Mental Health Exam 2 Chapter 18
Emotional regulation skills are taught to those diagnosed with borderline personality disorder to manage what?
Impulsive behaviors
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
A personality disorder is defined as a collection of traits that do what?
Cause behavioral dysfunction and inner distress
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
Which cluster of disorders corresponds to symptoms of being dramatic and emotional?
Cluster B
Into which personality disorder category are individuals placed whose behavior appears odd or eccentric?
Cluster A
Which personality disorder is most commonly found in clinical settings?
Borderline personality
Which cluster of personality disorders is represented by individuals who appear anxious or fearful?
Cluster C
When conducting a social history with a client diagnosed with a borderline personality disorder (BPD), which question would be most important to ask the client related to impulsivity?
"Do you always practice safe sex?"
A nursing instructor is teaching about using behavioral interventions when caring for clients with borderline personality disorder. Which statement by a student indicates a need for further instruction?
"Grossly disrespectful behaviors are better ignored."
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?
"I feel uncomfortable with what you said. My role is to support you in recovery."
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 get upset once in a while, too."
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 nurse is developing a nurse-client relationship with a client diagnosed with borderline personality disorder (BPD). Which statement by the nurse demonstrates that the nurse understands the client's fears of abandonment and intimacy?
"I will be seeing you during the daytime this week."
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 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 nursing instructor is teaching about the importance of bonding and how an easy temperament can serve as a protective factor against psychopathology. Which statement made by a student demonstrates a need for further instruction?
"Temperament is not changeable."
Personality disorders occur in approximately what percentage of the general population?
15%
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."
A client diagnosed with borderline personality disorder tells a nurse, "I'm afraid to get on a train because we'll probably get into a wreck." Which response by the nurse would be most appropriate?
"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 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
Which is considered the etiology of personality disorders?
A combination of psychosocial and biologic variables
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
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?
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
When describing the different clusters of personality disorders, the nurse includes which type as being characterized by dramatic or erratic behavior? Select all that apply. Paranoid Antisocial Borderline Avoidant Obsessive-compulsive
Antisocial Borderline
Which diagnosis is associated with a pervasive disregard for and violation of the rights of others?
Antisocial personality
Avoidant, dependent, and obsessive-compulsive personality disorders are characterized by what?
Anxious or fearful behaviors
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 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?
Assisting with sleep measures
A nurse is describing histrionic personality disorder to a group of new nurses. Which term would the nurse most likely use?
Attention seeking
A mental health nurse is planning a psychotherapy group for clients with personality disorders. The nurse knows the group will be comprised of a significant number of clients from Arab and Asian ethnicity. Which should the nurse consider when planning this group?
Be aware of the how each client's personality has been affected by his or her cultures values and beliefs.
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 counseling a 35-year-old client with a personality disorder. The client states that the client's problems are not the client's fault and that the client is a victim of circumstances and "fate." When experiencing stress, the client has impulsively called friends and family and stating, "It's my last day on earth." This client presentation is best described by which disorder?
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
When teaching a client with antisocial personality disorder (ASPD), which approach would be most appropriate for the nurse to use?
Direct
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
Borderline personality disorder (BPD) can be diagnosed beginning in which period?
Early adulthood
A client diagnosed with schizoid personality disorder is described by family members as what?
Emotionless 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.
Which personality disorder is diagnosed more often in women?
Histrionic
A nurse is conducting a review class on borderline personality disorder. When describing the characteristics associated with this disorder, which would the nurse most likely include? Select all that apply. Difficulty regulating moods Overinflated self-identity Problems with interpersonal relationships Thinking that is based on delusions Impulsive behavior
Impulsive behavior Problems with interpersonal relationships Difficulty regulating moods
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
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 characteristic as associated with schizoid personality disorder?
Introverted
A nurse is providing care to a client diagnosed with antisocial personality disorder. As part of the plan of care, the client is to participate in a problem-solving group. The nurse understands that this intervention is effective based on which rationale?
It helps to reinforce self-responsibility.
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
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
Which personality disorder is categorized as a Cluster B disorder?
Narcissistic personality disorder
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 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?
Obsessive-compulsive personality disorder
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
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 diagnosed with a personality disorder manifested by odd, eccentric behavior. Which personality disorder would be associated with this manifestation?
Paranoid
A client is admitted with a diagnosis of schizotypal personality disorder. Which characteristic would this client exhibit during social situations?
Paranoid thoughts
A psychiatric-mental health nurse is reviewing information about the possible theories associated with narcissitic personality disorder. The nurse demonstrates understanding of the information by identifying which concept as being associated with the development of this personality disorder?
Parental overindulgence of a child
Which personality disorder is characterized by an alteration between hostile self-assertion, such as stubbornness, and excessive dependence?
Passive-aggressive
How does personality disorder differ from personality traits?
Personality disorder causes impairment in social and occupational functioning, whereas traits do not.
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 Consistent regular work history Lack of remorse for actions Episodes involving scams for personal gain Detailed plans for future actions
Repeated incidents involving assaults Lack of remorse for actions Episodes involving scams for personal gain
When assessing a client with borderline personality disorder (BPD), which behaviors would the nurse expect to find? Select all that apply. Repeated, frequent crisis episodes Self-directed anger Intense personal awareness Learned helplessness Deceptive competence
Repeated, frequent crisis episodes Self-directed anger Learned helplessness Deceptive competence
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 other-directed violence
Which would be the priority nursing diagnosis for a client diagnosed with borderline personality disorder (BPD)?
Risk for self-mutilation
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 characteristic would the nurse expect to find? Select all that apply. Shyness Feelings of inadequacy Feelings of superiority Perfectionism Detail oriented
Shyness Feelings of inadequacy
A nurse is caring for a client diagnosed with schizoid personality trait. When developing a plan of care for the client, which would a nurse most likely include?
Social skills training
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
A client is diagnosed with paranoid personality disorder. Which would the nurse expect to assess? Select all that apply. Anger as a emotional response Distancing self from others Outwardly passive Tendency to be rigid and controlling Warm and full of humor
Tendency to be rigid and controlling Anger as a emotional response Distancing self from others
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 is providing care for a client who has been diagnosed with antisocial personality disorder. Which outcome should the nurse prioritize when planning this client's care?
The client will to express anger in an adaptive, nonviolent manner
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 client is diagnosed with avoidant personality disorder. When assessing the client, which would be evident? Select all that apply. Overly outgoing nature Timidity Sensitivity to negative comments Fear of rejection Absence of decision-making ability
Timidity Sensitivity to negative comments Fear of rejection
The use of pharmacotherapy in the treatment of personality disorders is optimized if this intervention is what?
Used in addition to psychotherapy
Which addresses the psychological domain of biopsychosocial interventions for a client with borderline personality disorder?
Withdrawing attention as much as possible