Deck 32: Personality Disorders

Question 1

Which is the priority nursing diagnosis when providing care to a client diagnosed with Paranoid Personality Disorder?

A)Risk for violence: directed toward others R/T suspicious thoughts
B)Risk for suicide R/T altered thought
C)Altered sensory perception R/T increased levels of anxiety
D)Social isolation R/T inability to relate to others

Answer 1

Risk for violence: directed toward others R/T suspicious thoughts

Question 2

Which client symptoms should lead the nurse to suspect a diagnosis of OCPD?

A)The client experiences unwanted,intrusive,and persistent thoughts.
B)The client experiences unwanted,repetitive behavior patterns.
C)The client experiences inflexibility and lack of spontaneity when dealing with others.
D)The client experiences obsessive thoughts that are externally imposed.

Answer 2

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

Question 3

Which nursing diagnosis should the nurse identify as appropriate when working with a client diagnosed with Schizoid Personality Disorder?

A)Altered thought processes R/T increased stress
B)Risk for suicide R/T loneliness
C)Risk for violence: directed toward others R/T paranoid thinking
D)Social isolation R/T inability to relate to others

Answer 3

Social isolation R/T inability to relate to others

Question 4

The nurse tells a client that the nursing staff will start alternating weekend shifts.Which response should the nurse identify as characteristic of clients diagnosed with OCPD?

A)"You really don't have to go by that schedule.I'd just stay home sick."
B)"There has got to be a hidden agenda behind this schedule change."
C)"Who do you think you are? I expect to interact with the same nurse every Saturday."
D)"You can't make these kinds of changes! Isn't there a rule that governs this decision?"

Question 5

Using a behavioral approach,which nursing intervention is most appropriate when caring for a client diagnosed with BPD?

A)Seclude the client when inappropriate behaviors are exhibited.
B)Contract with the client to reinforce positive behaviors with unit privileges.
C)Teach the purpose of antianxiety medications to improve medication compliance.
D)Encourage the client to journal feelings to improve awareness of abandonment issues.

Question 6

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?

A)"Their dramatic style tends to make their interpersonal relationships quite interesting and fulfilling."
B)"Their interpersonal relationships tend to be shallow and fleeting,serving their dependency needs."
C)"They tend to develop few relationships because they are strongly independent but generally maintain deep affection."
D)"They pay particular attention to details,which can frustrate the development of relationships."

Question 7

A highly emotional client presents at an outpatient clinic appointment wearing flamboyant attire,spiked heels,and theatrical makeup.Which personality disorder should the nurse associate with these assessment data?

A)Compulsive personality disorder
B)Schizotypal personality disorder
C)Histrionic personality disorder (HPD)
D)Manic personality disorder

Question 8

Which client situation statement should the nurse identify as reflective of the impulsive behavior that is commonly associated with BPD?

A)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."
B)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."
C)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."
D)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 9

A client diagnosed with Borderline Personality Disorder (BPD)brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules.Which approach is best for the nursing staff to implement?

A)Allow the clients to apply the democratic process when developing unit rules.
B)Maintain consistency of care by open communication to avoid staff manipulation.
C)Allow the client spokesperson to verbalize concerns during a unit staff meeting.
D)Maintain unit order by the application of autocratic leadership.

Question 10

A client diagnosed with Antisocial Personality Disorder comes to the nurses' station at 11:00 p.m. ,requesting to phone a lawyer to discuss filing for a divorce.The unit rules state that no phone calls are permitted after 10:00 p.m.Which nursing reply is most appropriate?

A)"Go ahead and use the phone.I know this pending divorce is stressful."
B)"You know better than to break the rules.I'm surprised at you."
C)"It is after the 10:00 p.m.phone curfew.You will be able to call tomorrow."
D)"The decision to divorce should not be considered until you have had a good night's sleep."

Question 11

During an assessment interview,a client diagnosed with Antisocial Personality Disorder spits,curses,and refuses to answer questions.Which is the most appropriate nursing statement to address this behavior?

A)"You are very disrespectful.You need to learn to control yourself."
B)"I understand that you are angry,but this behavior will not be tolerated."
C)"What behaviors could you modify to improve this situation?"
D)"What antipersonality disorder medications have helped you in the past?"

Question 12

During an interview,which client statement indicates to the nurse that a potential diagnosis of Schizotypal Personality Disorder should be considered?

