Personality Disorders NCLEX

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Mental Health: Mostly Personality D...

25 terms nelvehjemPreview NCLEX 83 terms Sal1 During an assessment interview, a client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions. Which is the appropriate nursing response to 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?

• ~ The appropriate nursing response is to reflect the clients 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.Define egosyntonicIn psychoanalysis, egosyntonic refers to the behaviors, values, and feelings that are in harmony with or acceptable to the needs and goals of the ego, or consistent with one's ideal self-image.Define egodystonicEgodystonic (or ego alien) is the opposite, referring to thoughts and behaviors (dreams, compulsions, desires, etc.) that are in conflict, or dissonant, with the needs and goals of the ego, or, further, in conflict with a person's ideal self-image.

At 11:00 p.m. a client diagnosed with antisocial personality

disorder demands to phone a lawyer to file for a divorce.Unit rules state that no phone calls are permitted after

10:00 p.m. Which nursing response 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.

3. It is after the 10:00 p.m. phone curfew. You will be able

to call tomorrow.

• A divorce shouldn't be considered until you have had a

good nights sleep.

• ~ The most appropriate response by the staff is to restate the unit rules in a

calm, assertive manner. The nurse can encourage the client to verbalize frustration while maintaining an accepting attitude. The nurse may also help the client to identify the true source of frustration.A client diagnosed with paranoid personality disorder becomes violent on a unit. Which nursing intervention is most appropriate?

• Provide objective evidence that reasons for violence

are unwarranted.

• Initially restrain the client to maintain safety.
• Use clear, calm statements and a confident physical

stance.

• Empathize with the clients paranoid perceptions.
• ~ The most appropriate nursing intervention is to use clear, calm statements and

to assume a confident physical stance. A calm attitude 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 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.

• ~ The nursing staff can best handle this situation by maintaining consistency of

care by open communication to avoid staff manipulation. Clients 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

providing secondary gains

• ~ 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 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 &

depends on public transportation

• A physically healthy client who is serious, inflexible,

perfectionistic, lacks spontaneity & depends on rules to provide security

• ~ A physically healthy adult client who lives with parents and depends 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 behaviors.A client expresses low self-worth, has much difficulty making decisions, avoids positions of responsibility & has a behavioral pattern of suffering in silence. Which statement best explains the etiology of this clients personality disorder?

• Childhood nurturance was provided from many

sources, and independent behaviors were encouraged.

• Childhood nurturance was provided exclusively from

one source, and independent behaviors were discouraged.

• Childhood nurturance was provided exclusively from

one source, and independent behaviors were encouraged.

• Childhood nurturance was provided from many

sources, and independent behaviors were discouraged.

• ~ The behaviors presented in the question represent symptoms of dependent

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

• 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 delusions and hallucinations, 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 psychosis, while clients diagnosed with avoidant personality disorder remain based in reality.

• ~ 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. Schizoid personality disorder is characterized by a profound deficit in the ability to form personal relationships.Clients diagnosed with schizoid personality disorder may exhibit odd and eccentric behaviors but not to the extent of psychosis.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

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

thinking

• Social isolation R/T inability to relate to others
• ~ 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 & indifferent to others. They prefer to work in isolation & are not sociable.

Looking at a slightly bleeding paper cut, the client screams, Somebody help me quick! Im bleeding. Call 911!A nurse should identify this behavior as characteristic of which personality disorder?

• Schizoid personality disorder
• Obsessive-compulsive personality disorder
• Histrionic personality disorder
• Paranoid personality disorder
• ~ The nurse should identify this behavior as characteristic of histrionic

personality disorder. Individuals with this disorder tend to be self-dramatizing, attention seeking, over gregarious, and seductive.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 elicit 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

• ~ The nurse should expect that a client diagnosed with borderline personality

disorder may use suicidal gestures to elicit a rescue response from others.Repetitive, self-mutilating behaviors are common in borderline personality disorders that result from feelings of abandonment following separation from significant others.A nurse tells a client that the nursing staff will start alternating weekend shifts. Which response should a nurse identify as characteristic of clients diagnosed with obsessive-compulsive personality disorder?

• You really don't have to go by that schedule. I'd just stay

home sick.

• There has got to be a hidden agenda behind this

schedule change.

• Who do you think you are? I expect to interact with the

same nurse every Saturday.

• You can't make these kinds of changes! Isn't there a

rule that governs this decision?

• ~ The nurse should identify that a client with obsessive-compulsive personality

disorder would have a difficult time accepting changes. This disorder is characterized by inflexibility and lack of spontaneity. Individuals with this disorder are very serious, formal, over-disciplined, perfectionistic, and preoccupied with rules.Which reaction to a compliment from another client should a nurse identify as a typical response from a client diagnosed with avoidant personality disorder?

• Interpreting the compliment as a secret code used to

increase personal power

• Feeling the compliment was well deserved
• Being grateful for the compliment but fearing later

rejection and humiliation

• Wondering what deep meaning and purpose is

attached to the compliment

• ~ The nurse should identify that a client diagnosed with avoidant personality

disorder would be grateful for the compliment but would fear later rejection and humiliation. Individuals diagnosed with avoidant personality disorder are extremely sensitive to rejection and are often awkward and uncomfortable in social situations.