FINAL - Chapter 24 - Personality Disorders NCLEX

FINAL - Chapter 24 - Personality Disorders NCLEX Social SciencesPsychologyClinical Psychology jhess214 Save NCLEX Personality Disorders questi...14 terms BuckeyesRN77 Preview

Mental Health: Mostly Personality D...

25 terms nelvehjemPreview Personality Disorder Practice Questi...15 terms melissahanley Preview Anxiety 30 terms gra 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?

• "You are very disrespectful. You need to learn to control yourself."
• "I understand that you are angry, but this behavior will not be tolerated."
• "What behaviors could you modify to improve this situation?"
• "What anti-personality-disorder medications have helped you in the past?"

ANS: B

The appropriate nursing statement is to reflect the client's feeling while setting firm limits on behavior. Clients diagnosed with antisocial personality disorder have a low tolerance for frustration, see themselves as victims, and use projection as a primary ego defense mechanism.Antidepressants and anxiolytics are used for symptom relief; however, there are no specific medications targeted for the diagnosis of a personality disorder.A client diagnosed with antisocial personality disorder comes to a 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?

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

ANS: C

The most appropriate response by the staff is to restate the unit rules in a calm, assertive manner. Because of the probability of manipulative behavior in this client population, it is imperative to maintain consistent application of rules.

A client diagnosed with paranoid personality disorder becomes violent on a unit. Which nursing intervention is most appropriate?

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

ANS: C

The most appropriate nursing intervention is to use clear, calm statements and to assume a confident physical stance. A calm attitude avoids escalating the aggressive behavior and provides the client with a feeling of safety and security. It may also be beneficial to have sufficient staff on hand to present a show of strength.A highly emotional client presents at an outpatient clinic appointment wearing flamboyant attire, spiked heels, and theatrical makeup. Which personality disorder should a nurse associate with this assessment data?

• Compulsive personality disorder
• Schizotypal personality disorder
• Histrionic personality disorder
• Manic personality disorder

ANS: C

The nurse should associate histrionic personality disorder with this assessment data. Individuals diagnosed with histrionic personality disorder tend to be self-dramatizing, attention seeking, overly gregarious, and seductive. They often use manipulation and exhibitionism as a means of gaining attention.A client diagnosed with borderline personality disorder brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the nursing staff best handle this situation?

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

ANS: B

The nursing staff can best handle this situation by maintaining consistency of care by open communication to avoid staff manipulation. Clients diagnosed with borderline personality disorder can exhibit negative patterns of interaction such as clinging and distancing, splitting, manipulation, and self-destructive behaviors.Which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with borderline personality disorder?

• Being firm, consistent, and empathic, while addressing specific client behaviors
• Promoting client self-expression by implementing laissez-faire leadership
• Using authoritative leadership to help clients learn to conform to society norms
• Overlooking inappropriate behaviors to avoid promoting secondary gains

ANS: A

The best nursing approach when working with a client diagnosed with borderline personality disorder is to be firm, consistent, and empathetic while addressing specific client behaviors. Individuals diagnosed with borderline personality disorder always seem to be in a state of crisis and can often have negative patterns of interaction such as manipulation and splitting.

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

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

ANS: C

A physically healthy adult client who lives with parents and relies on public transportation exhibits signs of dependent personality disorder.Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior.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 a nurse recognize?

• "Nurturance was provided from many sources, and independent behaviors were encouraged."
• "Nurturance was provided exclusively from one source, and independent behaviors were discouraged."
• "Nurturance was provided exclusively from one source, and independent behaviors were encouraged."
• "Nurturance was provided from many sources, and independent behaviors were discouraged."

ANS: B

Nurturance provided from one source and discouragement of independent behaviors can attribute to the etiology of dependent personality disorder. Dependent behaviors may be rewarded by a parent who is overprotective and discourages autonomy.Family members of a client ask a nurse to explain the difference between schizoid and avoidant personality disorders. Which is the appropriate nursing reply?

• "Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder

prefer to be alone."

• "Clients diagnosed with schizoid personality disorder exhibit odd, bizarre, and eccentric behavior, while clients diagnosed with avoidant

personality disorder do not."

• "Clients diagnosed with avoidant personality disorder are eccentric, and clients diagnosed with schizoid personality disorder are dull and

vacant."

• "Clients diagnosed with schizoid personality disorder have a history of psychotic thought processes, while clients diagnosed with avoidant

personality disorder remain based in reality."

ANS: A

The nurse should educate the family that clients diagnosed with avoidant personality disorder desire intimacy but fear it, while clients diagnosed with schizoid personality disorder prefer to be alone. Avoidant personality disorder is characterized by an extreme sensitivity to rejection which leads to social isolation. Schizoid personality disorder is characterized by a profound deficit in the ability to form personal relationships.During an interview, which client statement indicates to a nurse that a potential diagnosis of schizotypal personality disorder should be considered?

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

ANS: D

The nurse should assess that a client who states that he or she is getting a message from the beyond indicates a potential diagnosis of schizotypal personality disorder. Individuals with schizotypal personality disorder are aloof and isolated and behave in a bland and apathetic manner. The individual experiences magical thinking, ideas of reference, illusions, and depersonalization as part of daily life.

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?

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

ANS: B

The instructor should evaluate that learning has occurred when the student describes clients diagnosed with histrionic personality disorder as having shallow, fleeting interpersonal relationships that serve their dependency needs. Histrionic personality disorder is characterized by colorful, dramatic, and extroverted behavior. These individuals also have difficulty maintaining long-lasting relationships.Which nursing diagnosis should a nurse identify as appropriate when working with a client diagnosed with schizoid personality disorder?

• Altered thought processes R/T increased stress
• Risk for suicide R/T loneliness

C. Risk for violence: directed toward others R/T paranoid thinking

• Social isolation R/T inability to relate to others

ANS: D

An appropriate nursing diagnosis when working with a client diagnosed with schizoid personality disorder is social isolation R/T inability to relate to others. Clients diagnosed with schizoid personality disorder appear cold, aloof, and indifferent to others. They prefer to work in isolation and are unsociable.When planning care for a client diagnosed with borderline personality disorder, which self-harm behavior should a nurse expect the client to exhibit?

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

ANS: B

The nurse should expect that a client diagnosed with borderline personality disorder might use suicidal gestures to evoke a rescue response from others. Repetitive, self-mutilative behaviors are common in clients diagnosed with borderline personality disorders. These behaviors are generated by feelings of abandonment following separation from significant others.Which client situation should a nurse identify as reflective of the impulsive behavior that is commonly associated with borderline personality disorder?

• 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."
• 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."
• 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."
• 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."

ANS: D

The client who states, "I cut myself because you are leaving me" reflects impulsive behavior that is commonly associated with the diagnosis of borderline personality disorder. Repetitive, self-mutilative behaviors are common and are generated by feelings of abandonment following separation from significant others.