Quizlet Personality Disorders

Personality Disorders NCLEX TYPE Question
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1. A nurse manage is discussing the care of a client who has a personality

disorder with a newly licensed nurse. Which of the following statements by
the newly licensed nurse indicates an understanding of the teaching?
A. "I can promote my client's sense of control by establishing a schedule."
B. "I should encourage clients who have a schizoid personality disorder to
increase socialization."
C. "I should practice limit-setting to help prevent client manipulation."
D. "I should implement assertiveness training with clients who have antiso-
cial personality disorder.": C
When caring for a client who has a personality disorder, limit-setting is appropriate
to help prevent client manipulation.
2. A nurse is caring for a client who has avoidant personality disorder. Which
of the following statements is expected from a client who has this type of
personality disorder?
A. "I'm scared that you're going to leave me."
B. "I'll go to group therapy if you'll let me smoke."
C. "I need to feel that everyone admires me."
D. "I sometimes feel better if I cut myself.": A
Clients who have avoidant personality disorder often have a fear of abandonment.
This type of statement is expected.
3. A nurse is caring for a client who has borderline personality disorder.
The client says, "The nurse on the evening shift is always nice! You are the
meanest nurse ever!" The nurse should recognize the client's statement as
an example of which of the following defense mechanisms?
A. Regression
B. Splitting
C. Undoing
D. Identification: B
Splitting occurs when a person is unable to see both positive and negative qualities
at the same time. The client who has borderline personality disorder tends to see
a person as all bad one time and all good another time.
4. A nurse is assisting with a court-ordered evaluation of a client who has
antisocial personality disorder. Which of the following findings should the
nurse expect? (Select all that apply)
A. Demonstrates extreme anxiety when placed in a social situation
B. Has difficulty making even simple decisions
C. Attempts to convince other clients to give him their belongings
D. Becomes agitated if his personal area is not near and orderly
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E. Blames others for his past and current problems: C,E
-Exploitation and manipulation of others is an expected finding of antisocial per-
sonality disorder.
-Failure to accept personal responsibility is an expected finding of clients who have
antisocial personality disorder.
5. A charge nurse is preparing a staff education session on personality dis-
orders. Which of the following personality characteristics associated with all
of the personality disorders should the charge nurse include in the teaching?
(Select all that apply)
A. Difficulty in getting along with other members of a group
B. Belief in the ability to become invisible during times of stress
C. Display of defense mechanisms when routines are changed
D. Claiming to be more important than other persons
E. Difficulty understanding why it is inappropriate to have a personal rela-
tionship with staff: A,C,E
-Difficulty with social and professional relationships is a personality characteristic
that can be seen with all personality disorder types.
-Maladaptive response to stress is a personality characteristic that can be seen
with all personality disorder types.
-Difficulty understanding personal boundaries is a personality characteristic that
can be seen with all personality disorder types.
6. A 36-year-old client with paranoid schizophrenia believes the room is
bugged by the Central Intelligence Agency and a roommate is a foreign spy.
The client has never had a romantic relationship, has no contact with family,
and hasn't been employed for the past 14 years. Based on Erikson's theories,
the nurse should recognize that this client is in which stage of psychosocial
development?
A. Autonomy versus shame and doubt
B. Generativity versus stagnation
C. Integrity versus despair
D. Trust versus mistrust: D
This client's paranoid ideation indicates difficulty in trusting others.
7. Before eating a meal, a client with obsessive-compulsive disorder must
wash his hands for 18 minutes, comb his hair 444 strokes, and switch the
bathroom light on and off 44 times. What is the most appropriate long-term
treatment goal for this client?
A. Omit one unacceptable behavior each day
B. Increase the client's acceptance of therapeutic drug use
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C. Allow ample time for the client to complete all rituals before each meal
D. Systematically decrease the amount of time spent in - and the number of
repetitions of - rituals: D
When treating a client with obsessive-compulsive disorder, the long-term goal is
to systematically decrease the undesirable behavior.
8. The nurse counsels a client with obsessive-compulsive disorder. Which
statement by the client indicates the need for reassessment?
A. "I must work overtime every night this week or the job won't get done
right."
B. "I'm working on developing a relationship with one coworker whom I like."
C. "I've decided I won't be able to go to the islands for my vacation."
D. "I may never have many people in my life except for my family.": A
The perception that the client needs to work overtime every night indicates a
perfectionist tendency and an excessive focus on work to the exclusion of social
or leisure activities.
9. A client with antisocial personality disorder smokes where it is prohibited
and doesn't follow other unit or facility rules. The client gets others to do the
laundry and other personal chores, tries to divide the staff, and works only
with certain nurses. The primary focus on this client's care plan should be:
A. consistently enforcing unit rules and facility policy
B. isolating the client to decrease contact with easily manipulated clients
C. engaging in power struggles with the client to decrease the incidence of
manipulative behavior
D. using behavior modification to decrease the amount of negative behavior
by using negative reinforcement: A
Firmness and consistency about rules are the hallmarks of a care plan for a client
with a personality disorder.
10. During a private conversation, a client with borderline personality disor-
der asks the nurse to "keep my secret" and then displays multiple, self-in-
flicted, superficial lacerations on the forearms. What is the nurse's best
response?
A. "This type of behavior requires you to be on suicide precautions."
B. "I'm going to tell your physician. Do you want to tell me why you did that?"
C. "Tell me what type of instrument you used. I'm concerned about infection."
D. "Whenever something important occurs, the team needs to know about it.
I'll have to tell the others, but let's talk about it first.": D
This response informs the client of the nurse's planned actions and allows time to
discuss the client's action.
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11. Which nursing intervention is most appropriate for a client with obses-
sive-compulsive disorder?
A. Encouraging the client to concentrate on and pay attention to unwanted
thoughts
B. Giving antipsychotic medications as needed
C. Interrupting the client's ritual to empower the client in gaining control over
the ritual
D. Allowing the client to carry out his rituals: D
allowing the client to carry out rituals is important because such behavior is aimed
at preventing or reducing distress or preventing some dreaded event or situation
from occurring.
12. The nurse is assessing the client with paranoid personality disorder.
Which behavior should the nurse expect?
