Deck 19: Personality Disorders

Question 1

Which intervention would be appropriate for a patient with a nursing diagnosis of Ineffective coping as evidenced by manipulation of others?

A) Refer patient requests and questions about care to the primary nurse.
B) Provide negative reinforcement for any acting-out behavior.
C) Ignore rather than confront inappropriate interpersonal behavior.
D) Encourage the patient to discuss feelings of fear and inferiority.

Answer 1

Refer patient requests and questions about care to the primary nurse.

Question 2

The nurse reports to the interdisciplinary team that an antisocial patient lies to other patients,verbally abuses a patient with Alzheimer's disease,flatters his primary nurse,and is detached and superficial during counseling sessions.Which behavior should be the priority focus of limit setting?

A) Lying to other patients
B) Flattering the nursing staff
C) Verbally abusing other patients
D) Superficiality during counseling

Answer 2

Verbally abusing other patients

Question 3

A patient tells a nurse,"The others won't give me my pain meds early,but you are more understanding,you know what it's like to be in pain,and you don't want to see your patients suffer.Could you find a way to get me my pill now? I won't tell anyone." Which response by the nurse would be most therapeutic?

A) "I'm not comfortable doing that," then ignore subsequent requests for early meds.
B) "I'll have to check with your doctor about that;I will get back to you after I do."
C) "It would be unsafe to give the medicine early;none of us will do that."
D) "I understand that you have pain,but giving medicine too soon would not be safe."

Answer 3

"I understand that you have pain,but giving medicine too soon would not be safe."

Question 4

An appropriate outcome for a patient with a personality disorder and a nursing diagnosis of Ineffective coping as evidenced by use of manipulation would be that the patient will: _______.

A) refrain from manipulative behavior at all times
B) use manipulation only to get legitimate needs met
C) acknowledge manipulative behavior when it is pointed out
D) identify when he is experiencing feelings of anger

Question 5

A patient with borderline personality disorder has been making steady progress but one day gets a phone call from her boyfriend,who breaks off their relationship.Although she has not self-injured in over 2 months,she makes repeated lacerations on her forearm.Which statement about this and most maladaptive behaviors seen in personality disorders is most accurate?

A) People with personality disorders rarely achieve lasting improvement.
B) However dysfunctional,most behavior is the person's best effort to cope.
C) People with personality disorders are at the mercy of others' actions.
D) What appears to be improvement can be manipulation instead.

Question 6

A patient with borderline personality disorder has cut her wrists.The physician orders daily dressing changes for the lacerations.The nurse performing this care should:

A) encourage the patient to vent anger and aggression.
B) provide care in a matter-of-fact manner.
C) be kindly,sympathetic,and concerned.
D) offer to listen to the patient's feelings about cutting.

Question 7

A patient with paranoid personality disorder is noted to sit alone in a corner of the unit living room.When anyone approaches,the patient is haughty or simply ignores the other person.When staff invite her to join an activity,she tells them,"I do not care to be with people who do not like me." A nursing diagnosis that should be considered is:

A) splitting.
B) activity intolerance.
C) powerlessness.
D) impaired social interaction.

Question 8

Which nursing strategy leads patients to respond more positivity to limit setting?

A) Confront the patient with the inappropriateness of the behavior.
B) Explore with the patient the underlying dynamics of the behavior.
C) Reflect back to the patient an understanding of the patient's distress.
D) State clear disapproval of the behavior,and support its consequences.

Question 9

The nurse has recently set limits for a patient 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 mistaken.You're hateful." Which phenomenon is represented by this response?

A) Splitting
B) Denial
C) Reaction formation
D) Projection

Question 10

The nurse who assesses a patient previously diagnosed as having paranoid personality disorder is most likely to describe the patient as:

A) superficially charming.
B) intense and impulsive.
C) guarded and distant.
D) friendly and open.

Question 11

When a patient with a personality disorder uses manipulation as a way of getting needs met,the staff agree to use limit setting as an intervention.How does limit setting work to reduce manipulation?

A) Limit setting indulges the patient's desire for attention from staff.
B) It gives the patient a different concern on which to focus his anger.
C) External controls provide security while internal controls are developing.
D) When staff limit the patient's behavior,he is no longer anxious about it.

Question 12

A patient with antisocial personality disorder tells Nurse A,"You're a much better nurse than Nurse B said you were." The patient tells Nurse B,"Nurse A's upset with you for some reason." To Nurse C the patient states,"You'd like to think you're perfect,but I've seen three of your mistakes this morning." These comments can best be assessed as:

A) seductive.
B) detached.
C) guilt producing.
D) manipulative.

Question 13

The patient tells his primary nurse "I get into trouble because I have hair-trigger responses.I shoot from the hip.Lots of times that gets me into a mess." Which response would be most therapeutic?

