Chapter 22 My Nursing Test Banks

 

Kneisl, Contemporary Psychiatric-Mental Health Nursing, 3/e Test Bank
Chapter 22

Question 1

Type: MCSA

A nurse is studying personality disorders. What statement would indicate that the nurse can differentiate between personality traits and personality disorders?

1. Personality traits are persistent behavior traits that do not significantly interfere with an individuals life.

2. Personality traits are lifelong maladaptive patterns.

3. Personality traits are rigid, stereotyped behavioral patterns.

4. Personality traits are enduring and deviate from societal norms.

Correct Answer: 1

Rationale 1: Personality traits are persistent behavior patterns that do not significantly interfere with ones life, even though the behaviors may be annoying or frustrating to others. In contrast, personality disorders are enduring, rigid, stereotyped behavioral patterns that are lifelong and maladaptive and deviate from societal norms.

Rationale 2: Personality traits are persistent behavior patterns that do not significantly interfere with ones life, even though the behaviors may be annoying or frustrating to others. In contrast, personality disorders are enduring, rigid, stereotyped behavioral patterns that are lifelong and maladaptive and deviate from societal norms.

Rationale 3: Personality traits are persistent behavior patterns that do not significantly interfere with ones life, even though the behaviors may be annoying or frustrating to others. In contrast, personality disorders are enduring, rigid, stereotyped behavioral patterns that are lifelong and maladaptive and deviate from societal norms.

Rationale 4: Personality traits are persistent behavior patterns that do not significantly interfere with ones life, even though the behaviors may be annoying or frustrating to others. In contrast, personality disorders are enduring, rigid, stereotyped behavioral patterns that are lifelong and maladaptive and deviate from societal norms.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Differentiate personality traits and styles from personality disorders.

Question 2

Type: MCSA

How can the nurse differentiate the client with obsessive-compulsive personality disorder from a client with perfectionist personality traits?

1. Clients with obsessive-compulsive personality disorder will exhibit order in all areas of their lives.

2. Clients with obsessive-compulsive personality disorder will exhibit fear, anxiety, and an excessive need for order.

3. Clients with obsessive-compulsive personality disorder will exhibit the need for perfection in everyone but themselves.

4. Clients with obsessive-compulsive personality disorder will exhibit order in their work lives but are able to relax when away from work.

Correct Answer: 2

Rationale 1: The person with obsessive-compulsive personality disorder strives at all times to keep the world predictable and organized. These individuals suffer from fear and anxiety. Obsessive-compulsive individuals are excessively conscientious and rigid but can exhibit a contradictory pattern of slovenliness, which is also compulsive. They feel required to fulfill unending duties, responsibilities, and tasks, are self-critical, and adhere strictly and concretely to rules. Obsessive-compulsive individuals do not view taking work home and working long hours as an imposition, since work organizes their lives and binds their anxiety.

Rationale 2: The person with obsessive-compulsive personality disorder strives at all times to keep the world predictable and organized. These individuals suffer from fear and anxiety. Obsessive-compulsive individuals are excessively conscientious and rigid but can exhibit a contradictory pattern of slovenliness, which is also compulsive. They feel required to fulfill unending duties, responsibilities, and tasks, are self-critical, and adhere strictly and concretely to rules. Obsessive-compulsive individuals do not view taking work home and working long hours as an imposition, since work organizes their lives and binds their anxiety.

Rationale 3: The person with obsessive-compulsive personality disorder strives at all times to keep the world predictable and organized. These individuals suffer from fear and anxiety. Obsessive-compulsive individuals are excessively conscientious and rigid but can exhibit a contradictory pattern of slovenliness, which is also compulsive. They feel required to fulfill unending duties, responsibilities, and tasks, are self-critical, and adhere strictly and concretely to rules. Obsessive-compulsive individuals do not view taking work home and working long hours as an imposition, since work organizes their lives and binds their anxiety.

Rationale 4: The person with obsessive-compulsive personality disorder strives at all times to keep the world predictable and organized. These individuals suffer from fear and anxiety. Obsessive-compulsive individuals are excessively conscientious and rigid but can exhibit a contradictory pattern of slovenliness, which is also compulsive. They feel required to fulfill unending duties, responsibilities, and tasks, are self-critical, and adhere strictly and concretely to rules. Obsessive-compulsive individuals do not view taking work home and working long hours as an imposition, since work organizes their lives and binds their anxiety.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Differentiate personality traits and styles from personality disorders.

Question 3

Type: MCSA

A nurse is working with a client who has a diagnosis of obsessive-compulsive personality disorder. It is important for the nurse and client to discuss:

1. The effect of anger on perfectionism.

2. The need to feel superior.

3. The link between anxiety and perfectionism.

4. The need for medication.

Correct Answer: 3

Rationale 1: The person with obsessive-compulsive personality disorder strives at all times to keep the world predictable and organized. These individuals suffer from excessive fear and anxiety. Anger is not a prominent characteristic of obsessive-compulsive personality disorder. Medications are not a first line of treatment for personality disorders. Feelings of superiority are associated with narcissistic personality disorder.

Rationale 2: The person with obsessive-compulsive personality disorder strives at all times to keep the world predictable and organized. These individuals suffer from excessive fear and anxiety. Anger is not a prominent characteristic of obsessive-compulsive personality disorder. Medications are not a first line of treatment for personality disorders. Feelings of superiority are associated with narcissistic personality disorder.

Rationale 3: The person with obsessive-compulsive personality disorder strives at all times to keep the world predictable and organized. These individuals suffer from excessive fear and anxiety. Anger is not a prominent characteristic of obsessive-compulsive personality disorder. Medications are not a first line of treatment for personality disorders. Feelings of superiority are associated with narcissistic personality disorder.

Rationale 4: The person with obsessive-compulsive personality disorder strives at all times to keep the world predictable and organized. These individuals suffer from excessive fear and anxiety. Anger is not a prominent characteristic of obsessive-compulsive personality disorder. Medications are not a first line of treatment for personality disorders. Feelings of superiority are associated with narcissistic personality disorder.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Differentiate personality traits and styles from personality disorders.

Question 4

Type: MCSA

In describing personality disorders to a group of consumers, which statement by the nurse is accurate?

1. People with personality disorders are unable to experience painful feelings.

2. These disorders usually develop during the toddler stage.

3. People with personality disorders view their problems as separate from themselves.

4. Behavior is sporadic with no particular pattern.

Correct Answer: 3

Rationale 1: Clients with personality disorders display a lack of insight. There is no understanding of the impact of their behavior on others. Individuals with personality disorders often experience intense painful feelings. The behavior patterns are pervasive and enduring. Personality disorders develop through childhood as the personality develops and are evident in adolescence and young adulthood.

Rationale 2: Clients with personality disorders display a lack of insight. There is no understanding of the impact of their behavior on others. Individuals with personality disorders often experience intense painful feelings. The behavior patterns are pervasive and enduring. Personality disorders develop through childhood as the personality develops and are evident in adolescence and young adulthood.

Rationale 3: Clients with personality disorders display a lack of insight. There is no understanding of the impact of their behavior on others. Individuals with personality disorders often experience intense painful feelings. The behavior patterns are pervasive and enduring. Personality disorders develop through childhood as the personality develops and are evident in adolescence and young adulthood.