A. Able to trust only those who are fair and treat the client well
B. Sees the goodwill of another when that behavior does not exist
C. Acts the opposite of what the client may be thinking or feeling
D. Analyzes the behavior of others to find hidden and threatening meanings-
:D
The client with paranoid personality disorder exhibits mistrust and suspicion of
others such that the behavior of others is analyzed to find hidden and threatening
meanings.
13. The nurse identifies that an individual with antisocial personality disorder
exhibits poor judgment, emotional distance, aggression, and impulsivity.
Which step of the nursing process is being completed by the nurse?
A. Assessment
B. Diagnosis
C. Outcome Identification
D. Planning
E. Implementation
F. Evaluation: A
The nurse is completing an assessment of the client by collecting information about
the client's behavior.
14. The nurse is working with the client with paranoid personality disorder.
The nurse understands that the client likely experienced what in the past?
A. Little affection or approval during the childhood years
B. Lack of empathy and lack of nurturing during upbringing
C. Indifference and lack of affection during early upbringing
D. Recognition for accomplishments only in early childhood: A
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Individuals with paranoid personality disorder may have been subjected to parental
antagonism and harassment. They served as scapegoats for displaced parental
aggression and eventually gave up all hope of affection and approval.
15. The nurse is caring for the client with paranoid personality disorder.
Which approach should the nurse use when working with the client?
A. Use a businesslike manner using clear, concrete, and specific words
B. First use social conversation to work on developing social relationships
C. Include jokes when conversing to work on reducing the client's serious
behavior
D. Confront the client when stating suspicious ideas to aid the client in
seeing reality: A
Clients with paranoid personality disorder take everything seriously and are at-
tuned to the actions and motivations of others. A businesslike approach with clear,
concrete, and specific words keeps the intended message clear by decreasing
ambiguity.
16. The nurse reads in the medical record that the client with BPD has
"splitting." What is the nurse's interpretation of "splitting?"
A. The client is having an intense psychotic episode and has become cata-
tonic
B. The client has an identity disturbance with an unstable self-image or sense
of self
C. The client is using a defense mechanism in which all objects are seen as
good or bad
D. The client's behavior shows a pattern of unstable and intense interperson-
al relationships: C
Splitting is a primitive defense mechanism in which all objects, individuals, or
situations are seen as good or bad. Individuals with BPD have an inability to accept
and integrate positive and negative feelings.
17. The nurse is working with the client with histrionic personality disorder.
Which behaviors should the nurse expect? (Select all that apply)
A. Uses physical appearance to gain attention
B. Shows apathy in conversations until trust is established
C. Lacks close friends or companions other than first-degree relatives
D. Harbors recurrent suspicions about the fidelity of his or her marital partner
E. Discomfort in situations in which the client is not the center of attention-
: A,E
-The client with histrionic personality disorder requires constant affirmation of
approval and acceptance from others and often uses physical appearance to gain
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attention and approval.
-Diagnostic criteria for histrionic personality disorder include discomfort in situa-
tions in which the client is not the center of attention. The client requires constant
affirmation of approval and acceptance from others.
18. The client with bipolar personality is taking lithium 300mg tid and has the
lithium level 4 months ago 1.0, 2 months ago 1.2, and today 1.5. The nurse
receives an order to add fluoxetine 20 mg bid and to administer the client's
first dose. What should the nurse do? (Select all that apply)
A. Question the dose of lithium
B. Question the dose of fluoxetine
C. Notify the HCP of the lab results
D. Administer the dose of fluoxetine
E. Question the addition of fluoxetine: A,C,E
-The dose of lithium should be questioned because the lithium level of 1.5 is
nearing toxicity.
-The HCP should be notified. The lithium level of 1.5 is nearing toxicity.
-The addition of fluoxetine should be questioned. Fluoxetine (Prozac) will increase
the risk of lithium toxicity.
19. The client with BPD often attempts to manipulate staff to promote self
needs. Which behavior indicates that the client is able to overcome this
manipulative behavior?
A. Client insists on joining other clients in the dayroom because of feeling
lonely
B. Client asks for a cigarette 30 minutes after being told that cigarettes are
allowed once an hour
C. Client states to the nurse, "You are the best nurse, and only you are
allowed to care for me."
D. Client self-mutilates by cutting after the HCP discussed possible dis-
charge with the client: A
Wanting to join others because of loneliness is a nonmanipulative behavior.
20. The client with BPD states to the nurse, "Hey, you know what! You are my
favorite nurse. That night nurse sure doesn't understand me the way you do."
Which response by the nurse is most therapeutic?
A. "Hang in there. I won't enjoy coming to work as much after you are
discharged."
B. "I'm glad you're comfortable with me. Which night nurse doesn't under-
stand you?"
C. "I like you. Tomorrow you'll be discharged; I'm glad you will be able to
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return home."
D. "You are my favorite patient; I'll really miss caring for you when you are
discharged.": C
The most therapeutic response is one in which the nurse avoids responding to
the designation of favorite nurse and redirects the client to concentrate on the
impending discharge.
21. The nurse receives an order to administer phenelzine 15 mg tid to the
client diagnosed with BPD. Based on the finding of the client's medication
record, which should be the nurse's reasoning for questioning the medica-
tion order?
Fluoxetine 20 mg daily 0900, Carbamazepine 400 mg bid 0900 and 2100,
Alprozolam 0.5 bid 0900 and 2100
A. The combination phenelzine and fluoxetine will drastically lower the blood
pressure
B. Tension headaches may result when carbamazepine and alprazolam are
combined
C. MAOIs are not used to treat borderline personality disorder due to the risk
of suicide
D. Phenelzine and fluoxetine should not be taken together due to excessive
serotonin release: D
Fluoxetine (Prozac) is an SSRI, and phenelzine (Nardil) is an MAOI. SSRIs and
MAOIs should not be taken together because excessive release of serotonin
(serotonin syndrome) may result with associated mental, cardiovascular, GI and
neuromuscular alterations.
22. The client with no psychiatric history is admitted to an ED after physically
assaulting his wife. The client is frightened by his loss of control, which he
states was precipitated by his wife's complaining and lack of support. The
client tells the nurse he is self-employed, recently expanded his company
nationally, and has many well-known friends. The client's wife states, "The
business is losing money, yet he continues his lavish lifestyle; what's impor-
tant to him is who he knows and how it looks!" The nurse determines that
the client's behavior is typical of which disorder?