A)"I really don't have a problem.My family is inflexible,and every relative is out to get me."
B)"I am so excited about working with you.Have you noticed my new nail polish,'Ruby Red Roses'?"
C)"I spend all my time tending my bees.I know a whole lot of information about bees."
D)"I am getting a message from the beyond that we have been involved with each other in a previous life."

Question 13

When planning care for a client diagnosed with BPD,which self-harm behavior should the nurse expect the client to exhibit?

A)The use of highly lethal methods to commit suicide
B)The use of suicidal gestures to evoke a rescue response from others
C)The use of isolation and starvation as suicidal methods
D)The use of self-mutilation to decrease endorphins in the body

Question 14

Looking at a slightly bleeding paper cut,the client screams,"Somebody help me,quick! I'm bleeding.Call 911!" The nurse should identify this behavior as characteristic of which personality disorder?

A)Schizoid personality disorder
B)OCPD
C)Histrionic personality disorder
D)Paranoid personality disorder

Question 15

A client diagnosed with Paranoid Personality Disorder becomes violent on a unit.Which nursing intervention is most appropriate?

A)Provide objective evidence that violence is unwarranted.
B)Initially restrain the client to maintain safety.
C)Use clear,calm statements and a confident physical stance.
D)Empathize with the client's paranoid perceptions.

Question 16

Which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with BPD?

A)Being firm,consistent,and empathetic,while addressing specific client behaviors
B)Promoting client self-expression by implementing laissez-faire leadership
C)Using authoritative leadership to help clients learn to conform to societal norms
D)Overlooking inappropriate behaviors to avoid promoting secondary gains

Question 17

Which reaction to a compliment from another client should the nurse identify as a typical response from a client diagnosed with Avoidant Personality Disorder?

A)Interpreting the compliment as a secret code used to increase personal power
B)Feeling the compliment was well deserved
C)Being grateful for the compliment but fearing later rejection and humiliation
D)Wondering what deep meaning and purpose are attached to the compliment

Question 18

Family members of a client ask the nurse to explain the difference between schizoid and avoidant personality disorders.Which is the appropriate nursing reply?

A)"Clients diagnosed with Avoidant Personality Disorder desire intimacy but fear it,and clients diagnosed with Schizoid Personality Disorder prefer to be alone."
B)"Clients diagnosed with Schizoid Personality Disorder exhibit odd,bizarre,and eccentric behavior,whereas clients diagnosed with Avoidant Personality Disorder do not."
C)"Clients diagnosed with Avoidant Personality Disorder are eccentric,and clients diagnosed with Schizoid Personality Disorder are dull and vacant."
D)"Clients diagnosed with Schizoid Personality Disorder have a history of psychotic thought processes,whereas clients diagnosed with Avoidant Personality Disorder remain based in reality."

Question 19

A pessimistic client expresses low self-worth,has much difficulty making decisions,avoids positions of responsibility,and has a behavioral pattern of "suffering" in silence.Which underlying cause of this client's personality disorder should the nurse recognize?

A)Nurturance was provided from many sources,and independent behaviors were encouraged.
B)Nurturance was provided exclusively from one source,and independent behaviors were discouraged.
C)Nurturance was provided exclusively from one source,and independent behaviors were encouraged.
D)Nurturance was provided from many sources,and independent behaviors were discouraged.

Question 20

Which adult client should the nurse recognize as exhibiting the characteristics of a dependent personality disorder?

A)A physically healthy client who is dependent on meeting social needs by having contact with 15 cats
B)A physically healthy client who has a history of depending on intense relationships to meet basic needs
C)A physically healthy client who lives with parents and relies on public transportation
D)A physically healthy client who is serious,inflexible,perfectionistic,and depends on rules to provide security

Question 21

Which statements represent positive outcomes for clients diagnosed with Narcissistic Personality Disorder? Select all that apply.

A)The client will relate one empathetic statement toward another client in group by day 2.
B)The client will identify one personal limitation by day 1.
C)The client will acknowledge one strength that another client possesses by day 2.
D)The client will list four personal strengths by day 3.
E)The client will list two lifetime achievements by discharge.

Question 22

A client diagnosed with cluster C traits sits alone and ignores other's attempts to converse.When asked to join a group,the client states,"No,thanks." In this situation,which initial nursing diagnosis should the nurse assign?

A)Fear R/T hospitalization
B)Social isolation R/T poor self-esteem
C)Risk for suicide R/T to hopelessness
D)Powerlessness R/T dependence issues

Question 23

The nurse plans to confront a client about secondary gains related to extreme dependency on her spouse.Which nursing statement would be most appropriate?

