WILKES NSG 526 exam 3 2024-2025 With Q&A, Exams of Nursing

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WILKES NSG 526 exam 3 2024-2025 With

Q&A

A personality disorder is defined as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's ------------, is pervasive and -----------, has an onset in adolescence or early adulthood, is stable with inflexible Personality disorders were originally classified as Axis ---------- diagnoses in the DSM- IV-TR. - ANSWER>>II Personality disorders were originally classified as Axis II diagnoses in the DSM-IV-TR. Axis II classification was intended to focus attention on ----------I patterns that might be overlooked in the light of the more pronounced disorders of Axis I. - ANSWER>>behavior To receive a diagnosis of a personality disorder, an individual must demonstrate the criteria behaviors persistently and to such an extent that they impair the ability to function socially and ----------- In some people, the underlying feelings and behaviors may be intermittent and interfere interpersonally without impairment. Instead of having a personality disorder, the traits To receive a diagnosis of a personality disorder, an individual must demonstrate the criteria behaviors persistently and to such an extent that they impair the ability to function socially and occupationally. In some people, the underlying feelings and behaviors may be intermittent and interfere interpersonally without impairment. Instead of having a personality disorder, the individual is said to have traits of the disorder. Personality traits are defined as "prominent aspects of the personality that are exhibited in a wide range of important social and personal contexts" (APA, 2022, p. 735). Personality traits can also be noted without a ----------- - ANSWER>>without a formal diagnosis. Mix and match DSM-5 TR and the Clinical Picture of Cluster A Disorders DSM-5 TR and the Clinical Picture of Cluster B Disorders time, and leads to distress or impairment" - ANSWER>>culture individual is said to have --------- of the disorder. - ANSWER>>occupationally.

DSM-5 TR and the Clinical Picture of Cluster C Disorders with (Anxious, Fearful) (Odd or Eccentric) (Dramatic, Emotional, Erratic) - ANSWER>>DSM-5 TR and the Clinical Picture of Cluster A Disorders (Odd or Eccentric) DSM-5 TR and the Clinical Picture of Cluster B Disorders (Dramatic, Emotional, Erratic) DSM-5 TR and the Clinical Picture of Cluster C Disorders (Anxious, Fearful) Paranoid, Schizoid, and Schizotypal personality disorders are Cluster --------- which aligns with which one?------------------- 1. (Anxious, Fearful)

2. (Odd or Eccentric)
   3. (Dramatic, Emotional, Erratic) - ANSWER>>A Odd/Eccentric antisocial, borderline, histrionic, and narcissistic personality disorders are Cluster --------- which aligns with which one?------------------- 1. (Anxious, Fearful)
3. (Odd or Eccentric)
   3. (Dramatic, Emotional, Erratic) - ANSWER>>B Dramatic, Emotional, Erratic avoidant, dependent, obsessive-compulsive personality disorders are Cluster --------- which aligns with which one?-------------------
   4. (Anxious, Fearful)
   5. (Odd or Eccentric)

Nurses should strive for s------- and clarity to help decrease client anxiety. - ANSWER>>Schizoid (cluster A) avoids isolated aloof fear simplification (as with all of cluster A) Paranoid Schizoid Schizotypal Antisocial Borderline Histrionic Narcissistic Avoidant Dependent Obsessive-compulsive personality disorders Which one Characteristics: ideas of ------------; ------------ thinking or odd beliefs; perceptual distortions; vague, ---------speech; frightened, suspicious, ---------- affect; distant and ---------- social relationships. These clients tend to be frightened and suspicious in social situations. ------------ can ease their anxiety. - ANSWER>>Schizotypal (cluster A) reference magical stereotyped blunted strained Explanations (as with all of cluster A) Paranoid Schizoid Schizotypal Antisocial Borderline Histrionic Narcissistic Avoidant Dependent

Obsessive-compulsive personality disorders Which one: Characteristics: has superficial ---------, violates ---------- of others, exploits others, lies, cheats, lacks guilt or remorse, is ----------, acts out, and lacks empathy. As clients these individuals are extremely manipulative and ------------- Nurses must establish and adhere to a plan of care, and maintain clear ------------ if they are to minimize client manipulation and acting out. - ANSWER>>Antisocial (cluster B) charm rights impulsive manipulative and aggressive. boundaries Paranoid Schizoid Schizotypal Antisocial Borderline Histrionic Narcissistic Avoidant Dependent Obsessive-compulsive personality disorders Which one: Characteristics: unstable, intense relationships; --------- disturbances; impulsivity; self---- -----; rapid mood shifts; chronic e--------; intense fear of abandonment; splitting; and anger. A major defense is splitting (alternating between idealizing and devaluing). Selfmutilation and suicide-prone behavior are often-used impulsive self-destructive behaviors. ----------- is intense and pervasive and help with ---------- management is an important intervention. Relationship building, safety, and -------- setting are other foci. - ANSWER>>Borderline (cluster B) identity self-mutilation emptiness Anger/Anger limit setting

