Deck 20: Personality Disorders

Question 1

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

A) A benzodiazepine
B) A mood-stabilizing medication
C) A monoamine oxidase inhibitor (MAOI)
D) A serotonin norepinephrine reuptake inhibitor (SNRI)

Answer 1

A mood-stabilizing medication

Question 2

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 behaviour?

A) Narcissistic
B) Histrionic
C) Avoidant
D) Paranoid

Answer 2

Avoidant

Question 3

What is the priority nursing diagnosis for a patient 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 3

Risk for other-directed violence

Question 4

As a nurse prepares to administer medication to a patient diagnosed with borderline personality disorder, the patient 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 patient. Leave the medication on the table as requested.
B) Respond to the patient, "I'm worried that you might not take it. I'll come back later."
C) Say to the patient, "I must watch you take the medication. Please take it now."
D) Ask the patient, "Why don't you want to take your medication now?"

Question 5

What is an appropriate initial outcome for a patient diagnosed with a personality disorder who has impulse control interferences?

A) The patient will identify when feeling angry.
B) The patient will use impulsive behaviours only to get legitimate needs met.
C) The patient will identify harmful impulsive behaviours.
D) The patient will accept fulfillment of his or her requests within an hour rather than immediately.

Question 6

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

A) Ensure limits are adhered to by all staff.
B) Encourage the patient to discuss feelings of fear and inferiority.
C) Provide negative reinforcement for acting-out behaviour.
D) Ignore, rather than confront, inappropriate behaviour.

Question 7

When a patient 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 patient'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 patient's behaviour.

Question 8

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

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

Question 9

One month ago, a patient diagnosed with borderline personality disorder and a history of self-mutilation began dialectical behaviour therapy. Today, the patient phones to say, "I feel empty and want to hurt myself." What should the nurse do?

A) Arrange for emergency inpatient hospitalization.
B) Send the patient to the crisis intervention unit for 8 to 12 hours.
C) Assist the patient to choose coping strategies for triggering situations.
D) Advise the patient to take an anti-anxiety medication to decrease the anxiety level.

Question 10

Which statement made by a patient 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."

Question 11

A patient diagnosed with borderline personality disorder was hospitalized several times after self-mutilating episodes. The patient remains impulsive. Which nursing diagnosis is the initial focus of this therapy?

A) Risk for self-directed violence
B) Impaired skin integrity
C) Risk for injury
D) Powerlessness

Question 12

A patient says, "I get in trouble sometimes because I make quick decisions and act on them." Select 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 behavioural change."

Question 13

Which personality dimension is reflective of the behaviours of absorption, dissociation, eccentricity, openness to experience, and perceptual cognitive distortion?

A) Emotional dysregulation versus emotional stability
B) Constraint versus impulsivity
C) Antagonism versus compliance
D) Unconventionality versus closedness to experience

Question 14

A nurse reports to the treatment team that a patient diagnosed with antisocial personality disorder has displayed the behaviours below. This patient is detached and superficial during counselling sessions. Which behaviour by the patient most clearly warrants limit setting?

A) Flattering the nurse
B) Lying to other patients
C) Verbal abuse of another patient
D) Detached superficiality during counselling

Question 15

The nurse caring for an individual demonstrating symptoms of schizotypal personality disorder would expect assessment findings to include which of the following?

A) Arrogant, grandiose, and a sense of self-importance
B) Attention-seeking, melodramatic, and flirtatious
C) Impulsive, restless, socially aggressive behaviour
D) Socially anxious, rambling stories, peculiar ideas

Question 16

A patient's spouse filed charges after repeatedly being battered. The patient sarcastically says, "I'm sorry for what I did. I need psychiatric help." Which statement by the patient supports 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 behaviour has hurt my family."
D) "I hit because I am tired of being nagged. My spouse deserves the beating."

Question 17

For which behaviour would limit setting be most essential?

A) The patient who clings to the nurse and asks for advice about inconsequential matters
B) The patient who is flirtatious and provocative with staff members of the opposite sex
C) The patient who is hypervigilant and refuses to attend unit activities
D) The patient who urges a suspicious patient to hit anyone who stares

Question 18

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

A) Supporting behavioural change
B) Maintaining consistent limits
C) Monitoring suicide attempts
D) Using aversive therapy

Question 19

The history shows that a newly admitted patient is impulsive. The nurse would expect behaviour to be characterized by which of the following?

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

Question 20

Consider this comment to three different nurses by a patient diagnosed with antisocial personality disorder. "Another nurse said you don't do your job right." Collectively, these interactions can be assessed as which of the following?

A) Seductive
B) Detached
C) Manipulative
D) Guilt-producing

Question 21

Which personality traits are most likely to be documented regarding a patient demonstrating characteristics of an obsessive-compulsive personality disorder?

A) Affable, generous
B) Perfectionist, inflexible
C) Suspicious, holds grudges
D) Dramatic speech, impulsive

Question 22

Which of the following nursing diagnoses is appropriate to consider for a patient diagnosed with any of the personality disorders?

A) Noncompliance
B) Impaired social interaction
C) Disturbed personal identity
D) Diversional activity deficit

Question 23

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

A) Respect the patient's need for periods of social isolation.
B) Prevent the patient from violating the nurse's rights.
C) Teach the patient how to select clothing for outings.
D) Engage the patient in community activities.

Question 24

A patient diagnosed with borderline personality disorder self-inflicted wrist lacerations after gaining new privileges on the unit. In this case, the self-mutilation may have been due to which of the following?

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

Question 25

A new psychiatric technician says, "Schizophrenia . . . schizotypal! What's the difference?" The nurse's response should include which information?

A) A patient diagnosed with schizophrenia is not usually overtly psychotic.
B) In schizotypal personality disorder, the patient 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.

Question 26

A nurse determines desired outcomes for a patient diagnosed with schizotypal personality disorder. Select the best outcome.

A) The patient will adhere willingly to unit norms.
B) The patient will report decreased incidence of self-mutilative thoughts.
C) The patient will demonstrate fewer attempts at splitting or manipulating staff.
D) The patient will demonstrate the ability to introduce self to a stranger in a social situation.

Question 27

A patient 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 patients 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."

Question 28

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

A) Reclusive behaviour
B) Callous attitude
C) Perfectionism
D) Aggression
E) Clinginess

Question 29

A nurse set limits while interacting with a patient demonstrating behaviours associated with borderline personality disorder. The patient 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 assessed as which of the following?

A) Denial
B) Splitting
C) Defensive
D) Reaction formation

Question 30

For which patients 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

Question 31

A patient diagnosed with borderline personality disorder has self-inflicted wrist lacerations. The health care provider prescribes daily dressing changes. The nurse performing this care should do which of the following?

A) Maintain a stern and authoritarian affect
B) Provide care in a matter-of-fact manner
C) Encourage the patient to express anger
D) Be very rigid and challenging

Question 32

Which characteristic of personality disorders makes it most necessary for staff to schedule frequent team meetings in order to address the patient'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