Varcarolis Chapter 24 Personality Disorders
1. 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 should get the
money." These statements show:
a. shame.
b. suspiciousness
c. superficial remorse.
d. lack of guilt feelings. ✔️ANS: D
Rationalization is being used to explain behavior and deny wrongdoing. The individual who does not
believe he or she has done anything wrong will not manifest anxiety, remorse, or guilt about the act. The
patient's remarks cannot be assessed as shameful. Lack of trust and concern that others are determined
to do harm is not shown.
2. 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. ✔️ANS: A
Manipulative people frequently make requests of many different staff, hoping one will give in. Having
one decision maker provides consistency and avoids the potential for playing one staff member against
another. Positive reinforcement of appropriate behaviors is more effective than negative reinforcement.
The behavior should not be ignored; judicious use of confrontation is necessary. Patients with antisocial
personality disorders rarely have feelings of fear and inferiority.
,3. 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?" ✔️ANS: C
The individual with a borderline personality disorder characteristically demonstrates manipulative,
splitting, and self-destructive behaviors. Consistent limit setting is vital for the patient's safety, but also
to prevent splitting other staff. "Why" questions are not therapeutic. See relationship to audience
response question.
4. 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. ✔️ANS: C
This is an early outcome that paves the way for later taking greater responsibility for controlling
manipulative behavior. Identifying anger relates to anger and aggression control. Using manipulation to
get legitimate needs is an inappropriate outcome. The patient would ideally use assertive behavior to
, promote need fulfillment. Accepting fulfillment of requests within an hour rather than immediately
relates to impulsivity control.
5. 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. ✔️ANS: C
Patients manipulate and control staff in various ways. By keeping staff off balance or fighting among
themselves, the person with an antisocial personality disorder is left to operate as he or she pleases.
Seductive behavior has sexual connotations. The patient is displaying the opposite of detached behavior.
Guilt is not evident in the comments.
6. 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 ✔️ANS: C
Limits must be set in areas in which the patient's behavior affects the rights of others. Limiting verbal
abuse of another patient is a priority intervention and particularly relevant when interacting with a
1. 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 should get the
money." These statements show:
a. shame.
b. suspiciousness
c. superficial remorse.
d. lack of guilt feelings. ✔️ANS: D
Rationalization is being used to explain behavior and deny wrongdoing. The individual who does not
believe he or she has done anything wrong will not manifest anxiety, remorse, or guilt about the act. The
patient's remarks cannot be assessed as shameful. Lack of trust and concern that others are determined
to do harm is not shown.
2. 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. ✔️ANS: A
Manipulative people frequently make requests of many different staff, hoping one will give in. Having
one decision maker provides consistency and avoids the potential for playing one staff member against
another. Positive reinforcement of appropriate behaviors is more effective than negative reinforcement.
The behavior should not be ignored; judicious use of confrontation is necessary. Patients with antisocial
personality disorders rarely have feelings of fear and inferiority.
,3. 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?" ✔️ANS: C
The individual with a borderline personality disorder characteristically demonstrates manipulative,
splitting, and self-destructive behaviors. Consistent limit setting is vital for the patient's safety, but also
to prevent splitting other staff. "Why" questions are not therapeutic. See relationship to audience
response question.
4. 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. ✔️ANS: C
This is an early outcome that paves the way for later taking greater responsibility for controlling
manipulative behavior. Identifying anger relates to anger and aggression control. Using manipulation to
get legitimate needs is an inappropriate outcome. The patient would ideally use assertive behavior to
, promote need fulfillment. Accepting fulfillment of requests within an hour rather than immediately
relates to impulsivity control.
5. 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. ✔️ANS: C
Patients manipulate and control staff in various ways. By keeping staff off balance or fighting among
themselves, the person with an antisocial personality disorder is left to operate as he or she pleases.
Seductive behavior has sexual connotations. The patient is displaying the opposite of detached behavior.
Guilt is not evident in the comments.
6. 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 ✔️ANS: C
Limits must be set in areas in which the patient's behavior affects the rights of others. Limiting verbal
abuse of another patient is a priority intervention and particularly relevant when interacting with a
