PSYC 5015 Chapter 25- Addiction and Substance-Related Disorders (Portage learning), Quizzes of Nursing

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Chapter 24: Personality and Impulse-Control Disorders The nurse provides education about antisocial personality disorder (ASPD) to a group of vocational support workers involved with former inmates entering the workforce. Which description outlines how ASPD is defined?  A pattern of disregard for and violation of the rights of others  Unstable employment history and a pattern of being fired from jobs  The number of and the seriousness of crimes  Ongoing experiences of transient psychosis When documenting observations of the behaviors exhibited by a client diagnosed with borderline personality disorder, the nurse can correctly use which terms?  Impulsive, aggressive, and manipulative  Emotional, dramatic, and theatrical  Impulsive, self-destructive, unstable  Perfectionistic, rigid, and controlling Dialectical behavior therapy (DBT) combines behavior therapy with which of the following types of therapy?  Occupational  Cognitive  Art  Physical Which occurs when thinking, feeling, or behaviors occur outside a person’s awareness?  Dissociation  Impulsivity  Dichotomous thinking  Affective instability

The nurse completes an intake assessment for a client. Which symptoms are associated with dependent personality disorder? Select all that apply.  Drug addiction to opiates  Withdrawal from adult responsibilities  Expresses fears of being unable to manage self-care  Difficulty making everyday decisions  Insulin dependent diabetes Clients with borderline personality disorder (BPD) are usually admitted to an inpatient setting because of what?  Threats of self-harm  Medication noncompliance  Splitting  Agitation A client with a diagnosis of antisocial personality disorder would exhibit a history of conduct disorder before which age?  10 years  12 years  7 years  15 years A 21-year-old client is being evaluated in the clinic for anger management. The client describes experiencing repeated episodes lasting 20 to 30 minutes of aggressive behavior with angry verbal outbursts when feeling angry. Which diagnosis should the nurse assess for?  intermittent explosive disorder (IED)  kleptomania  conduct disorder (CD)  oppositional defiant disorder (ODD) A personality disorder is defined as a collection of traits that do what?

 Lead to aggression and violence  Lead to withdrawn and antisocial behavior  Cause behavioral dysfunction and inner distress  Are malleable and poorly defined A nurse is providing community education regarding adolescents with oppositional defiance disorder (ODD). Which point should the nurse include in the educational session?  Parental roles do not influence the development of ODD.  Behavior problems can develop when parental figures pay attention to a child's maladaptive behaviors.  It is ideal if parents can wait until adolescence to seek treatment.  Rewarding positive behaviors consistently can lead to ODD. The nurse provides care for a male client with a skin infection. The client also has a diagnosis of paranoid personality disorder. The client removes the peripheral intravenous device, expresses suspicion that the antibiotics are “poisoning” him and that others in the health care system are exerting control over his life. The client is hypervigilant and looks worried. What is the nurse’s priority intervention?  Express empathy and understanding of the client’s paranoid perceptions  Explain factually the evidence that the antibiotics contain no poison  Restrain the client to prioritize the safety of others  State awareness of client’s concern and gently offer an alternative perspective Clients with borderline personality disorder commonly exhibit which of the following symptoms? Select all that apply.  Extreme feelings of being loved and valued  Constant need for reassurance  Pattern of getting along well with diverse groups of people  History of unstable, insecure attachments  Fear of abandonment

The nurse is assigned to care for a client with dependent personality disorder. Which intervention should the nurse include in this client's care plan to promote independence?  Helping the client identify preferences, such as choosing which clothing item to wear  Scheduling competitive activities so the client can test skills  Avoiding discussing the client's feelings of helplessness  Spending long periods of unscheduled time with the client The nurse is working with a client with antisocial personality disorder. This client's desire to do everything for himself is based on which of the following?  Rewards for competitive behavior  Inability to delay gratification  Belief in his own self-worth  Sense of mistrust of others A student nurse is assessing a client with borderline personality disorder and notes that this client has a tendency to view others and situations with extremes of “bad” or “good.” The nurse documents this assessment finding as ...  Splitting  Manipulation  Dialectical behavior  Dissociation When teaching a client with antisocial personality disorder (ASPD), which approach would be most appropriate for the nurse to use?  Challenging  Negotiation  Lecturing  Direct The adult children of a client with narcissistic personality disorder meet with the therapist as part of their parent's treatment. The nurse is aware that which statement by the daughter is consistent with behavior typically associated with this personality disorder?

