A nurse caring for a client who has been diagnosed with a personality disorder should expect that the client will exhibit a.] frequent episodes of psychosis. b.] constant involvement with the needs of significant others. c.] inflexible and maladaptive responses to stress. d.]
abnormal ego functioning.
c.] inflexible and maladaptive responses to stress.
Personality patterns persist unmodified over long periods of time. Inflexible and maladaptive responses to stress are characteristic of individuals with a personality disorder.
Which statement is descriptive of clients with a personality disorder?
a.] They are resistant to behavioral change.
b.] They have an ability to tolerate frustration and pain.
c.] They usually seek help to change maladaptive behaviors.
d.] They have little difficulty forming satisfying and intimate relationships.
a.] They are resistant to behavioral change.
Personality disorders are deeply ingrained and pervasive. Clients with personality disorders find it very difficult, if not nearly impossible, to change.
Change proceeds very slowly.
Research has indicated that the antisocial personality may be characterized by
a.] social isolation.
b.] lack of remorse.
c.] learning difficulties.
d.] difficulty with reality testing.
b.] lack of remorse.
Individuals with an antisocial personality exhibit a lack of remorse when confronted with the results of their thoughtless, irresponsible behavior toward others.
The primary goal of milieu therapy for clients diagnosed with personality disorders is
a.] to manage the effect the behavior has on the entire group.
b.] to provide one-on-one therapy for each member of the milieu.
c.] to help the client remain uninvolved with other patients.
d.] to promote a laissez-faire attitude among the staff members.
a.] to manage the effect the behavior has on the entire group.
The primary goal of milieu therapy is affect management in a group context.
Characteristic behaviors the nurse will assess in the narcissistic client are
a.] dramatic expression of emotion, being easily led.
b.] perfectionism and preoccupation with detail.
c.] grandiose, exploitive, and rage-filled behavior.
d.] angry, highly suspicious, aloof, withdrawn behavior.
c.] grandiose, exploitive, and rage-filled behavior.
Narcissistic clients give the impression of being invulnerable and superior to others to protect their fragile self-esteem.
The client diagnosed with a personality disorder who is most likely to be admitted to a psychiatric unit is one who has
a.] paranoid personality disorder and is suspicious of his neighbors.
b.] narcissistic personality disorder and is highly self-important.
c.] borderline personality disorder and is impulsive.
d.] dependent personality disorder and clings to her husband.
c.] borderline personality disorder and is impulsive.
Clients with borderline disorder can decompensate into psychotic states under stress.
Hospitalization is needed at these times.
Characteristics the nurse will assess in the client diagnosed with antisocial personality disorder are
a.] deceitfulness, impulsiveness, and lack of empathy.
b.] perfectionism, preoccupation with detail, and verbosity.
c.] avoidance of interpersonal contact and preoccupation with being criticized.
d.] a need for others to assume responsibility for decision making and seeking nurture.
a.] deceitfulness, impulsiveness, and lack of empathy.
Antisocial clients have no conscience. Their sense of right and wrong is impaired, and they tend to do whatever serves them best without consideration for the rights or feelings of others.
Playing one staff member against another is an example of
a.] devaluation.
b.] splitting.
c.] impulsiveness.
d.] social ineptitude.
b.] splitting.
Splitting involves setting up individuals or groups to disagree.
While the two parties are busy disagreeing, they are too busy to maintain consistent limits for the manipulative client.
The client can enjoy the spectacle and do as he or she pleases.
Splitting is a process in which the client
a.] unconsciously represses undesirable aspects of self.
b.] places responsibility for his or her behavior outside the self.
c.] sees things as divided into “all good” or “all bad.”
d.] evidences lack of personal boundaries.
c.] sees things as divided into “all good” or “all bad.”
Splitting demonstrates the failure to integrate the positive and negative into a cohesive whole. An individual is not seen as a person with good and bad traits, but rather as all good or all bad.
A client arrested for an assault in which he savagely beat a classmate states, “The guy deserved everything he got.” The behaviors described are most consistent with the clinical picture of
a.] antisocial personality disorder.
b.] borderline personality disorder.
c.] schizotypal personality disorder.
d.] narcissistic personality disorder.
a.] antisocial personality disorder.
Clients with antisocial personality act out feelings without consideration for the rights of others.
