Personality Disorders
Your client arrives at her clinic appointment in a short, tight, brightly colored dress with high heels and dramatically bold makeup. Which personality disorder is most likely present?
A. Obsessive-compulsive
B. Histrionic
C. Paranoid
D. Antisocial
B. Histrionic
-Individuals with histrionic PD (cluster B) demonstrate overly dramatic, attention-seeking and/or seductive behaviors, using their physical appearance to draw attention.
-Those with obsessive-compulsive PD (cluster C) are often "perfectionists". They are compulsive and rigid about tidiness, timing, & details.
-Those with paranoid PD (cluster A) are always on guard and suspicious of others.
-Those with antisocial PD (cluster B) are manipulative, have no regard for rules or social norms, and do not take accountability for their actions. They are often aggressive/violent with no remorse or empathy.
You are developing a teaching plan about mental health conditions for a group of clients on a pediatric unit. Which of the following is most important to consider?
A. The client's relationship with his/her parents
B. The client's physical health conditions
C. The client's coping mechanisms
D. The client's developmental level
D. The client's developmental level
-Many mental health conditions are present and problematic during various stages of childhood and adolescence. It's important to consider the developmental level of the clients when planning teaching so that you know the teaching will be understood effectively. For example, you wouldn't teach a 6 y/o about disruptive mood dysregulation disorder (DMDD) the same way that you would teach a 16 y/o. The other answers are not relevant when creating a teaching plan if the child's developmental level is not considered, making it the most important factor (of the choices given).
The nurse is providing education to a group of parents about eating disorders. Which of the following is true regarding eating disorders?
A. Family therapy is not likely to help; the gold standard is individual psychotherapy
B. Eating disorders are not typically linked to anxiety or depression
C. Lack of control is a common theme; teaching should include ways to feel more in control
D. Individual, group, and family therapy may help address physiological needs
C. Lack of control is a common theme; the nurse should teach the client ways to feel more in control
-Lack of control is a very common theme among all eating disorders. The nurse should teach the client ways to feel more in control that do not involve food or purging behaviors. Behavior modification therapy is recommended for eating disorders as it helps the client feel more in control of their choices.
-Eating disorders are highly associated with family dysfunction. Family therapy and family support are necessary for recovery (especially for adolescents).
-Individual psychotherapy is also recommended, as comorbid anxiety and/or depression is extremely common with eating disorders. These clients also benefit from group therapy.
-Physiological needs may be addressed by a dietitian consult, medication, etc. (not therapy).
Which of the following is not an appropriate short-term goal for a client with a personality disorder?
A. The client will be able to cope adequately with life and demonstrate appropriate social interactions.
B. The client will verbalize rules of the unit and consequences for breaking them.
C. The client will verbalize underlying feelings of hostility, anxiety, or fear before acting on them.
D. The client will remain free from self-harm or suicide.
A. The client will be able to cope adequately with life and demonstrate appropriate social interactions.
-Short-term goals should be measurable and obtainable within the duration of a client's hospitalization. The ability to "cope adequately with life" is not measurable, and developing healthy coping mechanisms is more appropriate as a long-term goal.
-Verbalizing rules and consequences for breaking them, verbalizing underlying feelings, and remaining safe are all appropriate and measurable short-term goals for clients with personality disorders.
The nurse is educating a group of adolescents on the right of confidentiality. Which of the following should be included in the teaching?
A. Everything you tell us is strictly confidential, so we will not tell your parents anything that you say.
B. Until you are 18 years old, your parents have the right to know what you discuss with us.
C. We can only tell your parents something you discuss with us if you give us permission first.
D. What we discuss is confidential, but I will have to report suicidal ideations or self-harm to the provider.
D. What we discuss is confidential, but I will have to report suicidal ideations or self-harm to the provider.
-Adolescent clients have a right to confidentiality under HIPAA. However, there are some circumstances that require reporting of information for safety purposes. It's important to be honest and transparent about this with your patients.
Which of the following is TRUE regarding personality disorders?
