ch24 Personality Disorders
A patient diagnosed with antisocial personality disorder with impaired social interaction and defensive coping receives psychotherapy treatment. Which response of the patient indicates to the nurse the treatment has been effective? 1 The patient declares the government to be responsible for his or her condition. 2 The patient requests the nurse excuse him or her from a particular task. ! Correct 3 The patient plays a leading role in a group activity assigned by the nurse. 4 The patient ridicules a manic patient in the psychiatric unit.
A patient with antisocial personality disorder shows impaired social interaction and defensive coping. A patient who plays a leading role in a group activity indicates improvement of the symptoms, which may be the result of effective treatment. This is because the patient cooperates with others and interacts well. Psychotherapy aims to help patients take responsibility for their own actions in order to improve their conditions. The patient declaring the government to be responsible does not indicate effective treatment. A request to be excused from a therapy task doesn't indicate progress or effective treatment. Psychotherapy aims to make the patient interact with others and develop sensitivity towards others. Ridiculing another patient shows that the patient with antisocial personality disorder is not sensitive and does show empathy for others.
The nurse is caring for a patient with borderline personality disorder who has impaired social interaction. What symptoms does the nurse find in the patient? Select all that apply. ! Correct 1 The patient has unstable relationships. ! Correct 2 The patient reports to have intense relationships. 3 The patient does not show emotional response. 4 The patient engages in social activities. ! Correct 5 The patient feels rejected.
A patient with borderline personality disorder feels rejected due to differences in opinions and feelings from others. The patient has intense relationships due to extreme emotional responses. The patient has unstable relationships, as the partner is unable to understand the perceptions of the patient. The patient avoids engaging in social activities because he or she does not feel accepted by the dominant cultural group due to negative evaluation. Such patients show extreme emotional responses.
A nurse manages care for an individual diagnosed with avoidant personality disorder. Select the appropriate outcome for this patient. The patient will: 1 refrain from aggressive behavior toward others within five days. ! Correct 2 demonstrate use of assertive communication within three months. 3 establish an intimate relationship with another adult within two weeks. 4 make a permanent commitment never to self-mutilate within one week.
A person diagnosed with avoidant personality disorder is excessively anxious in social situations and hypersensitive to negative evaluation, but desires social interaction. Assertiveness training is intended to assist this person in self-expression. Outcome achievement for any of the personality disorders is slow because personality is a deeply ingrained characteristic. It is likely to take months or years to achieve desired outcomes. Persons diagnosed with avoidant personality disorder seldom self-mutilate or demonstrate aggression toward others.
The nurse is assessing a patient for a possible personality disorder. What behavior does the nurse identify as feature of paranoid personality disorder? 1 Excessive emotionality ! Correct 2 Reluctance to answer any questions 3 Defers questions to his or her mother 4 Dichotomous thinking
A person with paranoid personality disorder generally views others with suspicion and may be reluctant to answer any questions. People with histrionic personality disorder may exhibit excessive emotionality to the extent of being considered melodramatic. A person with dependent personality disorder may have low self-esteem and may be dependent on others for minor issues. For instance, the person may ask a family member to answer questions during an interview. A person with borderline personality disorder may have dichotomous thinking. This is due to splitting or an inability to view both the positive and negative aspects of a person as a part of the whole.
A client diagnosed with obsessive-compulsive personality disorder takes the nurse aside and mentions, "I've observed you interacting with that new patient. 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 the patient." B. "I see you are trying to control that patient's therapy as well as your own." C. "Your eye for perfection extends even to my nursing interventions." D. "That patient's care is really of no concern to you or to other clients."
A. "I will be continuing to follow the care plan for the patient."
Which is true of pharmacological therapies for treatment of personality disorders? A. Although there are no FDA-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident. B. Research has shown that currently available psychotropic drugs have not been shown to be effective in treating personality disorders. C. Patients with narcissistic personality disorder and obsessive-compulsive personality disorder have shown the most benefit from the use of antianxiety medications along with use of selective serotonin reuptake inhibitors. D. Patients with personality disorders have been shown to be resistant to accepting medication, and as a result most providers do not prescribe psychotropic drugs to these patients.
A. Although there are no FDA-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident.
Which statement is descriptive of clients with a personality disorder? 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.
A client arrested for an assault in which he savagely beat a classmate states, "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.
A nurse who is idealized by a client is at risk for A. becoming overinvolved 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 overinvolved and being protective and indulgent.
Characteristics the nurse will assess in the client diagnosed 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. a need for others to assume responsibility for decision making and seeking nurture.
A. deceitfulness, impulsiveness, and lack of empathy.
When providing care for a client diagnosed 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.
The primary goal of milieu therapy for clients diagnosed with personality disorders is A. to manage the effect the behavior has on the entire group. B. to provide one-on-one therapy for each member of the milieu. C. to help the client remain uninvolved with other patients. D. to promote a laissez-faire attitude among the staff members.
A. to manage the effect the behavior has on the entire group.
The nurse explains to a patient with a borderline personality disorder that the patient's former psychiatrist resigned and a new psychiatrist has been hired. Which patient reaction is most likely? 1 Silence 2 Withdrawal ! Correct 3 Rage 4 Anxiety
An individual with a borderline personality disorder tends to experience anger or rage when feeling rejected or ignored. Silence, withdrawal, and anxiety are not expected reactions.
The nurse explains to a patient with a borderline personality disorder that the patient's former psychiatrist resigned and a new psychiatrist has been hired. Which patient reaction is most likely? 1 Silence 2 Withdrawal ! Correct 3 Rage 4 Anxiety
An individual with a borderline personality disorder tends to experience anger or rage when feeling rejected or ignored. Silence, withdrawal, and anxiety are not expected reactions.