 “My parent never really seemed to see me as a person with my own thoughts and problems.”  “My parent was always timid and fearful.”  “My parent was constantly threatening to commit suicide.”  “My parent never had any family or friends over to the house.” Which occurs when thinking, feeling, or behaviors occur outside a person’s awareness?  Impulsivity  Dichotomous thinking  Dissociation  Affective instability When assessing a client with narcissistic personality disorder, the nurse would expect the client to demonstrate which of the following?  Mistrust of others  Genuine concern for others  Grandiose and superior self-concept  Dependence on others for decision making A school-age child has a diagnosis of disruptive behavior disorder. The school nurse conducts an education session to help the parents understand the diagnosis and to teach skills that the parents can implement to help address disruptive behavior. What can parents do to help? Select all that apply.  Take the child to the police as a scare tactic  Use time out for disruptive behavior  Make behavioral expectations clear and consistently enforce them  Teach problem-solving skills  Get the child a pet to care for

A client on an inpatient psychiatric unit has features of borderline personality disorder. The client is frequently angry, has an unstable sense of self, and is highly impulsive. The client can be verbally abusive to staff, who feel manipulated by the client's behaviors. Which intervention does the nurse determine as priority?  Social skills training  Increased recreational therapy  Setting limits  Stress management techniques The nurse is counseling a 35-year-old client with a personality disorder. The client states that the client's problems are not the client's fault and that the client is a victim of circumstances and “fate.” When experiencing stress, the client has impulsively called friends and family and stating, "It's my last day on earth." This client presentation is best described by which disorder?  Antisocial personality disorder  Histrionic personality disorder  Narcissistic personality disorder  Borderline personality disorder A client diagnosed with schizoid personality disorder is described by family members as what?  Dramatic and emotional  Tired and sad  Nervous and fearful  Emotionless and a loner The nurse in a medical setting provides care for a client with histrionic personality disorder concurrent with their medical challenges. During the initial assessment with the client, the nurse identifies an altered expression of sexuality. To guide further assessment, what factor does the nurse anticipate from the client?  Suppression of outward signs of sexual attraction  Having one long-term intimate partner  Having success in establishing social intimacy

 Demonstration of seductive behavior The nurse completes an assessment for a female client in an outpatient clinic. In addition to her medical issues, the client shares that she has a personality disorder. The client wears heavy makeup and demonstrates strong emotional intensity. Which personality disorder does the nurse identify based on the assessment findings?  Obsessive compulsive personality disorder  Schizotypal personality disorder  Histrionic personality disorder  Narcissistic personality disorder The nurse provides care to clients who have a tendency toward antisocial and criminal behavior. Which term was used in the past to describe people with this disorder?  Habitual criminal  Psychopath  Irresponsible  Schizophrenic An adult female client presents to the mental health clinic and is assessed by the nurse. During the assessment, the nurse observes the client engage warmly with an appropriately variable affect and to be open to share their life story. The story included a pattern of failed intimate relationships, which the client attributes to a mild form of cerebral palsy. The client lives in the parental home. The client’s father died when she was in high school and her mother passed away three months prior to the assessment. Interpersonally the client says she works hard to avoid conflict. References are made to being “unlovable” and that she is “engulfed in sadness” to the point of needing a disability income. This is due to the expressed fear of being “unable” to care for everyday needs independently. What disorder does the nurse suspect?  Dependent personality disorder  Major depressive disorder  Obsessional compulsive personality disorder  Generalized anxiety disorder

The nurse is attempting to establish a therapeutic nurse–client relationship with a client diagnosed with borderline personality disorder. Which action is most important for the nurse to do to establish this relationship?  Aggressively confront the client about boundary violations.  Respect the client's boundaries at all times.  Limit interactions to 10 minutes at a time.  Tell the client the relationship will last as long as the client wishes. A client with a diagnosis of dependent personality disorder is recovering from surgery. The nurse considers the importance of avoiding some interventions that could be therapeutic for another client without a personality disorder. Which intervention will the nurse avoid?  Telling the client what to do  Providing positive feedback  Identifying resources to aid in meal planning  Enhancing decision-making skills Which thought process would cause a client with antisocial personality disorder to want to do everything for the self?  Belief in own self-worth  Inability to delay gratification  Rewards for competitive behavior  Sense of mistrust of others The nurse is aware that for some personality disorders, denial of symptoms is common. Which therapeutic approach does the nurse choose to address this denial?  Compassion  Judgment  Self-disclosure  Sympathy

