Chapter 24: Personality Disorders Flashcards
(108 cards)
1
Q
profound lack of empathy
A
callousness
2
Q
an individual’s characteristic, relatively permanent pattern of thoughts, feelings, and behaviors that define her or his quality of experiences and relationships
A
personality
3
Q
Which cluster does the following personality disorder belong to?
paranoid personality disorder
a. cluster A
b. cluster B
c. cluster C
A
a. cluster A
4
Q
behaviors described as odd or eccentric
A
Cluster A
5
Q
behaviors described as dramatic, emotional, or erratic
A
Cluster B
6
Q
behaviors described as anxious or fearful
A
Cluster C
7
Q
Which cluster does the following personality disorder belong to?
schizoid personality disorder
a. cluster A
b. cluster B
c. cluster C
A
a. cluster A
8
Q
Which cluster does the following personality disorder belong to?
schizotypal personality disorder
a. cluster A
b. cluster B
c. cluster C
A
a. cluster A
9
Q
Which cluster does the following personality disorder belong to?
borderline personality disorder
a. cluster A
b. cluster B
c. cluster C
A
b. cluster B
10
Q
Which cluster does the following personality disorder belong to?
narcissistic personality disorder
a. cluster A
b. cluster B
c. cluster C
A
b. cluster B
11
Q
Which cluster does the following personality disorder belong to?
histrionic personality disorder
a. cluster A
b. cluster B
c. cluster C
A
b. cluster B
12
Q
Which cluster does the following personality disorder belong to?
antisocial personality disorder
a. cluster A
b. cluster B
c. cluster C
A
b. cluster B
13
Q
Which cluster does the following personality disorder belong to?
avoidant
a. cluster A
b. cluster B
c. cluster C
A
c. cluster C
14
Q
Which cluster does the following personality disorder belong to?
dependent
a. cluster A
b. cluster B
c. cluster C
A
c. cluster C
15
Q
Which cluster does the following personality disorder belong to?
OCD
a. cluster A
b. cluster B
c. cluster C
A
c. cluster C
16
Q
a long-standing distrust and suspiciousness of others based on the belief, unsupported by evidence, that others want to exploit, harm, or deceive the person
A
paranoid personality disorders
17
Q
T/F
Slightly more men than woman are diagnosed with paranoid personality disorder.
A
true
18
Q
What is the dominant defense mechanism for paranoid personality disorder?
a. jealousy
b. stealing
c. isolation
d. projection
A
d. projection
19
Q
Why is the patient diagnosed with paranoid personality disorder difficult to interveiw?
A
they fear that the information will be used against them
20
Q
What is the first line of treatment for paranoid persoality disorder?
A
psychotherapy
21
Q
T/F
Group therapy is recommended for the patient who has paranoid personality disroder.
A
false; group therapy is threatening to patients with paranoid personality disorder
22
Q
Pervasive distrust & suspiciousness of others.
A
paranoid personality disorders
23
Q
T/F
Women are more often affected by schizoid personality disorder.
A
false; men
24
Q
Pervasive pattern of detachment from social relationships (solitary occupation, flat affect, does not enjoy close relationship).
A
schizoid personality disorder
25
Is schizotypal personality disorder more common in men or women?
men
26
T/F
Individuals with schizotypal personality disorder are overly suspicious and anxious.
true
27
What is the major difference between schizotypal personality disorder and schizophrenia?
people with schizotypal personality disorder can be made aware of their suspiciousness, magical thinking, and odd beliefs; schizophrenia is characterized by stronger delusions
28
Name the medications for schizotypal personality disorder.
there are no specific medications for schizotypal personality disorder
29
Pervasive pattern of social & interpersonal deficits. Magical thinking, derealization, perceptual distortion.
schizotypal personality disorder
30
T/F
The borderline personality disorder patient is at risk for joining cult-like groups.
false; schizotypal personality disorder patient
31
Pervasive pattern of instability of interpersonal relationships- Splitting (at the first disappointment).
borderline personality disorder
32
T/F
Histrionic personality disorder is more common in men.
false; women
33
T/F
There are no specific pharmacological treatments available for people with histrionic personality disorder.
true
34
Pervasive pattern of excessive emotionality & attention seeking.
histrionic personality disorder
35
Pervasive pattern of disregard for a violation of the rights of others. h/o conduct disorder in childhood, tells lies, destructive or illegal acts/
antisocial personality disorder
36
Pervasive pattern of instability of interpersonal relationships- Splitting (at the first disappointment).
