Chapter 18: Personality Disorders

A nurse is interviewing a client and suspects that the client may have narcissistic personality disorder. Which statement by the client would help support the nurse's suspicions? "I like to work alone because then I can let my thoughts wander." "My spouse is poisoning my food to get rid of me and marry my spouse's boss." "I'm always the life of the party, making new friends all the time." "I have a very important position in life; everyone I know wants to be like me."

"I have a very important position in life; everyone I know wants to be like me." Individuals with narcissistic personality disorder are grandiose, have an inexhaustible need for admiration, and lack empathy. These individuals believe that they are superior, special, or unique and that others should recognize them in this way. The statement about having a very important position in life and everyone wanting to be like the client reflects this personality trait. The statement about poisoning the food reflects a paranoid personality trait. The statement about working alone suggests a schizoid personality trait. The statement about being the life of the party suggests a histrionic personality trait.

A nurse is caring for a client diagnosed with borderline personality disorder. The nurse has instructed the client about using the communication triad. The nurse determines that the client has understood this technique when stating what? "I should first tell the other person what I'd like to be different about the situation." "I should begin by telling the other person what has triggered my emotion." "Maybe I should start by describing the situation that has me upset." "I should start by stating my feelings as an 'I' statement."

"I should start by stating my feelings as an 'I' statement." The client should begin with an "I" statement and the identification of feelings. Many want to begin with the condition. If the client begins with the condition, the statement becomes accusatory and is likely to evoke defensiveness. The "I" statement is followed by a nonjudgmental statement of the emotional trigger, then followed by what the person would like differently or what would restore comfort to the situation.

A client with borderline personality disorder starts flirting with the nurse, saying the client dreams about the nurse at night and wants to kiss the nurse. What would be the best response by the nurse? "That is very sweet of you to say." "Let's talk about something else now." "I feel uncomfortable with what you said. My role is to support you in recovery." "I feel flattered that you think that much of me, but nurses don't date clients."

"I feel uncomfortable with what you said. My role is to support you in recovery." When a client violates boundaries, it is important to respond right away. If a client flirts with the nurse, the nurse should reply that this is not professional and out of place. The nurse should not encourage, dismiss, acknowledge, or ignore the behavior.

A client with paranoid personality disorder is admitted to a psychiatric facility. Which statement by the nurse would best establish rapport and encourage the client to confide in the nurse? "I know how you feel. I'd feel the same way in your situation." "It bothers me when I think people are talking about me." "I get upset once in a while, too." "It's normal not to trust anyone."

"I get upset once in a while, too." Sharing a benign, nonthreatening, personal fact or feeling helps the nurse establish rapport and encourages the client to confide in the nurse. The nurse cannot know how the client feels. Telling the client otherwise would justify the suspicions of a paranoid client; furthermore, the client relies on the nurse to interpret reality.

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." "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."

"No, only one cigarette is allowed per break time." The client is trying to manipulate the nurse in order to gratify the immediate need for a cigarette. In responding to manipulative behavior, the most therapeutic intervention is to maintain the limits that have been set and not to change the rules or make concessions for the client. The correct answer is the only option that is clear and assertive and maintains the rules.

A client with borderline personality disorder has had 21 admissions to the mental health unit, each of which was precipitated by a suicide attempt resulting in superficial cuts. During this admission, the client has developed a relationship with a highly supportive nurse and has progressed to having a pass to spend an afternoon in a nearby shopping mall. Later the day that the client uses the pass, the nurse is shocked when the emergency department calls to say that the client has just been brought in with multiple self-inflicted lacerations. The nurse asks a supervisor, "Everything was going well. How could this happen?" What response by the supervisor reflects an understanding of borderline personality disorder? "I wonder if all this could have been avoided if I'd clued you in on the client. This is a usual pattern. The client burned me once, too, when I first worked here." "I could have told you this would happen. Clients like these always get you in the end. I hope this will teach you not to get so involved." "I know what you mean. You put a lot of energy into working with this client. It must be disappointing for something like this to happen." "The client's behavior seems personal, but it's really not. Clients with borderline personality disorder act out to relieve anxiety. I suspect having the pass provoked a great deal of anxiety."