A. Schizoid personality disorder
B. Borderline personality disorder
C. Narcissistic personality disorder
D. Dependent personality disorder: C
Narcissistic personality disorder is characterized by constant seeking of praise and
attention, an egocentric attitude, envy, rage, and violence when others are not
supportive.
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23. The nurse is developing the plan of care for the client with schizoid
personality disorder. Which primary outcome should the nurse include?
A. Recognizes limits
B. Able to cope and control emotions
C. Validates ideas before taking action
D. Able to function independently in the community: D
An outcome for the individual with schizoid personality disorder focuses on improv-
ing functioning within the community.
24. The nurse is planning care for the client with avoidant personality disor-
der. Which interventions should the nurse plan? (Select all that apply)
A. Use reframing technique
B. Explore positive self-aspects
C. Practice social skills with client
D. Use decatastrophizing technique
E. Identify negative responses from others: A,B,C,D
-Reframing is a cognitive behavioral technique where alternative points of view are
examined to explain events and is used to enhance self-worth of the person with
avoidant personality disorder.
-Exploring positive aspects of self is used to enhance self-worth of the person with
avoidant personality disorder.
-Practicing social skills with the client in the safety of the nurse-client relationship
will help the client reduce social fears and develop meaningful social contact and
relationship skills.
-Decatastrophizing is a method of learning to assess situations in a realistic
manner instead of assuming a catastrophe will happen. Using this can enhance
self-worth.
25. The nurse is working with the individual with OCPD. Which approach
should the nurse use?
A. Inflexible and autocratic
B. Calm and nonconfrontational
C. Direct, hurried, and organized
D. Uninterrupted and confrontational: B
Persons with OCPD tend to maintain control by carefully and thoroughly following
procedures. It is important to use a calm and nonconfrontational approach, as any
request is likely to increase the client's anxiety level.
26. The client with OCD is being admitted to a mental health unit. The client is
refusing treatment for hand and face wounds caused by excessive washing,
and treatment for the mental health diagnosis. What actions should be taken
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by the nurse? (Select all that apply)
A. Do not treat the client; the client is competent
B. Treat the client's injuries; the client is incompetent
C. Notify the client's family; the client is incompetent
D. Notify the HCP of the refusal; the client is compentent
E. Notify the HCP of the refusal; the client is incompentent: A,D
-The client has the right to refuse treatment; the client is competent
-The nurse should notify the client's HCP of the refusal for treatment, and acknowl-
edge that the client is competent. A diagnosis of OCD does not indicate that the
client is incompetent.
27. During an initial home visit with the client, the nurse discovers cluttered
possessions taking up 75% of the living space and obstructing access
into the home and all rooms expect the bathroom. What should the nurse's
interpretation of the client's behavior?
A. Inability to focus related to possible passive-aggressive personality dis-
order
B. An attention-seeking behavior related to possible histrionic personality
disorder
C. Hoarding behavior related to possible obsessive-compulsive personality
disorder
D. Inattentiveness to surroundings related to possible borderline personality
disorder: C
Hoarding behavior is associated with OCD and OCPD. It is due to fear and anxiety
concerning loss of control over situations, objects, or people.
28. The nurse observes that the client diagnosed with OCPD is exhibiting
reaction formation. The nurse should plan to assess for which other defense
mechanisms commonly associated with this disorder? (Select all that apply)
A. Isolation
B. Undoing
C. Projection
D. Introjection
E. Rationalization
F. Intellectualization: A,B,E,F
-Isolation is a defense mechanism to separate a thought or memory from the
feelings or emotions associated with it.
-Undoing is a defense mechanism to symbolically negate or cancel out a previous
action or experience that is found to be intolerable.
-Rationalization is attempting to make excuses or formulate logical reasons to
justify unacceptable feelings or behaviors.
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-Intellectualization is an attempt to avoid expressing actual emotions associated
with a stressful situation by using the intellectual processes of logic, reasoning,
and analysis.
29. The client on a psychiatric unit is very demanding and belittling of one of
the nurses. The client is talking with others and telling them how mean the
nurse is to clients. Which nursing problem should the nurse include in the
client's written plan of care?
A. Social isolation due to negative behavior
B. Ineffective coping due to inability to interact with unit personnel
C. Risk for other-directed violence due to negative verbal comments
D. Chronic low self-esteem due to use of the defense splitting: D
Splitting is a defense mechanism in which the person is unable to integrate and
accept both positive and negative feelings, and people are considered either all
good or all bad.
30. The nurse is planning a counseling session with the client who has
antisocial personality disorder. The nurse should anticipate that the client
would use which primary ego defense mechanism?
A. Projection
B. Sublimation
C. Compensation
D. Rationalization: A
Projection is attributing feelings or impulses unacceptable to oneself onto another
person. The person with antisocial personality disorder will exploit and manipulate
others for personal gain.
31. The HCP writes in the client's progress notes, "Will switch medications
from the older medications to a newer GABA-ergic anticonvulsant to treat
client's instability of mood, transient mood crashes, and inappropriate and
intense outbursts of anger." Which medication should the nurse consider
when reviewing the HCP's new prescriptions?
A. Lithium
B. Gabapentin
C. Valproic acid
D. Carbamazepine: B
GABA is the main inhibitory neurotransmitter in the CNS. GABA-ergic anticon-
vulsants, such as gabapentin, appear to act by regulating neural firing in the
mesolimbic area.
32. The client with a BPD is prescribed phenelzine for decreasing impulsivity
and self-destructive acts. The nurse teaches the client to avoid foods high in
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tyramine when taking phenelzine to prevent what effect?
A. A hypotensive crisis
B. A hypertensive crisis
C. Poor absorption of tyramine
D. Cardiac rhythm abnormalities: B
The combination of tyramine-containing foods and MAOIs such as phenelzine
(Nardil) can result in a hypertensive crisis.
33. The nurse is checking the MAR listed below for the 75-year-old client
newly admitted to a behavioral health unit. Which medication should the
nurse question with the HCP?
A. Risperidone 2 mg at 0900
B. Fluoxetine 10 mg at 0900
C. Carbamazepine 200 mg at 0900 and 2100
D. Docusate sodium 100 mg at 0900: A
Risperidone (Risperdal) an antipsychotic medication, is prescribed at the regular
adult dose and not at an appropriate dose for an older adult. Metabolism is slowed
with aging, and adverse reactions can occur quickly in older adults.