borderline personality disorder
37
Characterized by feelings of entitlement and an exaggerated belief in their own importance.
narcissistic personality disorder
38
T/F
Borderline personality disorder is more common in males.
true
39
Pervasive pattern of social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation.
avoidant personality disorder
40
T/F
More women are diagnosed with avoidant personality disorder.
false; found equally among men and women
41
What is the main pathological personality trait for avoidant personality disorder?
low self-esteem
42
Pervasive & excessive need to be taken care of, clinging to nurse.
dependent personality disorder
43
characterized by a pattern of submissive and clininging behavior related to an overwhelming need to be care for
dependent personality disorder
44
What is the treatment of choice for dependent personality disorder?
psychotherapy
45
Name the medication that can treat dependent personality disorder.
no specific medications are indicated for this disorder
46
Pervasive pattern of preoccupation with orderliness, mental & interpersonal control.
obsessive-compulsive personality disorder
47
characterized by limited emotional expression, stubbornness, perseverance, and indecisiveness
obsessive-compulsive personality disorder
48
What are the hallmarks of obsessive-compulsive personality disorder?
preoccupation with perfectionism, orderliness, and control
49
Is obsessive-compulsive personality disorder more common in men or women?
men
50
T/F
Oldest siblings tend to be affected by obsessive-compulsive personality disorder more often than subsequent siblings.
true
51
What are the main pathological personality traits of people who have obsessive-compulsive personality traits?
rigidity ; inflexible standards for self and others
52
rapidly moving from one emotional extreme to another
emotional lability
53
acting quickly in response to emotions without considering the consequences
impulsivity
54
inability to view both positive and negative aspects of others as part of a whole
splitting
55
Borderline personality disorder __________ with age.
decrease
56
What is the preferred method for determining a diagnosis of borderline personality disorder?
semistructured interview
57
T/F
Borderline personality disorder usually begins after adulthood.
false; before adulthood
58
Which nursing diagnosis is most often associated with borderline personality disorder?
a. risk for suicide
b. risk for self-mutilation
c. risk for violence
d. impaired socialization
a. risk for suicide
59
T/F
The US is the only place where there are medications approved specifically for borderline personality disorder.
false; no approved medications by the FDA
60
__________ therapy can help individuals to identify and change inaccurate core perceptions of themselves and others and relationship problems.
a. cognitive behavioral
b. dialectical behavior
c. schema-focused
a. cognitive behavioral
61
__________ therapy is used to treat chronically suicidal individuals with borderline personality disorders; combines cognitive and behavioral techniques with mindfulness.
a. cognitive behavioral
b. dialectical behavior
c. schema-focused
b. dialectical behavior
62
__________ therapy combines parts of CBT with other forms of therapy that focus on the ways that individuals with themselves.
a. cognitive behavioral
b. dialectical behavior
c. schema-focused
c. schema-focused
63
What are the main pathological traits that characterize antisocial personality disorder?
antagonistic behaviors
64
What is the most disturbed quality associated with antisocial personality disorder?
callousness
65
T/F
Antisocial personality disorder is more common in men.
true
66
T/F
In the US, there are no medications approved by the FDA specifically intended to treat antisocial personality disorder.
true
67
Which statement made by the psychiatric nurse demonstrates an accurate understanding of the factors that affect an individual's personality?
a. "Therapy will help her identify that her problems are personality related."
b. "I'll need to learn more about the patient's cultural beliefs."
c. "It's encouraging to know that personality disorder respond well to treatment."
d. "A person's personality is fluid and adjusts to current social situations."
b. "I'll need to learn more about the patient's cultural beliefs."
68
When assessing a patient diagnosed with a borderline personality disorder, which statement by the patient warrants immediate attention?
a. "My mother died ten years ago."
b. "I haven't needed medication in weeks."
c. "My dad never loved me."
d. "I'd really like to hurt her for hurting me."
d. "I'd really like to hurt her for hurting me."
69
What is the current accepted professional view of the effect of culture on the development of a personality disorder?
a. There are not enough studies to confirm the role that ethnicity and race have on the prevalence of personality disorders.
b. The North American and Australian cultures produce higher incidences of personality disorders within their populations.
c. Neither culture nor ethnic background is generally considered in the development of personality disorders.
d. Personality disorders have been found to be primarily the products of genetic factors, not cultural factors.
a. There are not enough studies to confirm the role that ethnicity and race have on the prevalence of personality disorders.
