Chapter 24: Personality Disorders Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

MULTIPLE CHOICE 1. A health care provider recently convicted of Medicare fraud says to a nurse, ―Sure I overbilled. Everyone takes advantage of the government. There are too many rules to follow and I deserve the money.‖ These statements show a. shame. b. suspiciousness. c. superficial remorse. d. lack of guilt feelings. ANS: D Rationalization is being used to explain behavior and deny wrongdoing. The individual who does not believe he or she has done anything wrong will not manifest anxiety, remorse, or guilt about the act. The patient‘s remarks cannot be assessed as shameful. Lack of trust and concern that others are determined to do harm is not shown. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 24-24, 25, 58 (Table 24-1), 60 (Table 24-2) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 2. Which intervention is appropriate for an individual diagnosed with an antisocial personality disorder who frequently manipulates others? a. Refer requests and questions related to care to the case manager. b. Encourage the patient to discuss feelings of fear and inferiority. c. Provide negative reinforcement for acting-out behavior. d. Ignore, rather than confront, inappropriate behavior. ANS: A Manipulative people frequently make requests of many different staff, hoping one will give in. Having one decision maker provides consistency and avoids the potential for playing one staff member against another. Positive reinforcement of appropriate behaviors is more effective than negative reinforcement. The behavior should not be ignored; judicious use of confrontation is necessary. Patients with antisocial personality disorders rarely have feelings of fear and inferiority. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 24-24 | Pages 24-60 (Table 24-2), 24-66 (Box 24-2) TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 3. As a nurse prepares to administer medication to a patient diagnosed with a borderline personality disorder, the patient says, ―Just leave it on the table. I‘ll take it when I finish combing my hair.‖ What is the nurse‘s best response? a. Reinforce this assertive action by the patient. Leave the medication on the table as requested. b. Respond to the patient, ―I‘m worried that you might not take it. I‘ll come back later.‖ c. Say to the patient, ―I must watch you take the medication. Please take it now.‖ d. Ask the patient, ―Why don‘t you want to take your medication now?‖ ANS: C The individual with a borderline personality disorder characteristically demonstrates manipulative, splitting, and self-destructive behaviors. Consistent limit setting is vital not only for the patient‘s safety, but also to prevent splitting other staff. ―Why‖ questions are not therapeutic. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 24-42, 60 (Table 24-2), 66 (Box 24-2) TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 4. What is an appropriate initial outcome for a patient diagnosed with a personality disorder who frequently manipulates others? The patient will a. identify when feeling angry. b. use manipulation only to get legitimate needs met. c. acknowledge manipulative behavior when it is called to his or her attention. d. accept fulfillment of his or her requests within an hour rather than immediately.