"The client's behavior seems personal, but it's really not. Clients with borderline personality disorder act out to relieve anxiety. I suspect having the pass provoked a great deal of anxiety." It will be instructive for the more experienced nurse to share with the rationale behind self-inflicted injuries as a feature of borderline personality disorder. Understanding professional boundaries is a vital nursing role. Reinforcing an overhelping relationship or boundary blurring would not be professional or instructive. Berating the client and the client's behaviors would not be professional.

Which statement by a client with borderline personality disorder (BPD) is an example of catastrophizing? "This is the most awful thing that has ever happened to me." "No one ever listens to me." "I never get what I want." "If I had not made him mad, he wouldn't have hit me."

"This is the most awful thing that has ever happened to me." An example of a statement using catastrophizing is, "This is the most awful thing that has ever happened to me." Examples of dichotomizing statements include, "No one ever listens to me" and "I never get what I want." A statement in which a self-attribution error has occurred is "if I had not made him mad, he wouldn't have hit me."

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? "Please try to attend group therapy each day." "I and other members of the health care team would like you to attend group therapy each day." "You'll find your condition will improve much faster if you attend group therapy each day." "You'll be expected to attend group therapy each day."

"You'll be expected to attend group therapy each day." Rules and explanations must be brief, clear, and leave little room for misinterpretation. A client with antisocial personality disorder tends to disregard rules and authority and be socially irresponsible. The words "You'll be expected to attend..." are concise and concrete and convey precisely what behavior is expected. The other options leave open the interpretation that attendance is suggested but not mandatory.

For a person to be diagnosed with antisocial personality disorder, the individual must be a minimum of what age? 13 years 21 years 7 years 18 years

18 years Antisocial personality disorder diagnosis is given to individuals 18 years of age or older who fail to follow society's rules—that is they do not believe that society's rules are made for them and are consistently irresponsible.

Which is considered the etiology of personality disorders? Related to substance abuse A combination of psychosocial and biologic variables Genetic predetermination Related to childhood abuse, neglect, and trauma

A combination of psychosocial and biologic variables A combination of psychosocial and biologic factors is believed to be responsible for the formation of personality itself and personality disorders.

A nurse is reviewing the medical record of a female client diagnosed with borderline personality disorder (BPD). Which would the nurse identify as one of the strongest risk factors for this disorder? Parental alcohol abuse Abuse as a child History of depression Poverty

Abuse as a child Childhood sexual abuse, which more commonly affects girls, is one of the strongest risk factors for BPD. Various studies show that physical and sexual abuse seem to be significant risk factors for BPD. Other studies cite parental loss and separation. Parental alcohol abuse, poverty, and a history of depression have not been linked to BPD.

While shopping in a grocery store, a client with borderline personality disorder (BPD) greets the sibling of a neighbor with a great big hug. Then about 5 minutes later, the client walks past the sibling and ignores the sibling. The client is demonstrating what? Dichotomous thinking Affective instability Dissociation Identity diffusion

Affective instability Affective instability (rapid and extreme shift in mood) is a core characteristic of BPD and is evidenced by erratic emotional responses to situations and intense sensitivity to criticism or perceived slights. For example, a person may greet a casual acquaintance with intense affection, yet later be aloof with the same acquaintance. Dichotomous thinking involves evaluating experiences, people, and objects in terms of mutually exclusive categories (e.g., good or bad, success or failure, trustworthy or deceitful), which informs extreme interpretations of events that would normally be viewed as including both positive and negative aspects. Dissociation refers to times when thinking, feelings, or behaviors occur outside a person's awareness. Identity diffusion occurs when a person lacks aspects of personal identity or when personal identity is poorly developed.

Avoidant, dependent, and obsessive-compulsive personality disorders are characterized by what? Dramatic or erratic behaviors Odd or eccentric behaviors Manic or withdrawn behaviors Anxious or fearful behaviors

Anxious or fearful behaviors Clients with Cluster C personality disorders—which include avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder—are often anxious, tense, and fearful.

