Chapter 24: Personality Disorders Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition(A+ COMPLETE SOLUTIONS)

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A health care provider recently convicted of Medicare fraud says to a nurse, ―Sure I overbilled. Everyone takes advantage of the government. There are too many rules to follow and I deserve the mo... ney.‖ These statements show a. shame. b. suspiciousness. c. superficial remorse. 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 patient‘s remarks cannot be assessed as shameful. Lack of trust and concern that others are determined to do harm is not shown. testbanks_and_xanax PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 24-24, 25, 58 (Table 24-1), 60 (Table 24-2) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 2. Which intervention is appropriate for an individual diagnosed with an antisocial personality disorder who frequently manipulates others? a. Refer requests and questions related to care to the case manager. b. Encourage the patient to discuss feelings of fear and inferiority. c. Provide negative reinforcement for acting-out behavior. d. Ignore, rather than confront, inappropriate behavior. ANS: A Manipulative people 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. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 24-24 | Pages 24-60 (Table 24-2), 24-66 (Box 24-2) TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 3. As a nurse prepares to administer medication to a patient diagnosed with a borderline personality disorder, the patient says, ―Just leave it on the table. I‘ll take it when I finish combing my hair.‖ What is the nurse‘s best response? a. Reinforce this assertive action by the patient. Leave the medication on the table as requested. b. Respond to the patient, ―I‘m worried that you might not take it. I‘ll come back later.‖ c. Say to the patient, ―I must watch you take the medication. Please take it now.‖ d. Ask the patient, ―Why don‘t you want to take your medication now?‖ ANS: C The individual with a borderline personality disorder characteristically demonstrates manipulative, splitting, and self-destructive behaviors. Consistent limit setting is vital not only for the patient‘s safety, but also to prevent splitting other staff. ―Why‖ questions are not therapeutic. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 24-42, 60 (Table 24-2), 66 (Box 24-2) TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 4. What is an appropriate initial outcome for a patient diagnosed with a personality disorder who frequently manipulates others? 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. testbanks_and_xanax 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 control. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 24-24, 42 | Pages 24-60 (Table 24-2), 66 (Box 24-2) TOP: Nursing Process: Outcomes Identification MSC: Client Needs: Psychosocial Integrity 5. Consider this comment to three different nurses by a patient diagnosed with an antisocial personality disorder, ―Another nurse said you don‘t do your job right.‖ Collectively, these interactions can be assessed as a. seductive. b. detached. c. manipulative. d. guilt-producing. ANS: C 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 evident in the comments. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 24-24, 60 (Table 24-2) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 6. A nurse reports to the treatment team that a patient diagnosed with an antisocial personality disorder has displayed the behaviors below. This patient is detached and superficial during counseling sessions. Which behavior by the patient most clearly warrants limit setting? a. Flattering the nurse b. Lying to other patients c. Verbal abuse of another patient d. Detached superficiality during counseling ANS: C Limits must be set in areas in which the patient‘s behavior affects the rights of others. Limiting verbal abuse of another patient is a priority intervention and particularly relevant when interacting with a patient diagnosed with an antisocial personality disorder. The other concerns should be addressed during therapeutic encounters. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 24-60 (Box 24-2) | Page 24-60 (Table 24-2) TOP: Nursing Process: Planning MSC: Client Needs: Safe, Effective Care Environment testbanks_and_xanax 7. A patient diagnosed with borderline personality disorder has a history of self-mutilation and suicide attempts. The patient reveals feelings of depression and anger with life. Which type of medication would the nurse expect to be prescribed? a. Benzodiazepine b. Mood stabilizing medication c. Monoamine oxidase inhibitor (MAOI) d. Cholinesterase inhibitor ANS: B Mood stabilizing medications have been effective for many patients with borderline personality disorder. Cholinesterase inhibitors are prescribed for persons diagnosed with neurocognitive disorders. Use of anxiolytic medications is not supported by data given in the scenario. MAOIs require great diligence in adherence to a restricted diet and are rarely used for patients who are impulsive. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 24-48 TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity 8. A person‘s spouse filed charges after repeatedly being battered. The person sarcastically says, ―I‘m sorry for what I did. I need psychiatric help.‖ Which statement by this person supports an antisocial personality disorder? a. ―I have a quick temper, but I can usually keep it under control.‖ b. ―I‘ve done some stupid things in my life, but I‘ve learned a lesson.‖ c. ―I‘m feeling terrible about the way my behavior has hurt my family.‖ d. ―I hit because I am tired of being nagged. My spouse deserves the beating.‖ ANS: D The person with an antisocial personality disorder often impulsively acts out feelings of anger and feels no guilt or remorse. Persons with antisocial personality disorders rarely seem to learn from experience or feel true remorse. Problems with anger management and impulse control are common. [Show More]

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