Rationale 4: Clients with personality disorders display a lack of insight. There is no understanding of the impact of their behavior on others. Individuals with personality disorders often experience intense painful feelings. The behavior patterns are pervasive and enduring. Personality disorders develop through childhood as the personality develops and are evident in adolescence and young adulthood.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Identify the characteristics common to all three clusters of personality disorders.

Question 5

Type: MCSA

A client consistently fails to accept the consequences of his or her own behavior. The nurse identifies this behavior as characteristic of:

1. Immaturity.

2. A lack of structure.

3. A need for medication.

4. A personality disorder.

Correct Answer: 4

Rationale 1: The failure to accept the consequences of behavior is a trait common to people with all types of personality disorders. The failure to accept the consequences of behavior is due to the individuals self-perception rather than immaturity or a lack of structure. Medications are not a first line of treatment for personality disorders.

Rationale 2: The failure to accept the consequences of behavior is a trait common to people with all types of personality disorders. The failure to accept the consequences of behavior is due to the individuals self-perception rather than immaturity or a lack of structure. Medications are not a first line of treatment for personality disorders.

Rationale 3: The failure to accept the consequences of behavior is a trait common to people with all types of personality disorders. The failure to accept the consequences of behavior is due to the individuals self-perception rather than immaturity or a lack of structure. Medications are not a first line of treatment for personality disorders.

Rationale 4: The failure to accept the consequences of behavior is a trait common to people with all types of personality disorders. The failure to accept the consequences of behavior is due to the individuals self-perception rather than immaturity or a lack of structure. Medications are not a first line of treatment for personality disorders.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Identify the characteristics common to all three clusters of personality disorders.

Question 6

Type: MCSA

The nurse is working with a client who has been diagnosed with a personality disorder. Which situation best describes the clients external response to stress?

1. The client attends group therapy.

2. The client uses meditation when upset.

3. The client tries to change the environment instead of changing him- or herself.

4. The client engages in self-awareness exercises.

Correct Answer: 3

Rationale 1: When feeling threatened, the client with a personality disorder will try to change the environment instead of changing him- or herself. Meditation, self-awareness exercises, and group therapy attendance are attempts to understand and change ones behavior.

Rationale 2: When feeling threatened, the client with a personality disorder will try to change the environment instead of changing him- or herself. Meditation, self-awareness exercises, and group therapy attendance are attempts to understand and change ones behavior.

Rationale 3: When feeling threatened, the client with a personality disorder will try to change the environment instead of changing him- or herself. Meditation, self-awareness exercises, and group therapy attendance are attempts to understand and change ones behavior.

Rationale 4: When feeling threatened, the client with a personality disorder will try to change the environment instead of changing him- or herself. Meditation, self-awareness exercises, and group therapy attendance are attempts to understand and change ones behavior.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Identify the characteristics common to all three clusters of personality disorders.

Question 7

Type: MCSA

Impulse control is part of the care plan for a client with borderline personality disorder. Which of the following is particularly important to include?

1. A no-harm contract

2. Identification of behavior patterns

3. Identification of support sources

4. Management of emotions

Correct Answer: 1

Rationale 1: Impulsiveness describes the actions of those who act without considering the consequences of their behavior. Impulsiveness, together with identity disturbances, often leads to self-destructive behaviors. A no-harm contract is necessary for safety and should be prioritized before identification of support systems, emotion management, or recognition of behavior patterns.

Rationale 2: Impulsiveness describes the actions of those who act without considering the consequences of their behavior. Impulsiveness, together with identity disturbances, often leads to self-destructive behaviors. A no-harm contract is necessary for safety and should be prioritized before identification of support systems, emotion management, or recognition of behavior patterns.

Rationale 3: Impulsiveness describes the actions of those who act without considering the consequences of their behavior. Impulsiveness, together with identity disturbances, often leads to self-destructive behaviors. A no-harm contract is necessary for safety and should be prioritized before identification of support systems, emotion management, or recognition of behavior patterns.

Rationale 4: Impulsiveness describes the actions of those who act without considering the consequences of their behavior. Impulsiveness, together with identity disturbances, often leads to self-destructive behaviors. A no-harm contract is necessary for safety and should be prioritized before identification of support systems, emotion management, or recognition of behavior patterns.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Compare the biopsychosocial characteristics of various personality disorders.

Question 8

Type: MCSA

The nurse is caring for a client with schizoid personality disorder. Which nursing diagnosis is most appropriate for this client with a cluster A personality disorder?

1. Fear related to feelings of abandonment

2. High Risk for Violence, Self-Directed, related to poor impulse control

3. Social Isolation related to inadequate social skills, craving of solitude

4. Ineffective Individual Coping related to high dependency needs

Correct Answer: 3

Rationale 1: Individuals with schizoid personality disorder show a preference for solitary interests and claim to enjoy being alone. These individuals typically work at occupations that require minimal social interaction. High risk for Self-Directed violence and fear would be appropriate diagnoses for borderline personality disorder. Ineffective Individual Coping related to high dependency needs would be an appropriate nursing diagnosis for dependent personality disorder.

Rationale 2: Individuals with schizoid personality disorder show a preference for solitary interests and claim to enjoy being alone. These individuals typically work at occupations that require minimal social interaction. High Risk for Self-Directed violence and fear would be appropriate diagnoses for borderline personality disorder. Ineffective Individual Coping related to high dependency needs would be an appropriate nursing diagnosis for dependent personality disorder.

Rationale 3: Individuals with schizoid personality disorder show a preference for solitary interests and claim to enjoy being alone. These individuals typically work at occupations that require minimal social interaction. High Risk for Self-Directed violence and fear would be appropriate diagnoses for borderline personality disorder. Ineffective Individual Coping related to high dependency needs would be an appropriate nursing diagnosis for dependent personality disorder.

Rationale 4: Individuals with schizoid personality disorder show a preference for solitary interests and claim to enjoy being alone. These individuals typically work at occupations that require minimal social interaction. High Risk for Self-Directed violence and fear would be appropriate diagnoses for borderline personality disorder. Ineffective Individual Coping related to high dependency needs would be an appropriate nursing diagnosis for dependent personality disorder.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Compare the biopsychosocial characteristics of various personality disorders.

Question 9

Type: MCSA

What would the nurse expect to find when assessing a client with obsessive-compulsive personality disorder?

1. Difficulty completing projects

2. A sense of spontaneity

3. Open expression of feelings

4. Ability to tolerate mistakes

Correct Answer: 1

Rationale 1: Individuals with obsessive-compulsive personality disorder strive at all times to keep the world predictable and organized. They have difficulty in completing projects. Individuals with obsessive-compulsive disorder are excessively conscientious and rigid and are unable to tolerate mistakes or spontaneity. They feel required to fulfill unending duties, responsibilities, and tasks, are self-critical, and adhere strictly and concretely to rules. Individuals with obsessive-compulsive disorder rarely express their feelings openly.

Rationale 2: Individuals with obsessive-compulsive personality disorder strive at all times to keep the world predictable and organized. They have difficulty in completing projects. Individuals with obsessive-compulsive disorder are excessively conscientious and rigid and are unable to tolerate mistakes or spontaneity. They feel required to fulfill unending duties, responsibilities, and tasks, are self-critical, and adhere strictly and concretely to rules. Individuals with obsessive-compulsive disorder rarely express their feelings openly.

