schizoid

inability to form personal relationships

fails to respond to others in a meaningful way

"emotionally cold"

too serious

lacked a nurturing childhood

1.When assessing a client diagnosed with narcissistic personality disorder, the nurse
expects to identify which characteristic behavior?

grandiose feelings of self importance

schizotypal

graver than schizoid

"magical" thinking

illusions

under stress they may experience psychotic symptoms

Antisocial

socially irresponsible

disregards the rights of others

fails to conform to the law

borderline personality disorder

fluctuating extreme attitudes

highly impulsive

emotionally unstable

lacks clear sense of identity

"splitting" personality

histrionic

excitable, emotional, colorful, dramatic, extroverted

attention seekers/seductive/manipulative

more common in women. 2-3% of the population

narcisstic

exaggerated sense of self worth

lack of empathy

self centered

more common in men than women

avoidant

extremely sensitive to rejection/ socially withdrawn

awkward and uncomfortable in social situations

lonely and feels unwanted

2.A client diagnosed with a personality disorder is cold, aloof, and avoids others on the unit. The nurse recognizes that this behavior is symptomatic of which personality disorder?

A.Schizoid personality disorder

B.Dependent personality disorder

C.Borderline personality disorder

D.Antisocial personality disorder

a

dependent personality

relies on others for emotional support

more common in women and more common in the youngest child

lack of self confidence: evidenced in voice, posture, and mannerisms

obsessive compulsive disorder

inflexibility in the way things are done.

more common in men and the oldest child in a family

on the surface: calm and controlled. underneath: conflict

socially polite

why is it called "borderline" personality?

between neuroses and psychosis

characteristics of borderline personality disorder

▪Chronic depression

▪Inability to be alone

▪Clinging and distancing behaviors

▪Splitting

▪Manipulation

▪Self-destructive behaviors

▪Impulsivity

predisposing factors of personality disorder

▪Biochemical: Possible serotonergic defect

▪Genetic: Possible familial connection with depression

▪Psychosocial influences

▪Childhood trauma and abuse

▪Developmental factors

Fixed in the rapprochement phase of development (16 to 24 months old). The child fails to achieve task of autonomy

A client diagnosed with borderline personality disorder is admitted to a psychiatric unit. Which behavior pattern would the nurse expect to observe?

A.Social isolation

B.Suspiciousness of others

C.Bizarre speech patterns

D.Generates conflict among the staff

d-they have "splitting" behaviors which causes conflict

In assessing a client diagnosed with borderline personality disorder, which characteristic would the nurse expect to observe?

A.Predictability

B.Controlled anger

C.Little tolerance for being alone

D.Stable and satisfactory relationships

they do not like to be alone

borderline personality disorder diagnosis

Risk for Suicide

risk for self mutilation

complicated greiving

impaired social interaction

Disturbed personal identity related to underdeveloped ego

Anxiety (severe to panic) related to unconscious conflicts based on fear of abandonment

¡Chronic low self-esteem related to lack of positive feedback

nursing implementation for a patient with Borderline personality

safety first

confront internalized anger to help develop the personality

why is antisocial disorder not seen in clinical settings?

usually in jail/prison

predisposing factors of antisocial personality disorder

• Possible genetic influence
• Having a disruptive behavior disorder as a child (ADHD, conduct disorder)
• History of severe physical abuse
• Absent or inconsistent parental discipline
• Extreme poverty
• Removal from the home
• Growing up without parental figures of both genders
• Always being rescued when in trouble
• Maternal deprivation

An individual, with a history of antisocial personality disorder, was arrested for driving
under the influence of alcohol and causing a serious car accident. Which comment on this behavior would be expected?

A.“It's not my fault.”

B.“I'm too ashamed to talk about it.”

C.“I just don't remember doing it.”

D.“I'm really sorry about all the people I've hurt.”

a- they lack remorse

interventions for antisocial personality disorder

• Ensuring the safety of client and others
• Helping client recognize and decrease unacceptable behaviors
• Assisting client to gain insight into own behaviors
• Helping client to learn to delay gratification

how to treat personality disorder

¡Interpersonal Psychotherapy

¡Psychoanalytical Psychotherapy

¡Milieu or Group Therapy

¡Cognitive/Behavioral Therapy

¡Dialectical Behavior Therapy

¡Psychopharmacology

ritualistic behaviors- diagnosis

ineffective coping

A psychiatrist prescribes an anti-obsessional agent for a client who is using ritualistic behavior. A common anti-anxiety medication used for this type of client would be:

luvox

A hospitalized client, diagnosed with a borderline personality disorder, consistently breaks the unit’s rules. This behavior should be confronted because it will help the client:

make the patient aware of the problem

The client with antisocial personality disorder:

delay gratification

A person with antisocial personality disorder has difficulty relating to others because of never having learned to

empathize with others

antisocial client asks for the nurse's phone number. What do you do?

say, "i like you but our relationship is professional".

