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Varcarolis: Essentials of Psychiatric Mental Health Nursing

Test Bank
Chapter 10: Personality Disorders
MULTIPLE CHOICE
1. A physical therapist recently convicted of multiple counts of Medicare fraud says to a
nurse, Sure I overbilled. Why not? Everyone takes advantage of the government. They
have so many rules no one can follow them. These statements show:
a. shame.
b. superficial remorse.
c. suspiciousness.
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 patients remarks cannot be assessed as shameful.
Lack of trust and concern that others are determined to harm is not shown.
DIF: Cognitive Level: Application
TOP: Nursing Process: Assessment

REF: Text Pages: 178, 186


MSC: NCLEX: Psychosocial Integrity

2. Which intervention is appropriate for a patient with an antisocial personality disorder and
a nursing diagnosis of Ineffective coping related to manipulation of others?
a. Refer requests and questions related to care to the primary nurse.
b. Provide negative reinforcement for acting-out behavior.
c. Ignore, rather than confront, inappropriate behavior.
d. Encourage the patient to discuss feelings of fear and inferiority.
ANS: A
Manipulative patients 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.
DIF: Cognitive Level: Application
REF: Text Page: 189
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care
Environment
3. Which nursing strategy would make limit setting more acceptable for patients with
personality disorders?
a. Confront the patient with the inappropriateness of the behavior.
b. Explore with the patient the underlying dynamics of the behavior.
Copyright 2009 by Saunders, an imprint of Elsevier Inc.

Test Bank

10-2

c. Reflect back to the patient an understanding of the patients distress.


d. State a value judgment regarding the behavior and its consequences.
ANS: C
Setting limits is better accepted by patients if staff first use empathic mirroring without
making a value judgment. Exploring underlying dynamics of behavior with the patient
has little to do with patient acceptance of limits.
DIF: Cognitive Level: Application
REF: Text Page: 189
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
4. What is an appropriate initial outcome for a patient with a personality disorder and a
nursing diagnosis of Ineffective coping related to use of manipulation? 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 and
immediacy control.
DIF: Cognitive Level: Analysis
REF: Text Pages: 188-189
TOP: Nursing Process: Outcomes Identification
MSC: NCLEX: Psychosocial Integrity
5. Consider these comments to three different nurses by a patient with an antisocial
personality disorder: Youre a much better nurse than the day shift nurse said you were;
The nurse on night shift is upset with you for some reason; You think youre perfect
but Ive seen you make three mistakes. Collectively, these interactions can be assessed
as:
a. seductive.
b. detached.
c. guilt producing.
d. manipulative.
ANS: D
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 evidenced in all three
comments.

Copyright 2009 by Saunders, an imprint of Elsevier Inc.

Test Bank

10-3

DIF: Cognitive Level: Application


TOP: Nursing Process: Assessment

REF: Text Page: 189


MSC: NCLEX: Psychosocial Integrity

6. A nurse reports to the interdisciplinary team that a patient with an antisocial personality
disorder lies to other patients, verbally abuses a patient with Alzheimers disease, and
flatters the primary nurse. This patient is detached and superficial during counseling
sessions. Which behavior most clearly warrants limit setting?
a. Lying to other patients
b. Flattering the nurse
c. Verbal abuse of another patient
d. Detached superficiality during counseling
ANS: C
Limits must be set in areas in which the patients behavior affects the rights of others.
Limiting verbal abuse of another patient is a priority intervention. The other concerns
should be addressed during therapeutic encounters.
DIF: Cognitive Level: Analysis
TOP: Nursing Process: Planning
Environment

REF: Text Page: 181


MSC: NCLEX: Safe, Effective Care

7. A patient with borderline personality disorder has been hospitalized several times after
self-mutilating episodes and suicide attempts. During counseling, the patient reveals
feelings of mild depression and anger with life. The psychiatrist suggests use of
medication. For which type of medication should the nurse prepare a teaching plan?
a. Selective serotonin reuptake inhibitor (SSRI)
b. Antipsychotic
c. Benzodiazepine
d. Monoamine oxidase inhibitor (MAOI)
ANS: A
SSRIs are used to treat depression. Many patients with borderline personality disorder are
fearful of taking something over which they have little control. Because SSRIs have a
good side effect profile, the patient is more likely to comply with the medication. Lowdose antipsychotics or anxiolytics are not supported by the data given in the scenario.
MAOIs require great diligence in adherence to a restricted diet and are therefore rarely
used for patients who are impulsive.
DIF: Cognitive Level: Analysis
TOP: Nursing Process: Planning

