1. During an assessment interview, a client diagnosed with antisocial personality disorder spits,
curses, and refuses to answer questions. Which is the most appropriate nursing statement to
address this behavior?
1. “You are very disrespectful. You need to learn to control yourself.”
2. “I understand that you are angry, but this behavior will not be tolerated.”
3. “What behaviors could you modify to improve this situation?”
4. “What antisocial personality disorder medications have helped you in the past?”
ANS: 2
Chapter: Chapter 32, Personality Disorders
Objective: Describe appropriate nursing interventions for behaviors associated with borderline
personality disorder and antisocial personality disorder.
Page: 666
Heading: Planning/Implementation > Defensive Coping > Interventions
Integrated Processes: Nursing Process: Implementation
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Self
Feedback
Difficulty: Moderate
1. This is incorrect. The most appropriate nursing statement is to reflect the client’s
feelings while setting firm limits on behavior. Clients diagnaboirsbe.cdomw/tietsht
antisocial personality disorder have a low tolerance for frustration, see themselves
as victims, and use projection as a primary ego defense mechanism. This response
is
nontherapeutic
2. This is correct. and
The does
mostnot inform the
appropriate client statement
nursing of acceptable
is taobehaviors.
birrbe.cfolemc/ttestthe
client’s feelings while setting firm limits on behavior. Clients diagnosed with
antisocial personality disorder have a low tolerance for frustration, see themselves
as victims,
and use projection as a primary ego defense mechanism. Tahbeirbc.cloiemn/ttesnt
3. eeds
This direction to assist
is incorrect. in recognizing
The most appropriatehow others
nursing might feel
statement when
is to treated
reflect this
the client’s
feelings while setting firm limits on behavior. Clients diagnosed with antisocial
personality disorder have a low tolerance for frustration, seaebirtbh.ceomm/st esltves
as victims, and use projection as a primary ego defense mechanism.
4. This is incorrect. The most appropriate nursing statement is to reflect the client’s
feelings while setting firm limits on behavior. Clients diaganboirsbe.cdomw/teitsht
antisocial personality disorder have a low tolerance for frustration, see themselves
as victims,
, Townsend
PMHN, 10e
Chapter 31 - ETB
abirb.com/test
and use projection as a primary ego defense mechanism. Pharmacotherapy is generally not
recommended for antisocial personality disorder, unless it is being used to treat a comorbid
condition.
CON: Self
2. A client diagnosed with antisocial personality disorder comes to the nurses’ station at 11:00
p.m., requesting to phone a lawyer to discuss filing for a divorce. The unit rules state that no
phone calls are permitted after 10:00 p.m. Which nursing reply isabmirbo.csotma/tpesptropriate?
1. “Go ahead and use the phone. I know this pending divorce is stressful.”
2. “You know better than to break the rules. I’m surprised at you.”
3. “It is after the 10:00 p.m. phone curfew. You will be able to caalblirtbo.cmomo/trersot w.”
4. “The decision to divorce should not be considered until you have had a good night’s sleep.”
Feedback
1. This is incorrect. The most appropriate response by the staafbiribs.ctoomr/testtate the unit
rules in a calm, assertive manner. One of the most distinctive characteristics of
individuals with antisocial personality disorder is their tendency to ignore
conventional authority and rules. They act as though established social norms and
guidelines for self-discipline and cooperative behavior do naboirtb.acpompl/tyest o them.
Allowing the client to use the phone does not help him understand acceptable
2. This is incorrect. The most appropriate response by the staafbiribs.ctoomr/testtate the unit
rules in a calm, assertive manner. One of the most distinctive characteristics of
individuals with antisocial personality disorder is their tendency to ignore
conventional authority and rules. They act as though established social norms and
guidelines for self-discipline and cooperative behavior do naboirtb.acpompl/tyest o them.
Scolding the client does not demonstrate respect nor does it provide a supportive
3. This is correct. The most appropriate response by the staff aibsirtbo.cormes/tteast e the unit
rules
, Townsend
PMHN, 10e
Chapter 31 - ETB
abirb.com/test
with antisocial personality disorder is their tendency to ignore conventional authority
and rules. They act as though established social norms and guidelines for self-
discipline and cooperative behavior do not apply to them.
4. This is incorrect. The most appropriate response by the staaffbiribs.ctoomr/teessttate
the unit rules in a calm, assertive manner. One of the most distinctive
characteristics of individuals with antisocial personality disorder is their
tendency to ignore
conventional authority and rules. They act as though establaibsirhbe.cdoms/otecsital
norms and guidelines for self-discipline and cooperative behavior do not apply to
them. The
nursing priority is to enforce unit rules. Also, this reply is an example of the
CON: Self
3. A client diagnosed with paranoid personality disorder becomes violent on a unit. Which
nursing intervention is most appropriate?
1. Provide objective evidence that violence is unwarranted.
2. Initially restrain the client to maintain safety.
3. Use clear, calm statements and a confident physical stance.
4. Empathize with the client’s paranoid perceptions.
ANS: 3
Chapter: Chapter 31, Personality Disorders
Objective: Describe appropriate nursing interventions for behaviors associated with borderline
personality disorder and antisocial personality disorder. Page: 666
Heading: Planning/Implementation > Risk for Other-Directed
Viaoblirebn.ccoem/>tesItnterventions
Integrated Processes: Nursing Process: Implementation
Client Need: Safe and Effective Care Environment: Psychosocial Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Safety
Difficulty: Moderate
Feedback
1. This is incorrect. The most appropriate nursing intervention is to use clear, calm
statements and to assume a confident physical stance. A calm attitude provides the
client with a feeling of safety and security and avoids escalaabtiribn.cgomth/tesat ggressive
behavior. The nurse should also have sufficient staff available to present a show of
strength to the client if necessary. This conveys to the client evidence of control over
the situation and provides some physical security for the staff. The client will not be
able to understand that violence is unwarranted through evaibdierbn.ccoem/oterstattempts
, Townsend
PMHN, 10e
Chapter 31 - ETB
2. This is incorrect. The most appropriate nursing interventionabirb.com/test
is to use clear, calm
statements and to assume a confident physical stance. A caalbmirb.actotmit/utedste
provides the client with a feeling of safety and security and avoids escalating the
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