2/19/25, 5:03 PM Personality and Mood Disorders NCLEX Challenge Exam (Quiz #21: 30 Questions) - Nurseslabs

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Personality and Mood Disorders NCLEX Challenge

Exam (Quiz #21: 30 Questions)
UPDATED ON OCTOBER 17, 2023
BY MATT VERA BSN, R.N.

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1 point(s)
1. Question

The nursing diagnosis that would be most appropriate for a 22-year old client who uses
ritualistic behavior would be:

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A. Ineffective coping

B. Impaired adjustment

C. Personal identity disturbance

D. Sensory/perceptual alterations

Correct
Correct Answer: A. Ineffective coping
Ineffective coping is the impairment of a person’s adaptive behaviors and problem-
solving abilities in meeting life’s demands; ritualistic behavior fits under this category as
a defining characteristic. During the beginning of treatment, allow plenty of time for
rituals. Do not be judgmental or verbalize disapproval of the behavior. To deny the
client this activity can precipitate panic level of anxiety.
Option B: Gradually limit the amount of time allotted for ritualistic behavior as
the client becomes more involved in unit activities. Anxiety is minimized when
the client is able to replace ritualistic behaviors with more adaptive ones.
Encourage independence and give positive reinforcement for independent
behaviors. Positive reinforcement enhances self-esteem and encourages
repetition of desired behaviors.
Option C: Personal identity disturbance is not a priority diagnosis for the client.
Assess client’s level of anxiety. Investigate the types of situations that increase
anxiety and result in ritualistic behaviors. Helping the client recognize the
precipitating factors is the first step in teaching the client to interrupt the
escalating anxiety. Initially meet the client’s dependency needs as necessary.
Sudden and complete elimination of avenues for dependency would create
anxiety and will burden the client more.
Option D: This nursing diagnosis is appropriate, but it is not the priority.
Encourage the recognition of situations that provoke obsessive thoughts or
ritualistic behaviors. Recognition of precipitating factors is the first step in

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teaching the client to interrupt escalation of anxiety. Provide positive

reinforcement for non-ritualistic behaviors. Positive reinforcement enhances self-
esteem and encourages repetition of desired behaviors.

1 point(s)
2. Question

A psychiatrist prescribes an anti-obsessional agent for a client who is using ritualistic behavior.
A common anti-anxiety medication used for this type of client would be:

A. fluvoxamine (Luvox)

B. benztropine (Cogentin)

C. amantadine (Symmetrel)

D. diphenhydramine (Benadryl)

Incorrect
Correct Answer: A. fluvoxamine (Luvox).
This drug blocks the uptake of serotonin. Fluvoxamine is used to treat obsessive-
compulsive disorder (bothersome thoughts that won’t go away and the need to
perform certain actions over and over) and social anxiety disorder (extreme fear of
interacting with others or performing in front of others that interferes with normal life).
Fluvoxamine is in a class of medications called selective serotonin reuptake inhibitors
(SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain
that helps maintain mental balance.
Option B: Benztropine belongs to the synthetic class of muscarinic receptor
antagonists (anticholinergic drug). Thus, it has a structure similar to that of
diphenhydramine and atropine. However, it is long-acting so that its
administration can be with less frequency than diphenhydramine. It also induces
less CNS stimulation effect compared to that of trihexyphenidyl, making it a

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preferable drug of choice for geriatric patients. Moreover, benztropine is FDA

approved as adjunctive therapy of all forms of parkinsonism.
Option C: Amantadine is now used mostly for Parkinson’s disease. Clinical trials
have shown that amantadine decreases symptoms of bradykinesia, rigidity, and
tremor. There is a combined synergistic effect with added levodopa, which is
converted to dopamine by striatal enzymes in the CNS. There can be a transient
benefit to the drug, so short-term therapy for patients with the mild disease is
best.
Option D: Diphenhydramine, which is available as an over-the-counter
medication, is a first-generation antihistamine that is used in a variety of
conditions to treat and prevent dystonias, insomnia, pruritus, urticaria, vertigo,
and motion sickness. It also possesses local anesthetic properties for those
patients who have allergies to other, more commonly used local anesthetics;
however, this is an off-label use of the medication. An additional off-label use is
for the treatment of oral mucositis.

1 point(s)
3. Question

A 20-year old college student has been brought to the psychiatric hospital by her parents. Her
admitting diagnosis is borderline personality disorder. When talking with the parents, which
information would the nurse expect to be included in the client’s history? Select all that
apply.

A. Impulsiveness

B. Lability of mood

C. Ritualistic behavior

D. Psychomotor retardation

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E. Self-destructive behavior

Incorrect
Correct Answers: Answer: A, B, & E
Borderline personality disorder (BPD) is a serious psychological condition that’s
characterized by unstable moods and emotions, relationships, and behavior. It’s one of
several personality disorders recognized by the American Psychiatric Association (APA).
Personality disorders are psychological conditions that begin in adolescence or early
adulthood, continue over many years, and, when left untreated, can cause a great deal
of distress. Thankfully, the right treatments targeted for BPD can help significantly.
Option A: Impulsivity in at least two areas that are potentially self-damaging, for
example, spending, substance abuse, reckless driving, sex, binge eating, etc.
Note: Do not include suicidal or self-mutilating behavior covered in criterion 5.
BPD is associated with a tendency to engage in risky and impulsive behaviors,
such as going on shopping sprees, drinking excessive amounts of alcohol or
abusing drugs, engaging in promiscuous or risky sex, or binge eating. Also,
people with BPD are more prone to engage in self-harming behaviors, such as
cutting or burning and attempting suicide.
Option B: Affective instability caused by a marked reactivity of mood, for
example, intense episodic dysphoria, anxiety, or irritability, usually lasting a few
hours and rarely more than a few days. Emotional instability is a key feature of
BPD. Individuals feel like they’re on an emotional roller coaster with quick mood
shifts (i.e., going from feeling OK to feeling extremely down or blue within a few
minutes). Mood changes can last from minutes to days and are often intense.
Anger, anxiety, and overwhelming emptiness are common as well.
Option C: Obsessive-compulsive disorder (OCD) is often a disabling condition
consisting of bothersome intrusive thoughts that elicit a feeling of discomfort. To
reduce the anxiety and distress associated with these thoughts, the patient may
employ compulsions or rituals. These rituals may be personal and private, or
they may involve others to participate; the rituals are to compensate for the ego-
dystonic feelings of the obsessional thoughts and can cause a significant decline
in function.
Option D: Psychomotor retardation is a long established component of
depression that can have significant clinical and therapeutic implications for
treatment. Manifestations of psychomotor retardation include slowed speech,
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decreased movement, and impaired cognitive function. It is common in patients

with melancholic depression and those with psychotic features.
Option E: Borderline personality disorder (BPD) is 1 of 4 cluster-B disorders that
include borderline, antisocial, narcissistic, and histrionic. Borderline personality
disorder (BPD) is characterized by hypersensitivity to rejection and resulting
instability of interpersonal relationships, self-image, affect, and behavior.
Borderline personality disorder causes significant impairment and distress and is
associated with multiple medical and psychiatric co-morbidities.

