Personality Disorders
A nurse manager is discussing the care of a client who has a personality disorder with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?
A. "I can promote my client's sense of control by establishing a schedule"
B. "I should encourage clients who have a schizoid personality disorder to increase socialization"
C. "I should practice limit-setting to help prevent client manipulation
D. "I should implement assertiveness training with clients who have antisocial personality disorder"
What is C: When caring for a client who has a personality disorder, limit-setting is appropriate to help prevent client manipulation
A nurse is planning a staff education program on substance use in older adults. Which of the following is appropriate for the nurse to include in the presentation?
A. Older adults require higher doses of a substance to achieve a desired effect.
B. Older adults commonly use rationalization to cope with a substance use disorder
C. Older adults are at an increased risk for substance use following retirement
D. Older adults develop substance use to mask manifestations of dementia
What is C: Retirement and other life change stressors increase the risk for substance use in older adults, especially if there is prior history of substance use
A nurse is caring for a client who has early stage Alzheimer's disease and a new prescription for donepezil. The nurse should include which of the following statements when teaching the client about the medication?
A. "You should avoid taking over-the-counter acetaminophen while on donepezil"
B. "You can expect the progression of cognitive decline to slow with donepezil"
C. "You will be screened for underlying kidney disease prior to starting donepezil"
D. "You should stop taking donepezil if you experience nausea or diarrhea"
What is B: Donepezil slows the cognitive deterioration of Alzheimer's disease
A nurse is caring for an adolescent client who has anorexia nervosa with recent rapid weight loss and a current weight of 90 lb. Which of the following statements indicates the client is experiencing the cognitive distortion of catastrophizing?
A. "Life isn't worth living if I gain weight"
B. "Don't pretend like you don't know how fat I am"
C. "If I could be skinny, I know I'd be popular"
D. "When I look in the mirror, I see myself as obese"
What is A: This statement reflects the cognitive distortion of catastrophizing because the client's perception of her appearance or situation is much worse than her current condition.
A nurse is caring for a client who is screaming at staff members and other clients. Which of the following is a therapeutic response by the nurse to the client?
A. "Stop screaming and walk with me outside"
B. "Why are you so angry and screaming at everyone?"
C. "You will not get your way by screaming"
D. "What was going through your mind when you started screaming?"
What is A: Setting limits and the use of physical activity, such as walking to deescalate anger is an appropriate intervention. "Why" questions implies criticism and will often cause defensiveness. C is a nontherapeutic, close ended statement. The client is not ready to discuss the issue of what was going through his mind when he was screaming
A nurse is caring for a client who has avoidant personality disorder. Which of the following statements is expected from a client who has this type of personality disorder?
A. "I'm scared that you're going to leave me"
B. "I'll go to group therapy if you'll let me smoke"
C. "I need to feel that everyone admires me"
D. "I sometimes feel better if I cut myself"
What is A: Clients who have avoidant personality disorder often have a fear of abandonment. This type of statement is expected
A nurse is planning care for a client who is experiencing benzodiazepine withdrawal. Which of the following interventions should the nurse identify as the priority?
A. Orient the client frequently to time, place, and person.
B. Offer fluids and nourishing diet as tolerated.
C. Implement seizure precautions.
D. Encourage participation in group therapy sessions.
What is C: The greatest risk to the client is injury. Implementing seizure precautions is the priority intervention.
A nurse in a long-term care facility is caring for a client who has major neurocognitive disorder and attempts to wander out of the building. The client states, "I have to get home." Which of the following statements should the nurse make?
A. "You have forgotten that this is your home"
B. "You cannot go outside without a staff member"
C. "Why would you want to leave? Aren't you happy with your care?"
D. "I am your nurse. Let's walk together to your room"
What is D: it is appropriate for the nurse to introduce herself with each new interaction and to promote reality in a calm, reassuring manner
A nurse on an acute care unit is planning care for a client who has anorexia nervosa with binge-eating and purging behavior. Which of the following nursing actinos should the nurse include in the client's plan of care?
A. Allow the client to select preferred meal times
B. Establish consequences for purging behavior
C. Provide the client with a high-fat diet at the start of treatment
D. Implement one-to-one observation during meal times
What is D: The nurse should closely monitor the client during and after meals to prevent purging. The nurse should provide a highly structured milieu, including meal times for the client requiring acute care. The nurse should use a positive approach to client care that includes rewards rather than consequences. The nurse should limit high-fat and gas-producing foods at the start of treatment
A nurse is discussing the care of a client following a sexual assault with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of teaching?