A. Medications are necessary to treat the disorder
B. These individuals are typically compulsive and rigid/inflexible
C. Appropriate short-term goals include developing adequate coping skills & functional social interactions
D. These individuals typically have no problems with relationships or getting along with others
B. These individuals are typically compulsive and rigid/inflexible
-Individuals with personality disorders are typically rigid/inflexible, compulsive, and have difficulty with relationships in general (these are people who can't seem to get along with anyone or maintain healthy relationships).
-Medications may decrease symptoms (e.g., anxiety, depression, emotional dysregulation, aggression, abnormal cognitive/perceptual symptoms, etc.). However, medications CANNOT directly treat or cure personality disorders.
-Short-term goals include goals that can be accomplished before the patient is discharged. It takes time to develop adequate coping skills and functional social interactions, so these would not be realistic/appropriate short-term goals.
The nurse is taking care of a group of clients with Tourette's disorder. Which of the following is an appropriate nursing consideration for this condition?
A. This is treated with CNS stimulants.
B. This is often associated with an authoritarian parenting style.
C. Tics are voluntary behaviors, so the nurse should reward children for suppressing them.
D. This is commonly associated with comorbidities such as ADHD or OCD.
D. This is commonly associated with comorbidities such as ADHD or OCD.
-Antipsychotics are prescribed to treat tics associated with Tourette's disorder. Stimulants are used to treat ADHD.
-Tics are not voluntary behaviors. Although there are certain types of therapies to help treat tics, tics are not "bad behaviors" for the nurse to try to prevent by behavior modification. If a client purposely suppresses tics for a period of time, he/she will need "tic time" afterward to let out the tics and vent his/her feelings.
-Parenting styles do not cause Tourette's disorder, there are biological and other environmental hypotheses as to its etiology.
You are taking care of a 16 y/o client who has been severely restricting her calories. Upon assessment, you note bradycardia, amenorrhea, low bone density, and a BMI of 14.3. Which eating disorder do you suspect?
A. Anorexia nervosa
B. Binge eating disorder
C. Bulimia nervosa
A. Anorexia nervosa
-Anorexia nervosa is characterized by severe calorie restriction and a BMI of less than 17.0. These individuals often exhibit compensatory behaviors (e.g., excessive exercise), and may or may not have actual binging-purging episodes.
-Binge eating disorder is characterized by overeating (binging) WITHOUT compensatory behaviors (purging). These individuals are typically overweight or obese.
-Bulimia nervosa is characterized by binging and purging (which may include fasting/calorie restriction). These individuals are often normal weight or slightly overweight.
-The biggest difference between anorexia nervosa and bulimia nervosa is the client's BMI.
The nurse is taking care of a client with antisocial personality disorder. Which of the following is the most appropriate long-term goal for this client?
A. Encourage the client to verbalize fears or worries.
B. Encourage the client to pursue activities that they enjoy, regardless of the consequences.
C. Help the client take accountability for their behavior and abide by rules/laws.
D. Assist the client to prevent future relationships with abusive partners.
C. Help the client take accountability for their behavior and abide by rules/laws.
-Clients with antisocial personality disorder are manipulative, lack empathy, and have no regard for rules, social norms, or the rights of others. These clients are often in trouble for aggression, violence, or other legal violations and do not take accountability for their actions.
-These clients typically have hostile feelings as opposed to fears and anxiety. The nurse should encourage the client to express their hostile feelings.
-The nurse should NOT encourage the client to do things that he wants to do, as these are often violent acts and/or behaviors that violate others' basic human rights. Consequences should be reinforced.
-These clients are the perpetrators of violence (not victims of abuse).
Which of the following medications would be the most likely to be prescribed to a client with binge eating disorder?
A. Disulfiram
B. Sertraline
C. Lamotrigine
D. Risperidone
B. Sertraline
Co-occurring depression is common among clients with eating disorders, so an antidepressant may be prescribed to treat those Sx, making sertraline the most likely of these four medications to be prescribed.
The nurse is caring for a group of clients with personality disorders. Which finding requires further investigation?