70
Which personality disorders are generally associated with behaviors described as "odd or eccentric"? (SATA)
a. paranoid
b. schizoid
c. histrionic
d. obsessive-compulsive
e. avoidant
a. paranoid
b. schizoid
71
Which behaviors are examples of a primitive defense mechanism often relied upon by those diagnosed with a personality disorder? (SATA)
a. regularly attempts to split the staff
b. attempts to undo feelings of anger by offering to do favors
c. regresses to rocking and humming to soothe self when fearful
d. lashes out verbally when confronted with criticism
e. destroys another person's belongings when angry
a. regularly attempts to split the staff
b. attempts to undo feelings of anger by offering to do favors
c. regresses to rocking and humming to soothe self when fearful
72
Personality disorders often co-occur with mood and eating disorders. A young woman is undergoing treatment at an eating disorders clinic and her nurse suspects that she may also have a cluster B disorder because of her:
a. Desire to avoid eating
b. Dramatic response to frustration
c. Excessive exercise routine
d. Morose personality traits
b. Dramatic response to frustration
73
Larry is from a small town and began displaying aggressive and manipulative traits while still a teenager. Now 40 years old, Larry is serving a life sentence for the murders of his wife and her brother. John, the prison psychiatric nurse practitioner, recognizes that Larry's treatment will most likely:
a. Transform Larry to a model prisoner
b. Not improve Larry's coping skills
c. Reaffirm Larry's high-risk behaviors
d. Manifest as small incremental changes
d. Manifest as small incremental changes
74
Connor is a 28-year-old student, referred by his university for a psychiatric evaluation. He reports that he has no friends at the university and that people call him a loner. Connor has recently been "giving lectures" to pigeons at the university fountains. He is diagnosed as schizotypal, which differs from schizophrenia in that persons diagnosed with schizotypal:
a. Can be made aware of their delusions
b. Are far more delusional than schizophrenics
c. Have a greater need for socialization
d. Do not usually respond to antipsychotic medications
a. Can be made aware of their delusions
75
Garret's wife of 8 years is divorcing him because their marriage never developed a warm or loving atmosphere. Garrett states in therapy, "I have always been a loner." and says that he was never concerned about what others think. The nurse practitioner suggests that Garrett try a trial of bupropion (Wellbutrin) to:
a. improve his flat emotions
b. help him get a good night's sleep
c. increase the pleasure of living
d. prepare Garrett for group therapy
c. increase the pleasure of living
76
Josie, a 27-year-old patient, complains that most of the staff do not look like her. She says she can tell whether you are a caring person. Josie is unsure of what she wants to do with her life and her "mixed-up feelings" about relationships. When you tell her that you will be on vacation next week, she becomes very angry. Two hours later, she is found using a curling iron to burn her underarms and explains that it "makes the numbness stop." Given this presentation, which personality disorder would you suspect?
a. obsessive-compulsive
b. borderline
c. antisocial
d. schizotypal
b. borderline
77
A health care provider recently convicted of Medicare fraud says to a nurse, "Sure I overbilled. Everyone takes advantage of the government. There are too many rules to follow and I deserve the money." These statements show
a. shame.
b. suspiciousness.
c. superficial remorse.
d. lack of guilt feelings.
d. lack of guilt feelings.
78
Which intervention is appropriate for an individual diagnosed with an antisocial personality disorder who frequently manipulates others?
a. Refer requests and questions related to care to the case manager.
b. Encourage the patient to discuss feelings of fear and inferiority.
c. Provide negative reinforcement for acting-out behavior.
d. Ignore, rather than confront, inappropriate behavior.
a. Refer requests and questions related to care to the case manager.
79
As a nurse prepares to administer medication to a patient diagnosed with a borderline personality disorder, the patient says, "Just leave it on the table. I‘ll take it when I finish combing my hair." What is the nurse‘s best response?
a. Reinforce this assertive action by the patient. Leave the medication on the table as requested.
b. Respond to the patient, "I‘m worried that you might not take it. I‘ll come back later."
c. Say to the patient, "I must watch you take the medication. Please take it now."
d. Ask the patient, "Why don‘t you want to take your medication now?"
c. Say to the patient, "I must watch you take the medication. Please take it now."