They feel no remorse for their antisocial acts.
Which behavior would be inconsistent with defining characteristics for the nursing diagnosis of ineffective coping?
a.] Difficulty in relationships
b.] High levels of anxiety
c.] Manipulation
d.] Interdependence
d.] Interdependence
The characteristics for the diagnosis of ineffective coping include crisis, high levels of anxiety, anger, and aggression; child, elder, or spouse abuse; and difficulty in relationships and manipulation.
Interdependence would not be considered a symptom for ineffective coping.
When providing care for a client diagnosed with borderline personality disorder, the nurse will need to consider strategies for dealing with the client’s
a.] mood shifts, impulsivity, and splitting.
b.] grief, anger, and social isolation.
c.] altered sensory perceptions and suspicion.
d.] perfectionism and preoccupation with detail.
a.] mood shifts, impulsivity, and splitting.
Borderline personality disorder has the central characteristic of instability in affect, identity, and relationships.
Borderline individuals desperately seek relationships to avoid feeling abandoned, but they often drive others away with excessive demands, impulsive behavior, or uncontrolled anger.
Their frequent use of the defense of splitting strains personal relationships and creates turmoil in health care settings.
A newly admitted client has an axis II diagnosis of schizoid personality disorder. The nursing intervention of highest priority will be to
a.] set firm limits on behavior.
b.] respect need for social isolation.
c.] encourage expression of feelings.
d.] involve in milieu and group activities.
b.] respect need for social isolation.
Schizoid personality disorder has the primary feature of emotional detachment.
Individuals do not seek out or enjoy close relationships.
They are reclusive, avoidant, and uncooperative. They do not do well with resocialization.
A client diagnosed with obsessive-compulsive personality disorder takes the nurse aside and mentions, “I’ve observed you interacting with that new patient. You are not approaching him properly. You should be more forceful with him.” The best response for the nurse would be
a.] “I will be continuing to follow the care plan for the patient.”
b.] “I see you are trying to control that patient’s therapy as well as your own.”
c.] “Your eye for perfection extends even to my nursing interventions.”
d.] “That patient’s care is really of no concern to you or to other clients.”
a.] “I will be continuing to follow the care plan for the patient.”
Obsessive-compulsive personality disorder has the key factor of perfectionism with a focus on orderliness and control.
These individuals get so preoccupied with details and rules that they may not be able to accomplish the tasks.
Guard against engaging in power struggles with a client with obsessive-compulsive disorder.
The priority nursing intervention for a client diagnosed with borderline personality disorder is to
a.] protect other clients from manipulation.
b.] respect the client’s need for social isolation.
c.] assess for suicidal and self-mutilating behaviors.
d.] provide clear, consistent limits and boundaries.
c.] assess for suicidal and self-mutilating behaviors.
One of the primary nursing guidelines/interventions for clients with a personality disorder is to assess for suicidal and self-mutilating behaviors, especially during times of stress.
A nurse who is idealized by a client is at risk for
a.] becoming overinvolved and being protective and indulgent.
b.] becoming indecisive about planned interventions.
c.] developing a prejudicial, blaming orientation.
d.] stringent enforcement of boundaries and limits.
a.] becoming overinvolved and being protective and indulgent.
Finding an approach for helping clients with personality disorders who have overwhelming needs can be challenging for caregivers.
For example, a borderline female client may briefly idealize her male nurse on the inpatient unit, telling staff and clients alike that she is “the luckiest client because she has the best nurse in the hospital.”
The rest of the team initially realizes that this behavior is an exaggeration, and they have a neutral response. But after days of constant dramatic praise, some members of the team may start to feel inadequate and jealous of the nurse. They begin to make critical remarks about minor events to prove that the nurse is not perfect.
Open communication in staff meetings and ongoing clinical supervision are important aspects of self-care for the nurse working with these clients to maintain objectivity.
Clients demonstrating characacteristics of personality disorders have various self-defeating behaviors and interpersonal problems despite having near-normal ego functioning and intact reality testing. A nursing diagnosis that addresses this sort of interpersonal dysfunction is
a.] spiritual distress.
b.] defensive coping.
c.] impaired social interaction.
d.] disturbed sensory perception.
c.] impaired social interaction.
For a client who has difficulty in relationships and is very manipulative, the nursing diagnosis of impaired social interaction would be used.