A patient was diagnosed with narcissistic personality disorder. Which aspect of the nursing assessment is most important? 1 Pain rating 2 Level of anxiety ! Correct 3 Nutritional status 4 Attention span, hyperactivity
Anorexia nervosa and substance use disorders are often comorbidities for persons diagnosed with narcissistic personality disorder; therefore, it is important for the nurse to assess the patient's nutritional status. While it's important to assess pain in all patients, the greater risk in this scenario applies to the patient's nutritional status. Anxiety is associated with antisocial, avoidant, and obsessive-compulsive personality disorders. Attention deficit hyperactivity disorder is more often a comorbidity of borderline personality disorder.
Which characteristics will the nurse assess in the patient diagnosed with antisocial personality disorder? ! Correct 1 Deceitfulness, impulsiveness, and lack of empathy 2 Perfectionism, preoccupation with detail, and verbosity 3 Avoidance of interpersonal contact and preoccupation with being criticized 4 A need for others to assume responsibility for decision making and seeking nurture
Antisocial patients 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. None of the characteristics identified in the remaining options are generally associated with antisocial personality disorder.
Which assessment question focuses on the characteristic behaviors of a patient diagnosed with borderline personality disorder? Select all that apply. ! Correct 1 Have you ever attempted suicide? ! Correct 2 How would you describe your romantic relationships? 3 Do you experience visual or auditory hallucinations? ! Correct 4 Have you ever been told you are sarcastic? ! Correct 5 Over a few hours can your mood shift dramatically?
Areas of assessment related to borderline personality disorder typically include history of mood shifts, tendencies toward sarcasm and anger, as well as intense, unstable romantic relationships, and suicidal behaviors. Hallucinations are not characteristic of this disorder.
Which assessment question focuses on the characteristic behaviors of a patient diagnosed with borderline personality disorder? Select all that apply. ! Correct 1 Have you ever attempted suicide? ! Correct 2 How would you describe your romantic relationships? 3 Do you experience visual or auditory hallucinations? ! Correct 4 Have you ever been told you are sarcastic? ! Correct 5 Over a few hours can your mood shift dramatically?
Areas of assessment related to borderline personality disorder typically include history of mood shifts, tendencies toward sarcasm and anger, as well as intense, unstable romantic relationships, and suicidal behaviors. Hallucinations are not characteristic of this disorder.
Which is true of pharmacological therapies for treatment of personality disorders? Correct 1 Although there are no Food and Drug Administration (FDA)-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident. 2 Research has shown that currently available psychotropic drugs have not been shown to be effective in treating personality disorders. 3 Patients with narcissistic personality disorder and obsessivecompulsive personality disorder have shown the most benefit from the use of antianxiety medications along with use of selective serotonin reuptake inhibitors. 4 Patients with personality disorders have been shown to be resistant to accepting medication, and as a result most providers do not prescribe psychotropic drugs to these patients.
At this time in the United States, there are no FDA-approved medications for treating personality disorders. Prescribers are using the medications "offlabel" until evidence-based pharmacotherapies are proven to be safe and effective. There is evidence that mood stabilizers, antidepressants, and atypical antipsychotics are helpful in specific personality disorders. Pharmacologic evidence is lacking for the treatment of persons with narcissistic and obsessive-compulsive personality disorders. Although patients with personality disorders usually do not like taking medicine unless it calms them down and are fearful about taking something over which they have no control, providers do attempt to mediate symptoms with psychotropic agents for improved quality of life.
Which is true of pharmacological therapies for treatment of personality disorders? ! Correct 1 Although there are no Food and Drug Administration (FDA)- approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident. 2 Research has shown that currently available psychotropic drugs have not been shown to be effective in treating personality disorders. 3 Patients with narcissistic personality disorder and obsessivecompulsive personality disorder have shown the most benefit from the use of antianxiety medications along with use of selective serotonin reuptake inhibitors. 4 Patients with personality disorders have been shown to be resistant to accepting medication, and as a result most providers do not prescribe psychotropic drugs to these patients.
At this time in the United States, there are no FDA-approved medications for treating personality disorders. Prescribers are using the medications "offlabel" until evidence-based pharmacotherapies are proven to be safe and effective. There is evidence that mood stabilizers, antidepressants, and atypical antipsychotics are helpful in specific personality disorders. Pharmacologic evidence is lacking for the treatment of persons with narcissistic and obsessive-compulsive personality disorders. Although patients with personality disorders usually do not like taking medicine unless it calms them down and are fearful about taking something over which they have no control, providers do attempt to mediate symptoms with psychotropic agents for improved quality of life.
Belinda is a 24-year-old patient with borderline personality disorder (BPD). She is admitted to the inpatient psychiatric unit following a suicide attempt. You are caring for Belinda. Which of the following statements by Belinda illustrates a primary coping style of persons with BPD? A. "My provider says I might get out of here tomorrow. Do you think I'm ready to go?" B. "Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." C. "I will never again speak to any of my messed up family members. I know that this will help me be more functional." D. "I promise I am not feeling suicidal. I won't hurt myself."
B. "Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here."
Research has indicated that the 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.
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.
Playing one staff member against another is an example of A. devaluation. B. splitting. C. impulsiveness. D. social ineptitude.
B. splitting.
The priority nursing intervention for a client diagnosed 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.
The client diagnosed with a personality disorder who is most likely to be admitted to a psychiatric unit is one who has A. paranoid personality disorder and is suspicious of his neighbors. B. narcissistic personality disorder and is highly self-important. C. borderline personality disorder and is impulsive. D. dependent personality disorder and clings to her husband.
C. borderline personality disorder and is impulsive.
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.
Clients demonstrating characteristics of 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.