REF: Text Page: 192


MSC: NCLEX: Physiological Integrity

8. A patients spouse filed charges of battery. The patient tells the judge, Im so sorry for
what I did. I need psychiatric help. The patient has a long history of acting-out behaviors
and several arrests. When interviewing the patient about the relationship with the spouse,
which statement suggests this individual has an antisocial personality disorder?

Copyright 2009 by Saunders, an imprint of Elsevier Inc.

Test Bank
a.
b.
c.
d.

10-4

Ive done some stupid things in my life, but Ive learned a lesson.
Im feeling terrible about the way my behavior has hurt my family.
I have a quick temper, but I can usually keep it under control.
I hit because Im tired of being nagged. My spouse deserves the beating.

ANS: D
The patient with an antisocial personality disorder often impulsively acts out feelings of
anger and feels no guilt or remorse. Patients with antisocial personality disorders rarely
seem to learn from experience, rarely feel true remorse, and have problems with anger
management and impulse control.
DIF: Cognitive Level: Application
TOP: Nursing Process: Assessment

REF: Text Pages: 181, 186


MSC: NCLEX: Psychosocial Integrity

9. What is the priority nursing diagnosis for a patient with antisocial personality disorder
who has made threats against staff, ripped objects off walls, and thrown objects?
a. Disturbed sensory perception: auditory hallucinations
b. Risk for other-directed violence
c. Ineffective denial
d. Social isolation
ANS: B
Violence against property, along with threats to harm staff, makes this diagnosis the
priority. Patients with antisocial personality disorders rarely have psychotic symptoms.
When patients with antisocial personality disorders use denial, they use it effectively.
Patients with antisocial personality disorders are rarely socially isolated; instead, they
develop superficial relationships.
DIF: Cognitive Level: Application
TOP: Nursing Process: Diagnosis
Environment

REF: Text Pages: 181, 187


MSC: NCLEX: Safe, Effective Care

10. When a patient with a personality disorder uses manipulation to get needs met, the staff
decides to apply limit-setting interventions. What is the correct rationale for this action?
a. It respects the patients wishes so assertiveness will develop.
b. It provides an outlet for feelings of anger and frustration.
c. External controls are necessary while internal controls are being developed.
d. Anxiety is reduced when staff assumes responsibility for the patients behavior.
ANS: C
A lack of internal controls leads to manipulative behaviors such as lying, cheating,
conning, and flattering. To protect the rights of others, external controls must be
consistently maintained until the patient is able to behave appropriately.
DIF: Cognitive Level: Application
TOP: Nursing Process: Planning

REF: Text Pages: 188, 190-191


MSC: NCLEX: Psychosocial Integrity

Copyright 2009 by Saunders, an imprint of Elsevier Inc.

Test Bank

10-5

11. A patient with borderline personality disorder has had multiple hospitalizations for selfmutilating episodes and suicide attempts, but has now entered dialectical behavior
therapy on an outpatient basis. Counseling is focused on self-harm behavior management.
Today the patient phones a nurse and says, Im feeling empty and anxious and want to
cut 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 identify the trigger situation and choose a coping strategy.
d. advise the patient to take an anxiolytic drug to decrease the anxiety level.
ANS: C
The patient has responded appropriately to the urge for self-harm by calling a helping
individual. A component of dialectical behavior therapy is telephone access to the
therapist for coaching during crises. The nurse can assist the patient to choose an
alternative to self-mutilation. The need for a protective environment may not be
necessary if the patient is able to use cognitive strategies to determine a coping strategy
that will reduce the urge to mutilate. Taking a sedative and going to sleep should not be
the first-line intervention because sedation may reduce the patients ability to weigh
alternatives to mutilating behavior.
DIF: Cognitive Level: Analysis
REF: Text Page: 192
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care
Environment
12. The most challenging nursing intervention with patients with personality disorders who
use manipulation to get needs met is:
a. supporting behavioral change.
b. using aversive therapy.
c. maintaining consistent limits.
d. monitoring suicide attempts.
ANS: C
Maintaining consistent limits is by far the most difficult intervention because of the
patients superior skills at manipulation. Supporting behavioral change and monitoring
patient safety are less difficult tasks. Aversive therapy would probably not be part of the
care plan because positive reinforcement strategies for acceptable behavior seem to be
more effective than aversive techniques.
DIF: Cognitive Level: Comprehension REF: Text Page: 188
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
13. The history shows that a newly admitted patient has impulsivity. The nurse would expect
behavior characterized by:
a. adherence to a strict moral code.
b. manipulative, controlling strategies.

