Psychiatric Nursing Final Exam
Review
Antisocial PD - ans this disorder reflects constant disregard for others through exploitation and
repeated unlawful actions. No remorse for others, neglect responsibilities, tell lies, and perform
destructive or illegal acts w/o developing any insight into consequences.
*Psychopaths/Sociopaths*
Nursing Guidelines for Antisocial PD - ans 1. Try to prevent or reduce untoward effects of
manipulation (flattery, seductiveness, instilling of guilt):
• Set clear and realistic limits on specific behavior.
• Ensure that limits are adhered to by all staff.
• Carefully document signs of manipulation or aggression.
• Document behaviors (give times, dates, circumstances). Provide clear boundaries and
consequences.
2. Be aware that antisocial patients can instill guilt when they are not getting what they want.
Guard against being manipulated through feelings of guilt.
3. Substance abuse is best handled through a well-organized treatment program before
counseling and other forms of therapy are started.
Avoidant PD - ans characteristics are an extreme sensitivity to rejection and robust avoidance of
interpersonal situations. These individuals demonstrate poor self-confidence and are prone to
misinterpreting others' feedback because they are overly sensitive to rejection.
Nursing Guidelines for Avoidant PD - ans 1. A friendly, accepting, reassuring approach is the best
way to treat patients.
2. Being pushed into social situations can cause extreme and severe anxiety.
Borderline PD - ans most common and dramatic, is characterized by severe impairments in
functioning; instability in emotion regulation, interpersonal relationships, impulsivity, identity or
self-image distortions, and unstable mood.
Nursing Guidelines for Borderline PD - ans 1. Set realistic goals, use clear action words.
2. Be aware of manipulative behaviors (flattery, seductiveness, instilling of guilt).
3. Provide clear and consistent boundaries and limits.
4. Use clear and straightforward communication.
,Psychiatric Nursing Final Exam
Review
5. When behavioral problems emerge, calmly review the therapeutic goals and boundaries of
treatment.
6. Avoid rejecting or rescuing.
7. Assess for suicidal and self-mutilating behaviors, especially during times of stress.
Dependent PD - ans establish relationships in which they are submissive, self-doubting, and
avoid self responsibility. find it difficult to sustain autonomy and often seek out relationships in
which they can be taken care of.
Nursing Guidelines for Dependent PD - ans 1. Identify and help address current stresses.
2. Try to satisfy patient's needs at the same time that limits are set up in such a manner that
patient does not feel punished and withdraw.
3. Be aware that strong countertransference often develops in clinicians because of patient's
excessive clinging (demands of extra time, nighttime calls, crisis before vacations); therefore,
supervision is well advised.
4. Teach and role-model assertiveness.
dialectical behavior therapy - ans evidence-based theory to successfully treat chronically
suicidal pts w/ borderline personality disorder. combines cognitive behavioral techniques with
mindfulness, which emphasizes being aware of thoughts and actively shaping them.
histrionic PD - ans marked by emotional attention-seeking behavior in which the person needs
to be the center of attention.
-impulsive,melodramatic, flirtatious and provocative.
Nursing Guidelines for histrionic PD - ans 1. Understand seductive behavior as a response to
distress.
2. Keep communication and interactions professional, despite temptation to collude with the
patient in a flirtatious and misleading manner.
3. Encourage and model the use of concrete and descriptive rather than vague and
impressionistic language.
4. Teach and role-model assertiveness.
,Psychiatric Nursing Final Exam
Review
Narcissistic PD - ans arrogance w/ grandiose view of self-importance. Has the need for constant
admiration, along w/ a lack of empathy for others, which strains relationships. results in
exploitation of others. Underneath this personality is a person w/ intense shame and fear of
abandonment.
Nursing Guidelines for Narcissistic PD - ans 1. Remain neutral; avoid engaging in power struggles
or becoming defensive in response to the patient's disparaging remarks.
2. Convey unassuming self-confidence.
obsessive-compulsive PD - ans characteristics of perfectionism w/ a focus on orderliness and
control. These people become so preoccupied w/ details and rules that they may not be able to
accomplish a given task.
Nursing Guidelines for Obsessive-Compulsive PD - ans 1. Guard against power struggles with
patient. Need for control is very high.
2. Intellectualization, rationalization, reaction formation, isolation, and undoing are the most
common defense mechanisms.
paranoid PD - ans characterized by distrust and suspiciousness toward others based on the
belief that others want to exploit, harm, or deceive the person. these people are hypervigilant,
anticipate hostility, and may provoke hostile responses by initiating a "counterattack."
demonstrate jealousy, controlling behaviors, and unwillingness to forgive
Nursing Guidelines for Paranoid PD - ans 1. Avoid being too "nice" or "friendly."