34. The nurse teaches the communication triad to the client to manage
feelings. Which components should the nurse include? (Select all that apply)
A. Use an "I" statement to identify the present feelings
B. Use a "you" statement to identify the cause of the feeling
C. Make a nonjudgmental statement about an emotional trigger
D. Identify what would restore comfort to the situation for the client
E. Use a "they" statement to examine the effect of the client's feelings on
others: A,C,D
-Using "I" statements helps to avoid judgment and is part of the communication
triad.
- Nonjudgemental statements are included in the communication triad to manage
feelings.
-A mechanism for restoring comfort is included in the communication triad to
manage feelings.
35. The nurse includes milieu therapy in the treatment plan for the client
with antisocial personality disorder. What is the nurse's best rationale for
including milieu therapy?
A. Set's limits on the client's unacceptable behavior
B. Provides a very structured setting that helps the client learn how to have
C. Stimulates a social community where the client can learn to interact with
peers
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D. Provides one-on-one interaction and reality orientation with client and
nursing personnel: C
Milieu therapy helps the client with antisocial personality disorder learn to respond
adaptively to feedback from peers. The democratic approach with specific rules
and regulations, community meetings, and group therapy sessions simulates the
societal situation in which the client must live.
36. Which predisposing factor would be implicated in the etiology of para-
noid personality disorder?
A. The individual may have been subjected to parental demands, criticism,
and perfectionistic expectations
B. The individual may have been subjected to parental indifference, impas-
sivity, or formality
C. The individual may have been subjected to parental bleak and unfeeling
coldness
D. The individual may have been subjected to parental antagonism and
harassment: D
Individuals diagnosed with paranoid personality disorder most likely would be
subjected to parental antagonism and harassment. These individuals likely served
as scapegoats for displaced parental aggression and gradually relinquished all
hope of affection and approval. They learned to perceive the world as harsh and
unkind, a place calling for protective vigilance and mistrust.
37. The nurse is assessing a client diagnosed with borderline personality
disorder. According to Mahler's theory of object relations, which describes
the client's unmet developmental need?
A. The need for survival and comfort
B. The need for awareness of an external source for fulfillment
C. The need for awareness of separateness of self
D. The need for internalization of a sustained image of a love object/person: C
Phase 3 (5 to 36 months) is the separation-individuation phase. The main task
of this phase is the primary recognition of separateness from the mother figure.
According to Mahler's theory, fixation in this phase may predispose the child to
borderline personality.
38. Using interpersonal theory, which statement is true regarding develop-
ment of paranoid personality disorder?
A. Studies have revealed a higher incidence of paranoid personality disorder
among relatives of clients with schizophrenia
B. Clients diagnosed with paranoid personality disorder frequently have
been family scapegoats and subjected to parental antagonism and harass-
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ment
C. There is an alteration in the ego development so that the ego is unable to
balance the id and superego
D. During the anal stage of development, the client diagnosed with paranoid
personality disorder has problems with control within his or her environ-
ment: B
An example of an interpersonal theory of development might involve a client
whose background reflects parental emotional abuse to the extent that paranoid
personality disorder eventually will be diagnosed.
39. When confronted, a client diagnosed with narcissistic personality disor-
der states, "Contrary to what everyone believes, I do not think that the whole
world owes me a living." This client is using what defense mechanism?
A. Minimization
B. Denial
C. Rationalization
D. Projection: B
Denial is used when a client refuses to acknowledge the existence of a real
situation or associated feelings. When the client states, "I don't think the whole
world owes me a living," denial is being used to avoid facing others' perceptions.
40. A client diagnosed with borderline personality disorder coyly requests
diazepam (Valium). When the physician refuses, the client becomes angry
and demands to see another physician. What defense mechanism is the
client using?
A. Undoing
B. Splitting
C. Altruism
D. Reaction formation: B
The client in the question is using the defense mechanism of splitting. An individual
diagnosed with borderline personality disorder sees things as wither "all good" or
"all bad." In the question, when the client's manipulative charm does not work
in obtaining the drug from the "good" physician, the client determines that the
physician is now "bad" and seeks another physician to meet his or her needs.
41. A diabetic client admitted to a medical floor for medication stabilization
has a history of antisocial personality disorder. Which documented behav-
iors would support this diagnosis? (Select all that apply)
A. "Labile mood and affect and old scares noted on wrists bilaterally."
B. "Appears younger than stated age with famboyant hair and makeup."
C. "Began cursing when confronted with drug-seeking behaviors."
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D. "Demands foods prepared by personal chef to be delivered to room."
E. "Attempted to use insincere flattery to obtain extra snacks.": C,E
-Antisocial personality disorder is characterized by a pattern of socially irresponsi-
ble, exploitive, and guiltless behavior. These clients disregard the rights of others
and frequently fail to conform to social norms with respect to lawful behaviors. They
are also deceitful, impulsive, irritable, and aggressive.
-Antisocial personality disorder is characterized by a pattern of socially irresponsi-
ble, exploitive, and guiltless behavior. These clients disregard rules, authority, and
social norms. They will frequently use insincere flattery and manipulation for their
own gain.
42. Irresponsible, guiltless behavior is to a client diagnosed with cluster B
personality disorder as avoidant, dependent behavior is to a client diagnosed
with a:
A. Cluster A personality disorder
B. Cluster B personality disorder
C. Cluster C personality disorder
D. Cluster D personality disorder: C
Cluster C categorizes behaviors that are anxious or fearful, and it comprises the
following disorders: (1) avoidant personality disorder, which is characterized by
social withdrawal brought about by extreme sensitivity to rejections; (2) dependent
personality disorder, Which is characterized by allowing others to assume respon-
sibility for major areas of life because of one's inability to function independently;
and (3) obsessive-compulsive personality disorder, which is characterized by a
pervasive pattern of perfectionism and inflexibility.
43. A client tells the nurse, "When I was a waiter I used to spit in the dinners
of annoying customers." This statement would be associated with which
personality trait?
A. Paranoid personality trait
B. Schizoid personality trait
C. Passive-aggressive personality trait
D. Antisocial personality trait: C
Clients exhibiting passive-aggressive personality traits are characterized by a
passive resistance to demands for adequate performance in occupational and
social functioning. The client in the question is demonstrating passive-aggressive
traits toward customers that he or she finds annoying.