During an assessment interview, a client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions. Which is the most appropriate nursing statement to address this behavior?
A. "You are very disrespectful. You need to learn to control yourself."
B. "I understand that you are angry, but this behavior will not be tolerated."
C. "What behaviors could you modify to improve this situation?"
D. "What anti-personality-disorder medications have helped you in the past?"

b

A client diagnosed with antisocial personality disorder comes to a nurses' station at 11:00 p.m. requesting to phone a lawyer to discuss filing for a divorce. The unit rules state that no phone calls are permitted after 10:00 p.m. Which nursing reply is most appropriate?
A. "Go ahead and use the phone. I know this pending divorce is stressful."
B. "You know better than to break the rules. I'm surprised at you."
C. "It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow."
D. "The decision to divorce should not be considered until you have had a good night's sleep."

c

A client diagnosed with paranoid personality disorder becomes violent on a unit. Which nursing intervention is most appropriate?
A. Provide objective evidence, that violence is unwarranted.
B. Initially restrain the client to maintain safety.
C. Use clear, calm statements and a confident physical stance.
D. Empathize with the client's paranoid perceptions.

c

A highly emotional client presents at an outpatient clinic appointment wearing flamboyant attire, spiked heels, and theatrical makeup. Which personality disorder should a nurse associate with this assessment data?
A. Compulsive personality disorder
B. Schizotypal personality disorder
C. Histrionic personality disorder
D. Manic personality disorder

c

A client diagnosed with borderline personality disorder brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the nursing staff best handle this situation?
A. Allow the clients to apply the democratic process when developing unit rules.
B. Maintain consistency of care by open communication to avoid staff manipulation.
C. Allow the client spokesman to verbalize concerns during a unit staff meeting.
D. Maintain unit order by the application of autocratic leadership

b

Which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with borderline personality disorder?
A. Being firm, consistent, and empathic, while addressing specific client behaviors
B. Promoting client self-expression by implementing laissez-faire leadership
C. Using authoritative leadership to help clients learn to conform to society norms
D. Overlooking inappropriate behaviors to avoid promoting secondary gains

a

Which adult client should a nurse identify as exhibiting the characteristics of a dependent personality disorder?
A. A physically healthy client who is dependent on meeting social needs by contact with 15 cats
B. A physically healthy client who has a history of depending on intense relationships to meet basic needs
C. A physically healthy client who lives with parents and relies on public transportation
D. A physically healthy client who is serious, inflexible, perfectionistic, and depends on rules to provide security

c

A pessimistic client expresses low self-worth, has much difficulty making decisions, avoids positions of responsibility, and has a behavioral pattern of "suffering" in silence. Which underlying cause of this client's personality disorder should a nurse recognize?
A. "Nurturance was provided from many sources, and independent behaviors were encouraged."
B. "Nurturance was provided exclusively from one source, and independent behaviors were discouraged."
C. "Nurturance was provided exclusively from one source, and independent behaviors were encouraged."
D. "Nurturance was provided from many sources, and independent behaviors were discouraged."

b

Family members of a client ask a nurse to explain the difference between schizoid and avoidant personality disorders. Which is the appropriate nursing reply?
A. "Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone."
B. "Clients diagnosed with schizoid personality disorder exhibit odd, bizarre, and eccentric behavior, while clients diagnosed with avoidant personality disorder do not."
C. "Clients diagnosed with avoidant personality disorder are eccentric, and clients diagnosed with schizoid personality disorder are dull and vacant."
D. "Clients diagnosed with schizoid personality disorder have a history of psychotic thought processes, while clients diagnosed with avoidant personality disorder remain based in reality."

a

During an interview, which client statement indicates to a nurse that a potential diagnosis of schizotypal personality disorder should be considered?
A. "I really don't have a problem. My family is inflexible, and every relative is out to get me."
B. "I am so excited about working with you. Have you noticed my new nail polish: 'Ruby Red Roses'?"
C. "I spend all my time tending my bees. I know a whole lot of information about bees."
D. "I am getting a message from the beyond that we have been involved with each other in a previous life."