A nurse caring for a client who has been diagnosed with a personality disorder should expect that the client will exhibit 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.
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."
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
Which of the following are true of antisocial personality disorder (APD)? (select all that apply): A. It is the least studied of the personality disorders. B. It is characterized by rigidity and inflexible standards of self and others. C. Persons with APD display magical thinking. D. Persons with APD are concerned with personal pleasure and power. E. It is characterized by deceitfulness, disregard for others, and manipulation. F. Persons with APD usually present for treatment because of awareness of how their behavior is affecting others. G. Frontal lobe dysfunction is a brain change identified in APD.
D. Persons with APD are concerned with personal pleasure and power. E. It is characterized by deceitfulness, disregard for others, and manipulation. G. Frontal lobe dysfunction is a brain change identified in APD.
Mary Alice is a 37-year-old patient referred to the mental health clinic with a suspected personality disorder. She is withdrawn and suspicious and states she has always preferred to be alone. She describes herself as having "special powers" and states that she is thinking of opening a business where she gives "readings" to people about their future. She states, "I believe we can all read each other's thoughts at times." Based on this presentation, you suspect: A. obsessive-compulsive personality disorder. B. narcissistic personality disorder. C. avoidant personality disorder. D. schizotypal personality disorder (STPD).
D. schizotypal personality disorder (STPD).
What personality disorders are more common in women than in men? ! Correct 1 Dependent 2 Antisocial 3 Schizotypal 4 Obsessive-compulsive
Dependent personality disorder is more common in women than in men. Patients are submissive and have a high need to be taken care of. People with antisocial personality disorder are manipulative for personal gains and become hostile if their needs are blocked. People with schizotypal personality disorder become excessively anxious in social situations. Those with obsessive-compulsive personality disorder are rigid and have inflexible standards for self and others. Antisocial, schizotypal, and obsessivecompulsive personality disorders are more common in men than in women.
A patient with borderline personality disorder has suicidal intentions. The nurse plans to teach mindfulness and emotion regulation to improve interpersonal effectiveness skills in the patient. Which therapy does the nurse follow to effectively work with the patient? 1 Schema-focused therapy ! Correct 2 Dialectical behavior therapy 3 Supportive psychotherapy 4 Family therapy
Dialectical behavior therapy is used in patients with borderline personality disorder who have chronic suicidal intentions. The therapy includes cognitive and behavioral techniques like mindfulness and emotion regulation. It helps to improve interpersonal effectiveness skills in patients. Schema-focused therapy helps patients change their view about themselves. It helps in evaluating the behavior of people in stressful conditions. In supportive psychotherapy, the nurse encourages the patient to participate in activities. It helps to enhance the patient's ability to cope with stressors. In family therapy, the family members of the patient are taught how to assist the patient in handling stress.
What type of dialectical behavior therapy (DBT) for borderline personality disorder aims at reducing the person's destructive behavior? 1 Inpatient treatment ! Correct 2 Intensive outpatient treatment 3 Outpatient skills group 4 Aftercare therapy
During the intensive outpatient treatment phase of DBT, the aim is to reduce the patient's destructive behaviors, such as property damage. During inpatient treatment, the goal is primarily to reduce the risk of suicide. DBT provided in the outpatient skills group aims at helping the patient stabilize, acquire skills for behavioral function, and become more functional. Aftercare therapy helps the person improve quality of life skills and reinforces adaptive behaviors.
Which patient statement supports the diagnosis of histrionic personality disorder? Select all that apply. ! Correct 1 "My husband left because he said I flirt way too much." 2 "I think I'd feel better if I could just cry and let him know how I feel." 3 "I try really hard but I can never seem to please my husband." ! Correct 4 "I'm here because I got so depressed after my last divorce." ! Correct 5 "I like being the center of attention."
Histrionic personality disorder is characterized by emotional attentionseeking behaviors including self-centeredness, low frustration tolerance, and excessive emotionality. The person with histrionic personality disorder often is impulsive and melodramatic and may act flirtatious or provocative. Relationships do not last, because the partner often feels smothered or reacts to the insensitivity of the histrionic person. The individual with histrionic personality disorder does not have insight into his or her role in breaking up relationships and may seek treatment for depression or other comorbid condition.
Which statement concerning impulse control training is true? Select all that apply. ! Correct 1 The cost and benefit of actions are explored ! Correct 2 Patients are encouraged to stop and think before acting ! Correct 3 Focus is on social and interpersonal interactions 4 Interactions are weighed more heavily than outcomes ! Correct 5 Problem solving strategies are taught and practiced
Impulse control training assists the patient to mediate impulsive behavior through application of problem-solving strategies to social and interpersonal situations. Activities include assisting the patient to identify courses of possible action and their costs and benefits, cue himself or herself to "stop and think" before acting impulsively, evaluate the outcome of the chosen course of action, and practice problem solving (role playing) within the therapeutic environment. Interactions are not weighed more heavily than are outcomes.
Research has indicated that the antisocial personality may present with which characteristic? 1 Social isolation ! Correct 2 Lack of remorse 3 Learning difficulties 4 Difficulty with reality testing
Individuals with an antisocial personality exhibit a lack of remorse when confronted with the results of their thoughtless, irresponsible behavior toward others. Social isolation, learning difficulties, and difficulty with reality generally are not associated with personality disorders.
A person diagnosed with obsessive-compulsive personality disorder is consistently late for appointments and says, "I have to check the safety features and fluid levels on my car six times before I leave home." Which nursing diagnosis has the highest ? ! Correct 1 Anxiety 2 Altered family processes 3 Altered role performance 4 Impaired social interaction
Internally, this person is fearful of imminent catastrophe. This fear produces anxiety. Persons diagnosed with obsessive-compulsive personality disorder try to control the environment through perfectionism and orderliness. Traits include compulsivity, oppositionality, lack of emotional expressiveness, and perfectionism. Social interactions, family processes, and role performance for this individual will improve after the anxiety is reduced; therefore, these diagnoses have a lower priority.
