Deck 13: Personality Disorders

Question 1

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."

Answer 1

"Let's consider the advantages of being able to stop and think before acting."

Question 2

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

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

Answer 2

Refer the patient's requests and questions to the case manager.

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

Answer 3

Risk for other-directed violence

Question 4

The most challenging nursing intervention for patients diagnosed 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 5

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 6

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. 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

Question 7

A nurse reports to the interdisciplinary team that a patient diagnosed with an antisocial personality disorder lies to other patients, verbally abuses a patient diagnosed 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 8

A patient diagnosed with borderline personality disorder has been hospitalized several times after self-inflicted lacerations. 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-mutilation
B) Impaired skin integrity
C) Risk for injury
D) Powerlessness

Question 9

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; perfectionism.
B) charm, drama, seductiveness; seeking admiration.
C) difficulty being alone; indecisiveness, submissiveness.
D) grandiosity, attention seeking, and arrogance.

Question 10

A patient diagnosed with a personality disorder has used 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 11

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 12

A nurse in the emergency department tells an adult, "Your mother had a serious 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 13

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 14

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 15

A therapist recently convicted of multiple counts of Medicare fraud says, "Sure I overbilled. Why not? Everyone takes advantage of the government, so I did too." These statements show:

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

Question 16

Consider these comments made to three different nurses by a patient diagnosed 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 17

A patient diagnosed with borderline personality disorder and a history of self-mutilation has now begun dialectical behavior therapy (DBT) 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.

Question 18

A person's spouse filed charges of battery. The person has a long history of acting-out behaviors and several arrests. Which statement by the person 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 get tired of being nagged. My spouse deserved the beating."

Question 19

As a nurse prepares to administer an oral 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 will 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 20

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 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 21

Which characteristic of individuals diagnosed 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 22

A nurse set limits for a patient diagnosed 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 23

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

Question 24

A patient diagnosed 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 25

A patient who has been diagnosed with schizoid personality disorder is newly admitted to the unit. The best initial nursing intervention is to:

A) set firm limits.
B) engage in trust building.
C) involve in milieu and group activities.
D) encourage identification and expression of feelings.

Question 26

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) Dependent
D) Schizotypal
E) Narcissistic

Question 27

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) encourage the patient to express anger.
B) provide care in a kind but matter-of-fact manner.
C) demonstrate sympathy and concern.
D) offer to listen to the patient's feelings about cutting.

Question 28

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