1 point(s)
4. Question

A hospitalized client, diagnosed with a borderline personality disorder, consistently breaks the
unit’s rules. This behavior should be confronted because it will help the client:

A. Control anger

B. Reduce anxiety

C. Set realistic goals

D. Become more self-aware

Incorrect
Correct Answer: D. Become more self-aware.
Client’s must first become aware of their behavior before they can change it. Occurs
after the client is aware of the behavior and has a desire to change the behavior.
Review with the client the types of cognitive distortions that affect self-esteem (e.g.,
self-blame, mind reading, overgeneralization, selective inattention, all-or-none
thinking). These are the most common cognitive distortions people use. Identifying
them is the first step to correcting distortions that form one’s self-view.

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Option A: Maintain a neutral, calm, and respectful manner, although with some
clients this is easier said than done. Helps the client see himself or herself as
respected as a person even when behavior might not be appropriate. Keep in
mind clients with personality disorders might defend against feelings of low-self-
esteem through blaming, projection, anger, passivity, and demanding behaviors.
Many behaviors seen in PD clients cover a fragile sense of self. Often these
behaviors are the crux of clients’ interpersonal difficulties in all their
relationships.
Option B: Focus questions in a positive and active light; helps client refocus on
the present and look to the future. For example, “What can you do differently
now?” or “What have you learned from that experience?”. Allows the client to
look at past behaviors differently, and gives the client a sense that he or she has
choices in the future.
Option C: Set goals realistically, and renegotiate goals frequently. Remember
that a client’s negative self-view and distrust of the world took years to develop.
Unrealistic goals can set up hopelessness in clients and frustrations in nurse
clinicians. Clients might blame the nurse for not “helping them,” and nurses
might blame the client for not “getting better”.

1 point(s)
5. Question

When working with the nurse during the orientation phase of the relationship, a client with a
borderline personality disorder would probably have the most difficulty in:

A. Controlling anxiety.

B. Terminating the session on time.

C. Accepting the psychiatric diagnosis.

D. Setting mutual goals for the relationship.

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Incorrect
Correct Answer: D. Setting mutual goals for the relationship.
Clients with borderline personality disorders frequently demonstrate a pattern of
unstable interpersonal relationships, impulsiveness, affective instability, and frantic
efforts to avoid abandonment; these behaviors usually create great difficulty in
establishing mutual goals. Set goals realistically, and renegotiate goals frequently.
Remember that a client’s negative self-view and distrust of the world took years to
develop.
Option A: Teach stress-reduction techniques such as deep breathing relaxation,
meditation, and exercise. Clients experience intense anxiety and fear of
abandonment. Stress reduction techniques help the client focus more clearly. Be
non-judgmental and respectful when listening to client’s feelings, thoughts, or
complaints. Clients have an intense fear of rejection.
Option B: Clients with BPD can be manipulative. Consistent limit setting helps
provide structure and decrease negative behaviors. Use assertiveness when
setting limits on the client’s unreasonable demands for attention and time. Firm,
clear, nonjudgmental limits give the client structure.
Option C: Interventions often call for responses to the client’s intense and labile
mood swings, irritability, depression, and anxiety. Many of the dysfunctional
behaviors of BPD clients (e.g., parasuicidal, anger, manipulation, substance
abuse) are used as “behavioral solutions” to intense pain.

1 point(s)
6. Question

A client with a diagnosis of borderline personality disorder has negative feelings toward the
other clients on the unit and considers them all to be “bad.” The nurse understands this
defense is known as:

A. Splitting

B. Ambivalence

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C. Passive aggression

D. Reaction formation

Incorrect
Correct Answer: A. Splitting
Splitting is the compartmentalization of opposite-affect states and failure to integrate
the positive and negative aspects of self or others. Splitting is a term used in psychiatry
to describe the inability to hold opposing thoughts, feelings, or beliefs. Some might say
that a person who splits sees the world in terms of black or white—all or nothing. It’s a
distorted way of thinking in which the positive or negative attributes of a person or
event are neither weighed nor cohesive.
Option B: The simultaneous existence of contradictory feelings and attitudes,
such as pleasantness and unpleasantness or friendliness and hostility, toward the
same person, object, event, or situation. Eugen Bleuler, who first defined
ambivalence in a psychological sense and referred to it as affective ambivalence,
regarded extreme ambivalence, such as an individual expressing great love for
his or her mother while also asking how to kill her, as a major symptom of
schizophrenia.
Option C: Passive-aggressive behaviors are those that involve acting indirectly
aggressive rather than directly aggressive. Passive-aggressive people regularly
exhibit resistance to requests or demands from family and other individuals
often by procrastinating, expressing sullenness, or acting stubborn.
Option D: Reaction formation is a psychological defense mechanism in which a
person goes beyond denial and behaves in the opposite way to which he or she
thinks or feels. Conscious behaviors are adopted to overcompensate for the
anxiety a person feels regarding their socially unacceptable unconscious
thoughts or emotions. Usually, a reaction formation is marked by exaggerated
behavior, such as showiness and compulsiveness.

