Psych – Personality Disorders
1) The nursing diagnosis that would be most appropriate for a 22-year
old client who uses ritualistic behavior would be:
1. Ineffective coping
2. Impaired adjustment
3. personal identity disturbance
4. Sensory/perceptual alterations
2) A psychiatrist prescribes an anti-obsessional agent for a client who is
using ritualistic behavior. A common anti-anxiety medication used for this
type of client would be:
1. Fluvoxamine (Luvox)
2. Benztropine (Cogentin)
3. Amantadine (Symmetrel)
4. Diphenhydramine (Benadryl)
3) A 20-year old college student has been brought to the psychiatric
hospital by her parents. Her admitting diagnosis is borderline personality
disorder. When talking with the parents, which information would the nurse
expect to be included in the client’s history? Select all that apply.
1. Impulsiveness
2. Lability of mood
3. Ritualistic behavior
4. psychomotor retardation
5. self-destructive behavior
4) A hospitalized client, diagnosed with a borderline personality
disorder, consistently breaks the unit’s rules. This behavior should be
confronted because it will help the client:
1. Control anger
2. reduce anxiety
3. Set realistic goals
4. Become more self-aware
5) When working with the nurse during the orientation phase of the
relationship, a client with a borderline personality disorder would probably
have the most difficulty in:
1. Controlling anxiety
2. terminating the session on time
3. Accepting the psychiatric diagnosis
4. Setting mutual goals for the relationship
6) A client with a diagnosis of borderline personality disorder has
negative feelings toward the other clients on the unit and considers them all
to be “bad.” The nurse understands this defense is known as:
1. Splitting
2. Ambivalence
3. Passive aggression
4. Reaction formation
7) The client with antisocial personality disorder:
1. Suffers from a great deal of anxiety
2. Is generally unable to postpone gratification
3. Rapidly learns by experience and punishment
4. Has a great sense of responsibility toward others
8) A person with antisocial personality disorder has difficulty relating to
others because of never having learned to:
1. Count on others
2. Empathize with others
3. Be dependent on others
4. Communicate with others socially
9) A young, handsome man with a diagnosis of antisocial personality
disorder is being discharged from the hospital next week. He asks the nurse
for her phone number so that he can call her for a date. The nurse’s best
response would be:
1. “We are not permitted to date clients.”
2. “No, you are a client and I am a nurse.”
3. “I like you, but our relationship is professional.”
4. “It’s against my professional ethics to date clients.”
10) When caring for a client with a diagnosis of schizotypal personality
disorder, the nurse should:
1. Set limits on manipulative behavior
2. encourage participation in group therapy
3. Respect the client’s needs for social isolation
4. Understand that seductive behavior is expected.
11) A nurse is orienting a new client to the unit when another client rushes
down the hallway and asks the nurse to sit down and talk. The client
requesting the nurse’s attention is extremely manipulative and uses socially
acting-out behaviors when demands are unmet. The nurse should:
1. Suggest that the client requesting attention speak with another staff
member
2. Leave the new client and talk with the other client to avoid
precipitating acting out behavior
3. Tell the interrupting client to sit down and be patient, stating, “I’ll be
back as soon as possible.”
4. Introduce the two clients and suggest that the client join the new
client and the nurse on the tour
12) A client with a diagnosis of narcissistic personality disorder has been
given a day pass from the psychiatric hospital. The client is due to return at
6pm. At 5pm the client telephones the nurse in charge of the unit and says
“6 o’clock is too early. I feel like coming back at 7:30.” The nurse would be
most therapeutic by telling the client to:
1. Return immediately, to demonstrate control
2. Return on time or restrictions will be imposed
3. come back at 6:45, as a compromise to set limits
4. Come back as soon as possible or the police will be sent
13) An adult client with a borderline personality disorder become
nauseated and vomits immediately after drinking after drinking 2 ounces of
shampoo as a suicide gesture. The most appropriate initial response by the
nurse would be to:
1. Promptly notify the attending physician
2. Immediately initiate suicide precautions
3. Sit quietly with the client until nausea and vomiting subsides
4. Assess the client’s vital signs and administer syrup of ipecac
14) A nurse notices that a client is mistrustful and shows hostile behavior.
Which of the following types of personality disorder is associated with these
characteristics?
