Chapter 18: Personality Disorders

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 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.

Frontal lobe Limbic system

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

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

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

Introverted

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

Which is considered the etiology of personality disorders?

A combination of psychosocial and biologic variables

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?

Abuse as a child

Which personality disorder is most commonly found in clinical settings?

Borderline personality

Into which personality disorder category are individuals placed whose behavior appears odd or eccentric?

Cluster A

Which cluster of disorders corresponds to symptoms of being dramatic and emotional?

Cluster B

Clients with borderline personality disorder (BPD) are usually admitted to an inpatient setting because of what?

Threats of self-harm

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

Tolerate stress without self-mutilation.

A 43-year-old female client is observed walking and dancing around the unit dressed in red high heels and a provocative style of dress. The client is seen sitting on the lap of a male client on the unit, and they are laughing. Which is the most therapeutic nursing intervention?

"I need for you to get off his lap, this behavior is not appropriate."

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 start by stating my feelings as an 'I' statement."

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?

"No, only one cigarette is allowed per break time."

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?

"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 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 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

Treatment approaches for clients with personality disorders generally rely on which modality?

A combination of approaches

After teaching a group of nurses about borderline personality disorder, the leader determines that the education was successful when the group identifies that symptoms typically begin in which age group?

Adolescence

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

Which diagnosis is associated with a pervasive disregard for and violation of the rights of others?

Antisocial personality

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 is most often treated within the inpatient psychiatric setting?

Borderline

Which personality disorder would be placed in Cluster B?

Borderline

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 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.

Which occurs when thinking, feeling, or behaviors occur outside a person's awareness?

Dissociation

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

Eccentric and a loner

A nurse is preparing a teaching plan for a client with antisocial disorder. Which would the nurse most likely employ to promote successful education?

Engaging the client in a discussion to direct the topic to the client.

Which is considered a part of the social domain of the biopsychosocial interventions for the client diagnosed with borderline personality disorder (BPD)?

Establishing boundaries

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.

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

Impulsive behaviors

When documenting observations of the behaviors exhibited by a client diagnosed with borderline personality disorder, the nurse can correctly use which terms?

Impulsive, self-destructive, unstable

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

Impulsivity

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

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?

Paranoid

A client is a 25-year-old who has a long history of being suspicious of the client's friends and spouse. The client persistently accuses the client's spouse of being unfaithful. The client accuses friends of making statements that are insulting to the client's character. Which is the most accurate description of the client's personality?

Paranoid

A client is admitted with a diagnosis of schizotypal personality disorder. Which characteristic would this client exhibit during social situations?

Paranoid thoughts

How does personality disorder differ from personality traits?

Personality disorder is usually evident earlier in the person's development than are traits.

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

When reviewing the history of a client with antisocial personality disorder, which would the nurse expect to find? Select all that apply.

Repeated incidents involving assaults Lack of remorse for actions Episodes involving scams for personal gain

Clients with borderline personality disorder (BPD) are usually admitted to the inpatient setting because they exhibit what?

Self-harm

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

Self-injury

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?

Self-mutilation

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 nurse is assessing a client diagnosed with avoidant personality disorder. Which would the nurse expect to find? Select all that apply.

Shyness Feelings of inadequacy

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

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

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

A group of nursing students is reviewing information about antisocial personality disorder. The students demonstrate understanding of this disorder when they state what?

The individual must be at least 18 years of age.

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

Thought stopping