Chapter 24, Personality Disorders, EAQ Halter Valcaroli
Halter Varcarolis' Foundations of Psychiatric-Mental Health Nursing - Sherpath for Mental Health Nursing, 8th Edition
Which statement about persons diagnosed with personality disorders is accurate?
Characteristics of these disorders are most evident in social and interpersonal interactions.
Rationale: The presence of a personality disorder interferes with, or complicates, social and interpersonal function. Individuals who meet criteria for these disorders have problems with empathy or intimacy within their relationships. Persons diagnosed with personality disorders tend not to perceive themselves as having a problem but instead believe their problems are caused by how others behave toward them. Although short-term hospitalization may sometimes be necessary when acute problems occur, extended hospitalizations tend to be counterproductive for this population. In the United States, there are no Federal Drug Administration-approved medications specifically for treating personality disorders; however, some health care providers prescribe selected psychotropic medications for off-label use.
A patient diagnosed with antisocial personality disorder with impaired social interaction and defensive coping receives psychotherapy treatment. Which response of the patient indicates to the nurse the treatment has been effective?
Download Complete Test Bank Here
The patient plays a leading role in a group activity assigned by the nurse.
A patient with antisocial personality disorder shows impaired social interaction and defensive coping. A patient who plays a leading role in a group activity indicates improvement of the symptoms, which may be the result of effective treatment. This is because the patient cooperates with others and interacts well. Psychotherapy aims to help patients take responsibility for their own actions in order to improve their conditions. The patient declaring the government to be responsible does not indicate effective treatment. A request to be excused from a therapy task doesn't indicate progress or effective treatment. Psychotherapy aims to make the patient interact with others and develop sensitivity toward others. Ridiculing another patient shows that the patient with antisocial personality disorder is not sensitive and does show empathy for others.
A patient diagnosed with a borderline personality disorder shows the nurse multiple new, shallow self-inflicted cuts. Select the nurse's therapeutic response.
"I will care for your wounds, and then you should write down what you were thinking and feeling when this happened. We will discuss it later."
An approach useful for patients with borderline personality disorder relates to responses to superficial self-destructive behaviors. The nurse should remain neutral and provide wound care in a matter-of-fact manner. Then the patient is instructed to write down the sequence of events leading up to the injury, as well as the consequences, before staff will discuss the event. This cognitive exercise encourages the patient to think independently about his or her behavior instead of merely ventilating feelings. It facilitates the discussion with staff about alternative actions. It is not therapeutic to deny the seriousness of the wounds or confront the patient with the behavior. Instituting suicide precautions reinforces the behavior.
The nurse tells a patient diagnosed with borderline personality disorder, "A new case manager has been assigned to work with you." Which initial reaction is most likely for this patient?
Anger
A patient is withdrawn and suspicious and states he or she has always preferred to be alone. The patient describes him- or herself as having "special powers" and states, "I believe we can all read each other's thoughts at times." Based on this presentation, the nurse suspects which personality disorder?
Schizotypal (STPD)
The main traits that describe STPD are psychoticism, such as eccentricity, odd or unusual beliefs and thought processes, and social detachment by preferring to be socially isolated, as well as being overly suspicious or anxious. In obsessive-compulsive personality disorder the main pathologic personality traits are rigidity and inflexible standards of self and others, along with persistence to goals long after it is necessary, even if it is self-defeating or negatively affects relationships. People with narcissistic personality disorder come across as arrogant, with an inflated view of their self-importance. They have a need for constant admiration, along with a lack of empathy for others, a factor that strains most relationships over time. Traits of avoidant personality disorder include low self-esteem, feelings of inferiority compared with peers, and a reluctance to engage in unfamiliar activities involving new people.
A nurse observes that a patient with osteoarthritis behaves rudely to the staff and refuses to take treatment. On inquiry, the nurse learns that the patient thinks that all staff members are planning to harm and deceive him or her. What is the patient likely to be suffering from?
Paranoid personality disorder
Patients with paranoid personality disorder are suspicious and believe that others want to exploit, harm, and deceive them. They develop a defense system and try to counterattack the other person, and reject the treatment. They behave rudely and develop jealousy toward others. Patients with schizoid personality disorder have reduced emotional attachment and depression. Patients with obsessive-compulsive personality disorder have repetitive behavior. They remain preoccupied with minute details. In narcissistic personality disorder, patients are extremely worried about their prestige. They feel intense shame and fear of abandonment by others.
The nurse is caring for a rheumatoid arthritis patient with borderline personality disorder. Which behavior does the nurse find in the patient compared with other patients in the ward?