1 point(s)
7. Question

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The client with antisocial personality disorder:

A. Suffers from a great deal of anxiety.

B. Is generally unable to postpone gratification.

C. Rapidly learns by experience and punishment.

D. Has a great sense of responsibility toward others.

Correct
Correct Answer: B. Is generally unable to postpone gratification.
Individuals with this disorder tend to be self-centered and impulsive. They lack
judgment and self-control and do not profit from their mistakes. Antisocial personality
disorder (ASPD) is a deeply ingrained and rigid dysfunctional thought process that
focuses on social irresponsibility with exploitive, delinquent, and criminal behavior with
no remorse. Disregard for and the violation of others’ rights are common
manifestations of this personality disorder, which displays symptoms that include
failure to conform to the law, inability to sustain consistent employment, deception,
manipulation for personal gain, and incapacity to form stable relationships.
Option A: Antisocial personality disorder (ASPD) is a condition characterized by
a lack of empathy and regard for other people. People who have antisocial
personality disorder have little or no regard for right or wrong. They antagonize
and often act insensitively or in an unfeeling manner. Individuals with this
disorder may lie, engage in aggressive or violent behavior, and participate in
criminal activity.
Option C: People with ASPD often have legal problems resulting from failures to
conform to social norms and a lack of concern for the rights of others. They
display a lack of remorse for damaging behavior. As adults, the disorder can be
destructive to both the person living with it and those who come into contact
with them. People with antisocial personality disorder are more likely to engage

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in risk-taking behaviors, dangerous activities, and criminal acts. Those with the
disorder are often described as having no conscience and feel no regret or
remorse for their harmful actions.
Option D: They frequently lie and deceive others for personal gain. They have
difficulty feeling empathy for others. These characteristics often lead to major
difficulties in many life areas. At its core, the inability to consider the thoughts,
feelings, and motivations of other people can lead to harmful disregard for
others.

1 point(s)
8. Question

A person with antisocial personality disorder has difficulty relating to others because of never
having learned to:

A. Count on others.

B. Empathize with others.

C. Be dependent on others.

D. Communicate with others socially.

Correct
Correct Answer: B. Empathize with others.
The lack of superego control allows the ego and the id to control the behavior. Self-
motivation and self-satisfaction are of paramount concern. As adults, the disorder can
be destructive to both the person living with it and those who come into contact with
them. People with antisocial personality disorder are more likely to engage in risk-
taking behaviors, dangerous activities, and criminal acts. Those with the disorder are
often described as having no conscience and feel no regret or remorse for their harmful
actions.

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Option A: People who have antisocial personality disorder have little or no

regard for right or wrong. They antagonize and often act insensitively or in an
unfeeling manner. At its core, the inability to consider the thoughts, feelings, and
motivations of other people can lead to harmful disregard for others.
Option C: Antisocial personality disorder often has a significant impact on a
person’s ability to function, which can make it difficult to cope with many
aspects of life. According to the DSM-5, the condition can result in incarceration,
injury, or death due to harmful or criminal actions. The disorder also has the
potential to cause harm to friends, family members, co-workers, and strangers
who may be harmed by the person’s actions.
Option D: Most people with ASPD do not seek help on their own and
intervention likely only happens due to legal problems. Research suggests that
those who have the best outlook are those who have stronger social support
and better spousal and family ties.

1 point(s)
9. Question

A young, handsome man with a diagnosis of antisocial personality disorder is being

discharged from the hospital next week. He asks the nurse for her phone number so that he
can call her for a date. The nurse’s best response would be:

A. “We are not permitted to date clients.”

B. “No, you are a client and I am a nurse.”

C. “I like you, but our relationship is professional.”

D. “It’s against my professional ethics to date clients.”

Correct
Correct Answer: C. “I like you, but our relationship is professional.”

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This accepts the client as a person of worth rather than being cold or implying
rejection. However, the nurse maintains a professional rather than a social role.
Maintain a neutral, calm, and respectful manner, although with some clients this is
easier said than done. Helps a client see himself or herself as respected as a person
even when behavior might not be appropriate.
Option A: Keep in mind clients with personality disorders might defend against
feelings of low-self-esteem through blaming, projection, anger, passivity, and
demanding behaviors. Many behaviors seen in PD clients cover a fragile sense of
self. Often these behaviors are the crux of clients’ interpersonal difficulties in all
their relationships.
Option B: Focus questions in a positive and active light; helps client refocus on
the present and look to the future. For example, “What can you do differently
now?” or “What have you learned from that experience?”. Allows the client to
look at past behaviors differently, and gives the client a sense that he or she has
choices in the future.
Option D: Give the client honest and genuine feedback regarding your
observations as to his or her strengths, and areas that could use additional skills.
Feedback helps give clients a more accurate view of self, strengths, areas to work
on, as well as a sense that someone is trying to understand them.

1 point(s)
10. Question

When caring for a client with a diagnosis of schizotypal personality disorder, the nurse should:

A. Set limits on manipulative behavior.

B. Encourage participation in group therapy.

C. Respect the client’s needs for social isolation.

D. Understand that seductive behavior is expected.

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Incorrect
Correct Answer: C. Respect the client’s needs for social isolation.
These clients are withdrawn, aloof, and socially distant; allowing distance and providing
support may encourage the eventual development of a therapeutic alliance. Group
therapy would increase this client’s anxiety; cognitive or behavioral therapy would be
more appropriate.
Option A: In a respectful, neutral manner, explain expected client behaviors,
limits, and responsibilities during sessions with nurse clinician. Clearly state the
rules and regulations of the institution, and the consequences when these rules
are not adhered to. From the beginning, clients need to have explicit guidelines
and boundaries for expected behaviors on their part, as well as what the client
can expect from the nurse. Clients need to be fully aware that they will be held
responsible for their behaviors.
Option B: Assess the need for and encourage skills training workshops. Skills
training workshops offer the client wants to increase social skills through role-
play and interactions with others who are learning similar skills. This often acts as
a motivating factor where positive feedback and helpful suggestions are readily
available.
Option D: Intervene in manipulative behavior. All limits should be adhered to by
all staff involved. Behaviors should be documented objectively (give times, dates,
circumstances). Provide clear boundaries and consequences. The client will test
limits, and, once they understand that the limits are solid, this understanding can
motivate them to work on other ways to get their needs met. Hopefully, this will
be done with the nurse clinician throughout problem-solving alternative
behaviors and learning new effective communication skills.

