Chapter 30: Personality Disorders Nursing School Test Banks

Chapter 30: Personality Disorders
Test Bank

MULTIPLE CHOICE

1. Infants who experience nurturing environments develop the ability to:
a. Test others.
b. Trust others.
c. Manipulate others.
d. Model others behaviors.
ANS: B
When the infants needs are consistently met, a sense of trust and self-worth develops.

DIF: Cognitive Level: Comprehension REF: p. 348 OBJ: 2
TOP: Personality in Childhood KEY: Nursing Process Step: Assessment
MSC: Client Needs: Health Promotion and Maintenance

2. Behavioral theorists see personality disorders as the result of:
a. Social stressors
b. Conditioned responses
c. Neurophysical problems
d. An imbalance among the three forces of the personality
ANS: B
Behavioral theorists see personality disorders as the result of conditioned responses caused by previous events. Social stressors refer to sociocultural theories; neurophysical refers to biological theories; and imbalance among the three forces of the personality describes psychoanalytical theories.

DIF: Cognitive Level: Knowledge REF: p. 350 OBJ: 3
TOP: Behavioral Theories KEY: Nursing Process Step: N/A
MSC: Client Needs: Psychosocial Integrity

3. Paranoid personality disorders are diagnosed more often in:
a. Men
b. Women
c. Children
d. Adolescents
ANS: A
Paranoid personality disorders are diagnosed in up to 2.5% of the population, more often in men than in women.

DIF: Cognitive Level: Knowledge REF: p. 351 OBJ: 5
TOP: Eccentric Cluster KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

4. Studies of families, twins, and relatives with personality disorders have demonstrated that the developing personality is influenced by:
a. Genetics
b. Order of birth
c. Financial factors
d. Number of siblings
ANS: A
Studies of families, twins, and relatives of individuals with personality disorders have demonstrated that behavior and personality have a strong genetic influence.

DIF: Cognitive Level: Knowledge REF: p. 349 OBJ: 3
TOP: Biological Theories KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

5. The group of personality disorders characterized by odd or strange behaviors is known as the ____ cluster.
a. Erratic
b. Fearful
c. Eccentric
d. Obsessive-compulsive
ANS: C
The eccentric cluster is characterized by odd or strange behaviors. Individuals in this cluster find it difficult to be comfortable in social settings and do not relate well to others.

DIF: Cognitive Level: Knowledge REF: p. 351 OBJ: 5
TOP: Eccentric Cluster KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

6. The central feature of one of our most pressing mental health problems today is a pervasive pattern of disregard for, and violation of, the rights of others. This personality disorder is called:
a. Avoidant
b. Paranoid
c. Dependent
d. Antisocial
ANS: D
One of our most pressing mental health problems today is antisocial personality disorder, manifested as a pervasive pattern of disregard for and violation of the rights of others. Avoidant personality disorder refers to individuals who avoid situations for fear of rejection and humiliation; paranoid personality refers to individuals who assume that everyone is out to harm, deceive, or exploit them; and dependent personality refers to individuals who express the need to be cared for so they can avoid turning people away.

DIF: Cognitive Level: Comprehension REF: p. 351 OBJ: 4
TOP: Erratic Cluster Personality Disorders
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

7. The client relies on deceit and manipulation to get his own way. He seems to have a complete lack of conscience. His goal is always self-gratification at the other persons expense. He is referred to as:
a. A nerd
b. A psychotic
c. A psychopath
d. Narcissistic
ANS: C
The hallmark of psychopaths (sociopaths) is a lack of conscience. Psychopaths use charm, manipulation, intimidation, and violence to control others and satisfy their own selfish needs.

DIF: Cognitive Level: Application REF: p. 352 OBJ: 4
TOP: Erratic Cluster Personality Disorders
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

8. The childhood trait that increases the risk for developing an antisocial personality disorder is:
a. Poor impulse control
b. Frequent reading in solitude
c. Poor preschool learning practices
d. Difficulty controlling others in the environment
ANS: A
Some children have trouble controlling their impulses, so they become disruptive and develop antisocial ways of coping.

