Mental Health: 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 have a very important position in life; everyone I know wants to be like me." R: 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 nurse is assessing a client who is diagnosed with borderline personality disorder. Which client statement indicates the client is at risk for self-injurious behavior?

"I have felt so down lately. I don't enjoy doing anything anymore." R: Self-harm behavior is more likely to occur when the individual with borderline personality disorder is depressed, has highly unstable interpersonal relationships, and is paranoid, hypervigilant, and resentful.

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." R: Clients have a long-standing pattern of excessive emotionality and attention-seeking behaviors. A matter-of-fact approach to limit-setting and boundaries effectively limits the manipulative and attention-seeking behaviors.

The adult children of a client with narcissistic personality disorder meet with the therapist as part of their parent's treatment. The nurse is aware that which statement by the daughter is consistent with behavior typically associated with this personality disorder?

"My parent never really seemed to see me as a person with my own thoughts and problems." R: Clients with narcissistic personality disorder have a lifelong pattern of self-centeredness, self-absorption, inability to empathize with others, grandiosity, and extreme desire for the admiration of others. They feel that they are unusually special and often exaggerate their accomplishments to appear more important than they actually are. As sensitive as they are to the opinions of others, they are particularly insensitive to the needs or feelings of others and lack empathy.

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." R: Clients with borderline personality disorder may display negative behaviors that can interfere with therapy. The nurse will have to confront clients about their behaviors and set appropriate limits.

A client with borderline personality disorder has been admitted to the inpatient unit because the client has been engaging in wrist cutting. The client's sibling is visiting, and the sibling asks the nurse to explain why the client sometimes does this. Which response by the nurse would be most appropriate?

"Sometimes the self-injurious behavior is undertaken to relieve stress." R: Clients with borderline personality disorder are impulsive and may respond to stress by harming themselves. Self-harm is an effort to self-soothe by activating endogenous endorphins to provide comfort

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." R: 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.

For a person to be diagnosed with antisocial personality disorder, the individual must be a minimum of what age?

18 years R: 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.

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 R: Many children and adolescents show symptoms similar to those of BPD, such as moodiness, self-destruction, impulsiveness, lack of temper control, and rejection sensitivity. Because symptoms of BPD begin in adolescence, it makes sense that some of the children and adolescents would meet the criteria for BPD even though it is not diagnosed before young adulthood.

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 R: 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.

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 R: Clients who engage in self-mutilation secondary to borderline personality disorder typically use self mutilation as a cry for help, an expression of intense anger or helplessness, or a form of self punishment with the aim 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 R: Those with antisocial personality disorder display aggressive, irresponsible behavior that often leads to conflicts with society and subsequent involvement in the criminal justice system. People with this disorder commonly display behaviors such as fighting, lying, stealing, abusing children and spouses, abusing substances, and participating in confidence schemes. These people, while often superficially charming, lack genuine warmth.

Avoidant, dependent, and obsessive-compulsive personality disorders are characterized by what?

Anxious or fearful behaviors R: 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?

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

Which personality disorder would be placed in Cluster B?

Borderline R: 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 often treated within the inpatient psychiatric setting?

Borderline R: People with borderline personality disorder are believed to be the most frequent recipients of psychiatric care in both inpatient and outpatient settings due to the frequency of engaging in self-destructive behaviors.

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 R: 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.

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

Borderline personality disorder R: 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?

Borderline personality disorder R: Self-mutilation is frequently performed by individuals who have borderline personality disorder.

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

Cluster A R: 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 B R: 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.

Which cluster of personality disorders is represented by individuals who appear anxious or fearful?

Cluster C R: Cluster C includes clients who appear anxious or fearful, such as avoidant, dependent, and obsessive-compulsive.

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?

Discuss displacement of anger and set limits. R: 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.

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

Dissociation R: A cognitive dysfunction seen in BPD is dissociation, or times when thinking, feeling, or behaviors occur outside a person's awareness.

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. R: Client education efforts have to be creative and thought provoking. In teaching a person with antisocial disorder, a direct approach is best, but the nurse must avoid "lecturing," which the client will resent. In teaching the client about positive health care practices, impulse control, and anger management, the best approach is to engage the client in a discussion about the issue and then direct the topic to the major educational points. These clients often take great delight in arguing or showing how the rules of life do not apply to them. A sense of humor is important, as are clear teaching goals and avoiding being sidetracked.

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

Impulsive behaviors R: 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

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

Impulsivity R: 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.

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 R: Being consistent in expectations regarding rules and regulations for all clients will minimize the threat of manipulation.

A client is diagnosed with a personality disorder manifested by odd, eccentric behavior. Which personality disorder would be associated with this manifestation?

Paranoid R: 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?

Paranoid R: 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.

Which personality disorder is characterized by an alteration between hostile self-assertion, such as stubbornness, and excessive dependence?

Passive-aggressive R: Clients diagnosed with passive-aggressive personality disorder may alternate between hostile self-assertion, such as stubbornness, and excessive dependence, expressing contrition and guilt.

A nurse is conducting an inservice program on personality disorders. When describing obsessive-compulsive personality disorder, which characteristics would the nurse likely include? Select all that apply.

Preoccupation with control Strict attention to rules Difficulty with decision making Relationships primarily formal and polite R: Individuals with obsessive-compulsive personality disorder demonstrate a pervasive pattern of preoccupation with orderliness, perfectionism, and control. They also have the ability to delay rewards and maintain control by careful attention to rules. Perfectionists are prone to repetition and have difficulty making decisions. They can be overly conscientious about morality and ethics and value polite, formal, and correct interpersonal relationships.

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 R: 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.

A nurse is reviewing the history of a client diagnosed with antisocial personality disorder. Which would the nurse expect to find? Select all that apply.

Rationalization for harming an individual Inflated view of self R: Clients with antisocial personality disorder are impulsive and fail to plan ahead; rationalize having hurt, mistreated, or stolen from another; show a lack of empathy; have an inflated and arrogant self-appraisal; and are irresponsible and exploitative in sexual relationships, often with a history of multiple sexual partners.

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 R: 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 other-directed violence R: 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.

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

Risk for self-mutilation R: One of the first diagnoses to consider is risk for self-mutilation because protection of the client from self-injury is always a priority.

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

Self-harm

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 R: 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?

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

A nurse is caring for a client with schizoid personality trait. When developing a plan of care for the client, which would a nurse most likely include?

Social skills training R: Because individuals with schizoid personality trait often lack customary social skills, social skills training is useful in enhancing their ability to relate in interpersonal situations. The primary focus is to increase the client's ability to feel pleasure.

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 R: 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.

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. R: 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.

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

Thought stopping R: 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."

The psychiatric nurse expects similar experiences among all clients diagnosed with a Cluster A personality disorder related to ...

interpersonal relationships. R: Cluster A disorders all appear to share dysfunction in the ability to establish adaptive, meaningful interpersonal relationships.