1 point(s)
11. Question

A nurse is orienting a new client to the unit when another client rushes down the hallway and
asks the nurse to sit down and talk. The client requesting the nurse’s attention is extremely
manipulative and uses socially acting-out behaviors when demands are unmet. The nurse
should:

A. Suggest that the client requesting attention speak with another staff member.

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B. Leave the new client and talk with the other client to avoid precipitating acting
out behavior.

C. Tell the interrupting client to sit down and be patient, stating, “I’ll be back
as soon as possible.”

D. Introduce the two clients and suggest that the client join the new client and the
nurse on the tour.

Correct
Correct Answer: C. Tell the interrupting client to sit down and be patient, stating,
“I’ll be back as soon as possible.”
This sets realistic limits on behavior without rejecting the client. Identify behavioral
limits and behaviors that are expected. Client needs a clear structure. Expect frequent
testing of limits initially. Maintaining limits can enhance feelings of safety in the client.
Option A: Be clear with the client as to the unit/hospital/clinic policies. Give brief
concrete reasons for the rules, if asked, and then move on. Institutional policies
provide structure and safety. Be very clear about the consequences if
policies/limits are not adhered to. Client needs to understand the consequences
of breaking the rules.
Option B: When limits or policies are not followed, enforce the consequences in
a matter-of-fact, nonjudgmental manner. Enforces that the client is responsible
for his or her own actions. Make a clear and concrete written plan of care so
other staff can follow. Helps minimize manipulations and might help encourage
cooperation.
Option D: Some clients might attempt to instill guilt when they do not get what
they want. Remain neutral but firm. Nurses often want to be seen as “nice”
However, being professional and maintaining limits is the better therapeutic
approach.

1 point(s)
12. Question
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A client with a diagnosis of narcissistic personality disorder has been given a day pass from the
psychiatric hospital. The client is due to return at 6 pm. At 5 pm the client telephones the nurse
in charge of the unit and says “6 o’clock is too early. I feel like coming back at 7:30.” The nurse
would be most therapeutic by telling the client to:

A. Return immediately, to demonstrate control.

B. Return on time or restrictions will be imposed.

C. Come back at 6:45, as a compromise to set limits.

D. Come back as soon as possible or the police will be sent.

Incorrect
Correct Answer: B. Return on time or restrictions will be imposed.
This sets limits, points out reality, and places responsibility for behavior on the client. Be
clear with the client as to the unit/hospital/clinic policies. Give brief concrete reasons
for the rules, if asked, and then move on. Institutional policies provide structure and
safety. Be very clear about the consequences if policies/limits are not adhered to. Client
needs to understand the consequences of breaking the rules.
Option A: When limits or policies are not followed, enforce the consequences in
a matter-of-fact, nonjudgmental manner. Enforces that the client is responsible
for his or her own actions.
Option C: If the client becomes seductive, reiterate the therapeutic goals and
boundaries of treatment. The client is in the hospital/clinic for a reason. Being
taken in by seductive behavior undermines the effectiveness of the treatment.
Option D: Approach the client in a consistent manner in all interactions.
Enhances feelings of security and provides structure. Exceptions encourage
manipulative behavior. If the client becomes hostile or projects blame onto you

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or staff, project a neutral, calm demeanor, and avoid power struggles. Focus on
the client’s underlying feelings.

1 point(s)
13. Question

An adult client with a borderline personality disorder become nauseated and vomits
immediately after drinking 2 ounces of shampoo as a suicide gesture. The most appropriate
initial response by the nurse would be to:

A. Promptly notify the attending physician.

B. Immediately initiate suicide precautions.

C. Sit quietly with the client until nausea and vomiting subsides.

D. Assess the client’s vital signs and administer syrup of ipecac.

Incorrect
Correct Answer: C. Sit quietly with the client until nausea and vomiting subside.
This intervention demonstrates the nurse’s caring presence which is vital for this client.
Identify feelings experienced before and around the act of self-mutilation. Feelings are
a guideline for future intervention (e.g., rage at feeling left out or abandoned).
Option A: Although the treatment team does need to know about the event,
notification is not the immediate concern. Set and maintain limits on acceptable
behavior and make clear client’s responsibilities. If the client is hospitalized at
the time, be clear regarding the unit rules. Clear and non punitive limit setting is
essential for decreasing negative behaviors.
Option B: This is premature and it reinforces the client’s predisposition to
manipulative behavior. Secure a written or verbal no-harm contract with the
client. Identify specific steps (e.g., persons to call upon when prompted to self-
mutilate). The client is encouraged to take responsibility for healthier behavior.

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Talking to others and learning alternative coping skills can reduce frequency and
severity until such behavior ceases.
Option D: This medication is inappropriate in this situation; vomiting would be
expected after the ingestion of shampoo. After the treatment, discuss what
happened right before, and the thoughts and feelings that the client had
immediately before self-mutilating. identify dynamics for both client and
clinician. Allows the identification of less harmful responses to help relieve
intense tensions.

1 point(s)
14. Question

A nurse notices that a client is mistrustful and shows hostile behavior. Which of the following
types of personality disorder is associated with these characteristics?

A. Antisocial

B. Avoidant

C. Borderline

D. Paranoid

Incorrect
Correct Answer: D. Paranoid
Paranoid individuals have a need to constantly scan the environment for signs of
betrayal, deception, and ridicule, appearing mistrustful and hostile. They expect to be
tricked or deceived by others. Paranoid personality disorder is a chronic and pervasive
condition characterized by disruptive patterns of thought, behavior, and functioning.
This disorder is thought to affect between 1.21 to 4.4% of U.S. adults. Individuals with
paranoid personality disorder are at a greater risk of experiencing depression,
substance abuse, and agoraphobia.

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Option A: Antisocial personality disorder (ASPD) is a deeply ingrained and rigid

dysfunctional thought process that focuses on social irresponsibility with
exploitive, delinquent, and criminal behavior with no remorse. Disregard for and
the violation of others’ rights are common manifestations of this personality
disorder, which displays symptoms that include failure to conform to the law,
inability to sustain consistent employment, deception, manipulation for personal
gain, and incapacity to form stable relationships.
Option B: Avoidant personality disorder (AVPD) is an enduring pattern of
behavior related to social inhibition, feelings of inadequacy, and sensitivity to
rejection that causes problems in work situations and relationships. The disorder
is characterized by extreme shyness and sensitivity to criticism from others and is
known as a Cluster C personality disorder or one that involves anxious and
fearful personality disorders.
Option C: Borderline personality disorder (BPD) is a serious psychological
condition that’s characterized by unstable moods and emotions, relationships,
and behavior. It’s one of several personality disorders recognized by the
American Psychiatric Association (APA). BPD can often interfere with your ability
to enjoy life or achieve fulfillment in relationships, work, or school. It’s associated
with specific and significant problems in interpersonal relationships, self-image,
emotions, behaviors, and thinking.