The patient shows extreme fluctuating emotions.
Patients with borderline personality disorder have unstable moods. Such patients exhibit rapid emotional shifts. They may be extremely aggressive and suddenly become extremely calm. They have a history of violence and impulsivity. They are not always aggressive but they are emotionally unstable and may exhibit a range of emotions. The patients have attention-seeking behavior and may try to attract the attention of the nurse.
Which behavior is demonstrated by a patient who engages in splitting?
Sees things as divided into "all good" or "all bad."
Splitting demonstrates the failure to integrate the positive and negative into a cohesive whole. An individual is not seen as a person with good and bad traits, but rather as all good or all bad. Splitting is not described accurately by unconsciously repressing undesirable aspects of self, placing responsibility for behavior outside the self, or evidencing a lack of personal boundaries.
Which is true of pharmacologic therapies for treatment of personality disorders?
Although there are no Food and Drug Administration (FDA)-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident.
R: At this time in the United States, there are no FDA-approved medications for treating personality disorders. Prescribers are using the medications "off- label" until evidence-based pharmacotherapies are proven to be safe and effective. There is evidence that mood stabilizers, antidepressants, and atypical antipsychotics are helpful in specific personality disorders. Pharmacologic evidence is lacking for the treatment of persons with narcissistic and obsessive-compulsive personality disorders. Although patients with personality disorders usually do not like taking medicine unless it calms them down and are fearful about taking something over which they have no control, providers do attempt to mediate symptoms with psychotropic agents for improved quality of life.
A primary health care provider is planning therapy for a patient with narcissistic personality disorder. What treatment option does the nurse anticipate as most effective for the patient?
Individual cognitive-behavioral therapy
R: There is no medication indicated for narcissistic personality disorder. Treatment includes individual cognitive-behavioral therapy, family therapy, and group therapy. Patients with borderline personality disorders often respond to omega-3 supplementation for mood and emotion dysregulation symptoms. Patients with narcissistic personality disorder already have an inflated view of their self-importance, and assertive training may not help them. Such training helps patients with avoidant, dependent, or histrionic personality disorders to express their needs more openly and improves their self-esteem. Patients with borderline and schizotypal personality disorders benefit from low-dose antipsychotic medications, which reduce psychotic-like symptoms and improve day-to-day functioning.
How is the behavior of a cluster B personality disorder described?
Dramatic, emotional, or erratic
The behavior of a cluster B personality disorder is described as dramatic, emotional, or erratic. The behaviors in a cluster A personality disorder are described as odd or eccentric. Anxious or fearful behavior is descriptive of a cluster C personality disorder. Aggressive or destructive behaviors are not descriptive of any cluster of personality disorders.
A person diagnosed with obsessive-compulsive personality disorder is consistently late for appointments and says, "I have to check the safety features and fluid levels on my car six times before I leave home." Which nursing diagnosis has the highest priority?
Anxiety
Internally, this person is fearful of imminent catastrophe. This fear produces anxiety. Persons diagnosed with obsessive-compulsive personality disorder try to control the environment through perfectionism and orderliness. Traits include compulsivity, oppositionality, lack of emotional expressiveness, and perfectionism. Social interactions, family processes, and role performance for this individual will improve after the anxiety is reduced; therefore, these diagnoses have a lower priority.
A patient at the mental health center says to the nurse, "Most of the staff does not care about me, but you are different. You understand my problems." When the nurse tells this patient about an upcoming career change, the patient becomes very angry. An hour later, the patient loudly announces, "I'm going to cut my wrists. I need to be hospitalized immediately." Given this scenario, which personality disorder is most likely?
Borderline
The scenario describes splitting of staff and impulsivity associated with self-mutilation. These are common behaviors among persons diagnosed with borderline personality disorder. Persons diagnosed with narcissistic personality disorder are exploitive, grandiose, and disparaging. Persons diagnosed with avoidant personality disorder are excessively anxious in social situations and hypersensitive to negative evaluation. Persons diagnosed with histrionic personality disorder are seductive, flamboyant, attention seeking, and shallow.
Which statement made by a patient illustrates a primary coping style of persons with borderline personality disorder (BPD)?
"Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here."
A primary coping style used by patients with BPD is called splitting. Splitting is the inability to incorporate positive and negative aspects of oneself or others into a whole image. The individual may tend to idealize another person (friend, lover, health care professional) at the start of a new relationship and hope that this person will meet all of his or her needs. At the first disappointment or frustration, however, the individual quickly shifts to devaluation, despising the other person. The statements "My health care provider says I might get out of here tomorrow. Do you think I'm ready to go?", "I will never again speak to any of my messed up family members. I know that this will help me be more functional," and "I promise I am not feeling suicidal. I won't hurt myself" do not describe splitting, which is a primary coping style of patients with BPD.
