Which personality characteristic would the nurse expect to find in a client with anorexia nervosa?

Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which statement regarding a client’s home environment should a nurse associate with the development of anorexia nervosa?

Table of Contents

• Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which statement regarding a client’s home environment should a nurse associate with the development of anorexia nervosa?
• The home environment is overprotective and demands perfection.
• A client’s altered body image is evidenced by claims of “feeling fat,” even though the client is emaciated. Which is the appropriate outcome criterion for this client’s problem?
• The client will perceive personal ideal body weight and shape as normal.
• A nurse is counseling a client diagnosed with bulimia nervosa about the symptom of tooth enamel deterioration. Which explanation for this complication of bulimia nervosa should the nurse provide?
• The emesis produced during purging is acidic and corrodes the tooth enamel.
• A nurse is teaching a client diagnosed with an eating disorder about behavior-modification programs. Why is this intervention the treatment of choice?
• It allows clients to maintain control.
• A potential Olympic figure skater collapses during practice and is hospitalized for severe malnutrition. Anorexia nervosa is diagnosed. Which client statement best reflects insight related to this disorder?
• “I am angry at my mother. I can only get her approval when I win competitions.”
• The family of a client diagnosed with anorexia nervosa becomes defensive when the treatment team calls for a family meeting. Which is the appropriate nursing response?
• “Eating disorders have been correlated to certain familial patterns; without addressing these, your child’s condition will not improve.”
• A client diagnosed with bulimia nervosa has been attending a mental health clinic for several months. Which factor should a nurse identify as an appropriate indicator of a positive client behavioral change?
• The client demonstrated healthy coping mechanisms that decreased anxiety.
• The nurse is working with a client diagnosed with binge eating disorder. Which medication should the nurse expect to teach the client about?
• Lisdexamfetamine [Vyvanse]
• A nurse is attempting to differentiate between the symptoms of anorexia nervosa and the symptoms of bulimia. Which statement delineates the difference between these two disorders?
• Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not.
• A client diagnosed with a history of anorexia nervosa comes to an outpatient clinic after being medically cleared. The client states, “My parents watch me like a hawk and never let me out of their sight.” Which nursing diagnosis would take priority at this time?
• A nurse should identify topiramate [Topamax] as the drug of choice for which of the following conditions? [Select all that apply.]1. Binge eating with a diagnosis of obesity2. Bingeing and purging with a diagnosis of bulimia nervosa3. Weight loss with a diagnosis of anorexia nervosa4. Amenorrhea with a diagnosis of anorexia nervosa5. Emaciation with a diagnosis of bulimia nervosa
• A nursing instructor is teaching about the DSM-5 criteria for the diagnosis of binge-eating disorder. Which of the following student statements indicates that further instruction is needed? [Select all that apply.]1. “In this disorder, binge eating occurs exclusively during the course of bulimia nervosa.”2. “In this disorder, binge eating occurs, on average, at least once a week for three months.”3. “In this disorder, binge eating occurs, on average, at least two days a week for six months.”4. “In this disorder, distress regarding binge eating is present.”5. “In this disorder, distress regarding binge eating is absent.”
• During an assessment interview, a client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions. Which is the appropriate nursing response to this behavior?
• “I understand that you are angry, but this behavior will not be tolerated.”
• At 11 p.m. a client diagnosed with antisocial personality disorder demands to phone a lawyer to file for a divorce. Unit rules state that no phone calls are permitted after 10 p.m. Which nursing response is most appropriate?
• “It is after the 10 p.m. phone curfew. You will be able to call tomorrow.”
• A client diagnosed with paranoid personality disorder becomes violent on a unit. Which nursing intervention is most appropriate?
• Use clear, calm statements and a confident physical stance.
• A client diagnosed with borderline personality disorder brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the nursing staff best handle this situation?
• Maintain consistency of care by open communication to avoid staff manipulation.
• Which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with borderline personality disorder [BPD]?
• Being firm, consistent, and empathic, while addressing specific client behaviors
• Which adult client should a nurse identify as exhibiting the characteristics of a dependent personality disorder?
• A physically healthy client who lives with parents and depends on public transportation.
• A client expresses low self-worth, has much difficulty making decisions, avoids positions of responsibility, and has a behavioral pattern of “suffering” in silence. Which statement best explains the etiology of this client’s personality disorder?
• Childhood nurturance was provided exclusively from one source, and independent behaviors were discouraged.
• Family members of a client ask the nurse to explain the difference between schizoid and avoidant personality disorders. Which is the appropriate nursing response?
• Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone.
• Which nursing diagnosis should a nurse identify as appropriate when working with a client diagnosed with schizoid personality disorder?
• Social isolation R/T inability to relate to others
• Looking at a slightly bleeding paper cut, the client screams, “Somebody help me quick! I’m bleeding. Call 911!” A nurse should identify this behavior as characteristic of which personality disorder?
• Histrionic personality disorder
• When planning care for a client diagnosed with borderline personality disorder, which self-harm behavior should a nurse expect the client to exhibit?
• The use of suicidal gestures to elicit a rescue response from others
• A nurse tells a client that the nursing staff will start alternating weekend shifts. Which response should a nurse identify as characteristic of clients diagnosed with obsessive-compulsive personality disorder?
• “You can’t make these kinds of changes! Isn’t there a rule that governs this decision?”
• Which reaction to a compliment from another client should a nurse identify as a typical response from a client diagnosed with avoidant personality disorder?
