Personality Disorders
Which of the following best defines a personality disorder?
A. Temporary alteration in mood and behavior due to stress
B. Maladaptive, inflexible behavior pattern that impairs functioning
C. Cognitive distortion caused by a medical condition
D. Anxiety disorder characterized by fear and avoidance
B. Maladaptive, inflexible behavior pattern that impairs functioning
Rationale: A personality disorder involves enduring, rigid patterns of thinking, feeling, and behaving that deviate from cultural expectations and cause significant distress or dysfunction.
Which nursing intervention is most therapeutic for a patient with borderline personality disorder?
A. Encourage the patient to make spontaneous decisions.
B. Minimize observation to promote independence.
C. Set consistent limits and maintain a structured environment.
D. Provide reassurance for all emotional outbursts.
C. Set consistent limits and maintain a structured environment.
Rationale: Patients with BPD benefit from clear, consistent boundaries and predictable staff responses to prevent manipulation and maintain safety.
A 9-year-old diagnosed with autism spectrum disorder (ASD) frequently flaps his hands and becomes agitated when routines change. Which nursing intervention is most appropriate?
A. Encourage spontaneous group play to improve social skills.
B. Maintain a consistent daily schedule and prepare for transitions in advance.
C. Provide frequent surprises to increase adaptability.
D. Discourage repetitive behaviors to promote normal development.
B. Maintain a consistent daily schedule and prepare for transitions in advance.
Rationale: Children with ASD depend on predictable routines and can become distressed by change. Preparing them for transitions reduces anxiety and behavioral outbursts.
Which statement best describes somatic symptom disorder?
A. Intentional production of symptoms for material gain
B. Physical symptoms explained by medical findings
C. Psychological distress manifested as physical symptoms without organic cause
D. Multiple personalities emerging in response to stress
C. Psychological distress manifested as physical symptoms without organic cause
Rationale: Somatic symptom disorder involves real physical distress that cannot be fully explained medically. Symptoms serve as maladaptive coping mechanisms for psychological stressors.
During assessment, a patient with dissociative identity disorder suddenly changes voice and mannerisms. What should the nurse do first?
A. Confront the patient about switching personalities.
B. Maintain safety and continue calm, consistent communication.
C. Immediately end the interview to avoid triggering more stress.
D. Ask to meet the alternate personality for more information.
B. Maintain safety and continue calm, consistent communication.
Rationale: The nurse must remain grounded and consistent, ensuring safety while avoiding confrontation or reinforcement of dissociative behaviors.
Which personality disorder cluster is correctly matched with its general traits?
A. Cluster A – Dramatic, emotional, erratic
B. Cluster B – Anxious and fearful
C. Cluster C – Odd and eccentric
D. Cluster B – Impulsive, manipulative, attention-seeking
D. Cluster B – Impulsive, manipulative, attention-seeking
Rationale: Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders, all characterized by emotional dysregulation and impulsivity.
When planning care for a patient with antisocial personality disorder, which intervention is essential?
A. Foster insight by exploring unconscious conflicts.
B. Establish firm limits and consequences for unacceptable behavior.
C. Focus on empathy development through emotional confrontation.
D. Provide frequent unstructured social activities.
B. Establish firm limits and consequences for unacceptable behavior.
Rationale: ASPD patients are manipulative and disregard rules. Firm limits and consistent enforcement promote accountability and reduce manipulation.
A nurse caring for a child with intellectual developmental disorder (IDD) identifies the priority nursing problem as a self-care deficit. Which nursing intervention is most appropriate?
A. Complete all self-care tasks for the child.
B. Provide vague verbal directions to promote independence.
C. Break each hygiene task into small, concrete steps and use visual prompts.
D. Teach complex skills before basic ones to build confidence.
C. Break each hygiene task into small, concrete steps and use visual prompts.
Rationale: Patients with IDD benefit from stepwise instructions, repetition, and visual cues to support learning and independence in daily living skills.