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? Attempt to discuss placing the client into an assisted living environment Encourage the parents to discuss the possibility of the client going into a day-care program when the client goes home Ask the parents to keep a written schedule of activities for each day for the client Ask the parents how they have coped with the client's behaviors over the years

Ask the parents to keep a written schedule of activities for each day for the client When providing family and client education upon discharge, it is important for the nurse to ask the parents to keep a written schedule of daily activities for the client in order to keep a fixed routine with the aim of preventing chronic boredom and emptiness that is often associated with borderline personality disorder.

A nurse is providing care to a client with borderline personality disorder. When providing for the client's biopsychosocial needs, the nurse would address which in the biologic domain? Establishing a therapeutic relationship Assisting with problem solving Assisting with sleep measures Establishing boundaries

Assisting with sleep measures Assisting with sleep measures reflects a biopsychosocial intervention in the biologic domain. Establishing a therapeutic relationship, assisting with problem solving, and establishing boundaries would be interventions in the psychological domain.

A nurse is describing histrionic personality disorder to a group of new nurses. Which term would the nurse most likely use? Lacking empathy Sociopath Attention seeking Psychopath

Attention seeking A person with a histrionic personality disorder is often described as "attention seeking," "excitable," and "emotional." Psychopath and sociopath are terms used to describe the behavior of a person with antisocial personality disorder. Lacking empathy describes a person with a narcissistic personality disorder.

Which personality disorder would be placed in Cluster B? Borderline Schizoid Paranoid Avoidant

Borderline Borderline personality disorder is placed in Cluster B. Avoidant personality is in Cluster C. Paranoid and schizoid personalities are in Cluster A.

Which personality disorder is most commonly found in clinical settings? Borderline personality Antisocial personality Histrionic personality Narcissistic personality

Borderline personality Borderline personality disorder is the most common personality disorder found in clinical settings. It is three times more common in women than in men.

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? Schizotypal personality disorder Antisocial personality disorder Paranoid personality disorder Borderline personality disorder

Borderline personality disorder A person with borderline personality disorder almost always appears to be in a state of crisis and tends to have an exaggerated response to stressors. This exaggeration of emotional response is not typical of paranoid, schizotypal, or antisocial personality disorders.

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? Depression Bipolar disorder Borderline personality disorder Mania

Borderline personality disorder Borderline personality disorder is characterized by a disruptive pattern of instability related to self-identity, interpersonal relationships, and affect combined with marked impulsivity and destructive behavior.

Impulsivity and difficulty controlling anger are characteristic of which mental health diagnosis? Posttraumatic stress disorder Borderline personality disorder Schizophrenia Depression

Borderline personality disorder Impulsivity and difficulty controlling anger are characteristic of 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? Antisocial personality disorder Schizoid personality disorder Dependent personality disorder Borderline personality disorder

Borderline personality disorder Self-mutilation is frequently performed by individuals who have borderline personality disorder. Persons with dependent personality disorder, antisocial personality disorder, or schizoid personality disorder are not prone to self-mutilation and the accompanying attention that it provides.

A personality disorder is defined as a collection of traits that do what? Cause behavioral dysfunction and inner distress Are malleable and poorly defined Lead to aggression and violence Lead to withdrawn and antisocial behavior

Cause behavioral dysfunction and inner distress A personality disorder can be defined as a collection of personality traits that have become fixed and rigid to the point that the person experiences inner distress and behavioral dysfunction. A personality disorder also can be considered a lifelong pattern of behavior that affects many areas of the person's life, causes problems, and is not produced by another disorder or illness.

Into which personality disorder category are individuals placed whose behavior appears odd or eccentric? Cluster A Cluster B Cluster C Cluster D

Cluster A Cluster A includes individuals whose behavior appears odd or eccentric, such as paranoid or schizoid personality disorder.

Which cluster of disorders corresponds to symptoms of being dramatic and emotional? Cluster A Cluster B Cluster C Cluster D

Cluster B Cluster B includes individuals who appear dramatic, emotional, or erratic. Cluster C includes clients who appear anxious or fearful, such as avoidant, dependent, and obsessive-compulsive. Cluster A includes individuals whose behavior appears odd or eccentric. There is currently no Cluster D in the DSM-5.