• Being grateful for the compliment but fearing later rejection and humiliation
• Which factors differentiate a client diagnosed with social phobia from a client diagnosed with schizoid personality disorder?
• Clients diagnosed with social phobia avoid attending birthday parties, whereas clients diagnosed with schizoid personality disorder would isolate self on a continual basis
• Which client symptoms should lead a nurse to suspect a diagnosis of obsessive-compulsive personality disorder?
• The client experiences inflexibility and lack of spontaneity when dealing with others.
• Which client is a nurse most likely to admit to an inpatient facility for self-destructive behaviors?
• A client diagnosed with borderline personality disorder.
• When planning care for clients diagnosed with personality disorders, what should be the goal of treatment?
• to reduce personality trait inflexibility that interferes with functioning and relationships
• Which client situation would reflect the impulsive behavior that is commonly associated with borderline personality disorder?
• As the day-shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, “I cut myself because you are leaving me.”
• Which nursing diagnosis should be prioritized when providing nursing care to a client diagnosed with paranoid personality disorder?
• Risk for violence: directed toward others R/T paranoid thinking
• From a behavioral perspective, which nursing intervention is appropriate when caring for a client diagnosed with borderline personality disorder?
• Contract with the client to reinforce positive behaviors with unit privileges.
• A highly emotional client presents at an outpatient clinic appointment and states, “My dead husband returned to me during a séance.” Which personality disorder should a nurse associate with this behavior?
• Schizotypal personality disorder
• A nursing instructor is teaching students about clients diagnosed with histrionic personality disorder and the quality of their relationships. Which student statement indicates that learning has occurred?
• “Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs.”
• During an interview, which client statement should indicate to a nurse a potential diagnosis of schizotypal personality disorder?
• “I am getting a message from the beyond that we have been involved with each other in a previous life.”
• Which nursing diagnosis should be prioritized when providing nursing care to a client diagnosed with avoidant personality disorder?
• Social isolation R/T inability to relate to others
• A nurse is admitting a client with a new diagnosis of a personality disorder. Which of the following would make the nurse question this diagnosis? [Select all that apply.]1. The client has been diagnosed with sickle cell anemia.2. The client has an inflated self-appraisal and feels a sense of entitlement.3. The client has a history of a substance use disorder.4. The client is odd and eccentric but not delusional.5. The client has an intellectual developmental disorder.
• Which statements represent positive outcomes for clients diagnosed with narcissistic personality disorder? [Select all that apply.]1. The client will relate one empathetic statement to another client in group by day two.2. The client will identify one personal limitation by day one.3. The client will acknowledge one strength that another client possesses by day two.4. The client will list four personal strengths by day three.5. The client will list two lifetime achievements by discharge.
• A nurse is caring for a client diagnosed with antisocial personality disorder. Which factors should the nurse consider when planning this client’s care? [Select all that apply.]1. This client has personality traits that are deeply ingrained and difficult to modify.2. This client needs medication to treat the underlying physiological pathology.3. This client uses manipulation, making the implementation of treatment problematic.4. This client has poor impulse control that hinders compliance with a plan of care.5. This client is likely to have secondary diagnoses of substance abuse and depression.
• A client is being assessed for antisocial personality disorder. According to the DSM-5, which of the following symptoms must the client meet in order to be assigned this diagnosis? [Select all that apply.]1. Ego-centrism and goal setting based on personal gratification.2. Incapacity for mutually intimate relationships.3. Frequent feelings of being down, miserable, or hopeless.4. Disregard for and failure to honor financial and other obligations.5. Intense feelings of nervousness, tenseness, or panic.
• _______________________ personality disorder is characterized by a profound defect in the ability to form personal relationships or to respond to others in any meaningful emotional way.
• _____________________ personality disorder is characterized by colorful, dramatic, and extroverted behavior in excitable, emotional people.
• ________________________________ personality disorder is characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation
• _____________________ personality disorder is a pervasive distrust and suspiciousness of others, such that their motives are interpreted as malevolent.
• Which developmental characteristic should a nurse identify as typical of a client diagnosed with severe intellectual developmental disorder [IDD]?
• The client communicates wants and needs by “acting out” behaviors.
• Which nursing intervention related to self-care would be most appropriate for a teenager diagnosed with moderate IDD?
• Providing simple directions and praising client’s independent self-care efforts
• A child has been diagnosed with autistic spectrum disorder. The distraught mother cries out, “I’m such a terrible mother. What did I do to cause this?” Which nursing response is most appropriate?
• “Poor parenting doesn’t cause autistic spectrum disorder. Research has shown that abnormalities in brain structure or function are to blame. This is beyond your control.”
• In planning care for a child diagnosed with autistic spectrum disorder, which would be a realistic client outcome?
• The client will establish trust with at least one caregiver by day five.
• After an adolescent diagnosed with attention deficit/hyperactivity disorder [ADHD] begins methylphenidate [Ritalin] therapy, a nurse notes that the adolescent loses 10 pounds in a 2-month period. What is the best explanation for this weight loss?
• The pharmacological action of Ritalin causes a decrease in appetite.
• A nurse assesses an adolescent client diagnosed with conduct disorder who, at the age of 8, was sentenced to juvenile detention. How should the nurse interpret this assessment data?
