Question 1

A patient diagnosed with borderline personality disorder was hospitalized several times after self-mutilating episodes.The patient remains impulsive.Which nursing diagnosis is the initial focus of this therapy?

Accepted Answer

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

Question 2

The history shows that a newly admitted patient is impulsive.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 3

A health care provider recently convicted of Medicare fraud says to a nurse,"Sure I overbilled.Everyone takes advantage of the government.There are too many rules to follow and I should get the money." 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 manifest anxiety,remorse,or guilt about the act.The patient's remarks cannot be assessed as shameful.Lack of trust and concern that others are determined to do harm is not shown.

Question 4

What is the priority nursing diagnosis for a patient diagnosed 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 have impaired social interactions,but the risk for harming others is a higher priority.They direct violence toward others; not self.When patients with antisocial personality disorders use denial,they use it effectively.

Question 5

As a nurse prepares to administer medication to a patient diagnosed 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,but also to prevent splitting other staff."Why" questions are not therapeutic.See relationship to audience response question.

Question 6

Which intervention is appropriate for an individual diagnosed with an antisocial personality disorder who frequently manipulates others?

Accepted Answer

Manipulative people frequently make requests of many different staff,hoping one will give in.Having 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 7

What is the most challenging nursing intervention with patients diagnosed with personality disorders who use manipulation?

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 because positive reinforcement strategies for acceptable behavior seem to be more effective than aversive techniques.See relationship to audience response question.

Question 8

A patient says,"I get in trouble sometimes because I make quick decisions and act on them." Select the nurse's most therapeutic response.

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 outcomes of possible actions and choose an effective action.The incorrect responses shift the encounter to a social level or are judgmental.

Question 9

A nurse reports to the treatment team that a patient diagnosed with an antisocial personality disorder has displayed the behaviors below.This patient is detached and superficial during counseling sessions.Which behavior by the patient 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 and particularly relevant when interacting with a patient diagnosed with an antisocial personality disorder.The other concerns should be addressed during therapeutic encounters.

Question 10

When a patient diagnosed with a personality disorder uses manipulation to get needs met,the staff applies 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 11

Consider this comment to three different nurses by a patient diagnosed with an antisocial personality disorder,"Another nurse said you don't do your job right." Collectively,these interactions can be assessed as:

Accepted Answer

Patients manipulate and control staff in various ways.By keeping staff 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 evident in the comments.

Question 12

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

Accepted Answer

The characteristics of grandiosity,self-importance,and entitlement are consistent with narcissistic personality disorder.Charm,drama,seductiveness,and admiration seeking are seen in patients with histrionic personality disorder.Preoccupation with minute details and perfectionism are seen in individuals with obsessive-compulsive personality disorder.Patients with dependent personality disorder often express difficulty being alone and are indecisive and submissive.

Question 13

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

Accepted Answer

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

Question 14

A patient's spouse filed charges after repeatedly being battered.The patient sarcastically says,"I'm sorry for what I did.I need psychiatric help." Which statement by the patient supports 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 15

Others describe a worker as very shy and lacking in self-confidence.This worker stays in an office cubicle all day,never coming out for breaks or lunch.Which term best describes this behavior?

Accepted Answer

Patients with avoidant personality disorder are timid,socially uncomfortable,withdrawn,and avoid situations in which they might fail.They believe themselves to be inferior and unappealing.Individuals with histrionic personality disorder are seductive,flamboyant,shallow,and attention-seeking.Paranoia and narcissism are not evident.

Question 16

Which statement made by a patient diagnosed 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 17

The nurse caring for an individual demonstrating symptoms of schizotypal personality disorder would expect assessment findings to include:

Accepted Answer

Individuals with schizotypal personality disorder do not want to be involved in relationships.They are shy and introverted,speak little,and prefer fantasy and daydreaming to being involved with real people.The other behaviors would characteristically be noted in narcissistic,histrionic,and antisocial personality disorder.(The educator may reformat this question as multiple response.)

Question 18

A patient diagnosed with borderline personality disorder has a history of self-mutilation and suicide attempts.The patient reveals feelings of depression and anger with life.Which type of medication would the nurse expect to be prescribed?

Accepted Answer

Mood stabilizing medications have been effective for many patients with borderline personality disorder.Serotonin norepinephrine reuptake inhibitors (SNRI)or anxiolytics are not supported by data given in the scenario.MAOIs require great diligence in adherence to a restricted diet and are rarely used for patients who are impulsive.

Question 19

One month ago,a patient diagnosed with borderline personality disorder and a history of self-mutilation began dialectical behavior therapy.Today the patient phones to say,"I feel empty and want to hurt 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 will reduce the urge to mutilate.Taking a sedative and going to sleep should not be the first-line intervention because sedation may reduce the patient's ability to weigh alternatives to mutilating behavior.

Question 20

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

Accepted Answer

This is 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 occasionally be 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.

Quiz 24: Personality Disorders