Which conditions are comorbidities of borderline personality disorder? Select all that apply.
2. Anxiety disorder
3. Substance abuse
4. Depressive disorder
Comorbidities for borderline personality disorder include substance abuse, anxiety disorder, and depressive disorder. Bipolar and schizoaffective disorders are not comorbidities of borderline personality disorder.
A community mental health nurse works with an adult patient diagnosed with borderline personality disorder. The patient says to the nurse, "I'm under so much stress, I feel like cutting my throat." What should the nurse do first?
Talk with the patient about the feelings of stress.
The nurse is assessing a patient for a possible personality disorder. What behavior does the nurse identify as feature of paranoid personality disorder?
Reluctance to answer any questions
Research has indicated that the antisocial personality may present with which characteristic?
Lack of remorse
The priority nursing intervention for a patient diagnosed with borderline personality disorder is to
Assess for suicidal and self-mutilating behaviors
A nurse caring for a patient who has been diagnosed with a personality disorder should expect that the patient will exhibit which behavior?
Inflexible and maladaptive responses to stress
What personality disorder are common in women than in men?
Dependent
Which statement is descriptive of patients with a personality disorder?
They are resistant to behavioral change
The nurse is assessing a patient with narcissistic personality disorder. What behavior is the nurse most likely to find in this patient compared to other patients in the ward?
Exploitation of others
What signs and symptoms are associated with the nursing diagnosis of "defensive coping" for a patient diagnosed with antisocial personality disorder? Select all that apply.
Hostile laughter
Ridicule of others
A nurse manages care for an individual with a personality disorder. What is the most attainable outcome for this patient?
Within 4 weeks, the patient will describe personal characteristics of reactions to stress
What effect does group therapy have on the patient with schizotypal personality disorder?
It will allow opportunity to interact with others.
R: Group therapy may be beneficial to the patient diagnosed with schizotypal personality disorder because it will allow the opportunity to interact with others. Group members may become important to this patient and may be his or her only form of socialization. Neither approval nor rejection has much effect on the patient with schizotypal personality disorder. Group therapy may assist a patient with a narcissistic personality disorder in learning empathy. For the patient with an avoidant personality disorder, group therapy may be useful in processing anxiety-provoking symptoms.
What is the primary goal of milieu therapy for patients diagnosed with personality disorders?
Managing the effect of the behavior on the entire group.
The primary goal of milieu therapy is affect management in a group context. One-on-one therapy is not a goal of milieu management. Helping the patient remain uninvolved is not therapeutic. The staff would not be able to effectively manage the milieu if they adopted a laissez-faire attitude.
During an interview, the nurse asks a patient with borderline personality disorder about childhood experiences. What findings about the patient's childhood may relate to the patient's borderline personality disorder?
Seeking emotional support from their mother at the age of 18-24 months
A patient was admitted to the psychiatric inpatient unit because of manipulative and aggressive behavior. What appropriate strategy does the nurse follow while interacting with the patient?
The nurse asks questions to explore the patient's situation.
The nurse should try to explore the patient's feelings by asking questions about the situation. It helps to assess the patient's condition and to prepare an effective treatment plan. The nurse should also maintain a nonjudgmental attitude. Being judgmental and giving opinions can annoy the patient. The patient must be given an explanation of his or her present condition because it helps to reorient the patient to reality. Making closed-ended statements hinders communication.
What appropriate symptoms should the nurse asses to identify borderline personality disorder when interviewing patients? Select all that apply.
Tendency towards sarcasm
Feelings of emptiness
Frequency of mood shifts
A nurse manages care for an individual diagnosed with avoidant personality disorder. Select the appropriate outcome for this patient. The patient will:
Demonstrate use of assertive communication within 3 months.
An adult diagnosed with antisocial personality disorder begins an outpatient program at the community mental health center. Which is an appropriate outcome for this patient?
Listen attentively as others share their feelings
When providing care for a patient diagnosed with borderline personality disorder, the nurse will need to consider strategies for dealing with the patient's
Mood shifts, impulsivity, and splitting
A patient arrested for an assault in which the patient savagely beat a classmate states, "The guy deserved everything he got." The behaviors described are most consistent with the clinical picture of which disorder?
Antisocial personality disorder
0
1921