44. A client diagnosed with a personality disorder insists that a grandmother,
through reincarnation, has come back to life as a pet kitten. The though
process described is reflective of which personality disorder?
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A. Obsessive-compulsive personality disorder
B. Schizotypal personality disorder
C. Borderline personality disorder
D. Schizoid personality disorder: B
Cluster A includes paranoid, schizoid, and schizotypal personality disorders.
Clients diagnosed with schizotypal personality disorder are characterized by pe-
culiarities of ideation, appearance, and behavior; magical thinking; and deficits
in interpersonal relatedness that are not severe enough to meet the criteria for
schizophrenia. In the question, this client's statement reflects ideations of magical
thinking.
45. A client diagnosed with a personality disorder states, "You are the very
best nurse on the unit and not at all like that mean nurse who never lets
us stay up later than 9 pm." This statement would be associated with which
personality disorder?
A. Borderline personality disorder
B. Schizoid personality disorder
C. Dependent personality disorder
D. Paranoid personality disorder: A
Cluster B includes antisocial, borderline, histrionic, and narcissistic personality
disorders. Clients diagnosed with borderline personality disorder are characterized
by a marked instability in interpersonal relationships, mood, and self-image. Clients
with this disorder attempt to pit one individual against another. This is known
as "splitting" and is related to an inability to integrate and accept positive and
negative feelings. Splitting is a primitive ego defense mechanism that is common
in individuals with borderline personality disorder. In the question, the client's
statement typifies splitting behavior.
46. A male client diagnosed with a personality disorder boasts to the nurse
that he has to fight off female attention and is the highest paid in his
company. These statements are reflective of which personality disorder?
A. Obsessive-compulsive personality disorder
B. Avoidant personality disorder
C. Schizotypal personality disorder
D. Narcissistic personality disorder: D
Cluster B includes antisocial, borderline, histrionic, and narcissistic personality
disorders. Clients diagnosed with narcissistic personality disorder are character-
ized by a constant need for attention, a grandiose sense of self-importance, and
preoccupations with fantasies of success, power, brilliance, and beauty, all of which
this client is displaying.
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47. A nurse encourages an angry client to attend group therapy. Knowing that
the client has been diagnosed with a cluster B personality disorder, which
client response might the nurse expect?
A. Sarcastically states,"That group is only for crazy people with problems."
B. Scornfully states, "no, can't you see that I'm having a seance with my
mom?"
C. Suspiciously states, "No, that room has been bugged."
D. Hesitantly states, "OK, by only if I can sit next to you.": A
In the questions, the client's statement would represent a typical response from
someone who was diagnosed with an antisocial personality disorder. These clients
also display patterns of socially irresponsible, exploitive, and guiltless behaviors
that reflect a disregard for the rights of others. Cluster B includes antisocial,
borderline, histrionic, and narcissistic personality disorders. Clients diagnosed with
cluster B personality disorders exhibit behaviors that are dramatic, emotional, or
erratic.
48. A client has been diagnosed with a cluster A personality disorder. Which
of the following client statements would reflect cluster A characteristics?
(Select all that apply)
A. "I'm the best chef on the East Coast."
B. "My dinner has been poisoned."
C. "I have to wash my hands 10 times before eating."
D. "I just can't eat when I'm alone."
E. "When my mom died, her spirit entered my cat.": B,E
-This statement might be voiced by a client diagnosed with paranoid personality
disorder. Cluster A includes paranoid, schizoid, and schizotypal personality dis-
orders. This cluster's characteristic behaviors are odd or eccentric and include
patterns of suspiciousness and mistrust.
-This statement might be voiced by a client diagnosed with schizotypal personality
disorder. This cluster's characteristic behaviors are odd or eccentric and include
patterns of suspiciousness and mistrust.
49. Personality disorders are grouped in clusters according to their behav-
ioral characteristics. In which cluster are the disorders correctly matched
with their behavioral characteristics?
A. Cluster C: antisocial, borderline, histrionic, narcissistic disorders; anxious
or fearful characteristic behaviors
B. Cluster A: avoidant, dependent, obsessive-complusive disorders; odd or
eccentric characteristic behaviors
C. Cluster A: antisocial, borderline, histrionic, narcissistic disorders; dramat-
ic, emotional, or erratic characteristic behaviors
16 / 27
D. Cluster C: avoidant, dependent, obsessive-complusive disorders; anxious
or fearful characteristic behaviors: D
Cluster C includes avoidant, dependent, and obsessive-compulsive personality
disorder. Anxious or fearful is the correct description for clients diagnosed with a
cluster C personality disorder.
50. Which behavior would the nurse expect to observe if a client is diagnosed
with paranoid personality disorder?
A. The client sits alone at lunch and states, "Everyone wants to hurt me."
B. The client is irresponsible and exploits other peers in the milieu for
cigarettes
C. The client is shy and refuses to talk to other because of poor self-esteem
D. The client sits with peers and allows others to make decisions for the entire
group: A
Individuals with paranoid personality disorder would be isolative and believe that
others were out to get them. The behavior presented reflects a client diagnosed
with this disorder.
51. Which diagnostic criterion describes a characteristic of schizotypal per-
sonality disorder?
A. Neither desires nor enjoys close relationships, including being part of a
family
B. Is preoccupied with unjustified doubts about the loyalty of friends and
associates
C. Considers relationships to be more intimate than they actually are
D. Exhibits behavior or appearance that is odd, eccentric, or peculiar: D
Magical thinking and odd beliefs that influence behavior and are inconsistent with
subcultural norms are defined as criteria for schizotypal personality disorder, which
is often described as "latent schizophrenia." Clients with this diagnosis are odd and
eccentric but do not decompensate to the level of schizophrenia.
52. Which of the following diagnostic criteria describe the characteristics of
borderline personality disorder? (Select all that apply)
A. Arrogant, haughty behaviors or attitudes
B. Frantic efforts to avoid real or imagined abandonment
C. Recurrent suicidal and self-mutilating behaviors
D. Unrealistic preoccupation with fears of being left to take care of self
E. Chronic feelings of emptiness: B,C,E
-This criterion describes borderline personality disorder, which is characterized
by a pervasive pattern of instability of interpersonal relationships. Having real or
imagined feelings of abandonment is the first criterion of this disorder.
17 / 27
-Recurrent suicidal and self-mutilating behavior is a diagnostic criterion that de-
scribes borderline personality disorder.