• Childhood-onset conduct disorder is more severe than the adolescent-onset type, and these individuals likely develop antisocial personality disorder in adulthood.
• 1. Childhood-onset conduct disorder is more severe than the adolescent-onset type, and these individuals likely develop antisocial personality disorder in adulthood.
• The child’s mother is diagnosed with an anxiety disorder.
• A child has been recently diagnosed with mild IDD. What information about this diagnosis should the nurse include when teaching the child’s mother?
• Children with mild IDD develop academic skills up to a sixth-grade level.
• A nursing instructor is teaching about the developmental characteristics of clients diagnosed with moderate IDD. Which student statement indicates that further instruction is needed?
• “These clients can successfully complete elementary school.”
• A preschool child is admitted to a psychiatric unit with a diagnosis of autism spectrum disorder. To help the child feel more secure on the unit, which intervention should a nurse include in this client’s plan of care?
• Provide consistent caregivers.
• A preschool child diagnosed with autistic spectrum disorder has been engaging in constant head-banging behavior. Which nursing intervention is appropriate?
• Hold client’s head steady and apply a helmet.
• When planning care for a client, which medication classification should a nurse recognize as effective in the treatment of Tourette’s syndrome?
• Which behavioral approach should a nurse use when caring for children diagnosed with disruptive behavior disorders?
• Reinforcing positive actions to encourage repetition of desirable behaviors
• A child diagnosed with severe autistic spectrum disorder has the nursing diagnosis disturbed personal identity. Which outcome would best address this client diagnosis?
• The client will name own body parts as separate from others by day five.
• A nursing instructor presents a case study in which a three-year-old child is in constant motion and is unable to sit still during story time. She asks a student to evaluate this child’s behavior. Which student response indicates an appropriate evaluation of the situation?
• “This child’s behavior must be evaluated according to developmental norms.”
• A client has an IQ of 47. Which nursing diagnosis best addresses a client problem associated with this degree of IDD?
• Altered social interaction R/T nonadherence to social convention
• A physician orders methylphenidate [Ritalin] for a child diagnosed with ADHD. Which information about this medication should the nurse provide to the parents?
• Convey unconditional acceptance and positive regard.
• Which of the following risk factors, if noted during a family history assessment, should a nurse associate with the development of IDD? [Select all that apply.]1. A family history of Tay-Sachs disease2. Childhood meningococcal infection3. Deprivation of nurturance and social contact4. History of maternal multiple motor and verbal tics5. A diagnosis of maternal major depressive disorder
• Which of the following findings should a nurse identify that would contribute to a client’s development of ADHD? [Select all that apply.]1. The client’s father was a smoker.2. The client had a low birth weight.3. The client is lactose intolerant.4. The client has a sibling diagnosed with ADHD.5. The client has been diagnosed with dyslexia.
• The DSM-5 criteria for ODD specifies that: A persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness must be evident and last at least ______________ months
• Which should be the priority nursing intervention when caring for a child diagnosed with conduct disorder?
• Recognize escalating aggressive behavior and intervene before violence occurs.
• A mother questions the decreased effectiveness of methylphenidate [Ritalin] prescribed for her child’s ADHD. Which nursing response best addresses the mother’s concern?
• “Your child has probably developed a tolerance to Ritalin and may need a higher dosage.”
• After studying the DSM-5 criteria for oppositional defiant disorder [ODD], which listed symptom would a student nurse recognize?
• Arguing with authority figures for more than 6 months
• A client has recently been placed in a long-term care facility, because of marked confusion and inability to perform most activities of daily living. Which nursing intervention is most appropriate to maintain the client’s self-esteem?
• Allow client to choose between two different outfits when dressing for the day.
• A son, who recently brought his extremely confused parent to a nursing home for admission, reports feelings of guilt. Which is the appropriate nursing response?
• “Support groups are held here on Mondays for children of residents in similar situations.”
• A family asks why their father is attending activity groups at the long-term care facility. The son states, “My father worked hard all of his life. He just needs some rest at this point.” Which is the appropriate nursing response?
• “The groups benefit your father by providing social interaction, sensory stimulation, and reality orientation.”
• A couple resides in a long-term care facility. The husband is admitted to the psychiatric unit after physically abusing his wife. He states, “My wife is having an affair with a young man, and I want it investigated.” Which is the appropriate nursing response?
• “I understand that you are upset. We will talk about it.”
• A nursing instructor is teaching about reminiscence therapy. What student statement indicates that learning has occurred?
• “Reminiscence therapy encourages members to share both positive and negative significant life memories to promote resolution
• A student nurse asks the instructor, “Which psychiatric disorder is most likely initially diagnosed in the elderly?” Which instructor response gives the student accurate information?
• “Major depressive disorder is most likely diagnosed later in life.”
• An older client attending an adult day care program suddenly begins reporting dizziness, weakness, and confusion. What should be the initial nursing intervention?
• Advocate for a complete physical exam.
• An older client who lives with a caregiver is admitted to an emergency department with a fractured arm. The client is soaked in urine and has dried fecal matter on lower extremities. The client is 6 feet tall and weighs 120 pounds. Which condition should the nurse suspect?
• An older, emaciated client is brought to an emergency department by the client’s caregiver. The client has bruises and abrasions on shoulders and back in multiple stages of healing. When directly asked about these symptoms, which type of client response should a nurse anticipate?
• The client may deny or minimize the injuries.
• A client in the middle stage of Alzheimer’s disease has difficulty communicating because of cognitive deterioration. Which nursing intervention is appropriate to improve communication?
