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The nurse is caring for a client diagnosed with histrionic personality disorder who is exhibiting manipulative behaviors. Which action by the nurse would be appropriate?
A. Allow the client to express feelings.
B. Provide negative reinforcement.
C. Set limits with consequences.
D. Employ emphasis-guided imagery.
Answer: C
Rationale: Clients exhibiting manipulative behaviors would benefit from limit setting with appropriate consequences. Expression of feelings would be appropriate for clients in cluster C (behaviors are described as anxious or fearful). Negative reinforcement could increase manipulative behavior in clients with histrionic personality disorder. Emphasis-guided behavior is helpful in reducing stress in clients not decreasing manipulative behavior.
The nurse is interviewing a client diagnosed with avoidant personality disorder. The nurse correlates which behavior by the client as being associated with this diagnosis?
A. Preoccupation with details
B. Extreme shyness
C. Inability to make decisions
D. Manipulation
Answer: B
Rationale: Clients diagnosed with avoidant personality disorder exhibit extreme shyness and sensitivity to rejection. Clients with obsessive-compulsive personality disorder have a preoccupation with details. An inability to make decisions occurs in clients diagnosed with dependent personality disorder. Manipulation occurs in clients diagnosed with borderline personality disorder.
The nurse considers facilitating behavioral changes for a client diagnosed with a personality disorder. When planning nursing interventions, which action would be the priority focus?
A. Helping the client gain insight regarding the connection between the client's behaviors and problems
B. Educating the client to the benefits of both group and individual cognitive-behavioral therapy sessions
C. Identifying and effectively treating any associated mental illness disorder the client may be experiencing
D. Setting appropriate limits to manage existing manipulative or aggressive behaviors used for client coping.
Answer: A
Rationale: Members of the health care community join together in providing an environment in which the client with a personality disorder can affect behavior change. To accomplish this, the client must gain perspective into the problem underlying their maladaptive response to the world. This is often difficult because most people with these disorders lack insight and resist attempts to impose change. To facilitate behavioral change, the priority focus is to help the client gain insight into their problematic behaviors and so provide the motivation to work on and bring about personal change. While the other options identify foci that require attention, none of them have the priority that achieving self-awareness has on fostering behavioral changes.
A client diagnosed with borderline personality disorder has been admitted to the inpatient medical unit for crisis management after being told the client's spouse wants a divorce. Considering the behaviors associated with this disorder, which intervention would take priority for this client?
A. Keeping a self-reflective journal
B. Developing a no-harm contract
C. Being restricted to the unit
D. Encouraging participation in unit activities
Answer: B
Rationale: When a relationship ends, this person may experience feelings of worthlessness. Dissociation may occur to escape the feeling of being alone. At times, there may be brief episodes of paranoia and hallucinations because the person's ability to maintain a reality state is unstable. This is often the time when repeated threats of suicide or self-mutilation are exhibited. With a no-harm contract, the client signs an agreement promising not to do anything to harm or kill self within a specified period of time. The contract may also “require” the client to take some specified action if they want to act on suicidal thoughts such as call 911 or if hospitalized, notify staff. The other interventions may be appropriate for this client but would not take priority since they do not address the issue of client safety.
A client is diagnosed with narcissistic personality disorder. The nurse would expect the client to exhibit which behavior?
A. Sense of entitlement
B. Current paranoid behaviors
C. History of unstable relationships
D. History of self-mutilation
Answer: A
Rationale: Behaviors associated with narcissistic personality disorder include a sense of entitlement, grandiose sense of self-importance, and a demand for the best of everything. Paranoid behavior occurs in a variety of disorders but is not a classic characteristic of narcissistic personality disorders. Unstable relationships and self-mutilation are more likely to occur in borderline personality disorder.
A client diagnosed with borderline personality disorder shares with another client, “That nurse is mean and hates me. I want to have another nurse take care of me because that nurse is nice all the time.” The client is exhibiting which behavior?
A. Dissociation
B. Impulsivity
C. Manipulation
D. Splitting
Answer: D
Rationale: Along with mood changes, the client diagnosed with borderline personality disorder usually demonstrates an extreme view, or splitting, of their relationship to the world. Things are seen as all or none, black or white, love or hate, with no neutral ground. The client's statement is not reflective of dissociation, impulsivity, or manipulation.
A client is diagnosed with histrionic personality disorder. When assisting with the plan of care, interventions would focus on which client behavior?
A. Preoccupation with orderliness
B. Fear of disapproval
C. Dependency needs
D. Extreme egocentricity
Answer: D
Rationale: Clients diagnosed with histrionic personality disorder exhibit extreme egocentricity, shallow superficial relationships, and exaggerated behavior. A fear of disapproval occurs in avoidant personality disorder. A preoccupation with orderliness occurs in clients diagnosed with obsessive-compulsive personality disorder. Dependency needs occur in dependent personality disorder.