Rationale 3: Individuals with obsessive-compulsive personality disorder strive at all times to keep the world predictable and organized. They have difficulty in completing projects. Individuals with obsessive-compulsive disorder are excessively conscientious and rigid and are unable to tolerate mistakes or spontaneity. They feel required to fulfill unending duties, responsibilities, and tasks, are self-critical, and adhere strictly and concretely to rules. Individuals with obsessive-compulsive disorder rarely express their feelings openly.

Rationale 4: Individuals with obsessive-compulsive personality disorder strive at all times to keep the world predictable and organized. They have difficulty in completing projects. Individuals with obsessive-compulsive disorder are excessively conscientious and rigid and are unable to tolerate mistakes or spontaneity. They feel required to fulfill unending duties, responsibilities, and tasks, are self-critical, and adhere strictly and concretely to rules. Individuals with obsessive-compulsive disorder rarely express their feelings openly.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Compare the biopsychosocial characteristics of various personality disorders.

Question 10

Type: MCSA

A client with a diagnosis of paranoid personality disorder appears hypervigilant and sits alone in an isolated area of the unit. The client does not acknowledge other clients and often uses sarcasm when addressing staff. The nurse invites the client to attend a milieu group, but the client ignores the nurses efforts. An appropriate nursing diagnosis for this client is which of the following?

1. Activity Intolerance

2. Fear

3. Impaired Social Interaction

4. Powerlessness

Correct Answer: 3

Rationale 1: Individuals with paranoid personality disorder mistrust others and may appear hypervigilant. Impaired Social Interaction is a diagnosis for a client who participates in an insufficient quantity of social exchange and exhibits dysfunctional interactions. Fear and Powerlessness would be appropriate nursing diagnoses in the anxiousfearful cluster. Activity Intolerance is a nursing diagnosis appropriate for a client with physical limitations.

Rationale 2: Individuals with paranoid personality disorder mistrust others and may appear hypervigilant. Impaired Social Interaction is a diagnosis for a client who participates in an insufficient quantity of social exchange and exhibits dysfunctional interactions. Fear and Powerlessness would be appropriate nursing diagnoses in the anxiousfearful cluster. Activity Intolerance is a nursing diagnosis appropriate for a client with physical limitations.

Rationale 3: Individuals with paranoid personality disorder mistrust others and may appear hypervigilant. Impaired Social Interaction is a diagnosis for a client who participates in an insufficient quantity of social exchange and exhibits dysfunctional interactions. Fear and Powerlessness would be appropriate nursing diagnoses in the anxiousfearful cluster. Activity Intolerance is a nursing diagnosis appropriate for a client with physical limitations.

Rationale 4: Individuals with paranoid personality disorder mistrust others and may appear hypervigilant. Impaired Social Interaction is a diagnosis for a client who participates in an insufficient quantity of social exchange and exhibits dysfunctional interactions. Fear and Powerlessness would be appropriate nursing diagnoses in the anxiousfearful cluster. Activity Intolerance is a nursing diagnosis appropriate for a client with physical limitations.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: Compare the biopsychosocial characteristics of various personality disorders.

Question 11

Type: MCSA

The nurse is working with a client who exhibits a grandiose sense of self-importance. This characteristic is associated with which of the following personality disorders?

1. Narcissistic personality disorder

2. Avoidant personality disorder

3. Histrionic personality disorder

4. Dependent personality disorder

Correct Answer: 1

Rationale 1: Narcissistic personality disorder is characterized by a grandiose sense of self-importance and a sense of entitlement. Histrionic personality disorder is characterized by a lifelong tendency for dramatic, egocentric, attention-seeking response patterns. Dependent personality disorder is characterized by a pervasive, excessive, and unrealistic need to be cared for, fear of separation, lack of self-confidence, an inability to make decisions, and an inability to function independently. Avoidant personality disorder is characterized by a pattern of social withdrawal along with a sense of inadequacy, fear, and hypersensitivity to potential rejection or shame.

Rationale 2: Narcissistic personality disorder is characterized by a grandiose sense of self-importance and a sense of entitlement. Histrionic personality disorder is characterized by a lifelong tendency for dramatic, egocentric, attention-seeking response patterns. Dependent personality disorder is characterized by a pervasive, excessive, and unrealistic need to be cared for, fear of separation, lack of self-confidence, an inability to make decisions, and an inability to function independently. Avoidant personality disorder is characterized by a pattern of social withdrawal along with a sense of inadequacy, fear, and hypersensitivity to potential rejection or shame.

Rationale 3: Narcissistic personality disorder is characterized by a grandiose sense of self-importance and a sense of entitlement. Histrionic personality disorder is characterized by a lifelong tendency for dramatic, egocentric, attention-seeking response patterns. Dependent personality disorder is characterized by a pervasive, excessive, and unrealistic need to be cared for, fear of separation, lack of self-confidence, an inability to make decisions, and an inability to function independently. Avoidant personality disorder is characterized by a pattern of social withdrawal along with a sense of inadequacy, fear, and hypersensitivity to potential rejection or shame.

Rationale 4: Narcissistic personality disorder is characterized by a grandiose sense of self-importance and a sense of entitlement. Histrionic personality disorder is characterized by a lifelong tendency for dramatic, egocentric, attention-seeking response patterns. Dependent personality disorder is characterized by a pervasive, excessive, and unrealistic need to be cared for, fear of separation, lack of self-confidence, an inability to make decisions, and an inability to function independently. Avoidant personality disorder is characterized by a pattern of social withdrawal along with a sense of inadequacy, fear, and hypersensitivity to potential rejection or shame.

Global Rationale:

Cognitive Level: Evaluating

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Compare the biopsychosocial characteristics of various personality disorders.

Question 12

Type: MCSA

The nurse is working with a client who exhibits a pervasive, excessive, and unrealistic need to receive care. This clients behavior is a characteristic of which of the following personality disorders?

1. Histrionic personality disorder

2. Narcissistic personality disorder

3. Dependent personality disorder

4. Avoidant personality disorder

Correct Answer: 3

Rationale 1: Dependent personality disorder is characterized by a pervasive, excessive, and unrealistic need to be cared for, fear of separation, lack of self-confidence, an inability to make decisions, and an inability to function independently. Narcissistic personality disorder is characterized by a grandiose sense of self-importance and a sense of entitlement. Histrionic personality disorder is characterized by a lifelong tendency for dramatic, egocentric, attention-seeking response patterns. Avoidant personality disorder is characterized by a pattern of social withdrawal along with a sense of inadequacy, fear, and hypersensitivity to potential rejection or shame.

Rationale 2: Dependent personality disorder is characterized by a pervasive, excessive, and unrealistic need to be cared for, fear of separation, lack of self-confidence, an inability to make decisions, and an inability to function independently. Narcissistic personality disorder is characterized by a grandiose sense of self-importance and a sense of entitlement. Histrionic personality disorder is characterized by a lifelong tendency for dramatic, egocentric, attention-seeking response patterns. Avoidant personality disorder is characterized by a pattern of social withdrawal along with a sense of inadequacy, fear, and hypersensitivity to potential rejection or shame.