The nurse seeks to establish trust while assessing the social history of a client with antisocial personality disorder (ASPD). Which finding(s) demonstrate the client’s relationship challenges? Select all that apply.  persistent pattern of disregard for others  perceptive of the needs of others  a pattern of failed relationships  enduring relationships with family members  relationships end suddenly A client with a diagnosis of dependent personality disorder is recovering from surgery. The nurse considers the importance of avoiding some interventions that could be therapeutic for another client without a personality disorder. Which intervention will the nurse avoid?  Providing positive feedback  Enhancing decision-making skills  Identifying resources to aid in meal planning  Telling the client what to do The nurse completes an assessment for a female client in an outpatient clinic. In addition to her medical issues, the client shares that she has a personality disorder. The client wears heavy makeup and demonstrates strong emotional intensity. Which personality disorder does the nurse identify based on the assessment findings?  Schizotypal personality disorder  Narcissistic personality disorder  Obsessive compulsive personality disorder  Histrionic personality disorder A nurse working in an inner city youth support program identifies that antisocial personality disorder (ASPD) can develop in those who have dysfunctional attachments. Which are risks for developing dysfunctional attachments? Select all that apply.  Losing of a parent through death  Experiencing parental abandonment or neglect

 Experiencing physical or sexual abuse  Being the middle child  Having same-sex parent A family member of a client asks the nurse a question about personality disorders. The family member asks, “What personality disorder diagnosis makes a client most at risk for self-harm behaviors?” What is the nurse’s best response?  Borderline personality disorder  Schizoid personality disorder  Paranoid personality disorder  Antisocial personality disorder During neighborhood scans, a nurse working in a community outreach program has identified an individual staying in a local shelter. The person has not engaged with the program. During the day, the client can be observed sweeping the pavement in a particular alley with a broom. There is no obvious purpose to the behavior. The individual is dressed in winter clothing even though it is summer. The client mutters expressions that are audible but cannot be understood. Based on the observations, which disorder does the nurse consider?  Avoidant personality disorder  Schizotypal personality disorder  Obsessive compulsive personality disorder  Paranoid personality disorder The nurse in an outreach program for female clients with dependent personality disorder will be holding a discussion forum. Which of the following is an appropriate topic? Select all that apply.  improving one's ability to ask others for help  ingratiating oneself to others  improving one's self-esteem  fear of loneliness versus tolerance of abuse  making decisions and feeling good about them

A client is admitted to the mental health unit after the client's spouse brings the client to the emergency department. Upon arrival, the spouse explained that the client had been crying all weekend and stating that the client wanted to die. Upon further assessment, the spouse reports that the client always has difficulty controlling anger and frequently worries that the spouse will leave the client. Recently, the client has been getting drunk every night, which the client never used to do. What diagnosis should the nurse suspect applies to this client?  Depression  Borderline personality disorder  Bipolar disorder  Mania The nurse plans care for a client with antisocial personality disorder (ASPD) and concurrent chronic pain. Which assessment finding is anticipated?  Inability to offer commendations to the nurse  Exaggeration of the physical symptoms  Offering insight into ASPD symptoms  Truthfulness in describing physical symptoms The nurse is beginning to work with a client who has a diagnosis of paranoid personality disorder. Which question made by the nurse would be best in the beginning of the conversation?  “Are you feeling vulnerable today?”  “What would you like to accomplish today?”  “Would you like to work on relationships or distrust today?”  “That is a great watch you are wearing; did someone special give you that?” A client admitted on the inpatient mental health unit has been suspicious of other clients on the unit. This client is often angry at others' comments, and carries a grudge against a roommate for accidentally using the client's bath towel. Which personality disorder is most likely the client's diagnosis?  Histrionic  Antisocial  Borderline  Paranoid

The nurse–therapist is conducting a group therapy session in which one of the participants is an adult who has been diagnosed with narcissistic personality disorder. The nurse recognizes the significance of childhood experiences in the etiology of personality disorders, which for this client may have included what pattern?  The client's parents had excessively high performance expectations of the client and failure was met with severe sanctions.  The client's parent catered to the client's every need and the client used temper tantrums to successfully get the client's way.  The client's parent was a rigid disciplinarian who demanded complete subservience from both the client and the client's other parent.  The client's parent was in a constant state of crisis and depended heavily on the client for emotional support. Which addresses the psychological domain of biopsychosocial interventions for a client with borderline personality disorder?  Withdrawing attention as much as possible  Prevention of self-harm  Communication skills  Environmental management A high school teacher has referred an adolescent to the school health nurse for repeated episodes of aggressive behavior and verbalizing profanities loudly at other students in the class. The adolescent can sometimes be apologetic. The nurse should suspect which disruptive behavior disorder?  oppositional defiant disorder  pyromania  intermittent explosive disorder  conduct disorder The school nurse is observing children in a classroom at the teacher’s request. The teacher has concerns that one child is continuously disruptive. The nurse observes that the child sits alone without an obvious friend. The child goes to a group of classmates using building blocks. The child knocks down the tower and blames another child for the mishap. The teacher intervenes and the child is immediately argumentative with the teacher. The child has an angry outburst and kicks the blocks while walking away. Which disorder does the nurse identify from the child’s behavior?

