NUR 1511 Mental Health Chapter 18: Personality Disorders
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
The nurse would assess for which of the following characteristics in a client with narcissistic personality disorder
entitlement
Which of the following underlying emotions is commonly seen in an avoidant personality disorder?
fear
When discussing personality disorders, the term "treatment resistant" refers to a lack of response to medications prescribed.
False
When providing care to a client who consistently attempts to manipulate the staff, the nurse can best maintain the therapeutic milieu by doing what?
Instructing the staff to enforce all unit rules consistently
The nurse is 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 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
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
Which cluster of disorders corresponds to symptoms of being dramatic and emotional?
Cluster B
A client diagnosed with schizoid personality disorder is described by family members as what?
Emotionless and a loner
Which is considered the etiology of personality disorders?
A combination of psychosocial and biologic variables
Into which personality disorder category are individuals placed whose behavior appears odd or eccentric?
Cluster A
Clients with borderline personality disorder (BPD) are usually admitted to an inpatient setting because of what?
Threats of self-harm
A client is diagnosed with avoidant personality disorder. When assessing the client, which would be evident? Select all that apply.
Timidity Sensitivity to negative comments Fear of rejection
A patient with narcissistic personality disorder typically likes to be the center of attention.
False
The most important short-term goal for the client who tries to manipulate others would be to
acknowledge own behavior
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."
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."
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."
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."
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."
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."
Personality disorders occur in approximately what percentage of the general population?
15%
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
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 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 commonly found in clinical settings?
Borderline personality
A 30-year-old client who has not paid rent in 4 months is being evicted from an apartment. The client is brought to the hospital after the client uses a kitchen knife to cut the client's wrist in response to the stress of the eviction. The client's behavior is consistent with what?
Borderline personality disorder
A client is admitted to the mental health unit after the client's spouse brings the client to the emergency department. Upon arrival, the spouse explained that the client had been crying all weekend and stating that the client wanted to die. Upon further assessment, the spouse reports that the client always has difficulty controlling anger and frequently worries that the spouse will leave the client. Recently, the client has been getting drunk every night, which the client never used to do. What diagnosis should the nurse suspect applies to this client?
Borderline personality disorder
Impulsivity and difficulty controlling anger are characteristic of which mental health diagnosis?
Borderline personality disorder
Personality Disorder Cluster B (4)
Borderline personality disorder Antisocial personality disorder Narcissistic personality disorder Histrionic personality disorder
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?
Dependent
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 with borderline personality disorder is prescribed pharmacotherapy. The nurse understands that this treatment aims to control which of the following? Select all that apply.
Emotional dysregulation Impulsive aggression Cognitive disturbances Anxiety
Clients with a schizotypal personality disorder are most likely to benefit from which of the following nursing interventions?
Improving community functioning
Gambling, binge eating, and engaging in unsafe sex are examples of what?
Impulsivity
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
The nurse is conducting an education group for women at risk for self-mutilation. What is the most important goal for this group?
Learning strategies to refrain from self-harm
A 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
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 is admitted with a diagnosis of schizotypal personality disorder. Which characteristic would this client exhibit during social situations?
Paranoid thoughts
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 Consistent regular work history Lack of remorse for actions Episodes involving scams for personal gain Detailed plans for future actions
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 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
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 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
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 nurse working with a client with borderline personality disorder could establish which as outcome criteria?
Tolerate stress without self-mutilation.
The use of pharmacotherapy in the treatment of personality disorders is optimized if this intervention is what?
Used in addition to psychotherapy
Transient psychotic symptoms that occur with border-line personality disorder are most likely treated with of the following?
anti-psychotics
When interviewing a client with a personality disorder, the nurse would assess for which of the following?
disruption in some aspects of his or her life
The nurse working with a client with antisocial personality disorder would expect which of the following behaviors? SATA
exploitation of other clients seeking special privileges superficial friendliness toward others
When working with a client with a personality disorder, the nurse would expect to assess which of the following? SATA
impaired to empathize with others inability to empathize with others minimal insight
Which of the following would a nurse expect to assess in a patient with antisocial personality disorder?
manipulative behaviors
When working with a client with a narcissistic personality disorder, the nurse would use which of the following approaches?
matter-of-fact
Personality Disorder Cluster C (3)
obsessive personality disorder avoidant personality disorder dependent personality disorder
Personality Disorder Cluster A (3)
paranoid personality disorder schizoid personality disorder schizotypal personality disorder
Cognitive restructuring techniques include all the following except?
relaxation