A) "Let's look at ways to help you slow it down and think before acting."
B) "It might help to explore how you came to be that way-any ideas?"
C) "I'll bet you have some interesting stories to share about overreacting."
D) "It's good that you're showing readiness and motivation to change."

Question 14

A patient with antisocial personality disorder tells Nurse A,"You're a much better nurse than Nurse B said you were." The patient tells Nurse B,"Nurse A's upset with you for some reason." To Nurse C the patient states,"You'd like to think you're perfect,but I've seen three of your mistakes this morning." Which nursing intervention would be most helpful for addressing this behavior?

A) Hold a weekly staff meeting to discuss feelings and conflicts related to such behavior.
B) Confront the patient and advise her that if she continues this,she will lose privileges.
C) Get all staff to agree that any and all inappropriate behavior will simply be ignored.
D) Evaluate the patient for a medication increase or transfer to a long-term facility.

Question 15

In clinical supervision,the nurse caring for the patient with a paranoid personality disorder tells the advanced practice nurse,"I tried being caring and empathetic,but the patient just kept telling me to stay away." Which response by the advanced practice nurse would be best?

A) "Acting somewhat cynical and aloof,like they do,will make it easier for paranoid persons to bond with you over time.That,plus humor."
B) "You may be trying too hard too soon.Back off,give him some time to get used to you,then try your caring and empathetic approach again."
C) "Mistrustful people do not bond as others do,so first it's important to be realistic.Second,a neutral yet courteous approach will work better."
D) "You are on the right track,but give it more time.Actively conveying empathy and care will work,but paranoid persons respond more slowly."

Question 16

To plan effective interventions,the nurse should understand that the underlying reason a patient with paranoid personality disorder is so critical of others probably lies in the patient's:

A) need to control all aspects of the world around him.
B) use of intellectualization to protect against anxiety.
C) inflexible view of the environment and the people in it.
D) projection of blame for his own shortcomings onto others.

Question 17

While the nurse at the personality disorders clinic is interviewing a patient,the patient constantly scans the environment and frequently interrupts to ask what the nurse means by certain words or phrases.The nurse notes that the patient is very sensitive to the nurse's nonverbal behavior.His responses are often argumentative,sarcastic,and hostile.He suggests that he is being hospitalized "so they can exploit me." The patient's behaviors are most consistent with the clinical picture of:

A) paranoid personality disorder.
B) histrionic personality disorder.
C) avoidant personality disorder.
D) narcissistic personality disorder.

Question 18

A patient remanded by the court after his wife had him jailed for battery told the judge how sorry he was and suggested he needed psychiatric help.His history reveals acting-out behaviors as an adolescent and several adult arrests.The nurse interviews him about his relationship with his wife.Which statement by the patient is most consistent with a diagnosis of antisocial personality disorder?

A) "I've done some stupid things in my life,but I've learned a lesson."
B) "I'm feeling terrible about the way my behavior has hurt my family."
C) "I have a quick temper,but I can usually keep it under control."
D) "I hit her because she nags at me.She deserves it when I beat her up."

Question 19

A physical therapist recently convicted of multiple counts of Medicare fraud is brought to the emergency department after taking an overdose of sedatives.He tells the nurse,"Sure I overbilled.Why not? Everybody takes advantage of the government.They have too many rules.No one can abide by all of them." These statements can be assessed as showing:

A) glibness and charm.
B) superficial remorse.
C) lack of guilt feelings.
D) excessive suspiciousness.

Question 20

A patient with borderline personality disorder cut her wrists while out on a pass.For future planning,staff should consider that the reason for the self-mutilation is probably related to:

A) an inherited disorder that manifests itself as an incapacity to tolerate stress.
B) fear of abandonment associated with relationships or increasing autonomy.
C) use of projective identification and splitting to bring anxiety to manageable levels.
D) a constitutional inability to regulate affect,predisposing to psychic disorganization.

Question 21

Which statement by a patient with borderline personality disorder best indicates the treatment plan is helping?

A) "I think you are the best nurse on the unit."
B) "I hate my doctor.He never gives me what I ask for."
C) "I feel empty and want to cut myself,so I called you."
D) "I'm never going to get high on drugs again."

Question 22

Place the steps for limit setting in the most desirable order.

A) Implement consequences when undesired behaviors present.
B) Identify undesirable behavior and discuss concerns with patient.
C) Jointly establish consequences for future inappropriate behavior.
D) Jointly determine what behaviors would be preferred instead.

Question 23

When told that he is scheduled to interview a patient with narcissistic personality disorder,the nurse can anticipate the assessment findings will include the following:

A) charm,drama,seductiveness,and admiration seeking.
B) preoccupation with minute details and perfectionism.
C) difficulty being alone,indecisiveness,and submissiveness.
D) grandiosity,self-importance,and a sense of entitlement.

