Question 1

Family members of a client ask the nurse to explain the difference between schizoid and avoidant personality disorders. Which is the appropriate nursing reply?&#10;A) &#34;Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone.&#34;&#10;B) &#34;Clients diagnosed with schizoid personality disorder exhibit odd, bizarre, and eccentric behavior, whereas clients diagnosed with avoidant personality disorder do not.&#34;&#10;C) &#34;Clients diagnosed with avoidant personality disorder are eccentric, and clients diagnosed with schizoid personality disorder are dull and vacant.&#34;&#10;D) &#34;Clients diagnosed with schizoid personality disorder have a history of psychotic thought processes, whereas clients diagnosed with avoidant personality disorder remain based in reality.&#34;&#10;

Accepted Answer

1.This is correct. Clients diagnosed with avoidant personality disorder desire intimacy but fear it, whereas clients diagnosed with schizoid personality disorder prefer to be alone.
2.This is incorrect. Clients with avoidant personality disorder may be perceived as strange or odd.
3.This is incorrect. Clients with schizoid personality disorder are not perceived as dull and vacant; rather, they tend to want to be alone and may seem indifferent to others.
4.This is incorrect. Clients with schizoid personality disorder do not experience psychotic thought; rather, they are not spontaneous and have difficulty experiencing pleasure.

Question 2

Which client situation should the nurse identify as reflective of the impulsive behavior that is commonly associated with BPD?&#10;A) As the day-shift nurse leaves the unit, the client suddenly hugs the nurse's arm and whispers, &#34;The night nurse is evil. You have to stay.&#34;&#10;B) As the day-shift nurse leaves the unit, the client suddenly hugs the nurse's arm and states, &#34;I will be up all night if you don't stay with me.&#34;&#10;C) As the day-shift nurse leaves the unit, the client suddenly hugs the nurse's arm, yelling, &#34;Please don't go! I can't sleep without you being here.&#34;&#10;D) As the day-shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, &#34;I cut myself because you are leaving me.&#34;&#10;

Accepted Answer

1.This is incorrect. This client's statement that the night nurse is evil suggests manipulative behaviors, which are not typical of the impulsive behavior associated with BPD.
2.This is incorrect. This client's statement that they will be up all night does not demonstrate impulsivity associated with BPD; rather, this is an attempt at manipulation.
3.This is incorrect. This client's actions and statement that they cannot sleep without the nurse present do not demonstrate impulsivity; rather, they are an attempt at manipulation.
4.This is correct. The client's statement reflects self-mutilating behavior commonly associated with the diagnosis of BPD. Other types of destructive behaviors include scratching and burning. Repetitive, self-mutilating behaviors are common and are generated by feelings of abandonment following separation from significant others.

Question 3

A client is admitted to an inpatient psychiatric unit with the diagnosis of paranoid personality disorder. Which statement made by the client to the nurse reinforces the diagnosis? Select all that apply.

A) "It isn't my fault that I have a temper. I inherited it from my abusive parent."
B) "I could have gone to nursing school like you, but I never had good science teachers."
C) "My roommate doesn't talk to me unless she wants something."
D) "I like group therapy because the other clients can feel my feelings and relate to me."
E) "I don't like the unit rules and am not going to follow them. They don't apply to me."

"It isn't my fault that I have a temper. I inherited it from my abusive parent."
"I could have gone to nursing school like you, but I never had good science teachers."
"My roommate doesn't talk to me unless she wants something."

Accepted Answer

1.This is correct. Paranoid personality disorder is defined as a pattern of pervasive mistrust and suspiciousness of others and misinterpretation of others' motives as malevolent. Clients with paranoid personality disorder are tense and irritable. They are constantly on guard, hypervigilant, and ready for any real or imagined threat. People who are paranoid are extremely vulnerable and constantly on the defensive.
2.This is correct. Paranoid personality disorder is defined as a pattern of pervasive mistrust and suspiciousness of others and misinterpretation of others' motives as malevolent. These clients are envious and hostile toward those who are highly successful and believe the only reason they are not as successful is because they have been treated unfairly. People who are paranoid are extremely vulnerable and constantly on the defensive. Any real or imagined threat can release hostility and anger fueled by animosities from the past.
3.This is correct. Paranoid personality disorder is defined as a pattern of pervasive mistrust and suspiciousness of others, and misinterpretation of others' motives as malevolent These clients always feel that others plan to take advantage of them. People who are paranoid are extremely vulnerable and constantly on the defensive. Any real or imagined threat can release hostility and anger fueled by animosities from the past.
4.This is incorrect. Individuals with schizotypal personality disorder believe that magical thinking, ideas of reference, illusions, and depersonalization are part of their everyday world. Examples include superstitiousness; belief in clairvoyance, telepathy, or "sixth sense;" and belief that "others can feel my feelings."
5.This is incorrect. Antisocial personality disorder is a pattern of socially irresponsible, exploitative, and guiltless behavior that reflects a general disregard for the rights of others. These individuals exploit and manipulate others for personal gain and are unconcerned with obeying rules or the law.