1 point(s)
15. Question

Which of the following statements is typical for a client diagnosed with a paranoid personality
disorder?

A. “I understand you’re the one to blame.”

B. “I must be seen first; it’s not negotiable.”

C. “I see nothing humorous in this situation.”

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D. “I wish someone would select the outfit for me.”

Correct
Correct Answer: C. “I see nothing humorous in this situation.”
Clients with paranoid personality disorder tend to be extremely serious and lack a sense
of humor. While this mistrust is unfounded, their distrust of others makes it difficult to
form relationships and can interfere with many aspects of life including at home, at
school, and at work. People with PPD do not see their behaviors as out of the ordinary
but are perceived by others as hostile and suspicious.
Option A: Projection is a defense mechanism that involves taking our own
unacceptable qualities or feelings and ascribing them to other people.3 For
example, if you have a strong dislike for someone, you might instead believe
that they do not like you. Projection works by allowing the expression of the
desire or impulse, but in a way that the ego cannot recognize, therefore
reducing anxiety.
Option B: A pattern of disregarding or violating the rights of others. A person
with antisocial personality disorder may not conform to social norms, may
repeatedly lie or deceive others, or may act impulsively.
Option D: Dependent personality disorder (DPD) is a type of anxious personality
disorder. People with DPD often feel helpless, submissive or incapable of taking
care of themselves. They may have trouble making simple decisions. But, with
help, someone with a dependent personality can learn self-confidence and self-
reliance.

1 point(s)
16. Question

Which of the following characteristics is expected for a client with paranoid personality
disorder who receives bad news?

A. The client is overly dramatic after hearing the facts.

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B. The client focuses on self to not become over-anxious.

C. The client responds from a rational, objective point of view.

D. The client doesn’t spend time thinking about the information.

Correct
Correct Answer: C. The client responds from a rational, objective point of view.
Clients with paranoid personality disorder are affectively restricted, appear
unemotional, and appear rational and objective. People with PPD are always on guard,
believing that others are constantly trying to demean, harm, or threaten them. These
generally unfounded beliefs, as well as their habits of blame and distrust, interfere with
their ability to form close or even workable relationships.
Option A: Histrionic personality disorder, or dramatic personality disorder, is a
psychiatric disorder distinguished by a pattern of exaggerated emotionality and
attention-seeking behaviors. Histrionic personality disorder falls within the
“Cluster B” of personality disorders.
Option B: Narcissistic personality disorder (NPD) is an enduring pattern of inner
experience and behavior characterized by self-centeredness, lack of empathy,
and an exaggerated sense of self-importance. People with narcissistic personality
disorder are typically described as arrogant, conceited, self-centered, and
haughty. Because they imagine themselves as superior to others, they often
insist on possessing items that reflect a successful lifestyle.
Option D: Avoidant personality disorder (AVPD) is an enduring pattern of
behavior related to social inhibition, feelings of inadequacy, and sensitivity to
rejection that causes problems in work situations and relationships. The disorder
is characterized by extreme shyness and sensitivity to criticism from others and is
known as a Cluster C personality disorder or one that involves anxious and
fearful personality disorders.

1 point(s)
17. Question
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Which of the following types of behavior is expected from a client diagnosed with a paranoid
personality disorder?

A. Eccentric

B. Exploitative

C. Hypersensitive

D. Seductive

Incorrect
Correct Answer: C. Hypersensitive
People with paranoid personality disorders are hypersensitive to perceived threats.
While this mistrust is unfounded, their distrust of others makes it difficult to form
relationships and can interfere with many aspects of life including at home, at school,
and at work. People with PPD do not see their behaviors as out of the ordinary but are
perceived by others as hostile and suspicious.
Option A: Schizotypal personalities appear eccentric and engage in activities
others find perplexing. Schizotypal personality disorder is marked by a pervasive
pattern of social and interpersonal deficits. Individuals with schizotypal
personality disorder have little capacity—and perhaps even need—for close
relationships.
Option B: Clients with narcissistic personality disorder are interpersonally
exploitative to enhance themselves or indulge in their own desires. Narcissistic
personality disorder (NPD) is an enduring pattern of inner experience and
behavior characterized by self-centeredness, lack of empathy, and an
exaggerated sense of self-importance.
Option D: A client with a histrionic personality disorder can be extremely
seductive when in search of stimulation and approval. Histrionic personality
disorder, or dramatic personality disorder, is a psychiatric disorder distinguished

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by a pattern of exaggerated emotionality and attention-seeking behaviors.

Histrionic personality disorder falls within the “Cluster B” of personality
disorders.

1 point(s)
18. Question

Which of the following interventions is important for a client with paranoid personality
disorder taking olanzapine (Zyprexa)?

A. Explain effects of serotonin syndrome.

B. Teach the client to watch for extrapyramidal adverse reactions.

C. Explain that the drug is less effective if the client smokes.

D. Discuss the need to report paradoxical effects such as euphoria.

Correct
Correct Answer: C. Explain that the drug is less effective if the client smokes.
Olanzapine (Zyprexa) is less effective for clients who smoke cigarettes. Olanzapine
doesn’t cause euphoria (damn), and extrapyramidal side effects aren’t a problem.
However, the client should be aware of adverse effects such as tardive dyskinesia.
Option A: Serotonin syndrome is a potentially life-threatening condition
precipitated by the use of serotonergic drugs. It may be a consequence of
therapeutic medication use, accidental interactions between medications or
recreational drugs, or intentional overdose. Symptoms can range from mild to
fatal and classically include altered mental status, autonomic dysfunction, and
neuromuscular excitation. Multiple drugs may precipitate serotonin toxicity by a
variety of mechanisms. SSRIs such as citalopram, escitalopram, fluoxetine,
fluoxetine, paroxetine, and sertraline impair reuptake of serotonin from the
synaptic cleft into the presynaptic neuron.

