Foundations of Psychiatric Mental Health Nursing A Clinical Approach, 5th Edition by Elizabeth M. Varcarolis
Foundations of Psychiatric Mental Health Nursing A Clinical Approach, 5th Edition by Elizabeth M. Varcarolis
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Chapter 16: Personality Disorders
Complete Chapter Questions With Answers
Sample Questions Are Posted Below
MULTIPLE CHOICE
1) A physical therapist recently convicted of multiple counts of Medicare fraud is brought to the emergency department after taking an overdose of sedatives. He tells the nurse “Sure I overbilled. Why not? Everybody takes advantage of the government. They have too many rules. No one can abide by all of them.” These statements can be assessed as showing
| A. | glibness and charm. |
| B. | superficial remorse. |
| C. | lack of guilt feelings. |
| D. | excessive suspiciousness. |
ANS: C
Rationalization is being used to explain behavior and deny wrongdoing. Option B: The individual who does not believe he or she has done anything wrong will not manifest anxiety, remorse, or guilt about the act. Options A and D: The client’s remarks cannot be assessed as charming, and lack of trust and concern that others are determined to harm him are not shown.
DIF: Cognitive Level: Application REF: Text Page: 282
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
2) The intervention appropriate for an antisocial client with a nursing diagnosis of ineffective coping related to manipulation of others is to
| A. | refer requests and questions related to care to the primary nurse. |
| B. | provide negative reinforcement for acting-out behavior. |
| C. | ignore, rather than confront, inappropriate behavior. |
| D. | encourage the client to discuss feelings of fear and inferiority. |
ANS: A
Manipulative clients 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. Option B: Positive reinforcement of appropriate behaviors is more effective. Option C: Judicious use of confrontation is necessary. Option D: Antisocial clients rarely have these feelings.
DIF: Cognitive Level: Application REF: Text Page: 289
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
3) A nursing strategy that makes limit setting better accepted by clients with personality disorders is to first
| A. | confront the client with the inappropriateness of the behavior. |
| B. | explore with the client the underlying dynamics of the behavior. |
| C. | reflect back to the client an understanding of the client’s distress. |
| D. | state a value judgment regarding the behavior and its consequences. |
ANS: C
Setting limits is better accepted by clients if staff first use empathetic mirroring without making a value judgment, which are suggested in options A and D. Option B has little to do with client acceptance of limits.
DIF: Cognitive Level: Analysis REF: Text Page: 292, Text Page: 293
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
4) An appropriate outcome for a client with a personality disorder with a nursing diagnosis of ineffective coping related to use of manipulation would be that the client will
| A. | identify when 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 the decision that staff will fulfill a client request within an hour rather than immediately. |
ANS: C
This is an early outcome that paves the way for later taking greater responsibility for controlling manipulative behavior. Option A relates to anger and aggression control. Option B: This outcome is inappropriate. The client would ideally use assertive behavior to promote need fulfillment. Option D: This outcome relates to impulsivity and immediacy control.
DIF: Cognitive Level: Analysis REF: Text Page: 288
TOP: Nursing Process: Planning (Outcome Identification)
MSC: NCLEX: Psychosocial Integrity
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