• Verbalize the nurse’s perception of the implied communication.
• An older client is exhibiting symptoms of major depressive disorder. A physician is considering prescribing an antidepressant. Which physiological problem should make a nurse question this medication regime?
• Altered liver and kidney functioning
• An older client has met the criteria for a diagnosis of major depressive disorder. The client does not respond to antidepressant medications. Which therapeutic intervention should a nurse anticipate will be ordered for this client?
• Electroconvulsive therapy [ECT]
• A nurse is charting assessment information about a 70-year-old client. According to the U.S. Census Bureau, what term would the nurse use to describe this client?
• The nurse should document using the term elderly.
• Which individual is most likely to be below the poverty level in the United States?
• A 70-year-old Hispanic woman living alone
• A nurse is listening to a lecture on the environmental theory. Which statement[s] by the nurse indicates that teaching has been effective?[Select all that apply.]1. “Personality characteristics in old age are correlated with early life characteristics.”2. “Carcinogens can affect aging.”3. “Trauma can affect the aging process.”4. “The effects of sunlight can have an effect on the aging process.”5. “Decline in the immune system can affect the aging process.”
• A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the child’s face and arms. What other symptom should indicate to the nurse that the child may have been physically abused?
• The child shrinks at the approach of adults.
• A woman presents with a history of physical and emotional abuse in her intimate relationships. What should this information lead a nurse to suspect?
• The woman may be a victim of incest.
• A nursing instructor is developing a lesson plan to teach about domestic violence. Which information should be included?
• Power and control are central to the dynamic of domestic violence.
• A client is brought to an emergency department after being violently raped. Which nursing action is appropriate?
• Remain nonjudgmental while actively listening to the client’s description of the violent rape event.
• A raped client answers a nurse’s questions in a monotone voice with single words, appears calm, and exhibits a blunt affect. How should the nurse interpret this client’s responses?
• The client may be demonstrating a controlled response pattern.
• A client who is in a severely abusive relationship is admitted to a psychiatric inpatient unit. The client fears for her life. A staff nurse asks, “Why doesn’t she just leave him?” Which is the nursing supervisor’s most appropriate response?
• “These clients are paralyzed into inaction by a combination of physical threats and a sense of powerlessness.”
• A woman comes to an emergency department with a broken nose and multiple bruises after being beaten by her husband. She states, “The beatings have been getting worse, and I’m afraid next time he will kill me.” Which is the appropriate nursing response?
• “Let’s talk about your options so that you don’t have to go home.”
• A college student was sexually assaulted when out on a date. After several weeks of crisis intervention therapy, which client statement should indicate to a nurse that the student is handling this situation in a healthy manner?
• “I know that it was not my fault.”
• A client asks, “Why does a rapist use a weapon during the act of rape?” Which is the most appropriate nursing response?
• “To terrorize and subdue the victim”
• When questioned about bruises, a woman states, “It was an accident. My husband just had a bad day at work. He’s being so gentle now and even brought me flowers. He’s going to get a new job, so it won’t happen again.” This client is in which phase of the cycle of battering?
• Phase III: The honeymoon phase
• Which information should the nurse in an employee assistance program provide to an employee who exhibits symptoms of domestic physical abuse?
• Have ready access to the number of a safe house for battered women.
• A survivor of rape presents in an emergency department crying, pacing, and cursing her attacker. A nurse should recognize these client actions as which behavioral defense?
• Expressed response pattern
• Which assessment data should a school nurse recognize as a sign of physical neglect?
• The child is often absent from school and seems apathetic and tired.
• A client diagnosed with an eating disorder experiences insomnia, nightmares, and panic attacks that occur before bedtime. She has never married or dated, and she lives alone. She states to a nurse, “My father has recently moved back to town.” What should the nurse suspect?
• Possible history of childhood incest
• In planning care for a woman who presents as a survivor of domestic abuse, a nurse should be aware of which of the following data? [Select all that apply.]1. It often takes several attempts before a woman leaves an abusive situation.2. Substance abuse is a common factor in abusive relationships.3. Until children reach school age, they are usually not affected by abuse between their parents.4. Women in abusive relationships usually feel isolated and unsupported.5. Economic factors rarely play a role in the decision to stay.
• Which of the following nursing diagnoses are typically appropriate for an adult survivor of incest? [Select all that apply.]1. Low self-esteem2. Powerlessness3. Disturbed personal identity4. Knowledge deficit5. Nonadherence
• A nursing instructor is teaching about intimate partner violence. Which of the following student statements indicate that learning has occurred? [Select all that apply.]1. “Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner.”2. “Intimate partner violence is used to gain power and control over the other intimate partner.”3. “Fifty-one percent of victims of intimate violence are women.”4. “Women ages 25 to 34 experience the highest per capita rates of intimate violence.”5. “Victims are typically young married women who are dependent housewives.”
• Order the description of the progressive phases of Walker’s model of the “cycle of battering.” ________ This phase is the most violent and the shortest, usually lasting up to 24 hours.________ In this phase, the man’s tolerance for frustration is declining.________ In this phase, the batterer becomes extremely loving, kind, and contrite.
• A pattern of coercive control founded on and supported by physical and/or sexual violence or threat of violence of an intimate partner is termed ______________________.
• Physical ________________ of a child includes refusal of or delay in seeking health care, abandonment, expulsion from the home or refusal to allow a runaway to return home, and inadequate supervision

