Test bank For Varcarolis' Foundations of Psychiatric-Mental Health Nursing 9th Edition 2023 20. Others describe a worker as very shy and lacking in self-confidence. This worker stays in an office cubicle all day, never coming out for breaks or lunch. Which term best describes this behavior? a. Narcissistic b. Histrionic c. Avoidant d. Paranoid ANS: C Patients with avoidant personality disorder are timid, socially uncomfortable, withdrawn, and avoid situations in which they might fail. They believe themselves to be inferior and unappealing. Individuals with histrionic personality disorder are seductive, flamboyant, shallow, and attention-seeking. Paranoia and narcissism are not evident. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 24-17, 18 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 21. What is the priority intervention for a nurse beginning to work with a patient diagnosed with a schizotypal personality disorder? a. Respect the patient’s need for periods of social isolation. b. Prevent the patient from violating the nurse’s rights. c. Teach the patient how to select clothing for outings. d. Engage the patient in community activities. ANS: A Patients with schizotypal personality disorder are eccentric and often display perceptual and cognitive distortions. They are suspicious of others and have considerable difficulty trusting. They become highly anxious and frightened in social situations, thus the need to respect their desire for social isolation. Teaching the patient to match clothing is not the priority intervention. Patients with schizotypal personality disorder rarely engage in behaviors that violate the nurse’s rights or exploit the nurse. MSC: Client Needs: Psychosocial Integrity 22. A patient diagnosed with borderline personality disorder self-inflicted wrist lacerations after gaining new privileges on the unit. In this case, the self-mutilation may have been due to a. an inherited disorder that manifests itself as an incapacity to tolerate stress. b. use of projective identification and splitting to bring anxiety to manageable levels. c. a constitutional inability to regulate affect, predisposing to psychic disorganization. d. fear of abandonment associated with progress toward autonomy and independence. ANS: D Fear of abandonment is a central theme for most patients with borderline personality disorder. This fear is often exacerbated when patients with borderline personality disorder experience success or growth. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 24-33, 43 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe, Effective Care Environment 23. A patient diagnosed with borderline personality disorder has self-inflicted wrist lacerations. The health care provider prescribes daily dressing changes. The nurse performing this care should a. maintain a stern and authoritarian affect. b. provide care in a matter-of-fact manner. c. encourage the patient to express anger. d. be very rigid and challenging. ANS: B A matter-of-fact approach does not provide the patient with positive reinforcement for selfmutilation. The goal of providing emotional consistency is supported by this approach. The distracters provide positive reinforcement of the behavior or fail to show compassion. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 24-47, 48 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 24. A nurse set limits while interacting with a patient demonstrating behaviors associated with borderline personality disorder. The patient tells the nurse, “You used to care about me. I thought you were wonderful. Now I can see I was wrong. You’re evil.” This outburst can be assessed as a. denial. b. splitting. c. defensive. d. reaction formation. ANS: B Splitting involves loving a person, then hating the person because the patient is unable to recognize that an individual can have both positive and negative qualities. Denial is unconsciously motivated refusal to believe something. Reaction formation involves unconsciously doing the opposite of a forbidden impulse. The scenario does not indicate defensiveness. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 24-32, 33 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 25. Which characteristic of personality disorders makes it most necessary for staff to schedule frequent team meetings in order to address the patient’s needs and maintain a therapeutic milieu? a. Ability to achieve true intimacy b. Flexibility and adaptability to stress c. Ability to provoke interpersonal conflict d. Inability to develop trusting relationships ANS: C Frequent team meetings are held to counteract the effects of the patient’s attempts to split staff and set them against one another, causing interpersonal conflict. Patients with personality disorders are inflexible and demonstrate maladaptive responses to stress. They are usually unable to develop true intimacy with others and are unable to develop trusting relationships. Although problems with trust may exist, it is not the characteristic that requires frequent staff meetings. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 24-44, 45 TOP: Nursing Process: Planning MSC: Client Needs: Safe, Effective Care Environment 26. A nursing diagnosis appropriate to consider for a patient diagnosed with any of the personality disorders is a. nonadherence. b. impaired social interaction. c. disturbed personal identity. d. diversional activity deficit. ANS: B Without exception, individuals with personality disorders have problems with social interaction with others; hence, the diagnosis of “impaired social interaction.” For example, some individuals are suspicious and lack trust, others are avoidant, and still others are manipulative. None of the other diagnoses are universally applicable to patients with personality disorders; each might apply to selected clinical diagnoses, but not to others. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 24-2, 3 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 27. A new psychiatric technician says, “Schizophrenia … schizotypal! What’s the difference?” The nurse’s response should include which information? testbanks, varcarolis 9th edition new 2023
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