Ch. 15: Personality Disorders

Question 1

A client who has a personality disorder demonstrates ______ personality characteristics

Answer 1

Pathological

Question 2

A client who has a personality disorder exhibits impairments in _____ or _______ and _____

Answer 2

Self-identity or self-direction and interpersonal functioning

Question 3

Are the maladaptive behaviors of a personality disorder always perceived by the individual as dysfunctional?

Answer 3

No, sometimes some areas of personal functioning may be adequate

Question 4

What are some other mental health diagnsosis that co-occur with personality disorders?

Answer 4

Depression
Anxiety
Eating and substance use disorders

Question 5

What are some defense mechanisms that are used by clients who have personality disorders?

Answer 5

Repression
Regression
Suppression 
Undoing
Splitting

Question 6

What is splitting?

Answer 6

The inability to incorporate positive and negative aspects of oneself or others into a whole image

Question 7

What personality disorder is splitting commonly associated with?

Answer 7

Personality disorders

Question 8

In splitting, how does the client tend to characterize people or things?

Answer 8

All good or all bad at any particular moment

EX: “You are the worse person in the world. later that day”… “You are the best, but the nurse from the last shift is absolutely terrible”

Question 9

Clients who have a personality disorder will exhibit one or more of the following common pathological personality characteristics…what are they? (5)

Answer 9

1. Inflexibility/maladaptive response to stress
2. Compulsiveness and lack of social restraint
3. Inability to emotionally connect in social and professional relationships
4. Tendency to provoke interpersonal conflict
5. Ability to merge personal boundaries with others

Question 10

What are the 10 personality disorders?

Answer 10

Paranoid
Schizoid
Schizotypal
Antisocial
Borderline
Narcissistic
Histrionic
Avoidant
Dependent
Obsessive compulsive

Question 11

What characterizes cluster A and what 3 are part of this?

Answer 11

Cluster A: Odd, eccentric traits

• Paranoid
• Schizoid
• Schizotypal

Question 12

What characterizes cluster B and what 4 are part of this?

Answer 12

Cluster B: Emotional, dramatic, erratic traits

• Antisocial
• Borderline
• Histrionic
• Narcissistic

Question 13

What characterizes cluster C and what 3 are part of this?

Answer 13

Cluster C: Anxious or fearful; insecure and inadequacy

• Avoidant
• Dependent
• Obsessive-compulsive

Question 14

What cluster and what disorder is this:

Disregard for others with exploitations, repeated unlawful actions, deceit, and failure to accept personal responsibility

Answer 14

Cluster B–Anitsocial

Question 15

What cluster and what disorder is this:

Emotional detachment, disinterest in close relationships, and indifference to praise or criticism; often uncooperative

Answer 15

Cluster A–Schizoid

Question 16

What cluster and disorder is this:

Emotional attention-seeking behavior, in which the person needs to be the center of attention; often seductive and flirtatious

Answer 16

Cluster B–Histrionic

Question 17

What cluster and disorder is this:

Extreme dependency in close relationships with an urgent search to find a replacement when one relationship ends

Answer 17

Cluster C–Dependent

Question 18

What cluster and disorder is this:

Distrust and suspiciousness toward others based on unfounded beliefs that others want to harm, exploit, or deceive the person

Answer 18

Cluster A–Paranoid

Question 19

What cluster and disorder is this:

Perfectionism with a focus on orderliness and control to the extent that the individual may not be able to accomplish a given task

Answer 19

Cluster C–Obsessive-compulsive

Question 20

What cluster and disorder is this:

Instability of affect, identity, and relationships, as well as splitting behaviors, manipulation, impulsiveness, and fear of abandonment; often tries self-injury and may be suicidal

Answer 20

Cluster B–Suicidal

Question 21

What cluster and disorder is this:

Odd beliefs leading to interpersonal difficulties, an eccentric appearance, and magical thinking or perceptual distortions that are not clear delusions or hallucinations

Answer 21

Cluster A–Schizotypical

Question 22

What cluster and disorder is this:

