Deck 24: Personality Disorders

Question 1

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

A) Self-mutilation
B) Impaired skin integrity
C) Risk for injury
D) Powerlessness

Answer 1

Self-mutilation

Question 2

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

A) seductive.
B) detached.
C) manipulative.
D) guilt-producing.

Answer 2

manipulative.

Question 3

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

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

Answer 3

Maintaining consistent limits

Question 4

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) Benzodiazepine
B) Mood stabilizing medication
C) Monoamine oxidase inhibitor (MAOI)
D) Cholinesterase inhibitor

Question 5

The history shows that a newly admitted patient is impulsive. The nurse would expect behavior characterized by

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 6

A person's spouse filed charges after repeatedly being battered. The person sarcastically says, "I'm sorry for what I did. I need psychiatric help." 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."

Question 7

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 behavioral change."

Question 8

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

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

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 patient to discuss feelings of fear and inferiority.
C) Provide negative reinforcement for acting-out behavior.
D) Ignore, rather than confront, inappropriate behavior.

Question 10

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

A) identify when feeling angry.
B) use manipulation only to get legitimate needs met.
C) acknowledge manipulative behavior when it is called to his or her attention.
D) accept fulfillment of his or her requests within an hour rather than immediately.

Question 11

As a nurse prepares to administer medication to a patient diagnosed with a 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 12

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

Question 13

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 show

A) shame.
B) suspiciousness.
C) superficial remorse.
D) lack of guilt feelings.

Question 14

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 behavior.

Question 15

A nurse reports to the treatment team that a patient diagnosed with an antisocial personality disorder has displayed the behaviors below. This patient is detached and superficial during counseling sessions. Which behavior 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 counseling

Question 16

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 17

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

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 antianxiety medication to decrease the anxiety level.

Question 18

For which behavior would limit setting be most essential? The patient who

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

Question 19

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

Question 20

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

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.

Question 21

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 22

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

A) affable, generous.
B) perfectionist, inflexible.
C) suspicious, holds grudges.
D) dramatic speech, impulsive.

Question 23

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

Question 24

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

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

Question 25

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

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 26

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

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 27

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 28

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 29

A nursing diagnosis appropriate to consider for a patient diagnosed with any of the personality disorders is

A) nonadherence.
B) impaired social interaction.
C) disturbed personal identity.
D) diversional activity deficit.

Question 30

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 31

A nurse set limits while interacting with a patient demonstrating behaviors 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

A) denial.
B) splitting.
C) defensive.
D) reaction formation.

Question 32

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