Ch.23

Question 1

1. During an assessment interview, a client diagnosed with antisocial personality disorder
   spits, curses, and refuses to answer questions. Which is the appropriate nursing response
   to this behavior?
2. “You are very disrespectful. You need to learn to control yourself.”
3. “I understand that you are angry, but this behavior will not be tolerated.”
4. “What behaviors could you modify to improve this situation?”
5. “What anti-personality disorder medications have helped you in the past?”

Answer 1

2. “I understand that you are angry, but this behavior will not be tolerated.”

Question 2

2. At 11:00 p.m. a client diagnosed with antisocial personality disorder demands to phone
   a lawyer to file for a divorce. Unit rules state that no phone calls are permitted after
   10:00 p.m. Which nursing response is most appropriate?
3. “Go ahead and use the phone. I know this pending divorce is stressful.”
4. “You know better than to break the rules. I’m surprised at you.”
5. “It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow.”
6. “A divorce shouldn’t be considered until you have had a good night’s sleep.”

Answer 2

3. “It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow.”

Question 3

3. A client diagnosed with paranoid personality disorder becomes violent on a unit.
   Which nursing intervention is most appropriate?
4. Provide objective evidence that reasons for violence are unwarranted.
5. Initially restrain the client to maintain safety.
6. Use clear, calm statements and a confident physical stance.
7. Empathize with the client’s paranoid perceptions.

Answer 3

3. Use clear, calm statements and a confident physical stance.

Question 4

4. A client diagnosed with borderline personality disorder brings up a conflict with the
   staff in a community meeting and develops a following of clients who unreasonably
   demand modification of unit rules. How can the nursing staff best handle this situation?
5. Allow the clients to apply the democratic process when developing unit rules.
6. Maintain consistency of care by open communication to avoid staff manipulation.
7. Allow the client spokesman to verbalize concerns during a unit staff meeting.
8. Maintain unit order by the application of autocratic leadership.

Answer 4

2. Maintain consistency of care by open communication to avoid staff manipulation.

Question 5

5. Which nursing approach should be used to maintain a therapeutic relationship with a
   client diagnosed with borderline personality disorder?
6. Being firm, consistent, and empathic, while addressing specific client behaviors
7. Promoting client self-expression by implementing laissez-faire leadership
8. Using authoritative leadership to help clients learn to conform to society norms
9. Overlooking inappropriate behaviors to avoid providing secondary gains

Answer 5

1. Being firm, consistent, and empathic, while addressing specific client behaviors

Question 6

6. Which adult client should a nurse identify as exhibiting the characteristics of a
   dependent personality disorder?
7. A physically healthy client who is dependent on meeting social needs by contact with
   15 cat
8. A physically healthy client who has a history of depending on intense relationships to
   meet basic needs
9. A physically healthy client who lives with parents and depends on public
   transportation
10. A physically healthy client who is serious, inflexible, perfectionistic, lacks spontaneity,
    and depends on rules to provide security

Answer 6

3. A physically healthy client who lives with parents and depends on public
   transportation

Question 7

7. A client expresses low self-worth, has much difficulty making decisions, avoids
   positions of responsibility, and has a behavioral pattern of “suffering” in silence. Which
   statement best explains the etiology of this client’s personality disorder?
8. Childhood nurturance was provided from many sources, and independent behaviors
   were encouraged.
9. Childhood nurturance was provided exclusively from one source, and independent
   behaviors were discouraged.
10. Childhood nurturance was provided exclusively from one source, and independent
    behaviors were encouraged.
11. Childhood nurturance was provided from many sources, and independent behaviors
    were discouraged.

Answer 7

2. Childhood nurturance was provided exclusively from one source, and independent

Question 8

8. Family members of a client ask the nurse to explain the difference between schizoid
   and avoidant personality disorders. Which is the appropriate nursing response?
9. Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and
   clients diagnosed with schizoid personality disorder prefer to be alone.
10. Clients diagnosed with schizoid personality disorder exhibit delusions and
    hallucinations, while clients diagnosed with avoidant personality disorder do not.
11. Clients diagnosed with avoidant personality disorder are eccentric, and clients
    diagnosed with schizoid personality disorder are dull and vacant.
12. Clients diagnosed with schizoid personality disorder have a history of psychosis, while
    clients diagnosed with avoidant personality disorder remain based in reality.

