Deck 14: Personality Disorders

Question 1

The nurse conducts milieu therapy based on the understanding that:

A) Therapy is grounded in the milieu routine.
B) The milieu is a substitute for the patient's family.
C) Staff represents the authority within the milieu.
D) The milieu provides realistic community interactions.

Answer 1

The milieu provides realistic community interactions.

Question 2

When a patient diagnosed with borderline personality disorder experiences the death of a beloved parent,which characteristic response will the nurse anticipate?

A) Denies the death for a protracted period of time
B) Exhibits several different psychotic thought processes
C) Expresses extreme anger and rage by burning the parent's clothes
D) Becomes uncharacteristically helpful and attends to the funeral arrangements

Answer 2

Expresses extreme anger and rage by burning the parent's clothes

Question 3

Which behavior is supportive of a diagnosis of dependent personality disorder?

A) Perceives personal behavior to be embarrassing
B) Believes they are incapable of functioning independently
C) Tends to exaggerate the potential dangers of ordinary situations
D) Demands excessive attention from others whenever in a group situation

Answer 3

Believes they are incapable of functioning independently

Question 4

A patient with a borderline personality disorder tells the nurse,"My doctor tells me there's something wrong with the hard wiring of my brain,and that's why I'm so impulsive and get so many mood swings.He said he's going to prescribe some medication." Being aware of current practice guidelines,the nurse will prepare a teaching plan for:

A) Lithium (Lithobid)
B) Fluoxetine (Prozac)
C) Lorazepam (Ativan)
D) Haloperidol (Haldol)

Question 5

Which observation is supportive of a diagnosis of avoidant personality disorder?

A) Talks about "my three failed marriages"
B) Cries loudly whenever requests are denied
C) Fears criticism from others, including staff
D) Shows no remorse when accidentally breaking another patient's bracelet

Question 6

When analyzing the behaviors of a 23-year-old who meets the criteria for antisocial personality disorder,the nurse recognizes that which nursing diagnosis would be pertinent to his care?

A) Risk for self-mutilation
B) Disturbed personal identity
C) Impaired social interaction
D) Social isolation

Question 7

A 27-year-old woman diagnosed with borderline personality disorder displays a labile affect,impulsivity,frequent angry outbursts,and difficulty tolerating her angry feelings without self-injury.A priority nursing diagnosis for this patient is:

A) Anxiety
B) Risk for self-mutilation
C) Risk for other-directed violence
D) Ineffective coping

Question 8

When facilitating change in the behavior of a patient diagnosed with a personality disorder,which intervention will have the greatest impact on success?

A) Collaborating with the patient when establishing treatment goals
B) Educating the patient to the importance of complying with treatment interventions
C) Evaluating the patient's understanding of the etiology of the prescribed medications
D) Conducting regular assessments so the treatment can be changed when necessary

Question 9

The nurse is careful to provide a quiet,comfortable,safe environment when conducting an assessment interview.What is the reason this is particularly important when working with a patient believed to be exhibiting characteristics of a personality disorder?

A) These patients are generally experiencing chronic depression and are severely impaired socially.
B) A high stimulus environment will cause the patient to exhibit exacerbated behaviors that are loud and attention seeking.
C) The patient is easily intimidated and may become so withdrawn that the assessment will be difficult if not impossible to complete.
D) This disorder produces defensive, guarded, and impulsive behavior that is easily provoked into anger when the patient feels threatened.

Question 10

A patient who is diagnosed with schizoid personality disorder is isolative,does not speak to her peers,and sits through the community meeting without speaking.Her mother describes her as shy and having few friends.Which would be an appropriate nursing diagnosis for this patient?

A) Anxiety related to a new environment as evidenced by isolation and not talking with peers
B) Ineffective coping related to new environment as evidenced by isolation and minimal interaction with others
C) Impaired social interaction related to unfamiliar environment as evidenced by isolation and not talking with peers
D) Disturbed thought processes related to a new environment as evidenced by isolation and minimal interactions with others

Question 11

A patient with borderline personality disorder is having difficulty with memories of sexual abuse and reports vague,generalized pains,menstrual problems,and headaches that severely impact her ability to function independently.Which collaborative consult will have the greatest impact on the patient's health and wellness?

A) Occupational therapist exploring ways to reduce stress
B) Neurologist to evaluate the patient's reports of headaches
C) Acupuncturist exploring ways to reduce the generalized pain
D) Gynecologist to assess the patient's dysmenorrheal symptoms

Question 12

Which behavior supports the failure to successfully achieve the oral stage of Freud's psychosexual stages of development?

A) An adult's excessive dependency on parents
B) A history of multiple, simultaneous sex partners
C) A need to ritualistically turn the lights off repeatedly
D) A lack of guilt when responsible for mistreating others

Question 13

Which intervention will best ensure a nonjudgmental evaluation of a patient's noncompliance with the treatment plan for management of his antisocial behaviors?

A) Re-evaluating the patient's understanding of the goals of the prescribed treatment plan
B) Asking questions that focus on his perception of why he can follow his treatment plan
C) Expressing concern about the patient's long-term prognosis if his noncompliance continues
D) Re-assessing the patient for changes that may require the revision of his current treatment plan

Question 14

The patient tells the nurse,"I thought my doctor understood me completely.Now,I hate him! He doesn't understand me at all." The nurse assesses the patient's description of feelings about the physician as evidence of the use of:

A) Splitting
B) Dissociation
C) Isolation of affect
D) Projective identification

Question 15

A patient with borderline disorder tells the nurse,"It's hard to figure out who I am.Sometimes I'm sexually attracted to women and sometimes to men." The nurse using Freudian concepts can analyze this as a developmental problem related to:

A) Lack of separation-individuation
B) Isolation of affect during latency
C) Impaired development of sexual identity during the phallic stage
D) Overdevelopment of latency stage traits related to control issues

Question 16

A patient with antisocial personality disorder yells,"Shut up about that,or I'll punch you in the nose!" and shakes his fist at another patient in a group meeting after the patient speaks negatively of illicit drug use.The nurse quickly determines that the patient is at risk to act violently against others as evidenced by his aggressive behavior,verbal threats,and a history of impulsivity.Which is the best approach for the nurse to use?

