Chapter 18 - Personality disorder

When clients diagnosed with borderline personality disorder (BPD) see nurses as either all good or all bad, the client is using which primitive defense?

Splitting

Which occurs when a client tends to adore and idealize other people even after a brief acquaintance but then quickly leaves them if these others do not meet the client's expectations in some way?

Splitting

A 17-year-old client comes to the community crisis clinic with multiple superficial cuts on the wrist. The client is crying uncontrollably and states that the client's romantic partner has left and the client doesn't want to live without the partner. What would be the most therapeutic initial nursing response?

"I can see that you are feeling anxious. I will stay with you until you feel better."

A nurse is assessing a client and suspects that the client may have obsessive-compulsive personality disorder based on which statement?

"I need to have everything perfect. My life is organized down to the second."

A client asks the nurse to go to lunch with the client one day next week after the client is discharged. Which statement is the most therapeutic response?

"My role here is to help you recover. Let's talk about what else you can be doing after discharge."

A client who has a history of displaying passive aggressive behavior has a pattern of being late for counseling appointments or cancelling at the last minute. As a result, the counselor has set a limit with the client specifying that the client will forfeit the appointment if the client is more than 5 minutes late for an appointment. Today, the client has come to the counselor's office more than 10 minutes late, at which point the counselor has reminded the client of this limit. Which response would be most consistent with this client's diagnosis?

"Oh my gosh, I'm so sorry but it totally wasn't my fault because traffic was a complete nightmare."

A client with borderline personality disorder tells the nurse, "I'm afraid to get on a train because it will probably wreck." Which response(s) by a nurse would be appropriate? Select all that apply.

"What are the chances of that actually happening?"

The nurse is caring for a client with antisocial personality disorder. Which statement is most appropriate for the nurse to make when explaining unit rules and expectations to the client?

"You'll be expected to attend group therapy each day."

A client who has a diagnosis of histrionic personality disorder is admitted to an inpatient mental health unit. The client leaves the unit briefly without notifying the nurse or other members of the health care team. The client's nurse uses confrontation to remind the client of the rules of coming and going from the unit. The client has responded, "But those rules are more for the schizophrenics and crazy people, right?" How should the nurse respond?

"Your safety is the priority while you are admitted to this unit. Please ensure you notify your nurse prior to leaving."

A client diagnosed with borderline personality disorder tells a nurse that they "frequently space out." Which response(s) by the nurse are appropriate? Select all that apply.

- "What's happening around you when this occurs?" - "What do you think is triggering this?"

A client is diagnosed with avoidant personality disorder. When assessing the client, which would be evident? Select all that apply.

- Timidity - Sensitivity to negative comments - Fear of rejection

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?

18 years

Which is considered the etiology of personality disorders?

A combination of psychosocial and biologic variables

A nurse is reviewing the medical record of a client diagnosed with borderline personality disorder (BPD). Which element would the nurse identify as one of the strongest risk factors for this disorder?

Abuse as a child

A client comes to the clinic for a follow-up visit. Despite being warm and friendly with the nurse on a previous visit, today the client presents with anger and sarcastic undertones with the same nurse. The client is presenting which behavior commonly seen in borderline personality disorder?

Affective instability

What does the nurse recognize as the most likely explanation for the self-mutilating behaviors that occur with borderline personality disorder?

An expression of intense anger or helplessness in order to block emotional pain

The nurse is interviewing a client with a history of violence. The client boasts that the client "put a kid in a wheelchair" once when the client was younger and has maimed others. The client states, "Who cares? Life's tough." Violence and insensitivity are associated with which personality disorder?

Antisocial personality disorder

A client has a diagnosis of borderline personality disorder and lives at home with the client's parents. The client has been in the psychiatric unit for 2 weeks and is scheduled to be discharged tomorrow. Which would be most therapeutic when the client's parents come in to discuss discharge plans?

Ask the parents to keep a written schedule of activities for each day for the client

A nurse is describing histrionic personality disorder to a group of new nurses. Which term would the nurse most likely use?

Attention seeking

Which personality disorder would be placed in Cluster B?

Borderline

Which personality disorder is most commonly found in clinical settings?

Borderline personality

A 30-year-old client who has not paid rent in 4 months is being evicted from an apartment. The client is brought to the hospital after the client uses a kitchen knife to cut the client's wrist in response to the stress of the eviction. The client's behavior is consistent with what?