1. Antisocial
2. Avoidant
3. Borderline
4. Paranoid
15) Which of the following statements is typical for a client diagnosed with
a personality disorder?
1. “I understand you’re the one to blame.”
2. “I must be seen first; it’s not negotiable.”
3. “I see nothing humorous in this situation.”
4. “I wish someone would select the outfit for me.”
16) Which of the following characteristics is expected for a client with
paranoid personality disorder who receives bad news?
1. The client is overly dramatic after hearing the facts
2. The client focuses on self to not become over-anxious
3. The client responds from a rational, objective point of view
4. The client doesn’t spend time thinking about the information.
17) Which of the following types of behavior is expected from a client
diagnosed with a paranoid personality disorder?
1. Eccentric
2. exploitative
3. Hypersensitive
4. Seductive
18) Which of the following interventions is important for a client with
paranoid personality disorder taking olanzapine (Zyprexa)?
1. Explain effects of serotonin syndrome
2. Teach the client to watch for extrapyramidal adverse reactions
3. Explain that the drug is less effective if the client smokes
4. Discuss the need to report paradoxical effects such as euphoria.
19) A client with antisocial personality is trying to convince a nurse that he
deserves special privileges and that an exception to the rules should be
made for him. Which of the following responses is the most appropriate?
1. “I believe we need to sit down and talk about this.”
2. “Don’t you know better than to try to bend the rules?”
3. “What you’re asking me to do is unacceptable.”
4. “Why don’t you bring this request to the community meeting?”
20) A nurse notices other clients on the unit avoiding a client diagnosed
with antisocial personality disorder. When discussing appropriate behavior
in group therapy, which of the following comments is expected about this
client by his peers?
1. Lack of honesty
2. Belief in superstitions
3. Show of temper tantrums
4. Constant need for attention
21) Which of the following characteristics or client histories substantiates
a diagnosis of antisocial personality disorder?
1. Delusional thinking
2. Feelings of inferiority
3. Disorganized thinking
4. Multiple criminal charges
22) A client with borderline personality disorder is admitted to the unit
after slashing his wrist. Which of the following goals is most important after
promoting safety?
1. Establish a therapeutic relationship with the client
2. Identify whether splitting is present in the client’s thoughts
3. Talk about the client’s acting out and self-destructive tendencies.
4. Encourage the client to understand why he blames others
23) Which of the following characteristics or situations is indicated when a
client with borderline personality disorder has a crisis?
1. Antisocial behavior
2. Suspicious behavior
3. Relationship problems
4. Auditory hallucinations
24) Which of the following assessment findings is seen in a client
diagnosed with borderline personality disorder?
1. Abrasions in various healing stages
2. intermittent episodes of hypertension
3. Alternating tachycardia and bradycardia
4. Mild state of euphoria with disorientation
25) In planning care for a client with borderline personality disorder, a
nurse must be aware that this client is prone to develop which of the
following conditions?
1. Binge eating
2. Memory loss
3. Cult membership
4. Delusional thinking
26) Which of the following statements is expected from a client with
borderline personality disorder with a history of dysfunctional
relationships?
1. “I won’t get involved in another relationship.”
2. “I’m determined to look for the perfect partner.”
3. “I’ve decided to use better communication skills.”
4. “I’m going to be an equal partner in a relationship.”
27) Which of the following conditions is likely to coexist in clients with a
diagnosis of borderline personality disorder?
1. Avoidance
2. Delirium
3. Depression
4. Disorientation
28) Which of the following nursing interventions has priority for a client
with borderline personality disorder?
1. Maintain consistent and realistic limits
2. Give instructions for meeting basic self-care needs
3. Engage in daytime activities to stimulate wakefulness
4. Have the client attend group therapy on a daily basis
29) A nurse is assessing a client diagnosed with dependent personality
disorder. Which of the following characteristics is a major component to this
disorder?
1. Abrasive to others
2. Indifferent to others
3. Manipulative of others
4. Overreliance on others
30) Which of the following information must be included for the family of a
client diagnosed with dependent personality disorder?
1. Address coping skills
2. Explore panic attacks
3. Promote exercise programs
4. Decrease aggressive outbursts
31) Which of the following behaviors by a client with dependent
personality disorder shows the client has made progress toward the goal of
increasing problem solving skills?
