PSYCHIATRIC MENTAL HEALTH NURSING BY
MARY C TOWNSEND ALL CHAPTERS 2026
EXAM SCRIPT COMPLETE QUESTIONS AND
SOLUTIONS GRADED A+
◉ Nursing Guidelines for Antisocial PD. Answer: 1. Try to prevent or
reduce untoward effects of manipulation (flattery, seductiveness,
instilling of guilt):
• Set clear and realistic limits on specific behavior.
• Ensure that limits are adhered to by all staff.
• Carefully document signs of manipulation or aggression.
• Document behaviors (give times, dates, circumstances). Provide
clear boundaries and consequences.
2. Be aware that antisocial patients can instill guilt when they are
not getting what they want. Guard against being manipulated
through feelings of guilt.
3. Substance abuse is best handled through a well-organized
treatment program before counseling and other forms of therapy are
started.
◉ Avoidant PD. Answer: characteristics are an extreme sensitivity to
rejection and robust avoidance of interpersonal situations. These
individuals demonstrate poor self-confidence and are prone to
,misinterpreting others' feedback because they are overly sensitive to
rejection.
◉ Nursing Guidelines for Avoidant PD. Answer: 1. A friendly,
accepting, reassuring approach is the best way to treat patients.
2. Being pushed into social situations can cause extreme and severe
anxiety.
◉ Borderline PD. Answer: most common and dramatic, is
characterized by severe impairments in functioning; instability in
emotion regulation, interpersonal relationships, impulsivity, identity
or self-image distortions, and unstable mood.
◉ Nursing Guidelines for Borderline PD. Answer: 1. Set realistic
goals, use clear action words.
2. Be aware of manipulative behaviors (flattery, seductiveness,
instilling of guilt).
3. Provide clear and consistent boundaries and limits.
4. Use clear and straightforward communication.
5. When behavioral problems emerge, calmly review the therapeutic
goals and boundaries of treatment.
6. Avoid rejecting or rescuing.
7. Assess for suicidal and self-mutilating behaviors, especially during
times of stress.
,◉ Dependent PD. Answer: establish relationships in which they are
submissive, self-doubting, and avoid self responsibility. find it
difficult to sustain autonomy and often seek out relationships in
which they can be taken care of.
◉ Nursing Guidelines for Dependent PD. Answer: 1. Identify and
help address current stresses.
2. Try to satisfy patient's needs at the same time that limits are set
up in such a manner that patient does not feel punished and
withdraw.
3. Be aware that strong countertransference often develops in
clinicians because of patient's excessive clinging (demands of extra
time, nighttime calls, crisis before vacations); therefore, supervision
is well advised.
4. Teach and role-model assertiveness.
◉ dialectical behavior therapy. Answer: evidence-based theory to
successfully treat chronically suicidal pts w/ borderline personality
disorder. combines cognitive behavioral techniques with
mindfulness, which emphasizes being aware of thoughts and actively
shaping them.
◉ histrionic PD. Answer: marked by emotional attention-seeking
behavior in which the person needs to be the center of attention.
, -impulsive,melodramatic, flirtatious and provocative.
◉ Nursing Guidelines for histrionic PD. Answer: 1. Understand
seductive behavior as a response to distress.
2. Keep communication and interactions professional, despite
temptation to collude with the patient in a flirtatious and misleading
manner.
3. Encourage and model the use of concrete and descriptive rather
than vague and impressionistic language.
4. Teach and role-model assertiveness.
◉ Narcissistic PD. Answer: arrogance w/ grandiose view of self-
importance. Has the need for constant admiration, along w/ a lack of
empathy for others, which strains relationships. results in
exploitation of others. Underneath this personality is a person w/
intense shame and fear of abandonment.
◉ Nursing Guidelines for Narcissistic PD. Answer: 1. Remain neutral;
avoid engaging in power struggles or becoming defensive in
response to the patient's disparaging remarks.
