Chapter 30: Personality disorders

A client diagnosed with a personality disorder exhibits a pervasive pattern of grandiosity, need for admiration, and a lack of empathy. Which personality disorder would the nurse identify as being characterized by this behavior?

A. Narcissistic

B. Histrionic

C. Dependent

D. Obsessive-compulsive

A. Narcissistic

3 multiple choice options

A client is diagnosed with paranoid personality disorder. Which would the nurse expect to assess? Select all that apply.

A. Anger as a emotional response

B. Distancing self from others

C. Outwardly passive

D. Tendency to be rigid and controlling

E. Warm and full of humor

a, b, d

3 multiple choice options

When assessing a client diagnosed with schizotypal personality disorder, which would the nurse expect to find? Select all that apply.

A. Magical beliefs

B. Hallucination-like perceptions

C. Referential thinking

D. Undramatic behavior

E. Unusual mannerisms

a, b, c, e

3 multiple choice options

A mental health nurse educator provides information to hospital staff nurses about clients with antisocial personality disorder (ASPD). What is an expected symptom(s) of the disorder? Select all that apply.

A. selfish and lacking empathy toward others

B. feel the world is out to undermine them

C. difficulty expressing human compassion

D. disregard for the rules or social norms of society

E. receives social support from friends

a, b, c, d

3 multiple choice options

The nurse is teaching a client with schizoid personality how to function more comfortably with others in the community. Which nursing intervention would be effective to improve the client's social skills?

A. Teaching the client to make necessary requests in writing or over the phone.

B. Accompanying the client during initial interactions in the community.

C. Having the client suppress the display of any unusual behaviors in public.

D. Assisting in developing an explanation for bizarre behaviors to offer to others in the community.

A. Teaching the client to make necessary requests in writing or over the phone.

3 multiple choice options

The nurse is talking with a client that is suspected of having an avoidant personality disorder. Which behaviors observed by the nurse correlate with this suspicion?

A. Discusses they have three failed marriages but they were not the client's fault.

B. Cries and has a temper tantrum in the unit whenever requests are denied.

C. Does not speak out in group therapy because fears criticism from others.

D. Shows no remorse when accidentally breaking another client's bracelet.

C. Does not speak out in group therapy because fears criticism from others.

3 multiple choice options

A nurse is preparing for a discussion on dependent personality disorder. Which of the following terms would the nurse use when describing clients with this disorder? Select all that apply.

A. Compliant

B. Conciliatory

C. Placating

D. Competitive

E. Self-assurance

F. Overly pleasing

a, b, c, f

3 multiple choice options

When clients diagnosed with borderline personality disorder (BPD) see nurses as either all good or all bad, the client is using which primitive defense?

A. Splitting

B. Defending

C. Invalidating

D. Projective identification

A. Splitting

3 multiple choice options

A client with a diagnosis of dependent personality disorder is recovering from surgery. The nurse considers the importance of avoiding some interventions that could be therapeutic for another client without a personality disorder. Which intervention will the nurse avoid?

A. Providing positive feedback

B. Telling the client what to do

C. Enhancing decision-making skills

D. Identifying resources to aid in meal planning

B. Telling the client what to do

3 multiple choice options

The nurse in a medical setting provides care for a client with histrionic personality disorder concurrent with their medical challenges. During the initial assessment with the client, the nurse identifies an altered expression of sexuality. To guide further assessment, what factor does the nurse anticipate from the client?

A. Demonstration of seductive behavior

B. Having one long-term intimate partner

C. Having success in establishing social intimacy

D. Suppression of outward signs of sexual attraction

A. Demonstration of seductive behavior

3 multiple choice options

After teaching a group of nurses about different personality disorders, the group leader determines that the education was successful when the nurses identify which characteristic of schizotypal personality disorder?

A. Appear indistinct from the general population

B. Normal mannerisms

C. Neatly dressed appearance

D. Increased eccentricity

D. Increased eccentricity

3 multiple choice options

The nurse completes an assessment for a female client in an outpatient clinic. In addition to medical issues, the client shares that they have a personality disorder. The client wears heavy makeup and demonstrates strong emotional intensity. Which personality disorder does the nurse identify based on the assessment findings?

A. Schizotypal personality disorder

B. Narcissistic personality disorder

C. Histrionic personality disorder

D. Obsessive compulsive personality disorder

C. Histrionic personality disorder

3 multiple choice options

A nurse has worked for a year with a client with Antisocial Personality Disorder (ASPD). The client offers to provide fitness consultation for the nurse at a gym the client attends. Which is an effective response?