Copyright 2009 by Saunders, an imprint of Elsevier Inc.

Test Bank

10-6

c. postponing gratification to an appropriate time.


d. little time elapsed between thought and action.
ANS: D
The impulsive individual acts in haste without taking time to consider the consequences
of the action. None of the other options describes impulsivity.
DIF: Cognitive Level: Comprehension REF: Text Page: 189
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
14. A patient tells a nurse, I get into trouble sometimes because I make quick decisions and
act on them. A therapeutic response would be:
a. Lets consider the advantages of being able to stop and think before acting.
b. It sounds as though youve developed some insight into your situation.
c. Ill bet you have some interesting stories to share about overreacting.
d. Its good that youre showing readiness for behavioral change.
ANS: A
The patient is showing openness to learning techniques for impulse control. One
technique is to teach the patient to stop and think before acting impulsively. The patient
can then be taught to evaluate outcomes of possible actions and choose an effective
action. The second response is pseudotherapeutic. The third response shifts the encounter
to a social level. The fourth response is judgmental.
DIF: Cognitive Level: Application
REF: Text Page: 189
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
15. A nurse who assesses a patient with a paranoid personality disorder is most likely to
describe the patient as:
a. superficially charming.
b. intense and impulsive.
c. guarded and suspicious.
d. friendly and open.
ANS: C
Patients with paranoid personality disorder are highly mistrustful of others. They expect
to be exploited or wronged by others without justification. Patients with antisocial
personality disorders display superficial charm. Patients with borderline personality
disorder are intense and impulsive. Well-adjusted individuals display friendly openness.
DIF: Cognitive Level: Comprehension REF: Text Page: 180
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity

Copyright 2009 by Saunders, an imprint of Elsevier Inc.

Test Bank

10-7

16. A patient constantly scans the room and frequently interrupts to ask a nurse the meaning
of certain words or phrases. The patient is very sensitive to the nurses nonverbal
behaviors. Responses are often argumentative, sarcastic, or hostile. The patient says, I
was hospitalized so they can exploit me. These findings are most consistent with which
personality disorder?
a. Paranoid
b. Histrionic
c. Avoidant
d. Narcissistic
ANS: A
The behaviors described are consistent with the clinical picture given in the DSM-IV-TR.
A patient with histrionic personality disorder would be flamboyant and attention seeking.
A patient with avoidant personality disorder would be excessively anxious and
hypersensitive. A patient with narcissistic personality disorder would be grandiose and
disparaging of others.
DIF: Cognitive Level: Application
TOP: Nursing Process: Assessment

REF: Text Page: 180


MSC: NCLEX: Psychosocial Integrity

17. A nurse caring for a patient with a paranoid personality disorder tells a colleague, I tried
being caring and nurturing, but the patient just kept telling me to stay away. The
colleague can be helpful by advising Patients with paranoid personality disorders
respond best to:
a. a cynical, joking approach.
b. interpretation of their behaviors.
c. a neutral but courteous and concerned manner.
d. active friendliness because they require a long time to establish a relationship.
ANS: C
A detached, neutral, straightforward, and courteous approach is most effective. A cynical,
joking approach is never appropriate. Giving an interpretation of behaviors to a patient
would be a counterproductive approach. A warm, actively pursuant approach will be
interpreted as intrusive and threatening by the suspicious patient.
DIF: Cognitive Level: Application
REF: Text Pages: 180, 186-188
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care
Environment
18. A patient with a paranoid personality disorder is described as proud, aloof, very
suspicious, and overconfident. A nurse feels belittled after interacting with this patient
and says, Sometimes Id like to tell the patient You arent so great, either. The nurses
colleague would correctly advise:
a. It would be therapeutic to show the patient that you feel angry.
b. The relationship will deteriorate if you try to get revenge.
c. Tell the patient how much the belittling behavior hurts your feelings.