A 70-year-old client comes to the clinic with the client's daughter for group therapy. The client wants the daughter to do everything with the client, is afraid to be left alone, and is having difficulty making any individual decisions. Interventions for this client would center around the diagnosis of which personality disorder? Antisocial Dependent Schizoid Narcissistic

Dependent Dependent personalities lack self-confidence and are unable to function in an independent role. Clients go to great lengths to seek nurturance and support from others. They experience difficulty in making everyday decisions and are preoccupied with fears of being left alone to care for themselves.

A client with a personality disorder is upset and calls the nurse a "stupid cow." Which is an effective initial response to this client's behavior? Walk away from the client. Discuss displacement of anger and set limits. Demonstrate empathy by reaching out to touch the client. Report the behavior to the health care provider so that consistency and consequences can be followed.

Discuss displacement of anger and set limits. It is important to maintain open and clear lines of communication. The nurse should calmly set limits for the client's inappropriate expressions of anger. The client may view touch as a threat. Reporting the behavior to the health care provider would not be an initial response to the client's anger. Walking away and leaving the client does not help the client to learn to recognize anger without losing control.

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? Arrange for the client to be transferred to another unit. Confront the client firmly about how the client's behavior makes the nurse feel. Discuss the feelings with a colleague to promote coping. Direct the client to another staff member when the client tries to interact.

Discuss the feelings with a colleague to promote coping. Clients often test the nurse for a response, and nurses must decide how to respond to particular behaviors. This can be tricky because even negative responses can be viewed as positive reinforcement for the client. Discussing feelings with a colleague can promote the nurse's adaptive coping with the stress of working with a client diagnosed with a personality disorder. Grossly inappropriate and disrespectful behaviors require confrontation. There is no need to direct the client to another staff member or arrange for a transfer.

Which occurs when thinking, feeling, or behaviors occur outside a person's awareness? Dichotomous thinking Affective instability Dissociation Impulsivity

Dissociation A cognitive dysfunction seen in BPD is dissociation, or times when thinking, feeling, or behaviors occur outside a person's awareness. Affective instability is evidenced by erratic emotional responses to situations and intense sensitivity to criticism or perceived slights. Impulsivity occurs when there is difficulty delaying gratification or thinking through the consequences before acting on feelings, leading to unpredictable actions. Cognitively, people with BPD have dichotomous thinking. They evaluate experiences, people, and objects in terms of mutually exclusive categories, which informs extreme interpretations of events that would normally be viewed as including both positive and negative aspects.

A client with borderline personality disorder is prescribed pharmacotherapy. The nurse understands that this treatment aims to control which of the following? Select all that apply. Physical disability Anxiety Emotional dysregulation Impulsive aggression Cognitive disturbances

Emotional dysregulation Impulsive aggression Cognitive disturbances Anxiety Pharmacology is used to control emotional dysregulation, impulsive aggression, cognitive disturbances, impulsive aggression, cognitive disturbances, and anxiety as an adjunct to psychotherapy.

The nurse in charge of an inpatient psychiatric unit is frustrated and angry with a client who has borderline personality disorder. Which steps should the nurse take? Examine the nurse's own feelings to discover the source of the nurse's anger. Ignore the feelings and move on from the client. Confront the client firmly but compassionately about how the client's behavior makes the nurse feel. Direct the client to another staff member when the client tries to interact.

Examine the nurse's own feelings to discover the source of the nurse's anger. Working with clients who have personality disorders is difficult. For this reason, nurses may find it helpful to discuss their emotional reactions to clients who have personality disorders with knowledgeable and trusted nurse colleagues. Doing so can facilitate nurses working through negative countertransferences, resulting in their tolerating and accepting feelings of irritation and anger as natural reactions to clients with personality disorders. This realization can increase the nurse's own self-awareness and sense of emotional control.