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Option B: Extrapyramidal side effects (EPS), commonly referred to as drug-

induced movement disorders are among the most common adverse drug effects
patients experience from dopamine-receptor blocking agents. Centrally-acting,
dopamine-receptor blocking agents, namely the first-generation antipsychotics
haloperidol and phenothiazine neuroleptics, are the most common medications
associated with EPS.
Option D: The amphetamine class of drugs is used for medical and recreational
purposes. They carry a multitude of effects that include general and cognitive
performance enhancement along with euphoric effects. They also induce
aphrodisiac effects in many users. ADHD treatment commonly uses a
combination of dextroamphetamine and levoamphetamine, as well as pure
dextroamphetamine and lisdexamfetamine. Methamphetamine is a widely
trafficked and illegal drug used for recreational purposes. Athletes use many
drugs that are related to the amphetamine class of drugs for physical
performance enhancement. These drugs fall under bans by the world anti-
doping agency (WADA).

1 point(s)
19. Question

A client with antisocial personality is trying to convince a nurse that he deserves special
privileges and that an exception to the rules should be made for him. Which of the following
responses is the most appropriate?

A. “I believe we need to sit down and talk about this.”

B. “Don’t you know better than to try to bend the rules?”

C. “What you’re asking me to do is unacceptable.”

D. “Why don’t you bring this request to the community meeting?”

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Incorrect
Correct Answer: C. “What you’re asking me to do is unacceptable.”
These clients often try to manipulate the nurse to get special privileges or make
exceptions to the rules on their behalf. By informing the client directly when actions are
inappropriate, the nurse helps the client learn to control unacceptable behaviors by
setting limits. The nurse must be quite clear about establishing the boundaries of the
therapeutic relationship to ensure that neither the client’s nor the nurse’s boundaries
are violated.
Option A: By sitting down to talk about the request, the nurse is telling the
client there’s room for negotiating when there is none. Be aware of flattery as an
attempt to feed into your needs to feel special. Giving into the client’s thinking
that you are “the best” or “the only one” can pit you against other staff and
undermine the client’s need for limits.
Option B: Regardless of the clinical setting, the nurse must provide structure
and limit setting in the therapeutic relationship; in a clinic setting, this may mean
seeing the client for scheduled appointments of a predetermined length rather
than whenever the client appears and demands the nurse’s immediate attention.
Option D: Be clear with the client as to the unit/hospital/clinic policies. Give
brief concrete reasons for the rules, if asked, and then move on. Institutional
policies provide structure and safety.

1 point(s)
20. Question

A nurse notices other clients on the unit avoiding a client diagnosed with antisocial personality
disorder. When discussing appropriate behavior in group therapy, which of the following
comments is expected about this client by his peers?

A. Lack of honesty

B. Belief in superstitions

C. Show of temper tantrums

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D. Constant need for attention

Correct
Correct Answer: A. Lack of honesty
Clients with antisocial personality disorder tend to engage in acts of dishonesty, shown
by lying. Antisocial personality disorder (ASPD) is a deeply ingrained and rigid
dysfunctional thought process that focuses on social irresponsibility with exploitive,
delinquent, and criminal behavior with no remorse. Disregard for and the violation of
others’ rights are common manifestations of this personality disorder, which displays
symptoms that include failure to conform to the law, inability to sustain consistent
employment, deception, manipulation for personal gain, and incapacity to form stable
relationships.
Option B: People with this disorder display unusual thinking and behavior, as
well as appearance. People with schizotypal personality disorder might have odd
beliefs and often are very superstitious.
Option C: Borderline personality disorder is marked by unstable moods, poor
self-image, chaotic relationships, and impulsive behavior (such as sexual
promiscuity, substance abuse, overspending, and reckless driving).
Option D: People with histrionic personality disorder are shallow and constantly
seek attention. They often are very dramatic, possibly even childish, and overly
emotional.

1 point(s)
21. Question

Which of the following characteristics or client histories substantiates a diagnosis of antisocial

personality disorder?

A. Delusional thinking

B. Feelings of inferiority

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C. Disorganized thinking

D. Multiple criminal charges

Correct
Correct Answer: D. Multiple criminal charges
Clients with antisocial personality disorder are often sent for treatment by the court
after multiple crimes or for the use of illegal substances. Disregard for and the violation
of others’ rights are common manifestations of this personality disorder, which displays
symptoms that include failure to conform to the law, inability to sustain consistent
employment, deception, manipulation for personal gain, and incapacity to form stable
relationships.
Option A: Delusions are often part of psychotic disorders. They may occur along
with hallucinations, which involve perceiving something that isn’t really there,
like hearing voices or feeling bugs crawling on your skin. The nature of the
delusional symptoms may play a central role in the diagnosis. Delusional
disorder, for example, is characterized by non-bizarre delusions that often
involve the misinterpretation of an experience or perception. In schizophrenia,
the delusions may be bizarre and not rooted in reality.
Option B: An inferiority complex occurs when the feelings of inferiority are
intensified in the individual through discouragement or failure. Those who are at
risk for developing a complex include people who: show signs of low self-esteem
or self-worth or have low status in their peer group.
Option C: Disorganized thinking is one of the primary symptoms of
schizophrenia and it can lead to a variety of thought process disorders that
cause disjointed thoughts, a collapse or sudden stop in thought process,
randomly spoken words, and complete incoherence.

1 point(s)
22. Question

A client with borderline personality disorder is admitted to the unit after slashing his wrist.
Which of the following goals is most important after promoting safety?

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A. Establish a therapeutic relationship with the client.

B. Identify whether splitting is present in the client’s thoughts.

C. Talk about the client’s acting out and self-destructive tendencies.

D. Encourage the client to understand why he blames others.

Incorrect
Correct Answer: A. Establish a therapeutic relationship with the client.
After promoting safety, the nurse establishes a rapport with the client to facilitate
appropriate expression of feelings. At this time, the client isn’t ready to address the
unhealthy behavior. A therapeutic relationship must be established before the nurse
can effectively work with the client on self-destructive tendencies and the issues of
splitting.
Option B: Identify feelings experienced before and around the act of self-
mutilation. Feelings are a guideline for future intervention (e.g., rage at feeling
left out or abandoned). Explore with the client what these feelings might mean.
Option C: Work out a plan identifying alternatives to self-mutilating behaviors.
Anticipate certain situations that might lead to increased stress (e.g., tension or
rage). Identify actions that might modify the intensity of such situations.
Option D: Set and maintain limits on acceptable behavior and make clear
client’s responsibilities. If the client is hospitalized at the time, be clear regarding
the unit rules. Clear and non-punitive limit setting is essential for decreasing
negative behaviors.