80
What is an appropriate initial outcome for a patient diagnosed with a personality disorder who frequently manipulates others? The patient will
a. identify when feeling angry.
b. use manipulation only to get legitimate needs met.
c. acknowledge manipulative behavior when it is called to his or her attention.
d. accept fulfillment of his or her requests within an hour rather than immediately.
c. acknowledge manipulative behavior when it is called to his or her attention.
81
Consider this comment to three different nurses by a patient diagnosed with an antisocial personality disorder, "Another nurse said you don‘t do your job right." Collectively, these interactions can be assessed as
a. seductive.
b. detached.
c. manipulative.
d. guilt-producing.
c. manipulative.
82
A nurse reports to the treatment team that a patient diagnosed with an antisocial personality disorder has displayed the behaviors below. This patient is detached and superficial during counseling sessions. Which behavior by the patient most clearly warrants limit setting?
a. Flattering the nurse
b. Lying to other patients
c. Verbal abuse of another patient
d. Detached superficiality during counseling
c. Verbal abuse of another patient
83
A patient diagnosed with borderline personality disorder has a history of self-mutilation and suicide attempts. The patient reveals feelings of depression and anger with life. Which type of medication would the nurse expect to be prescribed?
a. Benzodiazepine
b. Mood stabilizing medication
c. Monoamine oxidase inhibitor (MAOI)
d. Cholinesterase inhibitor
b. Mood stabilizing medication
84
A person‘s spouse filed charges after repeatedly being battered. The person sarcastically says, "I‘m sorry for what I did. I need psychiatric help." Which statement by this person supports an antisocial personality disorder?
a. "I have a quick temper, but I can usually keep it under control."
b. "I‘ve done some stupid things in my life, but I‘ve learned a lesson."
c. "I‘m feeling terrible about the way my behavior has hurt my family."
d. "I hit because I am tired of being nagged. My spouse deserves the beating."
d. "I hit because I am tired of being nagged. My spouse deserves the beating."
85
What is the priority nursing diagnosis for a patient diagnosed with antisocial personality disorder who has made threats against staff, ripped art off the walls, and thrown objects?
a. Risk for other-directed violence
b. Risk for self-directed violence
c. Impaired social interaction
d. Ineffective denial
a. Risk for other-directed violence
86
When a patient diagnosed with a personality disorder uses manipulation to get needs met, the staff applies limit-setting interventions. What is the correct rationale for this action?
a. It provides an outlet for feelings of anger and frustration.
b. It respects the patient‘s wishes, so assertiveness will develop.
c. External controls are necessary due to failure of internal control.
d. Anxiety is reduced when staff assumes responsibility for the patient‘s behavior.
c. External controls are necessary due to failure of internal control.
87
One month ago, a patient diagnosed with borderline personality disorder and a history of self-mutilation began dialectical behavior therapy. Today the patient phones to say, "I feel empty and want to hurt myself." The nurse should
a. arrange for emergency inpatient hospitalization.
b. send the patient to the crisis intervention unit for 8 to 12 hours.
c. assist the patient to choose coping strategies for triggering situations.
d. advise the patient to take an antianxiety medication to decrease the anxiety level.
c. assist the patient to choose coping strategies for triggering situations.
88
What is the most challenging nursing intervention with patients diagnosed with personality disorders who use manipulation?
a. Supporting behavioral change
b. Maintaining consistent limits
c. Monitoring suicide attempts
d. Using aversive therapy
b. Maintaining consistent limits
89
The history shows that a newly admitted patient is impulsive. The nurse would expect behavior characterized by
a. adherence to a strict moral code.
b. manipulative, controlling strategies.
c. acting without thought on urges or desires.
d. postponing gratification to an appropriate time.
c. acting without thought on urges or desires.
90
A patient says, "I get in trouble sometimes because I make quick decisions and act on them." Select the nurse‘s most therapeutic response.
a. "Let‘s consider the advantages of being able to stop and think before acting."
b. "It sounds as though you‘ve developed some insight into your situation."
c. "I bet you have some interesting stories to share about overreacting."
d. "It‘s good that you‘re showing readiness for behavioral change."
a. "Let‘s consider the advantages of being able to stop and think before acting."
