A client who is dramatic, charming, and seductive has traits of which personality disorder? Show Narcissistic Antisocial Histrionic Borderline Histrionic Individuals with histrionic personality disorder are dramatic, charming, and seductive. They are excessively emotional and always the center of attention. Individuals with narcissistic personality disorder have a grandiose sense of their personal achievements. Individuals with antisocial personality disorder are callous, deceitful, and impulsive. Individuals with borderline personality disorder are emotionally unstable and impulsive and have feelings of emptiness. What term is used to identify the inability to view both positive and negative aspects of others as part of a whole? Devaluation Splitting Impulsiveness Social ineffectiveness Splitting Splitting is the inability to integrate both the positive and the negative qualities of an individual into a whole. The individual using this defense tends to think in extremes. Devaluation, impulsiveness, and social ineffectiveness do not accurately identify the behavior described. Which statement is descriptive of clients diagnosed with personality disorders? They are resistant to behavioral change. They have an ability to tolerate frustration and pain. They usually seek help to change maladaptive behaviors. They are able to form satisfying and intimate relationships. They are resistant to behavioral change. Personality disorders are deeply ingrained and pervasive. Clients diagnosed with personality disorders find it very difficult, if not impossible, to change. Because they are so resistant to change, these clients do not often seek help. This makes a client easily frustrated and intolerant of pain. They have difficulty establishing and maintaining intimate relationships that are satisfying. Which personality disorder is considered a Cluster B personality disorder? Avoidant personality disorder Borderline personality disorder Paranoid personality disorder Schizotypal personality disorder Borderline personality disorder Borderline personality disorder is considered a Cluster B personality disorder. Avoidant personality disorder is one of the disorders in Cluster C. Paranoid and schizotypal personality disorders are Cluster A personality disorders. Research has indicated that an individual diagnosed with an antisocial personality may present with which characteristic? Social isolation Lack of remorse Learning difficulties Difficulty with reality testing 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. Social isolation, learning difficulties, and difficulty with reality generally are not associated with antisocial personality disorder. The nurse is assessing a client diagnosed with narcissistic personality disorder. Which behavior is the nurse most likely to find in this client? Aggression toward others Exploitation of others Hypervigilance of others Submission to others Exploitation of others People diagnosed with narcissistic personality disorder are arrogant and need constant admiration. They lack social empathy and may exploit others for their own benefit. People diagnosed with borderline personality disorder and antisocial personality disorder are often aggressive toward others. People diagnosed with paranoid personality disorder view others with suspicion and may be hypervigilant of them. People diagnosed with dependent personality disorders feel insecure and may be submissive to others. For which characteristics will the nurse look when assessing a client suspected of having antisocial personality disorder? Deceitfulness, impulsiveness, and lack of empathy Perfectionism, preoccupation with detail, and verbosity Avoidance of interpersonal contact and preoccupation with being criticized A need for others to assume responsibility for decision-making and nurture-seeking Deceitfulness, impulsiveness, and lack of empathy Clients with antisocial personality disorder lack 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. Perfectionism and related traits are associated with obsessive-compulsive disorder. Avoidance of interpersonal contact is associated with avoidant personality disorder. A need for others to assume responsibility is associated with dependent personality disorder. What are individuals displaying when they believe they have a right to hurt others, take what they want, and treat others unfairly? Splitting Entitlement Impulsivity Manipulation Entitlement Having a sense of entitlement means a belief in one's right to hurt others, take what he or she wants, and treat others unfairly. Splitting is the inability to integrate both the positive and the negative qualities of an individual into one person. Impulsivity is engaging in risky behaviors without first evaluating the potential consequences. Manipulation involves finding the right angle to lure a person into complying with one's own desires. Which traits are typically common among avoidant, obsessive-compulsive, and dependent personality disorders? Select all that apply. Depressed Shallow Eccentric Fearful Tense Irrational Depressed Fearful Tense Avoidant, obsessive-compulsive, and dependent personality disorders are categorized as cluster C personality disorders. They are typically associated with anxious, fearful, tense, overcontrolled, and depressed behavior. Eccentric and irrational behaviors are typically seen in cluster A disorders. Shallow behavior is associated with cluster B disorders. Which personality traits are associated with borderline personality disorder? Select all that apply. Shyness Impulsivity Disinhibition Hypersensitivity Aggressive disregard Emotional dysregulation Impulsivity Hypersensitivity Emotional dysregulation Borderline