Copyright 2009 by Saunders, an imprint of Elsevier Inc.

Test Bank

10-8

d. You need to get some distance from the patient. Stay away for a day or two.
ANS: B
Courtesy, honesty, and respect are the cardinal rules in treating a paranoid individual. The
nurse cannot act out countertransference reactions. The goal is to make the patient feel
comfortable and secure in his or her surroundings. Retaliation and rejection thwart that
goal. The third response is inappropriate advice. The fourth response promotes
withdrawal from the patient. The behavior is inconsistent with earlier behavior and would
destroy trust.
DIF: Cognitive Level: Analysis
REF: Text Pages: 180, 186-188
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
19. The underlying reason a patient with a paranoid personality disorder is so critical of
others probably lies in the patients:
a. need to set limits.
b. use of intellectualization to protect against anxiety.
c. inflexible view of the environment.
d. projection of self-hate, hurt, and rage.
ANS: D
Projection allows the patient to disown negative feelings about self and see these feelings
as being directed at self from an outside source (the nurse). The patient then can
justifiably retaliate by being hostile to the nurse. To realize that the patient is accusing the
nurse of his or her own faults makes the criticism easier to manage without retaliation.
The other options are not related to the dynamics of critical behaviors on the part of the
patient.
DIF: Cognitive Level: Comprehension REF: Text Page: 180
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
20. A patient with a paranoid personality disorder sits alone in a corner of the unit living
room. When anyone approaches, the patient is arrogant or ignores the person. When
invited to join an activity, the patient says, I dont care to be with people who dont like
me. Which nursing diagnosis applies?
a. Fear
b. Activity intolerance
c. Powerlessness
d. Impaired social interaction
ANS: D
Impaired social interaction is a state in which an individual participates in an insufficient
(or excessive) quantity or quality of social exchange. A defining characteristic is
dysfunctional interaction with others. The patients suspiciousness, rigidity, and
distortions of reality related to projection are responsible.

Copyright 2009 by Saunders, an imprint of Elsevier Inc.

Test Bank

10-9

DIF: Cognitive Level: Application


TOP: Nursing Process: Diagnosis

REF: Text Pages: 180, 187


MSC: NCLEX: Psychosocial Integrity

21. A patient with a borderline personality disorder has had 14 hospitalizations for superficial
suicide attempts. On this admission, the patient has progressed to having a short pass to a
nearby shopping mall. The primary nurse is surprised when the emergency department
calls; the patient has been brought in with multiple self-inflicted lacerations. The nurse
asks a peer, Why? Everything was going well. How could this happen? Which response
by a peer reflects understanding of the patients disorder?
a. I know what you mean. You have put a lot of energy into working with this
patient. It must be disappointing to have something like this happen.
b. I could have told you this would happen. A patient like this always gets you in the
end. I hope this helps you learn the importance of avoiding overinvolvement.
c. The patients behavior seems personal, but it isnt. Patients with borderline
disorder act out to relieve anxiety. I suspect the pass caused a great deal of anxiety.
d. I wonder if all this could have been avoided if Id clued you about the patient.
This is a usual pattern. This happened to me once too, when I first worked here.
ANS: C
This is the only statement that addresses what would be the priority nursing diagnosis,
Risk for self-directed violence, and gives a possible reason for the patients acting-out.
The other statements are countertransference reactions.
DIF: Cognitive Level: Application
TOP: Nursing Process: Evaluation

