Chapter 24 - Personality Disorders

Question 1

A health care provider recently convicted of Medicare fraud says to a nurse, “Sure I overbilled. Everyone takes advantage of the government. There are too many rules to follow and I deserve the money.” These statements support what client characteristic?

a. shame.
b. suspiciousness.
c. superficial remorse.
d. lack of guilt feelings.

Answer 1

d. lack of guilt feelings.

Question 2

Which intervention is appropriate for an individual diagnosed with an antisocial personality disorder who frequently manipulates others?

a. Refer requests and questions related to care to the case manager.
b. Encourage the client to discuss feelings of fear and inferiority.
c. Provide negative reinforcement for acting-out behavior.
d. Ignore, rather than confront, inappropriate behavior.

Answer 2

a. Refer requests and questions related to care to the case manager.

Question 3

As a nurse prepares to administer medication to a client diagnosed with a borderline personality disorder, the client says, “Just leave it on the table. I’ll take it when I finish combing my hair.” What is the nurse’s best response?

a. Reinforce this assertive action by the client. Leave the medication on the table as requested.
b. Respond to the client, “I’m worried that you might not take it. I’ll come back later.”
c. Say to the client, “I must watch you take the medication. Please take it now.”
d. Ask the client, “Why don’t you want to take your medication now?”

Answer 3

c. Say to the client, “I must watch you take the medication. Please take it now.”

Question 4

What is an appropriate initial outcome for a client diagnosed with a personality disorder who frequently manipulates others?

a. The client will identify when feeling angry.
b. The client will use manipulation only to get legitimate needs met.
c. The client will acknowledge manipulative behavior when it is called to his or her attention.
d. The client will accept fulfillment of his or her requests within an hour rather than
immediately.

Answer 4

c. The client will acknowledge manipulative behavior when it is called to his or her attention.

Question 5

Consider this comment to three different nurses by a client diagnosed with an antisocial personality disorder, “Another nurse said you don’t do your job right.” Collectively, these interactions can be documented using which term?

a. seductive.
b. detached.
c. manipulative.
d. guilt-producing.

Answer 5

c. manipulative.

Question 6

Which behavior demonstrated by that a client diagnosed with an antisocial personality disorder most clearly warrants limit setting?

a. Flattering the nurse
b. Lying to other clients
c. Verbal abuse of another client
d. Detached superficiality during counseling

Answer 6

c. Verbal abuse of another client

Question 7

A client diagnosed with borderline personality disorder has a history of self-mutilation and suicide attempts. The client reveals feelings of depression and anger with life. Which type of medication would the nurse expect to be prescribed?

a. Benzodiazepine
b. Mood stabilizing medication
c. Monoamine oxidase inhibitor (MAOI)
d. Cholinesterase inhibitor

Answer 7

b. Mood stabilizing medication

Question 8

A client’s spouse filed charges after repeatedly being battered. Which statement by this person supports an antisocial personality disorder?

a. “I have a quick temper, but I can usually keep it under control.”
b. “I’ve done some stupid things in my life, but I’ve learned a lesson.”
c. “I’m feeling terrible about the way my behavior has hurt my family.”
d. “I hit because I am tired of being nagged. My spouse deserves the beating.”

Answer 8

d. “I hit because I am tired of being nagged. My spouse deserves the beating.”

Question 9

What is the priority nursing diagnosis for a client diagnosed with antisocial personality disorder who has made threats against staff, ripped art off the walls, and thrown objects?

a. Risk for other-directed violence
b. Risk for self-directed violence
c. Impaired social interaction
d. Ineffective denial

Answer 9

a. Risk for other-directed violence

Question 10

When a client diagnosed with a personality disorder uses manipulation to get needs met, the staff applies limit-setting interventions. What is the correct rationale for this action?

a. It provides an outlet for feelings of anger and frustration.
b. It respects the client’s wishes, so assertiveness will develop.
c. External controls are necessary due to failure of internal control.
d. Anxiety is reduced when staff assumes responsibility for the client’s behavior.

Answer 10

c. External controls are necessary due to failure of internal control.

Question 11

One month ago, a client diagnosed with borderline personality disorder and a history of self-mutilation began dialectical behavior therapy. Today the client telephones to say, “I feel empty and want to hurt myself.” The nurse should immediately take what action?

a. Arrange for emergency inpatient hospitalization.
b. Send the client to the crisis intervention unit for 8 to 12 hours.
c. Assist the client to choose coping strategies for triggering situations.
d. Advise the client to take an antianxiety medication to decrease the anxiety level.