personality disorder is highly associated with impulsivity, hypersensitivity, and emotional dysregulation. People with this disorder act quickly and impulsively in response to their emotions without considering the consequences. Because of their hypersensitivity, they exhibit separation anxiety. The emotional dysregulation trait is indicated by frequent mood swings. The trait of shyness predisposes people to schizoid personality disorder. People with the disinhibition trait show a lack of concern for the consequences of their actions. They are predisposed to antisocial personality disorder. People with an aggressive disregard trait who exhibit violent tendencies with no concern for others often have antisocial personality disorder. The nurse is assessing a client for a possible personality disorder. Which finding does the nurse identify as feature of paranoid personality disorder? Dichotomous thinking Excessive emotionality Reluctance to answer any questions Deferring questions to a family member Reluctance to answer any questions A person diagnosed with paranoid personality disorder generally views others with suspicion and may be reluctant to answer any questions. A person with diagnosed borderline personality disorder may have dichotomous thinking. People diagnosed with histrionic personality disorder may exhibit excessive emotionality to the extent of being considered melodramatic. A person diagnosed with dependent personality disorder may have low self-esteem and therefore be dependent on others for minor issues like answering questions. exemplified by splitting or an inability to view both the positive and negative aspects as a part of the whole. Which behavior is demonstrated by a client who engages in splitting with dichotomous thinking? Unconsciously represses undesirable aspects of self Places responsibility for behavior outside the self Sees things as divided into "all good" or "all bad" Demonstrates a lack of personal boundaries 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. Unconsciously repressing undesirable aspects of self, placing responsibility for behavior outside the self, or demonstrating a lack of personal boundaries are not behaviors considered part of splitting. Which personality disorder is characterized by persistent disregard for and violation of the rights of others with an absence of remorse for hurting others? Borderline Schizotypal Antisocial Narcissistic Antisocial Antisocial personality disorder is characterized by persistent disregard for and violation of the rights of others with an absence of remorse for hurting others. Borderline personality disorder is characterized by unstable and intense relationships and unstable and frequent mood changes. Schizotypal personality disorder is characterized by peculiar behavior, odd speech, and the presence of cognitive perceptual distortions in the absence of psychosis. Narcissistic personality disorder is characterized by a person's grandiose sense of personal achievements. A mental health nurse assesses a client diagnosed with antisocial personality disorder. Which co-morbid problem is most important for the nurse to include in the assessment? Generalized anxiety Alcohol use and abuse Compulsions and phobias Dysfunctional sleep patterns Alcohol use and abuse Antisocial disorders have a high rate of concordance with alcohol/substance use disorders, so it is important for the nurse to include this information in the assessment. Generalized anxiety, compulsions and phobias, and dysfunctional sleep patterns are not typically associated with antisocial personality disorder, so it is not as important for the nurse to include them in this assessment. An adult was caught shoplifting merchandise from a community thrift shop. When confronted, the individual replies, "All this stuff was donated, so I can take it." This comment suggests features of which personality disorder? Antisocial Histrionic Borderline Schizotypal Antisocial The person's statement shows disregard for others and a lack of remorse, both of which are characteristic of antisocial personality disorder. People with histrionic personality disorder attempt to become and remain the center of attention through manipulative behaviors. Borderline personality disorder (BPD) is marked by unstable, frequent mood changes. Schizotypal personality disorder is characterized by patterns of peculiar behavior and odd speech, which are not evident in this person's statement. A nurse observes that a client behaves rudely to the staff and refuses treatment. On inquiry, the nurse learns that The client says to the nurse, "I think that all staff members are planning to harm and deceive me." Which diagnosis does the nurse expect to see in the client's medical record? Schizoid personality disorder Paranoid personality disorder Narcissistic personality disorder Obsessive-compulsive personality disorder Paranoid personality disorder Clients diagnosed with paranoid personality disorder are suspicious and believe that others want to exploit, harm, and deceive them. They develop a defense system and try to counterattack the other person and reject the treatment, often behaving rudely. Clients diagnosed with schizoid personality disorder have reduced emotional attachment and depression. In narcissistic personality disorder, clients are extremely worried about their prestige; they feel intense shame and fear of abandonment by others. Clients diagnosed with obsessive-compulsive personality disorder exhibit repetitive behaviors. Which symptoms should the nurse assess to identify borderline personality disorder when interviewing clients? Select all that apply. Tendency toward intense anxiety Inclination toward