A)"Do you believe dependency issues have been a lifelong concern for you?"
B)"Have you noticed any anxiety during times when your husband makes decisions?"
C)"What do you know about individuals who depend on others for direction?"
D)"How have the specifics of your relationship with your spouse benefited you?"

Question 24

Natalia is admitted to an inpatient psychiatric unit with the diagnosis of Paranoid Personality Disorder.Which statement made by Natalia to the nurse enforces Natalia's diagnosis? Select all that apply.

A)"It isn't my fault that I have a temper.I inherited it from my abusive father."
B)"I could have gone to nursing school like you but I never had good science teachers who believed in me."
C)"My roommate doesn't talk to me unless she wants something."
D)"I like group therapy because the other patients can feel my feelings and relate to me."
E)"I don't like the unit rules and aren't going to follow them.They don't apply to me."

Question 25

The nurse is caring for a group of clients within the DSM-5 cluster B category of personality disorders.Which factors should the nurse consider when planning client care? Select all that apply.

A)These clients have personality traits that are deeply ingrained and difficult to modify.
B)These clients need medications to treat the underlying physiological pathology.
C)These clients use manipulation,making the implementation of treatment problematic.
D)These clients have poor impulse control that hinders compliance with a plan of care.
E)These clients commonly have secondary diagnoses of substance abuse and depression.

Question 26

The nurse should recognize which factors that distinguish personality disorders from psychosis?

A)Functioning is more limited in personality disorders than in psychosis.
B)Major disturbances of thought are absent in personality disorders.
C)Personality disordered clients require hospitalization more frequently.
D)Personality disorders do not affect family relationships as much as psychosis does.

Question 27

The nurse would expect a client diagnosed with Schizotypal Personality Disorder to exhibit which characteristic?

A)The client has many friends and associates but prefers to interact in small groups.
B)The client has many brief but intense relationships.
C)The client experiences incorrect interpretations of external events.
D)The client exhibits lack of tender feelings toward others.

Question 28

Jillian is a patient on a psychiatric unit for medication management related to her diagnosis of BPD.The nurse evaluates Jillian's care plan and confirms Jillian has reached her outcome goals when she makes which statement? Select all that apply.

A)"I think my therapist is the best health-care professional in the world even though we didn't always see eye-to-eye."
B)"I now understand that so much of my anger is due to the beatings I sustained as a child."
C)"I had a strong urge to scratch myself yesterday,and when this happened I came looking for you."
D)"Ever since my roommate and I had that big blowout,I've avoided her.She's really selfish and isn't a good friend anyway."

Question 29

Nina is an artist who dresses in long,colorful kaftans and wears sequin and rhinestone hats.Her makeup is dramatic and her long,false fingernails are always painted a bright color.Every time Nina attends a social event,she waltzes into the room and shouts "Hello people! I have arrived." Which behavior is congruent with Nina's diagnosis? Select all that apply.

A)Nina flirts with a man significantly younger who tells her that she doesn't look or act her age.
B)Nina responds with rage when a partygoer tells her that her dress is inappropriate for the event.
C)Nina becomes anxious when the hostess of a party excuses herself from speaking with Nina to greet other guests.
D)Nina feels awkward and uncomfortable in social situations due to her fear of rejection by others.

Question 30

Monica was diagnosed with Obsessive-Compulsive Disorder several years ago and visits the outpatient mental health clinic for medication evaluation.As the nurse updates Monica's health record with new assessment data,she reviews Monica's family history.The nurse knows that Monica most likely grew up in which family environment? Select all that apply.

A)One where punishment for undesirable behaviors was frequent
B)One where positive achievements were taken for granted and seldom acknowledged
C)One where following rigid restrictions and rules was required
D)One where cleaning one's room everyday was rewarded with a treat

Question 31

Which client is the nurse most likely to admit to an inpatient facility for self-destructive behaviors?

A)A client diagnosed with Antisocial Personality Disorder
B)A client diagnosed with BPD
C)A client diagnosed with Schizoid Personality Disorder
D)A client diagnosed with Paranoid Personality Disorder

Question 32

The nurse is assisting the social worker and therapist in leading a presentation on life skills to the patients on a psychiatric unit.Jerome,who has been diagnosed with BPD,begins to threaten another patient who constantly interrupts the presentation by asking questions.As Jerome's behavior escalates,which actions should the nurse take first? Select all that apply.

