Final- Mental Heath - Chapter 6-13

Front 1

Clinical picture/DSM IV TR definition of personality disorder

-personality disorders are categorized on Axis ___ along with mental retardation

(they are separate why?)

Back 1

2

to ensure that proper attention is given to these disorders and that they are not overlooked in the presence of Axis I disorders)

Front 2

when is personality unhealthy?

Back 2

when it interferes with or complicates, social, and interpersonal function

Front 3

Personality Disorders
--don’t have a lot of insight about the disorder and don’t seek treatment for the disorder

how do they find they usually get treated for a personality disorder?

Back 3

(usually the treatment
is for a medical condition/psychiatric disorder)

Front 4

Personality Disorders
-what exacerbates symptoms

Back 4

-stress

Front 5

personality disorder according to DSM-IV-TR. (Box 19-1):

Back 5

an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individuals culture.

Front 6

personality disorder according to DSM-IV-TR. (Box 19-1):
--the pattern is manifested in 2 (or more) of the following areas:

Back 6

1) cognition (ways of perceiving and interpreting self, their people, and events)
2) affectivity (range, intensity, liability, and appropriateness of emotional response)
3) interpersonal functioning
4) impulse control

Front 7

Personality Disorder
-the enduring pattern is ___ and _____ across a broad range of personal and social situations

Back 7

inflexible and pervasive

Front 8

Personality Disorder
-the enduring pattern leads to clinically significant

Back 8

distress or impairment on social, occupational, or other important areas of functioning

Front 9

Personality Disorder
-personality disorders are (stable/changing) and of (short/long) duration, and its onset can be traced back to

Back 9

stable and long

adolescence or early adulthood

Front 10

Personality Disorder
-it is not due to the direct physiological effects of a substance (medication, drugs) or a general medical condition (head trauma)

true or false

Back 10

true

Front 11

individuals who meet criteria for personality disorders exhibit consistent difficulty in 3 areas of day to day functioning:

Back 11

1) thoughts and emotions,

2) participation in interpersonal relationships,

3) managing impulses

Front 12

some people who have a personality disorder do not view these areas of difficulty as problem
behaviors attributable to themselves. they believe the problems originate from

Back 12

the behavior of other
people

Front 13

Schizoid Personality Disorder

-cluster __

Back 13

A (Odd or eccentric)

Front 14

Schizoid Personality Disorder

-example

Back 14

hermit

Front 15

Schizoid Personality Disorder

-primary feature

Back 15

emotional detachment

Front 16

Schizoid Personality Disorder


-_______may occur as a result of the persons limited interactions with others

Back 16

depersonalization

Front 17

Schizoid Personality Disorder
-etiology:

Back 17

based on a genetic predisposition to shyness. often raised in a cold and neglectful atmosphere in which they may conclude that relationships are unsatisfying and unnecessary

Front 18

Schizoid Personality Disorder


-this individual may be able to function in a solitary occupation but shows indifference to

Back 18

praise or criticism from others

Front 19

Schizoid Personality Disorder


-can be a precursor to (2)

Back 19

schizophrenia or delusional disorder

Front 20

Schizoid Personality Disorder

Interventions:
-what should you not try to do? (2)

-avoid

Back 20

-do not try to increase or force social interaction otherwise their anxiety will increase (they can eat in their room)

-do not be too friendly (provide personal space, if you get to close, anxiety will increase)

-avoid being too nice

Front 21

Borderline Personality Disorder
--cluster ___

Back 21

B “dramatic, emotional erratic

Front 22

what is the most stigmatized disorder

Back 22

Borderline Personality Disorder

Front 23

Borderline Personality Disorder
-can result from not being:

Back 23

-not being parented and not being able to establish identity with self and parent

Front 24

Borderline Personality Disorder
-what is their thinking like?

Back 24

-thinking that is all black or white (worship then hate a nurse)

Front 25

Borderline Personality Disorder
-occurs in men or woman?

Back 25

-mainly occurs in women (emotional or sexual abuse)

Front 26

Borderline Personality Disorder
-these patient's do not have parents so they are unable to do what?

Back 26

keep the identify of someone else in mind and they feel empty and abandoned

Front 27

Borderline Personality Disorder
-what is their major defense?

