A client diagnosed with antisocial personality disorder comes to a nurses' station at
11:00 p.m. requesting to phone a lawyer to discuss filing for a divorce. The unit rules
state that no phone calls are permitted after 10:00 p.m. Which nursing reply is most
appropriate?
A. "Go ahead and use the phone. I know this pending divorce is stressful."
B. "You know better than to break the rules. I'm surprised at you."
C. "It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow."
D. "The decision to divorce should not be considered until you have had a good night's
sleep." - ansANS: C
The most appropriate response by the staff is to restate the unit rules in a calm,
assertive manner. Because of the probability of manipulative behavior in this client
population, it is imperative to maintain consistent application of rules.
A client diagnosed with borderline personality disorder brings up a conflict with the staff
in a community meeting and develops a following of clients who unreasonably demand
modification of unit rules. How can the nursing staff best handle this situation?
A. Allow the clients to apply the democratic process when developing unit rules.
B. Maintain consistency of care by open communication to avoid staff manipulation.
C. Allow the client spokesman to verbalize concerns during a unit staff meeting.
D. Maintain unit order by the application of autocratic leadership. - ansANS: B
The nursing staff can best handle this situation by maintaining consistency of care by
open communication to avoid staff manipulation. Clients diagnosed with borderline
personality disorder can exhibit negative patterns of interaction such as clinging and
distancing, splitting, manipulation, and self-destructive behaviors.
A client diagnosed with cluster "C" traits sits alone and ignores other's attempts to
converse. When ask to join a group the client states, "No thanks." In this situation,
which should the nurse assign as an initial nursing diagnosis?
A. Fear R/T hospitalization
B. Social isolation R/T poor self-esteem
C. Risk for suicide R/T to hopelessness
D. Powerlessness R/T dependence issues - ansANS: B
Clients diagnosed with cluster "C" traits are described as anxious and fearful. The DSM-
IV-TR divides cluster "C" personality disorders into three categories: avoidant,
dependent, and obsessive-compulsive. Anxiety and fear contribute to social isolation.
A client diagnosed with paranoid personality disorder becomes violent on a unit. Which
nursing intervention is most appropriate?
A. Provide objective evidence, that violence is unwarranted.
B. Initially restrain the client to maintain safety.
C. Use clear, calm statements and a confident physical stance.
D. Empathize with the client's paranoid perceptions. - ansANS: C
The most appropriate nursing intervention is to use clear, calm statements and to
assume a confident physical stance. A calm attitude avoids escalating the aggressive
,behavior and provides the client with a feeling of safety and security. It may also be
beneficial to have sufficient staff on hand to present a show of strength.
A client exhibits dependency on staff and peers and expresses fear of abandonment.
Using Mahler's theory of object relations, which should the nurse expect to note in this
client's childhood?
A. Lack of fulfillment of basic needs by parental figures
B. Absence of the client's maternal figure during symbiosis
C. Difficulty establishing trust with the maternal figure
D. Inconsistency by the maternal figure during individuation - ansANS: D
During phase 3 (5 to 36 months) of Margaret Mahler's individuation theory, there should
be a strengthening of the ego and an acceptance of "self" with independent ego
boundaries. Inconsistency by the maternal figure during individuation may in later years
result in feelings of helplessness when the client is alone because of exaggerated fears
of being unable to care for self.
A highly emotional client presents at an outpatient clinic appointment wearing
flamboyant attire, spiked heels, and theatrical makeup. Which personality disorder
should a nurse associate with this assessment data?
A. Compulsive personality disorder
B. Schizotypal personality disorder
C. Histrionic personality disorder
D. Manic personality disorder - ansANS: C
The nurse should associate histrionic personality disorder with this assessment data.
Individuals diagnosed with histrionic personality disorder tend to be self-dramatizing,
attention seeking, overly gregarious, and seductive. They often use manipulation and
exhibitionism as a means of gaining attention.