2. Give clear and straightforward explanations of tests and procedures beforehand.
3. Use simple, clear language; avoid ambiguity.
4. Project a neutral but kind affect.
5. Warn about any changes, side effects of medication, and reasons for delay. Such interventions
may help allay anxiety and minimize suspiciousness. A written plan may help encourage
cooperation.
Schizoid PD - ans Emotionally detached! Does not seek out or enjoy close relationships. this
individual may be able to function in a solitary occupation but shows indifference to praise or
criticism from others. Depersonalization may occur.
Nursing Guidelines for Schizoid PD - ans 1. Avoid being too "nice" or "friendly."
, Psychiatric Nursing Final Exam
Review
2. Do not try to increase socialization.
3. Perform thorough diagnostic assessment as needed to identify symptoms or disorders the
patient is reluctant to discuss.
schizotypal PD - ans expressed in strikingly odd characteristics, including magical thinking,
derealization, perceptual distortions, and rigid, peculiar ideas. speech patterns may be
distinctive and bizarre.
Nursing Guidelines for Schizotypal PD - ans 1. Respect patient's need for social isolation.
2. Be aware of patient's suspiciousness, and employ appropriate interventions.
3. As with schizoid patient, perform careful diagnostic assessment as needed to uncover any
other medical or psychological symptoms that may need intervention (e.g., suicidal thoughts).
personality disorder - ans an enduring pattern of experience and behavior that deviates
significantly from the expectations w/in the individuals culture.
Cluster A personality disorders - ans characteristics of eccentric and odd behaviors, such as
social isolation and detachment. may also be perception distortions, unusual levels of
suspiciousness, Paranoid PD, Schizoid OD, & Schizotypal PD
Cluster B Personality Disorders - ans Dramatic, emotional, erratic behavior; problems with
impulse control and emotional processing, and relationships; manipulations and acting out;
Antisocial PD, Borderline PD, Histrionic PD, and Narcissistic PD
Cluster C Personality Disorders - ans Anxious or fearful behavior; rigid patterns of social shyness,
hypersensitivity, need for orderliness, and relationship dependency; Avoidant PD, Dependent
PD, Obsessive-Compulsive PD
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 - ans Inflexible and maladaptive responses to stress
Which statement is descriptive of clients with personality disorders?
Review
Antisocial PD - ans this disorder reflects constant disregard for others through exploitation and
repeated unlawful actions. No remorse for others, neglect responsibilities, tell lies, and perform
destructive or illegal acts w/o developing any insight into consequences.
*Psychopaths/Sociopaths*
Nursing Guidelines for Antisocial PD - ans 1. Try to prevent or reduce untoward effects of
manipulation (flattery, seductiveness, instilling of guilt):
• Set clear and realistic limits on specific behavior.
• Ensure that limits are adhered to by all staff.
• Carefully document signs of manipulation or aggression.
• Document behaviors (give times, dates, circumstances). Provide clear boundaries and
consequences.
2. Be aware that antisocial patients can instill guilt when they are not getting what they want.
Guard against being manipulated through feelings of guilt.
3. Substance abuse is best handled through a well-organized treatment program before
counseling and other forms of therapy are started.
Avoidant PD - ans characteristics are an extreme sensitivity to rejection and robust avoidance of
interpersonal situations. These individuals demonstrate poor self-confidence and are prone to
misinterpreting others' feedback because they are overly sensitive to rejection.
Nursing Guidelines for Avoidant PD - ans 1. A friendly, accepting, reassuring approach is the best
way to treat patients.
2. Being pushed into social situations can cause extreme and severe anxiety.
Borderline PD - ans most common and dramatic, is characterized by severe impairments in
functioning; instability in emotion regulation, interpersonal relationships, impulsivity, identity or
self-image distortions, and unstable mood.
Nursing Guidelines for Borderline PD - ans 1. Set realistic goals, use clear action words.
2. Be aware of manipulative behaviors (flattery, seductiveness, instilling of guilt).
3. Provide clear and consistent boundaries and limits.
4. Use clear and straightforward communication.
,Psychiatric Nursing Final Exam
Review
5. When behavioral problems emerge, calmly review the therapeutic goals and boundaries of
treatment.
6. Avoid rejecting or rescuing.
7. Assess for suicidal and self-mutilating behaviors, especially during times of stress.
Dependent PD - ans establish relationships in which they are submissive, self-doubting, and
avoid self responsibility. find it difficult to sustain autonomy and often seek out relationships in
which they can be taken care of.
Nursing Guidelines for Dependent PD - ans 1. Identify and help address current stresses.
