Chapter 30 Personality and impulse-control disorders

The nurse is assessing a client who is diagnosed with borderline personality disorder. Which client statement indicates the client is at risk for self-injurious behavior?

A) I have felt so down lately. I don't enjoy doing anything anymore.

B) I do what I do because others tell me to do so.

C) When I feel extremely anxious, it is like my mind goes somewhere else.

D) It is almost as if as soon as I think of doing something, I immediately do

A

A woman with borderline personality disorder has been admitted to the inpatient unit because she has been engaging in wrist cutting. The client's sister is visiting, and the sister asks the nurse to explain why her sister sometimes does this to herself. Which response by the nurse would be most appropriate?

A) Sometimes the self-injurious behavior is undertaken to relieve stress.

B) Self-injurious behavior often calms and sedates people with this diagnosis.

C) Sometimes they do it to avoid the onslaught of delusional thinking.

D) The self-mutilation often slows the mood swings your sister experiences.

A

The nurse has explained some of the biologic theories of causation to a client diagnosed with borderline personality disorder and his family. The nurse determines that the client and family have understood the instructions when they state which of the following?

A) The disorder may be caused by increased serotonin activity.

B) The disorder is caused by decreased dopamine activity in my brain.

C) A frontal lobe dysfunction may be causing this condition.

D) A decrease in hormonal substances increases the risk for this illness.

C

The nurse is assessing a client who has borderline personality disorder. Which of the following would be a priority?

A) Nutrition patterns

B) Personal hygiene practices

C) Physical functioning

D) Somatic complaints

A

A client diagnosed with borderline personality disorder tells the nurse that she frequently spaces out. Which response by the nurse would be most appropriate?

A) Do you feel stressed most of the time?

B) Does this frighten you when it happens?

C) What's happening around you when this occurs?

D) Do you feel as if you are out of your body?

C

The nurse is caring for a client diagnosed with borderline personality disorder. The nurse has instructed the client about using the communication triad. The nurse determines that the client has understood this technique when he states which of the following?

A) I should start by stating my feelings as an 'I' statement.

B) Maybe I should start by describing the situation that has me upset.

C) I should first tell the other person what I'd like to be different about the situation.

D) I should begin by telling the other person what has triggered my emotion.

A

A client with borderline personality disorder tells the nurse, I'm afraid to get on a train because we'll probably get into a wreck. Which response by the nurse would be most appropriate?

A) "Have you had a bad experience riding a train?

B) What are the chances of that actually happening?

C) Now you know that won't happen.

D) Have you thought about going by automobile?

B

A nursing instructor is preparing a class discussion on personality disorders and characteristics. Which term would the instructor include to differentiate personality disorders from normal personality? Select all that apply.

A) Inflexible

B) Short term

C) Pervasive

D) Unstable over time

E) Distressing

A, C, D, E

A group of nursing students is reviewing possible risk factors for development of borderline personality disorder. The students demonstrate understanding of the information when they identify which of the following as a risk factor? Select all that apply.

A) Childhood sexual abuse

B) Parental loss

C) Substance abuse

D) Family history

E) Genetics

A, B

A nurse is observing a client diagnosed with borderline personality disorder on the inpatient unit. Which of the following would the nurse most likely note?

A) Actively participating in several different groups

B) Openly verbalizing feelings

C) Participating in relationships in which the client has control

D) Adhering to the personal boundaries of others

C

A nurse is assessing a client with borderline personality disorder. Which question would be most appropriate to assess the client's level of impulsivity?

A) What things bother you and make you feel happy?

B) Have you ever felt sorry after acting as you did on the spur of the moment?

C) How do you view other people around you?

D) Have you ever felt like you were separated from your body?

B

As part of a client's treatment plan for borderline personality disorder, the client is engaged in dialectical behavior therapy. As part of the therapy, the client is learning how to control and change behavior in response to events. The nurse identifies the client as learning which type of skills?

A) Emotion regulation skills

B) Mindfulness skills

C) Distress tolerance skills

D) Self-management skills

D

A client with borderline personality disorder has difficulty maintaining boundaries of the professional relationship. Which of the following would be most effective for the nurse to do? Select all that apply.

A) Punish the client with seclusion for violating established boundaries.

B) Respond to the client's arrogance in a neutral, nonconfrontational manner.

C) Discuss the purpose of the limits in the therapeutic relationship.

D) State the parameters of the limits and boundaries clearly.

E) Ensure that any established limits are maintained consistently.

B, C, D, E

A nurse is engaged in role-playing with a client with borderline personality disorder to assist the client in learning how to communicate effectively. Which of the following would the nurse encourage the client to use? Select all that apply

A) Me statements

B) Validating perceptions with others

C) Paraphrasing before responding

D) Listening passively

E) Compromising

B, C, E

A nurse is assisting a client with borderline personality disorder in how to manage transient psychotic episodes that involve auditory hallucinations. The teaching is planned for times when the client is free of these symptoms. Which of the following would the nurse instruct the client to do first?

A) Use skills to tolerate painful feelings.

B) Practice deep abdominal breathing.

C) Identify early internal cues of distress.

D) Refer to cards listing potential symptoms.

B

The nurse is preparing to assess a client with a paranoid personality trait. The nurse integrates knowledge of this condition, anticipating that the client's affect and behavior will most likely be which of the following?