A. "That's an inappropriate offer"

B. "I'm your nurse not your friend"

C. "You seem interested in fitness and helping others"

D. "You have broken the therapeutic relationship and will need to find another nurse."

C. "You seem interested in fitness and helping others"

3 multiple choice options

A client presents to a mental health clinic. The nurse notes that the client is grandiose and brags that that they earn "a six-figure income" and tells the nurse that they are more well known that the president. Which diagnosis is grandiosity associated with?

A. Schizoid personality disorder

B. Borderline personality disorder

C. Narcissistic personality disorder

D. Obsessive compulsive personality disorder

C. Narcissistic personality disorder

3 multiple choice options

During an interview, a client with a history of violence states, "I once put someone in a wheelchair, but who cares? Life's tough." This attitude and behavior are consistent with which personality disorder?

A. schizoid

B. antisocial

C. histrionic

D. borderline

B. antisocial

3 multiple choice options

A nurse suspects that a client may be exhibiting characteristics of narcissistic personality disorder. Which finding would support the nurse's suspicion? Select all that apply.

A. Arrogance

B. Lack of empathy

C. Grandiosity

D. Preoccupation with fantasy

E. Undervalued personal wealth

a, b, c, d

3 multiple choice options

Hospital security cameras identify that a client with antisocial personality disorder (ASPD) stole items from the gift shop while on a leave from the medical unit. Which is the nurse’s best response to the client?

A. “Why did you steal from the gift shop?”

B. “Staff in the gift shop were surprised you stole items.”

C. “Tell me how you felt when you stole items from the gift shop”

D. “The consequences of stealing items from the gift shop includes the immediate loss of privileges.”

D. "The consequences of stealing items from the gift shop includes the immediate loss of privileges."

3 multiple choice options

The nurse is educating the family of a client diagnosed with schizoid personality disorder. Which family observation would best support this diagnosis?

A. "They tend to be distant and prefer solitude, even around family."

B. "Intense mood swings and emotional outbursts happen regularly."

C. "Social interactions seem to make them anxious, so they avoid most of them."

D. "Fatigue and frequent expressions of sadness are common."

A. "They tend to be distant and prefer solitude, even around family."

3 multiple choice options

As part of a client's treatment plan for borderline personality disorder (BPD), the client is engaged in dialectical behavior therapy (DBT). 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 element(s) of this therapy? Select all that apply.

A. emotion regulation

B. core mindfulness

C. distress tolerance

D. self-management

E. assertiveness training

a, b, c, d

3 multiple choice options

Which disorder is characterized by pervasive mistrust and suspiciousness of others?

A. Paranoid personality disorder

B. Schizoid personality disorder

C. Histrionic personality disorder

D. Dependent personality disorder

A. Paranoid personality disorder

3 multiple choice options

A mental health nurse is asked which symptom is associated with people who develop pyromania. Select all that apply.

A. Be thoughtful decision makers

B. Have strong interpersonal skills

C. Work or volunteer as a firefighter

D. Have an interest in observing fires

E. Have low self-esteem or depressive symptoms

c, d, e

3 multiple choice options

A client with borderline personality disorder tells the nurse, "Everything bad happens to me. I'm absolutely no good." The nurse interprets this statement as which of the following?

A. Dichotomous thinking

B. Dissociation

C. Impulsivity

D. Affective instability

A. Dichotomous thinking

3 multiple choice options

A client is admitted to the mental health unit after the client's spouse brings the client to the emergency department. Upon arrival, the spouse explained that the client had been crying all weekend and stating that the client wanted to die. Upon further assessment, the spouse reports that the client always has difficulty controlling anger and frequently worries that the spouse will leave the client. Recently, the client has been getting drunk every night, which the client never used to do. What diagnosis should the nurse suspect applies to this client?

A. Bipolar disorder

B. Borderline personality disorder

C. Depression

D. Mania

B. Borderline personality disorder

3 multiple choice options

Which client does a nurse discern to be more likely to be experiencing a personality disorder than a psychotic illness?

A. A client who experiences a command hallucination to stab themselves with a knife

B. A client who experiences persistent doubts that intensify every five years that they were switched at birth and their sibling is not their real sibling

C. A client who has a visual hallucination of a white dove circling the world and interprets it by understanding they are an ambassador for world peace

D. A client who dresses in a white lab coat and requires security personnel to stop them from entering the operating theatre because the person believes they are a famous surgeon

B. A client who experiences persistent doubts that intensify every five years that they were switched at birth and their sibling is not their real sibling

3 multiple choice options

A nurse is assessing a client with borderline personality disorder. Which response pattern would the nurse most likely assess? Select all that apply.