REF: Text Pages: 190-191


MSC: NCLEX: Psychosocial Integrity

22. A patient with borderline personality disorder self-inflicted wrist lacerations after gaining
new privileges on the unit. For future planning, staff should consider that the reason for
the self-mutilation is probably related to:
a. an inherited disorder that manifests itself as an incapacity to tolerate stress.
b. fear of abandonment associated with progress toward autonomy and independence.
c. use of projective identification and splitting to bring anxiety to manageable levels.
d. a constitutional inability to regulate affect, predisposing to psychic disorganization.
ANS: B
Fear of abandonment is a central theme for most patients with borderline personality
disorder. This fear is often exacerbated when patients with borderline personality disorder
experience success or growth. The first and fourth options are not evidence based. The
third option is unrelated to fear of abandonment.
DIF: Cognitive Level: Application
TOP: Nursing Process: Evaluation
Environment

REF: Text Pages: 182, 190-191


MSC: NCLEX: Safe, Effective Care

Copyright 2009 by Saunders, an imprint of Elsevier Inc.

Test Bank

10-10

23. A patient with borderline personality disorder has self-inflicted wrist lacerations. The
health care provider prescribes daily dressing changes. The nurse performing this care
should:
a. encourage the patient to express anger.
b. provide care in a matter-of-fact manner.
c. be very kind, sympathetic, and concerned.
d. offer to listen to the patients feelings about cutting.
ANS: B
A matter-of-fact approach does not provide the patient with positive reinforcement for
self-mutilation. The goal of providing emotional consistency is supported by this
approach. All other options provide positive reinforcement of the behavior.
DIF: Cognitive Level: Application
REF: Text Pages: 189-191
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
24. A nurse recently set limits for a patient with a 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 mistaken. Youre hateful. This outburst can be assessed as:
a. splitting.
b. denial.
c. reaction formation.
d. separation-individuation strategies.
ANS: A
Splitting involves loving a person, then hating the person because the patient is unable to
recognize that an individual can have both positive and negative qualities. Denial is
unconsciously motivated refusal to belief something. Reaction formation involves
unconsciously doing the opposite of a forbidden impulse. Separation-individuation
strategies refer to childhood behaviors related to developing independence from the
caregiver.
DIF: Cognitive Level: Application
TOP: Nursing Process: Assessment

REF: Text Pages: 189-191


MSC: NCLEX: Psychosocial Integrity

25. Which characteristic of individuals with personality disorders makes it most necessary
for staff to schedule frequent meetings?
a. Flexibility and adaptability to stress
b. Ability to achieve true intimacy
c. Ability to evoke interpersonal conflict
d. Inability to develop trusting relationships
ANS: C

Copyright 2009 by Saunders, an imprint of Elsevier Inc.

Test Bank

10-11

Frequent team meetings are held to counteract the effects of the patients attempts to split
staff and set them against one another, causing interpersonal conflict. Patients with
personality disorders are inflexible and demonstrate maladaptive responses to stress.
They are usually unable to develop true intimacy with others and are unable to develop
trusting relationships. Although the problem with trust exists, it is not the characteristic
that requires frequent staff meetings.
DIF: Cognitive Level: Application
TOP: Nursing Process: Assessment
Environment

REF: Text Pages: 178, 188


MSC: NCLEX: Safe, Effective Care

26. Which commonality would be most likely when working with patients with personality
disorders? The patients:
a. demonstrate behaviors that cause little distress to self or others.
b. have self-esteem issues despite outward confidence.
c. do not experience real distress from symptoms.
d. usually become psychotic when exposed to stress.
ANS: B
Self-esteem issues are present despite patterns of withdrawal, grandiosity, suspiciousness,
or unconcern. They seem to relate to early life experiences and are reinforced through
unsuccessful experiences in loving and working. Personality disorders involve lifelong,
inflexible, dysfunctional, and deviant patterns of behavior causing distress to others and
in some cases to self. Patients with personality disorders may experience very real
anxiety and distress when stress levels rise. Some individuals with personality disorders
may decompensate and show psychotic behavior under stress, but not all.
DIF: Cognitive Level: Application
TOP: Nursing Process: Assessment