A. A client with antisocial PD admitted for violent/homicidal ideations who is hostile.
B. A client with dependent PD who is generous, sensitive, clingy, and passive.
C. A client with narcissistic PD who is arrogant, grandiose, and has minimal empathy for others.
D. A client with obsessive-compulsive PD whose room is messy and cluttered.
D. A client with obsessive-compulsive PD whose room is messy and cluttered.
-Clients with OCPD are very strict about tidiness, cleanliness, and organization. If the opposite is noted, this may be a sign of severe emotional distress or instability, so the patient should be assessed immediately.
-The other clients are exhibiting typical traits so additional investigation is not warranted at this time
The nurse is caring for a 13 y/o child who has oppositional defiant disorder. Which symptoms should be expected?
A. Low self-esteem, refuses group therapy, argues about rules, & denies negative temperament.
B. Angry outbursts almost daily with an angry/irritable mood in between outbursts.
C. Often gets into friends' personal space, impulsive, & unable to complete tasks on time.
D. Repetitive behaviors, rigid routines, trouble socializing, & does not maintain eye contact.
A. Low self-esteem, refuses group therapy, argues about rules, & denies negative temperament. These are all symptoms expected with oppositional defiant disorder.
-Angry outbursts at least 3x/week in at least 2 settings with an angry/irritable mood in between outbursts is characteristic of disruptive mood dysregulation disorder (DMDD).
-Impulsivity, intrusiveness, and difficulty focusing or completing tasks on time are symptoms of ADHD.
-Repetitive behaviors, rigid routines, poor eye contact, and impaired social interactions are seen in autism spectrum disorder.
You are taking care of a group of clients with eating disorders. Which of the following clients is most likely to have bulimia nervosa?
A. A client with a BMI of 31.5 who eats 4-5 meals per day and feels guilty about eating
B. A client with a BMI of 16.1 who limits her calories, but sometimes indulges then takes several laxatives
C. A client with a BMI of 18.2 who has Russel's sign and parotid gland swelling
D. A client with a BMI of 15.6 who eats 500 calories per day and runs 5 miles per day
C. A client with a BMI of 18.2 who has Russel's sign and parotid gland swelling
-Bulimia nervosa is characterized by binging and purging behaviors with a normal or close to normal BMI. Purging behaviors may include self-induced vomiting, use of laxatives/diuretics/stimulants, fasting, excessive exercise, or any other behaviors with the intent to cause weight loss. Parotid gland swelling and Russel's sign (callouses/scarring on knuckles) are common signs of self-induced vomiting.
-Binge eating disorder (BED) is characterized by binging without purging, so clients are typically overweight or obese (BMI > 25) and is associated with intense feelings of guilt about eating.
-Anorexia nervosa includes severe calorie restriction with a low BMI (<17). This may or may not include binging and purging behaviors as well.
The nurse is caring for an adolescent client with anorexia nervosa. Which of the following is an appropriate consideration regarding goal-setting for this client?
A. The nurse should encourage the client's mother to set goals for the client.
B. The nurse should encourage the client to set long-term weight loss goals.
C. Avoiding conversations about food and weight is a good short-term goal.
D. Establishing a realistic weight gain goal is an appropriate short-term goal.
D. Establishing a realistic weight gain goal is an appropriate short-term goal.
-Short-term goals should be measurable and obtainable during the client's inpatient stay. For clients with eating disorders, this mainly revolves around weight goals (but must be realistic).
-The nurse should work with the client (not her mother) to set goals, utilizing recommendations from the dietitian.
-Clients with anorexia nervosa should not be encouraged to try and lose weight, especially long-term.
-The client should be encouraged to verbalize fears and anxieties about food/weight.
Use the terms oppositional defiant disorder and conduct disorder to complete these two sentences:
_____ is considered less severe than _____.
_____ can develop into antisocial personality disorder in adulthood.
Oppositional defiant disorder is considered less severe than conduct disorder.
Conduct disorder can develop into antisocial personality disorder in adulthood.