A. "I will administer prophylactic treatment for sexually transmitted infections like chlamydia"
B. "I am not required to obtain informed consent before the sexual assault nurse examiner collects forensic evidence"
C. "I can expect manifestations of rape-trauma syndrome to be similar to bipolar disorder"
D. "I should use narrative documentation when documenting subjective data"
What is A: The nurse must obtain informed consent to collect data that can be used as legal evidence. Manifestations of rape-trauma syndrome are similar to PTSD. The nurse should document subjective data using the client's verbatim statments
A nurse is caring for a client who has borderline personality disorder. The client says, "The nurse on the evening shift is always nice! You are the meanest nurse ever!" The nurse should recognize the client's statement is an example of which of the following defense mechanisms?
A. Regression
B. Splitting
C. Undoing
D. Identification
What is B: Splitting occurs when a person is unable to see both positive and negative qualities at the same time. The client who has borderline personality disorder tends to see a person as all bad one time and all good another time.
A nurse is caring for a client who has alcohol use disorder. The client is no longer experiencing withdrawal manifestations. Which of the following medications should the nurse anticipate administering to assist the client with maintaining abstinence from alcohol?
A. Chlordiazepoxide
B. Bupropion
C. Disulfiram
D. Carbamazepine
What is C:
A nurse is making a home visit to a client who is in the late stage of Alzheimer's disease. The client's partner, who is the primary caregiver, wishes to discuss concerns about the client's nutrition and the stress of providing care. Which of the following actions should the nurse take?
A. Verify that a current power of attorney document is on file
B. Instruct the client's partner to offer finger foods to increase oral intake
C. Provide information on resources for respite care
D. Schedule the client for placement of an enteral feeding tube
What is C: A power of attorney document does not address the client's care or the concerns of the caregiver. Clients in late stages of Alzheimer's disease are at risk for choking and are unable to eat without assistance. Offering finger foods is not appropriate. Providing information on resources for respite care is an appropriate action to provide the client's partner with a break from caregiving responsibilities
A nurse is caring for a client who has bulimia nervosa and has stopped purging behavior. The client tells the nurse that she is afraid she's going to gain weight. Which of the following responses should the nurse make?
A. "Many clients are concerned about their weight. However, the dietitian will ensure that you don't get too many calories in your diet"
B. "Instead of worrying about your weight, try to focus on other problems at this time"
C. "I understand you have concerns about your weight, but first let's talk about your recent accomplishments"
D. "You are not overweight and staff will ensure that you do not gain weight while you are in the hospital. We know that is important to you"
What is C: This statement acknowledges the client's concern and then focuses the conversation on the client's accomplishments which can promote client self-esteem and self-image
A charge nurse is leading a peer group discussion about family and community violence. Which of the following statements by a member of the group indicates an understanding of teaching?
A. "Children older than 3 are at greater risk for abuse"
B. "Substance use disorder does not increase the risk for violence"
C. "Entering an intimate relationship increases the risk for violence"
D. "Pregnancy increases the risk for violence toward the intimate partner"
What is D: children under 3 are at an increased risk for abuse. Substance use disorder increases risk for violence. Vulnerable persons are increased risk for violence when they try to leave the relationship. Pregnancy tends to increase the likelihood of violence toward the intimate partner
A nurse is assisting with a court-ordered evaluation of a client who has antisocial personality disorder. Which of the following findings should the nurse expect? (Select all that apply)
A. Demonstrates extreme anxiety when placed in a social situation
B. Has difficulty making even simple decisions
C. Attempts to convince other clients to give him their belongings
D. Becomes agitated if his personal area is not neat and orderly
E. Blames others for his past and current problems
What are C and E: Exploitation and manipulation of others is an expected finding of antisocial personality disorder. Failure to accept personal responsibility is an expected finding of clients who have antisocial personality disorder
A nurse is assessing a client who has alcohol use disorder and is experiencing withdrawal. Which of the following findings should the nurse expect? (Select all that apply)
A. Bradycardia
B. Fine tremors of both hands
C. Hypotension
D. Vomiting
E. Restlessness
What are B, D, & E:
A home health nurse is making a visit to a client who has Alzheimer's disease to assess the home for safety. Which of the following suggestions should the nurse make to decrease the client's risk for injury? (Select all that apply)
A. Install childproof door locks
B. Place rugs over electrical cords
C. Mark cleaning supplies with colored tape
D. Place the client's mattress on the floor
E. Install light fixtures above stairs
What are A, D, & E: Door locks that are difficult to open are appropriate to reduce the risk of the client wandering outside without supervision. Rugs create a fall risk and should be removed. Electrical cords should be secured to baseboards rather than covered. Cleaning supplies should be placed in locked cupboards. Marking the supplies with colored tape does not prevent the client's access to hazardous materials. Placing the mattress on the floor reduces the risk of falling out of bed. Stairs should have adequate lighting to reduce risk of falls
A nurse is preparing to obtain a nursing history from a client who has a new diagnosis of anorexia nervosa. Which of the following questions should the nurse include in the assessment? (Select all that apply)
