Which intervention is best for a client who has a borderline personality disorder Quizlet

d.schizotypal personality disorder (STPD).

Rationale: The main traits that describe STPD are psychoticism such as eccentricity, odd or unusual beliefs and thought processes, and social detachment by preferring to be socially isolated, as well as being overly suspicious or anxious. In obsessive-compulsive personality disorder the main pathological personality traits are rigidity and inflexible standards of self and others, along with persistence of goals long after they are necessary, even if they are self-defeating or negatively affect relationships. People with narcissistic personality disorder come across as arrogant, with an inflated view of their self-importance. They have a need for constant admiration, along with a lack of empathy for others, a factor that strains most relationships over time. Traits of avoidant personality disorder include low self-esteem, feelings of inferiority compared with peers, and a reluctance to engage in unfamiliar activities involving new people.

14. Which client situation should a nurse identify as reflective of the impulsive behavior that is commonly associated with borderline personality disorder?

A. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm and whispers, "The night nurse is evil. You have to stay."

B. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm and states, "I will be up all night if you don't stay with me."

C. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm, yelling, "Please don't go! I can't sleep without you being here."

D. As the day shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, "I cut myself because you are leaving me."

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Terms in this set (22)

Splitting is a process in which the client demonstrates what behavior?

Unconsciously represses undesirable aspects of self
Places responsibility for his or her behavior outside the self
Sees things as divided into "all good" or "all bad"
Evidences lack of personal boundaries

Sees things as divided into "all good" or "all bad"

Splitting demonstrates the failure to integrate the positive and negative into a cohesive whole. An individual is not seen as a person with good and bad traits, but rather as all good or all bad. This behavior does not relate to any of the other options.REF: 463-464

Playing one staff member against another is an example of what defense mechanism?

Devaluation
Splitting
Impulsiveness
Social ineptitude

Splitting

Splitting involves setting up individuals or groups to disagree. While the two parties are busy disagreeing, they are too busy to maintain consistent limits for the manipulative client. The client can enjoy the spectacle and do as he or she pleases. The example provided does not effectively describe any of the other options.REF: 463-464

Which characteristics will the nurse assess in the client diagnosed with antisocial personality?

Deceitfulness, impulsiveness, and lack of empathy
Perfectionism, preoccupation with detail, and verbosity
Avoidance of interpersonal contact and preoccupation with being criticized
A need for others to assume responsibility for decision making and seeking nurture

Deceitfulness, impulsiveness, and lack of empathy

Antisocial clients have no conscience. Their sense of right and wrong is impaired, and they tend to do whatever serves them best without consideration for the rights or feelings of others. Characteristics presented in the other options are not associated with this disorder.REF: 459

Research has indicated that the antisocial personality may be characterized by what behavior?

Social isolation
Lack of remorse
Learning difficulties
Difficulty with reality testing

Lack of remorse

Individuals with an antisocial personality exhibit a lack of remorse when confronted with the results of their thoughtless, irresponsible behavior toward others. This disorder is not associated with any other behaviors suggested by the remaining options.REF: 459

The client, diagnosed with which personality disorder, will most likely require admission to a psychiatric unit?

Paranoid personality disorder
Narcissistic personality disorder
Borderline personality disorder
Dependent personality disorder

Borderline personality disorder

Clients with borderline disorder can decompensate into psychotic states under stress. Hospitalization is needed at these times. Psychosis is not generally associated with the other options.REF: 464

Which statement is descriptive of clients with a personality disorder?

They are resistant to behavioral change.
They have an ability to tolerate frustration and pain.
They usually seek help to change maladaptive behaviors.
They have little difficulty with cognitive functioning.

They are resistant to behavioral change.

Personality disorders are deeply ingrained and pervasive. Clients with personality disorders find it very difficult, if not nearly impossible, to change. Change proceeds very slowly. None of the other options are generally associated with this disorder.REF: 458

What characteristic behaviors will the nurse assess in the narcissistic client?

Dramatic expression of emotion, being easily led
Perfectionism and preoccupation with detail
Grandiose, exploitive, and rage-filled behavior
Angry, highly suspicious, aloof, withdrawn behavior

Grandiose, exploitive, and rage-filled behavior

Narcissistic clients give the impression of being invulnerable and superior to others to protect their fragile self-esteem. None of the other options provide a description associated with narcissism.REF: 456

A client arrested for an assault in which he savagely beat a classmate states, "The guy deserved everything he got." The behaviors described are most consistent with the clinical picture of which disorder?

Antisocial personality disorder
Borderline personality disorder
Schizotypal personality disorder
Narcissistic personality disorder

Antisocial personality disorder

Clients with antisocial personality act out feelings without consideration for the rights of others. They feel no remorse for their antisocial acts. The description provided is not associated with any of the other suggested options.REF: 459

A nurse caring for a client who has been diagnosed with a personality disorder should expect that the client will exhibit which behaviors?