group activities Feelings of emptiness Extent of happiness Frequency of mood shifts Tendency toward intense anxiety Feelings of emptiness Frequency of mood shifts The nurse can assess borderline personality disorder by evaluating the tendency toward anxiety, anger, and irritability in the client. The nurse should assess feelings of emptiness and loneliness. A client with borderline personality disorder also experiences frequent extreme mood shifts. Clients with borderline personality do not engage in group activities due to anxiety. Extent of happiness doesn't help in identifying borderline personality disorder, because the client has mood swings. A nurse is managing the care of an individual diagnosed with avoidant personality disorder. What is the appropriate outcome for this client? The client will refrain from aggressive behavior toward others within 5 days. The client will demonstrate use of assertive communication within 3 months. The client will establish an intimate relationship with another adult within 2 weeks. The client will make a permanent commitment never to self-mutilate within 1 week. The client will demonstrate use of assertive communication within 3 months. A person diagnosed with avoidant personality disorder is excessively anxious in social situations and hypersensitive to negative evaluation but desires social interaction. Assertiveness training is intended to assist this person in self-expression. Outcome achievement for any of the personality disorders is slow because personality is a deeply ingrained characteristic. It is likely to take months or years to achieve desired outcomes, not just 5 days or 2 weeks. Clients diagnosed with avoidant personality disorder do not typically self-mutilate. Which statements are true of antisocial personality disorder (APD)? Select all that apply. Clients diagnosed with APD display magical thinking. Frontal lobe dysfunction is a brain change identified in APD. It is characterized by rigidity and inflexible standards of self and others. It is characterized by deceitfulness, disregard for others, and manipulation. Clients diagnosed with APD are concerned with personal pleasure and power. Clients diagnosed with APD usually present for treatment because of awareness of how their behavior is affecting others. Frontal lobe dysfunction is a brain change identified in APD. It is characterized by deceitfulness, disregard for others, and manipulation. Clients diagnosed with APD are concerned with personal pleasure and power. Characteristics of APD include personal pleasure-seeking, deceitfulness, disregard for others, manipulation, and frontal lobe dysfunction. Magical thinking is characteristic of schizotypal personality disorder. Rigidity and inflexible standards are characteristic of obsessive-compulsive personality disorder. People diagnosed with APD may present with depression because of the consequences of their behaviors, not because they care about the effects of their actions on others. A client diagnosed with borderline personality disorder has suicidal intentions. The nurse plans to teach mindfulness and emotion regulation to improve the client's interpersonal effectiveness skills and support which type of therapy? Family therapy Schema-focused therapy Dialectical behavior therapy Supportive psychotherapy Dialectical behavior therapy Dialectical behavior therapy is an advanced practice intervention used in clients with borderline personality disorder who have chronic suicidal intentions. This therapy includes cognitive and behavioral techniques like mindfulness and emotion regulation to improve interpersonal effectiveness skills in clients. In family therapy, the family members of the client are taught how to assist the client in handling stress. Family therapy helps the family learn how to function better as a unit. Schema-focused therapy helps clients change their views of themselves by evaluating the behavior of people in stressful conditions. In supportive psychotherapy, the therapist encourages the client to participate in activities to enhance the client's ability to cope with stressors. Which assessment questions does the nurse know focus on the characteristic behaviors of a client diagnosed with borderline personality disorder? Select all that apply. Does your mood shift dramatically over a few hours? Have you ever been told you are sarcastic? Do you experience visual or auditory hallucinations? How would you describe your romantic relationships? Does your mood shift dramatically over a few hours? Have you ever been told you are sarcastic? How would you describe your romantic relationships? Areas of assessment related to borderline personality disorder typically include history of mood shifts; tendencies toward sarcasm and anger; intense, unstable romantic relationships; and suicidal behaviors. Hallucinations are not characteristic of this disorder. A client at the mental health center says to the nurse, "The other staff members do not care about me, but you are different. You understand my problems." When the nurse tells this client about an upcoming career change, the client becomes very angry. An hour later, the client loudly announces, "I'm going to cut my wrists." Given this scenario, which personality disorder does the client most likely have? Narcissistic Borderline Avoidant Histrionic Borderline The scenario describes splitting of staff and impulsivity associated with self-mutilation. These are common behaviors among clients diagnosed with borderline personality disorder. Clients diagnosed with narcissistic personality disorder are exploitive, grandiose, and disparaging. Clients diagnosed with avoidant personality disorder are excessively anxious