Back 27

-splitting: (adoring then devaluing persons)

-inability to incorporate positive and negative aspects of self or others into whole imagine resulting in all good or bad thinking (alternating between idealizing and devaluing

Front 28

Borderline Personality Disorder
-splitting may be attributed to:

Back 28

-attributed to early psychological, sexual, or physical trauma/abuse

Front 29

Borderline Personality Disorder

Interventions
-safety (assess for, ________)

Back 29

- SI, especially in times of stress)

Front 30

Borderline Personality Disorder
--when patient is splitting, what should you do?

Back 30

get patient to discuss problems with the other nurse –validate feelings (otherwise it looks like you are agreeing)

Front 31

Borderline Personality Disorder
-when the nures is speaking with this patient, what must she be sure to provide?

-the staff must have:

-the nurse must also limit set, and reinforce what 2 things

Back 31

clear and consistent boundaries

--regular team meetings
-limit set, reinforce rules and boundaries

Front 32

Borderline Personality Disorder
-don’t rescue them, promote ___

Back 32

coping

Front 33

Borderline Personality Disorder
--can give what to resemble someone

Back 33

teddy bear

Front 34

Borderline Personality Disorder
-the nurse need to be aware of

Back 34

manipulative behaviors (flattery, seductiveness, instilling of guilt)

Front 35

Borderline Personality Disorder
--when behavior problems emerge, what should the nurse do?

Back 35

calmly review the therapeutic goals and boundaries of treatment

Front 36

Borderline Personality Disorder
--suggested therapy:

Back 36

dialectical behavior therapy

Front 37

Borderline Personality Disorder
--major features are patterns of marked instability in

Back 37

emotion regulation,
interpersonal relationships,
impulsivity,
identity or self-image distortions,
unstable mood

Front 38

Borderline Personality Disorder


-splitting, the primary defense or coping style used is the inability to

Back 38

incorporate positive and negative aspects of oneself or others into a whole image

Front 39

Borderline Personality Disorder

-etiology:

Back 39

develop as a result of early abandonment, which results in an unstable view of self and others

Front 40

Narcissistic Personality Disorder
--cluster ___

Back 40

B personality (dramatic, emotional, or erratic)

Front 41

Narcissistic Personality Disorder
-primary feature

Back 41

arrogance with a grandiose view of self importance

Front 42

Narcissistic Personality Disorder

-etiology:

Back 42

childhood neglect and criticism. as an adult they hide feelings of emptiness with invulnerability and self-sufficiency

Front 43

Narcissistic Personality Disorder

Interventions
-remain:
-do not (2)

Back 43

-remain neutral
-do not get defensive in response to the patient’s disparaging remarks
-do not get into power struggle in response to the patients remarks

Front 44

Narcissistic Personality Disorder
-how should the nurse act?

Back 44

-be confidant and show that you know what you’re doing and you are in charge

Front 45

Narcissistic Personality Disorder
-what should the nurse convey when interacting with this pt?

Back 45

-convey unassuming self-confidence

Front 46

Narcissistic Personality Disorder

Etiology:

Back 46

-childhood neglect and criticism --> doesn’t learn others can be comforting and supportive

Front 47

Histrionic Personality Disorder

-cluster ___

Back 47

B “dramatic, emotional, or erratic”

Front 48

Histrionic Personality Disorder
--ex:

Back 48

drama queens

Front 49

Histrionic Personality Disorder
--marked by

Back 49

emotional attention-seeking behavior in which the person needs to be the center of attention

Front 50

Histrionic Personality Disorder
-2 other characteristics of this disorder

Back 50

-impulsive and melodramatic

Front 51

Histrionic Personality Disorder


-etiology:

Back 51

beginning at 3-5 yrs of age with an overly intense attachment to the opposite sex parent, which results in fear and retaliation by the same sex parent.

Front 52

Histrionic Personality Disorder
-what are predisposing factors?

