Ch 21 Social Responses and
Personality Disorders Exam Questions
and Answers
5. Which behavior would be most characteristic of an individual with narcissistic
personality disorder?
a. A lifelong pattern of social withdrawal
b. Refusal to enter into relationships for fear of rejection
c. Belief in entitlement to special privileges that others may not have
d. Belief in possessing the ability to know what others are thinking - ANSWER-ANS:
C
Narcissistic individuals are egocentric people who have fragile self-esteem that
drives them to seek admiration and appreciation. As part of this, they display a sense
of entitlement, believing they have rights to special treatment.
DIF: Cognitive Level: Comprehension REF: Text Page: 387
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
6. A patient regularly uses manipulation to control situations. Staff working to reduce
this behavior should first convey the message that:
a. while the patient is accepted, the behavior is rejected as inappropriate.
b. if the patient cannot control the behavior, staff will establish external controls.
c. manipulative behavior results in frustration and anger among staff and patients.
d. manipulation of patients is no more acceptable than manipulation of unit staff. -
ANSWER-ANS: A
The staff always must seek to convey acceptance of the patient because this is a
building block for a therapeutic relationship. Inappropriate behaviors such as
manipulation should be identified, their negative consequences to the patient should
be discussed, and more adaptive behaviors should be substituted when the
therapeutic relationship has been established.
DIF: Cognitive Level: Application REF: Text Page: 388
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
7. Before the community meeting, a patient with antisocial personality disorder was
overheard coaching other patients to strongly object to the "no smoking" policy.
Which response would be most characteristic of this patient when approached by
staff members who wish to discuss the behavior?
a. "I knew they'd mess this up. I've learned to speak for myself in the future."
b. "Hey, it's not my fault. They object to you people running this place like a jail."
c. "I think the patients and staff should talk about the rules and negotiate some
changes."
, d. "I've learned something valuable from this. We'll talk about this in my therapy
session." - ANSWER-ANS: B
Patients with antisocial personality disorder usually do not accept responsibility for
their actions. They are unable to problem solve constructively, and they are unlikely
to voluntarily seek help with changing their behaviors.
DIF: Cognitive Level: Application REF: Text Page: 386
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
8. The majority of the treatment team maintains that a patient diagnosed with
antisocial personality disorder needs external limits and careful observation, however
two nurses state, "The patient is really a pleasant person. We shouldn't be so
judgmental." The most likely reason for the difference in staff opinions is that the
patient has been using which coping mechanisms?
a. Idealization and devaluation
b. Projection and rationalization
c. Splitting and projective identification
d. Reaction formation and identification - ANSWER-ANS: C
Splitting is the inability to integrate good and bad aspects of an object, resulting in
treating the object as all good or all bad. Projective identification is the practice of
projecting certain aspects of the self onto another, who then responds to the
negative or positive projections in a manner consistent with the projections. When a
patient idealizes the nurse, the nurse has a tendency to lose objectivity and move
toward overinvolvement, overprotection, and indulgence. In this instance, two staff
members are protective and indulgent, whereas others are more realistic.
DIF: Cognitive Level: Application REF: Text Pages: 390-391
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity
9. A patient with borderline personality disorder tells the nurse, "When I met my
boyfriend he was simply perfect. Now he is the worst person in the world. I tell him to
leave and then I feel so empty and awful that I have to cut myself." The description of
the boyfriend is strongly influenced by the patient's inclination to:
a. use splitting.
b. be attention-seeking.
c. display antisocial tendencies.
d. suffer from a formal thought disorder. - ANSWER-ANS: A
Splitting is the inability to integrate the good and bad aspects of an object. The
boyfriend is either perfect or the worst person in the world. This inability leads to
stress that cannot be managed in a healthy manner.
DIF: Cognitive Level: Application REF: Text Pages: 390-391
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
10. A patient with borderline personality disorder tells the nurse, "When my sister got
married and had a baby, she ignored me and I got so angry with her because she is
so inattentive to my needs." The patient's sense of entitlement to her sister's
attention is consistent with:
a. impulsivity.
b. narcissism.
