Question 1

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

Accepted Answer

The individual with obsessive-compulsive personality disorder (OCPD) is perfectionist, rigid, preoccupied with rules and procedures, and afraid of making mistakes. The other options refer to behaviours or traits not usually associated with OCPD. See relationship to audience response question.

Question 2

Which of the following nursing diagnoses is appropriate to consider for a patient diagnosed with any of the personality disorders?

Accepted Answer

Without exception, individuals with personality disorders have problems with social interaction with others; hence, the diagnosis of Impaired social interaction. For example, some individuals are suspicious and lack trust, others are avoidant, and still others are manipulative. None of the other diagnoses are universally applicable to patients with personality disorders; each might apply to selected clinical diagnoses, but not to others.

Question 3

What is the priority intervention for a nurse beginning to work with a patient diagnosed with a schizotypal personality disorder?

Accepted Answer

Patients with schizotypal personality disorder are eccentric and often display perceptual and cognitive distortions. They are suspicious of others and have considerable difficulty trusting. They become highly anxious and frightened in social situations, thus the need to respect their desire for social isolation. Teaching the patient to match clothing is not the priority intervention. Patients with schizotypal personality disorder rarely engage in behaviours that violate the nurse's rights or exploit the nurse.

Question 4

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 which of the following?

Accepted Answer

Fear of abandonment is a central theme for most patients with borderline personality disorder. This fear is often exacerbated when patients with borderline personality disorder experience success or growth.

Question 5

A new psychiatric technician says, "Schizophrenia . . . schizotypal! What's the difference?" The nurse's response should include which information?

Accepted Answer

The patient with schizotypal personality disorder might have problems thinking, perceiving, and communicating and might have an odd, eccentric appearance; however, the person can be made aware of misinterpretations, and overtly psychotic symptoms are usually absent. The individual with schizophrenia is more likely to display psychotic symptoms, remain ill for longer periods, and have more frequent and prolonged hospitalizations.

Question 6

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

Accepted Answer

Schizotypal individuals have poor social skills. Social situations are uncomfortable for them. It is desirable for the individual to develop the ability to meet and socialize with others. Individuals with schizotypal personality disorder usually have no issues with adherence to unit norms, nor are they self-mutilative or manipulative.

Question 7

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?

Accepted Answer

The patient is attempting to manipulate the nurse. Empathetic mirroring reflects back to the patient the nurse's understanding of the patient's distress or situation in a neutral manner that does not judge it and helps elicit a more positive response to the limit that is being set. The other options would be nontherapeutic; they lack the empathic mirroring component that tends to elicit a more positive response from the patient.

Question 8

A nurse plans care for an individual diagnosed with antisocial personality disorder. Which characteristic behaviours will the nurse expect? Select all that apply.

Accepted Answer

Individuals with antisocial personality disorders characteristically demonstrate manipulative, exploitative, aggressive, callous, and guilt-instilling behaviours. Individuals with antisocial personality disorders are more extroverted than reclusive, rarely show anxiety, and rarely demonstrate clinging or dependent behaviours. Individuals with antisocial personality disorders are more likely to be impulsive than to be perfectionists.

Question 9

A nurse set limits while interacting with a patient demonstrating behaviours 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 which of the following?

Accepted Answer

Splitting involves loving a person, then hating the person because the patient is unable to recognize that an individual can have both positive and negative qualities. Denial is unconsciously motivated refusal to believe something. Reaction formation involves unconsciously doing the opposite of a forbidden impulse. The scenario does not indicate defensiveness. See relationship to audience response question.

Question 10

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

Accepted Answer

Some personality disorders have evidence of genetic links, so the family history would show other members with similar traits. Heredity plays a role in schizotypal, antisocial, borderline, and obsessive-compulsive personality disorder.

Question 11

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 do which of the following?

Accepted Answer

A matter-of-fact approach does not provide the patient with positive reinforcement for self-mutilation. The goal of providing emotional consistency is supported by this approach. The distracters provide positive reinforcement of the behaviour or fail to show compassion.

Question 12

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?

Accepted Answer

Frequent team meetings are held to counteract the effects of the patient's attempts to split staff and set them against one another, causing interpersonal conflict. Patients with personality disorders are inflexible and demonstrate maladaptive responses to stress. They are usually unable to develop true intimacy with others and are unable to develop trusting relationships. Although problems with trust may exist, it is not the characteristic that requires frequent staff meetings. See relationship to audience response question.

Quiz 20: Personality Disorders