Back 52

-inborn character traits such as emotional expressiveness and egocentricity

Front 53

Histrionic Personality Disorder
-etiology (2)

Back 53

-inborn character traits of emotional expressiveness and egocentricity
-age 3-5 overly attached to parent of opposite sex --> fear or retaliation of same sex parent

Front 54

Histrionic Personality Disorder
--seductive, flirtatious behavior is a response to

Back 54

stress

Front 55

Histrionic Personality Disorder
--teach and role model

Back 55

assertiveness (don’t know how to express feelings)

Front 56

Histrionic Personality Disorder
-encourage and model the use of

Back 56

concrete and descriptive rather than vague and impressionistic language

Front 57

Avoidant Personality Disorder
-cluster ___

Back 57

C “anxious and fearful”

Front 58

Avoidant Personality Disorder

-extreme sensitivity to

Back 58

rejection and robust (strong) avoidance of interpersonal situations

Front 59

Avoidant Personality Disorder
-demonstrate poor

Back 59

self-confidence

Front 60

Avoidant Personality Disorder
-prone to

Back 60

misinterpreting others feedback b/c they are overly sensitive to rejection

Front 61

Avoidant Personality Disorder

-what do they desire?

Back 61

-strongly desire close relationships but they avoid them

Front 62

Avoidant Personality Disorder
-Etiology:
biological predisposition to

Back 62

-anxiety and physiological arousal in social situations

Front 63

Avoidant Personality Disorder
-Etiology:
-genetically on continuum of disorders related to

Back 63

social phobia (may be related to social anxiety disorder)

Front 64

Avoidant Personality Disorder
etiology:
-linked with

Back 64

parental and peer rejection and criticism

Front 65

Avoidant Personality Disorder
-what from childhood may be associated with this disorder?

Back 65

-timid temperament in infancy and childhood may be associated

Front 66

Avoidant Personality Disorder
Interventions

-do not force in

Back 66

social situation (anxiety increases)-

Front 67

Avoidant Personality Disorder
Interventions
-teach what 2 things

Back 67

-teach positive self talk
-teach assertiveness training

Front 68

Avoidant Personality Disorder
Interventions
-what is the best way to treat patients

Back 68

friendly and reassuring in gentle way

Front 69

Avoidant Personality Disorder
Interventions
-being pushed into social situations can cause extreme and severe anxiety

true or false

Back 69

true

Front 70

Implementation /Milieu Management
-primary goal: management of the

Back 70

pts affect in a group context or social context(community meetings, coping skills group and socializing groups are all helpful for these patients

Front 71

Implementation /Milieu Management
-what is the purpose?

Back 71

they have the opportunity to interact with peers and staff to discuss goals and learn problem solving
skills
-dealing with emotional issues that arise in the milieu requires a calm, unite approach by the staff to maintain safety and enhance self-control

Front 72

Implementation /Milieu Management
-primary goal: management of the pts affect in a group context or social context

-they have the opportunity to do what?

-helps tehm deal with what?

Back 72

-interact with peers and staff to discuss goals and learn problem solving
skills

-dealing with emotional issues that arise in the milieu requires a calm, unite approach by the staff to maintain safety and enhance self-control

Front 73

Implementation /Milieu Management
-common problems resulting from staff splitting can be minimized how?

Back 73

the unit leaders hold weekly staff meetings to ventilate their feelings about conflicts with patients and each other

Front 74

Implementation /Milieu Management
-how can you get patients to take more responsibility for themselves ?

Back 74

if they are actively involved in treatment plans

Front 75

Implementation /Milieu Management
--limit setting and confrontation about negative behavior is better accepted by the pt if

Back 75

the staff first employs empathetic mirroring (reflecting back to the pt an understanding of the pts distress without a value judgment)


ex: the nurse can listen to a patient’s emotional complaints about the staff and the hospital without correcting any errors, sampling noting that the patient truly feels hurt. showing empathy may decreased aggressive outbursts of the pt feels that staff are trying to understand feelings of frustration

Front 76

–for pts with borderline personality disorder – what can the nurse do to encourages the pt to think independently about his or her behavior instead of venting feelings. this also facilitates discussion

Back 76

-cognitive exercises (writing down the sequence of events leading up to the self-destructive injury and the consequences of the behavior before staff discuses the event

Front 77

Personality Disorders

-primary problem: can’t identify and verbalize feelings…primary intervention is

Back 77

help the pt identify and express feeling so they are not acted out

Front 78

Personality Disorders
-involve client in treatment planning (esp. someone who is demanding and controlling) because

Back 78

it will give them a sense of control..increase cooperation and compliance

Front 79

-empathetic mirroring:
what are we letting the client know when we do this:

we do this because data says that it decreases:

Back 79

your letting the client know that you are understanding with their level of distress,


aggressive behavior and it should be done BEFORE you do any limit setting very useful intervention

Front 80

-people with borderline personality disorder (self mutilation /self injury such as superficial cutting)
--what do you do if a pt comes up to you and says I just cut my arm?