in social situations and hypersensitive to negative evaluation. Clients diagnosed with histrionic personality disorder are seductive, flamboyant, attention-seeking, and shallow. A client has been diagnosed with narcissistic personality disorder. Which aspect of the nursing assessment is most important? Pain rating Level of anxiety Nutritional status Attention span and hyperactivity Nutritional status Anorexia nervosa and substance use disorders are often comorbidities for clients diagnosed with narcissistic personality disorder; therefore, it is important for the nurse to assess the client's nutritional status, because these disorders compromise this. Whereas it's important to assess pain in all clients, the greater risk in this scenario applies to the client's nutritional status. Anxiety is associated with antisocial, avoidant, and obsessive-compulsive personality disorders rather than narcissistic personality disorder. Attention deficit hyperactivity disorder is more often a comorbidity of borderline personality disorder. A client arrested for an assault in which the client savagely beat a classmate states, "The guy deserved everything he got." The behaviors described are most consistent with which personality disorder? Antisocial Borderline Schizotypal Narcissistic Antisocial Clients diagnosed with antisocial personality act out feelings without consideration for the rights of others. They feel no remorse for their antisocial acts. This lack of remorse for such behavior is not typical of borderline, schizotypal, or narcissistic personality disorders. Which stress management behavior is most reflective of personality disorders? Binge drinking every weekend Demonstrating ritualistic behaviors Blaming a spouse for the client's poor performance at work Having difficulty making a decision concerning which movie to view Blaming a spouse for the client's poor performance at work In people diagnosed with personality disorders (PDs), personality traits tend to be inflexible and unpredictable, and coping strategies tend to be more primitive and immature. They often blame others for their difficulties or even deny having a problem. Binge drinking is associated with addiction. Ritualistic behaviors are associated with obsessive compulsive disorder. Difficulty deciding what movie to view is not associated with a personality disorder. Which statement by a nurse providing care for clients diagnosed with personality disorders demonstrates therapeutic management of manipulative client behavior? Select all that apply. "Tell me what triggered your angry response to what I said." "The staff is responsible for determining unit rules that are fair for all clients." "Remember that all clients must follow the rules regarding use of the telephone." "Missing group today means that you will not be able to attend the pizza party later." "Tell me what you are trying to accomplish by being so rude to the staff and other clients." "The staff is responsible for determining unit rules that are fair for all clients." "Remember that all clients must follow the rules regarding use of the telephone." "Missing group today means that you will not be able to attend the pizza party later." Manipulation is the using or controlling of others or of situations for only one's personal benefit. Setting limits and rules, reinforcing the limits and rules, and enforcing consequences for disregarding the limits and rules demonstrates therapeutic management of manipulative behaviors. Asking what triggered an angry response and asking the client to identify the reason for rudeness are geared toward impulse control rather than management of manipulative behavior. What is a key difference between obsessive-compulsive personality disorder (OCPD) and obsessive-compulsive disorder (OCD)? Behaviors in people with OCD can fluctuate at different times; behaviors in people with OCPD are consistent over time. People with OCD tend to be more high functioning in across all areas of their lives than people with OCPD. Unwanted obsessions and ritualistic compulsions are well controlled in people with OCPD but not in people with OCD. Diagnostic criteria are clearer for OCPD than for OCD, so diagnosing OCPD is easier for clinicians. Behaviors in people with OCD can fluctuate at different times; behaviors in people with OCPD are consistent over time. Since OCPD is a personality disorder, these clients' behaviors and personality traits do not fluctuate. The intensity of the obsessive-compulsive behaviors in people with OCD can fluctuate at different times. Many people with OCPD seem to be high functioning, with no difficulty in functioning. People with OCD often have disruption in their ability to function in all areas of their lives. People with OCPD do not display unwanted obsessions or compulsive ritualistic behavior. Making a diagnosis between these two disorders can cause confusion in the clinical setting. Which statement best illustrates a primary coping style common for clients diagnosed with borderline personality disorder (BPD)? "I promise I am not feeling suicidal. I won't hurt myself." "My health care provider says I might get out of here tomorrow. Do you think I'm ready to go?" "I will never again speak to any of my messed up family members. I know that this will help me be more functional." "Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." "Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." A primary coping style used by clients diagnosed with BPD is splitting. Splitting is the inability to incorporate positive and negative aspects of oneself or others into a whole image. The individual may tend to idealize another person (e.g., a friend, lover, or health care