Test 3 Mental Health

A nurse is providing care to a client diagnosed with histrionic personality disorder. Which information would the nurse need to integrate into the plan of care? Select all that apply -The client's interests are focused on individual desires. The client's behavior continually centers the attention on themselves. -The client is quick to trust others.

"Attention seeking," "excitable," and "emotional" describe people with histrionic personality disorder. These individuals are lively and dramatic and draw attention to themselves by their enthusiasm, dress, and apparent openness. They are the "life of the party" and, on the surface, seem interested in others. Their insatiable need for attention and approval quickly becomes obvious. There are two main ways their need to be "center stage" is exhibited: (1) their interests and topics of conversation focus on their own desires and activities, and (2) their behavior, including their speech, continually calls attention to themselves. These needs are inflexible and persistent even after others attempt to meet them. Persons with histrionic personality disorders are quick to form new friendships and just as quick to become demanding. Because they are trusting and easily influenced by other opinions, their behavior often appears inconsistent. Their strong dependency need makes them overly trusting and gullible.

The nurse conducts an assessment to rule out antisocial personality disorder (ASPD) in a young adult. What aspect of the client's childhood is the priority assessment? Temperament

A child's temperament emerges soon after birth and remains relatively stable. It is understood to have a biological basis. The characteristics of a child's temperament include levels of energy, mood, adaptability to new environments, and intensity. These traits persist into adulthood and are fundamental consideration for personality disorder diagnostic criteria including ASPD. Physiological functioning including bowel patterns, the development of speech and school performance can be relevant assessment areas yet their importance is less significant than for temperament.

A client diagnosed with schizoid personality disorder is described by family members as what? Eccentric and a loner

A client diagnosed with schizoid personality disorder is described by family members as being eccentric and a loner, not dramatic and emotional, nervous and fearful, or tired and sad.

A client with a dependent personality disorder is receiving treatment on a medical unit. The client asks the nurse for assistance to open the tube of toothpaste so they can brush their teeth. Which is the best response by the nurse? "I'll stay here and you can show me what you've tried to do to get the top off"

A client with dependent personality disorder may look to others including the nurse to make everyday decisions and to assist with tasks both simple and complex. A helpful response by the nurse can integrate the typical challenges these clients face. The statement that validates the struggle, supports the client's individual efforts and supports the client by being present is the strongest response. Interventions that support dependency such as doing the task for the client or having someone else do it are not helpful. Offering a question using 'why' can contribute to defensiveness and a challenge to self-esteem.

An outreach nurse in a mental health clinic assists a client with schizoid personality disorder. The client expresses a desire to work part time. Which position is most likely to suit the client? Groundskeeper in a park

A client with schizoid personality disorder likely has profound social deficits and would lack social skills or interests to work with others. The idea of a solitary vocation such as doing grounds keeping work in a park could provide an opportunity for success to raise low self-esteem. Any job requiring interpersonal interaction or social pressure would be particularly uncomfortable for a client with schizoid personality disorder and likely lead to failure and further disappointment.

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

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

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

Affective instability is a rapid and extreme shift in mood and a core characteristic of borderline personality disorder. It is evidenced by erratic emotional responses to situations and intense sensitivity to criticism, perceived slights, or both.

Which statement is an example of catastrophizing? "If I fail this course, my life is over."

An example of catastrophizing is "if I fail this course, my life is over." Examples of dichotomizing are "I never get what I want" and "no one ever listens to me." "If I had not made him mad, he wouldn't have hit me" is an example of a self-attribution error.

The nurse is assigned to a client with schizoid personality disorder. Which does the nurse anticipate are client characteristics of the disorder? Select all that apply. -Reclusive and distant -Awkward interpersonal relations

An individual with schizoid personality disorder is likely to behave in a reclusive manner, keeping at distance from interpersonal interactions. Their social interactions are typically odd and their communications can be awkward. A client with this disorder would likely prefer to be alone and would not express fear of being alone. There is not a common association with a pattern of self-harm, so it would be unlikely to see scarring from self-inflicted burns or cutting. Impulsivity and mood instability is not associated with this personality disorder. It would be more common with borderline personality disorder.