A nurse is caring for a group of clients within the DSM-IV-TR cluster B category of
personality disorders. Which factors should the nurse consider when planning client
care? (Select all that apply.)
A. These clients have personality traits that are deeply ingrained and difficult to modify.
B. These clients need medications to treat the underlying physiological pathology.
C. These clients use manipulation, making the implementation of treatment problematic.
D. These clients have poor impulse control that hinders compliance with a plan of care.
E. These clients commonly have secondary diagnoses of substance abuse and
depression. - ansANS: A, C, D, E
The nurse should consider that individuals diagnosed with cluster B-type personality
disorders have deeply ingrained personality traits, use manipulation, have poor impulse
control, and often have secondary diagnoses of substance abuse and/or depression.
This cluster includes antisocial, borderline, histrionic, and narcissistic personality
disorders.
A nurse tells a client that the nursing staff will start alternating weekend shifts. Which
response should a nurse identify as characteristic of clients diagnosed with obsessive-
compulsive personality disorder?
,A. "You really don't have to go by that schedule. I'd just stay home sick."
B. "There has got to be a hidden agenda behind this schedule change."
C. "Who do you think you are? I expect to interact with the same nurse every Saturday."
D. "You can't make these kinds of changes! Isn't there a rule that governs this
decision?" - ansANS: D
The nurse should identify that a client diagnosed with obsessive-compulsive personality
disorder would have a difficult time accepting change. This disorder is characterized by
inflexibility and lack of spontaneity. Individuals diagnosed with this disorder are very
serious, formal, over disciplined, perfectionistic, and preoccupied with rules.
A nurse would expect a client diagnosed with schizotypal personality disorder to exhibit
which characteristic?
A. The client keeps to self and has few, if any relationships.
B. The client has many brief but intense relationships.
C. The client experiences incorrect interpretations of external events.
D. The client exhibits lack of tender feelings toward others. - ansANS: C
Clients who are diagnosed with schizotypal personality disorder experience odd beliefs
or magical thinking that influences behavior and is inconsistent with cultural norms. This
results in incorrect interpretations of external events.
A nursing instructor is teaching students about clients diagnosed with histrionic
personality disorder and the quality of their relationships. Which student statement
indicates that learning has occurred?
A. "Their dramatic style tends to make their interpersonal relationships quite interesting
and fulfilling."
B. "Their interpersonal relationships tend to be shallow and fleeting, serving their
dependency needs."
C. "They tend to develop few relationships because they are strongly independent but
generally maintain deep affection."
D. "They pay particular attention to details which can frustrate the development of
relationships." - ansANS: B
The instructor should evaluate that learning has occurred when the student describes
clients diagnosed with histrionic personality disorder as having shallow, fleeting
interpersonal relationships that serve their dependency needs. Histrionic personality
disorder is characterized by colorful, dramatic, and extroverted behavior. These
individuals also have difficulty maintaining long-lasting relationships.
A pessimistic client expresses low self-worth, has much difficulty making decisions,
avoids positions of responsibility, and has a behavioral pattern of "suffering" in silence.
Which underlying cause of this client's personality disorder should a nurse recognize?
A. "Nurturance was provided from many sources, and independent behaviors were
encouraged."
B. "Nurturance was provided exclusively from one source, and independent behaviors
were discouraged."
C. "Nurturance was provided exclusively from one source, and independent behaviors
were encouraged."
, D. "Nurturance was provided from many sources, and independent behaviors were
discouraged." - ansANS: B
Nurturance provided from one source and discouragement of independent behaviors
can attribute to the etiology of dependent personality disorder. Dependent behaviors
may be rewarded by a parent who is overprotective and discourages autonomy.
During an assessment interview, a client diagnosed with antisocial personality disorder
spits, curses, and refuses to answer questions. Which is the most appropriate nursing
statement to address this behavior?