The priority nursing intervention for a patient diagnosed with borderline personality disorder is to 1 Protect other patients from manipulation 2 Respect the patient's need for social isolation ! Correct 3 Assess for suicidal and self-mutilating behaviors 4 Provide clear, consistent limits and boundaries
One of the primary nursing guidelines or interventions for patients with a personality disorder is to assess for suicidal and self-mutilating behaviors, especially during times of stress.
What personality disorder is more common among men? 1 Avoidant personality disorder ! Correct 2 Paranoid personality disorder 3 Histrionic personality disorder 4 Narcissistic personality disorder
Paranoid personality disorder is more common among men than among women. People with this disorder believe that others want to exploit, harm, or deceive them. Avoidant personality disorder is equally prevalent among men and women. People with this disorder have a feeling of inferiority and tend to avoid unfamiliar activities involving new people. Histrionic and narcissistic personality disorders are more common among women. People with histrionic personality disorder are self-centered and show intense emotional attention-seeking behaviors. Those with narcissistic personality disorder are arrogant people with an inflated view of their self-importance.
A community mental health nurse works with an adult patient diagnosed with borderline personality disorder. The patient says to the nurse, "I'm under so much stress, I feel like cutting my throat." What should the nurse do first? 1 Extinguish the behavior by ignoring it. 2 Immediately notify the health care provider. ! Correct 3 Talk with the patient about the feelings of stress. 4 Initiate the process for involuntary hospitalization of the patient.
Patients diagnosed with borderline personality disorder are impulsive, with significant risks for suicide and self-mutilation. Discussing the dynamics of feelings and stress help the patient feel understood and is a positive action. The nurse as a therapeutic agent should respond and interact with the patient, but it is important to inform the treatment team (including the health care provider) afterward. If the nurse fails to respond, the patient may follow through with a suicide attempt. Involuntary hospitalization is not indicated at this point.
A patient arrested for an assault in which the patient savagely beat a classmate states, "The guy deserved everything he got." The behaviors described are most consistent with the clinical picture of which disorder? ! Correct 1 Antisocial personality disorder 2 Borderline personality disorder 3 Schizotypal personality disorder 4 Narcissistic personality disorder
Patients with antisocial personality act out feelings without consideration forthe rights of others. They feel no remorse for their antisocial acts.Such lack of remorse for what is considered heartless behavior is not associated with borderline, schizotypal or narcissistic personality disorders.
A patient gets excessively anxious in group activities such as playing an indoor game and is hypersensitive to negative evaluation. What interventions should the nurse perform while caring for this patient? Select all that apply. 1 The nurse avoids having a friendly approach with the patient. ! Correct 2 The nurse accepts the patient's request to not be involved in group activities. ! Correct 3 The nurse has a friendly approach towards the patient. 4 The nurse assigns the patient to another group activity. 5 The nurse insists the patient participate in group activates.
Patients with avoidant personality disorder get excessively anxious in social situations and group activities. Therefore, the nurse should have a friendly, reassuring, and accepting approach while caring for these patients. The nurse should respect the patient's decision to not be involved in group activities, as they can increase the patient's anxiety. Even if the client refuses to participate, the nurse should have a friendly approach towards the patient. The nurse should not insist the patient participate in group activities, but should provide encouragement to help the patient manage the anxiety and participate in group activities. Changing the group activity does not help in reducing anxiety.
A patient gets excessively anxious in group activities such as playing an indoor game and is hypersensitive to negative evaluation. What interventions should the nurse perform while caring for this patient? Select all that apply. 1 The nurse avoids having a friendly approach with the patient. ! Correct 2 The nurse accepts the patient's request to not be involved in group activities. ! Correct 3 The nurse has a friendly approach towards the patient. 4 The nurse assigns the patient to another group activity. 5 The nurse insists the patient participate in group activates.
Patients with avoidant personality disorder get excessively anxious in social situations and group activities. Therefore, the nurse should have a friendly, reassuring, and accepting approach while caring for these patients. The nurse should respect the patient's decision to not be involved in group activities, as they can increase the patient's anxiety. Even if the client refuses to participate, the nurse should have a friendly approach towards the patient. The nurse should not insist the patient participate in group activities, but should provide encouragement to help the patient manage the anxiety and participate in group activities. Changing the group activity does not help in reducing anxiety.
Which characteristic demonstrated by a patient diagnosed with a personality disorder will result most likely in an admission to a psychiatric unit? 1 Paranoid personality disorder and is suspicious of neighbors. 2 Narcissistic personality disorder and is highly self-important. ! Correct 3 Borderline personality disorder and reporting stress. 4 Dependent personality disorder and clings to spouse.
Patients with borderline disorder can decompensate into psychotic states under stress. Hospitalization is needed at these times. Neither paranoia, narcissism nor dependent personality traits are reasons for hospitalization.
The nurse is preparing to manage the care of a patient diagnosed with a borderline personality disorder. The nurse demonstrates an understanding of therapeutic interventions that focus on the characteristics of such disorders when making which statement to the patient? 1 "You must feel threatened when staff is involved with the problems of the other patients." 2 "When you feel the triggers of your agitation starting, come to me so I can help you de-escalate." ! Correct 3 "When you want my attention, please explain that to me rather than resorting to manipulative behavior." 4 "We are here to keep you safe, so I will ask you several times a day whether you feel the need to harm yourself."