professional) at the start of a new relationship and hope that this person will meet all of his or her needs. At the first disappointment or frustration, however, the individual quickly shifts to devaluation, despising the other person, as illustrated by the statement expressing disappointment in the nurse. Asking about the nurse's opinion on the client's discharge, expressing a plan to never speak to family, and denying suicidal thoughts and feelings do not indicate splitting or BPD. p. 170 Which characteristics are criteria for diagnosing borderline personality disorder? Select all that apply. Periods of manic behavior Recurrent suicidal behavior Chronic feelings of emptiness Compulsively performing ritualistic behaviors A pattern of unstable and intense personal relationships Recurrent suicidal behavior Chronic feelings of emptiness A pattern of unstable and intense personal relationships Borderline personality disorder can be diagnosed with many criteria including recurrent suicidal behavior, chronic feelings of emptiness, and a pattern of unstable and intense personal relationships among others. Periods of manic behavior are more characteristic of bipolar disorder, and compulsively performing ritualistic behaviors is more characteristic of obsessive compulsive disorder. Which statement most demonstrates a common defense mechanism used by clients diagnosed with a borderline personality disorder? "I'm so ashamed when I lose my temper." "There is nothing good I can say about my mother." "I can't go to group therapy unless you go with me." "I've attempted suicide on three different occasions." "There is nothing good I can say about my mother." Splitting is a primitive defense mechanism used by individuals demonstrating borderline personality characteristics. Shame, clinging, and suicidal attempts are behaviors exhibited by those with personality disorders, and are not considered defense mechanisms used by these individuals. A client becomes anxious in group activities and is hypersensitive to negative evaluation. Which interventions should the nurse perform while caring for this client? Select all that apply. Taking a friendly approach toward the client Assigning the client to another group activity Insisting that the client participate in group activities Adopting a firm, matter-of-fact approach with the client Accepting the client's request to not be involved in group activities Taking a friendly approach toward the client Accepting the client's request to not be involved in group activities Clients with avoidant personality features become very anxious in social situations and group activities. Therefore, the nurse should take a friendly, reassuring, and accepting approach toward such clients. The nurse should respect the client's decision to not be involved in group activities, because these can increase the client's anxiety. The nurse should not insist that the client participate in group activities; instead, the nurse should provide encouragement to help the client manage the anxiety and later participate in group activities. Changing the group activity does not help in reducing anxiety. Even if the client refuses to participate, the nurse should maintain a friendly approach toward the client rather than only being firm and matter-of-fact. The nurse is caring for a client who previously attempted suicide. The nurse reads in the client's medical history that he or she has been diagnosed with histrionic personality disorder. Which characteristics does the nurse expect to observe in the client? Select all that apply. The client is relaxed and calm. The client is in a long-term relationship. The client wants the best of everything. The client does not have attachment to his or her parents. The client feels comfortable when given complete attention. The client wants the best of everything. The client feels comfortable when given complete attention. Clients diagnosed with histrionic personality disorder try to seek attention. They remain uncomfortable unless they become the center of attention and feel comfortable with lots of attention. The client wants the best of everything and becomes angry if the demands are not fulfilled. The client has low frustration tolerance and is often irritated, not relaxed and calm. Clients have trouble maintaining long-term relationships. Clients with histrionic disorder typically have intense attachment only to the opposite-sex parent. The client develops a fear of attack from the same-sex parent. Which client statements support the diagnosis of histrionic personality disorder? Select all that apply. "I like being the center of attention." "My spouse left me because I flirt too much with others." "I need to be in the hospital because I got so depressed after my last divorce." "I try really hard, but I can never seem to please my spouse." "I think I'd feel better if I could just cry and let my spouse know how I feel." "I like being the center of attention." "My spouse left me because I flirt too much with others." "I need to be in the hospital because I got so depressed after my last divorce." Histrionic personality disorder is characterized by emotional attention-seeking behaviors including self-centeredness, low frustration tolerance, and excessive emotionality. The person diagnosed with histrionic personality disorder often is impulsive and melodramatic and may act flirtatiously or provocatively. Relationships do not last, because the partner often feels smothered or reacts to the insensitivity of the histrionic person. The individual diagnosed with histrionic personality disorder does not have insight into his or her role in breaking up relationships and may seek treatment for