Social inhibition and avoidance of all situations that require interpersonal contact, despite wanting close relationships, due to extreme fear of rejection; often very anxious in social situations

Answer 22

Cluster C–Avoidant

Question 23

What cluster and disorder is this:

Arrogance, grandiose views of self-importance, the need for consistent admiration, and a lack of empathy for others that strains most relationships; often sensitive to criticism

Answer 23

Cluster B–Narcissistic

Question 24

____ is always a priority concern because some clients who have a personality disorder are at risk for self-injury or violence

Answer 24

Safety

Question 25

Why is developing a therapeutic relationship often challenging with clients with personality disorders?

Answer 25

Due to the clients distrust or hostility toward others

Question 26

What will help build a therapeutic nurse-client relationship with a pt with personality disorder?

Answer 26

A firm, yet supportive approach and consistent care

Question 27

For clients who are manipulative, like those with borderline or antisocial personality disorder, what is essential?

Answer 27

Limit-setting and consistency

Question 28

Clients who have dependent and histrionic personality disorders often benefit from _____ & ____

Answer 28

Assertiveness training and modeling

Question 29

What PD tend to isolate themselves...what should we do as nurses if this happens?

Answer 29

Schizoid or schizotypical personality disorders isolate theselves; we should respect this need

Question 30

Clients who have histrionic personality disorder, who may be flirtatious...what is it important the nurse do?

Answer 30

Maintain professional boundaries and communication at all times

Question 31

When caring for clients who exhibit dependent behavior, self-assess frequently for ______

Answer 31

Countertransference reactions

Question 32

What are effective treatment modalities for clients who have PD?

Answer 32

Psychotherapy Group therapy Cognitive and behavior therapy

Question 33

What is a type of cognitive-behavioral therapy that is used for clients who exhibit self-injurious behavior?

Answer 33

Dialectical behavior therapy

Question 34

What does dialectical behavior focus on?

Answer 34

Gradual behavior changes and provides acceptance and validation for these clients

Question 35

A nurse manager is discussing the care of a client who has a PD with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching? A. I can promote my clients sense of control by establishing a schedule. B. Self-assessment will help me cope with emotional reactions to client care. C. I should practice limit-setting to help prevent client manipulation. D. Maintaining professional boundaries is a priority of client care.

Answer 35

A

Question 36

A nurse is caring for a client who has avoidant personality disorder. Which of the following statements is expected from a client who has this type of PD? A. I'm scared that you're going to leave me B. I'll go to group therapy if you let me smoke C. I need to feel that everyone admires me D. I sometimes feel better if I cut myself

Answer 36

A. Clients who have avoidant have a fear of abandonment-this statement is expected ``` B= avoidant PD C= Narcissistic PD D= Borderline ```

Question 37

A charge nurse is preparing a staff education session on PD. Which of the following should be included as personality characteristics associated with all of the personality disorders? (SATA) A. Difficult in getting along with other members of a group B. Belief in the ability to become invisible during times of stress C. Display of defense mechanisms when routines are changed D. Claiming to be more important than other persons E. Difficulty understanding why is it inappropriate to have a personal relationship with staff

Answer 37

A, C, E

Question 38

A nurse is caring for a client who has borderline PD. The client says, "The nurse on the evening shift is always nice! You are the meanest nurse ever!" The nurse should recognize the clients statement as an example of which of the following defense mechanisms? A. Regression B. Splitting C. Undoing D. Identification

Answer 38

B

Question 39

A nurse is assisting with a court-ordered evaluation of a client who has antisocial personality disorder. When assessing this client, which of the following are expected findings? (SATA) A. Demonstrates extreme anxiety when placed in a social situation B. Has difficulty making even simple decisions C. Attempts to convince other clients to give him their belongings D. Becomes agitates if his personal area is not neat and orderly E. Blames others for his past and current problems

Answer 39

C, E ``` A= avoidant B= Narcissistic D= Obsessive-compulsive ```