2. Convey unassuming self-confidence.
◉ obsessive-compulsive PD. Answer: characteristics of
perfectionism w/ a focus on orderliness and control. These people
MARY C TOWNSEND ALL CHAPTERS 2026
EXAM SCRIPT COMPLETE QUESTIONS AND
SOLUTIONS GRADED A+
◉ Nursing Guidelines for Antisocial PD. Answer: 1. Try to prevent or
reduce untoward effects of manipulation (flattery, seductiveness,
instilling of guilt):
• Set clear and realistic limits on specific behavior.
• Ensure that limits are adhered to by all staff.
• Carefully document signs of manipulation or aggression.
• Document behaviors (give times, dates, circumstances). Provide
clear boundaries and consequences.
2. Be aware that antisocial patients can instill guilt when they are
not getting what they want. Guard against being manipulated
through feelings of guilt.
3. Substance abuse is best handled through a well-organized
treatment program before counseling and other forms of therapy are
started.
◉ Avoidant PD. Answer: characteristics are an extreme sensitivity to
rejection and robust avoidance of interpersonal situations. These
individuals demonstrate poor self-confidence and are prone to
,misinterpreting others' feedback because they are overly sensitive to
rejection.
◉ Nursing Guidelines for Avoidant PD. Answer: 1. A friendly,
accepting, reassuring approach is the best way to treat patients.
2. Being pushed into social situations can cause extreme and severe
anxiety.
◉ Borderline PD. Answer: most common and dramatic, is
characterized by severe impairments in functioning; instability in
emotion regulation, interpersonal relationships, impulsivity, identity
or self-image distortions, and unstable mood.
◉ Nursing Guidelines for Borderline PD. Answer: 1. Set realistic
goals, use clear action words.
2. Be aware of manipulative behaviors (flattery, seductiveness,
instilling of guilt).
3. Provide clear and consistent boundaries and limits.
4. Use clear and straightforward communication.
5. When behavioral problems emerge, calmly review the therapeutic
goals and boundaries of treatment.
6. Avoid rejecting or rescuing.
7. Assess for suicidal and self-mutilating behaviors, especially during
times of stress.
,◉ Dependent PD. Answer: establish relationships in which they are
submissive, self-doubting, and avoid self responsibility. find it
difficult to sustain autonomy and often seek out relationships in
which they can be taken care of.
◉ Nursing Guidelines for Dependent PD. Answer: 1. Identify and
help address current stresses.
2. Try to satisfy patient's needs at the same time that limits are set
up in such a manner that patient does not feel punished and
withdraw.
3. Be aware that strong countertransference often develops in
clinicians because of patient's excessive clinging (demands of extra
time, nighttime calls, crisis before vacations); therefore, supervision
is well advised.
4. Teach and role-model assertiveness.
◉ dialectical behavior therapy. Answer: evidence-based theory to
successfully treat chronically suicidal pts w/ borderline personality
disorder. combines cognitive behavioral techniques with
mindfulness, which emphasizes being aware of thoughts and actively
shaping them.
◉ histrionic PD. Answer: marked by emotional attention-seeking
behavior in which the person needs to be the center of attention.
, -impulsive,melodramatic, flirtatious and provocative.
◉ Nursing Guidelines for histrionic PD. Answer: 1. Understand
seductive behavior as a response to distress.
2. Keep communication and interactions professional, despite
temptation to collude with the patient in a flirtatious and misleading
manner.
3. Encourage and model the use of concrete and descriptive rather
than vague and impressionistic language.
4. Teach and role-model assertiveness.
◉ Narcissistic PD. Answer: arrogance w/ grandiose view of self-
importance. Has the need for constant admiration, along w/ a lack of
empathy for others, which strains relationships. results in
exploitation of others. Underneath this personality is a person w/
intense shame and fear of abandonment.
◉ Nursing Guidelines for Narcissistic PD. Answer: 1. Remain neutral;
avoid engaging in power struggles or becoming defensive in
response to the patient's disparaging remarks.
2. Convey unassuming self-confidence.
◉ obsessive-compulsive PD. Answer: characteristics of
perfectionism w/ a focus on orderliness and control. These people