-Having chronic feelings of emptiness is a diagnostic criterion that describes
borderline personality disorder.
53. Which of the following diagnostic criteria describe the characteristics of
avoidant personality disorder? (Select all that apply)
A. Fearing shame and/or ridicule, does not form intimate relationships
B. Has difficulty making everyday decisions without reassurance from others
C. Is unwilling to be involved with people unless certain of being liked
D. Shows perfectionism that interferes with task completion
E. Views self as socially inept, unappealing, and inferior: A,C,E
-Clients diagnosed with avoidant personality disorder show a pervasive pattern
of social inhibitions, feelings of inadequacies, and hypersensitivity to negative
evaluation and find it difficult to form intimate relationships
-Clients diagnosed with avoidant personality disorder are extremely sensitive to
rejection and need strong guarantees of uncritical acceptance
-Although there may be a strong desire for companionship, a client with avoidant
personality disorder has such a pervasive pattern of inadequacy, social inhibition,
and withdrawal from life that the desire for companionship is negated.
54. When assessing a client diagnosed with histrionic personality disorder,
the nurse might identify which characteristic behavior?
A. Odd beliefs and magical thinking
B. Grandiose sense of self-importance
C. Preoccupation with orderliness and perfection
D. Attention-seeking flamboyance: D
Clients diagnosed with histrionic personality disorder have a pervasive pattern
of excessive emotionality and attention-seeking behaviors. These individuals are
uncomfortable in situations in which they are not the center of attention and have
a style of speech that is excessively impressionistic and lacking in detail.
55. When assessing a client exhibiting passive-aggressive personality traits,
which characteristic behavior might the nurse identify?
A. The client exhibits behaviors that attempt to "split" the staff
B. The client shows reckless disregard for the safety of self or others
C. The client has unjustified doubts about the trustworthiness of friends
D. The client seeks subtle retribution when feeling others have wronged him
or her: D
Clients exhibiting passive-aggressive traits believe another individual has wronged
them, and they may go to great lengths to seek retribution or "get even." This is
18 / 27
done in a subtle and passive manner, rather than by discussing their feelings with
the offending individual.
56. Although there are differences among the three personality disorder
clusters, there also are some traits common to all individuals diagnosed with
personality disorders. Which of the following are common traits? (Select all
that apply)
A. Failure to accept the consequences of their own behavior
B. Self-injurious behaviors
C. Reluctance in taking personal risks
D. Cope by altering environment instead of self
E. Lack of insight: A,D,E
-A common trait among individuals diagnosed with a personality disorder is the fail-
ure to accept the consequences of their own behavior. Although these individuals
can identify correct and appropriate behavior, they repeatedly avoid change and
cling to pattern that meet their unhealthy needs.
-A common train among individuals diagnosed with a personality disorder is their
response to stress. When feeling threatened, these individuals cope by attempting
to change the environment instead of changing themselves.
-A common trait among individuals diagnosed with a personality disorder is the lack
of insight. These individuals lack understanding of the impact of their behaviors on
others.
57. A client diagnosed with antisocial personality disorder states, "My kids
are so busy at home and school, they don't miss me or even know I'm gone."
Which nursing diagnosis applies to this client?
A. Risk for injury
B. Risk for violence: self-directed
C. Ineffective denial
D. Powerlessness: C
Ineffective denial is defined as the conscious or unconscious attempt to disavow
knowledge or meaning of an event to reduce anxiety or fear. The client presented
in the question is denying his or her children's need for parental support by turning
the situation around and making himself or herself sound like the victim who is not
needed.
58. A client diagnosed with borderline personality disorder superficially cut
both wrists, is disruptive in group, and is "splitting" staff. Which nursing
diagnosis would take priority?
A. Risk for self-mutilation R/T need for attention
B. Ineffective coping R/T inability to deal directly with feelings
19 / 27
C. Anxiety R/T fear of abandonment AEB "splitting" staff
D. Risk for suicide R/T past suicide attempt: A
Repetitive, self-mutilating behaviors are classic manifestations of borderline per-
sonality disorder. These individuals seek attention by self-mutilating until pain felt
in an effort to counteract feelings of emptiness. Some clients reported that "to feel
pain is better than to feel nothing." Because these clients often inflict injury on
themselves, this diagnosis must be prioritized to ensure client safety.
59. A client diagnosed with schizoid personality disorder chooses solitary
activities, lacks close friends, and appears indifferent to criticism. Which
nursing diagnosis would be appropriate for this client's problem?
A. Anxiety R/T poor self-esteem AEB lack of close friends
B. Ineffective coping R/T inability to communicate AEB indifference to criti-
cism
C. Altered sensory perception R/T threat to self-concept AEB magical think-
ing
D. Social isolation R/T discomfort with human interaction AEB avoiding
others: D
Clients diagnosed with schizoid personality disorder are unsociable and prefer
to work in isolation. These individuals are characterized primarily by a profound
defect in the ability to form personal relationships or to respond to others in any
meaningful or emotional way. They display a lifelong pattern of social withdrawal,
and their discomfort with human interaction is very apparent. This client is choosing
solitary activities and lacks friends. The nursing diagnosis of social isolation is
appropriate in addressing this client's problem.
60. A client exhibiting passive-aggressive personality traits continuously
complains to the marriage counselor about a nagging husband who criti-
cizes her indecisiveness. Which nursing diagnosis reflects this client's prob-
lem?
A. Social isolation R/T decreased self-esteem
B. Impaired social interaction R/T inability to express feelings openly
C. Powerlessness R/T spousal abuse
D. Self-esteem disturbance R/T unrealistic expectations of husband: B
Impaired social interaction is defined as the insufficient or excessive quality or
ineffective quality of social exchange. When the client in the question complains
about a nagging husband who criticizes her indecisiveness, she is passively
expressing impedes her ability to interact appropriately and to express feelings
openly, which leads to the correct nursing diagnosis, impaired social interaction.
20 / 27
61. A nurse is discharging a client diagnosed with narcissistic personality
disorder. Which employment opportunity is most likely to be recommended
by the treatment team?
A. Home construction
B. Air traffic controller
C. Night watchman at the zoo
D. Prison warden: D
Individuals diagnosed with narcissistic personality disorder have an exaggerated
sense of self-worth and believe they have an inalienable right to receive special
consideration. They tend to exploit others to fulfill their own desires. Because they
view themselves as "superior" begins, they believe they are entitled to special
rights and privileges. Because of the need to control others inherent in the job of
prison warden, this would be an appropriate job choice for a client diagnosed with
narcissistic personality disorder.