The nurse provides education to the parent of a child diagnosed with intermittent explosive disorder. In addition to medication, what additional therapy does the nurse recommend? Anger management

Anger management is warranted for clients diagnosed with intermittent explosive disorder. These individuals are at risk for substantial personal and social consequences for their outbursts including legal issues. Anger management in tandem with pharmacotherapy can be beneficial. The onset of this disorder can occur in childhood to mid-adulthood. Play therapy is not identified as an intervention to treat individuals with this disorder. Acute or long-term hospitalizations are not identified as effective treatment strategies for these individuals. Suicidal risk needs to be assessed and hospitalization may be warranted if suicide risk is identified.

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

A client presents to a mental health clinic. The nurse notes that the client is grandiose and brags that that they earn "a six-figure income" and tells the nurse that they are more well known that the president. Which diagnosis is grandiosity associated with? Narcissistic personality disorder

Clients with narcissistic personality disorder are most likely to over represent themselves and to express their personal fantasies. This grandiosity is not typical of individuals with Cluster A or C personality disorders, and grandiosity is not associated with borderline personality disorder.

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

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.

When facilitating change in the behavior of a client diagnosed with a paranoid personality disorder, the nurse knows which intervention will have the greatest impact on success? collaborating with the client when establishing treatment goals

Because clients with paranoid personality disorders need to feel in control, it is important to involve them in formulating their care plan. The nurse asks what the client would like to accomplish in concrete terms, such as minimizing problems at work, or getting along with others. Clients are more likely to engage in the therapeutic process if they believe they have something to gain. When planning interventions with a client who has a paranoid personality disorder, it is important to recognize that the person has disturbed values that do not reflect the views held by the general population. Because of these disturbances, the nurse needs to collaborate with the client regarding the goals that are identified during treatment. The remaining options although appropriate will not be attainable if the client does not recognize the interventions as being useful and personally applicable.

A nurse is assessing a client diagnosed with obsessive-compulsive personality disorder (OCPD). Which would the nurse expect to find? Select all that apply. -Need for perfection -Adherence to a highly structured life -Overly moralistic

Behaviorally, individuals with OCPD are perfectionists, maintaining a regulated, highly structured, strictly organized life. A need to control others and situations is common in their personal and work lives. They are prone to repetition and have difficulty making decisions and completing tasks because they become so involved in the details. They can be overly conscientious about morality and ethics and value polite, formal, and correct interpersonal relationships. They also tend to be rigid, stubborn, and indecisive and are unable to accept new ideas and customs. Their mood is tense and joyless.

A nurse is assessing a client and suspects that the client may have obsessive-compulsive personality disorder based on which statement? "I need to have everything perfect. My life is organized down to the second."

Behaviorally, individuals with obsessive-compulsive personality disorder are perfectionists, maintaining a regulated, highly structured, strictly organized life. A need to control others and situations is common in their personal and work lives. Therefore, the statement about everything being perfect and life being organized reflects this characteristic. The statement about not having any friends and no social interaction reflects a schizoid personality disorder manifested by introversion and reclusiveness, difficulty making friends, and lack of interest in social activity. The statement about not trusting anyone reflects a paranoid personality disorder. The statement about being better than anyone else reflects a narcissistic personality disorder, characterized by grandiosity and an inexhaustible need for admiration. Individuals are benignly arrogant and feel themselves to be above the conventions of their cultural group.

Brain dysfunction associated with borderline personality disorder (BPD) occurs in the limbic system and which lobe of the brain? Frontal

Biologic abnormalities are associated with three BPD characteristics: affective instability; transient psychotic episodes; and impulsive, aggressive, and suicidal behavior. Associated brain dysfunction occurs in the limbic system and frontal lobe and increases the behaviors of impulsiveness, parasuicide, and mood disturbance. Brain dysfunction of the temporal, parietal, and occipital lobes is not associated with BPD.

Which personality disorder is diagnosed more often in women? Histrionic

Borderline and histrionic personality disorders are diagnosed more often in women.

