personality disorders
define personality
totality of emotions and behavioral characteristics that are particular to a specific person and that remains somewhat stable and predictable over time
define traits
characteristics that a person is born with or develops early in life. stable over time
when do personality disorders occur?
when traits become inflexible and rigid
paranoid personality disorder
mistrust of others
suspicious and always on guard
oversensitive and insensitive to others
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extremely sensitive to rejection/ socially withdrawn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
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
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