62. Which client situation requires the nurse to prioritize the implementation
of limit setting?
A. A client making sexual advances toward a staff member
B. A client telling staff that another staff member allows food in the bedrooms
C. A client verbally provoking another client who is paranoid
D. A client refusing medications to receive secondary gains: C
A paranoid client has the potential to strike out defensively if provoked. Because
safety is the nurse's first concern, and this situation poses a physical threat, this
situation makes priority and needs immediate intervention by the nurse.
63. A client newly admitted to an in-patient psychiatric unit is diagnosed
with schizotypal personality disorder. The client states, "I envision my future
death by fire." Which is the most appropriate nursing response?
A. "I don't know what you mean by envisioning your future death."
B. "Your future death? Can you please tell me more about that?"
C. "I was wondering if you want to come to group to talk about that."
D. "I can see your thoughts are bothersome. How can I help?": D
Acknowledging the client's feelings about the altered thoughts is an important
response. The nurse supports the client's feelings but not the altered thoughts. At
the same time, the nurse explores ways to help the client feel comfortable.
64. A suicidal client is diagnosed with borderline personality disorder. Which
correctly written short-term outcome is most beneficial for the client?
A. The client will be free from self-injurious behavior
B. The client will express feelings without inflicting self-injury by discharge
C. The client will socialize with peers in the milieu by day 3
21 / 27
D. The client will acknowledge his or her role in altered interpersonal relation-
ships: B
The client's being able to express feelings without inflicting self-injury by discharge
is an outcome that reinforces the priority for client safety, is measurable, and has
a time frame.
65. A client diagnosed with an avoidant personality disorder has the nursing
diagnosis of social isolation R/T severe malformation of the spine AEB "I
can't be around people, looking like this." Which correctly written short-term
outcome is appropriate for this client's problem?
A. The client will see self as straight and tall by the time of discharge
B. The client will see self as valuable after attending assertiveness training
courses
C. The client will be able to participate in one therapy group by end of shift
D. The client will join in a charade game to decrease social isolation: C
This short-term outcome is stated in observable and measurable terms. This
outcome sets a specific time for achievement (by end of shift). It is short and specific
(one therapy group), and it is written in positive terms, all of which should contribute
to the final goal of the client having increased social interaction.
66. A client diagnoses with an obsessive-compulsive personality disorder
has a nursing diagnosis of anxiety R/T interference with hand washing AEB
"I'll go crazy if you don't let me do that." Which correctly written short-term
outcome is appropriate for this client?
A. During a 3-hour period after admission to the unit, the client will refrain
from hand washing.
B. The client will wash hands only at appropriate bathroom and meal intervals
C. The client will refrain from hand washing throughout the night
D. Within 72 hours of admission, the client will notify staff when signs and
symptoms of anxiety escalate: D
This short-term outcome is stated in observable and measurable terms. This
outcome sets a specific time for achievement (within 72 hours). It is specific (signs
and symptoms), and it is written in positive terms. When the client can identify signs
and symptoms of increased anxiety, the next step of problem-solving can begin.
67. A client diagnosed with antisocial personality disorder demands, at mid-
night, to speak to the ethics committee about the involuntary commitment
process. Which nursing statement is appropriate?
A. "I realize you're upset; however, this is not the appropriate time to explore
your concerns."
B. "Let me give you a sleeping pill to help put your mind at ease."
22 / 27
C. "It's midnight, and you are disturbing the other clients."
D. "I will document your concerns in your chart for the morning shift to
discuss with the ethics committee.": A
In this situation, the nurse empathizes with the client's concerns and then sets
limits on inappropriate behaviors in a matter-of-fact manner.
68. A client diagnosed with antisocial personality disorder is caught smug-
gling cigarettes into the nonsmoking clinical area. Which initial nursing
intervention is appropriate?
A. Confront the client about the behavior
B. Tell the client's primary nurse about the situation
C. Remind all clients of the no smoking policy in the community meeting
D. Teach alternative coping mechanisms to assist with anxiety: A
It is important to address an individual's behavior in a timely manner to set
appropriate limits. Limit setting is to be done in a calm, but firm, manner. A client
diagnosed with antisocial personality disorder may have no regard for rules or
regulations, which necessitates limit setting by the nurse.
69. After being treated in the ED for self-inflicted lacerations to wrists and
arms, a client with a diagnosis of borderline personality disorder is admitted
to the psychiatric unit. Which nursing intervention takes priority?
A. Administer tranquilizing drugs
B. Observe client frequently
C. Encourage client to verbalize hostile feelings
D. Explore alternative ways of handling frustration: B
The priority nursing intervention is to observe the client's behavior frequently. The
nurse should do this through routine activities and interactions to avoid appearing
watchful and suspicious. Close observations is required so that immediate inter-
ventions can be implemented as needed.
70. A 15 year-old client living in a residential facility has a nursing diagnosis
of ineffective coping R/T abuse AEB defiant responses to adult rules. Which
of the following interventions would address this nursing diagnosis appro-
priately? (Select all that apply)
A. Set limits on manipulative behavior
B. Refuse to engage in controversial and argumentative encounters
C. Obtain an order for tranquilizing medications
D. Encourage the discussion of angry feelings
E. Remove all dangerous objects from the client's environment: A,B,D
-Setting limits on manipulative behaviors is an appropriate intervention to dis-
courage dysfunctional coping, such as oppositional and defiant behaviors. It is
23 / 27
important to convey to the client that inappropriate behaviors are not tolerated.
-By refusing to engage in debate, argument, rationalization, or bargaining with a
client, the nurse has intervened effectively to decrease manipulative behaviors and
has decreased the opportunity for oppositional and defiant behaviors.
-Dealing with feelings honestly and directly discourages ineffective coping. The
client may cope with anger inappropriately by displacing this anger onto others.
71. A client diagnosed with a borderline personality disorder is given a
nursing diagnosis of disturbed personal identity R/T unmet dependency
needs AEB the inability to be alone. Which nursing intervention would be
appropriate?
