Review Practice Exercise 4

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Practice Exercise 4

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Total Questions : 6

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Question 1:

Which interventions should a nurse plan for a client with avoidant personality disorder? Select all that apply.

A. 1. Provide support and reassurance. B. Explore positive self-aspects. C. Reframing. D. De-catastrophizing. E. Identify negative responses from others.

Answer and Explanation

Choice A:

Providing support and reassurance helps build a therapeutic alliance and reduces anxiety during interactions. This intervention fosters trust and emotional safety, which are essential for gradual engagement and participation in therapy.

Choice B:

Exploring positive self-aspects assists the client in identifying personal strengths, counteracting persistent feelings of inferiority. This approach enhances self-worth and encourages healthier interpersonal relationships.

Choice C:

Reframing enables clients to reinterpret negative experiences or beliefs from a more balanced perspective, thereby reducing distortion in self-perception and improving coping responses.

Choice D:

De-catastrophizing helps the client challenge and modify irrational fears of failure or rejection by breaking down catastrophic thinking patterns into realistic evaluations. This technique is core to cognitive restructuring.

Choice E:

Identifying negative responses from others may reinforce avoidance and hypersensitivity to criticism, worsening the client’s social withdrawal. Instead, therapy should focus on reframing perceptions rather than validating perceived rejections.

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Question 2:

A public health nurse visits a client’s home and discovers a multitude of cluttered possessions taking up 75% of the living space, obscuring entrance into the home and access to all rooms except the bathroom. The chairs and table are covered with various objects. The nurse interprets the client’s behavior as:

A. Inability to focus related to a passive-aggressive personality disorder. B. Inattentiveness to surroundings related to a borderline personality disorder. C. An attention-seeking behavior related to a histrionic personality disorder. D. Hoarding related to an obsessive-compulsive disorder or obsessive-compulsive personality disorder.

Answer and Explanation

Choice A:

Passive-aggressive personality disorder involves indirect resistance to demands and procrastination, not accumulation of objects. The main feature is hostility expressed covertly, not environmental disorganization.

Choice B:

Borderline personality disorder is characterized by instability in mood, relationships, and self-image. Though impulsive behaviors may occur, excessive hoarding is not a diagnostic hallmark of this condition.

Choice C:

Histrionic personality disorder centers on attention-seeking and exaggerated emotional expression. Individuals crave admiration and dramatize behavior; cluttered accumulation of objects does not serve that purpose.

Choice D:

Hoarding is associated with excessive acquisition and retention of items, resulting in unsafe, cluttered environments. It reflects underlying obsessive fears and maladaptive attachment to possessions. Clients experience marked distress at the thought of discarding items, often rationalizing their need to keep them. The behavior interferes with daily functioning, hygiene, and safety, necessitating interventions that address cognitive distortions and promote gradual decluttering.

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Question 3:

The nurse is assisting a client with a dependent personality disorder to work on the goal of developing healthy relationships with family members. Which nursing intervention should the nurse initiate to help the client develop healthy relationships?

A. Determine a structure for each part of the day spent alone. B. Establish a nurse-client contract based on mutual cooperation. C. Practice disagreeing with statements verbalized by the nurse. D. Talk about self while participating in outside activities.

Answer and Explanation

Choice A:

Structuring each part of the day spent alone reinforces dependence, as it limits opportunities for the client to experience autonomy and internal control over choices and activities.

Choice B:

Establishing a nurse-client contract promotes cooperation, but it focuses on treatment compliance rather than interpersonal growth or assertiveness, making it insufficient for fostering independent relationships.

Choice C:

Practicing disagreement helps the client build autonomy and assertiveness, key deficits in dependent personality disorder. This technique encourages independent thinking, decision-making, and self-confidence—essential for developing balanced, healthy relationships that are not based on submissiveness or approval-seeking.

Choice D:

Talking about self during outside activities may enhance socialization, but without assertiveness and autonomy, it does not specifically address dependency patterns or the tendency to seek validation.

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Question 4:

Which of the following underlying emotions is commonly seen in an avoidant personality disorder?

A. Depression B. Fear C. Guilt D. Insecurity

Answer and Explanation

Choice A:

Depression may occur secondarily due to chronic isolation and low self-worth but is not the central emotion driving the disorder’s behaviors. It is an outcome, not the root cause.

Choice B:

The predominant emotional state in avoidant personality disorder is fear—specifically, fear of rejection, humiliation, and disapproval. This intense apprehension causes individuals to withdraw from social interaction despite craving connection, leading to impaired functioning in personal and occupational areas.

Choice C:

Guilt is not a core feature of avoidant personality disorder. Guilt typically arises in conditions involving moral conflict or perceived wrongdoing, which are not characteristic of AvPD.

Choice D:

Insecurity is a cognitive manifestation, not the primary emotion. It reflects self-doubt and low confidence, but the driving emotional force behind avoidance remains fear of rejection and criticism.

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Question 5:

Which of the following diagnostic criteria define avoidant personality disorder? Select all that apply.

A. Does not form intimate relationships because of fear of being shamed or ridiculed. 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.

Answer and Explanation

Choice A:

Avoiding intimate relationships due to fear of shame or ridicule is a defining feature of AvPD. Such individuals often withdraw from relationships to protect themselves from perceived humiliation, even though they desire closeness.

Choice B:

Difficulty making decisions without reassurance characterizes dependent personality disorder, where the individual relies excessively on others for guidance and support, not avoidance from fear of criticism.

Choice C:

Being unwilling to engage with others unless certain of being liked reflects the avoidance and hypersensitivity to rejection central to this disorder. This cautious approach leads to limited social networks and loneliness.

Choice D:

Perfectionism that interferes with task completion is typical of obsessive-compulsive personality disorder, where excessive orderliness and control dominate functioning, not avoidance due to fear.

Choice E:

Viewing oneself as socially inept and inferior is a core self-perception in AvPD. This negative self-image reinforces avoidance behaviors and perpetuates isolation and low self-confidence.Rationale for incorrect answers

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Question 6:

A nurse is caring for a client with an obsessive-compulsive personality disorder that involves rituals. What should the nurse conclude about the ritual?

A. Has a purpose but is useless. B. Is performed after long urging. C. Appears to be performed willingly. D. Seems illogical but is needed by the person. E. Views self as socially inept, unappealing, and inferior.

Answer and Explanation

Choice A:

The ritual does not merely have a useless purpose; to the client, it serves a critical psychological function of anxiety relief. Labeling it as useless fails to recognize the underlying compulsive drive.

Choice B:

The ritual is not performed after long urging but rather automatically when intrusive thoughts arise. Clients feel compelled to act immediately to decrease distress, not after external prompting.

Choice C:

The ritual does not appear to be performed willingly; it is ego-dystonic, meaning the individual recognizes it as unreasonable but feels powerless to stop, leading to significant internal conflict.

Choice D:

The ritual seems illogical but necessary to the person because it temporarily relieves anxiety created by obsessive thoughts. The act becomes a coping mechanism, reinforcing the cycle of compulsion by providing short-term relief despite its irrational nature. This repetitive behavior is not voluntary but driven by anxiety reduction and an overwhelming sense of duty or correctness.

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