DIF: Cognitive Level: Knowledge REF: p. 352 OBJ: 2 | 6
TOP: Erratic Cluster Personality Disorders
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

9. The client is a 38-year-old woman with a diagnosis of narcissistic personality disorder. Behaviors associated with this diagnosis are:
a. Avoidant
b. Odd or eccentric
c. Attention seeking
d. Reflective of lack of trust in others
ANS: C
A narcissistic personality disorder is characterized by grandiosity and the need to be admired.

DIF: Cognitive Level: Knowledge REF: p. 351 OBJ: 6
TOP: Erratic Cluster Personality Disorders
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

10. The client is unable to make a decision by herself. She clings to her husband and quickly moves to fill his requests. Although she sometimes appears angry, her emotions are not expressed. The clients diagnosis is:
a. Neuroticism
b. Paranoid personality disorder
c. Dependent personality disorder
d. Narcissistic personality disorder
ANS: C
The anxiety of dependent personality disorder is associated with separation and abandonment. Neuroticism refers to an individual who experiences a mental imbalance that causes distress and anxiety without affecting rational thought; paranoid personality disorder is displayed by assumptions that everyone is out to harm, deceive, or exploit; and narcissistic personality disorder is grandiose feelings of self-importance.

DIF: Cognitive Level: Application REF: p. 353 OBJ: 6
TOP: Fearful Cluster Personality Disorders
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

11. The nurse is planning goals for a male client with the diagnosis of personality disorder. What is the main goal of the clients therapy?
a. To adjust to his medications
b. To learn to get along with others
c. To learn to control his environment
d. To become aware of how his behavior affects his life
ANS: D
Although all are goals of care for clients with personality disorder, the most important goal is to help clients identify and then become responsible for their own behavior. This is necessary for all other treatment to be effective.

DIF: Cognitive Level: Application REF: p. 355 OBJ: 7
TOP: Nursing (Therapeutic) Process KEY: Nursing Process Step: Planning
MSC: Client Needs: Psychosocial Integrity

12. In treating clients with personality disorders, compliance with prescribed medications must be monitored frequently and safeguards must be put in place to prevent or reduce the risk for:
a. Deceit
b. Suicide
c. Homicide
d. Manipulation
ANS: B
Clients may hoard their medications until they have enough to make up a lethal dose.

DIF: Cognitive Level: Comprehension REF: p. 355 OBJ: 8
TOP: Treatments and Therapies
KEY: Nursing Process Step: Assessment | Nursing Process Step: Intervention
MSC: Client Needs: Physiological Integrity

13. A male client has schizotypal personality disorder. A female client compliments him on his style of dressing, and he interprets this as her caring deeply for him and desiring to date him. What is the client experiencing?
a. Paranoia
b. Ideas of reference
c. Inappropriate affect
d. Delusions of grandeur
ANS: B
Ideas of reference are incorrect perceptions of casual events as having great or significant meaning and are frequently seen in clients with schizotypal personality disorder. Paranoia refers to individuals who assume that everyone is out to harm, deceive, or exploit them; inappropriate affect refers to inappropriate emotional expressions; and delusions of grandeur are irrational grandiose thoughts, but they differ from ideas of reference in that an interaction is not necessary to cause the delusions of grandeur.

DIF: Cognitive Level: Application REF: p. 351 OBJ: 6
TOP: Eccentric Cluster KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

14. A wife is discussing her co-worker with her husband. The wife states, I am so tired of her. She is always dressing in flamboyant clothing and pretends to have an accent. She doesnt relate well to any of our co-workers because she is so superficial. Which personality disorder is being described?
a. Paranoid
b. Impulsive
c. Histrionic
d. Narcissistic
ANS: C
An individual with this type of personality disorder displays a pattern of excessive emotional expression and attention-seeking behaviors. Paranoid personality refers to individuals who assume that everyone is out to harm, deceive, or exploit them; impulsive personality refers to disorders that include behaviors such as gambling, use of drugs, and spending money irresponsibly; and narcissistic personality refers to grandiose feelings of self-importance.