Rationale 3: Dependent personality disorder is characterized by a pervasive, excessive, and unrealistic need to be cared for, fear of separation, lack of self-confidence, an inability to make decisions, and an inability to function independently. Narcissistic personality disorder is characterized by a grandiose sense of self-importance and a sense of entitlement. Histrionic personality disorder is characterized by a lifelong tendency for dramatic, egocentric, attention-seeking response patterns. Avoidant personality disorder is characterized by a pattern of social withdrawal along with a sense of inadequacy, fear, and hypersensitivity to potential rejection or shame.

Rationale 4: Dependent personality disorder is characterized by a pervasive, excessive, and unrealistic need to be cared for, fear of separation, lack of self-confidence, an inability to make decisions, and an inability to function independently. Narcissistic personality disorder is characterized by a grandiose sense of self-importance and a sense of entitlement. Histrionic personality disorder is characterized by a lifelong tendency for dramatic, egocentric, attention-seeking response patterns. Avoidant personality disorder is characterized by a pattern of social withdrawal along with a sense of inadequacy, fear, and hypersensitivity to potential rejection or shame.

Global Rationale:

Cognitive Level: Creating

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Compare the biopsychosocial characteristics of various personality disorders.

Question 13

Type: MCSA

The nurse is preparing to assess a client with a diagnosis of paranoid personality disorder. What client characteristics will the nurse expect to observe?

1. Grandiosity

2. Superficial charm

3. Affective instability

4. Suspicions and rigidity

Correct Answer: 4

Rationale 1: The major features of cluster A disorders are pervasive distrust, social detachment, and subsequent impairment in social and occupational functioning. Individuals with paranoid personality disorder are inflexible in their perception of the world. Affective instability, grandiosity, and superficial charm would be characteristic of cluster B diagnoses.

Rationale 2: The major features of cluster A disorders are pervasive distrust, social detachment, and subsequent impairment in social and occupational functioning. Individuals with paranoid personality disorder are inflexible in their perception of the world. Affective instability, grandiosity, and superficial charm would be characteristic of cluster B diagnoses.

Rationale 3: The major features of cluster A disorders are pervasive distrust, social detachment, and subsequent impairment in social and occupational functioning. Individuals with paranoid personality disorder are inflexible in their perception of the world. Affective instability, grandiosity, and superficial charm would be characteristic of cluster B diagnoses.

Rationale 4: The major features of cluster A disorders are pervasive distrust, social detachment, and subsequent impairment in social and occupational functioning. Individuals with paranoid personality disorder are inflexible in their perception of the world. Affective instability, grandiosity, and superficial charm would be characteristic of cluster B diagnoses.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Identify the developmental and psychobiologic characteristics that distinguish OddEccentric (Cluster A), DramaticEmotional (Cluster B), and AnxiousFearful (Cluster C) personality disorders from one another.

Question 14

Type: MCSA

A client presents with an inability to make decisions and function independently. The nurse knows these symptoms are indicative of which of the following disorders?

1. Dependent personality disorder

2. Paranoid personality disorder

3. Schizotypal personality disorder

4. Schizoid personality disorder

Correct Answer: 1

Rationale 1: Cluster C dependent personality disorders are characterized by a pervasive, excessive, and unrealistic need to be cared for, fear of separation, lack of self-confidence, an inability to make decisions, and an inability to function independently. Schizotypal personality disorder, paranoid personality disorder, and schizoid personality disorder are all cluster A diagnoses. The major features of these disorders are pervasive distrust, social detachment, and subsequent impairment in social and occupational functioning.

Rationale 2: Cluster C dependent personality disorders are characterized by a pervasive, excessive, and unrealistic need to be cared for, fear of separation, lack of self-confidence, an inability to make decisions, and an inability to function independently. Schizotypal personality disorder, paranoid personality disorder, and schizoid personality disorder are all cluster A diagnoses. The major features of these disorders are pervasive distrust, social detachment, and subsequent impairment in social and occupational functioning.

Rationale 3: Cluster C dependent personality disorders are characterized by a pervasive, excessive, and unrealistic need to be cared for, fear of separation, lack of self-confidence, an inability to make decisions, and an inability to function independently. Schizotypal personality disorder, paranoid personality disorder, and schizoid personality disorder are all cluster A diagnoses. The major features of these disorders are pervasive distrust, social detachment, and subsequent impairment in social and occupational functioning.

Rationale 4: Cluster C dependent personality disorders are characterized by a pervasive, excessive, and unrealistic need to be cared for, fear of separation, lack of self-confidence, an inability to make decisions, and an inability to function independently. Schizotypal personality disorder, paranoid personality disorder, and schizoid personality disorder are all cluster A diagnoses. The major features of these disorders are pervasive distrust, social detachment, and subsequent impairment in social and occupational functioning.

Global Rationale:

Cognitive Level: Creating

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Identify the developmental and psychobiologic characteristics that distinguish OddEccentric (Cluster A), DramaticEmotional (Cluster B), and AnxiousFearful (Cluster C) personality disorders from one another.

Question 15

Type: MCSA

The nurse admits a client who initially presents as intelligent, articulate, and superficially charming. The client claims his admission to the mental health unit is a big mistake. He states that there was a mix-up in the emergency room and he was incorrectly identified. A probable diagnosis is:

1. Antisocial personality disorder.

2. Avoidant personality disorder.

3. Dependent personality disorder.

4. Obsessive-compulsive personality disorder.

Correct Answer: 1

Rationale 1: Clients with antisocial personality disorder (ASPD) may initially appear charming, intellectually bright, and conversationally glib. These behaviors are manipulative and are used to create a situation that the person with ASPD can control. During the initial assessment interview, it is common for the person diagnosed with ASPD to refuse responsibility for admission to the mental health or forensic facility. Clients diagnosed with avoidant, dependent, or obsessive-compulsive personality disorder generally experience both social and occupational impairments as a result of their restricted affect, nonassertiveness, problems expressing feelings, unrealistic expectations of others, and impaired decision making and problem solving.

Rationale 2: Clients with antisocial personality disorder (ASPD) may initially appear charming, intellectually bright, and conversationally glib. These behaviors are manipulative and are used to create a situation that the person with ASPD can control. During the initial assessment interview, it is common for the person diagnosed with ASPD to refuse responsibility for admission to the mental health or forensic facility. Clients diagnosed with avoidant, dependent, or obsessive-compulsive personality disorder generally experience both social and occupational impairments as a result of their restricted affect, nonassertiveness, problems expressing feelings, unrealistic expectations of others, and impaired decision making and problem solving.

Rationale 3: Clients with antisocial personality disorder (ASPD) may initially appear charming, intellectually bright, and conversationally glib. These behaviors are manipulative and are used to create a situation that the person with ASPD can control. During the initial assessment interview, it is common for the person diagnosed with ASPD to refuse responsibility for admission to the mental health or forensic facility. Clients diagnosed with avoidant, dependent, or obsessive-compulsive personality disorder generally experience both social and occupational impairments as a result of their restricted affect, nonassertiveness, problems expressing feelings, unrealistic expectations of others, and impaired decision making and problem solving.