Patients with borderline personality disorder are often manipulative. Providing them with an alternative behavior is therapeutic. To be threatened when the needs of others interferes with meeting one's own needs is characteristic of narcissism. The statement about triggers of agitation is directed at aggressive disorders such as posttraumatic stress disorder. The statement regarding asking the patient whether he or she feels the need to harm him- or herself is directed toward depression and suicidal ideations.
The nurse is preparing to manage the care of a patient diagnosed with a borderline personality disorder. The nurse demonstrates an understanding of therapeutic interventions that focus on the characteristics of such disorders when making which statement to the patient? 1 "You must feel threatened when staff is involved with the problems of the other patients." 2 "When you feel the triggers of your agitation starting, come to me so I can help you de-escalate." ! Correct 3 "When you want my attention, please explain that to me rather than resorting to manipulative behavior." 4 "We are here to keep you safe, so I will ask you several times a day whether you feel the need to harm yourself."
Patients with borderline personality disorder are often manipulative. Providing them with an alternative behavior is therapeutic. To be threatened when the needs of others interferes with meeting one's own needs is characteristic of narcissism. The statement about triggers of agitation is directed at aggressive disorders such as posttraumatic stress disorder. The statement regarding asking the patient whether he or she feels the need to harm him- or herself is directed toward depression and suicidal ideations.
A primary health care provider is prescribing medications for a patient with borderline personality disorder who shows risk of self-injuring. Which medication would a nurse expect to be prescribed? ! Correct 1 Naltrexone (ReVia) 2 Diazepam (Valium) 3 Omega -3 supplements 4 Citalopram (Celexa)
Patients with borderline personality disorder are often self-injuring. Naltrexone is an opiod receptor antagonist. It is used to calm the patient who is self-injuring. Diazepam is a benzodiazepine drug. It is used to treat anxiety in patients. Omega-3 supplements are prescribed to treat mood and emotion dysregulation symptoms. Citalopram is a selective serotonin reuptake inhibitor. It is used to treat depression in patients but these drugs are not generally prescribed to patients with borderline personality disorder.
The nurse is caring for a rheumatoid arthritis patient with borderline personality disorder. Which behavior does the nurse find in the patient when compared to other patients in the ward? 1 The patient is always calm and depressed. ! Correct 2 The patient shows extreme fluctuating emotions. 3 The patient abuses peers and hospital staff. 4 The patient feels uncomfortable by the nurse's attention.
Patients with borderline personality disorder have unstable moods. Such patients exhibit rapid emotional shifts. They may be extremely aggressive and suddenly become extremely calm. They have a history of violence and impulsivity. They are not always aggressive but they are emotionally unstable and may exhibit a range of emotions. The patients have attention-seeking behavior and may try to attract the attention of the nurse.
During an interview, the nurse asks a patient with borderline personality disorder about childhood experiences. What findings about the patient's childhood may relate to the patient's borderline personality disorder? 1 Starting to explore their environment at the age of 11-18 months ! Correct 2 Seeking emotional support from their mother at the age of 18-24 months 3 Getting emotional support from their parents at the age of 2-5 years 4 Sleeping most of the time at the age of 0-1 month
Patients with borderline personality disorder may have disrupted childhoods, which means that there is a lack of attachment with the primary caregiver. At the age of 18-24 months, a child moves away from the mother and tries to become independent. The child does not require emotional support but comes back to the mother for emotional refueling. This phase is called rapprochement. Disruption or the lack of attachment in this phase can be crucial for causing personality disorders. The child learns to walk and starts exploring things between 11-18 months of age. When the child reaches the ages of 2-5 years, the child becomes an individual and does not seek emotional support from the mother. However, the child is confident to get support from his or her mother whenever needed. At the age of 0-1 month the infant spends most of his or her time sleeping.
When assessing a patient for personality disorders, the nurse notices that a patient behaves in a melodramatic way and acts flirtatiously. What personality disorder is the nurse most likely to suspect in the patient? 1 Paranoid personality disorder 2 Schizoid personality disorder ! Correct 3 Histrionic personality disorder 4 Narcissistic personality disorder
People with histrionic personality disorder have emotional attention-seeking behaviors. They are often melodramatic and act flirtatiously. People with paranoid personality disorder are extremely suspicious and often believe others will harm them. People with schizoid personality disorder exhibit emotional detachment and are viewed as loners. People with narcissistic personality disorder are arrogant and need constant admiration.
Which patient assessment data support the diagnosis of schizoid personality disorder? Select all that apply. ! Correct 1 Shares that, "I don't really care whether people are afraid of me." ! Correct 2 Is employed as a nightshift janitor at an office complex 3 Reports, "I like people but I have only two good friends" ! Correct 4 Raised in foster care after age 7 because of death of parents ! Correct 5 Has never been married
People with schizoid personality disorder exhibit a poor ability to function in their lives. Relationships are particularly affected because of the prominent feature of emotional detachment. People with this disorder do not seek out or enjoy close relationships and are viewed as loners. Neither approval nor rejection from others seems to have much effect. Friendships, dating, and sexual experiences are rare. Employment may be jeopardized if interpersonal interaction is necessary; individuals with this disorder may be able to function well in a solitary occupation. From a psychological perspective, people with this disorder often are raised in a cold and neglectful atmosphere in which they may conclude that relationships are unsatisfying and unnecessary.