A school-age child has a diagnosis of disruptive behavior disorder. The school nurse conducts an education session to help the parents understand the diagnosis and to teach skills that the parents can implement to help address disruptive behavior. What can parents do to help? Select all that apply. -Teach problem-solving skills -Use time out for disruptive behavior -Make behavioral expectations clear and consistently enforce them

Children with disruptive behavior disorder can benefit from improvements in problem solving to generate more perceptive interpretation of others' behavior, generate more thoughtful decisions, and consider the consequences of poor choices. Mild forms of punishment such as time out avoid the tendency for children to associate high levels of parental attention with disruptive behavior. Establishing clear behavioral expectations and reinforcing these consistently is a key strategy for parents and caregivers. Providing a pet to the child does not address the disruptive behavior and could add further stress to a household which is typically strained. Threats and punishments are more likely to generate disruptive behavior. Efforts to praise and reward adaptive behavior are more likely than to expose the child to threats.

When teaching a client with antisocial personality disorder (ASPD), which approach would be most appropriate for the nurse to use? Direct

Client education efforts have to be creative and thought provoking. In educating a person with ASPD, 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 teaching 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. Challenging or confronting the client would be inappropriate.

A nurse is assessing a client with borderline personality disorder. During the assessment the nurse notes that the client is using projective identification. Which of the following would support this interpretation? Client attributes own feelings falsely to others.

Clients falsely attributing to others their own unacceptable feelings, impulses, or thoughts is termed projective identification. Lacking a definitive sense of self reflects issues with separation-individuation. Misinterpreting environmental stimuli reflects cognitive schema. The inability to control emotional reactions in social situations reflects emotional dysregulation.

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.

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.

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

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

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

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

A psychiatric-mental health nurse is explaining the differences between obsessive compulsive disorder (OCD) and obsessive compulsive personality disorder (OCPD) to a group of staff nurses. Which characteristic would the nurse most likely include? Clients with OCPD are able to delay satisfaction.

Clients with OCD tend to use obsessive thoughts and compulsions when anxious but less so when anxiety decreases. Persons with OCPD do not demonstrate obsessions and compulsions but rather a pervasive pattern of preoccupation with orderliness, perfectionism, and control. They also have the capacity to delay rewards, whereas those with OCD do not.

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

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.

The nurse is talking to a client with schizoid personality disorder about finding a job. Which suggestion by the nurse would be most helpful? "There is a job posting at the hospital for a file clerk in medical records."

Clients with schizoid disorder often work well in jobs with minimal interpersonal demands. "Being a loner really limits your employment opportunities," is not a positive suggestion for this client because it negatively labels the client. "Maybe your friend could see it there is a night position available at a convenience store," does not promote independence in finding a job, and a job at a convenience store would entail interpersonal demands. "Perhaps working part-time at a fast-food restaurant would be something you could do," would not be correct because working in a fast-food restaurant would involve the use of many interpersonal skills.

The client was brought to the clinic after breaking out several windows. The nurse questions the client regarding this action. Further assessment reveals that the client has been involved with vandalism, conning others, running away from home, verbal bullying and intimidation, drinking alcohol, and sexual promiscuity. Which disorder woudl teh nurse most likely suspect? Conduct disorder

Conduct disorder is characterized by more serious violations of social norms, including aggressive behavior, destruction of property, and cruelty to animals. Children and adolescents with conduct disorder often lie to achieve short-term ends, may be truant from school, may run away from home, and may engage in petty larceny or even mugging. Oppositional defiant disorder is characterized by a persistent pattern of disobedience, argumentativeness, angry outbursts, low tolerance for frustration, and tendency to blame others for misfortunes, large and small. Children with oppositional defiant disorder have trouble making friends and often find themselves in conflict with adults.Episodes of aggressiveness that result in assault or destruction of property characterize people with intermittent explosive disorder. In kleptomania, individuals cannot resist the urge to steal, and they independently steal items that they could easily afford.

Dialectical behavior therapy (DBT) combines behavior therapy with which type of therapy? Cognitive therapy

DBT combines cognitive and behavior therapy strategies. Clinicians partner with clients and focus on many interconnected behaviors.