A. "What is your relationship like with your family?"
B. "Why do you want to lose weight?"
C. "Would you describe your current eating habits?"
D. "At what weight do you believe you will look better?
E. "Can you discuss your feelings about your appearance?"
What are A, C, & E: Nursing history should include family history. Asking Why questions promote a defensive response. Current eating habits should be assessed. Asking what weight the client believes she would look best at promotes cognitive distortion, places the focus on weight, and implies that the client's current appearance is not acceptable. The client's perception of the disorder should be included in the nursing assessment
A nurse is preparing to assess an infant who has shaken baby syndrome. Which of the following in an expected finding? (Select all that apply)
A. Sunken fontanels
B. Respiratory changes
C. Retinal hemorrhage
D. Altered level of consciousness
E. Increase in head circumference
What are B, C, D, & E: Bulging, rather than sunken fontanels are expected.
A charge nurse is preparing a staff education session on personality disorders. Which of the following personality characteristics associated with all of the personality disorders should the charge nurse include in the teaching? (select all that apply)
A. Difficulty in getting along with other members of a group
B. Belief in the ability to become invisible during times of stress
C. Display of defense mechanisms when routines are changed
D. Claiming to be more important than other persons
E. Difficulty understanding why it is inappropriate to have a personal relationship with staff
What are A, C, & E: Difficulty with social and professional relationships is a personality characteristic that can be seen with all personality disorder types. Maladaptive response to stress is a personality characteristic that can be seen with all personality disorder types. Difficulty understanding personal boundaries is a personality characteristic that can be seen with all personality disorder types
A nurse is providing teaching to the family of a client who has a substance use disorder. Which of the following statements by a family member indicate an understanding of the teaching? (Select all that apply)
A. "We need to understand that she is responsible for her disorder"
B. "Eliminating any codependent behavior will promote her recovery"
C. "She should participate in an Al-Anon group to help her recover"
D. "The primary goal of her treatment is abstinence from substance use"
E. "She needs to discuss her feelings about substance use to help her recover"
What are B, D, & E: Families should be aware of codependent behavior, such as enabling, that can promote substance use rather than recovery. Abstinence is the primary treatment goal. Clients must acknowledge their feelings about substance use as part of a substance use recovery program
A nurse is performing an admission assessment for a client who has delirium related to an acute UTI. Which of the following findings should the nurse expect? (Select all that apply)
A. History of gradual memory loss
B. Family report of personality changes
C. Hallucinations
D. Unaltered level of consciousness
E. Restlessness
What are B, C, & E: Memory loss in clients with dementia will be sudden rather than gradual. Rapid personality changes are seen in clients with delirium. Perceptual disturbances, such as hallucinations, are seen in clients with delirium. Rapidly fluctuating level of consciousness is seen in clients with delirium.
A nurse is performing admission assessment of a client who has bulimia nervosa with purging behavior. Which of the following is an expected finding? (Select all that apply)
A. Amenorrhea
B. Hypokalemia
C. Mottling of the skin
D. slightly elevated body weight
E. Presence of lanugo on the face
What are B & D: All other choices are found in clients with anorexia nervosa rather than bulimia nervosa
A nurse is assessing a client in an inpatient mental health unit. Which of the following findings should the nurse expect if the client is in the pre-asssaultive stage of violence? (Select all that apply)
A. Lethargy
B. Defensive responses to questions
C. Disorientation
D. Facial grimacing
E. Agitation
What are B, D, & E: Lethargy is more likely seen in patients with depression and disorientation is more likely seen in those with cognitive disorders