A nurse is reviewing the biologic theories associated with borderlline personalilty disorder. The nurse demonstrates understanding of the information by identifying which areas as being associated with brain dysfunction tied to borderline personality disorder? Select all that apply. Limbic system Cerebellum Temporal lobe Frontal lobe Hypothalamus

Frontal lobe Limbic system Associated brain dysfunction occurs in the limbic system and frontal lobe and increases the behaviors of impulsiveness, parasuicide, and mood disorders.

Emotional regulation skills are taught to those diagnosed with borderline personality disorder to manage what? Physical disability Problem solving Psychotic behaviors Impulsive behaviors

Impulsive behaviors Emotional regulation skills are taught to manage intense, labile moods which can lead to engaging in impulsive behaviors. These skills involve helping the client label and analyze the content of the emotion and develop strategies to reduce emotional vulnerability and the desire to act impulsively.

Emotional regulation skills are taught to those diagnosed with borderline personality disorder to manage what? Problem solving Physical disability Psychotic behaviors Impulsive behaviors

Impulsive behaviors Emotional regulation skills are taught to manage intense, labile moods which can lead to engaging in impulsive behaviors. These skills involve helping the client label and analyze the content of the emotion and develop strategies to reduce emotional vulnerability and the desire to act impulsively.

When documenting observations of the behaviors exhibited by a client diagnosed with borderline personality disorder, the nurse can correctly use which terms? Impulsive, aggressive, and manipulative Impulsive, self-destructive, unstable Emotional, dramatic, and theatrical Perfectionistic, rigid, and controlling

Impulsive, self-destructive, unstable Borderline personality behavior is characteristically impulsive, self-destructive, and unstable. It is antisocial, not borderline personality, behavior that is characteristically impulsive, aggressive, and manipulative. Obsessive-compulsive, not borderline personality, behavior is characteristically perfectionistic, rigid, and controlling, whereas histrionic personality, not borderline behavior, is characteristically emotional, dramatic, and theatrical.

Gambling, binge eating, and engaging in unsafe sex are examples of what? Impulsivity Dissociation Affective instability Identity diffusion

Impulsivity Impulsivity occurs in people who have difficulty delaying gratification or thinking through the consequences before acting on their feelings. Examples of impulsivity are gambling, spending money irresponsibly, binge eating, engaging in unsafe sex, and abusing substances. Identity diffusion occurs when a person lacks aspects of personal identity or when personal identity is poorly developed. Dissociation occurs when thinking, feeling, or behaviors occur outside a person's awareness.

After reviewing information about different personality disorders, a group of nursing students demonstrates understanding when they identify which as associated with schizoid personality disorder? Exuberant Introverted Overly friendly Highly social

Introverted People with schizoid personality disorder are characterized as being expressively impassive and interpersonally unengaged. They tend to be unable to experience the joyful and pleasurable aspects of life. They are introverted and reclusive and clinically appear distant, aloof, apathetic, and emotionally detached. Typically lifelong loners, they have difficulty making friends, seem uninterested in social activities, and seem to gain little satisfaction in personal relationships.

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 Histrionic Dependent Obsessive-compulsive

Narcissistic People with narcissistic personality disorder are grandiose, have an inexhaustible need for admiration, and lack empathy. Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation. Obsessive-compulsive personality disorder is characterized by a preoccupation with orderliness, perfectionism, and control.

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? Identity diffusion Nonsuicidal self-injury Dichotomous thinking Affective instability

Nonsuicidal self-injury Hospitalization is necessary during acute episodes involving nonsuicidal self-injury, but once this is controlled, the client is discharged. Dichotomous thinking, identity diffusion and affective instability characterize borderline personality disorder. Unless these are acute and lead to parasuicidal behavior, the client is treated in outpatient or day treatment settings.