depression or other comorbid condition. Feeling as though one cannot please a spouse or expressing a desire to cry do not necessarily indicate histrionic personality disorder. A client diagnosed with antisocial personality disorder participates in psychotherapy. Which response by the client most indicates to the nurse the treatment has been effective? The client declares the government to be responsible for his or her condition. The client requests the nurse to be excused from a particular task. The client plays a leading role in a group activity assigned by the nurse. The client ridicules a client experiencing acute mania. The client plays a leading role in a group activity assigned by the nurse. A client diagnosed with antisocial personality disorder shows impaired social interaction and defensive coping. A client who plays a leading role in a group activity indicates improvement of the symptoms, which may be the result of effective treatment. The client declaring the government to be responsible still indicates disruptive thought processes. A request to be excused from a therapy task doesn't indicate progress or effective treatment. Psychotherapy aims to help the client interact with others and develop sensitivity toward others. Ridiculing another client shows that the client with antisocial personality disorder is not sensitive and does not show empathy for others. Which client assessment findings best support the diagnosis of schizoid personality disorder? Select all that apply. Has never been married Raised in foster care after age 7 after death of parents Reports, "I like people but I have only two good friends." Is employed as a nightshift janitor at an office complex States, "I don't really care whether people are afraid of me." Has never been married Raised in foster care after age 7 after death of parents Is employed as a nightshift janitor at an office complex States, "I don't really care whether people are afraid of me." Rationale Which client statements support the diagnosis of dependent personality disorder? Select all that apply. "I've lived alone in the past but moved back home when my mother died." "It's hard, but I pay for the rent, all the utilities, and all the food." "My mother didn't like it, so I never spent the night at a friend's house." "I was sick a lot as a child, and so my family was always there for me." "It's been so hard with my spouse out of town so much for work." "My mother didn't like it, so I never spent the night at a friend's house." "I was sick a lot as a child, and so my family was always there for me." Clients diagnosed with dependent personality disorder have a high need to be taken care of, which can lead to patterns of submissiveness with fears of separation and abandonment by others. This may create problems for the client by leaving him or her more vulnerable to exploitation by others because of the passive and submissive nature. Clients diagnosed with dependent personality disorder are thought to have early and profound learning experiences during childhood in which disordered attachment and dependency develop on the caretaker. Dependent personality disorder may be the result of chronic physical illness or punishment of independent behavior in childhood. Moving back to the family home, being financially independent, and expressing how difficult separation has been are not statements that are supportive of a dependent personality disorder. The nurse assesses a new client suspected of having a schizotypal personality disorder. Which assessment question is this client most likely to answer affirmatively? "Do some types of situations frighten you?" "Do you often have episodes of prolonged crying?" "Is anyone in your family diagnosed with a mental illness?" "Is it ever extremely important for you to do everything correctly?" "Is anyone in your family diagnosed with a mental illness?" Schizotypal personality disorder is more common in families with a history of schizophrenia, so the client is most likely to answer "yes" to this question. Affirmative answers to the other questions are representative of characteristics of other disorders. An adult diagnosed with antisocial personality disorder begins a program at the community mental health center. Which is an appropriate outcome for this client? Do not engage in self-mutilation. Listen attentively as others share their feelings. Limit time spent engaging in compulsive behaviors. Attend the program dressed in seasonally appropriate clothing. Listen attentively as others share their feelings. Impaired social interaction in clients diagnosed with antisocial personality disorders are characterized by unstable relationships, lack of empathy, hostility, behaviors unaccepted by the dominant cultural group, grandiosity, dysfunctional interactions, and unacceptable social behavior. Desired outcomes include receptiveness, sensitivity and consideration of others, cooperation with others, and respectful interactions with others. Clients diagnosed with antisocial personality disorder are not likely to self-mutilate. Compulsive behaviors are more typical of obsessive-compulsive personality disorder. Clients diagnosed with schizotypal personality disorder are likely to have difficulty selecting seasonally appropriate clothing. Which are typical characteristics of Cluster A disorders? Select all that apply. Eccentric behavior Suspicious Warm Gregarious Irrational Eccentric behavior Suspicious Irrational Cluster A disorders include schizotypal, schizoid, and paranoid personality disorders. Clients with these disorders tend to have eccentric behavior, be suspicious, and be irrational. They are cold, not warm, and withdrawn, not gregarious. What