chapter 23

Question 1

28. A client is being assessed for antisocial personality disorder. According to the DSM-5, which of the following symptoms must the client meet in order to be assigned this diagnosis? (Select all that apply.)
29. Ego-centrism and goal setting based on personal gratification.
30. Incapacity for mutually intimate relationships.
31. Frequent feelings of being down miserable and/or hopeless.
32. Disregard for and failure to honor financial and other obligations.
33. Intense feelings of nervousness, tenseness, or panic.

Answer 1

Ans: 1, 2, 4

Question 2

27. A nurse is caring for a client diagnosed with antisocial personality disorder. Which factors should the nurse consider when planning this client’s care? (Select all that apply.)
28. This client has personality traits that are deeply ingrained and difficult to modify.
29. This client needs medication to treat the underlying physiological pathology.
30. This client uses manipulation, making the implementation of treatment problematic.
31. This client has poor impulse control that hinders compliance with a plan of care.
32. This client is likely to have secondary diagnoses of substance abuse and depression.

Answer 2

Ans: 1, 3, 4, 5

Question 3

25. A nurse is admitting a client with a new diagnosis of a personality disorder. Which of the following would make the nurse question this diagnosis? (Select all that apply.)
26. The client has been diagnosed with sickle cell anemia.
27. The client has an inflated self-appraisal and feels a sense of entitlement.
28. The client has a history of a substance use disorder.
29. The client is odd and eccentric but not delusional.
30. The client has an intellectual developmental disorder.
    25

Answer 3

Ans: 1, 3, 5

Question 4

26. Which statements represent positive outcomes for clients diagnosed with narcissistic personality disorder? (Select all that apply.)
27. The client will relate one empathetic statement to another client in group by day two.
28. The client will identify one personal limitation by day one.
29. The client will acknowledge one strength that another client possesses by day two.
30. The client will list four personal strengths by day three.
31. The client will list two lifetime achievements by discharge.
    2

Answer 4

Ans: 1, 2, 3

Question 5

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 5

Ans: 2

Question 6

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 6

Ans: 3

Question 7

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 7

Ans: 3

Question 8

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 8

Ans: 2

Question 9

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 9

Ans: 1

Question 10

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 10

Ans: 3

Question 11

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 11

Ans: 2

Question 12

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 12

Ans: 1

Question 13

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 other

Answer 13

Ans: 4

Question 14

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 14

Ans: 3

Question 15

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 15

Ans: 2

Question 16

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 obsessive-compulsive 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 16

Ans: 4

Question 17

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 17

Ans: 3

Question 18

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 18

Ans: 3

Question 19

15. Which client symptoms should lead a nurse to suspect a diagnosis of obsessive-compulsive 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 19

Ans: 3

Question 20

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 20

Ans: 2

Question 21

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 21

Ans: 3

Question 22

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 22

Ans: 4

Question 23

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 23

Ans: 1

Question 24

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 24

Ans: 2

Question 25

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 25

Ans: 2

Question 26

26. Which statements represent positive outcomes for clients diagnosed with narcissistic personality disorder? (Select all that apply.)
27. The client will relate one empathetic statement to another client in group by day two.
28. The client will identify one personal limitation by day one.
29. The client will acknowledge one strength that another client possesses by day two.
30. The client will list four personal strengths by day three.
31. The client will list two lifetime achievements by discharge.

Answer 26

Ans: 1, 2, 3

Question 27

27. A nurse is caring for a client diagnosed with antisocial personality disorder. Which factors should the nurse consider when planning this client’s care? (Select all that apply.)
28. This client has personality traits that are deeply ingrained and difficult to modify.
29. This client needs medication to treat the underlying physiological pathology.
30. This client uses manipulation, making the implementation of treatment problematic.
31. This client has poor impulse control that hinders compliance with a plan of care.
32. This client is likely to have secondary diagnoses of substance abuse and depression.

Answer 27

Ans: 1, 3, 4, 5

Question 28

28. A client is being assessed for antisocial personality disorder. According to the DSM-5, which of the following symptoms must the client meet in order to be assigned this diagnosis? (Select all that apply.)
29. Ego-centrism and goal setting based on personal gratification.
30. Incapacity for mutually intimate relationships.
31. Frequent feelings of being down miserable and/or hopeless.
32. Disregard for and failure to honor financial and other obligations.
33. Intense feelings of nervousness, tenseness, or panic.

Answer 28

Ans: 1, 2, 4

Question 29

29. _______________________ personality disorder is characterized by a profound defect in the ability to form personal relationships or to respond to others in any meaningful emotional way.

Answer 29

Ans: Schizoid

Question 30

30. _____________________ personality disorder is characterized by colorful, dramatic, and extraverted behavior in excitable, emotional people.

Answer 30

Ans: Histrionic

Question 31

31. ________________________________ personality disorder is characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation.

Answer 31

Ans: Dependent

Question 32

32. _____________________ personality disorder is a pervasive distrust and suspiciousness of others, such that their motives are interpreted as malevolent.

Answer 32

Ans: Paranoid

Question 33

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 33

Ans: 2

Question 34

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 34

Ans: 2

Question 35

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 35

Ans: 4

Question 36

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 36

Ans: 4