A patient with illness anxiety disorder frequently requests medical tests despite normal results. Which nursing response is most therapeutic?
A. “You must stop focusing on your health so much.”
B. “Your tests are normal, so nothing is wrong.”
C. “Let’s discuss what situations increase your anxiety about illness.”
D. “You need to avoid reading about diseases online.”
C. “Let’s discuss what situations increase your anxiety about illness.”
Rationale: This response uses therapeutic communication to identify triggers and underlying anxiety rather than dismissing the patient’s fears. It helps promote insight and coping.
The nurse identifies which primary nursing diagnosis for a patient with somatic symptom disorder who frequently visits the ED for chest pain despite negative tests?
A. Ineffective health maintenance
B. Anxiety related to misinterpretation of body sensations
C. Chronic pain related to cardiac ischemia
D. Risk for other-directed violence
B. Anxiety related to misinterpretation of body sensations
Rationale: Somatic symptom disorder often reflects maladaptive anxiety and catastrophic interpretation of normal bodily sensations.
The nurse identifies which behavior as most characteristic of borderline personality disorder (BPD)?
A. Suspiciousness and social withdrawal
B. Emotional instability and fear of abandonment
C. Detachment and restricted affect
D. Arrogance and grandiosity
B. Emotional instability and fear of abandonment
Rationale: Patients with BPD display intense, unstable relationships, impulsivity, and fear of abandonment. They often engage in self-injury and “splitting” behavior (seeing people as all good or all bad).
A nurse is implementing Dialectical Behavior Therapy (DBT) for a patient with borderline personality disorder. Which component best describes this approach?
A. Medication-focused approach to reduce impulsivity
B. Cognitive-behavioral therapy emphasizing mindfulness and distress tolerance
C. Psychodynamic therapy focusing on childhood trauma
D. Aversion therapy for self-harming behaviors
B. Cognitive-behavioral therapy emphasizing mindfulness and distress tolerance
Rationale: DBT integrates mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness, improving self-control and reducing self-harm.
The nurse is planning care for an adolescent with attention-deficit hyperactivity disorder (ADHD). Which intervention should be included?
A. Provide long, detailed instructions to improve focus.
B. Allow unstructured free time to encourage creativity.
C. Implement a token reward system for desired behaviors.
D. Discourage physical activity during school hours.
C. Implement a token reward system for desired behaviors.
Rationale: Behavioral reinforcement (token economy) helps children with ADHD improve impulse control and attention by linking behaviors to consistent, immediate rewards.
A patient suddenly becomes blind after witnessing a traumatic accident, but no ocular damage is found. Which diagnosis is most likely?
A. Factitious disorder
B. Conversion disorder
C. Illness anxiety disorder
D. Somatic symptom disorder
B. Conversion disorder
Rationale: Conversion disorder involves neurological symptoms (e.g., blindness, paralysis, seizures) triggered by psychological stress, without organic findings.
Which nursing intervention is most appropriate for a patient with a somatic disorder who continually focuses on physical complaints?
A. Provide frequent detailed physical assessments.
B. Reinforce symptom reporting to track changes.
C. Focus interactions on feelings rather than symptoms.
D. Confront the patient about exaggerating complaints.
C. Focus interactions on feelings rather than symptoms.
Rationale: The nurse should redirect attention from physical complaints to emotional needs, reinforcing the link between stress and somatic symptoms.
Which behavior is most consistent with antisocial personality disorder (ASPD)?
A. Excessive fear of rejection
B. Obsession with order and perfection
C. Persistent disregard for others’ rights and lack of remorse
D. Recurrent emotional outbursts and dependency
C. Persistent disregard for others’ rights and lack of remorse
Rationale: ASPD involves deceit, aggression, irresponsibility, and lack of guilt—often with a history of conduct disorder before age 15.
During assessment, the nurse suspects a patient may have antisocial personality disorder. Which history finding supports this diagnosis?