A client attends an outpatient mental health clinic accompanied by the client's spouse for an assessment. The client's spouse reports the client is easily irritated if the home is not maintained in a specific order and when the client is unable to complete a "to do" list on time. The client has a serious and formal demeanor. Which personality disorder best describes this client? Paranoid personality disorder Narcissistic personality disorder Avoidant personality disorder Obsessive-compulsive personality disorder

Obsessive-compulsive personality disorder Perfectionism, rigidity, controlling behavior, and extreme orderliness characterize people with obsessive-compulsive personality disorder. Their rigid perfectionism often results in indecisiveness, preoccupation with detail, and an insistence that others do things their way. Resisting authority and insisting that they and they alone are right are common behavioral patterns. Hoarding worthless objects, displaying stinginess, working excessively, showing stubbornness, and moralizing also occur to a high degree in people with this disorder.

A client is diagnosed with a personality disorder manifested by odd, eccentric behavior. Which personality disorder would be associated with this manifestation? Dependent Paranoid Obsessive-compulsive Avoidant

Paranoid Paranoid, schizoid, and schizotypal personality disorders are characterized by behavior that is odd or eccentric. Avoidant, dependent, and obsessive-compulsive personality disorders are characterized by anxiety and fearfulness.

A client admitted on the inpatient mental health unit has been suspicious of other clients on the unit. This client is often angry at others' comments, and carries a grudge against a roommate for accidentally using the client's bath towel. Which personality disorder is most likely the client's diagnosis? Histrionic Antisocial Paranoid Borderline

Paranoid People with paranoid personality disorder are suspicious and quick to take offense, project negative feelings onto others, have few friends, project hidden meaning into innocent remarks, are guarded, and are quick to react with anger and counterattack in response to imagined character or reputation attacks.

A client is admitted with a diagnosis of schizotypal personality disorder. Which characteristic would this client exhibit during social situations? Dependency needs Paranoid thoughts Trusting behaviors Perfectionism

Paranoid thoughts A schizotypal client would have paranoid thoughts in social situations. They experience acute discomfort in social situations and have cognitive or perceptual distortions.

How does personality disorder differ from personality traits? Personality traits usually cause the person a great deal of difficulty but only sporadically. Personality disorder is usually more long term than are traits. Personality disorder causes impairment in social and occupational functioning, whereas traits do not. Personality disorder is usually evident earlier in the person's development than are traits.

Personality disorder causes impairment in social and occupational functioning, whereas traits do not. Personality disorder is a collection of personality traits that have become fixed and rigid to the point that the person experiences inner distress and behavioral dysfunction. Personality disorder is a lifelong pattern of behavior that affects many areas of the person's life, causes problems, and is not produced by another disorder or illness.

Which statement accurately reflects the prognosis for a client with a personality disorder? Clients make the most improvement with short-term insight-oriented therapy. The prognosis for personality disorders is poor, even with very long-term therapy. Prognosis varies based on the degree of functional impairment and the client's motivation to change. Clients with personality disorders have a fairly good prognosis even without therapy.

Prognosis varies based on the degree of functional impairment and the client's motivation to change. At one time, the prognosis for all personality disorders was considered grim, because the general consensus was that these conditions were untreatable. Because people continue to grow and change throughout life, however, current views emphasize that personality disorders are treatable. Prognosis varies widely, 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? Impulse control Suicidal assessment Protection from self-mutilation Working on self-esteem

Protection from self-mutilation Clients with borderline personality disorder become intensely and inappropriately angry if they believe others are ignoring them and consequently may impulsively try to harm or mutilate themselves.

When reviewing the history of a client with antisocial personality disorder, which would the nurse expect to find? Select all that apply. Lack of remorse for actions Consistent regular work history Detailed plans for future actions Repeated incidents involving assaults Episodes involving scams for personal gain

Repeated incidents involving assaults Lack of remorse for actions Episodes involving scams for personal gain A client with antisocial personality disorder shows a pervasive pattern of disregard for and violation of the rights of others. History may reveal repeated incidents of physical fights or assaults demonstrating irritability and aggressiveness, repeated failure to sustain consistent work behavior or honor financial obligations, lack of remorse for actions, conning others for personal profit or pleasure, and impulsivity or failing to plan ahead.