Question 24

A nurse notices that although it is midsummer,a patient with borderline personality disorder has begun wearing long-sleeve shirts.The nurse investigates and discovers that the patient has cut her wrists.Place the nursing responses in the correct order,leaving out those which are inappropriate:

A)Call a "Medical Assistance Code."
B)Provide support and convey caring.
C)Assess the severity of the injury.
D)Discuss the patient's feelings.
E)Remain neutral while providing first aid.
F)Have the patient journal about the event.
G)Place the patient under constant one-to-one observation.

Question 25

Which of the following interventions would be appropriate when working with a woman whose nursing diagnosis is Ineffective coping related to impaired impulse control as evidenced by impulsive self-injurious behavior? (Select all that apply. )

A) Assist the patient to develop a list of effective coping options to carry for future use.
B) Encourage her to use negative reinforcers (e.g. ,pain)to discourage undesired behavior.
C) Guide the patient to examine the advantages and costs of her present coping strategies.
D) Help her to practice the desired responses in role plays and later in real-life situations.
E) Teach the patient to "cue" herself to stop and think before taking undesired actions.

Question 26

The nurse in the emergency department tells the daughter of a patient that her 86-year-old mother has had a stroke.The daughter tearfully asks the nurse,"Who will take care of me now?" When the nurse explores this query,the daughter mentions that her mother always tells her what job to take,what clothes to buy and wear,and what to have for lunch.The daughter states that she needs someone to direct her and reassure her when she gets anxious.With which personality disorder is this presentation most consistent?

A) Histrionic
B) Dependent
C) Narcissistic
D) Borderline

Question 27

For which behavior(s)would limit setting be most essential?

A) A patient clings to the nurse and asks for advice about inconsequential matters.
B) A woman is flirtatious and provocative toward staff members of the opposite sex.
C) An elderly man displays hypervigilance and refuses to attend unit activities.
D) A young woman urges a suspicious patient to hit anyone who stares at him.

Question 28

A patient tells the nurse that he is planning to hire a private detective to follow his wife,who he believes is having an extramarital affair.The patient looks behind the door to be sure no one is eavesdropping and asks the nurse what she did with his medical record after he left.The patient's behaviors are most consistent with a diagnosis of:

A) antisocial personality disorder.
B) schizoid personality disorder.
C) paranoid personality disorder.
D) obsessive-compulsive personality disorder.

Question 29

A worker is characterized by her co-workers as "painfully shy" and lacking in self-confidence.Her co-workers say she stays in her cubicle all day,never coming out for breaks or lunch.One day after falling on the ice in the parking lot,she goes to the nurse's office,where she apologizes for falling and mentions that she hopes the company will not fire her for being so clumsy.Which nursing approach or response would be most therapeutic?

A) Remain professional and a bit detached so as not to arouse suspiciousness on her part.
B) Reassure her that many others have fallen at work and not ever been criticized or fired.
C) Acknowledge her concerns in a matter-of-fact manner and provide first aid as needed.
D) Explain that an incident report about her fall will go to a manager who will contact her.

Question 30

A patient with borderline personality disorder has been hospitalized several times after self-injurious behavior and suicide attempts.The patient has entered dialectical behavior therapy on an outpatient basis.During therapy,the advanced practice nurse has been counseling her regarding self-harm behavior management.Today the patient called the nurse and reported "feeling empty and anxious" and wants to cut herself.Which response would best help in this situation?

A) Arrange for an emergency admission to a crisis unit.
B) Arrange for an emergency admission to an inpatient unit.
C) Assist the patient to identify and choose a coping strategy.
D) Advise the patient to take an anxiolytic,then go to sleep.

Question 31

The characteristic in individuals with personality disorders that makes it most necessary for staff to schedule frequent meetings is:

A) flexibility and unconventional responses to stress.
B) a desire to achieve emotional intimacy with staff.
C) a tendency to evoke countertransference and conflict.
D) an impaired ability to develop trusting relationships.

Question 32

A teacher comes to the mental health clinic saying a co-worker recently confronted her about behaviors that are annoying to other co-workers.She is now experiencing moderate to severe levels of anxiety.The co-worker told the patient that others find her very difficult because she is a perfectionist and micromanages the tasks of others on the teaching team,always demanding that things should be done according to her plans.The co-worker mentioned that the patient made everyone feel as though everything they tried was inadequate,and they feel frustrated and angry.The patient states she likes her co-workers and only wanted to help them be successful.The nurse realizes the patient's behaviors are most consistent with:

A) obsessive-compulsive personality disorder.
B) narcissistic personality disorder.
C) histrionic personality disorder.
D) schizoid personality disorder.

Question 33

A worker is characterized by her co-workers as "painfully shy" and lacking in self-confidence.Her co-workers say she stays in her cubicle all day,never coming out for breaks or lunch.One day after falling on the ice in the parking lot,she goes to the nurse's office,where she apologizes for falling and mentions that she hopes the company will not fire her for being so clumsy.With which diagnosis is this presentation most consistent?

A) Avoidant
B) Dependent
C) Histrionic
D) Paranoid