d

A nursing instructor is teaching students about clients diagnosed with histrionic personality disorder and the quality of their relationships. Which student statement indicates that learning has occurred?
A. "Their dramatic style tends to make their interpersonal relationships quite interesting and fulfilling."
B. "Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs."
C. "They tend to develop few relationships because they are strongly independent but generally maintain deep affection."
D. "They pay particular attention to details which can frustrate the development of relationships."

b

Which nursing diagnosis should a nurse identify as appropriate when working with a client diagnosed with schizoid personality disorder?
A. Altered thought processes R/T increased stress
B. Risk for suicide R/T loneliness
C. Risk for violence: directed toward others R/T paranoid thinking
D. Social isolation R/T inability to relate to others

d

When planning care for a client diagnosed with borderline personality disorder, which self-harm behavior should a nurse expect the client to exhibit?
A. The use of highly lethal methods to commit suicide
B. The use of suicidal gestures to evoke a rescue response from others
C. The use of isolation and starvation as suicidal methods
D. The use of self-mutilation to decrease endorphins in the body

b

Which client situation should a nurse identify as reflective of the impulsive behavior that is commonly associated with borderline personality disorder?
A. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm and whispers, "The night nurse is evil. You have to stay."
B. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm and states, "I will be up all night if you don't stay with me."
C. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm, yelling, "Please don't go! I can't sleep without you being here."
D. As the day shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, "I cut myself because you are leaving me."

ANS: D
The client who states, "I cut myself because you are leaving me" reflects impulsive behavior that is commonly associated with the diagnosis of borderline personality disorder. Repetitive, self-mutilative behaviors are common and are generated by feelings of abandonment following separation from significant others.

Which nursing diagnosis should be prioritized when providing care to a client diagnosed with paranoid personality disorder?
A. Risk for violence: directed toward others R/T suspicious thoughts
B. Risk for suicide R/T altered thought
C. Altered sensory perception R/T increased levels of anxiety
D. Social isolation R/T inability to relate to others

a

From a behavioral perspective, which nursing intervention is most appropriate when caring for a client diagnosed with borderline personality disorder?
A. Seclude the client when inappropriate behaviors are exhibited.
B. Contract with the client to reinforce positive behaviors with unit privileges.
C. Teach the purpose of antianxiety medications to improve medication compliance.
D. Encourage the client to journal feelings to improve awareness of abandonment issues.

b

A nurse tells a client that the nursing staff will start alternating weekend shifts. Which response should a nurse identify as characteristic of clients diagnosed with obsessive-compulsive personality disorder?
A. "You really don't have to go by that schedule. I'd just stay home sick."
B. "There has got to be a hidden agenda behind this schedule change."
C. "Who do you think you are? I expect to interact with the same nurse every Saturday."
D. "You can't make these kinds of changes! Isn't there a rule that governs this decision?"

d

Looking at a slightly bleeding paper cut, the client screams, "Somebody help me, quick! I'm bleeding. Call 911!" A nurse should identify this behavior as characteristic of which personality disorder?
A. Schizoid personality disorder
B. Obsessive-compulsive personality disorder
C. Histrionic personality disorder
D. Paranoid personality disorder

c

Which reaction to a compliment from another client should a nurse identify as a typical response from a client diagnosed with avoidant personality disorder?
A. Interpreting the compliment as a secret code used to increase personal power
B. Feeling the compliment was well deserved
C. Being grateful for the compliment but fearing later rejection and humiliation
D. Wondering what deep meaning and purpose are attached to the complimen

c

Which client symptoms should lead a nurse to suspect a diagnosis of obsessive-compulsive personality disorder?
A. The client experiences unwanted, intrusive, and persistent thoughts.
B. The client experiences unwanted, repetitive behavior patterns.
C. The client experiences inflexibility and lack of spontaneity when dealing with others.
D. The client experiences obsessive thoughts that are externally imposed.

c

Which client is a nurse most likely to admit to an inpatient facility for self-destructive behaviors?
A. A client diagnosed with antisocial personality disorder
B. A client diagnosed with borderline personality disorder
C. A client diagnosed with schizoid personality disorder
D. A client diagnosed with paranoid personality disorder

b

When planning care for clients diagnosed with personality disorders, what should be the anticipated treatment outcome?
A. To stabilize pathology with the correct combination of medications
B. To change the characteristics of the dysfunctional personality
C. To reduce inflexibility of personality traits that interfere with functioning and relationships
D. To decrease the prevalence of neurotransmitters at receptor sites

c

The nurse plans to confront a client about secondary gains related to extreme dependency on spouse. Which nursing statement would be most appropriate?
A. "Do you believe dependency issues have been a lifelong concern for you?"
B. "Have you noticed any anxiety during times when your husband makes decisions."
C. "What do you know about individuals who depend on others for direction?"
D. "How have the specifics of your relationship with your spouse benefited you?"

d

The nurse should recognize which factors that distinguish personality disorders from psychosis?

