TOWNSEND 2009

ACTIVITY#4

1. Kim has a diagnosis of borderline personality disorder. She often exhibits

alternating clinging and distancing behaviors. The most appropriate nursing
intervention with this type of behavior would be to:
a. Encourage Kim to establish trust in one staff person, with whom all therapeutic
interaction should take place.
b. Secure a verbal contract from Kim that she will discontinue these behaviors.
c. Withdraw attention if these behaviors continue.
d. Rotate staff members who work with Kim so that she will learn to relate to more
than one person.
2. Kim manipulates the staff in an effort to fulfill her own desires. All of the following
may be examples of manipulative behaviors in the borderline client except:
a. Refusal to stay in room alone, stating, “It’s so lonely.”
b. Asking Nurse Jones for cigarettes after 30 minutes, knowing the assigned nurse has
explained she must wait 1 hour.
c. Stating to Nurse Jones, “I really like having you for my nurse. You’re the best one
around here.”
d. Cutting arms with razor blade after discussing dismissal plans with physician.
3. “Splitting” by the client with borderline personality disorder denotes:
a. Evidence of precocious development
b. A primitive defense mechanism in which the client sees objects as all good or all
bad
c. A brief psychotic episode in which the client loses contact with reality
d. Two distinct personalities within the borderline client
4. According to Margaret Mahler, predisposition to borderline personality disorder
occurs when developmental tasks go unfulfilled in which of the following phases?
a. Autistic phase, during which the child’s needs for security and comfort go
unfulfilled
b. Symbiotic phase, during which the child fails to bond with the mother
c. Differentiation phase, during which the child fails to recognize a separateness
between self and mother
d. Rapprochement phase, during which the mother withdraws emotional support in
response to the child’s increasing independence

Situation: Jack was arrested for breaking into a jewelry store and stealing thousands
of dollars’ worth of diamonds. At his arraignment, the judge ordered a psychological
evaluation. He has just been admitted by court order to the locked unit. Based on a
long history of maladaptive behavior, he has been given the diagnosis of antisocial
personality disorder.
5. Which of the following characteristics would you expect to assess in Jack?
a. Lack of guilt for wrongdoing
b. Insight into his own behavior
c. Ability to learn from past experiences
d. Compliance with authority
6. Milieu therapy is a good choice for clients with antisocial personality disorder
because it:
a. Provides a system of punishment and rewards for behavior modification.
b. Emulates a social community in which the client may learn to live harmoniously
with others.
c. Provides mostly one-to-one interaction between the client and therapist.
d. Provides a very structured setting in which the clients have very little input into the
planning of their care.
7. In evaluating Jack’s progress, which of the following behaviors would be
considered the most significant indication of positive change?
a. Jack got angry only once in group this week.
b. Jack was able to wait a whole hour for a cigarette without verbally abusing the
staff.
c. On his own initiative, Jack sent a note of apology to a man he had injured in a
recent fight.
d. Jack stated that he would no longer start any more fights.
8. Donna and Katie work in the secretarial pool of a large organization. It is 30
minutes until quitting time when a supervisor hands Katie a job that will take an hour
and says he wants it before she leaves. She then says to Donna, “I can’t stay over! I’m
meeting Bill at 5 o’clock! Be a doll, Donna. Do this job for me!” Donna agrees,
although silently she is furious at Katie because this is the third time this has
happened in 2 weeks. Katie leaves and Donna says to herself, “This is crazy.
I’m not finishing this job for her. Let’s see how she likes getting in trouble for a
change.” Donna leaves without finishing the job. This is an example of which type of
personality characteristic?
a. Antisocial
b. Paranoid
c. Passive–aggressive
d. Obsessive–compulsive
9. Carol is a new nursing graduate being oriented on a medical/surgical unit by the
head nurse,
Mrs. Carey. When Carol describes a new technique she has learned for positioning
immobile clients, Mrs. Carey states, “What are you trying to do . . . tell me how to do
my job? We have always done it this way on this unit, and we will continue to do it
this way until I say differently!” This is an example of which type of personality
characteristic?
a. Antisocial
b. Paranoid
c. Passive–aggressive
d. Obsessive–compulsive
10. Which of the following behavioral patterns is characteristic of individuals with
histrionic personality disorder?
a. Belittling themselves and their abilities
b. Overreacting inappropriately to minor stimuli
c. Suspicious and mistrustful of others
d. A lifelong pattern of social withdrawal

