplements during pregnancy Access to breast milk after birth Ensuring attachment after birth
Ensuring attachment after birth
An outreach nurse in a mental health clinic assists a client with schizoid personality disorder. The client expresses a desire to work part time. Which position is most likely to suit the client? Greeter at a department store Furniture store sales Associate in a fast food restaurant Groundskeeper in a park
Groundskeeper in a park
The nurse is working in a prison setting with a client diagnosed with Antisocial Personality Disorder (ASPD). The client has identified impulse control issues particularly around urges for sexual intimacy. The client has assaulted people who have interfered with their gratification. What is the priority intervention for the nurse? Addressing an underlying substance use disorder Offering mindfulness distraction techniques Encouraging adherence to medication treatment Helping to express anger in an adaptive and non-violent manner
Helping to express anger in an adaptive and non-violent manner
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? Narcissistic personality disorder Histrionic personality disorder Schizotypal personality disorder Schizoid personality disorder
Histrionic personality disorder
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? Schizotypal personality disorder Schizoid personality disorder Narcissistic personality disorder Histrionic personality disorder
Histrionic personality disorder
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? Neatly dressed appearance Appear indistinct from the general population Normal mannerisms Increased eccentricity
Increased eccentricity
The nurse in an outpatient clinic conducts an assessment for a client employed full time as a professional. The client has an unstable mood and feels sad most of the time. The client shares that they were recently charged for shoplifting cosmetics valued under $10. The client has admitted to shoplifting more than five times before this incident. In addition to a mood disorder, what other disorder does the nurse identify? Schizo-affective disorder Kleptomania Hypomania Trichotillomania
Kleptomania
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 Having homosexual parents Being the middle child
Losing of a parent through death Experiencing physical or sexual abuse Experiencing parental abandonment or neglect
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. Make behavioral expectations clear and consistently enforce them Use time out for disruptive behavior Teach problem-solving skills Get the child a pet to care for Take the child to the police as a scare tactic
Make behavioral expectations clear and consistently enforce them Use time out for disruptive behavior Teach problem-solving skills
A prison nurse teaches a group of nursing students about personality disorders. Which finding serves as an example of pervasive pattern of disregard for and violation of the rights of others? Manipulates by advancing personal interests at another's expense Unable to or has difficulties to apply skills that are appropriate for their age Restricts food intake and uses laxatives Experiences periods of depression and elated mood
Manipulates by advancing personal interests at another's expense
A client presents to a mental health clinic. The nurse notes that the client is grandiose and brags that that they earn "a six-figure income" and tells the nurse that they are more well known that the president. Which diagnosis is grandiosity associated with? Borderline personality disorder Schizoid personality disorder Obsessive compulsive personality disorder Narcissistic personality disorder
Narcissistic personality disorder
After reviewing information about the various impulse control disorders, a nurse demonstrates understanding of the information by identifying which disorder as involving a persistent pattern of disobedience and argumentativeness? Oppositional defiant disorder Pyromania Kleptomania Conduct disorder
Oppositional defiant disorder
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? Obsessive compulsive disorder Attention deficit hyperactivity disorder Oppositional defiant disorder Antisocial personality disorder
Oppositional defiant disorder
Which would a nurse assess in a client suspected of having paranoid personality disorder? Select all that apply. Outwardly argumentative Overly forgiving Need to be in a position of power in a relationship Suspiciousness and guarded behavior Warm, funny demeanor
Outwardly argumentative Need to be in a position of power in a relationship Suspiciousness and guarded behavior
Upon admission, a client with a personality disorder identifies areas of concern for which the client would like help. The nurse is aware that which will most likely be addressed by the health care team? Budgeting Sexual expression Self-care Psychological distress
Psychological distress
Upon admission, a client with a personality disorder identifies areas of concern for which the client would like help. The nurse is aware that which will most likely be addressed by the health care team? Sexual expression Psychological distress Self-care Budgeting
Psychological distress
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? Habitual criminal Irresponsible Schizophrenic Psychopath
Psychopath
A client in a psychiatric unit is diagnosed with antisocial personality disorder (ASPD). The client becomes aggressive and hits another client on the unit in a disagreement over the TV remote. Staff gains control of the situation. When planning for the next day, what is the priority intervention for the client? Encourage all clients to negotiate a strategy to share the remote Administer benzodiazepine medications prophylactically Reinforce strategies to express anger in an adaptive manner Ban the aggressive client from watching TV during the admission
Reinforce strategies to express anger in an adaptive manner
When describing the etiology of pyromania to group of nurses, which neurotransmitter would the nurse identify as being linked to this disorder. Select all that apply. Epinephrine GABA Serotonin Dopamine Norepinephrine
Serotonin Norepinephrine
A nurse is assessing a client diagnosed with a narcissistic personality disorder. Which characteristics would the nurse expect to find? Select all that apply. Extreme gullibility Snobbish appearance Unrealistic grandiosity History of multiple hospitalizations Patronizing attitude
Snobbish appearance Unrealistic grandiosity Patronizing attitude
Which is the main reason why the periodic team meetings are important when caring for a client with antisocial personality? Rotating team members need to be apprised of the care planned for the client. The team needs to consider updating treatment recommendations as the client improves. Team consistency is important to prevent manipulation by the client. Staff frustrations in caring for the client need to be processed.