Answer 11

c. Assist the client to choose coping strategies for triggering situations.

Question 12

What is the most challenging nursing intervention with clients diagnosed with personality disorders who use manipulation?

a. Supporting behavioral change
b. Maintaining consistent limits
c. Monitoring suicide attempts
d. Using aversive therapy

Answer 12

b. Maintaining consistent limits

Question 13

The history shows that a newly admitted client is impulsive. The nurse would expect the client to demonstrate what characteristic behavior?

a. Adherence to a strict moral code.
b. Manipulative, controlling strategies.
c. Acting without thought on urges or desires.
d. Postponing gratification to an appropriate time.

Answer 13

c. Acting without thought on urges or desires.

Question 14

A client says, “I get in trouble sometimes because I make quick decisions and act on them.” What is the nurse’s most therapeutic response?

a. “Let’s consider the advantages of being able to stop and think before acting.”
b. “It sounds as though you’ve developed some insight into your situation.”
c. “I bet you have some interesting stories to share about overreacting.”
d. “It’s good that you’re showing readiness for behavioral change.”

Answer 14

a. “Let’s consider the advantages of being able to stop and think before acting.”

Question 15

A client diagnosed with borderline personality disorder was hospitalized several times after multiple episodes of head banging and carving on both wrists. The client remains impulsive. Which nursing diagnosis is the initial focus of this client’s care?

a. Self-mutilation
b. Impaired skin integrity
c. Risk for injury
d. Powerlessness

Answer 15

a. Self-mutilation

Question 16

Which statement made by a client diagnosed with borderline personality disorder indicates the treatment plan is effective?

a. “I think you are the best nurse on the unit.”
b. “I’m never going to get high on drugs again.”
c. “I felt empty and wanted to hurt myself, so I called you.”
d. “I hate my mother. I called her today, and she wasn’t home.”

Answer 16

c. “I felt empty and wanted to hurt myself, so I called you.”

Question 17

When preparing to interview a client diagnosed with narcissistic personality disorder, a nurse can anticipate the assessment findings will include which characteristics?

a. preoccupation with minute details; perfectionist.
b. charm, drama, seductiveness; seeking admiration.
c. difficulty being alone; indecisive, submissiveness.
d. grandiosity, self-importance, and a sense of entitlement.

Answer 17

d. grandiosity, self-importance, and a sense of entitlement.

Question 18

For which client behavior would limit setting be most essential?

a. The client who clings to the nurse and asks for advice about inconsequential matters.
b. The client who is flirtatious and provocative with staff members of the opposite sex.
c. The client who is hypervigilant and refuses to attend unit activities.
d. The client who urges a suspicious client to hit anyone who stares.

Answer 18

d. The client who urges a suspicious client to hit anyone who stares.

Question 19

The nurse caring for an individual demonstrating symptoms of schizotypal personality disorder would expect assessment findings to include what characteristics?

a. arrogant, grandiose, and a sense of self-importance.
b. attention seeking, melodramatic, and flirtatious.
c. impulsive, restless, socially aggressive behavior.
d. socially anxious, rambling stories, peculiar ideas.

Answer 19

d. socially anxious, rambling stories, peculiar ideas.

Question 20

Others describe a worker as very shy and lacking in self-confidence. This worker stays in an office cubicle all day, never coming out for breaks or lunch. Which term best describes this behavior?

a. Narcissistic
b. Histrionic
c. Avoidant
d. Paranoid

Answer 20

c. Avoidant

Question 21

What is the priority intervention for a nurse beginning to work with a client diagnosed with a schizotypal personality disorder?

a. Respect the client’s need for periods of social isolation.
b. Prevent the client from violating the nurse’s rights.
c. Teach the client how to select clothing for outings.
d. Engage the client in community activities.

Answer 21

a. Respect the client’s need for periods of social isolation.

Question 22

A client diagnosed with borderline personality disorder (BPD) self-inflicted wrist lacerations after gaining new privileges on the unit. In this case, the self-mutilation may have been due to which trigger?

a. An inherited disorder that manifests itself as an incapacity to tolerate stress.
b. Use of projective identification and splitting to bring anxiety to manageable levels.
c. A constitutional inability to regulate affect, predisposing to psychic disorganization.
d. Fear of abandonment associated with progress toward autonomy and independence.

