01.Answer d
Rational: Clients with borderline personality disorders frequently demonstrate a pattern of unstable interpersonal relationships, impulsiveness, affective instability, and frantic efforts to avoid abandonment; these behaviors usually create great difficulty in establishing mutual goals.
02.Answer: a.
Rational: Setting limits on manipulative behavior provides the structure that the client needs. Encouraging acting out behavior and allowing the client to set limits would be contraindicated.
The need for restraints in a client with borderline personality disorder would be rare, unless coexisting disorders exist
03.Answer b
Rational: The lack of superego control allows the ego and the id to control the behavior. Self-motivation and self-satisfaction are of paramount concern.
04.Answer: c.
Rational: A client with panic disorder commonly has feelings of powerlessness and helplessness,and can easily feel out of control.Teaching the client problem-solving and decision-making skills can promote the ability to cope and to have a sense of personal control.A client who experiences panic disorder typically doesn’t tend to engage in high-risk behaviors or have identity problems. A discussion about relationships is premature for this client.
05.Answer c
Rational: These clients are withdrawn, aloof, and socially distant; allowing distance and providing support may encourage the eventual development of a therapeutic alliance. Group therapy would increase this client’s anxiety; cognitive or behavioral therapy would be more appropriate.
06.Answer: b.
Rational: The client experiencing a panic attack is unable to focus and his ability to relate to others is diminished; therefore,short, simple sentences are the most effective means of communication. Telling the client that there’s no need to panic or that he’s safe,or offering detailed explanations invalidates
the client’s feelings of anxiety.
07.Answer c .
Rational: This intervention demonstrates the nurse’s caring presence which is vital for this client. (1) Although the treatment team does need to know about the event, notification is not the immediate concern. (2) This is premature and it reinforces the client’s predisposition to manipulative behavior. (4) This medication is inappropriate in this situation; vomiting would be expected after the ingestion of shampoo.
08.Answer: a.
Rational: By addressing the client’s actions that interfere with creating social relationships, the nurse can assist the client in becoming aware of the impact of inappropriate behaviors on
others and begin to work on how to prevent them. Talking with the client about following unit rules, encouraging him to change thinking patterns, and telling him that his negative feelings are causing personality changes don’t address how his spying behavior influences other clients and isolates him from effectively interacting with peers.
09.Answer c
Rational: Clients with paranoid personality disorder are affectively restricted, appear unemotional, and appear rational and objective.
10.Answer: b.
Rational: Willingness to risk self-revelation is a characteristic of a healthy interpersonal relationship. Minimal self-revelation is holding back on the relationship. Ego-dystonic behavior refers to thoughts, impulses, attitudes and behavior that the client feels are distressing, repugnant, or inconsistent with the rest of his personality. Intimacy while maintaining separate (rather than merging) identities is a characteristic of a healthy relationship.
11.Answer: a.
Rational: Pharmacologic management would consist of either tricyclic antidepressants or benzodiazepines. Proton pump inhibitors are used for GI disorders. Nitroprusside is a vasodilator used for hypertensive emergencies. Lithium carbonate is an antimanic agent.
12.Answer a
Rational: Clients with antisocial personality disorder tend to engage in acts of dishonesty, shown by lying.
13.Answer D.
Rational: Clients with antisocial personality disorder are often sent for treatment by the court after multiple crimes or for the use of illegal substances.
14.Answer a
Rational: Clients with borderline personality disorder tend to self-mutilate and have abrasions in various stages of healing.
15.Answer: d.
Rational: Constant patterns of anxiety that affect the client for more than 6 months and interfere with normal activities are characteristic of generalized anxiety disorder.
Pharmaceutical therapy with benzodiaze pines can help. Clients having regular obsessions are probably suffering from obsessivecompulsive disorder. Nightmares and flashbacks are typical symptoms of posttraumatic stress disorder.
16.Answer c
Rational: Chronic feelings of emptiness and sadness predispose a client to depression. About 40% of the clients with borderline struggle with depression.
17.Answer A
Rational: The family needs information about coping skills to help the client learn to handle stress. Clients with dependent personality disorder don’t have aggressive outbursts; they tend to be passive and submit to others. They don’t tend to have panic attacks. Exercise is a health promotion activity for all clients. Clients with dependent personality disorder wouldn’t need exercise promoted more than other people.
18.Answer: d.
Rational: Clients who have taken steroids can experience a manic episode. Anticholinergic,vasodilator, and antiemetic drugs don’t induce a manic episode.
19.Answer: a.
Rational: Keeping messages consistent,fostering trust, and avoiding deception will help to decrease suspiciousness. Encouraging social interactions, attending to basic daily needs, and providing pharmacologic therapy are general nursing interventions that are appropriate for any psychiatric disorder.
20.Answer: d.
Rational: The nurse should respond in a way that helps the client recognize that the way a person speaks can escalate anger and arouse anxiety and aggressive responses in others. Although the other responses spoken could be true for some clients, they don’t address the client’s acting out verbally and attempting to use aggressive words to intimidate others.
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