Frequent episodes of psychosis
Constant involvement with the needs of significant others
Inflexible and maladaptive responses to stress
Abnormal ego functioning

Inflexible and maladaptive responses to stress

Personality patterns persist unmodified over long periods of time. Inflexible and maladaptive responses to stress are characteristic of individuals with a personality disorder. The other options present behaviors not necessarily associated with this disorder.REF: 458

When providing care for a client diagnosed with borderline personality disorder, the nurse will need to consider strategies for dealing with which of the client's classic characteristics?

Mood shifts, impulsivity, and splitting
Grief, anger, and social isolation
Altered sensory perceptions and suspicion
Perfectionism and preoccupation with detail

Mood shifts, impulsivity, and splitting

Borderline personality disorder has the central characteristic of instability in affect, identity, and relationships. Borderline individuals desperately seek relationships to avoid feeling abandoned, but they often drive others away with excessive demands, impulsive behavior, or uncontrolled anger. Their frequent use of the defense of splitting strains personal relationships and creates turmoil in health care settings. The remaining options suggest characteristics not associated with this disorder.REF: 463

What is the priority nursing intervention for a client diagnosed with borderline personality disorder?

Protect other clients from manipulation.
Respect the client's need for attention.
Assess for suicidal and self-mutilating behaviors.
Provide clear, consistent limits and boundaries.

Assess for suicidal and self-mutilating behaviors.

One of the primary nursing guidelines/interventions for clients with a personality disorder is to assess for suicidal and self-mutilating behaviors, especially during times of stress. While the other options may be appropriate, none have the priority of safety.REF: 463-464

Clients demonstrating characteristics of personality disorders have various self-defeating behaviors and interpersonal problems despite having near-normal ego functioning and intact reality testing. Which nursing diagnosis best addresses this sort of interpersonal dysfunction?

Spiritual distress
Defensive coping
Impaired social interaction
Disturbed sensory perception

Defensive coping

For a client who has difficulty in relationships and is very manipulative, the nursing diagnosis of impaired social interaction would be used. None of the other options appropriately deals with this type of dysfunctional behavior.REF: 467

A client diagnosed with obsessive-compulsive personality disorder takes the nurse aside and mentions, "I've observed you interacting with that new patient. You are not approaching him properly. You should be more forceful with him." What response should the nurse provide to address the client's comment?

"I will be continuing to follow the care plan for the patient."
"I see you are trying to control that patient's therapy as well as your own."
"Your eye for perfection extends even to my nursing interventions."
"That patient's care is really of no concern to you or to other clients."

"I will be continuing to follow the care plan for the patient."

Obsessive-compulsive personality disorder has the key factor of perfectionism with a focus on orderliness and control. These individuals get so preoccupied with details and rules that they may not be able to accomplish the tasks. Guard against engaging in power struggles with a client with obsessive-compulsive disorder.REF: 458

A newly admitted client has a diagnosis of schizoid personality disorder. The nursing intervention of highest priority will be directed toward which classic client need?

Set firm limits on behavior.
Respect need for social isolation.
Encourage expression of feelings.
Involve in milieu and group activities.

Respect need for social isolation.

Schizoid personality disorder has the primary feature of emotional detachment. Individuals do not seek out or enjoy close relationships. They are reclusive, avoidant, and uncooperative. They do not do well with resocialization.REF: 455

FROM SLIDES

Which behavior indicates that a patient diagnosed with borderline personality disorder is improving?

The patient cries when her roommate refuses to go to the dining room with her
The patient yells at the group facilitator when he points out that she is monopolizing the group
The patient informs a staff member that she is having thought so harming herself
The patient tells the evening staff that the day staff excused her from group to smoke when she got upset

The patient informs a staff member that she is having thought so harming herself

FROM SLIDES

Use of splitting is most associated with which personality disorder?

Antisocial
Borderline
Dependent
Schizotypical

Borderline

FROM SLIDES

Perfectionism is a trait likely to be evident in a person with which personality disorder?

OCD
Narcissistic
Antisocial
Avoidant

OCD

FROM SLIDES

Antisocial, obsessive-compulsive, and schizotypal personality disorders occur most frequently in:

Adolescents
Children
Women
Men

Men

BLUE STAR

Personality Disorder basics:

Medication?
Frequent Hospitalization?
Understand the consequences of behavior?
Self perception of their behavior?

Medications - will not gear or control medications; treat comorbidities

Frequent Hospitalization - do not see patients for personality disorders; will come in for depression, anxiety

Understand the consequences of behavior - no

Self perception of their behavior - do not feel uncomfortable or disorganized; they feel fine

BLUE STAR

The nurse is caring for a patient with antisocial personal disorder. That patient uses abusive language and spits at the nurse and refuses to answer questions.

Create a therapeutic statement to address this situation.

Don't confront, don't threaten
Set limits, I understand you're angry but this behavior is unacceptable

BLUE STAR

The nurse is caring for a patient who has borderline personality disorder.

List the nursing interventions
What is the priority nursing intervention?

Safety!!
Assess for suicidal/homicidal thoughts and violent behavior
Set clear boundaries and limits

BLUE STAR

The nurse is planning care for patients with personality disorders. What is the expected outcome of treatment?

Reduce interfering personality traits; measurable outcomes
Medicine will not work

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