Answer 22

d. Fear of abandonment associated with progress toward autonomy and independence.

Question 23

A client diagnosed with borderline personality disorder has self-inflicted wrist lacerations. The health care provider prescribes daily dressing changes. The nurse performing this care should understand the need to deliver the care in what manner?

a. maintaining a stern and authoritarian affect.
b. providing care in a matter-of-fact manner.
c. encouraging the client to express anger.
d. being very rigid but not challenging.

Answer 23

b. providing care in a matter-of-fact manner.

Question 24

A nurse set limits while interacting with a client demonstrating behaviors associated with borderline personality disorder. The client tells the nurse, “You used to care about me. I thought you were wonderful. Now I can see I was wrong. You’re evil.” This outburst can be documented using what term?

a. denial.
b. splitting.
c. defensive.
d. reaction formation.

Answer 24

b. splitting.

Question 25

Which characteristic of personality disorders makes it most necessary for staff to schedule frequent team meetings in order to address the client’s needs and maintain a therapeutic milieu?

a. Ability to achieve true intimacy
b. Flexibility and adaptability to stress
c. Ability to provoke interpersonal conflict
d. Inability to develop trusting relationships

Answer 25

c. Ability to provoke interpersonal conflict

Question 26

Which nursing diagnosis is appropriate to consider for a client diagnosed with any of the personality disorders?

a. nonadherence.
b. impaired social interaction.
c. disturbed personal identity.
d. diversional activity deficit

Answer 26

b. impaired social interaction.

Question 27

A new psychiatric technician says, “Schizophrenia … schizotypal! What’s the difference?” The nurse’s response should include which information?

a. A client diagnosed with schizophrenia is not usually overtly psychotic.
b. In schizotypal personality disorder, the client remains psychotic much longer.
c. With schizotypal personality disorder, the person can be made aware of misinterpretations of reality.
d. Schizotypal personality disorder causes more frequent and more prolonged hospitalizations than schizophrenia.

Answer 27

c. With schizotypal personality disorder, the person can be made aware of misinterpretations of reality.

Question 28

What personality traits are most likely to be documented by a client demonstrating characteristics of an obsessive-compulsive personality disorder (OCPD)?

a. affable, generous.
b. perfectionist, inflexible.
c. suspicious, holds grudges.
d. dramatic speech, impulsive

Answer 28

b. perfectionist, inflexible.

Question 28

A nurse determines desired outcomes for a client diagnosed with schizotypal personality disorder. What is the best outcome?

a. The client will adhere willingly to unit norms.
b. The client will report decreased incidence of self-mutilative thoughts.
c. The client will demonstrate fewer attempts at splitting or manipulating staff.
d. The client will demonstrate ability to introduce self to a stranger in a social situation.

Answer 28

d. The client will demonstrate ability to introduce self to a stranger in a social situation.

Question 29

A client says, “The other nurses won’t give me my medication early, but you know what it’s like to be in pain and don’t let your clients suffer. Could you get me my pill now? I won’t tell anyone.” Which response by the nurse would be most therapeutic?

a. “I’m not comfortable doing that,” and then ignore subsequent requests for early medication.
b. “I understand that you have pain but giving medicine too soon would not be safe.”
c. “I’ll have to check with your doctor about that; I will get back to you after I do.”
d. “It would be unsafe to give the medicine early; none of us will do that.”

Answer 29

b. “I understand that you have pain but giving medicine too soon would not be safe.”

Question 30

A nurse plans care for an individual diagnosed with antisocial personality disorder. Which characteristic behaviors will the nurse expect? (Select all that apply.)

a. Reclusive behavior
b. Callous attitude
c. Perfectionism
d. Aggression
e. Clinginess
f. Anxiety

Answer 30

b. Callous attitude
d. Aggression

Question 31

For which clients diagnosed with personality disorders would a family history of similar problems be most likely? (Select all that apply.)

a. Obsessive-compulsive
b. Antisocial
c. Borderline
d. Schizotypal
e. Narcissistic

Answer 31

a. Obsessive-compulsive
b. Antisocial
c. Borderline
d. Schizotypal