2. Try to satisfy patient's needs at the same time that limits are set up in such a manner that
patient does not feel punished and withdraw.
3. Be aware that strong countertransference often develops in clinicians because of patient's
excessive clinging (demands of extra time, nighttime calls, crisis before vacations); therefore,
supervision is well advised.
4. Teach and role-model assertiveness.
dialectical behavior therapy - ans evidence-based theory to successfully treat chronically
suicidal pts w/ borderline personality disorder. combines cognitive behavioral techniques with
mindfulness, which emphasizes being aware of thoughts and actively shaping them.
histrionic PD - ans marked by emotional attention-seeking behavior in which the person needs
to be the center of attention.
-impulsive,melodramatic, flirtatious and provocative.
Nursing Guidelines for histrionic PD - ans 1. Understand seductive behavior as a response to
distress.
2. Keep communication and interactions professional, despite temptation to collude with the
patient in a flirtatious and misleading manner.
3. Encourage and model the use of concrete and descriptive rather than vague and
impressionistic language.
4. Teach and role-model assertiveness.
,Psychiatric Nursing Final Exam
Review
Narcissistic PD - ans arrogance w/ grandiose view of self-importance. Has the need for constant
admiration, along w/ a lack of empathy for others, which strains relationships. results in
exploitation of others. Underneath this personality is a person w/ intense shame and fear of
abandonment.
Nursing Guidelines for Narcissistic PD - ans 1. Remain neutral; avoid engaging in power struggles
or becoming defensive in response to the patient's disparaging remarks.
2. Convey unassuming self-confidence.
obsessive-compulsive PD - ans characteristics of perfectionism w/ a focus on orderliness and
control. These people become so preoccupied w/ details and rules that they may not be able to
accomplish a given task.
Nursing Guidelines for Obsessive-Compulsive PD - ans 1. Guard against power struggles with
patient. Need for control is very high.
2. Intellectualization, rationalization, reaction formation, isolation, and undoing are the most
common defense mechanisms.
paranoid PD - ans characterized by distrust and suspiciousness toward others based on the
belief that others want to exploit, harm, or deceive the person. these people are hypervigilant,
anticipate hostility, and may provoke hostile responses by initiating a "counterattack."
demonstrate jealousy, controlling behaviors, and unwillingness to forgive
Nursing Guidelines for Paranoid PD - ans 1. Avoid being too "nice" or "friendly."
2. Give clear and straightforward explanations of tests and procedures beforehand.
3. Use simple, clear language; avoid ambiguity.
4. Project a neutral but kind affect.
5. Warn about any changes, side effects of medication, and reasons for delay. Such interventions
may help allay anxiety and minimize suspiciousness. A written plan may help encourage
cooperation.
Schizoid PD - ans Emotionally detached! Does not seek out or enjoy close relationships. this
individual may be able to function in a solitary occupation but shows indifference to praise or
criticism from others. Depersonalization may occur.
Nursing Guidelines for Schizoid PD - ans 1. Avoid being too "nice" or "friendly."
, Psychiatric Nursing Final Exam
Review
2. Do not try to increase socialization.
3. Perform thorough diagnostic assessment as needed to identify symptoms or disorders the
patient is reluctant to discuss.
schizotypal PD - ans expressed in strikingly odd characteristics, including magical thinking,
derealization, perceptual distortions, and rigid, peculiar ideas. speech patterns may be
distinctive and bizarre.
Nursing Guidelines for Schizotypal PD - ans 1. Respect patient's need for social isolation.
2. Be aware of patient's suspiciousness, and employ appropriate interventions.
3. As with schizoid patient, perform careful diagnostic assessment as needed to uncover any
other medical or psychological symptoms that may need intervention (e.g., suicidal thoughts).
personality disorder - ans an enduring pattern of experience and behavior that deviates
significantly from the expectations w/in the individuals culture.
Cluster A personality disorders - ans characteristics of eccentric and odd behaviors, such as
social isolation and detachment. may also be perception distortions, unusual levels of
suspiciousness, Paranoid PD, Schizoid OD, & Schizotypal PD
Cluster B Personality Disorders - ans Dramatic, emotional, erratic behavior; problems with
impulse control and emotional processing, and relationships; manipulations and acting out;
Antisocial PD, Borderline PD, Histrionic PD, and Narcissistic PD
Cluster C Personality Disorders - ans Anxious or fearful behavior; rigid patterns of social shyness,
hypersensitivity, need for orderliness, and relationship dependency; Avoidant PD, Dependent
PD, Obsessive-Compulsive PD
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 - ans Inflexible and maladaptive responses to stress
Which statement is descriptive of clients with personality disorders?