Rationale 4: Clients with antisocial personality disorder (ASPD) may initially appear charming, intellectually bright, and conversationally glib. These behaviors are manipulative and are used to create a situation that the person with ASPD can control. During the initial assessment interview, it is common for the person diagnosed with ASPD to refuse responsibility for admission to the mental health or forensic facility. Clients diagnosed with avoidant, dependent, or obsessive-compulsive personality disorder generally experience both social and occupational impairments as a result of their restricted affect, nonassertiveness, problems expressing feelings, unrealistic expectations of others, and impaired decision making and problem solving.

Global Rationale:

Cognitive Level: Creating

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Identify the developmental and psychobiologic characteristics that distinguish OddEccentric (Cluster A), DramaticEmotional (Cluster B), and AnxiousFearful (Cluster C) personality disorders from one another.

Question 16

Type: MCSA

The student nurse is comparing the essential characteristics of each cluster of personality disorders. The student correctly identifies the essential characteristics of cluster C disorders as:

1. Anxiety.

2. Pervasive distrust.

3. Impulsivity.

4. Openness.

Correct Answer: 1

Rationale 1: Cluster C consists of dependent, avoidant, and obsessive-compulsive disorders. These disorders are characterized by anxiety. Cluster A consists of the paranoid, schizoid, and schizotypal personality disorders. The major features of these disorders are pervasive distrust, social detachment, and subsequent impairment in social and occupational functioning. Cluster B consists of borderline, antisocial, narcissistic, and histrionic disorders. A major feature of these disorders is impulsivity. Openness would be a characteristic of a mentally healthy individual.

Rationale 2: Cluster C consists of dependent, avoidant, and obsessive-compulsive disorders. These disorders are characterized by anxiety. Cluster A consists of the paranoid, schizoid, and schizotypal personality disorders. The major features of these disorders are pervasive distrust, social detachment, and subsequent impairment in social and occupational functioning. Cluster B consists of borderline, antisocial, narcissistic, and histrionic disorders. A major feature of these disorders is impulsivity. Openness would be a characteristic of a mentally healthy individual.

Rationale 3: Cluster C consists of dependent, avoidant, and obsessive-compulsive disorders. These disorders are characterized by anxiety. Cluster A consists of the paranoid, schizoid, and schizotypal personality disorders. The major features of these disorders are pervasive distrust, social detachment, and subsequent impairment in social and occupational functioning. Cluster B consists of borderline, antisocial, narcissistic, and histrionic disorders. A major feature of these disorders is impulsivity. Openness would be a characteristic of a mentally healthy individual.

Rationale 4: Cluster C consists of dependent, avoidant, and obsessive-compulsive disorders. These disorders are characterized by anxiety. Cluster A consists of the paranoid, schizoid, and schizotypal personality disorders. The major features of these disorders are pervasive distrust, social detachment, and subsequent impairment in social and occupational functioning. Cluster B consists of borderline, antisocial, narcissistic, and histrionic disorders. A major feature of these disorders is impulsivity. Openness would be a characteristic of a mentally healthy individual.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Identify the developmental and psychobiologic characteristics that distinguish OddEccentric (Cluster A), DramaticEmotional (Cluster B), and AnxiousFearful (Cluster C) personality disorders from one another.

Question 17

Type: MCSA

A 30-year-old man is accused of sexual assault and is arrested by law enforcement. During the interview with the forensic nurse, the client uses flattery and compliments the nurses interview skills. He asks the nurse for her phone number so his lawyer can contact her as an expert witness for his case. How should the nurse respond?

1. Tell the client that she is listed in the phone book.

2. In a way that establishes the boundaries of the nurseclient relationship.

3. Tell the client that the nurse is working for the prosecution.

4. In a way that nurtures the clients feelings.

Correct Answer: 2

Rationale 1: Individuals with antisocial personality disorder sometimes manipulate nurses to assume the roles of nurturers and rescuers. These clients have lifelong patterns of victimizing and exploiting others. Nurses should never give out telephone numbers, assign special privileges, or be available to clients outside the therapeutic relationship. It is of primary importance to set boundaries for the interaction in a professional, therapeutic manner and implement appropriate self-disclosure.

Rationale 2: Individuals with antisocial personality disorder sometimes manipulate nurses to assume the roles of nurturers and rescuers. These clients have lifelong patterns of victimizing and exploiting others. Nurses should never give out telephone numbers, assign special privileges, or be available to clients outside the therapeutic relationship. It is of primary importance to set boundaries for the interaction in a professional, therapeutic manner and implement appropriate self-disclosure.

Rationale 3: Individuals with antisocial personality disorder sometimes manipulate nurses to assume the roles of nurturers and rescuers. These clients have lifelong patterns of victimizing and exploiting others. Nurses should never give out telephone numbers, assign special privileges, or be available to clients outside the therapeutic relationship. It is of primary importance to set boundaries for the interaction in a professional, therapeutic manner and implement appropriate self-disclosure.

Rationale 4: Individuals with antisocial personality disorder sometimes manipulate nurses to assume the roles of nurturers and rescuers. These clients have lifelong patterns of victimizing and exploiting others. Nurses should never give out telephone numbers, assign special privileges, or be available to clients outside the therapeutic relationship. It is of primary importance to set boundaries for the interaction in a professional, therapeutic manner and implement appropriate self-disclosure.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain the concepts that would enable the psychiatricmental health nurse to apply the nursing process to the care of clients with personality disorders.

Question 18

Type: MCSA

The nurse is working with a client who has a history of impulsive and self-harming behavior. The nurse will need to address which of the following in the plan of care?

1. Boundary setting

2. Confidentiality

3. Safety

4. Appropriate self-disclosure

Correct Answer: 3

Rationale 1: Impulsive clients act before thinking about the potential consequences of their actions. Safety maintenance becomes a priority for a client with a history of impulsiveness and self-harm. Confidentiality is maintained for all clients at all times. Boundary setting and appropriate self-disclosure are measures incorporated for clients who display manipulative behavior.

Rationale 2: Impulsive clients act before thinking about the potential consequences of their actions. Safety maintenance becomes a priority for a client with a history of impulsiveness and self-harm. Confidentiality is maintained for all clients at all times. Boundary setting and appropriate self-disclosure are measures incorporated for clients who display manipulative behavior.

Rationale 3: Impulsive clients act before thinking about the potential consequences of their actions. Safety maintenance becomes a priority for a client with a history of impulsiveness and self-harm. Confidentiality is maintained for all clients at all times. Boundary setting and appropriate self-disclosure are measures incorporated for clients who display manipulative behavior.

Rationale 4: Impulsive clients act before thinking about the potential consequences of their actions. Safety maintenance becomes a priority for a client with a history of impulsiveness and self-harm. Confidentiality is maintained for all clients at all times. Boundary setting and appropriate self-disclosure are measures incorporated for clients who display manipulative behavior.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Explain the concepts that would enable the psychiatricmental health nurse to apply the nursing process to the care of clients with personality disorders.