A. Mood lability

B. Anger issues

C. Impulsive behavior

D. Suicide ideation

E. Fear of abandonment

a, b, c, e

3 multiple choice options

Which of the following is likely the etiologic basis of the compulsive patterns seen in people with obsessive-compulsive personality disorder (OCPD)?

A. Parental overcontrol

B. Lack of nurturing

C. Substance use within the family

D. Hyperactivity as a child

A. Parental overcontrol

3 multiple choice options

A nurse is educating a client with borderline personality disorder to reshape thinking patterns. Which cognitive restructuring technique that would be helpful for this client will the nurse educate the client about?

A. When negative thoughts begin, tell yourself "stop."

B. Learn to look at situations realistically rather than assuming the worst.

C. Recognize negative thoughts and replace them with positive ones.

D. Express needs using "I" statements.

C. Recognize negative thoughts and replace them with positive ones.

3 multiple choice options

A nurse is conducting a mental status exam of a client with borderline personality disorder (BPD). The client verbalizes statements that demonstrate a view of things as absolute, with no perception of compromise. The nurse interprets this type of thinking, documenting it as which of the following?

A. Dichotomous

B. Abstract

C. Irrational

D. Disorganized

A. Dichotomous

3 multiple choice options

The nurse is caring for a client with antisocial personality disorder. Which statement is most appropriate for the nurse to make when explaining unit rules and expectations to the client?

A. "You'll be expected to attend group therapy each day."

B. "I and other members of the health care team would like you to attend group therapy each day."

C. "You'll find your condition will improve much faster if you attend group therapy each day."

D. "Please try to attend group therapy each day."

A. "You'll be expected to attend group therapy each day."

3 multiple choice options

The nurse is planning an approach that will be most effective in developing a therapeutic relationship with a client. In which disorder(s) will the nurse best employ a matter-of-fact approach with the client? Select all that apply.

A. Paranoid

B. Antisocial

C. Schizotypal

D. Narcissistic

E. Avoidant

a, b, d

3 multiple choice options

The nurse assesses a client who states they have only two friends. The client shares that they are willing to do anything to maintain these relationships, including putting others' needs before theirs, being submissive and adapting their behavior to please these two friends. The client explains that they find decision making a challenge and that these two friends make most of the decisions. These characteristics are associated with which personality disorders?

A. Avoidant

B. Dependent

C. Narcissistic

D. Schizotypal

B. Dependent

3 multiple choice options

Which is the underlying issue in kleptomania?

A. Act of stealing

B. Low income

C. Anxiety

D. Need for recognition

A. Act of stealing

3 multiple choice options

Which personality disorder is diagnosed more often in females?

A. Histrionic

B. Schizoid

C. Antisocial

D. Narcissistic

A. Histrionic

3 multiple choice options

The nurse is preparing a plan of care for a client with dependent personality disorder and assigns an outcome to increase problem-solving skills. Which client behavior would indicate progress toward meeting that outcome?

A. The client is asking questions to gain information.

B. The client is being polite and agreeable to what the nurse says.

C. The client is controlling emotions when talking about traumatic incidents.

D. The client requests assistance prior to attempting a task independently.

A. The client is asking questions to gain information.

3 multiple choice options

The nurse is assessing a client diagnosed with borderline personality disorder. Which documentation would most accurately reflect the client's behavior while maintaining a nonjudgmental tone?

A. "Client demonstrates difficulty regulating emotions, leading to unpredictable mood changes."

B. "Client shows aggressive tendencies when faced with frustration or stress."

C. "Client's rigid thinking patterns affect interpersonal relationships and problem-solving."

D. "Client displays attention-seeking behavior during interactions with staff."

A. "Client demonstrates difficulty regulating emotions, leading to unpredictable mood changes."

3 multiple choice options

The facilitator of a social skills training program contacts a mental health nurse about a client diagnosed with histrionic personality disorder attending the program. The facilitator feels the client has well-developed social skills and does not need assertiveness training. How do you respond?

A. Their interactions are dramatic and this makes their interpersonal relationships fulfilling. The referral was inappropriate

B. They develop few relationships due to their strong independence. Attending group will allow the facilitator to challenge their inflated self-esteem

C. Their interpersonal relationships tend to be shallow and their self-esteem is low. Having success interacting with others in group will help the client

D. They have success establishing and maintaining interactions with others. This client would be better in a situation where they use their confidence to help others, such as a public speaking group

C. Their interpersonal relationships tend to be shallow and their self-esteem is low. Having success interacting with others in group will help the client

3 multiple choice options

A client is diagnosed with a personality disorder manifested by odd, eccentric behavior. Which personality disorder would be associated with this manifestation?