A)Use a threatening tone to tell Jerome to stop the behavior or he will be sent to his room.
B)Use a calm voice to ask the other patients to leave the room.
C)Administer an injectable antipsychotic to calm Jerome.
D)Ask the social worker and therapist to alert the other staff nurses to the situation.

Question 33

While improving,a client demands to have a phone installed in the intensive care unit room.When the nurse states,"This is not allowed;it is a unit rule," the client angrily demands to see the doctor.Which approach should the nurse use in this situation?

A)Provide an explanation for the necessity of the unit rule.
B)Assist the client to discuss anger and frustrations.
C)Call the physician and relay the request.
D)Arrange for a phone to be installed in the client's unit room.

Question 34

When planning care for clients diagnosed with personality disorders,which treatment outcome should the nurse anticipate?

A)To stabilize pathology with the correct combination of medications
B)To change the characteristics of the dysfunctional personality
C)To reduce inflexibility of personality traits that interfere with functioning and relationships
D)To decrease the prevalence of neurotransmitters at receptor sites

Question 35

Which nursing statement reflects a common characteristic of a client diagnosed with Paranoid Personality Disorder?

A)"This client consistently criticizes care and has difficulty getting along with others."
B)"This client is shy and fades into the background."
C)"This client expects special treatment,and setting limits will be necessary."
D)"This client is expressive during group and is very pleased with self."

Question 36

Which statement regarding antisocial personality disorder is true? Select all that apply.

A)Antisocial personality disorder is more common in men than in women and among the lower socioeconomic classes.
B)Patients with antisocial personality disorder have difficulty maintaining relationships and remaining employed.
C)As children,patients with antisocial personality disorder escaped to an inner world where they could avoid reality.
D)Patients with antisocial personality disorder are impulsive and self-destructive.

Question 37

When a client on an acute care psychiatric unit demonstrates behaviors and verbalizations indicating a lack of guilt feelings,which nursing intervention would help the client to meet desired outcomes?

A)Provide external limits on client behavior.
B)Foster discussions of rationales for behavioral change.
C)Implement interventions consistently by only one staff member.
D)Encourage the client to involve self in care.

Question 38

A client exhibits dependency on staff and peers and expresses fear of abandonment.Using Mahler's theory of object relations,which should the nurse expect to note in this client's childhood?

A)Lack of fulfillment of basic needs by parental figures
B)Absence of the client's maternal figure during symbiosis
C)Difficulty establishing trust with the maternal figure
D)Inconsistency by the maternal figure during individuation

Question 39

Which characteristics should the nurse recognize as being exhibited by individuals diagnosed with any personality disorder?

A)These clients accept and are comfortable with their altered behaviors.
B)These clients understand that their altered behaviors result from anxiety.
C)These clients seek treatment to avoid interpersonal discomfort.
D)These clients avoid relationships due to past negative experiences.

Question 40

Which client statement would demonstrate a common characteristic of a cluster B personality disorder?

A)"I wish someone would make that decision for me."
B)"I built this building by using materials from outer space."
C)"I'm afraid to go to group because it is crowded with people."
D)"I didn't have the money for the ring,so I just took it."

Question 41

Max is diagnosed with BPD.One of Max's current defensive mechanisms is to engage in suicidal ideation when he feels threatened.The type of therapy that will most benefit Max is ______________ ______________ therapy.

Question 42

Jamal is a young adult who has been arrested for several petty crimes in the past.Recently,Jamal was arrested for physically assaulting a patron in a bar after they exchanged aggressive words.Upon evaluation,Jamal is diagnosed with Antisocial Personality Disorder.The nurse caring for Jamal includes the nursing diagnosis risk for other-directed violence in Jamal's care plan.Which nursing intervention is most appropriate for Jamal? Select all that apply.

A)Keeping all promises made to Jamal
B)Turning down Jamal's light after care is completed
C)Explaining to Jamal the punishment he will receive if he doesn't obey all unit rules
D)Encouraging Jamal to exercise when he becomes frustrated

Question 43

Roger displays emotional dysregulation,impulsive behavior,and aggressive symptoms.He is diagnosed with BPD.The most effective pharmacotherapy for Max is _______________ agents.

Question 44

Kimberly is diagnosed with Antisocial Behavior Disorder.Kimberly's grandiosity,denial of obvious weaknesses,and projection of blame onto others is an example of a _________ coping strategy.