Question 19

Type: MCSA

A client with borderline personality disorder gives written notice of intention to leave the hospital after a voluntary admission. The client tells the nurse, I will rescind my notice if you expand my smoking privileges. The nurse should respond in a way that:

1. Convinces the client to rescind the notice.

2. Provides exceptions to the unit rules.

3. Refers the client to the physician.

4. Consistently reinforces the unit rules.

Correct Answer: 4

Rationale 1: The client is exhibiting manipulation. The nurse should incorporate clear, concise, and consistent limit setting and directions. When infractions of the rules or manipulative behavior occur, apply consequences immediately. Responding consistently to the manipulative behavior will help gradually lessen its intensity. It would encourage staff splitting to refer the client to the physician. Attempting to coerce a client to change, or allowing rule exceptions, is nontherapeutic and counterproductive.

Rationale 2: The client is exhibiting manipulation. The nurse should incorporate clear, concise, and consistent limit setting and directions. When infractions of the rules or manipulative behavior occur, apply consequences immediately. Responding consistently to the manipulative behavior will help gradually lessen its intensity. It would encourage staff splitting to refer the client to the physician. Attempting to coerce a client to change, or allowing rule exceptions, is nontherapeutic and counterproductive.

Rationale 3: The client is exhibiting manipulation. The nurse should incorporate clear, concise, and consistent limit setting and directions. When infractions of the rules or manipulative behavior occur, apply consequences immediately. Responding consistently to the manipulative behavior will help gradually lessen its intensity. It would encourage staff splitting to refer the client to the physician. Attempting to coerce a client to change, or allowing rule exceptions, is nontherapeutic and counterproductive.

Rationale 4: The client is exhibiting manipulation. The nurse should incorporate clear, concise, and consistent limit setting and directions. When infractions of the rules or manipulative behavior occur, apply consequences immediately. Responding consistently to the manipulative behavior will help gradually lessen its intensity. It would encourage staff splitting to refer the client to the physician. Attempting to coerce a client to change, or allowing rule exceptions, is nontherapeutic and counterproductive.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain the concepts that would enable the psychiatricmental health nurse to apply the nursing process to the care of clients with personality disorders.

Question 20

Type: MCSA

The nursing staff is discussing boundary setting. Which of the following statements about boundary setting is inaccurate?

1. Boundaries are established by providing consistent expectations.

2. Boundaries define the therapeutic relationship.

3. Boundaries provide guidelines for self-control.

4. Boundaries are established to make the nursing staffs job easier.

Correct Answer: 4

Rationale 1: While the establishment of boundaries may make the nursing staffs job easier, that is not the client-focused therapeutic intention. Boundary setting is implemented to define the therapeutic relationship and to provide consistent expectations and guidelines for client self-control.

Rationale 2: While the establishment of boundaries may make the nursing staffs job easier, that is not the client-focused therapeutic intention. Boundary setting is implemented to define the therapeutic relationship and to provide consistent expectations and guidelines for client self-control.

Rationale 3: While the establishment of boundaries may make the nursing staffs job easier, that is not the client-focused therapeutic intention. Boundary setting is implemented to define the therapeutic relationship and to provide consistent expectations and guidelines for client self-control.

Rationale 4: While the establishment of boundaries may make the nursing staffs job easier, that is not the client-focused therapeutic intention. Boundary setting is implemented to define the therapeutic relationship and to provide consistent expectations and guidelines for client self-control.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain the concepts that would enable the psychiatricmental health nurse to apply the nursing process to the care of clients with personality disorders.

Question 21

Type: MCSA

A student nurse is working with a client on the inpatient unit who exhibits manipulative behavior. What action should the student incorporate into interactions with this client?

1. Limit setting

2. No-harm contract

3. Confront negative self-concepts

4. Matter-of-fact approach

Correct Answer: 1

Rationale 1: A major intervention in dealing with manipulative behavior is limit setting. It is important to set limits only on the behavior that is most dysfunctional and problematic. A no-harm contract would be implemented for a client with self-destructive behavior. A matter-of-fact approach is useful for suspicious clients. Confrontation of negative self-concepts is useful when working with clients with a cluster C diagnosis.

Rationale 2: A major intervention in dealing with manipulative behavior is limit setting. It is important to set limits only on the behavior that is most dysfunctional and problematic. A no-harm contract would be implemented for a client with self-destructive behavior. A matter-of-fact approach is useful for suspicious clients. Confrontation of negative self-concepts is useful when working with clients with a cluster C diagnosis.

Rationale 3: A major intervention in dealing with manipulative behavior is limit setting. It is important to set limits only on the behavior that is most dysfunctional and problematic. A no-harm contract would be implemented for a client with self-destructive behavior. A matter-of-fact approach is useful for suspicious clients. Confrontation of negative self-concepts is useful when working with clients with a cluster C diagnosis.

Rationale 4: A major intervention in dealing with manipulative behavior is limit setting. It is important to set limits only on the behavior that is most dysfunctional and problematic. A no-harm contract would be implemented for a client with self-destructive behavior. A matter-of-fact approach is useful for suspicious clients. Confrontation of negative self-concepts is useful when working with clients with a cluster C diagnosis.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Manage the triad of manipulation, narcissism, and impulsiveness when demonstrated by clients with personality disorders.

Question 22

Type: MCSA

The client with a diagnosis of borderline personality disorder shows the nurse multiple superficial cuts to the arms that were made during the night. The client states, I told the night staff that I was feeling alone. The nurse recognizes that the self-mutilation may be a result of:

1. Manipulation.

2. Anxiety.

3. Splitting.

4. Impulsive behavior.

Correct Answer: 4

Rationale 1: Clients with borderline personality disorder often act before thinking about the potential consequences of their actions. Safety maintenance is a primary concern when working with impulsive clients. Manipulation is an attempt to get needs met through using or exploiting others. Splitting is a type of manipulative behavior that attempts to set one staff member against another. Anxiety is associated with cluster C disorders.

Rationale 2: Clients with borderline personality disorder often act before thinking about the potential consequences of their actions. Safety maintenance is a primary concern when working with impulsive clients. Manipulation is an attempt to get needs met through using or exploiting others. Splitting is a type of manipulative behavior that attempts to set one staff member against another. Anxiety is associated with cluster C disorders.

Rationale 3: Clients with borderline personality disorder often act before thinking about the potential consequences of their actions. Safety maintenance is a primary concern when working with impulsive clients. Manipulation is an attempt to get needs met through using or exploiting others. Splitting is a type of manipulative behavior that attempts to set one staff member against another. Anxiety is associated with cluster C disorders.

Rationale 4: Clients with borderline personality disorder often act before thinking about the potential consequences of their actions. Safety maintenance is a primary concern when working with impulsive clients. Manipulation is an attempt to get needs met through using or exploiting others. Splitting is a type of manipulative behavior that attempts to set one staff member against another. Anxiety is associated with cluster C disorders.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Manage the triad of manipulation, narcissism, and impulsiveness when demonstrated by clients with personality disorders.

Question 23

Type: MCSA

The nurse and a client talk about healthy ways to meet needs. The client states, When I am looking really good, it is not asking too much for people to acknowledge me. The nurse recognizes that this experience is indicative of:

1. Affective instability.

2. Splitting.

3. Feelings of emptiness.

4. A sense of entitlement.

Correct Answer: 4

Rationale 1: Individuals with narcissism have a constant desire to be the center of attention that is based on a strong sense of entitlement. Narcissistic individuals feel they deserve to be treated in a special manner. When their need for constant attention is not met, the narcissistic person feels rejected and may retaliate through acting-out behaviors. Affective instability and feelings of emptiness are characteristics of borderline personality disorder. Splitting is a manipulative tactic to pit individuals against one another.