is the most helpful strategy for the nursing staff to support self-care among nurses who help clients with personality disorders? Whenever possible, assign personality disorder clients to nurses who have less experience and may be more eager to help. Encourage clients to use splitting behaviors, so they can be supported by the nurses for whom they have the most respect. Implement frequent avenues of communication and continuously available supervision to support the nurses' confidence and effectiveness. Provide training to help the nurses learn how to ignore their own feelings about clients and put the clients' well-being first. Implement frequent avenues of communication and continuously available supervision to support the nurses' confidence and effectiveness. Helping clients with personality disorders can be an overwhelming challenge. Frequent communication among staff and continuous availability of supervision and support are vital in times when the behaviors of these clients start to affect the confidence, feelings, behaviors, and effectiveness of staff members. Less experienced nurses may easily become vengeful in response to a difficult client's sense of entitlement, manipulativeness, dependency, ingratitude, impulsivity, and rage. Splitting should not be encouraged. Clients may use splitting to praise or disparage nurses to peers in such a way that the peers begin to react negatively toward each other. Nurses should acknowledge and accept their emotional responses and attempt to ensure their own well-being. A client diagnosed with antisocial personality disorder becomes frustrated and angry when unable to connect to the internet. The client then curses loudly, disrupting, frightening, and disturbing others. Which nursing actions are therapeutic? Select all that apply. Seclude the client for one hour to allow for de-escalation. Say to the client, "Step aside and I will get you connected to the Internet." Ask the client, "How were you feeling when you were having this difficulty?" Encourage the client to recognize signs of mounting tension and seek assistance. Tell the client, "Further outbursts will result in suspension of your computer privileges." Ask the client, "How were you feeling when you were having this difficulty?" Encourage the client to recognize signs of mounting tension and seek assistance. Tell the client, "Further outbursts will result in suspension of your computer privileges." Therapeutic responses by the nurse include exploring the situation, encouraging description, setting limits on and expectations of the client's behavior, suggesting other means of coping, and identifying results of inappropriate behavior. The nurse should assist the client to identify the source of anger as well as the function that anger, frustration, and rage serve. It is inappropriate to seclude this client because criteria for seclusion are not met. This scenario provides an opportunity for a therapeutic encounter, so the nurse should process it with the client rather than completing the task for the client. A 22-year-old client is anxious and irritable during the initial assessment. Following a physical altercation with her former significant other, she has had suicidal ideation and panic attacks. The nurse finds she also has a history of childhood sexual abuse. What medication would be most helpful for this client to address the underlying personality disorder and recent panic attacks? Selective serotonin reuptake inhibitor (SSRI) Benzodiazepine Anticonvulsant Lithium Selective serotonin reuptake inhibitor (SSRI) This client meets the diagnostic criteria for borderline personality disorder. SSRIs can help clients with borderline personality disorder who have co-occurrence with panic attacks. Benzodiazepines are not appropriate because of the risk of overdose. An anticonvulsant or lithium may be useful in borderline personality disorder but do not address the panic attacks. A client diagnosed with obsessive-compulsive personality disorder takes the nurse aside and says, "I saw you interacting with that new client. Your approach is not correct. You should be more forceful and directive." Select the nurse's best response. "I will continue to follow the care plan for the client." "I see you are trying to control that client's therapy as well as your own." "Your eye for perfection extends even to my nursing interventions." "That client's care is really of no concern to you or to other clients." "I will continue to follow the care plan for the client." Obsessive-compulsive personality disorder involves perfectionism, with a focus on orderliness and control. These individuals get so preoccupied with details and rules that they may attempt to control others' behavior. The nurse's best response is to not engage the client by saying he or she will continue to follow the care plan. Noting that the client is trying to control another's therapy, that his or her eye for perfection extends to the nurse's actions, and that another client's care should be of no concern are responses that can engage the client in a power struggle and/or affirm the client's behavior. A 30-year-old client has a history of self-mutilation and multiple citations for driving under the influence of alcohol. He says to the nurse, "I know it's not good for me to cut or drive drunk. It actually scares me when I think about some of the stupid things I've done and what could have happened to me." What is the nurse's most therapeutic response? "I believe that once we address your alcohol abuse, you'll find you won't engage in risky behaviors anymore." "You need to have better self-control. It's one thing to cut yourself, but you're putting the lives of others