A. Ask the client directly, "Have you thought about killing yourself?"
B. Maintain a low level of stimuli in the client's environment
C. Frequently orient the client to reality and surroundings
D. Help the client identify values and beliefs: D
This client has been diagnosed with borderline personality disorder resulting from
fixation in an earlier developmental level. This disruption during the establishment
of the client's value system has led to disturbed personal identity. When the nurse
helps the client to identify internalized values, beliefs, and attitudes, the client
begins to distinguish personal identity.
72. A client diagnosed with a dependent personality disorder has a nursing
diagnosis of social isolation R/T parental abandonment AEB fear of involve-
ment with individuals not in the immediate family. Which nursing intervention
would be appropriate?
A. Address inappropriate interactions during group therapy
B. Recognize when client is playing one staff member against another
C. Role-model positive relationships
D. Encourage client to discuss conflicts evident withing the family system: C
Role-modeling positive relationships would provide a motivation to initiate interac-
tions with others outside the client's family. This is an appropriate intervention for
the nursing diagnosis of social isolation.
73. A client diagnosed with paranoid personality disorder needs information
regarding medications. Which nursing intervention would best assist this
client in understanding prescribed medications?
A. Ask the client to join the medication education group
B. Provide one-on-one teaching in the client's room
C. During rounds, have the physician ask if the client has any questions
D. Let the client read the medication information handout: B
When a client is diagnosed with paranoid personality disorder, one-on-one teach-
24 / 27
ing in a client's room would decrease the client's paranoia, support a trusting
relationship, and allow the client to ask questions. The nurse also would be able to
evaluate the effectiveness of medication teaching.
74. A nursing student is studying the historical aspects of personality disor-
der. Which entry on the examination indicates that learning has occurred?
A. Zeus, in the 3rd century BC, identified, described, and applied the theory
of object relations
B. Hippocrates, in the 4th century BC, identified four fundamental personality
styles
C. Narcissus, in 923 AD introduced the word "personality" from the Greek
term "persona."
D. Achilles, in 866 AD, described the pathology of personality as a complex
behavioral phenomenon: B
In the 4th century B.C., Hippocrates, also known as the father of medicine,
identified four fundamental personality styles that he concluded stemmed from
excesses in the four humors: the irritable and hostile choleric (yellow bile), the
pessimistic melancholic (black bile), the overly optimistic and extroverted sanguine
(blood), and the apathetic phlegmatic (phlegm).
75. A nursing student is learning about narcissistic personality disorder.
Which of the following student statements indicate that learning has oc-
curred? (Select all that apply)
A. "These clients have peculiarities of ideation."
B. "These clients require constant approval and affirmation."
C. "These clients are impulsive and self-destructive."
D. "These clients express a grandiose sense of self-importance."
E. These clients have a deep need for admiration.": D
Narcissistic personality disorder is characterized by a grandiose sense of self-im-
portance and preoccupations with fantasies of success, power, brilliance, and
beauty. These clients sometimes may exploit others for self-gratification.
76. A nursing instructor is teaching about personality disorder characteris-
tics. Which student statement indicates that learning has occurred?
A. "Clients diagnosed with personality disorders need frequent hospitaliza-
tions."
B. "Clients perceive their behaviors as uncomfortable and disorganized."
C. "Personality disorders cannot be cured or controlled successfully with
medication."
D. "Practitioners have a good understanding about the etiology of personal-
ity disorder.": C
25 / 27
It is important for nurses to understand that for individuals diagnosed with per-
sonality disorders, no prescribed medications are available to cure or control
these disorders. Clients' inappropriate behaviors and skewed perceptions often
lead to anxiety or depression or both; therefore, anxiolytics, antidepressants, and
antipsychotics sometimes are prescribed.
77. A client is diagnosed with intermittent explosive disorder. The clinic
nurse should anticipate potentially teaching about which of the following
medication? (Select all that apply)
A. Sertraline (Soloft)
B. Paliperidone (Invea)
C. Buspirone (BuSpar)
D. Phenelzine (Nardil)
E. Valproate sodium (Depakote): B,E
-An antipsychotic medication like paliperidone (Invega) can be prescribed for
intermittent explosive disorder.
-A mood stabilizing medication like valproate sodium (Depakote) can be prescribed
for intermittent explosive disorder.
78. A client diagnosed with dependent personality disorder has a nursing
diagnosis of altered sleep pattern R/T impending divorce. The client is pre-
scribed oxazepam (Serax) prn. Which is an appropriate correctly written
outcome for this nursing diagnosis?
A. The client verbalizes a decrease in tension and racing thoughts
B. The client expresses understanding about the medication side effects by
day 2
C. The client sleep 4 to 6 hours a night by day 3
D. The client notifies the nurse when the medication is needed: C
This outcome relates directly to the stated nursing diagnosis (altered sleep pat-
tern), is measurable (sleeps 4 to 6 hours a night), and has a time frame (by day
3).
79. A client diagnosed with paranoid personality disorder is prescribed
risperidone (Risperdal). The client is noted to have restlessness and weak-
ness in the lower extremities and is drooling. Which nursing intervention
would be most important?
A. Hold the next dose of risperidone and document the findings
B. Monitor vital signs and encourage the client to rest in his or her room
C. Give the ordered prn dose of trihexyphenidyl (Artane)
D. Get a fasting blood sugar measurement because of potential hyper-
glycemia: C
26 / 27
The symptoms noted are EPS caused by antipsychotic medications. These can be
corrected by using anticholinergic medications, such as trihexyphenidyl (Artane),
benztropine (Cogentin), or diphenhydramine (Benadryl).
80. A client diagnosed with obsessive-compulsive personality disorder is
admitted to a psychiatric unit in a highly agitated state. The physician pre-
scribes a benzodiazepine. Which of the following medications should the
nurse expect to administer? (Select all that apply)
A. Clonazepam (Klonopin)
B. Lithium carbonate (Lithium)
C. Clozapine (Clozaril)
D. Olanzapine (Zyprexa)
E. Chlordiazepoxide (Librium): A,E
-Clonazepam (Klonopin) is a benzodiazepine medication.
-Chlordiazepoxide (Librium) is a benzodiazepine medication.
27 / 27

Quizlet Personality Disorders

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What are some common characteristics of personality disorders?

What is splitting and how does it relate to borderline personality disorder?

Personality Disorders NCLEX TYPE Question

Study online at https://quizlet.com/_8i4y02

1. A nurse manage is discussing the care of a client who has a personality

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