A. Recurrent major depressive episodes since adolescence
B. Chronic anxiety and fear of rejection since childhood
C. Conduct disorder behaviors before age 15
D. Obsessive behaviors related to contamination fears
C. Conduct disorder behaviors before age 15
Rationale: Conduct disorder (e.g., aggression, law-breaking) in childhood is a precursor to ASPD in adulthood per DSM-5 diagnostic criteria.
During assessment, a 12-year-old with conduct disorder states, “I don’t care if I hurt people; they deserve it.” Which priority nursing diagnosis is appropriate?
A. Ineffective coping
B. Risk for other-directed violence
C. Impaired social interaction
D. Defensive coping
B. Risk for other-directed violence
Rationale: Conduct disorder involves aggression, property destruction, and disregard for others’ rights. Safety of others is the priority—monitor for escalating anger and establish behavioral limits.
Which finding suggests factitious disorder rather than somatic symptom disorder?
A. Symptoms cause significant distress and impairment.
B. The patient reports vague pain and fatigue.
C. The patient appears eager for procedures and falsifies data.
D. The patient expresses fear of having cancer despite normal results.
C. The patient appears eager for procedures and falsifies data.
Rationale: Factitious disorder involves intentional symptom fabrication for emotional attention or sympathy (primary gain), not for tangible benefit (as in malingering).
Which nursing intervention is priority during a dissociative episode?
A. Explore early childhood trauma immediately.
B. Provide grounding techniques and ensure safety.
C. Encourage the patient to describe alternate personalities.
D. Offer benzodiazepines for rapid control.
B. Provide grounding techniques and ensure safety.
Rationale: The priority is safety and reorientation to the present. Techniques such as deep breathing, touching an object, or stating the date/time help the patient reconnect to reality.
The nurse notes that a patient with borderline personality disorder suddenly idolizes the nurse and later angrily accuses them of neglect. This behavior reflects which defense mechanism?
A. Denial
B. Projection
C. Splitting
D. Rationalization
C. Splitting
Rationale: Splitting is a hallmark defense in BPD, in which individuals view others as all good or all bad, leading to unstable relationships and emotional lability.
A key goal of nursing care for a patient with borderline personality disorder is to help the patient:
A. Eliminate all negative emotions.
B. Develop stable relationships and self-image.
C. Increase dependence on staff for safety.
D. Avoid discussing painful experiences.
B. Develop stable relationships and self-image.
Rationale: The primary treatment goals in BPD are to build emotional regulation, impulse control, and interpersonal stability through therapy and consistent care.
A nurse develops a plan of care for a teenager with severe ADHD and poor academic performance. Which collaborative action best promotes long-term success?
A. Recommend placement in a strict residential program.
B. Coordinate with school staff to develop an Individualized Education Plan (IEP).
C. Encourage parents to provide extra homework each night.
D. Increase stimulant doses to improve attention span.
B. Coordinate with school staff to develop an Individualized Education Plan (IEP).
Rationale: Collaboration with school personnel ensures academic accommodations and behavioral supports tailored to the student’s needs—critical for promoting functional improvement and confidence.
A patient with dissociative amnesia is found wandering in another city without recollection of identity. Which diagnosis is most appropriate?
A. Dissociative identity disorder
B. Dissociative fugue
C. Depersonalization disorder
D. Conversion disorder
B. Dissociative fugue
Rationale: Dissociative fugue involves sudden travel away from home, loss of personal identity, and amnesia for past events, often triggered by trauma or stress.
A patient diagnosed with somatic symptom disorder states, “My pain is unbearable, but no one believes me.” Which nurse response is most therapeutic?
A. “Your pain is all in your head.”
B. “The doctor said nothing is wrong, so you should relax.”
C. “I believe you are feeling real pain. Let’s talk about ways to manage it.”
D. “You should try to ignore your pain and focus on positive thoughts.”
C. “I believe you are feeling real pain. Let’s talk about ways to manage it.”
Rationale: This response acknowledges the patient’s distress while promoting adaptive coping. It maintains trust and validates the experience without reinforcing illness behavior.