Which statement about an individual with a personality disorder is true?
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Solution
The individual typically remains in the mainstream of society, although he has problems in social and occupational roles.
An individual with a personality disorder usually is not hospitalized unless a coexisting Axis I psychiatric disorder is present. Generally, these individuals make marginal adjustments and remain in society, although they typically experience relationship and occupational problems related to their inflexible behaviors.
Option A: Personality disorders are chronic, lifelong patterns of behavior; acute episodes do not occur. Psychotic behavior is usually not common, although it can occur in either schizotypal personality disorder or borderline personality disorder.
Option B: Because these disorders are enduring and evasive and the individual is inflexible, the prognosis for recovery is unfavorable.
Option D: Generally, the individual does not seek treatment because he does not perceive problems with his own behavior. Distress can occur based on other people’s reaction to the individual’s behavior.
Tyrion describes himself as “very religious, with strong opinions about what is right and what is wrong.” He is quite judgmental about beliefs and lifestyles that are “unacceptable.” Which statement supports the nurse’s analysis that this client’s behavior is typical of someone with a personality disorder?
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Solution
Inflexible behaviors, along with use of rigid defense mechanisms, are characteristic.
Individuals with personality disorder have inflexible behavior patterns and rigid defense mechanisms. They are unlikely to change over time. Option B: Such individuals generally lack self-insight and are more likely to have
Option B: Such individuals generally lack self-insight and are more likely to have external locus of control thinking (blaming others for problems).
Option C: Religious fanatics may be motivated by other psychodynamics (possibly psychotic states).
Option D: However, strong belief systems do not necessarily mean mental instability. A mentally healthy person may have belief systems that are strong and that govern conduct.
Angela has a history of conflict-filled relationships. Despite an expressed desire for friends, she acts in ways that tend to alienate people. Which nursing intervention would be important for Angela?
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Solution
Establish a therapeutic relationship in which the nurse uses role-modeling and role-playing for appropriate behaviors.
A therapeutic relationship shows acceptance, and using role modeling and role-playing can help the client to learn appropriate behaviors.
Option B is an inappropriate and unrealistic solution to the client’s problem behaviors.
Option C is also inappropriate because the client is not likely to accept direct criticism of her behavior; such individuals do not perceive a problem with their own behavior.
Option D ignores the client’s potential for growth and improvement.
A client with antisocial personality disorder was admitted in a unit at Nurseslabs Hospital. The newly admitted client stole money from an elderly in the unit. Which of the following is the most appropriate for the nurse to say to this client?
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Solution
“The consequences of stealing are loss of privileges.”
The most appropriate response is to reinforce the consequences of behavior that disregard the rights of others.
Option A is incorrect because this client is likely to rationalize and excuse the behavior.
Option B is also incorrect because the nurse should not encourage the client to provide excuses or explanations of behaviors that are clearly against the rules.
Option D: A client with antisocial personality disorder is unlikely to have compassion for others and typically lacks respect for the rights of others.
Nurse Danita is working with clients who have personality disorders. Which of the following techniques would the nurse use to deal with her own feelings that interfere with therapeutic performance?
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Solution
Seeking peer or supervisor direction
The nurse is likely to have strong reactions to clients with personality disorders, especially those who display intense emotions and manipulative behaviors. Seeking the direction of peers and supervisors can help clarify issues and determine the best nursing responses to difficult behaviors.
Barbara is a client with borderline personality disorder. She is defensive and emotionally labile and often becomes suddenly and explosively angry. When interacting with her, you as a nurse would:
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Solution
Take a calm, quiet, and nonconfrontational approach, and avoid arguing with Barbara.
The best way to respond to the client with angry behavior is a calm, nonconfrontational, nonargumentative approach. This will avoid further escalating the client’s behavior.
Option A: Confronting the client’s behavior could exacerbate anger and trigger explosive behavior.
Option C: Telling the client to calm down minimizes the client’s problems, and the mention of restraints may be perceived as threatening to the client.
Option D: Touch may also be perceived as threatening; it is not recommended for a client who may become explosive.
When a client with personality disorder begins demonstrating manipulative behavior, which of the following nursing actions are most appropriate? Select all that apply.
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Solution
Answer: A, C, E, F
These interventions allow the nurse to immediately confront the client’s manipulative behavior and provide consistent structure (through limit-setting and team approach).
Option B is appropriate for the client with obsessive-compulsive behavior.
Option D, for someone with somatization problem.
Nurse Florence assesses Mrs. B with borderline personality disorder. Which of the following behaviors are common to this diagnosis? Select all that apply.
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Solution
Answer: A, B, E
These are all common characteristics of an individual with borderline personality disorder.
Suspiciousness and mistrust of others (option C) are characteristic of paranoid personality disorder.
Options D and F are characteristic of someone with schizoid personality disorder, which is generally aloof in relationships and has unusual speech and mannerisms.
Nurse Aldrich is working with the family of Mary Ann, a client with a personality disorder. Which of the following should Nurse Aldrich encourage the family members to work on?
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Solution
Improving self-functioning
Family members typically benefit from working on ways to improve self-functioning. This facilitates ownership of problems among individuals involved in ongoing relationship difficulties.
Option A: The direct expression of problems is helpful and therefore should not be avoided.
Option B: It would be impossible to change the client’s behavior; encouraging family members to do so would frustrate them.
Option D: The client’s defenses are likely to blame others for problems; consequently, supporting his blaming others is not helpful.
Mrs. B is diagnosed with borderline personality disorder has a nursing diagnosis of Risk for self-directed violence, which is related to the client’s self-mutilation behavior (burning arms with cigarettes). Which client behavior would indicate a positive outcome of intervention?
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Solution
Mrs. B tells the nurse about wanting to burn herself.
The fact that Mrs. B directly tells the nurse about wanting to self-mutilate, rather than acting on these feelings, is evidence of her responding to nursing intervention.