A nurse is caring for a client that does not want to participate in group therapy. Which behavior is supportive of a diagnosis of dependent personality disorder? believes he or she is incapable of functioning independently

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. These behaviors are designed to elicit care taking from others. The dependent person must rely on others to make decisions and assume responsibility of major areas of life. Low self-esteem and exaggeration are seen in avoidant personality disorder. Attention seeking is seen in narcissistic personality disorder.

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

Discussing feelings provides some relief, but avoiding personal harm is the highest priority for clients at risk for self-mutilation. It is helpful to learn problem-solving techniques and how to express anger, but the priority is for the client not to cause personal harm.

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

Upon admission, a client with a personality disorder identifies areas of concern for which the client would like help. The nurse is aware that which will most likely be addressed by the health care team? Psychological distress

Even though clients with personality disorders have diverse and multiple needs, psychotic symptoms and psychological distress are often the only areas addressed by health-care providers. In many cases, important needs such as self-care, sexual expression and budgeting go unaddressed in the health care system.

Which is a psychosocial explanation for the development of personality disorders? Failure to complete a developmental task jeopardizes future personality development.

Failure to complete a developmental task jeopardizes the person's ability to achieve future developmental tasks. Self-directed people are realistic and effective and can adapt their behavior to achieve goals. Highly cooperative people are described as empathic, tolerant, compassionate, supportive, and principled; this trait does not tend to devolve into personality disorder with time. People low, not high, in self-directedness are helpless and unreliable. Self-transcendence describes the extent to which a person considers himself or herself to be an integral part of the universe. This is a protective factor against personality disorders.

A client with antisocial personality disorder uses manipulation to try leaving the unit with another client's family members after visiting hours. Which of the following interventions is best to deal with the manipulative behavior? Assist the client to identify patterns of behavior and consequences as determined by the team plan.

Following the team plan ensures consistency of response to the client's manipulative behavior. Learning the relationship between behavior and consequences is a positive outcome for the client. Answers A, C, and D are not appropriate interventions for the client exhibiting manipulative behavior.

A client with borderline personality disorder says to the nurse, "I feel so comfortable talking with you. You seem to have a special way about you that really helps me." Which would be the most appropriate response by the nurse? "I'm here to help you just as all the staff members are."

For the borderline personality disorder client, personal boundaries are unclear, and clients often have unrealistic expectations. Clients easily can misinterpret the nurse's genuine interest and caring as a personal friendship, and the nurse may feel flattered by a client's compliments. The nurse must be quite clear about establishing the boundaries of the therapeutic relationship to ensure that neither the client's nor the nurse's boundaries are violated. Stating that the nurse's role is no different from that of the other staff denies that the nurse is somehow "special" to the client. The nurse should not implicitly validate the client's view by thanking him or her or by exploring the lesser role of other staff with the client. Stating "I'm glad you feel comfortable with me" misses an opportunity to reinforce healthy boundaries. Conversely, stating "I cannot be your friend" is unnecessarily direct and is not empathic; such a response may jeopardize therapeutic rapport with the client. Redirection is preferred over confrontation.

A client with a diagnosis of antisocial personality disorder would exhibit a history of conduct disorder before which age? 15 years

For the diagnosis of antisocial personality disorder, a person would have evidence of a conduct disorder before 15 years of age.

When the nurse is not informed of developmental and cultural issues related to the client's background, which of the following may be expected? Normal patterns of behavior may be labeled as deviant, immoral, or insane.

If the nurse does not remain culturally sensitive, it is possible that symptoms or behaviors that are observed might be misinterpreted as deviant or immoral. Client behavior is always based upon client history and cultural background; understanding of behavior cannot be obtained simply from conventional wisdom.

People who are impulse-driven and have difficulty delaying gratification frequently participate in which of the following behaviors? Select all that apply. Gambling Shopping beyond their means Binge eating Abusing alcohol

Impulsivity is a characteristic of people with borderline personality disorder (BPD). They have difficulty delaying gratification and often act "in the moment." Gambling, spending money irresponsibly, binge eating, engaging in unsafe sex, and abusing substances are typical.