The home environment is overprotective and demands perfection.

A client’s altered body image is evidenced by claims of “feeling fat,” even though the client is emaciated. Which is the appropriate outcome criterion for this client’s problem?

The client will perceive personal ideal body weight and shape as normal.

A nurse is counseling a client diagnosed with bulimia nervosa about the symptom of tooth enamel deterioration. Which explanation for this complication of bulimia nervosa should the nurse provide?

The emesis produced during purging is acidic and corrodes the tooth enamel.

A nurse is teaching a client diagnosed with an eating disorder about behavior-modification programs. Why is this intervention the treatment of choice?

It allows clients to maintain control.

“I am angry at my mother. I can only get her approval when I win competitions.”

The family of a client diagnosed with anorexia nervosa becomes defensive when the treatment team calls for a family meeting. Which is the appropriate nursing response?

“Eating disorders have been correlated to certain familial patterns; without addressing these, your child’s condition will not improve.”

A client diagnosed with bulimia nervosa has been attending a mental health clinic for several months. Which factor should a nurse identify as an appropriate indicator of a positive client behavioral change?

The client demonstrated healthy coping mechanisms that decreased anxiety.

The nurse is working with a client diagnosed with binge eating disorder. Which medication should the nurse expect to teach the client about?

Lisdexamfetamine [Vyvanse]

A nurse is attempting to differentiate between the symptoms of anorexia nervosa and the symptoms of bulimia. Which statement delineates the difference between these two disorders?

Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not.

A client diagnosed with a history of anorexia nervosa comes to an outpatient clinic after being medically cleared. The client states, “My parents watch me like a hawk and never let me out of their sight.” Which nursing diagnosis would take priority at this time?

A nurse should identify topiramate [Topamax] as the drug of choice for which of the following conditions? [Select all that apply.]1. Binge eating with a diagnosis of obesity2. Bingeing and purging with a diagnosis of bulimia nervosa3. Weight loss with a diagnosis of anorexia nervosa4. Amenorrhea with a diagnosis of anorexia nervosa5. Emaciation with a diagnosis of bulimia nervosa

A nursing instructor is teaching about the DSM-5 criteria for the diagnosis of binge-eating disorder. Which of the following student statements indicates that further instruction is needed? [Select all that apply.]1. “In this disorder, binge eating occurs exclusively during the course of bulimia nervosa.”2. “In this disorder, binge eating occurs, on average, at least once a week for three months.”3. “In this disorder, binge eating occurs, on average, at least two days a week for six months.”4. “In this disorder, distress regarding binge eating is present.”5. “In this disorder, distress regarding binge eating is absent.”

During an assessment interview, a client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions. Which is the appropriate nursing response to this behavior?

“I understand that you are angry, but this behavior will not be tolerated.”

At 11 p.m. a client diagnosed with antisocial personality disorder demands to phone a lawyer to file for a divorce. Unit rules state that no phone calls are permitted after 10 p.m. Which nursing response is most appropriate?

“It is after the 10 p.m. phone curfew. You will be able to call tomorrow.”

A client diagnosed with paranoid personality disorder becomes violent on a unit. Which nursing intervention is most appropriate?

Use clear, calm statements and a confident physical stance.

A client diagnosed with borderline personality disorder brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the nursing staff best handle this situation?

Maintain consistency of care by open communication to avoid staff manipulation.

Which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with borderline personality disorder [BPD]?

Being firm, consistent, and empathic, while addressing specific client behaviors

Which adult client should a nurse identify as exhibiting the characteristics of a dependent personality disorder?

A physically healthy client who lives with parents and depends on public transportation.

A client expresses low self-worth, has much difficulty making decisions, avoids positions of responsibility, and has a behavioral pattern of “suffering” in silence. Which statement best explains the etiology of this client’s personality disorder?

Childhood nurturance was provided exclusively from one source, and independent behaviors were discouraged.

Family members of a client ask the nurse to explain the difference between schizoid and avoidant personality disorders. Which is the appropriate nursing response?

Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone.

Which nursing diagnosis should a nurse identify as appropriate when working with a client diagnosed with schizoid personality disorder?

Social isolation R/T inability to relate to others

Looking at a slightly bleeding paper cut, the client screams, “Somebody help me quick! I’m bleeding. Call 911!” A nurse should identify this behavior as characteristic of which personality disorder?

Histrionic personality disorder

When planning care for a client diagnosed with borderline personality disorder, which self-harm behavior should a nurse expect the client to exhibit?