Question 4

Nina is an artist who dresses in long, colorful kaftans and wears sequin and rhinestone hats. Her makeup is dramatic, and her long, false fingernails are always painted a bright color. Every time Nina attends a social event, she waltzes into the room and shouts "Hello people! I have arrived." Which behavior is congruent with Nina's diagnosis? Select all that apply.

A) Nina flirts with someone significantly younger who tells her that she doesn't look or act her age.
B) Nina responds with rage when a partygoer tells her that her dress is inappropriate for the event.
C) Nina becomes anxious when the hostess of a party excuses herself from speaking with Nina to greet other guests.
D) Nina feels awkward and uncomfortable in social situations due to her fear of rejection by others.

Accepted Answer

1.This is correct. HPD is characterized by colorful, dramatic, and extroverted behavior in excitable, emotional people. They have difficulty maintaining long-lasting relationships, though they require constant affirmation of approval and acceptance from others. This often gives rise to seductive, flirtatious behavior in efforts to reassure themselves of their attractiveness and gain approval. 
2.This is incorrect. People with narcissistic personality disorder are often grounded in grandiose distortions of reality; their moods are usually optimistic, relaxed, cheerful, and carefree. This can easily change, however, because of fragile self-esteem. If they do not meet self-expectations, do not receive the positive feedback they expect from others, or draw criticism from others, they may respond with rage, shame, humiliation, or dejection. They may turn inward and fantasize rationalizations that convince them of their continued stature and perfection.
.
3.This is correct. People with HPD often demonstrate, to an extreme, what our society tends to foster and admire in its members: to be well liked, successful, popular, extroverted, attractive, and sociable. However, beneath these surface characteristics is a driven quality-an all-consuming need for approval and a desperate striving to be conspicuous and evoke affection or attract attention at all costs. Failure to evoke the attention and approval they seek often results in feelings of dejection and anxiety.
4.This is incorrect. Individuals with avoidant personality disorder are awkward and uncomfortable in social situations. From a distance, others may perceive them as timid, withdrawn, or perhaps cold and strange. They desire to have close relationships but avoid connecting with others because of their fear of rejection. Depression, anxiety, and anger at oneself for failing to develop social relations are commonly experienced.

Question 5

A client was diagnosed with OCPD several years ago and visits the outpatient mental health clinic for medication evaluation. As the nurse updates her health record with new assessment data, she reviews the client's family history. The nurse knows that the client most likely grew up in which family environment? Select all that apply.

A) One where punishment for undesirable behaviors was frequent
B) One where positive achievements were taken for granted and seldom acknowledged
C) One where following rigid restrictions and rules was required
D) One where cleaning one's room everyday was rewarded with a treat

Accepted Answer

1.This is correct. The individual with OCPD was reared in an overly controlled environment. These parents condemn their children if they do not live up to the imposed strict standards, and punishment for undesirable behaviors is frequent.
2.This is correct. Positive achievements in these families are expected, taken for granted, and only occasionally acknowledged by their parents, whose comments and judgments are limited to pointing out transgressions and infractions of rules. In this environment, individuals become experts in learning what they must not do to avoid punishment and condemnation rather than what they can do to achieve attention and praise.
3.This is correct. The individual with OCPD was reared in an overly controlled environment where they learn to heed rigid restrictions and rules.
4.This is incorrect. Clients with OCPD disorder most likely did not grow up in a home where achievements were rewarded. They grew up in a strict environment with high expectations, where achievement was expected and not seen as anything special.

Question 6

The nurse is assisting the social worker and therapist in leading a presentation on life skills to the clients on a psychiatric unit. The client, who has been diagnosed with BPD, begins to threaten another client who constantly interrupts the presentation by asking questions. As the client's behavior escalates, which actions should the nurse take first? Select all that apply.

A) Use a threatening tone to tell the client to stop the behavior or he will be sent to his room.
B) Use a calm voice to ask the other clients to leave the room.
C) Administer an injectable antipsychotic to calm the client.
D) Ask the social worker and therapist to alert the other staff nurses to the situation.