A) Angry and hostile

B) Flirtatious and seductive

C) Fearful and anxious

D) Friendly and open

A

The nurse is caring for a client with schizoid personality trait. When developing the plan of care for the client, which of the following would the nurse most likely include?

A) Social skills training

B) Anger management training

C) Relaxation techniques

D) Coping skills training

A

A nursing instructor is preparing a teaching plan for a class of nursing students about antisocial personality disorder. Which of the following would the nurse include as a term often used to describe the behaviors associated with this condition? Select all that apply.

A) Psychopath

B) Manipulator

C) Criminality

D) Sociopath

E) Psychotic

A, D

A nurse is reading a journal article about the various theories associated with the development of antisocial personality disorder. The article mentions difficult temperament as a possible theory. The nurse demonstrates understanding of this concept when identifying which of the following as a key behavior associated with a difficult temperament? Select all that apply.

A) Aggression

B) Inattention

C) Hyperactivity

D) Impulsivity

E) Depression

F) Paranoia

A, B, C, D

A nurse is developing a plan of care for a client diagnosed with an antisocial personality disorder who has been admitted to the inpatient psychiatric unit. Which of the following would the nurse most likely include? Select all that apply.

A) Developing a therapeutic relationship

B) Bargaining about the unit rules

C) Holding the client responsible for behavior

D) Discouraging client from discussing thoughts

E) Using a firm, lecture-like approach for teaching

A, C

A nurse is working with the family of a client who has been diagnosed with antisocial personality disorder. Which of the following would be most important for the nurse to focus on when teaching the family about this disorder?

A) Anger management

B) Boundary setting

C) Medication therapy

D) Self-responsibility

B

A group of nursing students is reviewing information about antisocial personality disorder. The students demonstrate understanding of this disorder when they state which of the following?

A) The disorder occurs more frequently in women.

B) The individual must be at least 18 years of age.

C) The disorder is found primarily in Asian individuals.

D) Alcohol abuse disorder rarely accompanies this disorder.

B

A nurse is providing care to a client with antisocial personality disorder. As part of the plan of care, the client is to participate in a problem-solving group. The nurse understands that this intervention is effective based on which rationale?

A) It requires the client to develop attachments.

B) It sets up specific boundaries for the client.

C) It helps reinforce self-responsibility.

D) It avoids confrontation about dysfunctional patterns.

C

The nurse is reviewing the medical record of a client diagnosed with antisocial personality disorder. The nurse notes that the client has had numerous episodes involving irritability, aggressiveness, and impulsivity and has exhibited callousness toward others. Based on this information, which nursing diagnosis would the nurse most likely identify as a priority?

A) Risk for Other-Directed Violence

B) Risk for Self-Injury

C) Risk for Suicide

D) Risk for Self-Directed Violence

A

A client is brought into the emergency department because of complaints from the neighbors that the client was acting strangely. The nurse assesses the client and suspects schizotypal personality disorder based on assessment of which of the following? Select all that apply.

A) Magical beliefs

B) Hallucinations

C) Paranoia

D) Avoidance of eye contact

E) Meticulous dress

A, C, D

A nurse is assessing a client diagnosed with avoidant personality disorder. Which of the following would the nurse most likely expect to find? Select all that apply.

A) Shyness

B) Feelings of inadequacy

C) Feelings of superiority

D) Perfectionism

E) Detail oriented

A, B

A group of nursing students is reviewing information about schizoid personality trait. The students demonstrate understanding of the information when they identify which disorder as the most common comorbid disorder?

A) Depression

B) Substance abuse

C) Avoidant personality disorder

D) Anxiety

C

A nurse is interviewing a client and suspects that the client may have narcissistic personality disorder. Which client statement would help support the nurse's suspicions?

A) I have a very important position in life; everyone I know wants to be like me.

B) My wife is poisoning my food so she can get rid of me and marry her boss.

C) I like to work alone because then I can let my thoughts wander.

D) I'm always the life of the party, making new friends all the time.

A

A nurse is developing a teaching plan for a client with an impulse-control disorder. The nurse is planning to explain the emotional aspects associated with the behavior as part of the plan. Which of the following would the nurse describe as occurring first before the individual commits the act?

A) Remorse

B) Tension

C) Regret

D) Pleasure

B

A nurse is reading an article about a young girl who developed gastrointestinal symptoms from a hair ball because of a ritual that she engaged in. The girl would pull out hair over several hours to relieve tension and anxiety and then eat the hair. The nurse most likely is reading an article about which of the following?

A) Kleptomania

B) Trichotillomania

C) Pyromania

D) Intermittent explosive disorder

B

A nurse is working with a client who is a compulsive gambler. Which of the following would the nurse emphasize as crucial for relapse prevention? Select all that apply

A) Medication therapy

B) Family involvement

C) Identification of triggers

D) Anger management

E) Milieu management

B, C

A nursing instructor is describing depressive and negativistic personality traits to a group of nursing students. The instructor determines that the teaching was successful when the students identify which of the following as characteristic of negativistic personality traits? Select all that apply.

A) Anhedonia

B) Hostility

C) Pessimism

D) Oppositionality

E) Guilt

B, D, E