The use of suicidal gestures to elicit a rescue response from others

A nurse tells a client that the nursing staff will start alternating weekend shifts. Which response should a nurse identify as characteristic of clients diagnosed with obsessive-compulsive personality disorder?

“You can’t make these kinds of changes! Isn’t there a rule that governs this decision?”

Which reaction to a compliment from another client should a nurse identify as a typical response from a client diagnosed with avoidant personality disorder?

Being grateful for the compliment but fearing later rejection and humiliation

Which factors differentiate a client diagnosed with social phobia from a client diagnosed with schizoid personality disorder?

Clients diagnosed with social phobia avoid attending birthday parties, whereas clients diagnosed with schizoid personality disorder would isolate self on a continual basis

Which client symptoms should lead a nurse to suspect a diagnosis of obsessive-compulsive personality disorder?

The client experiences inflexibility and lack of spontaneity when dealing with others.

Which client is a nurse most likely to admit to an inpatient facility for self-destructive behaviors?

A client diagnosed with borderline personality disorder.

When planning care for clients diagnosed with personality disorders, what should be the goal of treatment?

to reduce personality trait inflexibility that interferes with functioning and relationships

Which client situation would reflect the impulsive behavior that is commonly associated with borderline personality disorder?

As the day-shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, “I cut myself because you are leaving me.”

Which nursing diagnosis should be prioritized when providing nursing care to a client diagnosed with paranoid personality disorder?

Risk for violence: directed toward others R/T paranoid thinking

From a behavioral perspective, which nursing intervention is appropriate when caring for a client diagnosed with borderline personality disorder?

Contract with the client to reinforce positive behaviors with unit privileges.

A highly emotional client presents at an outpatient clinic appointment and states, “My dead husband returned to me during a séance.” Which personality disorder should a nurse associate with this behavior?

Schizotypal personality disorder

A nursing instructor is teaching students about clients diagnosed with histrionic personality disorder and the quality of their relationships. Which student statement indicates that learning has occurred?

“Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs.”

During an interview, which client statement should indicate to a nurse a potential diagnosis of schizotypal personality disorder?

“I am getting a message from the beyond that we have been involved with each other in a previous life.”

Which nursing diagnosis should be prioritized when providing nursing care to a client diagnosed with avoidant personality disorder?

Social isolation R/T inability to relate to others

A nurse is admitting a client with a new diagnosis of a personality disorder. Which of the following would make the nurse question this diagnosis? [Select all that apply.]1. The client has been diagnosed with sickle cell anemia.2. The client has an inflated self-appraisal and feels a sense of entitlement.3. The client has a history of a substance use disorder.4. The client is odd and eccentric but not delusional.5. The client has an intellectual developmental disorder.

Which statements represent positive outcomes for clients diagnosed with narcissistic personality disorder? [Select all that apply.]1. The client will relate one empathetic statement to another client in group by day two.2. The client will identify one personal limitation by day one.3. The client will acknowledge one strength that another client possesses by day two.4. The client will list four personal strengths by day three.5. The client will list two lifetime achievements by discharge.

A nurse is caring for a client diagnosed with antisocial personality disorder. Which factors should the nurse consider when planning this client’s care? [Select all that apply.]1. This client has personality traits that are deeply ingrained and difficult to modify.2. This client needs medication to treat the underlying physiological pathology.3. This client uses manipulation, making the implementation of treatment problematic.4. This client has poor impulse control that hinders compliance with a plan of care.5. This client is likely to have secondary diagnoses of substance abuse and depression.

A client is being assessed for antisocial personality disorder. According to the DSM-5, which of the following symptoms must the client meet in order to be assigned this diagnosis? [Select all that apply.]1. Ego-centrism and goal setting based on personal gratification.2. Incapacity for mutually intimate relationships.3. Frequent feelings of being down, miserable, or hopeless.4. Disregard for and failure to honor financial and other obligations.5. Intense feelings of nervousness, tenseness, or panic.

_______________________ personality disorder is characterized by a profound defect in the ability to form personal relationships or to respond to others in any meaningful emotional way.

_____________________ personality disorder is characterized by colorful, dramatic, and extroverted behavior in excitable, emotional people.

________________________________ personality disorder is characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation

_____________________ personality disorder is a pervasive distrust and suspiciousness of others, such that their motives are interpreted as malevolent.

Which developmental characteristic should a nurse identify as typical of a client diagnosed with severe intellectual developmental disorder [IDD]?

The client communicates wants and needs by “acting out” behaviors.

Providing simple directions and praising client’s independent self-care efforts

A child has been diagnosed with autistic spectrum disorder. The distraught mother cries out, “I’m such a terrible mother. What did I do to cause this?” Which nursing response is most appropriate?

“Poor parenting doesn’t cause autistic spectrum disorder. Research has shown that abnormalities in brain structure or function are to blame. This is beyond your control.”

In planning care for a child diagnosed with autistic spectrum disorder, which would be a realistic client outcome?

The client will establish trust with at least one caregiver by day five.

After an adolescent diagnosed with attention deficit/hyperactivity disorder [ADHD] begins methylphenidate [Ritalin] therapy, a nurse notes that the adolescent loses 10 pounds in a 2-month period. What is the best explanation for this weight loss?