Characteristics: grandiosity, fantasies of power or brilliance, need to be a-------, sense of entitlement, arrogant, patronizing, rude, overestimates self and underestimates others. This behavior covers a fragile ego. In health care setting demand the ------- of everything. When client is corrected, when boundaries are defined, or when limits are set on client's behavior, client feels --------------, degraded, and empty. To lower anxiety the client may launch a --------- The nurse should gently help the client identify attempts to seek and become ---------, exhibit grandiose behavior, and sense of entitlement. - ANSWER>>Narcissistic (cluster B) admired best humiliated counterattack. perfect Paranoid Schizoid Schizotypal Antisocial Borderline Histrionic Narcissistic Avoidant Dependent Obsessive-compulsive personality disorders Which one: Characteristics: social inhibition, feelings of ------, hypersensitivity to criticism, preoccupation with fear of rejection and ----------, and self perceived to be socially inept. Low self-esteem and hypersensitivity grow as support networks decrease. Demands of workplace often ----------. Project that caregivers will harm them through disapproval and perceive ------------ where none exists. Nurses can teach socialization skills, provide positive feedback, and

build ------------ - ANSWER>>Avoidant (cluster C) inadequacy overwhelming rejection self-esteem. Paranoid Schizoid Schizotypal Antisocial Borderline Histrionic Narcissistic Avoidant Dependent Obsessive-compulsive personality disorders Which one: Characteristics: inability to make daily decisions without advice and reassurance, need of others to be responsible for important areas of life, anxious and helpless when alone, and submissive. Solicit care taking by ----------. Fear abandonment if they are too competent. Experience anxiety and may have co-existing ------------ - ANSWER>>Dependent (cluster C) clinging co-existing depression. Paranoid Schizoid Schizotypal Antisocial Borderline Histrionic Narcissistic Avoidant Dependent Obsessive-compulsive personality disorders Which one:

Associated brain dysfunction occurs in the -------- system and ---------- lobe and increases the behaviors of impulsiveness, parasuicide, and mood disturbance. A decrease in ---------- activity and an increase in ------noradrenergic receptor sites may be related to the irritability and impulsiveness common in people with this disorder It has also been hypothesized that an increase in ----------- may be responsible for transient psychotic states - ANSWER>>limbic/frontal

• decreased serotonin
• increase α hypothesized that increase in DOPAMINE borderline personality These dysfunctions could be caused by a number of events, including trauma, e--------, and A----------. People with BPD manifest psychotic-like symptoms, including p---------- thinking, dissociation, depersonalization, and de-------. These symptoms seem to be associated with intense ------------ - ANSWER>>epilepsy ADHD paranoid derealization. anxiety. The psychoanalytic views of borderline-BPD focus on two important psychoanalytic concepts: s------------ individuation and p----------- identification - ANSWER>>separation projective A person with BPD has not achieved the normal and healthy developmental stage of separation-individuation, during which a child develops a sense of s--------, a permanent sense of s----------others (object constancy), and integration of seeing both bad and good components of self (Jorgensen, 2006). Those with BPD lack the ability to separate from the primary caregiver and develop a separate and distinct personality or self-------------

Psychoanalytic theory suggests that these separation difficulties occur because the primary caregivers' behaviors have been in--------- or insensitive to the needs of the child - ANSWER>>self significant others identity inconsistent Projective identification is believed to play an important role in the development of BORDERLINE-BPD and is a defense mechanism by which people with BPD protect their fragile self-image. For example, when overwhelmed by anxiety or anger at being disregarded by another, they defend against the intensity of these feelings by unconsciously b----------- others for what happens to them. They project their feelings onto a significant other with the unconscious hope that the other knows how to d-------- with it. Projective identification becomes a defensive way of interacting with the world, deal rejection. Individuals with BPD develop dysfunctional beliefs and maladaptive schemas leading them to misinterpret environmental stimuli continuously, which in turn leads to ---------- and inflexible behavior patterns in response to new situations and people Because those with BPD have been conditioned to anticipate rejection and disappointment in the past, they become entrenched in a pattern of fear and anxiety regarding encountering new people or situations. They have fears that ------- is going to strike any minute. Early in life, clients with BPD develop maladaptive schemas or dysfunctional ways of interpreting people and events. The work of cognitive therapists is to ----------- these distortions in thinking patterns and replace them with realistic ones. - ANSWER>>rigid disaster challenge (remember CBT) The biosocial viewpoint proposed by Marsha --------- and colleagues sees BORDERLINE-BPD as a multifaceted problem, a combination of a person's innate emotional vulnerability and his or her inability to control that emotion in social interactions (emotional dysregulation) and the environment (Linehan, 1993). The emotional dysregulation and aggressive impulsivity entail both social learning and -- ------- regulation. Much of the neurobiological research is directed at neurotransmitter functions involving s----------, n--------- d--------, a--------, gamma-aminobutyric acid (GABA), and v---------- (Joyce et al., 2006; Gollan, Lee, & Coccaro, 2005). which leads to more r--------------- - ANSWER>>projective identification- BLAMING