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

The nurse completes an intake assessment for a client. Which symptoms are associated with dependent personality disorder? Select all that apply. -Difficulty making everyday decisions -Withdrawal from adult responsibilities -Expresses fears of being unable to manage self-care

Individuals with dependent personality disorder can struggle with planning without seeking advice or direction from others. They have a tendency to avoid taking on responsibilities associated with adulthood. Individuals have a level of concern about being able to manage their personal needs which exceeds logical explanation. There is no clear association between opiate addiction or diabetes and dependent personality disorder.

After teaching a group of nurses about different personality disorders, the group leader determines that the education was successful when the nurses identify which characteristic of schizotypal personality disorder? Increased eccentricity

Individuals with schizotypal personality disorder are dramatic. These individuals are perceived as strikingly odd or strange in appearance and behavior, even to laypersons. They may have unusual mannerisms, an unkempt manner of dress that does not quite "fit together," and inattention to usual social conventions (e.g., avoiding eye contact, wearing clothes that are stained or ill-fitting, and being unable to join in the give-and-take banter of coworkers).

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

Informing the client of the length of the relationship as much as possible allows the client to engage in and prepare for termination with a safe and adaptive expression of the emotions attached to the ending of the relationship.

A client with borderline personality disorder (BPD) who is receiving dialectical behavior therapy as part of his treatment program is participating in a skills group. The client is learning how to be assertive and problem solve. Which type of skills group is the client involved with? Interpersonal effectiveness skills

Interpersonal effectiveness skills include the development of assertiveness and problem-solving skills within an interpersonal context. Mindfulness skills are the psychological and behavioral versions of meditation skills usually taught in Eastern spiritual practice. They are used to help the person improve observation, description, and participation skills by learning to focus the mind and awareness on the current moment's activity. Emotion regulation skills are taught to manage intense, labile moods, to help the client label and analyze the context of the emotion, and to develop strategies to reduce emotional vulnerability. Distress tolerance skills involve helping the individual tolerate and accept distress as a part of normal life.

Which is the main reason why the periodic team meetings are important when caring for a client with antisocial personality? Team consistency is important to prevent manipulation by the client.

It is important to be consistent and firm with the care plan and not to make independent changes in rules or consequences. Any change should be made by the staff as a group and conveyed to all staff members working with this client. Consistency is essential and may require team dialogue. If the client can find just one person to make independent changes, any plan will become ineffective. Care providers must be kept up to date on the components of the client's treatment plan, but this can be accomplished without meetings. Similarly, updates can be communicated or documented in different ways. Staff's frustrations must be dealt with appropriately, but the primary focus for all treatment planning should be centered on meeting the client's needs.

In response to a client's manipulative behavior, the nurse should provide ... Consistent limits

Limit setting is the most effective way of dealing with manipulative behavior.

Which of the following would be consistent with the use of the Five Senses Exercise to help a client with borderline personality disorder (BPD) avoid self-destructive behaviors? Light a scented candle

Linehan suggests using the Five Senses Exercise, which includes lighting a scented candle. The other interventions would not be soothing or beneficial.

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

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.

When analyzing the behaviors of a client who meets the criteria for antisocial personality disorder, the nurse recognizes that which nursing diagnoses would be pertinent to the client's care? ineffective coping

Nursing diagnoses commonly used when working with these clients include defensive chronic coping, ineffective role performance, risk for other-directed violence. The client with antisocial personality disorder is impulsive, manipulative, and dishonest. Clients with this disorder are frequently involved in illegal matters. Self-mutilation and disturbed identity are more appropriate for clients with borderline personality disorder. Social isolation would apply more readily to Cluster A disorders.

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

One of the first diagnoses to consider with this client population is risk for self-mutilation, because protection of the client from self-injury is always a priority. The other diagnoses may be appropriate for the client, but risk for self-mutilation would be the priority.

After reviewing information about the various impulse control disorders, a nurse demonstrates understanding of the information by identifying which disorder as involving a persistent pattern of disobedience and argumentativeness? Oppositional defiant disorder

Oppositional defiant disorder is characterized by a persistent pattern of disobedience, argumentativeness, angry outbursts, low tolerance for frustration, and tendency to blame others for misfortunes, large and small. Conduct disorder is characterized by more serious violations of social norms, including aggressive behavior, destruction of property, and cruelty to animals. In kleptomania, individuals cannot resist the urge to steal, and they independently steal items that they could easily afford. Irresistible impulses to start fires characterize pyromania: repeated fire setting with tension or arousal before setting fires; fascination or attraction to the fires; and gratification when setting, witnessing, or participating in the aftermath of fire.