A patient experiences extreme anxiety in social situations and seems to have some intellectual and perceptual distortions but can be made aware of the misinterpretations of reality. What is the patient likely to be suffering from? 1 Schizoid personality disorder ! Correct 2 Schizotypal personality disorder 3 Paranoid personality disorder 4 Obsessive-compulsive personality disorder
People with schizotypal personality disorder have severe social and interpersonal deficits. They experience anxiety in social situations. They may have some intellectual and perceptual distortions but can be made aware of reality, unlike those with schizophrenia. Schizoid personality disorder can be a precursor to schizophrenia or delusional disorder. People with this disorder are emotionally detached loners who do not seek out or enjoy close relationships. People with paranoid personality disorder tend to be afraid that others will harm or deceive them. So, they are hostile and view others with suspicion. People with obsessive-compulsive disorder have a fear of imminent catastrophe. They tend to rehearse over and over how they will respond in a social circumstance.
A nurse manages care for an individual with a personality disorder. What is the most attainable outcome for this patient? 1 Within two weeks, the patient will establish a satisfying intimate relationship with another adult. 2 Within five days, the patient will identify factors that led to development of the personality disorder. 3 Within one week, the patient will make a permanent commitment never to self-mutilate. ! Correct 4 Within four weeks, the patient will describe
Personality disorders are pervasive, long-standing patterns of behavior. It is unrealistic to expect dramatic changes in a short period of time. Outcomes should be realistic and focused on problem-solving and cognitive reframing.
A nurse manages care for an individual with a personality disorder. What is the most attainable outcome for this patient? 1 Within two weeks, the patient will establish a satisfying intimate relationship with another adult. 2 Within five days, the patient will identify factors that led to development of the personality disorder. 3 Within one week, the patient will make a permanent commitment never to self-mutilate. ! Correct 4 Within four weeks, the patient will describe personal characteristics of reactions to stress.
Personality disorders are pervasive, long-standing patterns of behavior. It is unrealistic to expect dramatic changes in a short period of time. Outcomes should be realistic and focused on problem-solving and cognitive reframing.
A nurse caring for a patient who has been diagnosed with a personality disorder should expect that the patient will exhibit which behavior? 1 Frequent episodes of psychosis 2 Constant involvement with the needs of significant others ! Correct 3 Inflexible and maladaptive responses to stress 4 Abnormal ego functioning
Personality patterns persist unmodified over long periods of time. Inflexible and maladaptive responses to stress are characteristic of individuals with a personality disorder. Psychosis, abnormal ego functioning, and caregiving tendencies generally are not characteristic of personality disorders.
A newly admitted patient has an axis II diagnosis of schizoid personality disorder. The nursing intervention of highest priority will be to 1 Set firm limits on behavior ! Correct 2 Respect need for social isolation 3 Encourage expression of feelings 4 Involve in milieu and group activities
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.
Which behavior is demonstrated by a patient who engages in splitting? 1 Unconsciously represses undesirable aspects of self. 2 Places responsibility for behavior outside the self. ! Correct 3 Sees things as divided into "all good" or "all bad." 4 Evidences a lack of personal boundaries.
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. Splitting is not described accurately by unconsciously repressing undesirable aspects of self, placing responsibility for behavior outside the self, or evidencing a lack of personal boundaries.
What term is used to identify the inability to view both positive and negative aspects of others as part of a whole? 1 Devaluation ! Correct 2 Splitting 3 Impulsiveness 4 Social ineptitude
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 patient. The patient can enjoy the spectacle and do as he or she pleases. Devaluation, impulsiveness, and social ineptitude do not accurately identify the behavior described.
Screening for which personality disorder should be focused on the male population? Select all that apply. ! Correct 1 Antisocial ! Correct 2 Schizotypal ! Correct 3 Paranoid 4 Dependent 5 Borderline
Statistically more males than females are diagnosed with antisocial, paranoid, and schizotypal personality disorders. More females than males are diagnosed with borderline and dependent personality disorders.
Which behavior would be consistent with defining characteristics for the nursing diagnosis of ineffective coping? Select all that apply. ! Correct 1 Aggressiveness 2 Interdependence ! Correct 3 Manipulation ! Correct 4 High levels of anxiety ! Correct 5 Difficulty in relationships
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.
A patient is withdrawn and suspicious and states he or she has always preferred to be alone. The patient describes him- or herself as having "special powers" and states, "I believe we can all read each other's thoughts at times." Based on this presentation, the nurse suspects which personality disorder? 1 Obsessive-compulsive 2 Narcissistic 3 Avoidant ! Correct 4 Schizotypal (STPD)
The main traits that describe STPD are psychoticism, such as eccentricity, odd or unusual beliefs and thought processes, and social detachment by preferring to be socially isolated, as well as being overly suspicious or anxious. In obsessive-compulsive personality disorder the main pathological personality traits are rigidity and inflexible standards of self and others, along with persistence to goals long after it is necessary, even if it is self-defeating or negatively affects relationships. People with narcissistic personality disorder come across as arrogant, with an inflated view of their self-importance. They have a need for constant admiration, along with a lack of empathy for others, a factor that strains most relationships over time. Traits of avoidant personality disorder include low self-esteem, feelings of inferiority compared with peers, and a reluctance to engage in unfamiliar activities involving new people.
What appropriate symptoms should the nurse asses to identify borderline personality disorder when interviewing patients? Select all that apply. ! Correct 1 Frequency of mood shifts 2 Extent of happiness ! Correct 3 Feelings of emptiness 4 Inclination towards group activities ! Correct 5 Tendency towards sarcasm
The nurse can assess borderline personality disorder by evaluating the tendency of sarcasm, anger, and bitterness in the patient. The nurse should asses feelings of emptiness and loneliness. A patient with borderline personality disorder experiences extreme mood shifts. The nurse should asses the frequency of extreme mood shifts that occur in an hour or days. Patients with borderline personality do not engage in group activities due to anxiety. Extent of happiness doesn't help in identifying borderline personality disorder as the patient has mood swings.