1 point(s)
23. Question

Which of the following characteristics or situations is indicated when a client with borderline
personality disorder has a crisis?

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A. Antisocial behavior

B. Suspicious behavior

C. Relationship problems

D. Auditory hallucinations

Incorrect
Correct Answer: C. Relationship problems
Relationship problems can precipitate a crisis because they bring up issues of
abandonment. Clients with borderline personality disorder aren’t usually suspicious;
they’re more likely to be depressed or highly anxious.
Option A: Antisocial personality disorder (ASPD) is a deeply ingrained and rigid
dysfunctional thought process that focuses on social irresponsibility with
exploitive, delinquent, and criminal behavior with no remorse. Disregard for and
the violation of others’ rights are common manifestations of this personality
disorder, which displays symptoms that include failure to conform to the law,
inability to sustain consistent employment, deception, manipulation for personal
gain, and incapacity to form stable relationships.
Option B: Individuals with paranoid personality disorder typically experience
symptoms that interfere with daily life. In general, people with this condition feel
suspicious of others. While this mistrust is unfounded, their distrust of others
makes it difficult to form relationships and can interfere with many aspects of life
including at home, at school, and at work. People with PPD do not see their
behaviors as out of the ordinary but are perceived by others as hostile and
suspicious.
Option D: Derived from the Greek ‘schizo’ (splitting) and ‘phren’ (mind) with the
term first coined by Eugen Bleuler in 1908, schizophrenia is a functional

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psychotic disorder characterized by the presence of delusional beliefs,

hallucinations, and disturbances in thought, perception, and behavior.

1 point(s)
24. Question

Which of the following assessment findings is seen in a client diagnosed with borderline
personality disorder?

A. Abrasions in various healing stages.

B. Intermittent episodes of hypertension.

C. Alternating tachycardia and bradycardia.

D. Mild state of euphoria with disorientation.

Incorrect
Correct Answer: A. Abrasions in various healing stages.
Clients with borderline personality disorder tend to self-mutilate and have abrasions in
various stages of healing. Unfortunately, self-mutilation is a common behavior,
particularly among those with BPD. One study found that, among college students (not
necessarily with BPD), attachment issues (insecure attachment, childhood separation,
and emotional neglect) along with sexual abuse and dissociation, were significant risk
factors for self-injury, and that the risk factors were gender-specific.
Option B: Under conditions of stress, people with BPD may experience changes
in thinking, including paranoid thoughts (for example, thoughts that others may
be trying to cause them harm), or dissociation (feeling spaced out, numb, or like
they’re not really in their body).
Option C: BPD is associated with a tendency to engage in risky and impulsive
behaviors, such as going on shopping sprees, drinking excessive amounts of
alcohol or abusing drugs, engaging in promiscuous or risky sex, or binge eating.

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Also, people with BPD are more prone to engage in self-harming behaviors, such
as cutting or burning and attempting suicide.
Option D: Emotional instability is a key feature of BPD. Individuals feel like
they’re on an emotional roller coaster with quick mood shifts (i.e., going from
feeling OK to feeling extremely down or blue within a few minutes). Mood
changes can last from minutes to days and are often intense. Anger, anxiety, and
overwhelming emptiness are common as well.

1 point(s)
25. Question

In planning care for a client with borderline personality disorder, a nurse must be aware that
this client is prone to develop which of the following conditions?

A. Binge eating

B. Memory loss

C. Cult membership

D. Delusional thinking

Correct
Correct Answer: A. Binge eating
Clients with borderline personality disorder are likely to develop dysfunctional coping
and act out in self-destructive ways such as binge eating. Help clients to cope and to
control emotions. The nurse can help the clients to identify their feelings and learn to
tolerate them without exaggerated responses such as destruction of property or self-
harm; keeping a journal often helps clients gain awareness of feelings.
Option B: Cognitive restructuring is a technique useful in changing patterns of
thinking by helping clients to recognize negative thoughts and feelings and to

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replace them with positive patterns of thinking; thought stopping is a technique

to alter the process of negative or self-critical thought patterns.
Option C: Minimizing unstructured time by planning activities can help clients to
manage time alone; clients can make a written schedule that includes
appointments, shopping, reading the paper, and going for a walk.
Option D: Regardless of the clinical setting, the nurse must provide structure
and limit setting in the therapeutic relationship; in a clinic setting, this may mean
seeing the client for scheduled appointments of a predetermined length rather
than whenever the client appears and demands the nurse’s immediate attention.

1 point(s)
26. Question

Which of the following statements is expected from a client with borderline personality
disorder with a history of dysfunctional relationships?

A. “I won’t get involved in another relationship.”

B. “I’m determined to look for the perfect partner.”

C. “I’ve decided to use better communication skills.”

D. “I’m going to be an equal partner in a relationship.”

Correct
Correct Answer: B. “I’m determined to look for the perfect partner.”
Clients with borderline personality disorder would decide to look for a perfect partner.
This characteristic is a result of the dichotomous manner in which these clients view the
world. They go from relationship to relationship without taking responsibility for their
behavior. BPD can often interfere with the ability to enjoy life or achieve fulfillment in
relationships, work, or school. It’s associated with specific and significant problems in
interpersonal relationships, self-image, emotions, behaviors, and thinking.