Which would a nurse assess in a client suspected of having paranoid personality disorder? Select all that apply. -Need to be in a position of power in a relationship -Suspiciousness and guarded behavior -Outwardly argumentative

Paranoid personality disorder is characterized by a long-standing suspiciousness and mistrust of people in general. Individuals with these traits refuse to assume personal responsibility for their own feelings, assign responsibility to others, and avoid relationships in which they are not in control of or lose power in. These individuals are suspicious, guarded, and hostile. They are consistently mistrustful of others' motives, even relatives and close friends. Actions of others are often misinterpreted as deception, deprecation, and betrayal, especially regarding the loyalty or trustworthiness of friends and associates. People with paranoid personality disorder are unforgiving and hold grudges; their typical emotional responses are anger and hostility. They distance themselves from others and are outwardly argumentative and abrasive; internally, they feel powerless, fearful, and vulnerable. Their outward demeanor often seems cold, sullen, and humorless.

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

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 nurse is careful to provide a quiet, comfortable, safe environment when conducting an assessment interview. What is the reason this is particularly important when working with a client believed to be exhibiting characteristics of a personality disorder? This disorder produces defensive, guarded, and impulsive behavior that is easily provoked into anger when the client feels threatened.

Personality disorders are diagnosed when there is impairment of personality functioning and personality traits that are maladaptive. Individuals have identity problems such as egocentrism or being self-centered, and their sense of self-esteem comes from gaining power or pleasure that is often at the expense of others. Their behavior often fails to conform to cultural, social, or legal norms, and they are motivated by personal gratification. Individuals with these disorders are often withdrawn, defensive, guarded, and impulsive, and may demonstrate an escalation of anger or make hostile or threatening comments. The remaining options are specific to certain types of personality disorders.

The nurse is working in a prison setting with a client diagnosed with Antisocial Personality Disorder (ASPD). The client has identified impulse control issues particularly around urges for sexual intimacy. The client has assaulted people who have interfered with their gratification. What is the priority intervention for the nurse? Helping to express anger in an adaptive and non-violent manner

Promoting safety for clients and staff is a priority intervention for clients with ASPD. Other interventions to tolerate distress, improve coping, manage substance abuse and promote adherence to treatment are all relevant yet take a back seat to reduction of risk for aggression or violence.

A client with antisocial personality disorder (ASPD) is admitted to hospital. The nurse identifies which nursing diagnosis as the priority? Risk for other directed violence

Protection of clients and staff is always a priority in care. Clients with ASPD have a high risk for violence, low impulse control and a disregard for others. Their initial presentation can be very engaging, yet when needs are unmet or when provoked by others, there is a risk for violence. This risk for violence supersedes other concerns in the care environment of a hospital. Other needs can be addressed, including problem solving, improved family functioning and social interactions with others, but these are not priorities.

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."

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.

Which of the following is likely the etiologic basis of the compulsive patterns seen in people with obsessive-compulsive personality disorder (OCPD)? Parental overcontrol

The basis of the compulsive patterns seen in OCPD is parental overcontrol and overprotection that is consistently restrictive and sets distinct limits on the child's behavior. Lack of nurturing is not implicated in this disorder, nor is substance use within the family. Clients diagnosed with paranoid personality disorder may have been hyperactive as a child.

The nurse in an outpatient clinic conducts an assessment for a client employed full time as a professional. The client has an unstable mood and feels sad most of the time. The client shares that they were recently charged for shoplifting cosmetics valued under $10. The client has admitted to shoplifting more than five times before this incident. In addition to a mood disorder, what other disorder does the nurse identify? Kleptomania

The client can afford to pay for the make-up but shoplifts instead. This condition is called kleptomania. Stealing provides a psychological release of cognitive tension rather than economic or personal need for the item. Hypomania describes expansive thoughts and overly goal-directed behavior associated with bipolar disorder. Trichotillomania is a term that describes hair pulling. It is not associated with stealing yet the release of tension by pulling hair has some similarities with kleptomania. Schizo-affective disorder is a mood disorder with episodes of psychosis or mania often in response to periods of stress.