A. Functioning is more limited in personality disorders than in psychosis.
B. Major disturbances of thought are absent in personality disorders.
C. Personality disordered clients require hospitalization more frequently.
D. Personality disorders do not affect family relationships as much as psychosis.

b

Which client statement would demonstrate a common characteristic of Cluster "B" personality disorder?
A. "I wish someone would make that decision for me."
B. "I built this building by using materials from outer space."
C. "I'm afraid to go to group because it is crowded with people."
D. "I didn't have the money for the ring, so I just took it.

When a client on an acute care psychiatric unit demonstrates behaviors and verbalizations indicating a lack of guilt feelings, which nursing intervention would help the client to meet desired outcomes?
A. Provide external limits on client behavior.
B. Foster discussions of rationales for behavioral change.
C. Implement interventions consistently by only one staff member.
D. Encourage the client to involve self in care.

ANS: A
Because the client, due to a lack of guilt, cannot or will not impose personal limits on maladaptive behaviors, these limits must be delineated and enforced by staff.

Which characteristics should a nurse recognize as being exhibited by individuals diagnosed with any personality disorders?
A. These clients accept and are comfortable with their altered behaviors.
B. These clients understand that their altered behaviors result from anxiety.
C. These clients seek treatment to avoid interpersonal discomfort.
D. These clients avoid relationships due to past negative experiences.

a

A nurse would expect a client diagnosed with schizotypal personality disorder to exhibit which characteristic?
A. The client keeps to self and has few, if any relationships.
B. The client has many brief but intense relationships.
C. The client experiences incorrect interpretations of external events.
D. The client exhibits lack of tender feelings toward others.

c- "magical thinking" and possibly psychosis under stress

While improving, a client demands to have a phone installed in the intensive care unit (ICU) room. When a nurse states, "This is not allowed. It is a unit rule." The client angrily demands to see the doctor. Which approach should the nurse use in this situation?
A. Provide an explanation for the necessity of the unit rule.
B. Assist the client to discuss anger and frustrations.
C. Call the physician and relay the request.
D. Arrange for a phone to be installed in the client's unit room.

b

Which nursing statement reflects a common characteristic of a client diagnosed with paranoid personality disorder?
A. "This client consistently criticizes care and has difficulty getting along with others."
B. "This client is shy and fades into the background."
C. "This client expects special treatment and setting limits will be necessary."
D. "This client is expressive during group and is very pleased with self."

a

A client exhibits dependency on staff and peers and expresses fear of abandonment. Using Mahler's theory of object relations, which should the nurse expect to note in this client's childhood?
A. Lack of fulfillment of basic needs by parental figures
B. Absence of the client's maternal figure during symbiosis
C. Difficulty establishing trust with the maternal figure
D. Inconsistency by the maternal figure during individuation

d

A client diagnosed with cluster "C" traits sits alone and ignores other's attempts to converse. When ask to join a group the client states, "No thanks." In this situation, which should the nurse assign as an initial nursing diagnosis?
A. Fear R/T hospitalization
B. Social isolation R/T poor self-esteem
C. Risk for suicide R/T to hopelessness
D. Powerlessness R/T dependence issues

b

Which statements represent positive outcomes for clients diagnosed with narcissistic personality disorder? (Select all that apply.)
A. The client will relate one empathetic statement toward another client in group by day 2.
B. The client will identify one personal limitation by day 1.
C. The client will acknowledge one strength that another client possesses by day 2.
D. The client will list four personal strengths by day 3.
E. The client will list two lifetime achievements by discharge.

abc

A nurse is caring for a group of clients within the DSM-IV-TR cluster B category of personality disorders. Which factors should the nurse consider when planning client care? (Select all that apply.)
A. These clients have personality traits that are deeply ingrained and difficult to modify.
B. These clients need medications to treat the underlying physiological pathology.
C. These clients use manipulation, making the implementation of treatment problematic.
D. These clients have poor impulse control that hinders compliance with a plan of care.
E. These clients commonly have secondary diagnoses of substance abuse and depression.

all