Back 80

nurses needs to: be matter of fact and DO NOT REACT, then ask the client to write the sequence of
events leading up to the cutting, and the consequences of the cutting, and that needs to happen before you discuss the incident (if you discuss the incident you are reinforcing the behavior you don’t want)

Front 81

Interventions for manipulative behavior: limit setting is done why?

Back 81

(establishing the parameters of desirable and acceptable patient behavior)

Front 82

Interventions for manipulative behavior: limit setting
-4 step

Back 82

-discuss concerns about behavior with patient
-identify unacceptable behavior “you hit John”
-identify expected behavior “there is no hitting”
-identify the consequences if that limit is exceed “if you are unable to control yourself, I will help you
get into control by helping you spend time in open seclusion so you cant settle yourself down”

Front 83

Interventions for manipulative behavior: limit setting

why do we have to identify situation and consequences of the behavior (-

Back 83

someone who is impulsive does not think about consequences)

Front 84

Interventions for manipulative behavior: limit setting
-what do we want to teach the patient?

Back 84

-teach patient to cue himself to “stop and think” about consequences before acting impulsively

Front 85

Interventions for manipulative behavior: limit setting

-practice what with the patient in social and interpersonal situations?

Back 85

problem solving in social and interpersonal situations outside the therapeutic envt

Front 86

Interventions for manipulative behavior: limit setting

-provide what for successful outcomes?

Back 86

positive reinforcement (praise and rewards) for successful outcomes

Front 87

1. A nurse caring for a client who has been diagnosed with a personality disorder should expect that the client will exhibit which of the following characteristics?
A) Frequent episodes of psychosis
B) Constant involvement with the needs of significant others
C) Inflexible and maladaptive responses to stress
D) Abnormal ego functioning

Back 87

C) Inflexible and maladaptive responses to stress



Personality patterns persist unmodified over long periods of time. Characteristics of inflexible and maladaptive response to stress is one of these characteristics for individuals with personality disorder.
Text page: 434

Front 88

Which statement is descriptive of clients with personality disorders?
A) They are resistant to behavioral change.
B) They have an ability to tolerate frustration and pain.
C) They usually seek help to change maladaptive behaviors.
D) They have little difficulty forming satisfying and intimate relationships.

Back 88

A) 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.
Text page: 434

Front 89

Research has indicated that antisocial personality may be characterized by:
A) social isolation.
B) lack of remorse.
C) learning difficulties.
D) difficulty with reality testing.

Back 89

B) lack of remorse.


The antisocial personality exhibits a lack of remorse when confronted with the results of their thoughtless, irresponsible behavior towards others.
Text page: 438

Front 90

The primary goal of milieu therapy for clients with personality disorders is
A) manage the affect behavior has on the entire group.
B) one-on-one therapy.
C) to help the client remain uninvolved with other patients.
D) a laissez faire attitude.

Back 90

A) manage the affect behavior has on the entire group.

Front 91

Characteristic behaviors the nurse will assess in the narcissistic client are
A) dramatic expression of emotion, being easily led.
B) perfectionism and preoccupation with detail.
C) grandiose, exploitive, and rage-filled behavior.
D) angry, highly suspicious, aloof, withdrawn behavior.

Back 91

C) grandiose, exploitive, and rage-filled behavior.

Narcissistic clients give the impression of being invulnerable and superior to others to protect their fragile self-esteem.
Text page: 439

Front 92

Characteristics the nurse will assess in the client with antisocial personality disorder are
A) deceitfulness, impulsiveness, and lack of empathy.
B) perfectionism, preoccupation with detail, and verbosity.
C) avoidance of interpersonal contact and preoccupation with being criticized.
D) need for others to assume responsibility for decision-making and seeks nurture

Back 92

A) 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.
Text page: 437

Front 93

Playing one staff member against another is an example of
A) devaluation.
B) splitting.
C) impulsiveness.
D) social ineptitude.

Back 93

B) 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.
Text page: 437

Front 94

Splitting is a process in which the client
A) unconsciously represses undesirable aspects of self.
B) places responsibility for his or her behavior outside the self.
C) sees things as divided into "all good" or "all bad."
D) evidences lack of personal boundaries.