A nurse is reviewing the medical record of a client diagnosed with antisocial personality disorder. The nurse notes that the client has had numerous episodes involving irritability, aggressiveness, and impulsivity and has exhibited callousness toward others. Based on this information, which nursing diagnosis would the nurse identify as a priority? Risk for suicide Risk for self-directed violence Risk for other-directed violence Risk for self-injury

Risk for other-directed violence Although they can be interpersonally charming, these clients can become verbally and physically abusive if their expectations are not met. Protection of other clients and staff from manipulative and sometimes abusive behavior is a priority. Thus, a nursing diagnosis of risk for other-directed violence would be a priority. Clients with antisocial personality disorder are less likely to engage in self-injury or self-violence; rather, they are more likely to strike out at those who are perceived to be interfering with their immediate gratification. Risk for suicide would be a priority if the client was also experiencing depression.

Which would be the priority nursing diagnosis for a client diagnosed with borderline personality disorder (BPD)? Ineffective coping Risk for self-mutilation Personal identity disturbance Disturbed thought process

Risk for self-mutilation One of the first diagnoses to consider is risk for self-mutilation because protection of the client from self-injury is always a priority. Disturbed thought process, ineffective coping, and personal identity disturbance are all potential nursing diagnoses, but they would not be the priority.

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? Manipulation Distrust Perfection Self-dramatization

Self-dramatization The client with histrionic personality disorder uses self-dramatization and emotional exaggeration to draw attention to self. The antisocial personality tends to be manipulative. Paranoid personality disorder causes the client to be suspicious and distrust others. In obsessive-compulsive personality disorder, the client's perfectionism interferes with task completion.

Clients with borderline personality disorder (BPD) are usually admitted to the inpatient setting because they exhibit what? Impulsivity Splitting Self-harm Aggression

Self-harm Clients with BPD are usually admitted to the inpatient setting because of threats of self-harm.

The most serious consequence of behaviors seen in borderline personality disorder includes what? Identity diffusion Dissociation Self-injury Impulsivity

Self-injury The turmoil and unsuccessful interpersonal relationships and social experiences associated with borderline personality disorder may lead the person to undermine the self when a goal is about to be reached. The most serious consequences are suicide attempts and parasuicidal behaviors. Identity diffusion occurs when a person lacks aspects of personal identity or when personal identity is poorly developed. Impulsivity occurs in people who have difficulty delaying gratification or thinking through the consequences before acting on their feelings. Dissociation occurs when thinking, feeling, or behaviors occur outside a person's awareness.

A client in the emergency department has self-inflicted wounds on both arms. Assessment reveals that the client was diagnosed with borderline personality disorder 6 months ago, for which the client has been receiving outpatient treatment. The client tells the nurse that the client recently found out the client's therapist is moving and will no longer be able to work with the client. What is the priority nursing diagnosis for this client? Anxiety Loneliness Stress Self-mutilation

Self-mutilation Although all the above are problems for this client, the highest priority nursing diagnosis is self-mutilation. If left untreated, self-mutilation can lead to suicide attempts.

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? Social skills training Stress management techniques Increased recreational therapy Setting limits

Setting limits The nurse introduces the use of limit setting when clients engage in manipulative, acting-out, dependent, or similar inappropriate behaviors.

A nurse is assessing a client diagnosed with avoidant personality disorder. Which would the nurse expect to find? Select all that apply. Feelings of superiority Detail oriented Feelings of inadequacy Shyness Perfectionism

Shyness Feelings of inadequacy Individuals with avoidant personality disorder appear timid, shy, and hesitant; fear criticism; and feel inadequate and inferior. These individuals are extremely sensitive to negative comments and disapproval and appraise situations more negatively than others do. Individuals with obsessive-compulsive personality disorder exhibit perfectionism and an intense involvement in details such that they have difficulty making decisions and completing tasks.

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

Splitting Because clients with BPD view the world in absolutes, nurses and other treatment team members are alternately categorized as all good or all bad. This primitive defense is called splitting, and it presents clinicians with a challenge to work openly with each other, as well as the client, until the issue can be resolved through team meetings and clinical supervision. This is not an example of defending, invalidating, or projective identification.