Rationale 2: Individuals with narcissism have a constant desire to be the center of attention that is based on a strong sense of entitlement. Narcissistic individuals feel they deserve to be treated in a special manner. When their need for constant attention is not met, the narcissistic person feels rejected and may retaliate through acting-out behaviors. Affective instability and feelings of emptiness are characteristics of borderline personality disorder. Splitting is a manipulative tactic to pit individuals against one another.

Rationale 3: Individuals with narcissism have a constant desire to be the center of attention that is based on a strong sense of entitlement. Narcissistic individuals feel they deserve to be treated in a special manner. When their need for constant attention is not met, the narcissistic person feels rejected and may retaliate through acting-out behaviors. Affective instability and feelings of emptiness are characteristics of borderline personality disorder. Splitting is a manipulative tactic to pit individuals against one another.

Rationale 4: Individuals with narcissism have a constant desire to be the center of attention that is based on a strong sense of entitlement. Narcissistic individuals feel they deserve to be treated in a special manner. When their need for constant attention is not met, the narcissistic person feels rejected and may retaliate through acting-out behaviors. Affective instability and feelings of emptiness are characteristics of borderline personality disorder. Splitting is a manipulative tactic to pit individuals against one another.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Manage the triad of manipulation, narcissism, and impulsiveness when demonstrated by clients with personality disorders.

Question 24

Type: MCSA

A client with a diagnosis of borderline personality disorder has had several hospitalizations for suicide attempts and self-mutilation. A priority nursing intervention for this client would include which of the following?

1. Safety maintenance

2. Social interaction

3. Anxiety reduction

4. Concrete communication

Correct Answer: 1

Rationale 1: Safety maintenance is a priority nursing intervention for a client with a history of self-mutilation and suicide attempts. Concrete communication is a nursing intervention for clients with cognitive impairments. Increasing social interaction is a nursing intervention appropriate for clients with cluster A diagnoses. Anxiety reduction is a nursing intervention appropriate for clients with cluster C diagnoses.

Rationale 2: Safety maintenance is a priority nursing intervention for a client with a history of self-mutilation and suicide attempts. Concrete communication is a nursing intervention for clients with cognitive impairments. Increasing social interaction is a nursing intervention appropriate for clients with cluster A diagnoses. Anxiety reduction is a nursing intervention appropriate for clients with cluster C diagnoses.

Rationale 3: Safety maintenance is a priority nursing intervention for a client with a history of self-mutilation and suicide attempts. Concrete communication is a nursing intervention for clients with cognitive impairments. Increasing social interaction is a nursing intervention appropriate for clients with cluster A diagnoses. Anxiety reduction is a nursing intervention appropriate for clients with cluster C diagnoses.

Rationale 4: Safety maintenance is a priority nursing intervention for a client with a history of self-mutilation and suicide attempts. Concrete communication is a nursing intervention for clients with cognitive impairments. Increasing social interaction is a nursing intervention appropriate for clients with cluster A diagnoses. Anxiety reduction is a nursing intervention appropriate for clients with cluster C diagnoses.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Focus nursing intervention on a clients specific and unique response to the personality disorder.

Question 25

Type: MCSA

Which of the following interventions would the nurse implement to address the client with feelings of abandonment?

1. Assist client to suppress feelings of abandonment.

2. Encourage client to never get involved in a relationship again.

3. Assist client to express deep rage at the ending of the relationship.

4. Assist client to verbalize feelings of abandonment in an appropriate manner.

Correct Answer: 4

Rationale 1: An intervention for a client with feelings of abandonment would be that the client verbalizes rather than acts on feelings of abandonment. It would not be therapeutic to encourage the client to never get involved in a relationship again. Verbal expression of deep rage would imply affective instability. Suppression of feelings is not a therapeutic intervention.

Rationale 2: An intervention for a client with feelings of abandonment would be that the client verbalizes rather than acts on feelings of abandonment. It would not be therapeutic to encourage the client to never get involved in a relationship again. Verbal expression of deep rage would imply affective instability. Suppression of feelings is not a therapeutic intervention.

Rationale 3: An intervention for a client with feelings of abandonment would be that the client verbalizes rather than acts on feelings of abandonment. It would not be therapeutic to encourage the client to never get involved in a relationship again. Verbal expression of deep rage would imply affective instability. Suppression of feelings is not a therapeutic intervention.

Rationale 4: An intervention for a client with feelings of abandonment would be that the client verbalizes rather than acts on feelings of abandonment. It would not be therapeutic to encourage the client to never get involved in a relationship again. Verbal expression of deep rage would imply affective instability. Suppression of feelings is not a therapeutic intervention.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Focus nursing intervention on a clients specific and unique response to the personality disorder.

Question 26

Type: MCSA

Clients with antisocial personality disorder display a lack of empathy and will put their own needs above the needs of others. Interventions for clients with antisocial personality disorder will be targeted toward which of the following behaviors?

1. Displaying a great deal of responsibility toward others

2. Displaying a disregard for the rights of others

3. Displaying a great deal of self-control

4. Displaying a great deal of anxiety

Correct Answer: 2

Rationale 1: Clients with antisocial personality disorder are driven to manipulate others for their own gain. They have no regard for the rights or feelings of others. Individuals with antisocial personality disorder are often irresponsible in all areas of life that do not have an immediate reward for them. These individuals will only display anxiety when experiencing extreme external stress. The individual with antisocial personality disorder is impulsive and will act without regard for consequences.

Rationale 2: Clients with antisocial personality disorder are driven to manipulate others for their own gain. They have no regard for the rights or feelings of others. Individuals with antisocial personality disorder are often irresponsible in all areas of life that do not have an immediate reward for them. These individuals will only display anxiety when experiencing extreme external stress. The individual with antisocial personality disorder is impulsive and will act without regard for consequences.

Rationale 3: Clients with antisocial personality disorder are driven to manipulate others for their own gain. They have no regard for the rights or feelings of others. Individuals with antisocial personality disorder are often irresponsible in all areas of life that do not have an immediate reward for them. These individuals will only display anxiety when experiencing extreme external stress. The individual with antisocial personality disorder is impulsive and will act without regard for consequences.

Rationale 4: Clients with antisocial personality disorder are driven to manipulate others for their own gain. They have no regard for the rights or feelings of others. Individuals with antisocial personality disorder are often irresponsible in all areas of life that do not have an immediate reward for them. These individuals will only display anxiety when experiencing extreme external stress. The individual with antisocial personality disorder is impulsive and will act without regard for consequences.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Focus nursing intervention on a clients specific and unique response to the personality disorder.

Question 27

Type: MCSA

The nurse is planning care for an individual diagnosed with borderline personality disorder. The nurse realizes that interventions will have to be focused on which of the following behaviors?

1. Desiring order and perfection

2. Not being able to make decisions

3. Acting out when feeling abandoned or disrespected

4. Withdrawing and becoming isolative

Correct Answer: 3

Rationale 1: Clients with borderline personality disorder often experience feelings of abandonment when left alone and may act out. Clients who are not able to make decisions may have dependent personality disorder. Clients who want order and perfection are often diagnosed with obsessive-compulsive personality disorder. Individuals with cluster A disorders will often withdraw and become isolative.