The pharmacological action of Ritalin causes a decrease in appetite.

A nurse assesses an adolescent client diagnosed with conduct disorder who, at the age of 8, was sentenced to juvenile detention. How should the nurse interpret this assessment data?

Childhood-onset conduct disorder is more severe than the adolescent-onset type, and these individuals likely develop antisocial personality disorder in adulthood.

1. Childhood-onset conduct disorder is more severe than the adolescent-onset type, and these individuals likely develop antisocial personality disorder in adulthood.

The child’s mother is diagnosed with an anxiety disorder.

A child has been recently diagnosed with mild IDD. What information about this diagnosis should the nurse include when teaching the child’s mother?

Children with mild IDD develop academic skills up to a sixth-grade level.

A nursing instructor is teaching about the developmental characteristics of clients diagnosed with moderate IDD. Which student statement indicates that further instruction is needed?

“These clients can successfully complete elementary school.”

A preschool child is admitted to a psychiatric unit with a diagnosis of autism spectrum disorder. To help the child feel more secure on the unit, which intervention should a nurse include in this client’s plan of care?

Provide consistent caregivers.

A preschool child diagnosed with autistic spectrum disorder has been engaging in constant head-banging behavior. Which nursing intervention is appropriate?

Hold client’s head steady and apply a helmet.

When planning care for a client, which medication classification should a nurse recognize as effective in the treatment of Tourette’s syndrome?

Which behavioral approach should a nurse use when caring for children diagnosed with disruptive behavior disorders?

Reinforcing positive actions to encourage repetition of desirable behaviors

A child diagnosed with severe autistic spectrum disorder has the nursing diagnosis disturbed personal identity. Which outcome would best address this client diagnosis?

The client will name own body parts as separate from others by day five.

A nursing instructor presents a case study in which a three-year-old child is in constant motion and is unable to sit still during story time. She asks a student to evaluate this child’s behavior. Which student response indicates an appropriate evaluation of the situation?

“This child’s behavior must be evaluated according to developmental norms.”

A client has an IQ of 47. Which nursing diagnosis best addresses a client problem associated with this degree of IDD?

Altered social interaction R/T nonadherence to social convention

A physician orders methylphenidate [Ritalin] for a child diagnosed with ADHD. Which information about this medication should the nurse provide to the parents?

Convey unconditional acceptance and positive regard.

Which of the following risk factors, if noted during a family history assessment, should a nurse associate with the development of IDD? [Select all that apply.]1. A family history of Tay-Sachs disease2. Childhood meningococcal infection3. Deprivation of nurturance and social contact4. History of maternal multiple motor and verbal tics5. A diagnosis of maternal major depressive disorder

Which of the following findings should a nurse identify that would contribute to a client’s development of ADHD? [Select all that apply.]1. The client’s father was a smoker.2. The client had a low birth weight.3. The client is lactose intolerant.4. The client has a sibling diagnosed with ADHD.5. The client has been diagnosed with dyslexia.

The DSM-5 criteria for ODD specifies that: A persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness must be evident and last at least ______________ months

Which should be the priority nursing intervention when caring for a child diagnosed with conduct disorder?

Recognize escalating aggressive behavior and intervene before violence occurs.

A mother questions the decreased effectiveness of methylphenidate [Ritalin] prescribed for her child’s ADHD. Which nursing response best addresses the mother’s concern?

“Your child has probably developed a tolerance to Ritalin and may need a higher dosage.”

After studying the DSM-5 criteria for oppositional defiant disorder [ODD], which listed symptom would a student nurse recognize?

A client has recently been placed in a long-term care facility, because of marked confusion and inability to perform most activities of daily living. Which nursing intervention is most appropriate to maintain the client’s self-esteem?

Allow client to choose between two different outfits when dressing for the day.

A son, who recently brought his extremely confused parent to a nursing home for admission, reports feelings of guilt. Which is the appropriate nursing response?

“Support groups are held here on Mondays for children of residents in similar situations.”

A family asks why their father is attending activity groups at the long-term care facility. The son states, “My father worked hard all of his life. He just needs some rest at this point.” Which is the appropriate nursing response?

“The groups benefit your father by providing social interaction, sensory stimulation, and reality orientation.”

A couple resides in a long-term care facility. The husband is admitted to the psychiatric unit after physically abusing his wife. He states, “My wife is having an affair with a young man, and I want it investigated.” Which is the appropriate nursing response?

“I understand that you are upset. We will talk about it.”

A nursing instructor is teaching about reminiscence therapy. What student statement indicates that learning has occurred?

A student nurse asks the instructor, “Which psychiatric disorder is most likely initially diagnosed in the elderly?” Which instructor response gives the student accurate information?

“Major depressive disorder is most likely diagnosed later in life.”

An older client attending an adult day care program suddenly begins reporting dizziness, weakness, and confusion. What should be the initial nursing intervention?

Advocate for a complete physical exam.

An older client who lives with a caregiver is admitted to an emergency department with a fractured arm. The client is soaked in urine and has dried fecal matter on lower extremities. The client is 6 feet tall and weighs 120 pounds. Which condition should the nurse suspect?

