Deck 21: Social Responses and Personality Disorders

Question 1

A patient with borderline personality disorder tells the nurse,"When I met my boyfriend he was simply perfect.Now he is the worst person in the world.I tell him to leave and then I feel so empty and awful that I have to cut myself." The description of the boyfriend is strongly influenced by the patient's inclination to:

A) use splitting.
B) be attention-seeking.
C) display antisocial tendencies.
D) suffer from a formal thought disorder.

Answer 1

use splitting.

Question 2

The majority of the treatment team maintains that a patient diagnosed with antisocial personality disorder needs external limits and careful observation,however two nurses state,"The patient is really a pleasant person.We shouldn't be so judgmental." The most likely reason for the difference in staff opinions is that the patient has been using which coping mechanisms?

A) Idealization and devaluation
B) Projection and rationalization
C) Splitting and projective identification
D) Reaction formation and identification

Answer 2

Splitting and projective identification

Question 3

Which statement best describes persons with personality disorders?

A) The patient's coping skills are severely impaired by cognitive impairment.
B) The patient's maladaptive behaviors involve only a single aspect of personality.
C) The patient has enduring ways of relating that often provoke negative reactions.
D) The patient has considerable resilience when faced with stressful life situations.

Answer 3

The patient has enduring ways of relating that often provoke negative reactions.

Question 4

Before the community meeting,a patient with antisocial personality disorder was overheard coaching other patients to strongly object to the "no smoking" policy.Which response would be most characteristic of this patient when approached by staff members who wish to discuss the behavior?

A) "I knew they'd mess this up. I've learned to speak for myself in the future."
B) "Hey, it's not my fault. They object to you people running this place like a jail."
C) "I think the patients and staff should talk about the rules and negotiate some changes."
D) "I've learned something valuable from this. We'll talk about this in my therapy session."

Question 5

The relationships of patients with borderline and narcissistic personality disorders move through predictable stages.Initially there is idealization and overvaluation of the object and then disappointment when unrealistic needs are not met.The nurse can predict that the final stages will be:

A) devaluation and rejection of the object.
B) forgiveness and reinvestment in the object.
C) reaction formation to the object and distancing.
D) projection and incorporation of the object into a delusion.

Question 6

Which behavior would be most characteristic of a person diagnosed with an antisocial personality disorder?

A) The individual pleads guilty to the crime, shows remorse, and develops symptoms of severe depression after realizing the impact of the crime on family members.
B) After being convicted of a felony, the individual serves a jail sentence, becomes repentant, and then never commits another crime.
C) When apprehended for committing a crime, the individual withdraws from contacts and remains mute and unresponsive.
D) After committing a crime, the individual persuades the judge to suspend the sentence but later violates probation.

Question 7

Which behavior would be most characteristic of an individual with narcissistic personality disorder?

A) A lifelong pattern of social withdrawal
B) Refusal to enter into relationships for fear of rejection
C) Belief in entitlement to special privileges that others may not have
D) Belief in possessing the ability to know what others are thinking

Question 8

A nursing diagnosis appropriate to consider for a patient with antisocial personality disorder is:

A) risk for self-directed injury.
B) impaired social interaction.
C) disturbed personal identity.
D) disturbed sensory perception.

Question 9

Which comment about relationships would be most characteristic of a patient with antisocial personality disorder?

A) "The only reason for interacting is to take advantage of others."
B) "'Live and let live' is as good a philosophy as any to live by."
C) "I've always found that 'help one another' is a good policy."
D) "I'll be your doormat. Feel free to take advantage of me."

Question 10

A nurse has become the focus of projective identification by the patient.The greatest risk to the nurse-patient relationship is that the nurse will become:

A) afraid to be alone with the patient.
B) prejudicial and biased against the patient.
C) overly strict and inflexible regarding patient expectations.
D) unable to effectively place limits on the patient's behaviors.

Question 11

A patient with borderline personality disorder tells the nurse,"When my sister got married and had a baby,she ignored me and I got so angry with her because she is so inattentive to my needs." The patient's sense of entitlement to her sister's attention is consistent with:

A) impulsivity.
B) narcissism.
C) magical thinking.
D) passive aggression.

Question 12

Milieu work with patients with personality disorders is most effective when it:

A) focuses on interactional behaviors in the here and now.
B) facilitates a process of delving into the patient's early childhood.
C) provides strict structure to compensate for a lack of personal boundaries.
D) promotes regression to help the patient work through earlier conflicts.

Question 13

Which characteristic exhibited by an individual diagnosed with a personality disorder makes it advisable to schedule frequent staff meetings with the patient as the focus? The patient tends to:

A) manipulate to circumvent established limits.
B) become introverted when in a group of peers.
C) rapidly and successfully adapt to internal stress.
D) develop same-gender interdependent relationships.