DIF: Cognitive Level: Application REF: p. 351 OBJ: 6
TOP: Erratic Cluster Personality Disorders Personality Disorders
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

15. Medications are used with extreme caution in clients with personality disorders because of their questionable effectiveness. If a client is receiving an antipsychotic medication, it is especially important for the nurse to monitor the client for side effects of:
a. Increased thirst and urination, nausea, and anorexia
b. Dry mouth, altered taste, sexual dysfunction, and dizziness
c. Bone marrow depression, gastrointestinal symptoms, and confusion
d. Extrapyramidal movements, dry mouth, blurred vision, and photophobia
ANS: D
These side effects are characteristic of antipsychotic medications and should be assessed because they sometimes become irreversible. Increased thirst, urination, nausea, and anorexia are side effects most commonly seen with lithium; dry mouth, altered taste, sexual dysfunction, and dizziness are commonly seen with antidepressants; and bone marrow depression, gastrointestinal symptoms, and confusion are seen most frequently with anticonvulsants.

DIF: Cognitive Level: Application REF: p. 355 OBJ: 8
TOP: Treatments and Therapies KEY: Nursing Process Step: Assessment
MSC: Client Needs: Physiological Integrity

16. The daughter of an elderly man notices that her father has stopped seeing his friends for their daily walk and acts in an aggressive manner when anyone comes to his house. She states that he normally looks forward to interacting with his friends on a daily basis, and his general demeanor is friendly and caring. What does the nurse advise?
a. This is a normal part of aging and there should be no reason for concern.
b. The change in personality and behavior should be ignored as it is manipulative.
c. The change in personality and behavior should be evaluated.
d. The change in personality and behavior indicates it is time for nursing home placement.
ANS: C
A sudden change in personality is not a normal sign of aging. By older adulthood, the personality is deeply entrenched. Patterns of thinking and behaving remain intact until death. Do not assume that a personality change in an older adult is normal. Changes in emotional control, responses, and levels of interest must be investigated. Many physical and biochemical problems first appear as subtle changes in personality.

DIF: Cognitive Level: Application REF: p. 349 OBJ: 2
TOP: Personality in Older Adulthood KEY: Nursing Process Step: Assessment
MSC: Client Needs: Physiological Integrity

17. The 40-year-old woman who works at the same entry level job for many years without seeking advancement and politely declines when friends ask her to try new vacation spots or hobbies may be suffering from which personality disorder?
a. Histrionic
b. Paranoid
c. Schizoid
d. Avoidant
ANS: D
In avoidant personality disorder, anxiety is related to a fear of rejection and humiliation. To prevent possible rejection, individuals narrow their interests to a small range of activities. It is part of the fearful cluster of disorders. Histrionic is part of the erratic cluster characterized by excessive emotional expression. Paranoid and schizoid are included in the eccentric cluster, where the main characteristics are suspicion and the inability to maintain relationships.

DIF: Cognitive Level: Application REF: p. 353 OBJ: 6
TOP: Fearful Cluster Personality Disorders
KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity

18. Two nurses are discussing a new patient during report. They discover that she has the staff divided on their opinion of her. One group has had very positive interactions with her and find her to be very cooperative. The other group has had a difficult time in gaining her compliance in treatment interventions. What action would be most appropriate in dealing with this situation?
a. Provide consistent limit setting with the client.
b. Assign the staff with the positive interactions to the clients care.
c. Work with the group experiencing the negative interactions to maintain an accepting attitude.
d. Take away privileges from the client until she changes her behavior.
ANS: A
Clients use a technique called splitting, emotionally dividing the staff by complimenting one group and degrading another. Consistent limit setting and reinforcement help clients to define their limits, but care providers must keep in mind their own therapeutic boundaries and communicate with each other frequently.