A client is diagnosed with schizotypal personality disorder. The nurse would identify which thought pattern as consistent with this condition?
A. Self-absorbed thoughts
B. Magical thinking
C. Egocentric
D. Preoccupation with perfection
Answer: B
Rationale: The thinking patterns and opinions of people diagnosed with schizotypal personality disorder are unusual and bizarre, often with paranoid undertones. They often display magical thinking or the belief that thoughts, words, and actions can cause or prevent an occurrence by extraordinary means. Self-absorbed thoughts are characteristic of schizoid personality disorder. An egocentric thought pattern is indicative of histrionic personality disorder. Clients diagnosed with obsessive-compulsive personality disorder are preoccupied with perfection and orderliness.
Which nursing care focus should the nurse expect as the priority in the care plan for a client diagnosed with borderline personality disorder?
A. Self-harm risk, related to self-mutilating behaviors
B. Other-directed violence risk, related to need for manipulation
C. Impaired communication, related to social withdrawal
D. Impaired social interaction, related to indifference toward others
Answer: A
Rationale: Self-harm risk related to self-mutilating behaviors would be the priority nursing care focus for a client diagnosed with borderline personality disorder. Impaired communication, related to social withdrawal, relates to schizoid personality disorder. Impaired social interaction, related to indifference toward others, is consistent with the diagnosis of schizotypal personality disorder.
A client is being seen in the mental health clinic. When taking the health history, the nurse notes that the client has a history of vandalism, verbal assaults, and truancy. The nurse interprets these behaviors as supporting which personality disorder?
A. Dependent
B. Narcissistic
C. Antisocial
D. Borderline
Answer: C
Rationale: Antisocial personality disorder is characterized by the client acting impulsively and recklessly. Vandalism, fighting, verbal assaults, and truancy are characteristic behaviors. Clients with dependent personality disorders feel a need to be taken care of. Clients with narcissistic personality disorders have a consistent need for attention. Clients with borderline personality disorder are manipulative and impulsive.
A client is diagnosed with a personality disorder. Assessment of a client diagnosed with a personality disorder reveals that the client has a consistent pattern of lying and stealing as well as a history of several arrests for breaking the law. The client also has not been able to maintain employment due to a lack of following through with assigned responsibilities, consistently shown disregard for others and infringement on the rights of others. The client’s assessment likely correlates with which personality disorder?
A. Antisocial
B. Narcissistic
C. Histrionic
D. Dependent
Answer: A
Rationale: Antisocial personality disorder exhibits a persistent pattern of disregard and infringement on the rights of others in a society. A false sense of privileged revenge against others is demonstrated by their basic cold indifference to the laws of society and humanity. The other personality disorders are not associated with a sense of societal disregard.
A nurse is assisting with the development of the plan of care for a client diagnosed with a schizoid personality disorder. Which problem area would be a priority focus for nursing care?
A. Social interaction
B. Suspiciousness
C. All or none thinking
D. Superiority over others
Answer: A
Rationale: People with a schizoid personality disorder are withdrawn and secluded and demonstrate an emotional indifference toward social relationships. Therefore social interaction would be a priority focus of care. Paranoid personality disorder is associated with suspiciousness. Borderline personality disorder is associated with all or none thinking. Narcissistic personality disorder is associated with beliefs of superiority of others.
The nurse is assessing a client diagnosed with borderline personality disorder. Which assessment would be most important for the nurse to make?
A. Inconsistencies between vocalizations and behaviors
B. Evidence of scars or cuts
C. Nonverbal behaviors
D. Resistance to questioning
Answer: B
Rationale: It would be important to assess for any scars or cuts that may indicate self-mutilating behaviors since this behavior raises safety concerns. The other areas of assessment would be important but would not take priority.
A client is diagnosed with antisocial personality disorder. Based on expected assessment findings, which outcome would be the most appropriate?
A. Increases interactions with others
B. Exhibits relaxed posture
C. Decreases manipulative behaviors
D. Gains control over impulses
Answer: D
Rationale: The person with antisocial personality disorder is suspicious and feels betrayed by the world. Thinking that humans are basically evil and out to undermine, the person performs actions impulsively and recklessly to avoid being sabotaged. The other outcomes are not associated with characteristics that are classically demonstrated by individuals diagnosed with antisocial personality disorder.
Which response by the nurse manager would best address the concerns of a nurse who expresses uncertainty about how to evaluate the short-term progress of a client being treated for borderline personality disorder?