91
A patient diagnosed with borderline personality disorder was hospitalized several times after multiple episodes of head banging and carving on both wrists. The patient remains impulsive. Which nursing diagnosis is the initial focus of this patient‘s care?
a. Self-mutilation
b. Impaired skin integrity
c. Risk for injury
d. Powerlessness
a. Self-mutilation
92
Which statement made by a patient diagnosed with borderline personality disorder indicates the treatment plan is effective?
a. "I think you are the best nurse on the unit."
b. "I‘m never going to get high on drugs again."
c. "I felt empty and wanted to hurt myself, so I called you."
d. "I hate my mother. I called her today, and she wasn‘t home."
c. "I felt empty and wanted to hurt myself, so I called you."
93
When preparing to interview a patient diagnosed with narcissistic personality disorder, a nurse can anticipate the assessment findings will include
a. preoccupation with minute details; perfectionist.
b. charm, drama, seductiveness; seeking admiration.
c. difficulty being alone; indecisive, submissiveness.
d. grandiosity, self-importance, and a sense of entitlement.
d. grandiosity, self-importance, and a sense of entitlement.
94
For which behavior would limit setting be most essential? The patient who
a. clings to the nurse and asks for advice about inconsequential matters.
b. is flirtatious and provocative with staff members of the opposite sex.
c. is hypervigilant and refuses to attend unit activities.
d. urges a suspicious patient to hit anyone who stares.
d. urges a suspicious patient to hit anyone who stares.
95
The nurse caring for an individual demonstrating symptoms of schizotypal personality disorder would expect assessment findings to include
a. arrogant, grandiose, and a sense of self-importance.
b. attention seeking, melodramatic, and flirtatious.
c. impulsive, restless, socially aggressive behavior.
d. socially anxious, rambling stories, peculiar ideas.
d. socially anxious, rambling stories, peculiar ideas.
96
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
c. Avoidant
97
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.
a. Respect the patient‘s need for periods of social isolation.
98
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.
d. fear of abandonment associated with progress toward autonomy and independence.
99
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.
b. provide care in a matter-of-fact manner.
100
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.
b. splitting.
101
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
c. Ability to provoke interpersonal conflict
102
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.
b. impaired social interaction.
103
A new psychiatric technician says, "Schizophrenia … schizotypal! What‘s the difference?" The nurse‘s response should include which information?
a. A patient diagnosed with schizophrenia is not usually overtly psychotic.
b. In schizotypal personality disorder, the patient remains psychotic much longer.
c. With schizotypal personality disorder, the person can be made aware of misinterpretations of reality.
d. Schizotypal personality disorder causes more frequent and more prolonged hospitalizations than schizophrenia.
c. With schizotypal personality disorder, the person can be made aware of misinterpretations of reality.
104
Personality traits most likely to be documented regarding a patient demonstrating characteristics of an obsessive-compulsive personality disorder are
a. affable, generous.
b. perfectionist, inflexible.
c. suspicious, holds grudges.
d. dramatic speech, impulsive.
b. perfectionist, inflexible.
105
A nurse determines desired outcomes for a patient diagnosed with schizotypal personality disorder. Select the best outcome. The patient will a. adhere willingly to unit norms.
b. report decreased incidence of self-mutilative thoughts.
c. demonstrate fewer attempts at splitting or manipulating staff.
d. demonstrate ability to introduce self to a stranger in a social situation.
d. demonstrate ability to introduce self to a stranger in a social situation.
106
A patient says, "The other nurses won‘t give me my medication early, but you know what it‘s like to be in pain and don‘t let your patients suffer. Could you get me my pill now? I won‘t tell anyone." Which response by the nurse would be most therapeutic?
a. "I‘m not comfortable doing that," and then ignore subsequent requests for early medication.
b. "I understand that you have pain, but giving medicine too soon would not be safe."
c. "I‘ll have to check with your doctor about that; I will get back to you after I do."
d. "It would be unsafe to give the medicine early; none of us will do that."
b. "I understand that you have pain, but giving medicine too soon would not be safe."
107
A nurse plans care for an individual diagnosed with antisocial personality disorder. Which characteristic behaviors will the nurse expect? (SATA)
a. Reclusive behavior
b. Callous attitude
c. Perfectionism
d. Aggression
e. Clinginess
f. Anxiety
b. Callous attitude
d. Aggression
108
For which patients diagnosed with personality disorders would a family history of similar problems be most likely? (SATA)
a. Obsessive-compulsive
b. Antisocial
c. Borderline
d. Schizotypal
e. Narcissistic
a. Obsessive-compulsive
b. Antisocial
c. Borderline
d. Schizotypal