A) Secluding the patient to protect the other patients and staff
B) Putting the patient in restraints to protect the entire milieu
C) Exploring alternate ways to handle frustrating topics in the group
D) Telling the patient to leave the group until he can behave appropriately

Question 17

Which self-reflective intervention is most appropriate for the nurse to engage in when managing care for patients who exhibit characteristics of personality disorders?

A) Reinforcing the therapeutic boundaries between the nurse and patient as often as needed
B) Requesting a temporary transfer to a medical unit periodically to help minimize burn-out
C) Frequently self-assessing for biases and prejudices that result in patient care that is compromised
D) Arriving at a personal decision regarding the use of both chemical and physical restraints to assure milieu safety.

Question 18

The nurse counsels a mother to allow her 2-year-old child to keep a blanket that he uses to comfort himself.The basis for this counseling is:

A) Sullivan's theory of "good me"
B) Freud's developmental theory
C) Mahler's theory of object relations
D) Kernberg's conceptualization object constancy

Question 19

Which outcome has priority for a patient with borderline personality disorder being discharged from an outpatient treatment environment?

A) Patient demonstrates control over self-destructive impulses.
B) Patient can identify symptoms that indicate a need for psychotherapy.
C) Patient demonstrates an understanding of the importance of medication compliance.
D) Patient actively participates in a community 12-step group related to relevant care.

Question 20

When planning care for a patient with antisocial personality disorder,which consideration has greatest importance?

A) Addressing the demand for constant attention
B) Teaching coping skills related to frustration tolerance
C) Identifying behaviors related to well-developed superegos
D) Managing the manipulative behaviors resulting from a charming persona

Question 21

Which behavior is of particular concern to the nurse when managing the care of a patient diagnosed with a personality disorder?

A) Reporting a staff member for 'wanting to hurt me'
B) Shoplifting two candy bars from the hospital's gift shop
C) Asking much more frequently to be allowed to 'smoke a cigarette'
D) Refusing for three days to either bathe or change into clean clothing

Question 22

Which assessment data is supportive of a diagnosis of antisocial personality disorder? Select all that apply.

A) Was reprimanded to a juvenile correction facility at age 14
B) Mother reports characteristic behaviors as early as age 7
C) Is below age-appropriate norms for both weight and height
D) Patient states, "I don't like school and skip whenever I feel like it."
E) Has been admitted to a drug rehabilitation program twice in 4 years

Question 23

Which behavior is supportive of a histrionic personality disorder?

A) Withholding of feelings and low self-esteem
B) Insistence on others conforming to own methods
C) Engaging in impulsive acts like unprotected sex
D) Initial charm dissolving into coldness and blaming others

Question 24

A psychiatric technician mentions to the nurse,"All these patients with Axis II problems! It makes me wonder how so many mothers could have been such poor parents and messed up their kids so badly!" The response by the nurse that helps put the development of personality disorders into perspective is:

A) "Parenting is the responsibility of fathers, too, so don't blame only mothers."
B) "Personality disorder is often related to sexual abuse that occurs without parental knowledge."
C) "There is some evidence to suggest a biologic component to personality disorders."
D) "Peer interactions may be more important in child development than parental involvement."

Question 25

When implementing Freud's theory of human psychosexual development,the nurse observes for behaviors that are characteristic of successful completion of stages that include (select all that apply):

A) Anal, where self-confidence is formed
B) Oral, where the ability to trust is developed
C) Latency, where a person learns inner control
D) Adjustment, where developmental failures are re-addressed
E) Phallic, where the ability to interact with others is grounded

Question 26

Which intervention will provide the most information regarding a patient's self-perception of their role in their environment?

A) Asking the patient to keep a journal about things they enjoy doing
B) Observing the patient interact with family members at a unit picnic
C) Encouraging the patient to discuss the successes they have experienced
D) Helping the patient select appropriate, attractive clothing for family visitation day

Question 27

Which statement correctly describes the schizotypal personality disorder?

A) Psychotic behavior will require a long hospitalization.
B) There may be misinterpretation of events but not psychosis.
C) There is greater personality disorganization than in schizophrenia.
D) The patient will be outgoing, actively seeking interactions with others.

Question 28

A patient with a personality disorder asks the nurse,"Is it true I have an inherited brain disorder?" The nurse replies,knowing that:

A) There is proof that personality disorders are inherited.
B) All persons with personality disorders display brain abnormalities.
C) Individuals with personality disorders manifest some biological markers.
D) Individuals with personality disorders show an error in brain glucose metabolism.

Question 29

A psychiatric technician remarks to the nurse,"That patient with dependent personality disorder is so clingy!" The response by the nurse that will be helpful to the technician is:

A) "I think everyone feels that way. It's difficult to have someone clinging."
B) "Patients with personality disorders have little regard for the rights of others."
C) "The patient fears having to function independently without direction from someone else."
D) "The patient is so preoccupied with perfection and structure that she's afraid to do anything at all."