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Option A: It’s unlikely that an unsuccessful relationship will cause clients to

make a change. They tend to be demanding and impulsive in relationships.
People with BPD tend to have intense relationships with loved ones
characterized by frequent conflicts, arguments, and break-ups. BPD is associated
with an intense fear of being abandoned by loved ones and attempts to avoid
real or imagined abandonment. This usually leads to difficulty trusting others,
putting a strain on relationships.
Option C: There’s no thought given to what one wants or needs from a
relationship. Because they tend to blame others for problems, it’s unlikely they
would express a desire to learn communication skills. Individuals with BPD have
difficulties related to the stability of their sense of self. They report many ups
and downs in how they feel about themselves. One moment they may feel good
about themselves, but the next they may feel they are bad or even evil.
Option D: Emotional instability is a key feature of BPD. Individuals feel like
they’re on an emotional roller coaster with quick mood shifts (i.e., going from
feeling OK to feeling extremely down or blue within a few minutes). Mood
changes can last from minutes to days and are often intense. Anger, anxiety, and
overwhelming emptiness are common as well.

1 point(s)
27. Question

Which of the following conditions is likely to coexist in clients with a diagnosis of borderline
personality disorder?

A. Depression

B. Delirium

C. Avoidance

D. Disorientation

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Incorrect
Correct Answer: A. Depression
Chronic feelings of emptiness and sadness predispose a client to depression. About
40% of the clients with borderline struggle with depression. Individuals with BPD have
difficulties related to the stability of their sense of self. They report many ups and
downs in how they feel about themselves. One moment they may feel good about
themselves, but the next they may feel they are bad or even evil.
Option B: Delirium is characterized by an acute change in cognition and a
disturbance of consciousness, usually resulting from an underlying medical
condition or from medication or drug withdrawal. Delirium affects 10 to 30
percent of hospitalized patients with medical illness; more than 50 percent of
persons in certain high-risk populations are affected.
Option C: Avoidant personality disorder (AVPD) is an enduring pattern of
behavior related to social inhibition, feelings of inadequacy, and sensitivity to
rejection that causes problems in work situations and relationships. The disorder
is characterized by extreme shyness and sensitivity to criticism from others and is
known as a Cluster C personality disorder or one that involves anxious and
fearful personality disorders.
Option D: Disorientation is a state of mental confusion that includes losing track
of direction and time. A version of disorientation typical for people with mid- to
late-stage Alzheimer’s disease, or related dementia, is sundowning. Sundowning
is also known as sundown syndrome and late-day confusion.

1 point(s)
28. Question

Which of the following nursing interventions has priority for a client with borderline
personality disorder?

A. Maintain consistent and realistic limits.

B. Give instructions for meeting basic self-care needs.

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C. Engage in daytime activities to stimulate wakefulness.

D. Have the client attend group therapy on a daily basis.

Incorrect
Correct Answer: A. Maintain consistent and realistic limits.
Clients with borderline who are needy, dependent, and manipulative will benefit greatly
from maintaining consistent and realistic limits. Regardless of the clinical setting, the
nurse must provide structure and limit setting in the therapeutic relationship; in a clinic
setting, this may mean seeing the client for scheduled appointments of a
predetermined length rather than whenever the client appears and demands the
nurse’s immediate attention.
Option B: They don’t tend to have difficulty meeting their self-care needs. The
nurse can help the clients to identify their feelings and learn to tolerate them
without exaggerated responses such as destruction of property or self-harm;
keeping a journal often helps clients gain awareness of feelings.
Option C: They don’t tend to have sleeping difficulties. Minimizing unstructured
time by planning activities can help clients to manage time alone; clients can
make a written schedule that includes appointments, shopping, reading the
paper, and going for a walk.
Option D: They enjoy attending group therapy because they often attempt to
use the opportunity to become the center of attention. It is important to teach
basic communication skills such as eye contact, active listening, taking turns
talking, validating the meaning of another’s communication, and using “I”
statements.

1 point(s)
29. Question

A nurse is assessing a client diagnosed with a dependent personality disorder. Which of the
following characteristics is a major component of this disorder?

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A. Abrasive to others

B. Indifferent to others

C. Manipulative of others

D. Over-reliance on others

Incorrect
Correct Answer: D. Over-reliance on others.
Clients with dependent personality disorder are extremely over-reliant on others; they
aren’t abrasive or assertive. They’re clinging and demanding of others; they don’t
manipulate. Dependent personality disorder (DPD) is a type of anxious personality
disorder. People with DPD often feel helpless, submissive or incapable of taking care of
themselves. They may have trouble making simple decisions. But, with help, someone
with a dependent personality can learn self-confidence and self-reliance.
Option A: People with DPD have an overwhelming need to have others take
care of them. Often, a person with DPD relies on people close to them for their
emotional or physical needs. Others may describe them as needy or clingy.
Option B: People with DPD may believe they can’t take care of themselves. They
may have trouble making everyday decisions, such as what to wear, without
others’ reassurance.
Option C: In patients with dependent personality disorder, the need to be taken
care of results in loss of their autonomy and interests. Because they are intensely
anxious about taking care of themselves, they become excessively dependent
and submissive.

1 point(s)
30. Question

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Which of the following information must be included for the family of a client diagnosed with
a dependent personality disorder?

A. Promote exercise programs

B. Explore panic attacks

C. Address coping skills

D. Decrease aggressive outbursts

Correct
Correct Answer: C. Address coping skills.
The family needs information about coping skills to help the client learn to handle
stress. When the client is ready and interested, teach the client coping skills to help
defuse tension and trouble feelings (e.g., anxiety reduction, assertiveness skills).
Increasing skills help the client use healthier ways to defuse tensions and get needs
met.
Option A: Exercise is a health promotion activity for all clients. Clients with a
dependent personality disorder wouldn’t need exercise promoted more than
other people. Clients may benefit from coping skills training (e.g., anger
management skills, emotional regulation skills, interpersonal skills). Provide
referrals and/or involve professional experts.
Option B: They don’t tend to have panic attacks. Identify behavioral limits and
behaviors that are expected. Client needs a clear structure. Expect frequent
testing of limits initially. Maintaining limits can enhance feelings of safety in the
client. Identify what the client sees as the behaviors and circumstances that lead
to the hospitalization. Ascertain client’s understanding of behaviors and
responsibility for own actions.
Option D: Clients with a dependent personality disorder don’t have aggressive
outbursts; they tend to be passive and submit to others. When appropriate, try

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to understand underlying feelings prompting inappropriate behaviors. Often

acting out behaviors stem from underlying feelings of anger, fear, shame,
insecurity, loneliness, etc. Talking about feelings can lead to problem-solving and
growth for the client.

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