REF: Text Page: 178


MSC: NCLEX: Psychosocial Integrity

27. What is the priority intervention for a nurse working with a patient with a schizotypal
personality disorder?
a. Respect the patients need for social isolation.
b. Teach the patient how to match clothing.
c. Prevent the patient from violating the nurses rights.
d. Keep emotional distance to avoid exploitation.
ANS: A
Patients with schizotypal personality disorder are eccentric and often display perceptual
and cognitive distortions. They are suspicious of others and have considerable difficulty
trusting. They become highly anxious and frightened in social situations, thus the need to
respect their desire for social isolation. Teaching the patient to match clothing is not the
priority intervention. Patients with schizotypal personality disorder rarely engage in
behaviors that violate the nurses rights or exploit the nurse.
DIF: Cognitive Level: Application

REF: Text Pages: 181, 185, 188

Copyright 2009 by Saunders, an imprint of Elsevier Inc.

Test Bank

10-12

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity


28. A patient tells a nurse, I hired a private detective to follow my wife. I think shes having
an extramarital affair. The patient is suspicious; frequently checks behind doors, and
asks the nurse, Where are you storing my medical records? These behaviors are most
consistent with which personality disorder?
a. Antisocial
b. Schizoid
c. Paranoid
d. Obsessive-compulsive
ANS: C
DSM-IV-TR criteria for paranoid personality disorder include suspiciousness, lack of trust
in others, fear of confiding in others, fear that personal information will be used against
the individual, holding grudges, and interpreting remarks as being demeaning or
threatening. The patient with antisocial personality disorder is aggressive, manipulative,
and exploitative. The patient with schizoid personality disorder is avoidant and reclusive.
The patient with obsessive-compulsive personality disorder is a perfectionist and is rigid
and preoccupied with details and control issues.
DIF: Cognitive Level: Analysis
TOP: Nursing Process: Assessment

REF: Text Page: 180


MSC: NCLEX: Psychosocial Integrity

29. A homeless person is brought to the hospital after an assault. The person says, A hospital
is the gateway to hell. The person then withdraws and does not to talk with anyone. A
schizoid personality disorder is diagnosed. Which approach will be most useful when
working with this patient?
a. Seek detailed information about the assault to help the patient see why it occurred.
b. Simply and clearly tell the patient what is going to be done before taking any
action.
c. Alternate between being warm and friendly and neutral and business-like.
d. Try to inject a bit of humor into the situation to relieve tension.
ANS: B
When a patient is having difficulty understanding reality, the nurse should communicate
in clear, simple, concise language. Seeking detailed information about the assault is
inappropriate for a patient unable to test reality accurately. Alternating between
friendliness and business-like neutrality hinders establishment of trust. Injecting humor
into the situation is inappropriate for a patient unable to test reality accurately.
DIF: Cognitive Level: Application
REF: Text Pages: 180, 188
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

Copyright 2009 by Saunders, an imprint of Elsevier Inc.

Test Bank

10-13

30. A worker is described by others as very shy and lacking in self-confidence. This person
stays in a cubicle all day, never coming out for breaks or lunch. One day after falling on
ice in the parking lot, the worker goes to a nurses office, apologizes for falling, and says,
I hope the company wont fire me for being so clumsy. This workers behavior could
best be assessed as:
a. avoidant.
b. dependent.
c. histrionic.
d. paranoid.
ANS: A
Patients with avoidant personality disorder are timid, socially uncomfortable, withdrawn,
and avoid situations in which they might fail. They believe themselves to be inferior and
unappealing. Individuals with dependent personality disorder are clinging, needy, and
submissive. Individuals with histrionic personality disorder are seductive, flamboyant,
shallow, and attention seeking. Individuals with paranoid personality disorder are
suspicious, hostile, and project blame.
DIF: Cognitive Level: Application
TOP: Nursing Process: Assessment

REF: Text Pages: 184, 186


MSC: NCLEX: Psychosocial Integrity

31. A nurse in the emergency department tells the daughter of an older adult woman, Your
mother had a severe stroke. The daughter tearfully says, Who will take care of me
now? My mother always tells me what to do, what to wear, and what to eat. I need
someone to reassure me when I get anxious. This behavior could best be assessed as:
a. histrionic.
b. dependent.
c. narcissistic.
d. borderline.
ANS: B
The main characteristic of the dependent personality is a pervasive need to be taken care
of that leads to submissive behaviors and fear of separation. Histrionic behavior is
characterized by flamboyance, attention seeking, and seductiveness. Narcissistic behavior
is characterized by grandiosity and exploitive behavior. Patients with borderline
personality disorder demonstrate separation anxiety, impulsivity, and splitting.
DIF: Cognitive Level: Analysis
TOP: Nursing Process: Assessment

REF: Text Page: 185


MSC: NCLEX: Psychosocial Integrity

32. For which behavior would limit setting be most essential? The patient:
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.