Name three traits of someone with dependent personality disorder
- Fear of being alone
- Lack of self confidence
- Feelings of helplessness
- Immediately jumps into a new relationship following a break-up
- Avoids conflict for fear of losing support from others
- Needing excessive reassurance
- Easily hurt by criticism
- Defaults to what others want/prefer. Passive
- Clingy and submissive in relationships
The nurse is providing education about risk factors and comorbidities for child and adolescent disorders. Which statement should NOT be included?
A. Depression is a common comorbidity for other mental health disorders.
B. Children with separation anxiety disorder often have a parent with an anxiety disorder.
C. Children/adolescents with conduct disorder are at high risk for legal trouble and incarceration.
D. Most children who have Tourette's disorder also have substance use disorder.
D. Most children who have Tourette's disorder also have substance use disorder.
- Common comorbidities with Tourette's include ADHD and OCD, not SUD. Conditions that increase the risk of SUD include oppositional defiant disorder, conduct disorder, and ADHD (these three are also commonly comorbid together, along with other mood, anxiety, and learning disorders).
- The other options are accurate
Which of the following findings requires further intervention by the nurse?
A. The client with bulimia nervosa is observed eating extra food after finishing her dinner
B. The tech is weighing a client with anorexia nervosa without showing the client her weight
C. The client expresses fears related to eating and limiting exercise while in the hospital
D. The tech accompanies a client with an eating disorder to her room after lunch and stays for 1 hour
A. The client with bulimia nervosa is observed eating extra food after finishing her dinner
-Clients with bulimia or anorexia nervosa (binging-purging type) should be monitored closely for signs of binging, as this is what triggers purging behaviors.
-Clients with anorexia nervosa should be weighed daily while inpatient to monitor their progress, but the weight should not be shown to the client as this can be triggering.
-Clients with eating disorders often have control issues and underlying fears/anxieties. It's always therapeutic to encourage clients to verbalize their feelings.
-Clients with bulimia nervosa and anorexia nervosa should be monitored closely (may need 1:1 observation) during meals and for at least 1 hour after meals, especially in the bathroom.
Which of the following is an appropriate nursing consideration regarding the use of electroconvulsive therapy (ECT)?
A. ECT is commonly used to treat childhood conditions, such as Autism or ADHD.
B. The nurse is responsible for obtaining informed consent for ECT procedures.
C. ECT is a first-line option for most mental health conditions.
D. ECT is reserved for very severe, treatment-resistant cases of certain mental health conditions.
D. ECT is reserved for very severe, treatment-resistant cases of certain mental health conditions.
-Electroconvulsive therapy is never a first-line treatment, and it is not used to treat eating disorders, childhood disorders, or personality disorders.
-The nurse is not responsible for obtaining informed consent, as this requires a provider to explain the risks vs. benefits of the procedure to the client. The nurse's role is verifying that informed consent has been obtained and on file before the procedure takes place.
You are meeting with an 8yo client who gets easily distracted and sometimes makes risky choices during recess. When you ask him a question he starts to answer but gets distracted by the items on your desk. Which medication is this client most likely to get prescribed?
A. Chlordiazepoxide
B. Lithium
C. Dextroamphetamine
D. Aripiprazole
C. Dextroamphetamine
This is a CSN stimulant often given to treat ADHD, which is what this client likely has. The other medications (a benzo, a mood stabilizer, and an antipsychotic) would not be indicated for this client, at least not based on the current presentation.
Which of the following are appropriate nursing interventions for clients with personality disorders? Select all that apply.
A. Set firm, consistent boundaries, especially for those with cluster B disorders.
B. Monitor clients with borderline PD for suicidal ideations, self-mutilation, or threats of self-harm.
C. Initiate suicide precautions for patients with a history of self-harm.
D. Encourage clients to verbalize their feelings while providing empathy and support.
E. Ignore manipulative or problematic behaviors.
A. Set firm, consistent boundaries, especially for those with cluster B disorders.
B. Monitor clients with borderline PD for suicidal ideations, self-mutilation, or threats of self-harm.
D. Encourage clients to verbalize their feelings while providing empathy and support.
-Clients with cluster B disorders (histrionic, borderline, antisocial, & narcissistic) are often dramatic, erratic, and manipulative. These clients require firm, consistent boundaries (especially for borderline PD). Manipulative or problematic behaviors should be addressed immediately.
