Deck 13: Personality Disorders

Question 1

When preparing to interview a patient 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.

Answer 1

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

Question 2

A patient with borderline personality disorder has a history of self-mutilation and suicide attempts.The patient reveals feelings of depression and anger with life.The psychiatrist suggests the use of a medication.Which type of medication should the nurse expect?

A)Selective serotonin reuptake inhibitor (SSRI)
B)Monoamine oxidase inhibitor (MAOI)
C)Benzodiazepine
D)Antipsychotic

Answer 2

Selective serotonin reuptake inhibitor (SSRI)

Question 3

A patient with borderline personality disorder and a history of self-mutilation has now begun dialectical behavior therapy on an outpatient basis.Counseling focuses on self-harm behavior management.Today the patient telephones to say,"I'm feeling empty and want to cut 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 identify the trigger situation and choose a coping strategy.
D)advise the patient to take an antianxiety medication to decrease the anxiety level.

Answer 3

assist the patient to identify the trigger situation and choose a coping strategy.

Question 4

Which statement made by a patient 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 hate my doctor for not giving me what I ask for."
D)"I felt empty and wanted to cut myself,so I called you."

Question 5

When a patient with a personality disorder uses manipulation to get his or her needs met,the staff decides to apply 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 while internal controls are developed.
D)Anxiety is reduced when staff members assume responsibility for the patient's behavior.

Question 6

What is an appropriate initial outcome for a patient 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 7

A physical therapist recently convicted of multiple counts of Medicare fraud says to a nurse,"Sure I overbilled.Why not? Everyone takes advantage of the government.They have so many rules;no one can follow them." These statements show:

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

Question 8

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

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

Question 9

The most challenging nursing intervention with patients with personality disorders who use manipulation to get their needs met is:

A)supporting behavioral change.
B)monitoring suicide attempts.
C)maintaining consistent limits.
D)using aversive therapy.

Question 10

A nurse reports to the interdisciplinary team that a patient with an antisocial personality disorder lies to other patients,verbally abuses a patient with dementia,and flatters the primary nurse.This patient is detached and superficial during counseling sessions.Which behavior 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 11

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

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 12

As a nurse prepares to administer a medication to a patient 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 13

Which intervention is appropriate for a patient with an antisocial personality disorder who frequently manipulates others?

A)Refer the patient's requests and questions related to care to the case manager.
B)Encourage the patient to discuss his or her feelings of fear and inferiority.
C)Provide negative reinforcement for acting-out behavior.
D)Ignore,rather than confront,inappropriate behavior.

Question 14

A patient with borderline personality disorder is hospitalized several times after self-mutilating episodes.The patient remains impulsive.Dialectical behavior therapy starts on an outpatient basis.Which nursing diagnosis is the focus of this therapy?

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

Question 15

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

A)Disturbed sensory perception-auditory
B)Risk for other-directed violence
C)Ineffective denial
D)Ineffective coping

Question 16

A patient tells a nurse,"I sometimes get into trouble because I make quick decisions and act on them." A therapeutic response would be:

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'll bet you have some interesting stories to share about overreacting."
D)"It's good that you're showing readiness for behavioral change."

Question 17

A patient's spouse filed charges of battery.The patient says,"I'm sorry for what I did.I need psychiatric help." The patient has a long history of acting-out behaviors and several arrests.Which statement by the patient suggests 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'm tired of being nagged.My spouse deserves the beating."

Question 18

Consider these comments to three different nurses by a patient with an antisocial personality disorder: "You're a better nurse than the day shift nurse said you were";"Another nurse said you don't do your job right";"You think you're perfect,but I've seen you make three mistakes." Collectively,these interactions can be assessed as:

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

Question 19

The history shows that a newly admitted patient has impulsivity.The nurse would expect behavior characterized by:

A)adherence to a strict moral code.
B)manipulative,controlling strategies.
C)postponing gratification to an appropriate time.
D)little time elapsed between thought and action.

Question 20

A nurse in the emergency department tells an adult,"Your mother had a severe stroke." The adult tearfully says,"Who will take care of me now? My mother always told me what to do,what to wear,and what to eat.I need someone to reassure me when I get anxious." Which term best describes this behavior?

A)Histrionic
B)Dependent
C)Narcissistic
D)Borderline

Question 21

A nurse plans the 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

Question 22

Which characteristic of individuals with personality disorders makes it most necessary for staff to schedule frequent meetings?

A)Ability to achieve true intimacy
B)Flexibility and adaptability to stress
C)Ability to evoke interpersonal conflict
D)Inability to develop trusting relationships

Question 23

What is the priority intervention for a nurse beginning to work with a patient 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)Engage the patient in many community activities.
D)Teach the patient how to match clothing.

Question 24

A nurse set limits for a patient with a 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 mistaken.You're terrible." This outburst can be assessed as:

A)denial.
B)splitting.
C)reaction formation.
D)separation-individuation strategies.

Question 25

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

A)Obsessive-compulsive
B)Antisocial
C)Dependent
D)Schizotypal
E)Narcissistic

Question 26

A patient with borderline personality disorder self-inflicted wrist lacerations after gaining new privileges on the unit.The cause of the self-mutilation is probably related to:

A)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)constitutional inability to regulate affect,predisposing to psychic disorganization
D)fear of abandonment associated with progress toward autonomy and independence

Question 27

Which commonality would be most applicable to the patient with a personality disorder? The patient:

A)demonstrates behaviors that cause distress to self rather than to others.
B)has self-esteem issues,despite his or her outward presentation.
C)usually becomes psychotic when exposed to stress.
D)does not experience real distress from symptoms.

Question 28

A patient with borderline personality disorder has self-inflicted wrist lacerations.The health care provider prescribes daily dressing changes.The nurse performing this care should:

A)encourage the patient to express anger.
B)provide care in a matter-of-fact manner.
C)be very kind,sympathetic,and concerned.
D)offer to listen to the patient's feelings about cutting.