Copyright 2009 by Saunders, an imprint of Elsevier Inc.

Test Bank

10-14

ANS: D
This is a manipulative behavior. Because manipulation violates the rights of others, limit
setting is absolutely necessary. Furthermore, limit setting is necessary in this case because
the safety of at least two other patients is at risk. Limit setting may occasionally be used
with dependent behavior (clinging to the nurse) and histrionic behavior (flirting with staff
members), but other therapeutic techniques are also useful. Limit setting is not needed for
a patient who is hypervigilant and refuses to attend unit activities; rather, the need to
develop trust is central to patient compliance.
DIF: Cognitive Level: Analysis
TOP: Nursing Process: Planning
Environment

REF: Text Pages: 188-189


MSC: NCLEX: Safe, Effective Care

33. When preparing to interview a patient with narcissistic personality disorder, a nurse can
anticipate the assessment findings will include:
a. charm, drama, seductiveness; seeking admiration.
b. preoccupation with minute details; perfectionist.
c. describes difficulty being alone; indecisive, submissiveness.
d. grandiosity, self-importance, and a sense of entitlement.
ANS: D
According to the DSM-IV-TR, the characteristics of grandiosity, self-importance, and
entitlement are consistent with narcissistic personality disorder. Charm, drama,
seductiveness, and admiration seeking are seen in patients with histrionic personality
disorder. Preoccupation with minute details and perfectionism are seen in individuals
with obsessive-compulsive personality disorder. Patients with dependent personality
disorder often express difficulty being alone and are indecisive and submissive.
DIF: Cognitive Level: Comprehension REF: Text Page: 183
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity
34. Which statement made by a patient with borderline personality disorder indicates the
treatment plan is effective?
a. I think you are the best nurse on the unit.
b. I hate my doctor for not giving me what I ask for.
c. I felt empty and wanted to cut myself, so I called you.
d. Im never going to get high on drugs again.
ANS: C
Seeking a staff member instead of impulsively self-mutilating shows an adaptive coping
strategy. The first response demonstrates idealization. The second response demonstrates
devaluation. The fourth response demonstrates wishful thinking.
DIF: Cognitive Level: Analysis
TOP: Nursing Process: Evaluation

REF: Text Pages: 190-191


MSC: NCLEX: Psychosocial Integrity

Copyright 2009 by Saunders, an imprint of Elsevier Inc.

Test Bank

10-15

35. A patient with borderline personality disorder was hospitalized several times after selfmutilating episodes. The patient remains impulsive. Dialectical behavior therapy is
started on an outpatient basis. This therapy will focus on which nursing diagnosis?
a. Impaired skin integrity
b. Risk for self-directed violence
c. Risk for injury
d. Powerlessness
ANS: B
Risk for self-mutilation is a nursing diagnosis relating to patient safety needs and is
therefore of high priority. Impaired skin integrity and Powerlessness may be appropriate
foci for care but are not the priority nor related to this therapy. Risk for injury implies
accidental injury, which is not the case for the patient with borderline personality
disorder.
DIF: Cognitive Level: Analysis
TOP: Nursing Process: Diagnosis

REF: Text Pages: 187, 192


MSC: NCLEX: Psychosocial Integrity

36. As a nurse prepares to administer medication to a patient with a borderline personality


disorder, the patient says, Just leave it on the table. Ill take it when I finish combing my
hair. What is the nurses best response?
a. Reinforce this assertive action by the patient. Leave the medication on the table as
requested.
b. Say to the patient, I must watch you take the medication. Please take it now.
c. Ask the patient, Why dont you want to take your medication now?
d. Respond to the patient, Im worried that you might not take it. Ill come back
later.
ANS: B
The individual with a borderline personality disorder characteristically demonstrates
manipulative, splitting, and self-destructive behaviors. Consistent limit setting is vital for
the patients safety, but also to prevent splitting other staff. Why questions are not
therapeutic. In the fourth option, the patient has successfully manipulated the nurse.
DIF: Cognitive Level: Application
TOP: Nursing Process: Assessment
Environment