Team consistency is important to prevent manipulation by the client.
A client with a diagnosis of dependent personality disorder is recovering from surgery. The nurse considers the importance of avoiding some interventions that could be therapeutic for another client without a personality disorder. Which intervention will the nurse avoid? Telling the client what to do Providing positive feedback Identifying resources to aid in meal planning Enhancing decision-making skills
Telling the client what to do
A male client addicted to cocaine is interviewed by the nurse in a community outpatient addiction program. The client reveals that he engages in criminal behavior to support his drug habit. When in the pursuit of drugs, the client relies on stealing and prostitution; otherwise, the client does not engage in criminal activity. For what reason does the nurse determine a diagnosis of antisocial personality disorder (ASPD) is not warranted? The client is a drug abuser The client is male and prostitution is rare The client engages in antisocial behavior only to obtain drugs The client has no other personality disorders
The client engages in antisocial behavior only to obtain drugs
A psychiatric-mental health clinical nurse specialist is conducting an orientation for a newly-hired group of psychiatric nurses at the mental health center. The center provides care to a large population of clients, many of whom have been diagnosed with personality disorders. When describing the challenges posed when working with clients with personality disorders, which information would the nurse most likely include? Select all that apply. The nurse can easily but mistakenly believe the client simply lacks motivation or the willingness to make changes. Clients with personality disorders challenge the ability of therapeutic staff to work as a team. It can take a long time to change their behaviors, attitudes, or coping skills. Team members may have differing opinions about individual clients. Clients with personality disorders are obviously unable to function more effectively.
The nurse can easily but mistakenly believe the client simply lacks motivation or the willingness to make changes. Clients with personality disorders challenge the ability of therapeutic staff to work as a team. It can take a long time to change their behaviors, attitudes, or coping skills. Team members may have differing opinions about individual clients.
The nurse completes a required assessment for a client mandated for treatment for antisocial personality disorder. The client spits, uses obscene language, and refuses to answer questions. How should the nurse respond? "You are very disrespectful. You need to learn to control yourself." "I'm going to call security and inject you with a needle if you don't cooperate." I feel like spitting and swearing back at you, do you think that would be appropriate for me? Why is it OK for you?" The spitting, profanity and refusal to answer questions will not be tolerated. I will return in 5 minutes to continue the assessment."
The spitting, profanity and refusal to answer questions will not be tolerated. I will return in 5 minutes to continue the assessment."
A nurse is assessing a client diagnosed with a narcissistic personality disorder. Which characteristics would the nurse expect to find? Select all that apply. Unrealistic grandiosity Patronizing attitude Snobbish appearance Extreme gullibility History of multiple hospitalizations
Unrealistic grandiosity Patronizing attitude Snobbish appearance
A nurse is assessing a client diagnosed with a narcissistic personality disorder. Which characteristics would the nurse expect to find? Select all that apply. Unrealistic grandiosity Snobbish appearance Patronizing attitude Extreme gullibility History of multiple hospitalizations
Unrealistic grandiosity Snobbish appearance Patronizing attitude
A nurse is seeing a female client who has been mandated to counseling sessions after shoplifting numerous times. Which disruptive behavior disorder is the client most likely experiencing? intermittent explosive disorder kleptomania pyromania internalizing behavior
kleptomania