A. "You are very disrespectful. You need to learn to control yourself."
B. "I understand that you are angry, but this behavior will not be tolerated."
C. "What behaviors could you modify to improve this situation?"
D. "What anti-personality-disorder medications have helped you in the past?" - ansANS:
B
The appropriate nursing statement is to reflect the client's feeling while setting firm limits
on behavior. Clients diagnosed with antisocial personality disorder have a low tolerance
for frustration, see themselves as victims, and use projection as a primary ego defense
mechanism. Antidepressants and anxiolytics are used for symptom relief; however,
there are no specific medications targeted for the diagnosis of a personality disorder.
During an interview, which client statement indicates to a nurse that a potential
diagnosis of schizotypal personality disorder should be considered?
A. "I really don't have a problem. My family is inflexible, and every relative is out to get
me."
B. "I am so excited about working with you. Have you noticed my new nail polish: 'Ruby
Red Roses'?"
C. "I spend all my time tending my bees. I know a whole lot of information about bees."
D. "I am getting a message from the beyond that we have been involved with each other
in a previous life." - ansANS: D
The nurse should assess that a client who states that he or she is getting a message
from the beyond indicates a potential diagnosis of schizotypal personality disorder.
Individuals with schizotypal personality disorder are aloof and isolated and behave in a
bland and apathetic manner. The individual experiences magical thinking, ideas of
reference, illusions, and depersonalization as part of daily life.
Family members of a client ask a nurse to explain the difference between schizoid and
avoidant personality disorders. Which is the appropriate nursing reply?
A. "Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and
clients diagnosed with schizoid personality disorder prefer to be alone."
B. "Clients diagnosed with schizoid personality disorder exhibit odd, bizarre, and
eccentric behavior, while clients diagnosed with avoidant personality disorder do not."
C. "Clients diagnosed with avoidant personality disorder are eccentric, and clients
diagnosed with schizoid personality disorder are dull and vacant."
D. "Clients diagnosed with schizoid personality disorder have a history of psychotic
thought processes, while clients diagnosed with avoidant personality disorder remain
based in reality." - ansANS: A
11:00 p.m. requesting to phone a lawyer to discuss filing for a divorce. The unit rules
state that no phone calls are permitted after 10:00 p.m. Which nursing reply is most
appropriate?
A. "Go ahead and use the phone. I know this pending divorce is stressful."
B. "You know better than to break the rules. I'm surprised at you."
C. "It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow."
D. "The decision to divorce should not be considered until you have had a good night's
sleep." - ansANS: C
The most appropriate response by the staff is to restate the unit rules in a calm,
assertive manner. Because of the probability of manipulative behavior in this client
population, it is imperative to maintain consistent application of rules.
A client diagnosed with borderline personality disorder brings up a conflict with the staff
in a community meeting and develops a following of clients who unreasonably demand
modification of unit rules. How can the nursing staff best handle this situation?
A. Allow the clients to apply the democratic process when developing unit rules.
B. Maintain consistency of care by open communication to avoid staff manipulation.
C. Allow the client spokesman to verbalize concerns during a unit staff meeting.
D. Maintain unit order by the application of autocratic leadership. - ansANS: B
The nursing staff can best handle this situation by maintaining consistency of care by
open communication to avoid staff manipulation. Clients diagnosed with borderline
personality disorder can exhibit negative patterns of interaction such as clinging and
distancing, splitting, manipulation, and self-destructive behaviors.
A client diagnosed with cluster "C" traits sits alone and ignores other's attempts to
converse. When ask to join a group the client states, "No thanks." In this situation,
which should the nurse assign as an initial nursing diagnosis?
A. Fear R/T hospitalization
B. Social isolation R/T poor self-esteem
C. Risk for suicide R/T to hopelessness
D. Powerlessness R/T dependence issues - ansANS: B
Clients diagnosed with cluster "C" traits are described as anxious and fearful. The DSM-
IV-TR divides cluster "C" personality disorders into three categories: avoidant,
dependent, and obsessive-compulsive. Anxiety and fear contribute to social isolation.