at risk when you drink and drive." "It's good that you feel scared. You can remember that feeling the next time you're about to do something impulsive." "When you think back on the risks you've taken, can you identify anything that those situations had in common?" "When you think back on the risks you've taken, can you identify anything that those situations had in common?" The client has recognized the riskiness of his behaviors, which may help motivate change. The nurse should encourage him to identify patterns of thought or events that trigger his impulsive actions by asking what those situations had in common. Alcohol abuse is one aspect of the client's impulsivity, but the client's self-harm suggests the nurse should help him identify additional triggers. The nurse should not tell the client to have better self-control, which is judgmental. The nurse should not tell the client "It's good that you feel scared," which lacks compassion and is not therapeutic. A nurse plans care for a client diagnosed with borderline personality disorder (BPD). Which nursing diagnosis is most likely to apply to this client? Ineffective relationships related to frequent splitting Social isolation related to fear of embarrassment or rejection Ineffective impulse control related to violence as evidenced by cruelty to animals Disturbed thought processes related to recurrent suspicion of people and situations Ineffective relationships related to frequent splitting Frequent use of spitting is a characteristic of BPD and often results in ineffective relationships. People diagnosed with BPD do not isolate themselves; in fact, they seek relationships to avoid feelings of abandonment. The poor impulse control associated with BPD is evidenced by self-destructive behaviors rather than cruelty to animals. Recurrent suspicion is not associated with BPD. How can the nurse manager address the needs of a nursing staff who cares primarily for clients diagnosed with personality disorders? Schedule monthly in-services on the management of this client population. Design schedules to provide staff with 3 consecutive days off each period. Require that nursing staff rotate to another nursing unit for 6 months every 24 months. Hold a daily meeting to focus on communication between nursing and supervisory staff. Hold a daily meeting to focus on communication between nursing and supervisory staff. Frequent communication among staff and continuous availability of supervision and support are vital in times when the behaviors of these patients start to affect the confidence, feelings, behaviors, and effectiveness of staff members. Planning monthly in-services, manipulating the schedule to give time off, and requiring that the staff move to other units periodically fail to provide the opportunity for communication and support. Which interventions by the nurse are best associated specifically with care provided for a client diagnosed with paranoid disorder? Select all that apply. Monitoring the client for behaviors associated with psychosis Discussing how the client's statements hurt the feelings of others Failing to react when the client speaks disrespectfully to the nurse Giving the client a copy of the daily routine he or she is expected to follow Explaining why the scheduled therapy session will be delayed 30 minutes Giving the client a copy of the daily routine he or she is expected to follow Explaining why the scheduled therapy session will be delayed 30 minutes The paranoid client is suspicious and mistrustful, and he or she may develop perceptional distortions. Giving clear instructions and explanations will help minimize these tendencies. This can be done by giving the client a copy of a daily routine and explaining any scheduling delays. Monitoring for psychotic behavior is appropriate for any client with a risk for cognitive or perceptual distortions; it is not specific to paranoid disorder. The narcissistic client is associated with thoughtless, disparaging comments such as calling the nurse fat or making hurtful statements about others on the unit. What are the primary symptoms of narcissistic personality disorder?Symptoms. Have an exaggerated sense of self-importance.. Have a sense of entitlement and require constant, excessive admiration.. Expect to be recognized as superior even without achievements that warrant it.. Exaggerate achievements and talents.. What are the behaviors of a narcissist?Narcissistic personality disorder involves a pattern of self-centered, arrogant thinking and behavior, a lack of empathy and consideration for other people, and an excessive need for admiration. Others often describe people with NPD as cocky, manipulative, selfish, patronizing, and demanding.
Who is most likely to be diagnosed with narcissistic personality disorder?Prevalence of lifetime NPD was 6.2%, with rates greater for men (7.7%) than women (4.8%). NPD was significantly more prevalent among Black men and women and Hispanic women, younger adults, and separated/divorced/widowed and never married adults. NPD was associated with mental disability among men but not women.
Which behavior is most typical for a client with borderline personality disorder?People with BPD have an intense fear of abandonment and have trouble regulating their emotions, especially anger. They also tend to show impulsive and dangerous behaviors, such as reckless driving and threatening self-harm. All of these behaviors make it difficult for them to maintain relationships.
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What type of behavior is most likely to be present in a client diagnosed with narcissistic personality disorder?
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