VIDEBECK 2011
1. When working with a client with a paranoid personality disorder, the nurse would
use which of the following approaches?
a. Cheerful
b. Friendly
c. Serious
d. Supportive
Diagnosed when there is impairment of personality functioning and personality traits
that are maladaptive.
2. Which of the following underlying emotions is commonly seen in a passive-
aggressive personality disorder?
a. Anger
b. Depression
c. Fear
d. Guilt
Characterized by a negative attitude and a pervasive pattern of passive resistance to
demands for adequate social and occupational performance.
3. Cognitive restructuring techniques include all the following except
a. Decatastrophizing
b. Positive self-talk
c. Reframing
d. Relaxation
Relaxation in psychology, is the emotional state of a living being, of low tension, in
which there is an absence of arousal that could come from sources such as anger,
anxiety, or fear.
4. Transient psychotic symptoms that occur with borderline personality disorder are
most likely treated with which of the following?
a. Anticonvulsant mood stabilizers
b. Antipsychotics
c. Benzodiazepines
d. Lithium
The most up-to-date evidence suggests that anticonvulsant agents such as topiramate,
valproate, or lamotrigine, and atypical antipsychotics such as aripiprazole and
olanzapine, are most effective in treating BPD.
5. Clients with a histrionic personality disorder are most likely to benefit from which
of the following nursing interventions?
a. Cognitive restructuring techniques
b. Improving community functioning
c. Providing emotional support
d. Teaching social skills
6. When interviewing any client with a personality disorder, the nurse would assess
for which of the following?
a. Ability to charm and manipulate people
b. Desire for interpersonal relationships
c. Disruption in some aspects of his or her life
d. Increased need for approval from others
7. The nurse would assess for which of the following characteristics in a client with
narcissistic personality disorder?
a. Entitlement
b. Fear of abandonment
c. Hypersensitivity
d. Suspiciousness
8. The most important short-term goal for the client who tries to manipulate others
would be to
a. Acknowledge own behavior
b. Express feelings verbally
c. Stop initiating arguments
d. Sustain lasting relationships
Select all that apply.
1. When working with a client with a personality disorder, the nurse would expect to
assess the following:
a. High levels of self-awareness
b. Impaired interpersonal relationships
c. Inability to empathize with others
d. Minimal insight
e. Motivation to change
f. Poor reality testing

2. The nurse working with a client with antisocial personality disorder would expect
which of the following behaviors?
a. Compliance with expectations and rules
b. Exploitation of other clients
c. Seeking special privileges
d. Superficial friendliness toward others
e. Utilization of rituals to allay anxiety
f. Withdrawal from social activities

CLINICAL EXAMPLE
Susan Marks, 25 years old, is diagnosed with borderline personality disorder. She has
been attending college sporadically but has only 15 completed credits and no real
career goal. She is angry because her parents have told her she must get a job to
support herself. Last week, she met a man in the park and fell in love with him on the
first date. She has been calling him repeatedly, but he will not return her calls.
Declaring that her parents have deserted her and her boyfriend doesn’t love her
anymore, she slashes her forearms with a sharp knife. She then calls 911, stating, “I’m
about to die! Please help me!” She is taken by ambulance to the emergency room and
is admitted to the inpatient psychiatry unit.

1. Identify two priority nursing diagnoses that would be appropriate for Susan on her
admission to the unit.
Risk for self-mutilation, ineffective coping
2. Write an expected outcome for each of the identified nursing diagnoses.
Risk for self-mutilation: The client will be safe and free of significant injury.
Ineffective coping: The client will demonstrate increased control of impulsive
behavior.
3. List three nursing interventions for each of the identified nursing diagnoses.
Risk for self-mutilation: Discuss presence and intensity of self-harm urges
with client; negotiate a no-self-harm contract with the client; help the client to
identify triggers from self-harm behavior.
Ineffective coping: Help the client to identify feelings by keeping a journal;
discuss ways the client can use distraction when gratification must be delayed;
discuss alternative ways the client can express feelings without an exaggerated
response.
4. What community resources or referrals would be beneficial for Susan?
Outpatient therapist, community support services, vocational/career
counseling, self-help group.