A client diagnosed with paranoid personality disorder becomes violent on a unit. Which
nursing intervention is most appropriate?
A. Provide objective evidence, that violence is unwarranted.
B. Initially restrain the client to maintain safety.
C. Use clear, calm statements and a confident physical stance.
D. Empathize with the client's paranoid perceptions. - ansANS: C
The most appropriate nursing intervention is to use clear, calm statements and to
assume a confident physical stance. A calm attitude avoids escalating the aggressive
,behavior and provides the client with a feeling of safety and security. It may also be
beneficial to have sufficient staff on hand to present a show of strength.
A client exhibits dependency on staff and peers and expresses fear of abandonment.
Using Mahler's theory of object relations, which should the nurse expect to note in this
client's childhood?
A. Lack of fulfillment of basic needs by parental figures
B. Absence of the client's maternal figure during symbiosis
C. Difficulty establishing trust with the maternal figure
D. Inconsistency by the maternal figure during individuation - ansANS: D
During phase 3 (5 to 36 months) of Margaret Mahler's individuation theory, there should
be a strengthening of the ego and an acceptance of "self" with independent ego
boundaries. Inconsistency by the maternal figure during individuation may in later years
result in feelings of helplessness when the client is alone because of exaggerated fears
of being unable to care for self.
A highly emotional client presents at an outpatient clinic appointment wearing
flamboyant attire, spiked heels, and theatrical makeup. Which personality disorder
should a nurse associate with this assessment data?
A. Compulsive personality disorder
B. Schizotypal personality disorder
C. Histrionic personality disorder
D. Manic personality disorder - ansANS: C
The nurse should associate histrionic personality disorder with this assessment data.
Individuals diagnosed with histrionic personality disorder tend to be self-dramatizing,
attention seeking, overly gregarious, and seductive. They often use manipulation and
exhibitionism as a means of gaining attention.
A nurse is caring for a group of clients within the DSM-IV-TR cluster B category of
personality disorders. Which factors should the nurse consider when planning client
care? (Select all that apply.)
A. These clients have personality traits that are deeply ingrained and difficult to modify.
B. These clients need medications to treat the underlying physiological pathology.
C. These clients use manipulation, making the implementation of treatment problematic.
D. These clients have poor impulse control that hinders compliance with a plan of care.
E. These clients commonly have secondary diagnoses of substance abuse and
depression. - ansANS: A, C, D, E
The nurse should consider that individuals diagnosed with cluster B-type personality
disorders have deeply ingrained personality traits, use manipulation, have poor impulse
control, and often have secondary diagnoses of substance abuse and/or depression.
This cluster includes antisocial, borderline, histrionic, and narcissistic personality
disorders.
A nurse tells a client that the nursing staff will start alternating weekend shifts. Which
response should a nurse identify as characteristic of clients diagnosed with obsessive-
compulsive personality disorder?
,A. "You really don't have to go by that schedule. I'd just stay home sick."
B. "There has got to be a hidden agenda behind this schedule change."
C. "Who do you think you are? I expect to interact with the same nurse every Saturday."
D. "You can't make these kinds of changes! Isn't there a rule that governs this
decision?" - ansANS: D
The nurse should identify that a client diagnosed with obsessive-compulsive personality
disorder would have a difficult time accepting change. This disorder is characterized by
inflexibility and lack of spontaneity. Individuals diagnosed with this disorder are very
serious, formal, over disciplined, perfectionistic, and preoccupied with rules.
A nurse would expect a client diagnosed with schizotypal personality disorder to exhibit
which characteristic?
A. The client keeps to self and has few, if any relationships.
B. The client has many brief but intense relationships.
C. The client experiences incorrect interpretations of external events.
D. The client exhibits lack of tender feelings toward others. - ansANS: C
Clients who are diagnosed with schizotypal personality disorder experience odd beliefs
or magical thinking that influences behavior and is inconsistent with cultural norms. This
results in incorrect interpretations of external events.