Accepted Answer

1.This is incorrect. Using a threatening tone with an agitated and aggressive client can lead to escalation in the client's behavior. This can endanger everyone's safety on the unit. The nurse should speak to the client in a soft and calm, but firm, voice when trying to deescalate the client.
2.This is correct. The nurse's first priority is always to maintain the safety of the clients and staff. Asking the clients to leave the room helps ensure that they will not be injured should the client become violent. Using a calm voice when speaking with the clients helps them remain calm.
3.This is incorrect. Administering any medication, including an injectable antipsychotic, is only warranted once other less invasive strategies have been tried and have failed. The nurse must first try to deescalate the client verbally before moving on to physical interventions.
4.This is correct. The nurse's priority is always to maintain the safety of the clients and staff. The nurse asks the social worker and therapist to leave the room to protect them. In addition, the nurse requires backup from the other unit nurses in this situation to help calm the client before he becomes violent. The other staff nurses also need to be notified of the situation so they may help keep the other clients on the unit calm.

Question 7

Jillian is a client on a psychiatric unit for medication management related to her diagnosis of BPD. The nurse evaluates Jillian's care plan and confirms Jillian has reached her outcome goals when she makes which statement? Select all that apply.

A) "I think my therapist is the best health-care professional in the world even though we didn't always see eye-to-eye."
B) "I now understand that so much of my anger is due to the beatings I sustained as a child."
C) "I had a strong urge to scratch myself yesterday, and when this happened I came looking for you."
D) "Ever since my roommate and I had that big blowup, I've avoided her. She's really selfish and isn't a good friend anyway."

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Accepted Answer

1.This is correct. Clients with BPD tend to see people as all good or all bad and overvalue those they have a relationship with until the client feels threatened or slighted by the other person. These clients struggle with emotional regulation and easily shift allegiances. Jillian's statement shows that her view of the therapist is not all good or all bad and that she can still maintain this relationship even though it included conflict in the past.
2.This is correct. Some theorists believe that BPD is a result of childhood trauma, such as abuse. Most people with this disorder display behaviors of anger, aggression, and even violence at times, but they don't recognize or understand the connection between this past trauma and present anger. Jillian's statement demonstrates that she understands she experiences anger and why she does.
3.This is correct. Clients with BPD may engage in self-mutilation, which may include cutting, scratching, and burning. Some clients with BPD have reported that "to feel pain is better than to feel nothing." The pain validates their existence. Jillian's statement indicates that she recognizes the self-mutilation behavior as one that needs to be controlled, and to do this she may need to seek the help and support of another individual.
4.This is incorrect. Distancing behaviors as seen in BPD are characterized by hostility, anger, and devaluation of others, arising from a feeling of discomfort with closeness. Distancing behaviors also occur in response to separations, confrontations, or attempts to limit certain behaviors. Devaluation of others is manifested by discrediting or undermining the other person's strengths and personal significance. Jillian's statement indicates that she is engaging in distancing behaviors.

Question 8

The client is a young adult who has been arrested for several petty crimes in the past. Recently, the client was arrested for physically assaulting a patron in a bar after they exchanged aggressive words. Upon evaluation, he is diagnosed with antisocial personality disorder. The nurse caring for him includes the nursing diagnosis "risk for other-directed violence" in his care plan. Which nursing intervention is most appropriate for the client? Select all that apply.

A) Keeping all promises made to the client
B) Turning down the client's light after care is completed
C) Explaining to the client the punishment he will receive if he doesn't obey all unit rules
D) Encouraging the client to exercise when he becomes frustrated

Accepted Answer

1.This is correct. The nurse must convey an accepting attitude toward a potentially violent client. Feelings of rejection are undoubtedly familiar to the client. The nurse must develop trust by being honest, keeping all promises, and conveying the message to the client that it is not him but the behavior that is unacceptable. An attitude of acceptance promotes feelings of self-worth. Trust is the basis of a therapeutic relationship.
2.This is correct. The nurse must maintain a low level of stimuli in the potentially violent client's environment (low lighting, few people, simple decor, low noise level). A stimulating environment may increase agitation and promote aggressive behavior.
3.This is incorrect. Clients are not punished for disobeying unit rules but rather face consequences of their behavior. It is nontherapeutic for the nurse to tell the client that he will be punished for unacceptable behavior. One of the reasons the client is receiving care is to help him develop healthy coping skills, which should be encouraged.
4.This is correct. Physically demanding activities help the violent client relieve pent-up tension. The client may implement large motor skills to channel hostile energy into socially acceptable behavior.

Deck 15: Personality Disorders