Personality Disorders

A client diagnosed with BPD manipulates the staff in an effort to fulfill their own desires. All of the following may be examples of manipulative behaviors except:

• Refusal to stay in room alone, stating, “It’s so lonely.”

• Asking the nurse for cigarettes after 30 minutes, knowing that the assigned nurse has explained the client must wait 1 hour.

• Stating to the nurse, “I really like having you for my nurse. You’re the best one around here.”

• Making superficial cuts to their arms after discussing discharge plans with physician.

A client on the psychiatric unit has a diagnosis of antisocial personality disorder. Which characteristic is consistent with this diagnosis?

• Lack of guilt for wrongdoing

• Insight into own behavior

• Ability to learn from past experiences

• Compliance with authority

Which behavioral pattern is characteristic of individuals with narcissistic personality disorder?

• Overly self-centered and exploitative of others

• Suspicious and mistrustful of others

• Rule conscious and disapproving of change

• Anxious and socially isolated

Which behavioral pattern is characteristic of individuals with schizoid personality disorder?

• Belittling themselves and their abilities

• A lifelong pattern of social withdrawal

• Suspiciousness and mistrust of others

• Overreacting inappropriately to minor stimuli

A client with a diagnosis of BPD often exhibits alternating clinging and distancing behaviors. Which is the most appropriate nursing intervention for the client with this type of behavior?

• Encourage the client to establish trust in one staff person with whom all therapeutic interaction should take place.

• Secure a verbal contract from the client to discontinue these behaviors.

• Withdraw attention if these behaviors continue.

• Rotate staff members who work with the client so that the client will learn to relate to more than one person.

A male client with antisocial personality disorder was found on the bed in a female client’s room. When instructed to leave the room, the client states, “I’m sick of you telling me what I can and can’t do. If I want to carry on a relationship with one of these ladies, it’s my right. I’ll do exactly as I please!” Which action by the nurse is a priority at this point?

• Reassure the client that he will have plenty of opportunities with women after he is discharged.

• Reinforce the rules of the treatment program that all clients are expected to follow.

• Escort the client to a seclusion room.

• Establish a trusting relationship by telling the client that an exception will be made just this once.

A nurse assists a client with a diagnosis of obsessive-compulsive disorder (OCD) in his preparations for bedtime. One hour later the client calls the nurse and says that he is feeling anxious; he asks the nurse to sit and talk for a while. Which is the appropriate initial nursing action?

• Tell the client that it is time for sleep and that you will talk with him tomorrow.

• Administer the prescribed as-needed antianxiety medication.

• Ask the unlicensed assistive personnel to sit with the client.

• Sit and talk with the client.

A nurse is preparing to admit a client with a diagnosis of obsessive-compulsive disorder (OCD) to the mental health unit. The nurse would expect to note which behaviors in the client?

• Suspicious and hostile

• Frightened and delusional

• Rigidness in thought and inflexibility

• Flexible and adaptable

A nurse caring for a client who has been diagnosed with a personality disorder should expect that the client will exhibit which of the following characteristics?

• Frequent episodes of psychosis

• Constant involvement with the needs of significant others

• Inflexible and maladaptive responses to stress

• Abnormal ego functioning

A 16-year-old has stolen money from his invalid grandmother, uses drugs and alcohol, and frequently beats up acquaintances who disagree with him. Arrested for an assault in which he beat a classmate and caused brain damage, he stated in court "The guy deserved everything he got." The behaviors described are most consistent with the clinical picture of:

• antisocial personality disorder.

• borderline personality disorder.

• schizotypal personality disorder.

• narcissistic personality disorder.