Borderline personality disorder

A client is admitted to the mental health unit after the client's spouse brings the client to the emergency department. Upon arrival, the spouse explained that the client had been crying all weekend and stating that the client wanted to die. Upon further assessment, the spouse reports that the client always has difficulty controlling anger and frequently worries that the spouse will leave the client. Recently, the client has been getting drunk every night, which the client never used to do. What diagnosis should the nurse suspect applies to this client?

Borderline personality disorder

Impulsivity and difficulty controlling anger are characteristic of which mental health diagnosis?

Borderline personality disorder

The nurse is in the process of planning the care of a psychiatric-mental health client and has specified the following outcome: The client will be free from self-inflicted harm. What is this client's most likely diagnosis?

Borderline personality disorder

The nurse is conducting an admission assessment of a 41-year-old client. Each time that the nurse asks the client a question, the client defers to the client's spouse to answer the question. Such behavior is consistent with which personality disorder?

Dependent personality disorder

The nurse in charge of an inpatient psychiatric unit is irritated with a client who has borderline personality disorder. Which step should the nurse take?

Discuss the feelings with a colleague to promote coping.

A client diagnosed with schizoid personality disorder is described by family members as what?

Emotionless and a loner

A nurse caring for a client with borderline personality disorder (BPD) consistently informs the client of the length of the relationship and routinely prepares the client for termination and the end of hospitalization. Which is the nurse trying to prevent?

Maladaptive expression of emotions

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

Impulsive behaviors

Gambling, binge eating, and engaging in unsafe sex are examples of what?

Impulsivity

When providing care to a client who consistently attempts to manipulate the staff, the nurse can best maintain the therapeutic milieu by doing what?

Instructing the staff to enforce all unit rules consistently

The nurse is conducting an education group for women at risk for self-mutilation. What is the most important goal for this group?

Learning strategies to refrain from self-harm

A client diagnosed with a personality disorder exhibits a pervasive pattern of grandiosity, need for admiration, and a lack of empathy. Which personality disorder would the nurse identify as being characterized by this behavior?

Narcissistic

A nurse is preparing an inservice program for a group of mental health nurses on the topic of borderline personality disorder. When discussing the need for hospitalization, which would the nurse include as the most likely reason for inpatient hospitalization?

Nonsuicidal self-injury

How does personality disorder differ from personality traits?

Personality disorder causes impairment in social and occupational functioning, whereas traits do not.

Which statement accurately reflects the prognosis for a client with a personality disorder?

Prognosis varies based on the degree of functional impairment and the client's motivation to change.

A client with borderline personality disorder has been admitted to the inpatient unit after being found in the client's parents' bedroom, burning the client's arm with an iron. This injury required a brief stay in the hospital's burn unit prior to transfer to your psychiatric unit. Which is the nursing care priority for this client during the first 24 hours of admission?

Protection from self-mutilation

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

Risk for self-mutilation

The nurse is admitting a client with histrionic personality disorder to the inpatient unit. The nurse would anticipate that this client may exhibit which behavior?

Self-dramatization

The most serious consequence of behaviors seen in borderline personality disorder includes what?

Self-injury

A client on an inpatient psychiatric unit has features of borderline personality disorder. The client is frequently angry, has an unstable sense of self, and is highly impulsive. The client can be verbally abusive to staff, who feel manipulated by the client's behaviors. Which intervention does the nurse determine as priority?

Setting limits

A client with borderline personality disorder (BPD) who evaluates experiences, people, and objects in terms of mutually exclusive categories (e.g., good or bad, success or failure) is demonstrating which type of thinking?

Splitting

The nurse-therapist is conducting a group therapy session in which one of the participants is an adult who has been diagnosed with narcissistic personality disorder. The nurse recognizes the significance of childhood experiences in the etiology of personality disorders, which for this client may have included what pattern?

The client's parent catered to the client's every need and the client used temper tantrums to successfully get the client's way.

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

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

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

Thought stopping

A nurse working with a client with borderline personality disorder could establish which as outcome criteria?

Tolerate stress without self-mutilation.

The use of pharmacotherapy in the treatment of personality disorders is optimized if this intervention is what?

Used in addition to psychotherapy