Answer 8

1. Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and
   clients diagnosed with schizoid personality disorder prefer to be alone.

Question 9

9. Which nursing diagnosis should a nurse identify as appropriate when working with a
   client diagnosed with schizoid personality disorder?
10. Altered thought processes R/T increased stress
11. Risk for suicide R/T loneliness
12. Risk for violence: directed toward others R/T paranoid thinking
13. Social isolation R/T inability to relate to others

Answer 9

4. Social isolation R/T inability to relate to others

Question 10

10. Looking at a slightly bleeding paper cut, the client screams, “Somebody help me
    quick! I’m bleeding. Call 911!” A nurse should identify this behavior as characteristic of
    which personality disorder?
11. Schizoid personality disorder
12. Obsessive-compulsive personality disorder
13. Histrionic personality disorder
14. Paranoid personality disorder

Answer 10

3. Histrionic personality disorder

Question 11

11. When planning care for a client diagnosed with borderline personality disorder, which
    self-harm behavior should a nurse expect the client to exhibit?
12. The use of highly lethal methods to commit suicide
13. The use of suicidal gestures to elicit a rescue response from others
14. The use of isolation and starvation as suicidal methods
15. The use of self-mutilation to decrease endorphins in the body

Answer 11

2. The use of suicidal gestures to elicit a rescue response from others

Question 12

12. A nurse tells a client that the nursing staff will start alternating weekend shifts. Which
    response should a nurse identify as characteristic of clients diagnosed with obsessivecompulsive
    personality disorder?
13. “You really don’t have to go by that schedule. I’d just stay home sick.”
14. “There has got to be a hidden agenda behind this schedule change.”
15. “Who do you think you are? I expect to interact with the same nurse every Saturday.”
16. “You can’t make these kinds of changes! Isn’t there a rule that governs this decision?”

Answer 12

4. “You can’t make these kinds of changes! Isn’t there a rule that governs this decision?”

Question 13

13. Which reaction to a compliment from another client should a nurse identify as a
    typical response from a client diagnosed with avoidant personality disorder?
14. Interpreting the compliment as a secret code used to increase personal power
15. Feeling the compliment was well deserved
16. Being grateful for the compliment but fearing later rejection and humiliation
17. Wondering what deep meaning and purpose is attached to the compliment

Answer 13

3. Being grateful for the compliment but fearing later rejection and humiliation

Question 14

14. Which factors differentiate a client diagnosed with social phobia from a client
    diagnosed with schizoid personality disorder?
15. Clients diagnosed with social phobia are treated with cognitive behavioral therapy,
    whereas clients diagnosed with schizoid personality disorder need medications.
16. Clients diagnosed with schizoid personality disorder experience anxiety only in social
    settings, whereas clients diagnosed with social phobia experience generalized anxiety.
17. Clients diagnosed with social phobia avoid attending birthday parties, whereas clients
    diagnosed with schizoid personality disorder would isolate self on a continual basis.
18. Clients diagnosed with schizoid personality disorder avoid attending birthday parties,
    whereas clients diagnosed with social phobia would isolate self on a continual basis.

Answer 14

3. Clients diagnosed with social phobia avoid attending birthday parties, whereas clients
   diagnosed with schizoid personality disorder would isolate self on a continual basis.

Question 15

15. Which client symptoms should lead a nurse to suspect a diagnosis of obsessivecompulsive
    personality disorder?
16. The client experiences unwanted, intrusive, and persistent thoughts.
17. The client experiences unwanted, repetitive behavior patterns.
18. The client experiences inflexibility and lack of spontaneity when dealing with others.
19. The client experiences obsessive thoughts that are externally imposed.