Personality Disorders Exam Questions
and Answers
5. Which behavior would be most characteristic of an individual with narcissistic
personality disorder?
a. A lifelong pattern of social withdrawal
b. Refusal to enter into relationships for fear of rejection
c. Belief in entitlement to special privileges that others may not have
d. Belief in possessing the ability to know what others are thinking - ANSWER-ANS:
C
Narcissistic individuals are egocentric people who have fragile self-esteem that
drives them to seek admiration and appreciation. As part of this, they display a sense
of entitlement, believing they have rights to special treatment.
DIF: Cognitive Level: Comprehension REF: Text Page: 387
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
6. A patient regularly uses manipulation to control situations. Staff working to reduce
this behavior should first convey the message that:
a. while the patient is accepted, the behavior is rejected as inappropriate.
b. if the patient cannot control the behavior, staff will establish external controls.
c. manipulative behavior results in frustration and anger among staff and patients.
d. manipulation of patients is no more acceptable than manipulation of unit staff. -
ANSWER-ANS: A
The staff always must seek to convey acceptance of the patient because this is a
building block for a therapeutic relationship. Inappropriate behaviors such as
manipulation should be identified, their negative consequences to the patient should
be discussed, and more adaptive behaviors should be substituted when the
therapeutic relationship has been established.
DIF: Cognitive Level: Application REF: Text Page: 388
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
7. Before the community meeting, a patient with antisocial personality disorder was
overheard coaching other patients to strongly object to the "no smoking" policy.
Which response would be most characteristic of this patient when approached by
staff members who wish to discuss the behavior?
a. "I knew they'd mess this up. I've learned to speak for myself in the future."
b. "Hey, it's not my fault. They object to you people running this place like a jail."
c. "I think the patients and staff should talk about the rules and negotiate some
changes."
, d. "I've learned something valuable from this. We'll talk about this in my therapy
session." - ANSWER-ANS: B
Patients with antisocial personality disorder usually do not accept responsibility for
their actions. They are unable to problem solve constructively, and they are unlikely
to voluntarily seek help with changing their behaviors.
DIF: Cognitive Level: Application REF: Text Page: 386
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
8. The majority of the treatment team maintains that a patient diagnosed with
antisocial personality disorder needs external limits and careful observation, however
two nurses state, "The patient is really a pleasant person. We shouldn't be so
judgmental." The most likely reason for the difference in staff opinions is that the
patient has been using which coping mechanisms?
a. Idealization and devaluation
b. Projection and rationalization
c. Splitting and projective identification
d. Reaction formation and identification - ANSWER-ANS: C
Splitting is the inability to integrate good and bad aspects of an object, resulting in
treating the object as all good or all bad. Projective identification is the practice of
projecting certain aspects of the self onto another, who then responds to the
negative or positive projections in a manner consistent with the projections. When a
patient idealizes the nurse, the nurse has a tendency to lose objectivity and move
toward overinvolvement, overprotection, and indulgence. In this instance, two staff
members are protective and indulgent, whereas others are more realistic.
DIF: Cognitive Level: Application REF: Text Pages: 390-391
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity
9. A patient with borderline personality disorder tells the nurse, "When I met my
boyfriend he was simply perfect. Now he is the worst person in the world. I tell him to
leave and then I feel so empty and awful that I have to cut myself." The description of
the boyfriend is strongly influenced by the patient's inclination to:
a. use splitting.
b. be attention-seeking.
c. display antisocial tendencies.
d. suffer from a formal thought disorder. - ANSWER-ANS: A
Splitting is the inability to integrate the good and bad aspects of an object. The
boyfriend is either perfect or the worst person in the world. This inability leads to
stress that cannot be managed in a healthy manner.
DIF: Cognitive Level: Application REF: Text Pages: 390-391
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
10. A patient with borderline personality disorder tells the nurse, "When my sister got
married and had a baby, she ignored me and I got so angry with her because she is
so inattentive to my needs." The patient's sense of entitlement to her sister's
attention is consistent with:
a. impulsivity.
b. narcissism.