 Oppositional defiant disorder  Attention deficit hyperactivity disorder  Obsessive compulsive disorder  Antisocial personality disorder A client is admitted to the hospital medical unit with an admitting diagnosis of antisocial personality disorder. The client also has a history of alcohol use. What is the nurse’s priority intervention for this client?  Medicate the client immediately.  Ensure the safety of other clients and staff.  Place referral to Alcoholics Anonymous (AA).  Initiate alcohol withdrawal protocol. After teaching a group of nurses about borderline personality disorder, the leader determines that the education was successful when the group identifies that symptoms typically begin in which age group?  Middle-age individuals  Late adulthood  Young adulthood  Adolescence A client is diagnosed with a personality disorder manifested by odd, eccentric behavior. Which personality disorder would be associated with this manifestation?  Obsessive-compulsive  Dependent  Paranoid  Avoidant The facilitator of a social skills training program contacts a mental health nurse about a client diagnosed with histrionic personality disorder attending the program. The facilitator feels the

client has well-developed social skills and does not need assertiveness training. How does the nurse respond?  "They develop few relationships due to their strong independence. Attending group will allow the facilitator to challenge their inflated self-esteem."  "Their interactions are dramatic and this makes their interpersonal relationships fulfilling. The referral was inappropriate."  "They have success establishing and maintaining interactions with others. This client would be better in a situation where they use their confidence to help others, such as a public speaking group."  "Their interpersonal relationships tend to be shallow and their self-esteem is low. Having success interacting with others in group will help the client." The nurse is admitting a client with histrionic personality disorder to the inpatient unit. The nurse would anticipate that this client may exhibit which behavior?  Perfection  Distrust  Manipulation  Self-dramatization The nurse is interviewing a client with a history of violence. The client boasts that the client “put a kid in a wheelchair” once when the client was younger and has maimed others. The client states, “Who cares? Life's tough.” Violence and insensitivity are associated with which personality disorder?  Antisocial personality disorder  Histrionic personality disorder  Borderline personality disorder  Schizoid personality disorder While shopping in a grocery store, a client with borderline personality disorder (BPD) greets the sibling of a neighbor with a great big hug. Then about 5 minutes later, the client walks past the sibling and ignores the sibling. The client is demonstrating what?  Dissociation

 Dichotomous thinking  Affective instability  Identity diffusion Which of the following is likely the etiologic basis of the compulsive patterns seen in people with obsessive-compulsive personality disorder (OCPD)?  Substance use within the family  Parental overcontrol  Lack of nurturing  Hyperactivity as a child The nurse is assessing the mood of a client with borderline personality disorder. Which area would the nurse most likely assess to gather the best information? Select all that apply.  Evidence of self harm  Appearance  Blood pressure  Adherence to medication therapy  Activity level The nurse is caring for a client with antisocial personality disorder. Which statement is most appropriate for the nurse to make when explaining unit rules and expectations to the client?  "You'll be expected to attend group therapy each day."  "You'll find your condition will improve much faster if you attend group therapy each day."  "I and other members of the health care team would like you to attend group therapy each day."  "Please try to attend group therapy each day." Clients with borderline personality disorder (BPD) usually exhibit which type of thinking?  Abstract