Rationale 2: Clients with borderline personality disorder often experience feelings of abandonment when left alone and may act out. Clients who are not able to make decisions may have dependent personality disorder. Clients who want order and perfection are often diagnosed with obsessive-compulsive personality disorder. Individuals with cluster A disorders will often withdraw and become isolative.

Rationale 3: Clients with borderline personality disorder often experience feelings of abandonment when left alone and may act out. Clients who are not able to make decisions may have dependent personality disorder. Clients who want order and perfection are often diagnosed with obsessive-compulsive personality disorder. Individuals with cluster A disorders will often withdraw and become isolative.

Rationale 4: Clients with borderline personality disorder often experience feelings of abandonment when left alone and may act out. Clients who are not able to make decisions may have dependent personality disorder. Clients who want order and perfection are often diagnosed with obsessive-compulsive personality disorder. Individuals with cluster A disorders will often withdraw and become isolative.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Focus nursing intervention on a clients specific and unique response to the personality disorder.

Question 28

Type: MCSA

A client with borderline personality disorder approaches the nurse voicing concerns about being ignored by the nursing staff and feeling unimportant. The client blames the nursing staff for not paying attention to the client. The nurses best therapeutic response to this client would include which of the following statements?

1. Tell me more about your feeling of being ignored.

2. Thats all in your imagination.

3. You need to share your feelings with the nurses you feel are ignoring you.

4. I will bring it up at the next meeting.

Correct Answer: 3

Rationale 1: The client is attempting to split the staff, which is manipulative behavior. The behavior needs to be addressed immediately and consistently. Referring the client to the nurses in question utilizes a team approach. Deferring the matter until the next unit meeting does not immediately address the manipulation. Dismissing the clients concerns as imaginary will send the message that they are not taken seriously by nursing staff. Engaging the client to explore the feelings of being ignored reinforces the splitting.

Rationale 2: The client is attempting to split the staff, which is manipulative behavior. The behavior needs to be addressed immediately and consistently. Referring the client to the nurses in question utilizes a team approach. Deferring the matter until the next unit meeting does not immediately address the manipulation. Dismissing the clients concerns as imaginary will send the message that they are not taken seriously by nursing staff. Engaging the client to explore the feelings of being ignored reinforces the splitting.

Rationale 3: The client is attempting to split the staff, which is manipulative behavior. The behavior needs to be addressed immediately and consistently. Referring the client to the nurses in question utilizes a team approach. Deferring the matter until the next unit meeting does not immediately address the manipulation. Dismissing the clients concerns as imaginary will send the message that they are not taken seriously by nursing staff. Engaging the client to explore the feelings of being ignored reinforces the splitting.

Rationale 4: The client is attempting to split the staff, which is manipulative behavior. The behavior needs to be addressed immediately and consistently. Referring the client to the nurses in question utilizes a team approach. Deferring the matter until the next unit meeting does not immediately address the manipulation. Dismissing the clients concerns as imaginary will send the message that they are not taken seriously by nursing staff. Engaging the client to explore the feelings of being ignored reinforces the splitting.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Modify the possible effects of the nurses positive and negative emotional responses to clients who have personality disorders.

Question 29

Type: MCSA

A client with a diagnosis of antisocial personality disorder comes to the nurses station at 11:00 p.m. requesting to use the phone. The client insists on consulting a lawyer immediately to discuss filing for a divorce. The unit rules prohibit phone calls after 10:00 p.m. Which of the following responses is therapeutic for this client?

1. It is after 10:00 p.m. You can call tomorrow.

2. You know better than to break the rules. Im surprised at you.

3. You really dont want to file for a divorce, do you?

4. You may go ahead and use the phone. I know this is hard for you.

Correct Answer: 1

Rationale 1: The client with antisocial personality disorder is impulsive as manifested by the clients making decision to make a phone call without regard for the unit rules or the lawyers office hours. It is necessary to respond consistently to the clients demands and not allow exceptions. Attempting to coerce the client into changing behavior is nontherapeutic.

Rationale 2: The client with antisocial personality disorder is impulsive as manifested by the clients making decision to make a phone call without regard for the unit rules or the lawyers office hours. It is necessary to respond consistently to the clients demands and not allow exceptions. Attempting to coerce the client into changing behavior is nontherapeutic.

Rationale 3: The client with antisocial personality disorder is impulsive as manifested by the clients making decision to make a phone call without regard for the unit rules or the lawyers office hours. It is necessary to respond consistently to the clients demands and not allow exceptions. Attempting to coerce the client into changing behavior is nontherapeutic.

Rationale 4: The client with antisocial personality disorder is impulsive as manifested by the clients making decision to make a phone call without regard for the unit rules or the lawyers office hours. It is necessary to respond consistently to the clients demands and not allow exceptions. Attempting to coerce the client into changing behavior is nontherapeutic.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Modify the possible effects of the nurses positive and negative emotional responses to clients who have personality disorders.

Question 30

Type: MCSA

The nurse is learning how to handle feelings of frustration and helplessness when caring for clients with cluster B personality disorders. Which of the following statements by the nurse would reflect that learning has taken place?

1. I can just ignore my feelings and focus on the clients needs.

2. As long as my words are therapeutic, the client cannot tell what I am really thinking.

3. I need to maintain professional distance by using empathy.

4. I can talk about my feelings with my friends.

Correct Answer: 3

Rationale 1: To avoid being drawn in by manipulative behaviors often exhibited by clients with cluster B personality disorders, the nurse must maintain professional distance by using empathy. The nurse must be self-aware at all times when working with clients. When working with clients with personality disorders, the nurses words and actions must be congruent. The nurse needs to work through her feelings of frustration and helplessness in a way that protects the clients confidentiality.

Rationale 2: To avoid being drawn in by manipulative behaviors often exhibited by clients with cluster B personality disorders, the nurse must maintain professional distance by using empathy. The nurse must be self-aware at all times when working with clients. When working with clients with personality disorders, the nurses words and actions must be congruent. The nurse needs to work through her feelings of frustration and helplessness in a way that protects the clients confidentiality.

Rationale 3: To avoid being drawn in by manipulative behaviors often exhibited by clients with cluster B personality disorders, the nurse must maintain professional distance by using empathy. The nurse must be self-aware at all times when working with clients. When working with clients with personality disorders, the nurses words and actions must be congruent. The nurse needs to work through her feelings of frustration and helplessness in a way that protects the clients confidentiality.

Rationale 4: To avoid being drawn in by manipulative behaviors often exhibited by clients with cluster B personality disorders, the nurse must maintain professional distance by using empathy. The nurse must be self-aware at all times when working with clients. When working with clients with personality disorders, the nurses words and actions must be congruent. The nurse needs to work through her feelings of frustration and helplessness in a way that protects the clients confidentiality.

Global Rationale:

Cognitive Level: Creating

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Modify the possible effects of the nurses positive and negative emotional responses to clients who have personality disorders.

Kneisl, Contemporary Psychiatric-Mental Health Nursing, 3/e Test Bank

Copyright 2012 by Pearson Education, Inc.

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