Question 1

When preparing to interview a patient with narcissistic personality disorder,a nurse can anticipate the assessment findings will include:

Accepted Answer

According to the Diagnostic and Statistical Manual of Mental Disorders (fourth edition,text revision)(DSM-IV-TR),the characteristics of grandiosity,self-importance,and a sense of entitlement are consistent with narcissistic personality disorder.Charm,drama,seductiveness,and admiration seeking are observed in patients with histrionic personality disorder.Preoccupation with minute details and perfectionism are observed in individuals with obsessive-compulsive personality disorder.Patients with dependent personality disorder often express difficulty being alone and are indecisive and submissive.

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?

Accepted Answer

SSRIs are used to treat depression.Many patients with borderline personality disorder are fearful of taking something over which they have little control.Because SSRIs have a good side effect profile,the patient is more likely to comply with the medication.Low-dose antipsychotic or anxiolytic medications are not supported by the data given in this scenario.MAOIs require great diligence in adherence to a restricted diet and are rarely used for patients who are impulsive.

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:

Accepted Answer

The patient has responded appropriately to the urge for self-harm by calling a helping individual.A component of dialectical behavior therapy is telephone access to the therapist for "coaching" during crises.The nurse can assist the patient to choose an alternative to self-mutilation.The need for a protective environment may not be necessary if the patient is able to use cognitive strategies to determine a coping strategy that reduces the urge to mutilate.Taking a sedative and going to sleep should not be the first-line intervention;sedation may reduce the patient's ability to weigh alternatives to mutilating behavior.

Question 4

Which statement made by a patient with borderline personality disorder indicates the treatment plan is effective?

Accepted Answer

Seeking a staff member instead of impulsively self-mutilating shows an adaptive coping strategy.The incorrect responses demonstrate idealization,devaluation,and wishful thinking.

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?

Accepted Answer

A lack of internal controls leads to manipulative behaviors such as lying,cheating,conning,and flattering.To protect the rights of others,external controls must be consistently maintained until the patient is able to behave appropriately.

Question 6

What is an appropriate initial outcome for a patient with a personality disorder who frequently manipulates others? The patient will:

Accepted Answer

Acknowledging manipulative behavior is an early outcome that paves the way for taking greater responsibility for controlling manipulative behavior at a later time.Identifying anger relates to anger and aggression control.Using manipulation to get legitimate needs is an inappropriate outcome.The patient will ideally use assertive behavior to promote the fulfillment of legitimate needs.Accepting fulfillment of requests within an hour rather than immediately relates to impulsivity and immediacy control.

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:

Accepted Answer

Rationalization is being used to explain behavior and deny wrongdoing.The individual who does not believe he or she has done anything wrong will not exhibit anxiety,remorse,or guilt about the act.The patient's remarks cannot be assessed as shameful.Lack of trust or concern that others are determined to cause harm is not evident.

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?

Accepted Answer

Patients with avoidant personality disorder are timid,socially uncomfortable,and withdrawn and avoid situations in which they might fail.They believe themselves to be inferior and unappealing.Individuals with dependent personality disorder are clinging,needy,and submissive.Individuals with histrionic personality disorder are seductive,flamboyant,shallow,and attention seeking.Individuals with paranoid personality disorder are suspicious and hostile and project blame.

Question 9

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

Accepted Answer

Maintaining consistent limits is by far the most difficult intervention because of the patient's superior skills at manipulation.Supporting behavioral change and monitoring patient safety are less difficult tasks.Aversive therapy would probably not be part of the care plan;positive reinforcement strategies for acceptable behavior are more effective than aversive techniques.

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?

Accepted Answer

Limits must be set in areas in which the patient's behavior affects the rights of others.Limiting verbal abuse of another patient is a priority intervention.The other concerns should be addressed during therapeutic encounters.

Question 11

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

Accepted Answer

This option is an example of a manipulative behavior.Because manipulation violates the rights of others,limit setting is absolutely necessary.Furthermore,limit setting is necessary in this case because the safety of at least two other patients is at risk.Limit setting may be occasionally used with dependent behavior (clinging to the nurse)and histrionic behavior (flirting with staff members),but other therapeutic techniques are also useful.Limit setting is not needed for a patient who is hypervigilant and refuses to attend unit activities;rather,the need to develop trust is central to patient compliance.

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?

Accepted Answer

The individual with a borderline personality disorder characteristically demonstrates manipulative,splitting,and self-destructive behaviors.Consistent limit setting is vital for the patient's safety,as well as to prevent splitting other staff members."Why" questions are not therapeutic.

Question 13

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

Accepted Answer

Manipulative patients frequently make requests of many different staff members,hoping someone will give in.Having only one decision-maker provides consistency and avoids the potential for playing one staff member against another.Positive reinforcement of appropriate behaviors is more effective than negative reinforcement.The behavior should not be ignored;judicious use of confrontation is necessary.Patients with antisocial personality disorders rarely have feelings of fear and inferiority.

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?

Accepted Answer

Risk for self-mutilation is a nursing diagnosis relating to patient safety needs and is therefore a high priority.Impaired skin integrity and powerlessness may be appropriate foci for care but are not the priority or related to this therapy.Risk for injury implies accidental injury,which is not the case for the patient with borderline personality disorder.

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?

Accepted Answer

Violence against property,along with threats to harm staff,makes this diagnosis the priority.Patients with antisocial personality disorders rarely have psychotic symptoms.When patients with antisocial personality disorders use denial,they use it effectively.Although ineffective coping applies,the risk for violence is a higher priority.

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:

Accepted Answer

The patient is showing openness to learning techniques for impulse control.One technique is to teach the patient to stop and think before acting impulsively.The patient can then be taught to evaluate the outcomes of possible actions and choose an effective action.The incorrect responses shift the encounter to a social level or are judgmental.

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?

Accepted Answer

The patient with an antisocial personality disorder often impulsively acts out feelings of anger and feels no guilt or remorse.Patients with antisocial personality disorders rarely seem to learn from experience or feel true remorse.Problems with anger management and impulse control are common.

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:

Accepted Answer

Patients manipulate and control staff members in various ways.By keeping staff members off balance or fighting among themselves,the person with an antisocial personality disorder is left to operate as he or she pleases.Seductive behavior has sexual connotations.The patient is displaying the opposite of detached behavior.Guilt is not evidenced in the comments.

Question 19

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

Accepted Answer

The impulsive individual acts in haste without taking time to consider the consequences of the action.None of the other options describes impulsivity.

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?

Accepted Answer

The main characteristic of the dependent personality is a pervasive need to be taken care of that leads to submissive behaviors and a fear of separation.Histrionic behavior is characterized by flamboyance,attention seeking,and seductiveness.Narcissistic behavior is characterized by grandiosity and exploitive behavior.Patients with borderline personality disorder demonstrate separation anxiety,impulsivity,and splitting.

Quiz 13: Personality Disorders