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."

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 antisocial personality disorder is begging to use the phone to call the client's spouse, even though it is against the unit rules. The client begs, "It is just this once, and my spouse will be so hurt if I don't call." Which would be the most appropriate response by the nurse? "You may not use the phone to call your spouse."

The client may attempt to bend the rules "just this once" with numerous excuses and justifications. The nurse's frank refusal to be manipulated or charmed will help decrease manipulative behavior. Reference to the nurse getting "in trouble" does not directly address the client's request and the antisocial client may perceive this as indicating a need to increase manipulative behavior. Similarly, referring to a need to "focus on recovery" may be perceived as the nurse making an excuse, which is invalid because this is not the rationale for the nurse denying the request. The client may increase manipulation in response to this.

A client with a diagnosis of dependent personality disorder is recovering from surgery. The nurse considers the importance of avoiding some interventions that could be therapeutic for another client without a personality disorder. Which intervention will the nurse avoid? Telling the client what to do

The client with dependent personality disorder struggles with decision making and will look to others to assist with tasks they are physically able to do. The nurse should avoid telling a client with dependent personality disorder what to do and allow the individual to make their own decisions. Clients with dependent personality disorder would benefit from receiving constructive feedback outlining accomplishments, efforts to enhance decision making and help identifying resources for meal planning.

During neighborhood scans, a nurse working in a community outreach program has identified an individual staying in a local shelter. The person has not engaged with the program. During the day, the client can be observed sweeping the pavement in a particular alley with a broom. There is no obvious purpose to the behavior. The individual is dressed in winter clothing even though it is summer. The client mutters expressions that are audible but cannot be understood. Based on the observations, which disorder does the nurse consider? Schizotypal personality disorder

The details in the case represent the typical profile of an individual with schizotypal personality disorder. The individual appears socially odd and does not engage in help seeking. They engage in unusual mannerisms and their communication is impaired with some psychotic references. Individuals with paranoid personality disorder have a mindset of suspicion and they tend to be isolative and avoid social contact. People with obsessive compulsive personality disorder have a pattern of rigid thinking and perfectionist qualities. Although the person in this case sweeps for unusually long periods of time in a repetitive way, there is little or no connection with the pattern seen in someone with obsessive compulsive personality disorder.

The nurse in a medical setting provides care for a client with histrionic personality disorder concurrent with their medical challenges. During the initial assessment with the client, the nurse identifies an altered expression of sexuality. To guide further assessment, what factor does the nurse anticipate from the client? Demonstration of seductive behavior

The presentation of histrionic personality disorder in women typically includes an element of seductive dress and interpersonal communication. These qualities are overt and there is typically little or no restraint in terms of expression. Many clients struggle to maintain long-term relationships. Clients may experience sexual intimacy yet express unmet needs of social intimacy and belonging.

A 17-year-old client comes to the community crisis clinic with multiple superficial cuts on the wrist. The client is crying uncontrollably and states that the client's romantic partner has left and the client doesn't want to live without the partner. What would be the most therapeutic initial nursing response? "I can see that you are feeling anxious. I will stay with you until you feel better."

The priority is to provide for a safe environment and to use anxiety reduction techniques to calm the client. The nurse exhibits empathy, calmness, and support in the crisis, unlike the authoritarian setting of boundaries at the outset. The other responses are incorrect. Suggesting the client will find another partner provides false reassurance. Asserting that many partners change their minds in relationships is dismissive of the client's experience.

A prison nurse teaches a group of nursing students about personality disorders. Which finding serves as an example of pervasive pattern of disregard for and violation of the rights of others? Manipulates by advancing personal interests at another's expense

The terminology of a "pervasive pattern of disregard for and violation of the rights of others" refers to a client with antisocial personality disorder. The disorder is characterized by an individual who may manipulate others and who has a pattern of violating the rights of other people. The first description pertains to someone with an eating disorder. A person with variable moods would have an affective disorder such as bipolar disorder. A person who cannot apply age appropriate skills may have a developmental delay.

