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The individual with obsessive-compulsive personality disorder is perfectionist, rigid, preoccupied with rules and procedures, and afraid of making mistakes. The other options refer to behaviors or traits not usually associated with OCPD.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 24-21, 22 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

29. A nurse determines desired outcomes for a patient diagnosed with schizotypal personality disorder. Select the best outcome. The patient will a. adhere willingly to unit norms. b. report decreased incidence of self-mutilative thoughts. c. demonstrate fewer attempts at splitting or manipulating staff. d. demonstrate ability to introduce self to a stranger in a social situation.

ANS: D

Schizotypal individuals have poor social skills. Social situations are uncomfortable for them. It is desirable for the individual to develop the ability to meet and socialize with others. Individuals with schizotypal PD (Personality Disorder) usually have no issues with adherence to unit norms, nor are they self-mutilative or manipulative.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 24-12 and 24-13 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. “I’m not comfortable doing that,” and then ignore subsequent requests for early medication. b. “I understand that you have pain, but giving medicine too soon would not be safe.” c. “I’ll have to check with your doctor about that; I will get back to you after I do.” d. “It would be unsafe to give the medicine early; none of us will do that.”

30. A patient says, “The other nurses won’t give me my medication early, but you know what it’s like to be in pain and don’t let your patients suffer. Could you get me my pill now? I won’t tell anyone.” Which response by the nurse would be most therapeutic?

ANS: B

The patient is attempting to manipulate the nurse. Empathetic mirroring reflects back to the patient the nurse’s understanding of the patient’s distress or situation in a neutral manner that does not judge it and helps elicit a more positive response to the limit that is being set. The other options would not be nontherapeutic; they lack the empathetic mirroring component that tends to elicit a more positive response from the patient.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 24-30, 44, 60 (Table 24-2)

MSC: Client Needs: Psychosocial Integrity

Multiple Response

TOP: Nursing Process: Implementation a. Reclusive behavior b. Callous attitude c. Perfectionism d. Aggression e. Clinginess f. Anxiety

1. A nurse plans care for an individual diagnosed with antisocial personality disorder. Which characteristic behaviors will the nurse expect? (Select all that apply.)

ANS: B, D

Individuals with antisocial personality disorders characteristically demonstrate manipulative, exploitative, aggressive, callous, and guilt-instilling behaviors. Individuals with antisocial personality disorders are more extroverted than reclusive, rarely show anxiety, and rarely demonstrate clinging or dependent behaviors. Individuals with antisocial personality disorders are more likely to be impulsive than to be perfectionists.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 24-23 to 25 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. Obsessive-compulsive b. Antisocial c. Borderline d. Schizotypal e. Narcissistic

2. For which patients diagnosed with personality disorders would a family history of similar problems be most likely? (Select all that apply.)

ANS: A, B, C, D

Some personality disorders have evidence of genetic links, so the family history would show other members with similar traits. Heredity plays a role in schizotypal, antisocial, borderline, and obsessive-compulsive personality disorder.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 24-9, 21, 26, 37 TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance

Chapter 25: Suicide and Nonsuicidal Self-Injury

Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

Multiple Choice

1. An adult outpatient diagnosed with major depressive disorder has a history of several suicide attempts by overdose. Given this patient’s history and diagnosis, which antidepressant medication would the nurse expect to be prescribed?

a. Amitriptyline b. Fluoxetine c. Desipramine d. Tranylcypromine sulfate

ANS: B

Selective serotonin reuptake inhibitor antidepressants are very safe in overdosage situations, which is not true of the other medications listed. Given this patient’s history of overdosing, it is important that the medication be as safe as possible in the event of another overdose of prescribed medication.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 25-25, 26

MSC: Client Needs: Physiological Integrity

TOP: Nursing Process: Planning a. Turning on the oven and letting gas escape into the apartment during the night b. Cutting the wrists in the bathroom while the spouse reads in the next room c. Overdosing on aspirin with codeine while the spouse is out with friends d. Jumping from a railroad bridge located in a deserted area late at night

2. Four individuals have given information about their suicide plans. Which plan evidences the highest suicide risk?

ANS: D

This is a highly lethal method with little opportunity for rescue. The other options are lower lethality methods with higher rescue potential. See relationship to audience response question.

PTS: 1

DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 25-15, 16

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Assessment a. Psychiatric hospitalization of a suicidal patient b. Referral of a formerly suicidal patient to a support group c. Suicide precautions for 24 hours for newly admitted patients d. Helping school children learn to manage stress and be resilient

3. Which measure would be considered a form of primary prevention for suicide?