A. “It's hard since the behaviors are so deeply established into the way the client interacts with others.”
B. “Focus on how the client's use of effective impulse control has improved since admission.”
C. “If behavioral changes don't occur during hospitalization, the prognosis for change is poor.”
D. “No real progress will be made until the client recognizes and accepts that a problem exists.”
Answer: B
Rationale: The effectiveness of implemented interventions for clients with personality disorders is difficult to measure. Changes do not occur quickly and are often not recognizable during the brief treatment period. Short-term outcomes that involve interaction with other clients and impulse control can be evaluated within the confined milieu. The client's behavior following discharge will demonstrate whether actual improvement has occurred. While true that the potential for improvement is limited by the deeply ingrained patterns of pervasive behaviors and self-reflection is needed, these statements don't help the nurse evaluate the client's progress.
A nurse practitioner is conducting an in-service presentation about personality disorders to the staff at the local community mental health center. The nurse practitioner determines that the teaching was successful when the group identifies which personality disorder as associated with an increased risk for physical, verbal, emotional, or sexual abuse?
A. Histrionic
B. Dependent
C. Schizoid
D. Borderline
Answer: B
Rationale: There is an increased incidence of abuse and surrender in clients with dependent personality disorder. Because the abused person is so afraid of being alone, the abuse is endured even when help is offered to leave the situation. The other personality disorders do not carry with them the increased incidence of abuse.
When gathering data about a client with suspected obsessive-compulsive personality disorder, which characteristic(s) would the nurse most likely find? Select all that apply.
A. Detail-focused
B. Stubbornness
C. Insecurity
D. Perfectionism
E. Flexible control
Answer: A, B, D
Rationale: Insecurity is not a manifestation of obsessive-compulsive personality disorder. Stubbornness, a focus on details, rigid control, and striving for perfection occur in clients diagnosed with obsessive-compulsive personality disorder.
When considering the treatment for personality disorders, the nurse should reinforce teaching that focuses on which intervention(s)? Select all that apply.
A. Minimizing external stimuli by using stress reduction techniques
B. Attempting to correct error in thinking with risperidone
C. Determining usefulness of behavioral therapy to bring about changes in conduct
D. Improving interpersonal relationships through the development of trust
E. Improving problem-solving skills through use of critical thinking
Answer: B, C, D, E
Rationale: A combination of psychotherapy and medication is the preferred approach to treatment of personality disorders, although the symptoms of these disorders are less responsive to drugs. Thinking errors can be somewhat improved with antipsychotic medications such as risperidone and olanzapine. Cognitive-behavioral therapy and individual, group, and family therapy may be used. Attention to the development of trust is appropriate for such clients. This disorder often manifests with poor problem-solving skills and so therapy attempts to address this dysfunction. The inability to manage external stimuli is not a characteristic of personality disorders. However, reducing environmental stress is often the first step in treatment.
When gathering data about a client diagnosed with antisocial personality disorder, the nurse should expect to observe which characteristic(s)? Select all that apply.
A. Dishonesty
B. Grandiose view of self
C. Inability to make self-care decisions
D. Preoccupation with orderliness
E. Lack of guilt
Answer: A, E
Rationale: The nurse would expect deceit and dishonesty and lack of guilt to occur in the client diagnosed with antisocial personality disorder. A grandiose view of self occurs in narcissistic personality disorder. Clients diagnosed with dependent personality disorder have an inability to make self-care decisions. A preoccupation with orderliness occurs in clients diagnosed with obsessive-compulsive personality disorders.
Which intervention(s) would the nurse consider for inclusion into the care plans of clients demonstrating characteristics of cluster B personality disorders? Select all that apply.
A. Reintroducing stated outcomes when unit rules are broken.
B. Monitoring frequently for indications of self-mutilation.
C. Approaching the client from the back to avoid triggering aggressive behavior.
D. Reinforcing that staff does not show favoritism toward certain clients.
E. Intervene when client dress is sexually provocative.
Answer: A, B, D, E
Rationale: Dramatic, emotional, or erratic behavior is characteristic of individuals with a cluster B personality disorder. The category includes the antisocial, borderline, narcissistic, and histrionic personality disorders. Typical characteristics for each disorder in this group include injury to self or others, manipulation/exploitation, provocative sexual behavior/dress, impulsivity/anger, and feelings of arrogance/self-importance. Therefore setting limits by reintroducing outcomes when rules are broken, frequently monitoring for self-harm, reinforcing no staff favoritism, and intervening for provocative dressing address these characteristics. Approaching the client from the front, not the back, would be appropriate to avoid triggering aggressive behavior.