What is the psychosocial assessment focus for a patient diagnosed with antisocial personality disorder? Select all that apply. ! Correct 1 Substance abuse ! Correct 2 Current stressors 3 Chronic medical issues ! Correct 4 Homicidal ideations ! Correct 5 Anxiety level
The nurse should assess this patient for current stressors, history of past and current substance abuse, current anxiety level, and any homicidal or suicidal ideations. Currently there is no research to associate this disorder with physiological causes.
A patient was admitted to the psychiatric in-patient unit due to manipulative and aggressive behavior. What appropriate strategy does the nurse follow while interacting with the patient? ! Correct 1 The nurse asks questions to explore the patient's situation. 2 The nurse maintains a judgmental attitude towards the patient. 3 The nurse avoids explaining the present situation of the patient. 4 The nurse uses closed-ended statements while interacting with the patient.
The nurse should try to explore the patient's feelings by asking questions about the situation. It helps to assess the patient's condition and to prepare an effective treatment plan. The nurse should also maintain a nonjudgmental attitude. Being judgmental and giving opinions can annoy the patient. The patient must be given an explanation of his or her present condition, as it helps to reorient the patient to reality. Making closed-ended statements hinders communication.
Which intervention by the nurse is associated specifically with care provided for a patient diagnosed with paranoid disorder? Select all that apply. ! Correct 1 Giving the patient a copy of the daily routine the patients are expected to follow ! Correct 2 Monitoring the patient for behaviors associated with psychosis ! Correct 3 Explaining why the scheduled therapy session will be delayed 30 minutes 4 Discussing how the patient's statements hurt the feelings of others on the unit 5 Failing to react when the patient remarks, "You're fat"
The paranoid patient is suspicious, mistrustful, and may develop perceptional distortions. Giving clear instructions and explanations will help minimize these tendencies. Monitoring for psychotic behavior is appropriate for any patient with a risk for cognitive or perceptual distortions. The narcissistic patient is associated with thoughtless, disparaging comments.
A nurse is caring for a patient with paranoia and severe social and interpersonal deficits. What interventions should the nurse perform while caring for the patient? 1 Be overfriendly with the patient. ! Correct 2 Leave the patient alone when needed. 3 Involve the patient in group tasks frequently. 4 Ignore suspicions voiced by the patient.
The patient with schizotypal personality disorder has paranoia and severe social and interpersonal deficits. The nurse should leave the patient alone and respect the patient's need for social isolation. The nurse should avoid being overfriendly or nice to the patient, as the patient may become manipulative and misinterpret the nurse's behavior. The nurse shouldn't try to increase the socialization of the patient by frequently involving his or her in group tasks. It can make the patient aggressive. The patient must be left alone when needed to help the patient become calm. The nurse should be aware of the suspicious behavior of the patient and should make a note. It helps to follow appropriate interventions in the patient's treatment.
A nurse is caring for a patient with paranoia and severe social and interpersonal deficits. What interventions should the nurse perform while caring for the patient? 1 Be overfriendly with the patient. Correct 2 Leave the patient alone when needed. 3 Involve the patient in group tasks frequently. 4 Ignore suspicions voiced by the patient.
The patient with schizotypal personality disorder has paranoia and severe social and interpersonal deficits. The nurse should leave the patient alone and respect the patient's need for social isolation. The nurse should avoid being overfriendly or nice to the patient, as the patient may become manipulative and misinterpret the nurse's behavior. The nurse shouldn't try to increase the socialization of the patient by frequently involving his or her in group tasks. It can make the patient aggressive. The patient must be left alone when needed to help the patient become calm. The nurse should be aware of the suspicious behavior of the patient and should make a note. It helps to follow appropriate interventions in the patient's treatment.
Which statement about persons diagnosed with personality disorders is accurate? 1 Patients readily recognize their problems and seek professional assistance. 2 Extended hospitalization is the best intervention and commonly needed for stabilization. ! Correct 3 Characteristics of these disorders are most evident in social and interpersonal interactions. 4 Research has produced multiple medications that effectively manage symptoms of personality disorders.
The presence of a personality disorder interferes with, or complicates, social and interpersonal function. Individuals who meet criteria for these disorders have problems with empathy or intimacy within their relationships. Persons diagnosed with personality disorders tend not to perceive themselves as having a problem but instead believe their problems are caused by how others behave toward them. While short-term hospitalization may sometimes be necessary when acute problems occur, extended hospitalizations tend to be counter-productive for this population. In the United States, there are no Federal Drug Administration-approved medications specifically for treating personality disorders; however, some health care providers prescribe selected psychotropic medications for off-label use.
What are the features of antisocial personality disorder? 1 Symptoms tend to peak around 30 years of age. 2 Level of 5-hydroxyindoleacetic acid in the urine is high. ! Correct 3 Prevalence is higher among African-American men. 4 Patients commonly exhibit self-destructive behaviors.
The prevalence of antisocial personality disorder is higher among African Americans and it is more common among men. The symptoms peak in the late teenage years and the mid-20s. A change in serotonin transmission has been implicated in aggression and impulsivity seen in this disorder. 5- Hydroxyindoleacetic acid is a metabolite of serotonin. Its level in the urine is decreased in antisocial personality disorder. Self-destructive behavior is common in borderline personality disorder. In antisocial personality disorder, the person is exploitative of others.
What is the primary goal of milieu therapy for patients diagnosed with personality disorders? ! Correct 1 Managing the effect of the behavior on the entire group. 2 Providing one-on-one therapy for each member of the milieu. 3 Helping the patient remain uninvolved with other patients. 4 Promoting a laissez-faire attitude among the staff members.
The primary goal of milieu therapy is affect management in a group context. One on one therapy is not a goal of milieu management. Helping the patient remain uninvolved is not therapeutic. The staff would not be able to effectively manage the milieu if they adopted a laissez-faire attitude.