Back 94

C) 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.
Text page: 437

Front 95

A 16-year-old has stolen money from his invalid grandmother, uses drugs and alcohol, and frequently beats up acquaintances who disagree with him. Arrested for an assault in which he beat a classmate and caused brain damage, he stated in court "The guy deserved everything he got." The behaviors described are most consistent with the clinical picture of
A) antisocial personality disorder.
B) borderline personality disorder.
C) schizotypal personality disorder.
D) narcissistic personality disorder.

Back 95

A) 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.
Text page: 437

Front 96

Which behavior would be inconsistent with defining characteristics for the nursing diagnosis of ineffective coping?
A) Difficulty in relationships
B) High levels of anxiety
C) Manipulation
D) Interdependence

Back 96

D) Interdependence

The characteristics for the diagnosis of ineffective coping include crisis, high levels of anxiety, anger and aggression; child, elder, or spouse abuse; and difficulty in relationships and manipulation. Interdependence would not be considered a symptom for ineffective coping.
Text page: 447

Front 97

A nurse is assigned to work with a client with borderline personality disorder. The nurse will need to consider strategies for dealing with the client's
A) mood shifts, impulsivity, and splitting.
B) grief, anger, and social isolation.
C) altered sensory perceptions and suspicion.
D) perfectionism and preoccupation with detail.

Back 97

A) 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.
Text pages: 437, 438

Front 98

a client has been diagnosed with dependent personality disorder. Which behavior descriptions can the nurse expect to assess?
A) Anxious, fearful
B) Odd, eccentric
C) Dramatic, emotional, erratic
D) Disoriented, disorganized

Back 98

A) Anxious, fearful

Front 99

A newly admitted client has an axis II diagnosis of schizoid personality disorder. The nursing intervention of highest priority will be to
A) set firm limits on behavior.
B) respect need for social isolation.
C) encourage expression of feelings.
D) involve in milieu and group activities.

Back 99

B

Schizoid personality disorder has the primary feature of emotional detachment. The person does not seek out or enjoy close relationships. They are reclusive, avoidant, and uncooperative. They do not do well with resocialization.
Text pages: 436 and 449

Front 100

A client with dependent personality disorder who had been living with her newly married son was admitted a week ago for treatment of depression, which began after her son suggested that she move out. Which remark by the client would the nurse evaluate as showing improvement in the client's condition?
A) "My son's suggestion hurt me greatly."
B) "My son is less at fault than my daughter-in-law."
C) "I'm going to need help to afford to rent an apartment."
D) "How will I ever live alone with no one to look after my affairs?"

Back 100

C

Dependent personality disorder has a primary feature of extreme dependency in a close relationship, with an urgent search to find a replacement when one relationship ends. Clients have a deeply held conviction of personal incompetence, with the fear that they cannot survive on their won. Self reflection on the possibility of moving into an apartment shows improvement.
Text pages: 440, 441

Front 101

A client with histrionic personality disorder winks at an attractive nurse and states, "You and I should be able to turn those resident physicians into jelly if you'd wear your skirts about two inches shorter." The nurse's reply should be based on the understanding that the client's use of seductive behavior is
A) a response to stress.
B) based on a need to dominate.
C) seated in primitive rage.
D) callous disregard for others.

Back 101

A) a response to stress.


The histrionic person is impulsive and melodramatic and may act flirtatious or provocative to get the spotlight in an attempt to reduce stress.
Text pages: 438, 439

Front 102

A client with obsessive-compulsive personality disorder takes the nurse aside and mentions "I've observed you interacting with Mr. D. You are not approaching him properly. You should be more forceful with him." The best response for the nurse would be
A) "I will be continuing to follow the care plan for Mr. D."
B) "I see you are trying to control Mr. D's therapy as well as your own."
C) "Your eye for perfection extends even to my nursing interventions."
D) "Mr. D's care is really of no concern to you or to other clients."

Back 102

A) "I will be continuing to follow the care plan for Mr. D."


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.
Text pages: 440, 441

Front 103

The priority nursing intervention for a client with borderline personality disorder is to
A) protect other clients from manipulation.
B) respect the client's need for social isolation.
C) assess for suicidal and self-mutilating behaviors.
D) provide clear, consistent limits and boundaries.

Back 103

C) 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.
Text page: 437