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Assessment 3 N450 Personality disorders (1)
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Assessment 3 N450 Personality disorders (1)
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Assessment 3 N450 Personality disordersCluster A - ANS-Odd/Eccentric- results in person becoming alienated from others
Paranoia (suspicious pattern)-distrusting, feels threatened, aggressive, pacing, speaking loudly,
glaring, clenching fists and jaws
Schizoid (asocial patter)- restricted emotional expression, voluntary withdrawal, avoidance, poor
occupational fx
Scizotypal (eccentric)- magical thinking, odd beliefs, perceptual distortions
Cluster B - ANS-Dramatic/emotional/erratic- these clients seek out relationships but can not
maintain them because of their excessive demands & instability. Their main goal is to use others
to meet their own needs.
Cluster B- Antisocial - ANS-individual does not want to conform to social rules/norms and are
reckless to being safe with self and others. They are manipulative and deceitfulness (repeatedly
lying), lack ability to learn from experience, and are selfish and don't feel any remorse.
Cluster B- Borderline Personality Disorder - ANS-Individual has a difficulty regulating emotion
(affective instability) and has extreme fears of abandonment leading to dysfunctional
relationships which often leads to individual engaging in self-injury/harm (SI). They have intense
and short lived relationships because they can not tolerate intimacy due to the extreme feelings
of idealization and devaluation. They have identity disturbances, are impulsive and carry chronic
feelings of emptiness.
Cluster B- Histrionic - ANS-Individual has exaggerated liability (characterized by emotions that
are easily aroused or freely expressed, and that tend to alter quickly and spontaneously;
emotionally unstable) and shallow expression of emotions. They need constant approval,
seductiveness, and have concerns about owns attractiveness. They are attention seeking and
are discomforted when not the center of attention. Overvaluation of relationships.
Cluster B- Narcissistic - ANS-Characteristics: exploitive, grandiose, disparaging, filled with rage,
very sensitive to rejection, criticism, cannot show empathy, handles aging poorly
Cluster C - ANS-Anxious and fearful behavior- they generally feel insecure or inadequate. They
depend on others for reassurance or they isolate themselves for fear of rejection.
Cluster C: Avoidant Personality Disorder - ANS-A pattern of social inhibition, feelings
inadequacy, and hypersensitivity to negative evaluation by four more: avoids occupational
activities due to fear of criticism, disapproval, or rejection; generally unwilling to get involved with
,others unless certain of being like; restrained in intimate relationship due to fear or shame you;
preoccupied with concerns of rejection and criticism and social situations; inhibited in new
situations due to a sense of inadequacy; views self as social inept or inferior; reluctant to take
risks or trying to things because of potential embarrassment.
Cluster C: Dependent Personality Disorder - ANS-Characterized by a pervasive and excessive
need to be taken care of that results in submissive and clinging behaviors, difficulty making
decisions, and fears of separation as evidenced by five or more: difficulty making decisions
without advice and reassurance from others; needs others to assume responsibility for most
major areas; have difficulty expressing disagreement due to fear of loss of approval; difficulty
doing things on their own; excessive attempts to obtain support from others; Uncomfortable
when alone due to not being self-sufficient; urgently seeks a new relationship when a close
relationship ends; preoccupied with fears of being left alone
Cluster C: Obsessive-Compulsive - ANS-Are perfectionist, detail oriented; Has need for control;
are inflexible and rigid; preoccupied with details; highly critical of self and others. They Have a
belief in an absolute correct solution and experience indecision.
Personality disorder causes - ANS-67-86% etiology of sexual abuse
46-71% etiology of physical abuse
Working with clients with personality disorders needs to be perceived as a ________ rather than
a burden. - ANS-Challenge- this allows the nurse to sharpen skills in patience, self awareness,
creativity and non judgment
Nurse needs to beware of ________ when assessing a PD client - ANS-Beware of counter
transference reactions
Ex. - refers to the nurse's behavioral and emotional response to the client- responses may be
related to unresolved feelings toward significant others from the nurse's past- may be generated
in response to transference feelings on the part of the client
- nurse over identifies with the client's feelings as they remind him or her of problems from the
nurse's past or present
- the nurse promotes and encourages client's dependence
- nurse defends the clients behavior to other staff members
- nurse is bored and apathetic in sessions with the client
- the nurse's anger engenders feelings of disgust toward the client
During a team meeting the RN who is experiencing a countertransference reaction to a patient
would state:
a. "He reminds me so much of my sweet uncle."
b. "That patient asked me out to dinner."
c. "I think the team needs to discuss how best to manage the patient's manipulative behaviors."
, d. "I believe it's okay to cry." - ANS-a
rationale: Countertransference usually consists of feelings related to persons other than the
patient but transferred to the patient. This range of both positive and negative feelings may
interfere with the ability to be therapeutic. Reporting a patient's attempt at arranging a social
interaction or the need to manage a patient's maladaptive behavior are appropriate occurrences
to report to the team but do not demonstrate countertransference. Crying is not associated with
countertransference.
The nurse practicing with therapeutic intentions versus social ones will:
a. offer to visit the patient following discharge.
b. assess the patient's needs following discharge.
c. ignore the patient's requests for a date while on the unit.
d. feel sadness and cry in response to the patient's depression. - ANS-b,
rationale:
The establishment and maintenance of objectivity and goal-directedness is crucial in therapeutic
relationships. Assessing patient needs in preparation for discharge demonstrates therapeutic
intentions. Offering to visit the patient following discharge is an example of blurring boundaries
and the risk of unprofessional conduct that may come as a result. Inappropriate social requests
should not be ignored but should be discussed with the team for decision-making purposes.
Crying and feeling sad in response to a patient's condition may suggest a potential for a
boundary violation as an example of countertransference.
A newly admitted patient continually touches the nursing staff members and makes sexual
innuendoes when interactions are attempted. The initial therapeutic manner of managing such
behavior is to:
a. avoid the patient until the behaviors cease.
b. demand firmly that the patient cease all inappropriate touching.
c. ask the patient to explain why the sexual innuendoes occur.
d. explain that the behavior is inappropriate and must stop - ANS-d:
rationale: Patients generally stop these behaviors when asked and should be reminded that
these actions are inappropriate. The nurse then discusses the underlying need. If the behaviors
continue, then setting limits can be stronger. Avoiding the patient without an explanation is
incongruent with professionalism. Demands are ineffective and disrespectful. While a discussion
concerning the behavior is appropriate, it is not the initial response.
A patient experiencing a loss of reality believes in the angry voices in her head. The nurse will
respond to a newly admited patient who is experiencing auditory hallucinations. The nurse
initially makes which response?
a. "There are no voices in your head."
b. "Try to ignore them by listening to your favorite music ."
c."I am not hearing those voices, but I understand that you do."
d. "Just listen to my voice to distract yourself." - ANS-c
rationale: Initially the nurse acknowledges and respects the patient's experience while
presenting reality and avoiding reinforcement of the hallucinations. Stating that there are no
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