-Clients with borderline PD are at extremely high risk of suicide or self-harm (whether it's true suicidal ideation or attention-seeking behavior, it is extremely common and dangerous). Intervene ASAP if threats/behaviors/ideations are noted.
-Encouraging clients to verbalize feelings is a universally therapeutic strategy.
-Suicide precautions are not necessarily indicated for clients with a history of self-harm unless they currently have thoughts or behaviors indicating risk.
Which of the following are appropriate interventions for children with ADHD? Select all that apply.
A. Provide rewards for task completion and set clear limits on unacceptable behaviors.
B. Assign bigger tasks to be completed over several hours to increase their attention span.
C. Administer methylphenidate for restlessness in the evenings.
D. Obtain the child's attention before speaking to him/her.
E. Encourage them to participate in therapy.
A. Provide rewards for task completion and set clear limits on unacceptable behaviors.
D. Obtain the child's attention before speaking to him/her.
E. Encourage them to participate in therapy.
-For children with ADHD, tasks should be divided into smaller steps and more breaks should be allowed. Forcing children to sit and focus for long periods of time will not help their attention span.
-Methylphenidate is a CNS stimulant often used to treat ADHD, but it should not be used in the evenings as this will cause insomnia. The last dose should be given at least 6hrs before bedtime
Name three findings that may necessitate hospitalization for a client with an eating disorder
• Malnutrition - 20% below expected wt = inpatient Tx, 30% below expected wt = intensive (2-6mos) inpatient Tx
• Dehydration - May observe orthostatic hypotension, tachycardia, elevated sodium levels
• Severe electrolyte imbalances
• Cardiac arrhythmia
• Severe bradycardia
• Hypothermia - temp below 96.8°F
• Hypotension - also assess orthostatics
• Suicidal ideation
Which of the following are appropriate nursing considerations regarding clients with refeeding syndrome? Select all that apply.
A. All clients with eating disorders should be monitored for refeeding syndrome.
B. Clients at risk for refeeding syndrome should have a dietitian consult.
C. Clients at risk for refeeding syndrome should cut their calorie intake in half.
D. Clients at risk for refeeding syndrome should have continuous telemetry/cardiac monitoring.
E. Clients at risk for refeeding syndrome should have electrolytes checked frequently.
B. Clients at risk for refeeding syndrome should have a dietitian consult.
D. Clients at risk for refeeding syndrome should have continuous telemetry/cardiac monitoring.
E. Clients at risk for refeeding syndrome should have electrolytes checked frequently.
-When a severely malnourished client begins the re-nourishment process, there is a risk for refeeding syndrome due to rapid electrolyte shifts. This may cause potentially fatal arrhythmias, so these clients should have their electrolytes monitored frequently and should be on telemetry (continuous cardiac monitoring).
-A dietitian consult is necessary to develop a safe, healthy renourishment plan. Dietitian consults are also recommended in general for clients with eating disorders to safely meet their weight goals and develop healthy eating habits.
-Refeeding syndrome is not a risk for clients with binge eating disorder, and generally not a risk for clients with bulimia.
- It would not be appropriate to instruct the client to cut their calories in half.
Place the 10 personality disorders in their proper clusters (A, B and C):
Paranoid
Obsessive-Compulsive
Histrionic
Narcissistic
Dependent
Antisocial
Borderline
Schizoid
Avoidant
Schizotypal
Cluster A (Odd or Eccentric): Paranoid, schizoid, and schizotypal
Cluster B (Dramatic, Emotional, or Erratic): Antisocial, borderline, histrionic, and narcissistic
Cluster C (Anxious or Fearful): Avoidant, dependent, and obsessive-compulsive