REF: Text Page: 189


MSC: NCLEX: Safe, Effective Care

MULTIPLE RESPONSE
1. A nurse plans care for an individual diagnosed with antisocial personality disorder. Which
characteristic behaviors will the nurse expect? (More than one answer is correct.)
a. Aggression
b. Callous attitude
c. Reclusive behavior
d. Anxiety

Copyright 2009 by Saunders, an imprint of Elsevier Inc.

Test Bank

10-16

e. Clinginess
f. Perfectionism
ANS: A, B
Individuals with antisocial personality disorders characteristically demonstrate
manipulative, exploitative, aggressive, callous, and guilt-instilling behaviors. Individuals
with antisocial personality disorders are more extroverted than reclusive, rarely show
anxiety, and rarely demonstrate clinging or dependent behaviors. Individuals with
antisocial personality disorders are more likely to be impulsive than to be perfectionists.
DIF: Cognitive Level: Application
TOP: Nursing Process: Assessment

REF: Text Page: 181


MSC: NCLEX: Psychosocial Integrity

2. For which patients with personality disorders would a family history of similar problems
be most likely? (More than one answer is correct.)
a. Schizotypal
b. Antisocial
c. Dependent
d. Obsessive-compulsive
e. Narcissistic
ANS: A, B, D
Some personality disorders have evidence of genetic links, so the family history would
show other members with similar traits. Heredity plays a role in schizotypal, paranoid,
schizoid, antisocial, and obsessive-compulsive personality disorder.
DIF: Cognitive Level: Application
TOP: Nursing Process: Assessment

REF: Text Page: 179


MSC: NCLEX: Psychosocial Integrity

3. A parent has schizophrenia. If this individuals child develops a personality disorder,


which disorders are most likely? (More than one answer is correct.)
a. Schizotypal
b. Antisocial
c. Paranoid
d. Schizoid
e. Histrionic
ANS: A, C, D
Some personality disorders have evidence of genetic links, so the family history would
show other members with similar traits. When a family history is positive for
schizophrenia, schizotypal, paranoid, and schizoid personality disorders are more likely.
DIF: Cognitive Level: Application
TOP: Nursing Process: Assessment

REF: Text Page: 179


MSC: NCLEX: Psychosocial Integrity

MATCHING

Copyright 2009 by Saunders, an imprint of Elsevier Inc.

Test Bank

10-17

Place the steps for limit setting in the most desirable order.
a. With patient input, identify undesirable patient behavior.
b. Discuss concerns about behavior with patient.
c. Together establish what behavior is desirable in a given situation.
d. Jointly establish consequences for nonoccurrence of desired behavior.
e. Monitor for occurrence and nonoccurrence of desired behaviors.
f. Communicate expectations and consequences to the patient in simple terms.
1. 1
2. 2
3. 3
4. 4
5. 5
6. 6
1. ANS: B
DIF: Cognitive Level: Application
REF: Text Page: 189
TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity
NOT: This sequence of steps is logical and involves the patient in the process.
2. ANS: A
DIF: Cognitive Level: Application
REF: Text Page: 189
TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity
NOT: This sequence of steps is logical and involves the patient in the process.
3. ANS: C
DIF: Cognitive Level: Application
REF: Text Page: 189
TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity
NOT: This sequence of steps is logical and involves the patient in the process.
4. ANS: D
DIF: Cognitive Level: Application
REF: Text Page: 189
TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity
NOT: This sequence of steps is logical and involves the patient in the process.
5. ANS: F
DIF: Cognitive Level: Application
REF: Text Page: 189
TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity
NOT: This sequence of steps is logical and involves the patient in the process.
6. ANS: E
DIF: Cognitive Level: Application
REF: Text Page: 189
TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity

Copyright 2009 by Saunders, an imprint of Elsevier Inc.