• lack of -------------- - ANSWER>>diffusion role/role incoherence inconsistency commitment It is not unusual for people with --------- to direct their actions in accord with the wishes of other people. For example, one woman with ----------- describes herself: "I am a singer because my mother wanted me to be. I live in the city because my manager thought that I should. I become whatever anyone tells me to be. Whenever someone recommends a song, I wonder why I didn't think of that. My boyfriend tells me what to wear." - ANSWER>>borderline- BPD borderline-BPD The thinking of people with BPD is di-------------- They either think in black and white (per is good or bad) or their thinking becomes dis----

---

Another cognitive dysfunction common in BPD is dis--------, or times when thinking, feeling, or behaviors occur outside a person's awareness - ANSWER>>dichotomous. (divided into two parts) disorganized dissociation T or F In BPD, there are not any concerns with failure to engage in active problem solving. (meaning the patient becomes ----------)

• but the funny thing is --------------- are rarely taken - ANSWER>>F hopeless, relying on others for help suggestions Borderline-BPD Self-injurious behavior can be compulsive (e.g., hair pulling), episodic or repetitive (cutting wrists, arms, or other body parts) and is more likely to occur when the individual with BPD is depressed; has highly unstable interpersonal relationships, especially

problems with intimacy and sociability; and is paranoid, hyper------- and re----------- - ANSWER>>hypervigilant (alert, watchful), and resentful. Borderline treatment strategies: ----------- is a psychosocial treatment developed by Marsha M. Linehan specifically to treat individuals with borderline personality disorder. - ANSWER>>DBT Borderline Basically, DBT maintains that some people, due to invalidating environments during upbringing and due to biological factors as yet unknown, react abnormally to emotional stimulation. Their level of arousal goes up much more quickly, peaks at a higher level, and takes more time to return to baseline. This explains why borderlines are known for crisis-strewn lives and extreme emotional lability (emotions that shift rapidly). Because of their past invalidation, they do not have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task. The treatment itself is based largely on behaviorist theory with some cognitive therapy elements as well. There are two essential parts of the treatment, and without either of these parts the therapy is not considered "DBT adherent."

• Decreasing high-risk suicidal behaviors
  • Decreasing responses or beh - ANSWER>>post- traumatic core mindfulness skills, emotion regulation skills, interpersonal effectiveness skills, and distress tolerance skills The Four Modules of DBT are
• Mindfulness
• Interpersonal Effectiveness
• Emotion Regulation
• Distress Tolerance Which one is the capacity to pay attention, non-judgmentally to the present moment. It is derived from teachings of the Buddha, the Zen tradition being perhaps one of its most well-known proponents. Living in the moment - ANSWER>>mindfulness The Four Modules of DBT are
• Mindfulness

Pharmacologic Interventions - --------- medication is better for people with BPD. Clients with BPD may be taking several medications, particularly if they have a comorbid disorder, such as a mood disorder or substance abuse. Pharmacotherapy is used to control emotional dysregulation, impulsive aggression, ------------- disturbances, and anxiety as an adjunct to psychotherapy - ANSWER>>- less cognitive Sleep Enhancement - Facilitation of regular sleep-wake cycles may be needed because of disturbed sleep patterns. Conservative approaches should be exhausted before recommending medication. Establishing a regular bedtime routine, monitoring bedtime snacks and drinks, and avoiding foods and drinks that interfere with sleep should be tried. If relaxation exercises are used, they should be adapted to the tolerance of the individual. Moderate exercises (e.g., brisk walking) 3 to 4 hours before bedtime activates both serotonin and endorphins, thereby enhancing calmness and a sense of well-being before bedtime. For clients who have difficulty falling asleep and experience interrupted sleep, it helps to establish some basic sleeping routines. The bedroom should be reserved for only two activities: sleep and sex. Therefore, the client should remove the television, computer, and exercise equipment from the bedroom. If the clie - ANSWER>>physically and sexually furniture Borderline patients need: ----------- medications ------------- enhancement sleep boundaries/natural Some additional strategies for establishing the boundaries of the relationship include the following: Documenting in the client chart the agreed-on appointment expectations Sharing the treatment plan with the client Confronting violations of the agreement in a non--------- way Discussing the purpose of limits in the therapeutic relationship and applicability to other relationships. - ANSWER>>non- punitive Established ------------- (testing limits is a ---------- way of ) identifying - ANSWER>>less