A. Avoidant

B. Dependent

C. Obsessive-compulsive

D. Paranoid

D. Paranoid

3 multiple choice options

The nurse is educating the parents of a client with a personality disorder. They are concerned that their 22-year-old has never shown an interest in a romantic relationship, has no real hobbies or friends, and is happy being the only guard in a factory on the night shift. Which potential comment by the nurse is accurate?

A. "People with schizoid personality disorder, which the client has, tend to be lifelong loners."

B. "People with antisocial personality disorder, which the client has, tend to be lifelong loners."

C. "People with dependent personality disorder, which the client has, tend to be lifelong loners."

D. "People with histrionic personality disorder, which the client has, tend to be lifelong loners."

A. "People with schizoid personality disorder, which the client has, tend to be lifelong loners."

3 multiple choice options

A nurse is providing care to a client diagnosed with histrionic personality disorder. Which information would the nurse need to integrate into the plan of care? Select all that apply.

A. The client's interests are focused on individual desires.

B. The client's behavior continually centers the attention on themselves.

C. The client's needs are highly flexible.

D. The client is quick to trust others.

E. The client is rarely influenced by others.

a, b, d

3 multiple choice options

What quality does the nurse consider when planning care for a client diagnosed with obsessive-compulsive personality disorder?

A. Unlikely to seek mental health care when experiencing life-altering symptoms

B. Likely to become anxious when stopped from acting out compulsive behaviors

C. Aware their quality of life is impacted by the disorder but fearful to make changes

D. Unaware their quality of life is impacted by the disorder and fearful to make changes

C. Aware their quality of life is impacted by the disorder but fearful to make changes

3 multiple choice options

The care plan for a client with antisocial personality disorder (ASPD) targets improved empathic understanding of others. Which intervention supports the client in achieving this outcome?

A. art therapy to improve self-esteem

B. visual imagery to promote relaxation

C. simulation to experience manipulation

D. music therapy for enhancing mood

C. simulation to experience manipulation

3 multiple choice options

The nurse is assigned to a client with schizoid personality disorder. Which does the nurse anticipate are client characteristics of the disorder? Select all that apply.

A. Fear of being alone

B. Reclusive and distant

C. Evidence of past self-harm

D. Awkward interpersonal relations

E. Unstable moods with impulsive behaviors

b, d

3 multiple choice options

When describing the different clusters of personality disorders, the nurse includes which type as being characterized by dramatic or erratic behavior? Select all that apply.

A. Paranoid

B. Antisocial

C. Borderline

D. Avoidant

E. Obsessive-compulsive

b, c

3 multiple choice options

What is the nurse's treatment intervention for a client with histrionic personality disorder?

A. Monitor weekly blood lithium levels

B. Address client's requests with priority over other clients

C. Challenge the expectation for others to fulfill their needs

D. Monitor client for symptoms of extrapyramidal side effects (EPS)

C. Challenge the expectation for others to fulfill their needs

3 multiple choice options

A nurse is reviewing information about the different types of personality disorders. Which type would the nurse identify as most likely being involved with a lack of caring about others? Select all that apply.

A. Schizotypal personality disorder

B. Borderline personality disorder

C. Antisocial personality disorder

D. Narcissistic personality disorder

E. Obsessive-compulsive personality disorder

a, c, d

3 multiple choice options

A community mental health nurse is consulted by an outreach worker to assist with the diagnosis of an individual who lives in a shelter. The client appears poorly groomed, wearing clothes that fit poorly and do not match. The client overtly avoids contact with other shelter residents by walking around the perimeter of the room and looking downward yet in the direction of another resident in the room. Verbal interactions are rambling monologues with references to physics and the end of the world. Based on the worker's description, which diagnosis does the nurse identify?

A. Schizoid personality disorder

B. Paranoid personality disorder

C. Narcissistic personality disorder

D. Schizotypal personality disorder

D. Schizotypal personality disorder

3 multiple choice options

When assessing a client with a histrionic personality disorder, which of the following would the nurse expect to find? Select all that apply.

A. Sexually seductive

B. Gullible

C. Untrusting of others

D. Needs that are inflexible

E. Few friendships

a, b, d

3 multiple choice options