 All or nothing  Circumstantial  Magical A nurse working in a facility where clients with antisocial personality disorder (ASPD) receive care. Which interventions support client self-responsibility? Select all that apply.  Supporting flexibility around unit rules  Describing the benefits of choosing responsible behavior  Negotiating about boundary violations between clients  Arguing with the client at their same level of intensity  Providing detailed feedback when self-responsibility is noted The nurse is talking with a client that is diagnosed with histrionic personality disorder. Which statement made by the client does the nurse identify correlates with this diagnosis?  “All of the other clients on this unit must follow the rules of the unit.”  “No one is paying attention to me and I am so angry!”  “Why do you think others on the unit are being friendly to me.”  “I am just not sure what activity to do, will you tell me?” A nurse is working with clients in recovery who have been diagnosed with antisocial personality disorder (ASPD). Which intervention(s) promotes a violence-free environment? Select all that apply.  Maintain alertness to manipulative behaviors by the client.  Avoid validating personal strengths.  Prepare comprehensive explanations to avoid becoming sidetracked.  Remove all objects that may be used as a weapon.  Approach the client from the front and speak clearly if the client is hostile. A mental health nurse educator receives a call from a hospital nurse requesting clarification about a client admitted to a medical unit. The client is admitted for treatment of pneumonia, and

the admitting diagnosis includes avoidant personality disorder traits. The nurse requests information about how to anticipate the client’s interpersonal needs. How does the nurse educator respond?  Clients desire social interaction but they lack trust  Clients have a grandiose and over-inflated view of their potentials and avoid therapeutic efforts to generate insight  Clients are dependent on others and require challenges to these behavioral deficits  Clients exhibit paranoid delusions and have suspicions of others A community mental health nurse is consulted by an outreach worker to assist with the diagnosis of an individual who lives in a shelter. The client appears poorly groomed, wearing clothes that fit poorly and do not match. The client overtly avoids contact with other shelter residents by walking around the perimeter of the room and looking downward yet in the direction of another resident in the room. Verbal interactions are rambling monologues with references to physics and the end of the world. Based on the worker’s description, which diagnosis does the nurse identify?  Narcissistic personality disorder  Schizotypal personality disorder  Schizoid personality disorder  Paranoid personality disorder A client with borderline personality disorder (BPD) usually is treated with multiple medications. They can include which of the following types? Select all that apply.  Anti-seizure medications  Hypnotics  Antidepressants  Anxiolytics  Mood stabilizers A nurse is caring for a variety of children on a psychiatric unit. Which child is at risk to develop narcissistic personality disorder? Select all that apply.  A middle child in a family of three

 A child of parents with narcissistic personality disorder  An immigrant child of a refugee family  An only child of a prominent sports celebrity  A child movie actor Which personality disorder is diagnosed more often in women?  Antisocial  Histrionic  Narcissistic  Schizoid When reviewing the history of a client with antisocial personality disorder, which would the nurse expect to find? Select all that apply.  Episodes involving scams for personal gain  Lack of remorse for actions  Repeated incidents involving assaults  Consistent regular work history  Detailed plans for future actions Personality disorders occur in approximately what percentage of the general population?  30%  25%  40%  15% The nurse is teaching a client with paranoid personality disorder to validate ideas with another person before taking action. Which statement made by the client indicates that teaching is effective?  “I will start basing my decisions and actions on reality.”

 “I am going to have to learn to trust other people.”  “If I understand the origins of my paranoid thinking.”  “I will be able to differentiate when my suspicions are true.” A nurse is working with an adolescent diagnosed with conduct disorder. The nurse is engaged in social skills training. If successful, which outcome would the nurse expect?  Enhanced thinking about consequences of choices  Ability to examine responses after an emotional conflict  Ability to identify alternative solutions to a problem  Recognition of how actions affect others A client is diagnosed with paranoid personality disorder. Which would the nurse expect to assess? Select all that apply.  Tendency to be rigid and controlling  Warm and full of humor  Distancing self from others  Outwardly passive  Anger as a emotional response The nurse is asked to assess an adult for Antisocial Personality Disorder (ASPD). Which details occurring prior to the age of 15 support the diagnosis? Select all that apply.  Experiencing psychosis  Attempting suicide  Stealing a purse from a woman in a store  Initiating frequent physical fights  Killing a neighbor’s cat The nurse is caring for a client with schizotypal personality disorder that was experiencing transient psychotic episodes that lead to admission. The client was unkempt and appeared not to have bathed for quite some time. When planning the care of this client, which will be the focus of the nursing intervention(s)? Select all that apply.  Establishing close relationships with others

 Development of social skills  Development of self-care skills  Encourage the client to seek a hobby  Improve functioning in the community Which defense mechanism is used by people diagnosed with borderline personality disorder to protect their fragmented self-image?  Projective identification  Repression  Regression  Compensation What is the nurse’s treatment intervention for a client with histrionic personality disorder?  Monitor weekly blood lithium levels  Address client’s requests with priority over other clients  Challenge the expectation for others to fulfill their needs  Monitor client for symptoms of extrapyramidal side effects (EPS)