1. The client is courteous
2. The client asks questions
3. The client stops acting out
4. The client controls emotions
32) A client with schizotypal personality disorder is sitting in a puddle of
urine. She’s playing in it, smiling, and softly singing a child’s song. Which
action would be best?
1. Admonish the client for not using the bathroom
2. Firmly tell the client that her behavior is unacceptable
3. Ask the client if she’s ready to get cleaned up now
4. Help the client to the shower, and change the bedclothes.
33) A client with avoidant personality disorder says occupational therapy is
boring and doesn’t want to go. Which action would be best?
1. State firmly that you’ll escort him to OT.
2. Arrange with OT for the client to do a project on the unit.
3. Ask the client to talk about why OT is boring
4. Arrange for the client not to attend OT until he is feeling better
34) A nurse discusses job possibilities with a client with schizoid
personality disorder. Which suggestion by the nurse would be helpful?
1. “You can work in a family restaurant part-time on the weekend and
holidays.”
2. “Maybe your friend could get you that customer service job where you
work only on the weekends.”
3. “Your idea of applying for the position of filing and organizing records
is worth pursuing.”
4. “Being an introvert limits the employment opportunities you can
pursue.”
35) When assessing a client diagnosed with impulse control disorder, the
nurse observes violent, aggressive, and assaultive behavior. Which of the
following assessment data is the nurse also likely to find? Select all that
apply.
1. The client functions well in other areas of his life.
2. The degree of aggressiveness is out of proportion to the stressor.
3. The violent behavior is mist often justified by the stressor.
4. The client has a history of parental alcoholism and chaotic, abusive
family life.
5. The client has no remorse about the inability to control his anger.
ANSWERS
1. 1. Ineffective coping is the impairment of a person’s adaptive
behaviors and problem-solving abilities in meeting life’s demands;
ritualistic behavior fits under this category as a defining
characteristic.
2. 1. This drug blocks the uptake of serotonin.
3. 1, 2, 5.
4. 4. Client’s must first become aware of their behavior before they can
change it. (3) Occurs after the client is aware of the behavior and has
a desire to change the behavior.
5. 4. Clients with borderline personality disorders frequently
demonstrate a pattern of unstable interpersonal relationships,
impulsiveness, affective instability, and frantic efforts to avoid
abandonment; these behaviors usually create great difficulty in
establishing mutual goals.
6. 1. Splitting is the compartmentalization of opposite-affect states and
failure to integrate the positive and negative aspects of self or others.
7. 2. Individuals with this disorder tend to be self-centered and
impulsive. They lack judgment and self-control and do not profit from
their mistakes.
8. 2. The lack of superego control allows the ego and the id to control the
behavior. Self-motivation and self-satisfaction are of paramount
concern.
9. 3. This accepts the client as a person of worth rather than being cold
or implying rejection. However, the nurse maintains a professional
rather than a social role.
10. 3. These clients are withdrawn, aloof, and socially distant; allowing
distance and providing support may encourage the eventual
development of a therapeutic alliance. Group therapy would increase
this client’s anxiety; cognitive or behavioral therapy would be more
appropriate.
11. 3. This sets realistic limits on behavior without rejecting the client
12. 2. This sets limits, points out reality, and places responsibility for
behavior on the client.
13. 3. This intervention demonstrates the nurse’s caring presence which
is vital for this client. (1) Although the treatment team does need to
know about the event, notification is not the immediate concern. (2)
This is premature and it reinforces the client’s predisposition to
manipulative behavior. (4) This medication is inappropriate in this
situation; vomiting would be expected after the ingestion of shampoo.
14. 4. Paranoid individuals have a need to constantly scan the
environment for signs of betrayal, deception, and ridicule, appearing
mistrustful and hostile. They expect to be tricked or deceived by
others.
15. 3. Clients with paranoid personality disorder tend to be extremely
serious and lack a sense of humor.
16. 3. Clients with paranoid personality disorder are affectively restricted,
appear unemotional, and appear rational and objective.
17. 3. People with paranoid personality disorders are hypersensitive to
perceived threats. Schizotypal personalities appear eccentric and
engage in activities others find perplexing. Clients with narcissistic
personality disorder are interpersonally exploitative to enhance
themselves or indulge in their own desires. A client with histrionic
personality disorder can be extremely seductive when in search of
stimulation and approval.