A patient at the mental health center says to the nurse, "Most of the staff does not care about me, but you are different. You understand my problems." When the nurse tells this patient about an upcoming career change, the patient becomes very angry. An hour later, the patient loudly announces, "I'm going to cut my wrists. I need to be hospitalized immediately." Given this scenario, which personality disorder is most likely? 1 Narcissistic ! Correct 2 Borderline 3 Histrionic 4 Avoidant
The scenario describes splitting of staff and impulsivity associated with selfmutilation. These are common behaviors among persons diagnosed with borderline personality disorder. Persons diagnosed with narcissistic personality disorder are exploitive, grandiose, and disparaging. Persons diagnosed with avoidant personality disorder are excessively anxious in social situations and hypersensitive to negative evaluation. Persons diagnosed with histrionic personality disorder are seductive, flamboyant, attention seeking, and shallow.
A patient at the mental health center says to the nurse, "Most of the staff does not care about me, but you are different. You understand my problems." When the nurse tells this patient about an upcoming career change, the patient becomes very angry. An hour later, the patient loudly announces, "I'm going to cut my wrists. I need to be hospitalized immediately." Given this scenario, which personality disorder is most likely? 1 Narcissistic ! Correct 2 Borderline 3 Histrionic 4 Avoidant
The scenario describes splitting of staff and impulsivity associated with selfmutilation. These are common behaviors among persons diagnosed with borderline personality disorder. Persons diagnosed with narcissistic personality disorder are exploitive, grandiose, and disparaging. Persons diagnosed with avoidant personality disorder are excessively anxious in social situations and hypersensitive to negative evaluation. Persons diagnosed with histrionic personality disorder are seductive, flamboyant, attention seeking, and shallow.
A nurse assesses an individual diagnosed with schizoid personality disorder. Which characteristics are most likely? Select all that apply. ! Correct 1 Uncle diagnosed with schizophrenia 2 Multiple somatic complaints ! Correct 3 Complaints of depression 4 Hyperactivity ! Correct 5 Male gender
There is increased prevalence of schizoid personality disorder in families with a history of schizophrenia or schizotypal personality disorder. More men are diagnosed with this problem and depression is frequently present. Hyperactivity is associated more commonly with borderline personality disorder. Somatic complaints are more common in persons diagnosed with antisocial personality disorder.
A primary health care provider is planning therapy for a patient with narcissistic personality disorder. What treatment option does the nurse anticipate as most effective for the patient? 1 Omega-3 supplements 2 Assertiveness training ! Correct 3 Individual cognitive-behavioral therapy 4 Low-dose antipsychotic medications
There is no medication indicated for narcissistic personality disorder. Treatment includes individual cognitive-behavioral therapy, family therapy, and group therapy. Patients with borderline personality disorders often respond to omega-3 supplementation for mood and emotion dysregulation symptoms. Patients with narcissistic personality disorder already have an inflated view of their self-importance, and assertive training may not help them. Such training helps patients with avoidant, dependent, or histrionic personality disorders to express their needs more openly and improves their self-esteem. Patients with borderline and schizotypal personality disorders benefit from low-dose antipsychotic medications, which reduce psychoticlike symptoms and improve day-to-day functioning.
A primary health care provider is planning therapy for a patient with narcissistic personality disorder. What treatment option does the nurse anticipate as most effective for the patient? 1 Omega-3 supplements 2 Assertiveness training ! Correct 3 Individual cognitive-behavioral therapy 4 Low-dose antipsychotic medications
There is no medication indicated for narcissistic personality disorder. Treatment includes individual cognitive-behavioral therapy, family therapy, and group therapy. Patients with borderline personality disorders often respond to omega-3 supplementation for mood and emotion dysregulation symptoms. Patients with narcissistic personality disorder already have an inflated view of their self-importance, and assertive training may not help them. Such training helps patients with avoidant, dependent, or histrionic personality disorders to express their needs more openly and improves their self-esteem. Patients with borderline and schizotypal personality disorders benefit from low-dose antipsychotic medications, which reduce psychoticlike symptoms and improve day-to-day functioning.
The nurse tells a patient diagnosed with borderline personality disorder, "A new case manager has been assigned to work with you." Which initial reaction is most likely for this patient? 1 Guilt ! Correct 2 Anger 3 Silence 4 Withdrawal
This scenario is likely to cause the patient to feel rejected. Patients diagnosed with borderline personality disorder show separation anxiety and emotional lability (rapidly moving from one emotional extreme to another). Typically, these emotional shifts include responding to situations with emotions that are out of proportion to the circumstances, pathological fear of separation, and intense sensitivity to perceived personal rejection. Withdrawal and guilt are reactions more likely from a person diagnosed with dependent personality disorder. This patient could be expected to react rather than being silent.
Which statement by the nurse demonstrates communication specifically appropriate for a patient diagnosed with antisocial personality disorder? Select all that apply. 1 "Remember you promised to tell me if you begin to think about hurting yourself." ! Correct 2 "I don't accept responsibility for you losing privileges for arguing with staff." 3 "You don't have to go to the unit party if it will make you anxious." ! Correct 4 "Referring to the staff in a sexual manner is not acceptable behavior." ! Correct 5 "No, I don't think the rules are the problem, but you need to follow the rules."
Those individuals diagnosed with antisocial personality disorder can be manipulative and exploitive of others as well as being seductive. Staff must prevent the patient from instilling unwarranted guilt on others for their actions or behaviors. Social anxiety is associated with avoidance disorder, while self-harm is associated with borderline personality disorder.
Patients with borderline personality disorder (BPD) exhibit negative effect, which includes emotional ___, described as rapidly moving from one emotional extreme to another.
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