A nurse is caring for a client with antisocial personality disorder. What client characteristic should the nurse consider when formulating a plan of care?

Suffers from extreme anxiety.

Rapidly learns by experience if punished.

Usually is unable to postpone gratification.

Has a great sense of responsibility toward others.

Answer and Explanation

The Correct Answer is C

Antisocial personality disorder is a chronic psychiatric condition characterized by a pervasive pattern of disregard for and violation of the rights of others. Clients often exhibit deceitfulness, impulsivity, irritability, and lack of remorse. They may manipulate others for personal gain and show poor compliance with social norms. Impulsivity, lack of empathy, and irresponsibility are core features. These individuals often fail to plan ahead and struggle with delayed gratification, making structured behavioral interventions and firm boundaries essential in care planning.

Rationale for correct answer

C. The client’s inability to delay gratification reflects the impulsivity and poor behavioral control typical of antisocial personality disorder. This trait contributes to risk-taking, noncompliance, and difficulty adhering to long-term goals, which must be considered when designing care plans.

Rationale for incorrect answers

A. Extreme anxiety is not a hallmark of antisocial personality disorder. These clients typically show low levels of anxiety and may appear indifferent or unconcerned about consequences.

B. Punishment rarely leads to rapid learning in antisocial clients due to their low sensitivity to negative consequences and lack of remorse. Behavioral change requires consistent reinforcement and structured consequences.

D. A strong sense of responsibility toward others is absent in antisocial personality disorder. These individuals often exploit others and lack empathy, making them unreliable in interpersonal commitments.

Take Home Points

Antisocial personality disorder is marked by impulsivity, lack of empathy, and disregard for social norms.
Clients often struggle with delayed gratification and may require structured, consequence-based interventions.
Unlike anxiety disorders, antisocial traits include emotional detachment and low remorse.
Differentiate from borderline personality disorder by noting the absence of emotional instability and fear of abandonment.

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Correct Answer is A

Explanation

Borderline personality disorder is marked by intense instability in relationships, affect, and self-image. Clients often experience rapid shifts in emotional states, impulsivity, and chronic fears of abandonment. A hallmark feature is splitting, a primitive defense mechanism where individuals categorize others as entirely good or entirely bad. This black-and-white thinking leads to idealization and devaluation, often directed toward caregivers. Their interpersonal relationships are chaotic, and they may alternate between clinging and rejecting behaviors based on perceived threats to attachment.

Rationale for correct answer

A. The statement reflects splitting, where the client idealizes one nurse while devaluing another. This is a classic interpersonal pattern in borderline personality disorder, driven by unstable affect and fear of abandonment. The exaggerated praise and simultaneous criticism are attempts to manage internal emotional turmoil and maintain perceived security in relationships.

Rationale for incorrect answers

B. Schizoid personality disorder is characterized by detachment and limited emotional expression. Individuals with this disorder avoid close relationships and are unlikely to express strong opinions or emotional comparisons between caregivers.

C. Passive-aggressive traits involve indirect resistance and covert hostility, such as procrastination or intentional inefficiency. The client’s statement lacks the subtle defiance or undermining typical of passive-aggressive behavior.

D. Paranoid personality disorder involves pervasive distrust and suspicion. While these individuals may criticize others, their statements are typically rooted in fear of harm or betrayal, not emotional idealization or relational splitting.

Take Home Points

Splitting is a hallmark defense mechanism in borderline personality disorder, leading to idealization and devaluation.
Borderline clients often express intense emotional reactions and unstable interpersonal attachments.
Schizoid personality disorder presents with emotional detachment and limited interpersonal engagement.
Paranoid personality disorder involves mistrust and suspicion, not emotional instability or relational idealization.

A. Suggest that the client calm down and explain that sometimes trays get mixed up. B. Inform the client that the behavior is inappropriate and send the client out of the dining room. C. Tell the client it is frustrating not to get the correct tray, but throwing the tray at the dietician is unacceptable behavior. D. Inform the client that throwing the tray at the dietician will make matters worse and may result in being placed in seclusion.

Correct Answer is C

Explanation

Borderline personality disorder is a complex psychiatric condition marked by pervasive instability in mood, self-image, and interpersonal relationships. Clients often exhibit intense emotional reactions, impulsivity, and fear of abandonment. They may use splitting, projection, and externalization to cope with distress. Therapeutic communication must be firm, empathetic, and nonjudgmental, with clear boundaries. Staff consistency and validation of feelings without reinforcing maladaptive behaviors are essential. Impulsivity, emotional dysregulation, and interpersonal conflict are hallmark features.

Rationale for correct answer

C. This response uses empathy and limit-setting, which are essential in managing borderline personality disorder. It validates the client’s frustration while clearly stating that aggressive behavior is unacceptable. This approach maintains therapeutic rapport and reinforces behavioral boundaries without escalating the situation.

Rationale for incorrect answers

A. The word calm may invalidate the client’s emotional experience and minimize their distress. Suggesting that trays get mixed up ignores the emotional intensity and risks escalating the situation by appearing dismissive.

B. The word inappropriate introduces judgment and punishment, which can trigger feelings of rejection and abandonment in borderline clients. Sending the client out of the dining room may reinforce maladaptive behaviors and damage therapeutic trust.

D. The word seclusion implies a punitive consequence and may escalate the client’s fear of abandonment or loss of control. This response lacks empathy and may provoke further acting out rather than de-escalating the situation.

Take Home Points

Borderline personality disorder requires firm, empathetic communication that validates feelings while setting behavioral limits.
Avoid punitive or judgmental language, which may escalate emotional dysregulation and reinforce maladaptive coping.
Therapeutic responses should balance empathy with boundaries to maintain safety and trust.
Differentiate borderline personality disorder from antisocial and histrionic disorders by focusing on emotional instability and fear of abandonment.

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A nurse is caring for a client with antisocial personality disorder. What client characteristic should the nurse consider when formulating a plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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 p.m.” This statement would be associated with which personality disorder?

Correct Answer is A

Explanation

A client with borderline personality disorder receives the wrong meal tray for lunch and angrily states, “The next time I see the dietician, I am going to throw this tray at her!” What is the nurse’s most appropriate response?

Correct Answer is C

Explanation

A nurse is caring for a client with borderline personality disorder. Which intervention should the nurse perform?

Which client situation requires the nurse to prioritize the implementation of limit setting?

A nurse is caring for a client diagnosed with paranoid personality disorder in an acute care facility. Which intervention should the nurse use to control the client’s suspiciousness?

When assessing a client diagnosed with histrionic personality disorder, the nurse might identify which characteristic behavior?

A client has the diagnosis of histrionic personality disorder. Which behavior should the nurse expect when assessing this client?

A nurse should anticipate that a client diagnosed with antisocial personality disorder may use the primary ego defense mechanism of:

When working with a client with a narcissistic personality disorder, the nurse would use which of the following approaches?