A client with borderline personality disorder (BPD) tells the nurse, "You are good but the nurse on the afternoon shift is bad. The doctor is bad, too, but the therapist is good." The nurse interprets this statement as reflecting what? Splitting Cognitive schema Identity diffusion Dissociation

Splitting Persons with BPD view the world in absolutes; nurses and other treatment team members are alternately categorized as all good or all bad. This defense is called splitting and presents clinicians with a challenge to work openly with each other, as well as the client, until the issue can be resolved through team meetings and clinical supervision. Identity diffusion occurs when a person lacks aspects of personal identity or when personal identity is poorly developed. Dissociation is a cognitive dysfunction reflected as thinking, feeling, or behaving outside a person's awareness. Cognitive schema refers to patterns of thoughts that determine how a person interprets events.

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? Thought stopping Decatastrophizing Positive self-talk Splitting

Splitting Splitting occurs in this situation. Thought stopping is a technique to alter the process of negative or self-critical thought patterns such as, "I'm dumb, I'm stupid." Decatastrophizing is a technique that involves learning to assess situations realistically rather than always assuming a catastrophe will happen. In positive self-talk, the client reframes negative thoughts into positive ones.

The nurse is counseling a 28-year-old client with avoidant personality disorder. Despite being employed, the client verbalizes having low quality of life due to anxiety and isolation. Which therapeutic goals does the nurse establish as priority? The client will engage in less risk-taking behavior The client will be able to accept a job promotion. The client will experience increased self-esteem. The client will form a romantic relationship.

The client will experience increased self-esteem. People with avoidant personality disorder have a pattern of social discomfort, timidity, and fear of negative evaluation. They are preoccupied with what they perceive as their own shortcomings and will form relationships with others only if they believe acceptance is guaranteed. People with this disorder often view themselves as unattractive and inferior to others and are often socially inept. The priority goal should address increasing the client's self-esteem.

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 was in a constant state of crisis and depended heavily on the client for emotional support. The client's parent was a rigid disciplinarian who demanded complete subservience from both the client and the client's other parent. The client's parent catered to the client's every need and the client used temper tantrums to successfully get the client's way. The client's parents had excessively high performance expectations of the client and failure was met with severe sanctions.

The client's parent catered to the client's every need and the client used temper tantrums to successfully get the client's way. Narcissistic personality disorder is characterized by an exaggerated sense of self-importance. It is plausible that a client's high degree of control and entitlement early in life may have contributed to or exacerbated such tendencies. The other patterns of interaction would not tend to promote entitlement or a grandiose self-view.

Which is a technique used to help the client with borderline personality disorder gain control over self-critical thoughts? Communication triad Delay gratification Thought stopping Affective instability

Thought stopping Thought stopping is a practice that may help the client control the a technique to alter the process of negative or self-critical thought patterns such as "I'm dumb, I'm stupid, I can't do anything right."

Clients with borderline personality disorder (BPD) are usually admitted to an inpatient setting because of what? Threats of self-harm Agitation Splitting Medication noncompliance

Threats of self-harm Clients with BPD are usually admitted to an inpatient setting because of threats of self-harm. Observing for antecedents of self-injurious behavior and intervening before an episode is an important safety intervention. Clients who are agitated or are using the primitive defense mechanism of splitting are usually not admitted to an inpatient setting. The client should be educated on an outpatient basis for medication compliance unless the problem is a threat to the self or others.

A nurse working with a client with borderline personality disorder could establish which as outcome criteria? Display anger more frequently. Act out neediness. Filter concerns and insecurities through the nurse. Tolerate stress without self-mutilation.

Tolerate stress without self-mutilation. Clients with borderline personality disorder frequently engage in impulsive acts, particularly self-mutilation. Tolerating stress without self-mutilation indicates a positive outcome for a client with such maladaptive behaviors as the typical impulsivity of self-mutilation.

The use of pharmacotherapy in the treatment of personality disorders is optimized if this intervention is what? The primary treatment modality Only minimally effective due to severe side effects Used in addition to psychotherapy Well accepted by the clients

Used in addition to psychotherapy The use of pharmacotherapy in the treatment of personality disorders is considered to be used in addition to psychotherapy.