A nurse is caring for a variety of children on a psychiatric unit. Which child is at risk to develop narcissistic personality disorder? Select all that apply. -A child movie actor -An only child of a prominent sports celebrity -A child of parents with narcissistic personality disorder

Theories about the development of narcissistic personality disorder place emphasis on the developmental environment of the child. Overvaluation and receiving every want places a child who experiences fame and has access to financial resources at higher risk. Growing up in a prominent family may also increase risk. Due to family dynamics, children of parents with narcissistic personality disorder are also at risk. It's more likely that a first- or last-born child in a family would develop the disorder than a middle child. Unless there were unique cultural beliefs that bestow privilege, a child of immigrant parents is not a greater risk of the disorder.

An adult female client presents to the mental health clinic and is assessed by the nurse. During the assessment, the nurse observes the client engage warmly with an appropriately variable affect and to be open to share their life story. The story included a pattern of failed intimate relationships, which the client attributes to a mild form of cerebral palsy. The client lives in the parental home. The client's father died when she was in high school and her mother passed away three months prior to the assessment. Interpersonally the client says she works hard to avoid conflict. References are made to being "unlovable" and that she is "engulfed in sadness" to the point of needing a disability income. This is due to the expressed fear of being "unable" to care for everyday needs independently. What disorder does the nurse suspect? Dependent personality disorder

There are several links in the stem of this question to dependent personality disorder. These include a warm and agreeable presentation, a history of a chronic childhood condition, living at home, struggling with the loss of her parents, avoiding conflict, feeling unworthy and having struggled to maintain relationships. The client feels unable to care for her personal needs. There are few indications for MDD in this case. It's more likely there is a dysthymic mood than major depression. There is no reference to worry to suggest GAD. There is not any indication of rigidity associated with obsessional compulsive personality disorder.

The nurse provides care to clients who have a tendency toward antisocial and criminal behavior. Which term was used in the past to describe people with this disorder? Psychopath

There is a concern that nurses will perpetuate the stigma about people with mental illnesses including personality disorders. The terms psychopath and sociopath are used to describe individuals with antisocial personality disorder. These terms are no longer used in DSM-5 and they carry stigma when used in a way to associate clients with evil and criminality. The terms outlined as distractors may be used in stigmatizing mays but these terms have never formally been used to describe the disorder.

The primary care nurse providing services for children in their first year of life identifies children at greatest risk for developing histrionic personality disorder. Which child is at greatest risk? A highly alert and responsive female infant cared for by her mother

Those at greatest risk of developing histrionic personality disorder are females who are alert and responsive to stimuli. Theories of etiology do not place quiet or passive or male children at risk for histrionic personality disorder.

A 36-year-old client demonstrates a pattern of overexpressiveness with emotions. The client has a relationship history in which the client is attention seeking. The client has recently been experiencing difficulty maintaining appropriate boundaries with colleagues at a new job. The nurse would most likely suspect which disorder? Histrionic personality disorder

Those with histrionic personality disorder strive to constantly be the center of attention by focusing exclusively on their own desires and interests during conversations with others. Other measures to gain attention include provocative dress and dramatic and highly emotional behaviors and displays. Despite their theatricality, their speech style is superficial and lacking in detail. Because of feelings of insecurity, people with this disorder often engage in seductive behaviors to gain approval.

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

To be diagnosed with ASPD, the individual must be at least 18 years old and must have exhibited one or more childhood behavioral characteristics of conduct disorder before the age of 15 years, such as aggression to people or animals, destruction of property, deceitfulness or theft, or serious violation of rules.

dentity diffusion occurs in clients diagnosed with borderline personality disorder. Which description would the nurse most commonly associate with identity diffusion in these clients? Select all that apply Self-image instability Feelings of emptiness Inconsistency

Unstable self-image is often manifested as an identity disturbance or identity diffusion, a loss of the capacity for self-definition and commitment to values, goals, or relationships. The nurse can recognize identity diffusion if the patient reports an ongoing "emptiness" or contradictory behavior. The person's thoughts and behavior will seem fragmented and superficial.

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

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.

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