DIF: Cognitive Level: Application REF: p. 355 OBJ: 9
TOP: Nursing (Therapeutic) Process KEY: Nursing Process Step: Assessment
MSC: Client Needs: Physiological Integrity

19. Clients suffering from a personality disorder usually do not seek treatment because they:
a. Do not have identifiable impairments
b. Cannot be treated
c. Are unable to recognize their problems
d. Often do not have health insurance
ANS: C
People with personality disorder often have serious impairments but do not seek treatment because they are unable to recognize their own problems. Their distorted self-perception and view of reality often place them in the position of seeing themselves as the victim. Most individuals with personality disorders are considered treatable to varying degrees. Health insurance is not the reason the individual does not seek treatment.

DIF: Cognitive Level: Application REF: p. 354 OBJ: 7
TOP: Treatments and Therapies KEY: Nursing Process Step: Assessment
MSC: Client Needs: Physiological Integrity

MULTIPLE RESPONSE

20. Which are characteristics of a personality disorder? (Select all that apply.)
a. Delusions
b. Depression
c. Hallucinations
d. Inappropriate sexual behaviors
e. Inflexible and maladaptive behaviors
f. Difficulties with interpersonal relations
g. Behaviors that cause significant functional impairment
ANS: A, B, D, E, F, G
Delusions, depression, inappropriate sexual behaviors, inflexible and maladaptive behaviors, difficulties with interpersonal relations, and behaviors that cause significant functional impairment are all characteristics of personality disorders. Hallucinations refer to other types of mental health disorders.

DIF: Cognitive Level: Comprehension REF: p. 350 OBJ: 4
TOP: Personality Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

21. Personality disorders that are considered to be in the erratic cluster include: (Select all that apply.)
a. Antisocial
b. Borderline
c. Paranoid
d. Histrionic
e. Avoidant
f. Obsessive-compulsive
g. Narcissistic
ANS: A, B, D, G
The main characteristic of the erratic cluster of personality disorders is dramatic behavior. Paranoid personality disorder belongs to the eccentric cluster of personality disorders; and avoidant personality disorder and obsessive-compulsive personality disorder belong to the fearful cluster.

DIF: Cognitive Level: Knowledge REF: p. 351 OBJ: 4
TOP: Personality Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

22. Characteristics of borderline personality disorder include which of the following? (Select all that apply.)
a. Fear of being abandoned
b. Splitting
c. Gambling
d. Engaging in unsafe sex
e. Isolation of self from others
ANS: A, B, C, D
Borderline personality disorder is characterized by fear of abandonment. Therefore, they avoid being alone. Because of instability, behaviors demonstrated to staff may be called splitting, complimenting one group while degrading another. Because of the impulsivity, borderline personality disorder clients often engage in risk-taking activities including gambling and engaging in unsafe sex.

DIF: Cognitive Level: Application REF: p. 353 OBJ: 6
TOP: Erratic Cluster Personality Disorders
KEY: Nursing Process Step: Assessment MSC: Client Needs: Physiological Integrity

COMPLETION

23. A characteristic trait of an individual with __________ disorder is that they may be extremely orderly and overly preoccupied with details that they may accomplish very little.

ANS:
obsessive-compulsive personality
Persons with obsessive-compulsive personality disorder focus their anxiety on uncertainty of future events. They are extremely orderly and so preoccupied with details that they accomplish very little.

DIF: Cognitive Level: Comprehension REF: p. 354 OBJ: 4
TOP: Fearful Cluster Personality Disorders Personality Disorders
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

24. An individual with an __________ personality disorder relies on deceit and manipulation to get his or her way.

ANS:
antisocial
An individual with an antisocial personality disorder has a disregard for and repeatedly violates the rights of others through manipulation and deceit.

DIF: Cognitive Level: Comprehension REF: p. 352 OBJ: 4
TOP: Erratic Cluster Personality Disorders Personality Disorders
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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