NR 547 Week 7
1. Michelle is a 24-year-old who is seen in the ED after a non-fatal suicide attempt. She states
that her boyfriend of three months announced that he was leaving town to visit his parents for
the weekend. She moved in with herboyfriend two weeks after they began dating and
expected to be asked to gowith him. Her boyfriend told her that the trip was only for the
weekend and he would be back in two days. She responded to him by screaming, crying, and
accusing him of not caring about her. She stated that she was "in a rage."Michelle
acknowledges that she has been in serial relationships since age 12;she states, "my boyfriends
always leave me because I am a bad person." Shecannot provide details about why she
considers herself "bad'. She admits toself-cutting as a coping mechanism because she often
feels "empty inside"; both inner forearms are scarred and contain several open wounds.
Based on DSM-5-TR (APA, 2022), doe: unable to determine
Rationale: Michelle meets only five diagnostic criteria for the diagnosis of bor- derline
personality disorder: efforts to avoid abandonment; unstable and intense relationships;
suicidal and self-mutilating behavior; inappropriate, intense anger; and feelings of emptiness.
Information was not collected about Michelle's possiblesubstance use; the PMHNP should
rule out substance use disorder as a potentialcause of symptoms before formulating the
diagnosis.
2. Lesley is a 32-year-old who is referred for a fitness for duty examination byher human
resources department after several instances of "inappropriately provocative" behavior. She
states that her behavior has been misinterpretedby others; she simply likes to "dress to
impress, and my outfits make some people in the office uncomfortable because I take care of
myself." Lesley states that she has been in a 16-year monogamous relationship with her
partner. She indicates that she does not have any close friends or associatesat work as she
keeps mostly to herself.
Lesley arrives at her appointment with impeccable hair and makeup and a low-cut shirt, tight
jeans, and heels. She is wearing several rings on each handand has long manicured nails. Her
speech is even in tone and coherent in content. Affect is within normal range and appropriate
to the context.
Based on DSM-5-TR (APA, 2022), does Lesley meet diagnostic criteri: No
Rationale: Although Lesley dresses in what may be considered a provocative man-ner and
takes pains with her appearance, she does not appear to meet any addi- tional criteria
consistent with histrionic personality disorder. Her speech and affect are normal, and she
appears to express emotion appropriately for the situation. Her
behavior is not overly dramatized or exaggerated. She denies intimate relationshipsother than
her partner.
, 3. Cluster C: Cluster C personality disorders are characterized by anxious orfearful thinking
and behavior.
-AVOIDANT PERSONALITY DISORDER
• extreme sensitivity to criticism or rejection
• may feel inadequate, inferior, or unattractive
• often socially inhibited, withdrawn, or shy, though they greatly desire companion-ship
• typically avoid activities that require interpersonal contact
-DEPENDENT PERSONALITY DISORDER
• excessive dependence on others
• feeling the need to have others assume responsibility for significant portions oftheir lives
• appears submissive or clingy
• often tolerating abuse or poor treatment
• tend to lack self-confidence
• intense discomfort when left alone for any length of time
-OBSESSIVE-COMPULSIVE PERSONALITY DISORDER
• pervasive pattern of perfectionism and inflexibility
• preoccupation with details, orderliness, or rules to control others, tasks, andsituations
• emotionally constricted, perseverative, stubborn, and indecisive, sometimes ne- glecting
friends or enjoyable activities because of excessive commitment to work orsome other project
-PERSONALITY CHANGES DUE TO GENERAL MEDICAL CONDITION
• brain disease or damage, postencephalitic syndrome, and postconcussional syn-drome
• signs and symptoms include emotional instability, lack of impulse control, aggres-sive
behavior, outbursts of rage, suspicion, apathy, or paranoia
4. Shannon is a 40-year-old who presents with complaints of anxiety. She states her anxiety
is related to work; she has been expected to delegate a project to others on her team, and she
is concerned that her teammates will not be able to complete the project "the way it should be
done." She has madea detailed schedule and lists for the project and is concerned that the
minutedetails she has recorded will be missed.
Shannon meets several criteria for obsessive-compulsive personality disor-der. What
additional information will support this diagnosis? Select all that apply.
"I try to relax twice a week by attending a yoga class."