A nursing instructor is teaching students about clients diagnosed with histrionic
personality disorder and the quality of their relationships. Which student statement
indicates that learning has occurred?
A. "Their dramatic style tends to make their interpersonal relationships quite interesting
and fulfilling."
B. "Their interpersonal relationships tend to be shallow and fleeting, serving their
dependency needs."
C. "They tend to develop few relationships because they are strongly independent but
generally maintain deep affection."
D. "They pay particular attention to details which can frustrate the development of
relationships." - ansANS: B
The instructor should evaluate that learning has occurred when the student describes
clients diagnosed with histrionic personality disorder as having shallow, fleeting
interpersonal relationships that serve their dependency needs. Histrionic personality
disorder is characterized by colorful, dramatic, and extroverted behavior. These
individuals also have difficulty maintaining long-lasting relationships.
A pessimistic client expresses low self-worth, has much difficulty making decisions,
avoids positions of responsibility, and has a behavioral pattern of "suffering" in silence.
Which underlying cause of this client's personality disorder should a nurse recognize?
A. "Nurturance was provided from many sources, and independent behaviors were
encouraged."
B. "Nurturance was provided exclusively from one source, and independent behaviors
were discouraged."
C. "Nurturance was provided exclusively from one source, and independent behaviors
were encouraged."
, D. "Nurturance was provided from many sources, and independent behaviors were
discouraged." - ansANS: B
Nurturance provided from one source and discouragement of independent behaviors
can attribute to the etiology of dependent personality disorder. Dependent behaviors
may be rewarded by a parent who is overprotective and discourages autonomy.
During an assessment interview, a client diagnosed with antisocial personality disorder
spits, curses, and refuses to answer questions. Which is the most appropriate nursing
statement to address this behavior?
A. "You are very disrespectful. You need to learn to control yourself."
B. "I understand that you are angry, but this behavior will not be tolerated."
C. "What behaviors could you modify to improve this situation?"
D. "What anti-personality-disorder medications have helped you in the past?" - ansANS:
B
The appropriate nursing statement is to reflect the client's feeling while setting firm limits
on behavior. Clients diagnosed with antisocial personality disorder have a low tolerance
for frustration, see themselves as victims, and use projection as a primary ego defense
mechanism. Antidepressants and anxiolytics are used for symptom relief; however,
there are no specific medications targeted for the diagnosis of a personality disorder.
During an interview, which client statement indicates to a nurse that a potential
diagnosis of schizotypal personality disorder should be considered?
A. "I really don't have a problem. My family is inflexible, and every relative is out to get
me."
B. "I am so excited about working with you. Have you noticed my new nail polish: 'Ruby
Red Roses'?"
C. "I spend all my time tending my bees. I know a whole lot of information about bees."
D. "I am getting a message from the beyond that we have been involved with each other
in a previous life." - ansANS: D
The nurse should assess that a client who states that he or she is getting a message
from the beyond indicates a potential diagnosis of schizotypal personality disorder.
Individuals with schizotypal personality disorder are aloof and isolated and behave in a
bland and apathetic manner. The individual experiences magical thinking, ideas of
reference, illusions, and depersonalization as part of daily life.
Family members of a client ask a nurse to explain the difference between schizoid and
avoidant personality disorders. Which is the appropriate nursing reply?
A. "Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and
clients diagnosed with schizoid personality disorder prefer to be alone."
B. "Clients diagnosed with schizoid personality disorder exhibit odd, bizarre, and
eccentric behavior, while clients diagnosed with avoidant personality disorder do not."
C. "Clients diagnosed with avoidant personality disorder are eccentric, and clients
diagnosed with schizoid personality disorder are dull and vacant."
D. "Clients diagnosed with schizoid personality disorder have a history of psychotic
thought processes, while clients diagnosed with avoidant personality disorder remain
based in reality." - ansANS: A