Answer 15

3. The client experiences inflexibility and lack of spontaneity when dealing with others.

Question 16

16. Which client is a nurse most likely to admit to an inpatient facility for self-destructive
    behaviors?
17. A client diagnosed with antisocial personality disorder
18. A client diagnosed with borderline personality disorder
19. A client diagnosed with schizoid personality disorder
20. A client diagnosed with paranoid personality disorder

Answer 16

2. A client diagnosed with borderline personality disorder

Question 17

17. When planning care for clients diagnosed with personality disorders, what should be
    the goal of treatment?
18. To stabilize the client’s pathology by using the correct combination of psychotropic
    medications
19. To change the characteristics of the dysfunctional personality
20. To reduce personality trait inflexibility that interferes with functioning and
    relationships
21. To decrease the prevalence of neurotransmitters at receptor sites

Answer 17

3. To reduce personality trait inflexibility that interferes with functioning and
   relationships

Question 18

18. Which client situation would reflect the impulsive behavior that is commonly
    associated with borderline personality disorder?
19. As the day-shift nurse leaves the unit, the client suddenly hugs the nurse’s arm and
    whispers, “The night nurse is evil. You have to stay.”
20. As the day-shift nurse leaves the unit, the client suddenly hugs the nurse’s arm and
    states, “I will be up all night if you don’t stay with me.”
21. As the day-shift nurse leaves the unit, the client suddenly hugs the nurse’s arm, yelling,
    “Please don’t go! I can’t sleep without you being here.”
22. As the day-shift nurse leaves the unit, the client suddenly shows the nurse a bloody
    arm and states, “I cut myself because you are leaving me.”

Answer 18

4. As the day-shift nurse leaves the unit, the client suddenly shows the nurse a bloody
   arm and states, “I cut myself because you are leaving me.”

Question 19

19. Which nursing diagnosis should be prioritized when providing nursing care to a client
    diagnosed with paranoid personality disorder?
20. Risk for violence: directed toward others R/T paranoid thinking
21. Risk for suicide R/T altered thought
22. Altered sensory perception R/T increased levels of anxiety
23. Social isolation R/T inability to relate to others

Answer 19

1. Risk for violence: directed toward others R/T paranoid thinking

Question 20

20. From a behavioral perspective, which nursing intervention is appropriate when caring
    for a client diagnosed with borderline personality disorder?
21. Seclude the client when inappropriate behaviors are exhibited.
22. Contract with the client to reinforce positive behaviors with unit privileges.
23. Teach the purpose of anti-anxiety medications to improve medication compliance.
24. Encourage the client to journal feelings to improve awareness of abandonment issues.

Answer 20

2. Contract with the client to reinforce positive behaviors with unit privileges.

Question 21

21. A highly emotional client presents at an outpatient clinic appointment and states, “My
    dead husband returned to me during a séance.” Which personality disorder should a nurse
    associate with this behavior?
22. Obsessive-compulsive personality disorder
23. Schizotypal personality disorder
24. Narcissistic personality disorder
25. Borderline personality disorder

Answer 21

2. Schizotypal personality disorder

Question 22

22. A nursing instructor is teaching students about clients diagnosed with histrionic
    personality disorder and the quality of their relationships. Which student statement
    indicates that learning has occurred?
23. “Their dramatic style tends to make their interpersonal relationships quite interesting
    and fulfilling.”
24. “Their interpersonal relationships tend to be shallow and fleeting, serving their
    dependency needs.”
25. “They tend to develop few relationships because they are strongly independent but
    generally maintain deep affection.”
26. “They pay particular attention to details, which can interfere with the development of
    relationships. ”

Answer 22

2. “Their interpersonal relationships tend to be shallow and fleeting, serving their
   dependency needs.”

Question 23

23. During an interview, which client statement should indicate to a nurse a potential
    diagnosis of schizotypal personality disorder?
24. “I don’t have a problem. My family is inflexible, and relatives are out to get me.”
25. “I am so excited about working with you. Have you noticed my new nail polish, ‘Ruby
    Red Roses’?”
26. “I spend all my time tending my bees. I know a whole lot of information about bees.”
27. “I am getting a message from the beyond that we have been involved with each other
    in a previous life.”

Answer 23

4. “I am getting a message from the beyond that we have been involved with each other
   in a previous life.”

Question 24

24. Which nursing diagnosis should be prioritized when providing nursing care to a client
    diagnosed with avoidant personality disorder?
25. Risk for violence: directed toward others R/T paranoid thinking
26. Risk for suicide R/T altered thought
27. Altered sensory perception R/T increased levels of anxiety
28. Social isolation R/T inability to relate to others

Answer 24

4. Social isolation R/T inability to relate to others