An older, emaciated client is brought to an emergency department by the client’s caregiver. The client has bruises and abrasions on shoulders and back in multiple stages of healing. When directly asked about these symptoms, which type of client response should a nurse anticipate?

The client may deny or minimize the injuries.

A client in the middle stage of Alzheimer’s disease has difficulty communicating because of cognitive deterioration. Which nursing intervention is appropriate to improve communication?

Verbalize the nurse’s perception of the implied communication.

An older client is exhibiting symptoms of major depressive disorder. A physician is considering prescribing an antidepressant. Which physiological problem should make a nurse question this medication regime?

Altered liver and kidney functioning

An older client has met the criteria for a diagnosis of major depressive disorder. The client does not respond to antidepressant medications. Which therapeutic intervention should a nurse anticipate will be ordered for this client?

Electroconvulsive therapy [ECT]

A nurse is charting assessment information about a 70-year-old client. According to the U.S. Census Bureau, what term would the nurse use to describe this client?

The nurse should document using the term elderly.

Which individual is most likely to be below the poverty level in the United States?

A 70-year-old Hispanic woman living alone

A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the child’s face and arms. What other symptom should indicate to the nurse that the child may have been physically abused?

The child shrinks at the approach of adults.

A woman presents with a history of physical and emotional abuse in her intimate relationships. What should this information lead a nurse to suspect?

The woman may be a victim of incest.

A nursing instructor is developing a lesson plan to teach about domestic violence. Which information should be included?

Power and control are central to the dynamic of domestic violence.

A client is brought to an emergency department after being violently raped. Which nursing action is appropriate?

Remain nonjudgmental while actively listening to the client’s description of the violent rape event.

A raped client answers a nurse’s questions in a monotone voice with single words, appears calm, and exhibits a blunt affect. How should the nurse interpret this client’s responses?

The client may be demonstrating a controlled response pattern.

A client who is in a severely abusive relationship is admitted to a psychiatric inpatient unit. The client fears for her life. A staff nurse asks, “Why doesn’t she just leave him?” Which is the nursing supervisor’s most appropriate response?

“These clients are paralyzed into inaction by a combination of physical threats and a sense of powerlessness.”

A woman comes to an emergency department with a broken nose and multiple bruises after being beaten by her husband. She states, “The beatings have been getting worse, and I’m afraid next time he will kill me.” Which is the appropriate nursing response?

“Let’s talk about your options so that you don’t have to go home.”

A college student was sexually assaulted when out on a date. After several weeks of crisis intervention therapy, which client statement should indicate to a nurse that the student is handling this situation in a healthy manner?

“I know that it was not my fault.”

A client asks, “Why does a rapist use a weapon during the act of rape?” Which is the most appropriate nursing response?

“To terrorize and subdue the victim”

When questioned about bruises, a woman states, “It was an accident. My husband just had a bad day at work. He’s being so gentle now and even brought me flowers. He’s going to get a new job, so it won’t happen again.” This client is in which phase of the cycle of battering?

Phase III: The honeymoon phase

Which information should the nurse in an employee assistance program provide to an employee who exhibits symptoms of domestic physical abuse?

Have ready access to the number of a safe house for battered women.

A survivor of rape presents in an emergency department crying, pacing, and cursing her attacker. A nurse should recognize these client actions as which behavioral defense?

Expressed response pattern

Which assessment data should a school nurse recognize as a sign of physical neglect?

The child is often absent from school and seems apathetic and tired.

A client diagnosed with an eating disorder experiences insomnia, nightmares, and panic attacks that occur before bedtime. She has never married or dated, and she lives alone. She states to a nurse, “My father has recently moved back to town.” What should the nurse suspect?

Possible history of childhood incest

In planning care for a woman who presents as a survivor of domestic abuse, a nurse should be aware of which of the following data? [Select all that apply.]1. It often takes several attempts before a woman leaves an abusive situation.2. Substance abuse is a common factor in abusive relationships.3. Until children reach school age, they are usually not affected by abuse between their parents.4. Women in abusive relationships usually feel isolated and unsupported.5. Economic factors rarely play a role in the decision to stay.

Which of the following nursing diagnoses are typically appropriate for an adult survivor of incest? [Select all that apply.]1. Low self-esteem2. Powerlessness3. Disturbed personal identity4. Knowledge deficit5. Nonadherence

A nursing instructor is teaching about intimate partner violence. Which of the following student statements indicate that learning has occurred? [Select all that apply.]1. “Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner.”2. “Intimate partner violence is used to gain power and control over the other intimate partner.”3. “Fifty-one percent of victims of intimate violence are women.”4. “Women ages 25 to 34 experience the highest per capita rates of intimate violence.”5. “Victims are typically young married women who are dependent housewives.”

Order the description of the progressive phases of Walker’s model of the “cycle of battering.” ________ This phase is the most violent and the shortest, usually lasting up to 24 hours.________ In this phase, the man’s tolerance for frustration is declining.________ In this phase, the batterer becomes extremely loving, kind, and contrite.

A pattern of coercive control founded on and supported by physical and/or sexual violence or threat of violence of an intimate partner is termed ______________________.

Physical ________________ of a child includes refusal of or delay in seeking health care, abandonment, expulsion from the home or refusal to allow a runaway to return home, and inadequate supervision