18. 3. Olanzapine (Zyprexa) is less effective for clients who smoke
cigarettes. Olanzapine doesn’t cause euphoria (damn), and
extrapyramidal side effects aren’t a problem. However, the client
should be aware of adverse effects such as tardive dyskinesia.
19. 3. These clients often try to manipulate the nurse to get special
privileges or make exceptions to the rules on their behalf. By
informing the client directly when actions are inappropriate, the nurse
helps the client learn to control unacceptable behaviors by setting
limits. By sitting down to talk about the request, the nurse is telling
the client there’s room for negotiating when there is none.
20. 1. Clients with antisocial personality disorder tend to engage in acts
of dishonesty, shown by lying.
21. 4. Clients with antisocial personality disorder are often sent for
treatment by the court after multiple crimes or for the use of illegal
substances.
22. 1. After promoting safety, the nurse establishes a rapport with the
client to facilitate appropriate expression of feelings. At this time, the
client isn’t ready to address unhealthy behavior. A therapeutic
relationship must be established before the nurse can effectively work
with the client on self-destructive tendencies and the issues of
splitting.
23. 3. Relationship problems can precipitate a crisis because they bring
up issues of abandonment. Clients with borderline personality disorder
aren’t usually suspicious; they’re more likely to be depressed or highly
anxious.
24. 1. Clients with borderline personality disorder tend to self-mutilate
and have abrasions in various stages of healing.
25. 1. Clients with borderline personality disorder are likely to develop
dysfunctional coping and act out in self-destructive ways such as binge
eating.
26. 2. Clients with borderline personality disorder would decide to look
for a perfect partner. This characteristic is a result of the dichotomous
manner in which these clients view the world. They go from
relationship to relationship without taking responsibility for their
behavior. It’s unlikely that an unsuccessful relationship will cause
clients to make a change. They tend to be demanding and impulsive in
relationships. There’s no thought given to what one wants or needs
from a relationship. Because they tend to blame others for problems,
it’s unlikely they would express a desire to learn communication skills.
27. 3. Chronic feelings of emptiness and sadness predispose a client to
depression. About 40% of the clients with borderline struggle with
depression.
28. 1. Clients with borderline who are needy, dependent, and
manipulative will benefit greatly from maintaining consistent and
realistic limits. They don’t tend to have difficulty meeting their self-
care needs. They enjoy attending group therapy because they often
attempt to use the opportunity to become the center of attention. They
don’t tend to have sleeping difficulties.
29. 4. Clients with dependent personality disorder are extremely
overreliant on others; they aren’t abrasive or assertive. They’re
clinging and demanding of others; they don’t manipulate.
30. 1. The family needs information about coping skills to help the client
learn to handle stress. Clients with dependent personality disorder
don’t have aggressive outbursts; they tend to be passive and submit to
others. They don’t tend to have panic attacks. Exercise is a health
promotion activity for all clients. Clients with dependent personality
disorder wouldn’t need exercise promoted more than other people.
31. 2. The client with dependent personality disorder is passive and tries
to please others. By asking questions, the client is beginning to gather
information, the first step of decision making.
32. 4. A client with schizotypal personality disorder can experience high
levels of anxiety and regress to childlike behaviors. This client may
require help needing self-care needs. The client may not respond to
the other options or those options may generate more anxiety.
33. If given the chance, a client with avoidant personality disorder
typically elects to remain immobilized. The nurse should insist that the
client participate in OT. Arranging for the client to do a project on the
unit validates and reinforces the client’s desire to avoid getting to OT.
Addressing an invalid issue such as the client’s perceived boredom
avoids the real issue: the client’s need for therapy.
34. 3. Clients with schizoid personality disorder prefer solitary activities,
such as filing, to working with others. Working as a cashier or in
customer service would involve interacting with many people.
35. 1, 2, 4. A client with an impulse control disorder who displays violent,
aggressive, and assaultive behavior generally functions well in other
areas of his life. The degree of aggressiveness is typically out of
proportion with the stressor. Such a client commonly has a history of
parental alcoholism and a chaotic family life, and often verbalizes
sincere remorse and guilt for the aggressive behavior.