1. Michelle is a 24-year-old who is seen in the ED after a non-fatal suicide attempt. She states
that her boyfriend of three months announced that he was leaving town to visit his parents for
the weekend. She moved in with herboyfriend two weeks after they began dating and
expected to be asked to gowith him. Her boyfriend told her that the trip was only for the
weekend and he would be back in two days. She responded to him by screaming, crying, and
accusing him of not caring about her. She stated that she was "in a rage."Michelle
acknowledges that she has been in serial relationships since age 12;she states, "my boyfriends
always leave me because I am a bad person." Shecannot provide details about why she
considers herself "bad'. She admits toself-cutting as a coping mechanism because she often
feels "empty inside"; both inner forearms are scarred and contain several open wounds.
Based on DSM-5-TR (APA, 2022), doe: unable to determine
Rationale: Michelle meets only five diagnostic criteria for the diagnosis of bor- derline
personality disorder: efforts to avoid abandonment; unstable and intense relationships;
suicidal and self-mutilating behavior; inappropriate, intense anger; and feelings of emptiness.
Information was not collected about Michelle's possiblesubstance use; the PMHNP should
rule out substance use disorder as a potentialcause of symptoms before formulating the
diagnosis.
2. Lesley is a 32-year-old who is referred for a fitness for duty examination byher human
resources department after several instances of "inappropriately provocative" behavior. She
states that her behavior has been misinterpretedby others; she simply likes to "dress to
impress, and my outfits make some people in the office uncomfortable because I take care of
myself." Lesley states that she has been in a 16-year monogamous relationship with her
partner. She indicates that she does not have any close friends or associatesat work as she
keeps mostly to herself.
Lesley arrives at her appointment with impeccable hair and makeup and a low-cut shirt, tight
jeans, and heels. She is wearing several rings on each handand has long manicured nails. Her
speech is even in tone and coherent in content. Affect is within normal range and appropriate
to the context.
Based on DSM-5-TR (APA, 2022), does Lesley meet diagnostic criteri: No
Rationale: Although Lesley dresses in what may be considered a provocative man-ner and
takes pains with her appearance, she does not appear to meet any addi- tional criteria
consistent with histrionic personality disorder. Her speech and affect are normal, and she
appears to express emotion appropriately for the situation. Her
behavior is not overly dramatized or exaggerated. She denies intimate relationshipsother than
her partner.
, 3. Cluster C: Cluster C personality disorders are characterized by anxious orfearful thinking
and behavior.
-AVOIDANT PERSONALITY DISORDER
• extreme sensitivity to criticism or rejection
• may feel inadequate, inferior, or unattractive
• often socially inhibited, withdrawn, or shy, though they greatly desire companion-ship
• typically avoid activities that require interpersonal contact
-DEPENDENT PERSONALITY DISORDER
• excessive dependence on others
• feeling the need to have others assume responsibility for significant portions oftheir lives
• appears submissive or clingy
• often tolerating abuse or poor treatment
• tend to lack self-confidence
• intense discomfort when left alone for any length of time
-OBSESSIVE-COMPULSIVE PERSONALITY DISORDER
• pervasive pattern of perfectionism and inflexibility
• preoccupation with details, orderliness, or rules to control others, tasks, andsituations
• emotionally constricted, perseverative, stubborn, and indecisive, sometimes ne- glecting
friends or enjoyable activities because of excessive commitment to work orsome other project
-PERSONALITY CHANGES DUE TO GENERAL MEDICAL CONDITION
• brain disease or damage, postencephalitic syndrome, and postconcussional syn-drome
• signs and symptoms include emotional instability, lack of impulse control, aggres-sive
behavior, outbursts of rage, suspicion, apathy, or paranoia
4. Shannon is a 40-year-old who presents with complaints of anxiety. She states her anxiety
is related to work; she has been expected to delegate a project to others on her team, and she
is concerned that her teammates will not be able to complete the project "the way it should be
done." She has madea detailed schedule and lists for the project and is concerned that the
minutedetails she has recorded will be missed.
Shannon meets several criteria for obsessive-compulsive personality disor-der. What
additional information will support this diagnosis? Select all that apply.
"I try to relax twice a week by attending a yoga class."