Question 14

To assist in diagnosing a patient suspected of being impulsive,the nurse would have to see behavior that:

A) exhibits self-depreciation.
B) inflexibly adheres to a strict moral code.
C) uses manipulative, controlling strategies.
D) shows an inability to formulate realistic plans.

Question 15

A patient regularly uses manipulation to control situations.Staff working to reduce this behavior should first convey the message that:

A) while the patient is accepted, the behavior is rejected as inappropriate.
B) if the patient cannot control the behavior, staff will establish external controls.
C) manipulative behavior results in frustration and anger among staff and patients.
D) manipulation of patients is no more acceptable than manipulation of unit staff.

Question 16

A patient with a personality disorder tells a nurse,"What do you say we cancel the therapy today and watch a good movie?" Which reply by the nurse is most therapeutic?

A) "Don't be manipulative."
B) "This isn't a social occasion."
C) "You'd rather not work on your problems today?"
D) "You know our time together has to be spent problem solving."

Question 17

After caring for a patient with a personality disorder the nurse states,"At first I thought this was such a nice person.Now I realize it's like working with the devil." The two different views held by the nurse are most likely the result of:

A) countertransference.
B) lack of emotional self-control.
C) objective assessment of the patient.
D) inability of the patient to profit from therapy.

Question 18

A patient tells a nurse about being in a relationship with a significant other for more than 1 year and states,"the person is available when I need support,but neither of us tries to control the other." The nurse can correctly assess this relationship as:

A) narcissistic.
B) enmeshed.
C) disconnected.
D) interdependent.

Question 19

A patient with a personality disorder has shared with staff that family members have acted cruelly while at the same time telling the family about receiving indifferent care from staff members.This behavior is identified as the patient's attempt to:

A) learn how much acting out will be tolerated by the unit's staff.
B) align family and staff to maximize efforts for patient behavioral change.
C) seek a structured, therapeutic environment while internal controls are being developed.
D) create family-staff conflict, thus diverting focus from the patient's need for self-examination.

Question 20

An admission note describes a patient as being "lively,excessively emotional,attention seeking,and superficial." The patient's history reveals stormy relationships with friends and lovers.The patient only seems comfortable when the focus of attention and becomes anxious when the focus changes.The nurse anticipates that the DSM-IV-TR diagnosis that is being considered is _____ personality disorder.

A) paranoid
B) antisocial
C) histrionic
D) obsessive-compulsive

Question 21

The nurse is caring for a patient diagnosed with borderline personality disorder who cut both forearms after learning that the psychiatrist was going on vacation.While changing the dressing daily,it would be advisable for the nurse to:

A) express sympathy and concern.
B) maintain a matter-of-fact attitude.
C) encourage discussion of the self-mutilation.
D) reassure the patient by stating, "I will not abandon you."

Question 22

A goal for a patient with impulsive behavior is "The patient will explore the causes and consequences of impulsive behavior." A strategy that will best assist the patient in achieving this goal is:

A) using rewards for appropriate behavior.
B) using relaxation exercises to reduce interpersonal anxiety.
C) keeping a diary to describe events before and after the behavior.
D) frequent clinical supervision for the nurse providing therapy for the patient.

Question 23

The frustration of caring for a patient who displays maladaptive social responses such as manipulation,impulsivity,and self-mutilation can be most effectively managed when staff members:

A) focus on patient strengths.
B) are watchful about patient limits.
C) rely on the milieu to prompt responsible behavior.
D) are experienced enough to ignore feelings of frustration.

Question 24

The care plan for a patient with a personality disorder contains the following interventions: demonstrate accessibility,maintain confidentiality,and maintain consistent behavior by all nursing staff.The goal of these interventions is the:

A) patient's serotonin levels will stabilize.
B) patient will not engage in self-mutilation.
C) patient will participate in therapeutic nurse-patient relationships.
D) patient will not use manipulation as a way of relating to staff and family.

Question 25

A nurse working with a patient diagnosed with borderline personality disorder will need to consider therapeutic strategies for which likely patient characteristics? (Select all that apply.)

A) Unpredictable mood shifts
B) A strong sense of interdependence
C) Impulsivity that leads to extreme risk taking
D) Tendency to overreact to even minor criticism
E) Hallucinations that may be either visual or auditory

Question 26

A nursing diagnosis that would be appropriate to consider for any patient with a personality disorder is:

A) anxiety.
B) risk for self-mutilation.
C) disturbed thought processes.
D) impaired social interaction.