A helpful technique for managing feelings is known as the COMMUNICATION TRIAD. The triad provides a specific syntax and order for clients to identify and express their feelings and seek relief. The sentence" consists of three parts: An ------------ statement to identify the prevailing feeling A nonjudgmental statement of the --------------- What the client would like ------------- or what would restore comfort to the situation - ANSWER>>"I" emotional trigger differently The PMH-APRN must emphasize with clients that they begin with the: 1.) "I" statements (i.e. I get mad when you treated me that way) or 2.) condition (you treated me that way and I got mad) Why? - ANSWER>>"I" statements because condition becomes accusatory, provokes defensiveness Three activities associated with thought stopping are effective: Taking a quick deep breath when the behavior is noted (this also stimulates relaxation) Visualizing a stop sign or saying "---------" when possible (this allows the person to hear externally and internally) Deliberately replacing the undesired behavior with a positive alternative (e.g., instead of ruminating about an angry situation, think about a neutral or positive self-affirmation). The sequencing and combining of the steps puts the person back in ----------- - ANSWER>>STOP control. The Office of the U.S. Surgeon General produced a report indicating that the unmet mental health needs of children and their families is a public health crisis (Department of --------- and Human Services [DHHS], 2001). The report calls for a national action agenda to promote mental health in children and treat more effectively their mental disorders. Among the many important goals in this national agenda are plans to: Improve assessment and recognition of children's mental health needs.

Defense mechanisms commonly employed by children are re---------, re-------- formation, and pro-------------. The child comes to deal with the world through these distorted views in an attempt to defend against painful unconscious issues. However, the unconscious content continues to influence the behavior and conscious thoughts of the child, often in ways that severely impair his or her ability to function in life. Defense mechanisms are, therefore, considered to be symptoms of -------------- - ANSWER>>repression, reaction formation, and projection. mental health problems. Psychodynamic Theory: The focus of treatment is attempting to bring repressed conflicts and issues into awareness so that they can be addressed and resolved. A primary way in which this occurs is through --------, a process whereby the child unconsciously directs feelings and desires from other relationships in life onto the therapist. So the relationship between therapist and child is used as a focus for interpretation and change. - ANSWER>>transference Developmental Theory - An understanding of developmental theory helps you identify --- ------ in adolescent growth and development processes and intervene appropriately. The theories of Freud, Erikson, and ----------- provide considerable insight into the adolescent's struggle to attain adulthood. The development of an adolescent's sense of identity entails a preoccupation with self--- ------. It also entails a connection between future role and past experiences. In the search for a new sense of sameness and continuity, many adolescents must repeat the crisis resolutions of earlier years to integrate these past elements and establish the lasting ideals of a final identity. According to Erikson, these crisis periods or stages are reviews of the adolescent's sense of t-------, a---------, i--------, and i-------, in that order. Equally important for an adolescent's development is c--------Piaget's research reveal - ANSWER>>deviations Sullivan self-image. trust, autonomy, initiative, and industry cognition. formal (3rd stage) 12-14, adult level

self-reflective Object-Relations Theory - Object-relations theory is built on the foundation of ------------ theory and is based on the work of Fairbairn, Winnicott, Klein, Mahler, Stem, and others (Kaslow & Magnavita, 2002). In this theory, an object is defined as a -------- or thing in the child's environment that has psychological significance to the child. A major assumption of the theory is that rather than being driven simply by physical needs or instincts that enhance survival, infants have an innate biologic need for ---------

-. These ------- increase in quality and complexity as a child develops. - ANSWER>>psychodynamic person or thing relationships/relationships. Object-Relations Theory - Initially infants are (differentiate or undifferentiate --------------) from the object they seek (the primary caregiver) and are in a state of diffuse, unorganized experiences. The child is totally dependent on the mother to organize the child's different experiences into an -- ----------. As the young child begins to (differentiate or undifferentiate --------------), that is, separate and develop a sense of his or her own self as an individual, the relationships with interpersonal "objects" in the world of the child are (externalized or internalized ----- ----) and become the internal mental representations that form the self. The differentiated self forms the basis for the child's future views of his or her own worth and the availability and responsiveness of others. Ultimately, it determines whether or not the child becomes healthy, strong, and creative. Development of the self is c - ANSWER>>undifferentiate understandable whole. differentiate internalized repeat in relationships Attachment Theory - Attachment theory builds on the psychodynamic concepts of psychic ---------- and the impact of --------- processes.