Personality & Behavioral Disorders
A nurse is assessing a client who frequently threatens to leave relationships because they fear being abandoned. The client has rapidly changing emotions and engages in impulsive behaviors. Which disorder should the nurse suspect?
A. Antisocial personality disorder
B. Borderline personality disorder
C. Avoidant personality disorder
D. Narcissistic personality disorder
Borderline personality disorder
Rationale: Borderline personality disorder is characterized by unstable relationships, fear of abandonment, emotional instability, impulsivity, and an unstable self-image.
A client with schizophrenia reports hearing voices telling them that someone is trying to harm them. Which neurotransmitter is most associated with the positive symptoms of schizophrenia?
A. Dopamine
B. GABA
C. Acetylcholine
D. Endorphins
Dopamine
Rationale: Increased dopamine activity in certain brain pathways is associated with positive symptoms of schizophrenia, including hallucinations and delusions.
A nurse begins caring for a client with a history of trauma. Which action demonstrates trauma-informed care?
A. "Tell me exactly what happened to you."
B. "You need to talk about your trauma before we can help you."
C. "Would you like me to explain what I'm going to do before we begin?"
D. "Try not to think about what happened."
C
Rationale: Trauma-informed care promotes safety, trust, collaboration, empowerment, and choice. Giving the client control helps reduce the risk of retraumatization.
A client with anorexia nervosa is admitted to the hospital. Which assessment finding requires the most immediate attention?
A. Fear of gaining weight
B. Distorted body image
C. Heart rate of 42/min
D. Refusal to eat breakfast
C — Heart rate of 42/min
Rationale: Severe bradycardia indicates cardiovascular compromise. Although the psychological symptoms require treatment, cardiovascular instability can become life-threatening.
The nurse is assessing an older adult. Which finding is most consistent with Alzheimer's disease?
A. Sudden onset of confusion
B. Gradual progressive memory loss
C. Symptoms that completely resolve after sleep
D. Rapid changes in consciousness over several hours
B — Gradual progressive memory loss
Rationale: Alzheimer's disease typically develops gradually and progressively, beginning commonly with short-term memory problems and eventually affecting other cognitive and functional abilities.
The nurse is caring for a client with antisocial personality disorder. Which behavior would the nurse expect?
A. Extreme fear of criticism
B. Dependence on others for decision-making
C. Manipulation and lack of remorse
D. Avoidance of social situations
Manipulation and lack of remorse
Rationale: Antisocial personality disorder involves disregard for the rights of others, deceitfulness, manipulation, impulsivity, aggression, and lack of remorse.
A client with major depressive disorder reports low mood, loss of interest, sleep disturbances, and feelings of hopelessness. Which neurotransmitters are commonly associated with depression?
A. Dopamine and GABA only
B. Serotonin and norepinephrine
C. Acetylcholine and glutamate only
D. Endorphins and dopamine only
Serotonin and norepinephrine
Rationale: Depression has been associated with dysregulation of several neurotransmitters, particularly serotonin and norepinephrine. Dopamine can also play a role, especially in motivation and reward.
A nurse is using the 4 R's of trauma-informed care. Which nursing action represents Recognize?
A. Understanding that trauma is widespread
B. Identifying signs and symptoms of trauma
C. Creating interventions based on the client's needs
D. Avoiding practices that could retraumatize the client
B — Identifying signs and symptoms of trauma
Rationale: The 4 R's are Realize, Recognize, Respond, and Resist retraumatization. Recognize means identifying signs and symptoms that may indicate trauma.
A client with bulimia nervosa reports frequent self-induced vomiting. Which laboratory result should the nurse anticipate?
A. Increased potassium
B. Decreased potassium
C. Increased calcium
D. Decreased sodium only
B — Decreased potassium
Rationale: Repeated vomiting can cause loss of potassium, resulting in hypokalemia. Severe hypokalemia can cause potentially life-threatening cardiac dysrhythmias.
The nurse is caring for a client with dementia who becomes increasingly confused and agitated in the evening. Which intervention is appropriate?
A. Increase environmental stimulation
B. Maintain a consistent routine
C. Frequently move the client to different rooms
D. Encourage multiple visitors at bedtime
B — Maintain a consistent routine
Rationale: A predictable environment and consistent routine can reduce confusion and agitation. Increased stimulation and frequent environmental changes may worsen symptoms.
A parent reports that their 14-year-old has repeatedly stolen from others, physically assaulted classmates, intentionally destroyed property, and frequently violates school rules. Which disorder should the nurse suspect?
A. ADHD
B. Oppositional defiant disorder
C. Conduct disorder
D. Intermittent explosive disorder
Conduct disorder
Rationale: Conduct disorder involves persistent behaviors that violate the rights of others or major societal rules, including aggression, theft, destruction of property, and serious rule violations.
A client reports taking opioids every day. The client states, "I don't even get high anymore, but I feel terrible when I stop." Which concept best explains the client's statement?
A. Hallucination
B. Tolerance and physical dependence
C. Therapeutic effect
D. Placebo effect
Tolerance and physical dependence
Rationale: Tolerance means increasing amounts of a substance are needed to achieve the same effect. Physical dependence means withdrawal symptoms can occur when the substance is reduced or stopped.
Which client has the greatest risk for suicide?
A. A client who reports feeling sad after losing a job
B. A client who reports occasional anxiety
C. A client who has a specific suicide plan and access to a firearm
D. A client who reports difficulty sleeping
C
Rationale: A specific plan, intent, and access to a lethal method significantly increase suicide risk. This client requires immediate safety assessment and intervention.
A client with anorexia nervosa has been hospitalized for severe malnutrition. Which nursing intervention is most important when nutritional rehabilitation begins?
A. Rapidly increase caloric intake
B. Monitor for complications of refeeding
C. Allow the client to eat whatever foods they choose
D. Avoid monitoring laboratory values
B — Monitor for complications of refeeding
Rationale: Clients with severe malnutrition are at risk for refeeding syndrome, which can cause dangerous electrolyte shifts, particularly involving phosphorus, potassium, and magnesium.
A client taking lithium reports diarrhea, vomiting, severe tremors, and difficulty walking. What should the nurse do?
A. Administer the next dose
B. Encourage the client to exercise
C. Hold lithium and notify the provider
D. Give the client caffeine
C — Hold lithium and notify the provider
Rationale: These can be manifestations of lithium toxicity. Severe toxicity can progress to neurological complications, seizures, and potentially life-threatening conditions.
The nurse is assessing a 12-year-old who frequently argues with teachers, refuses to follow rules, deliberately annoys others, and becomes easily irritated. The child has not demonstrated aggression, theft, or destruction of property. Which diagnosis is most consistent with these findings?
A. Conduct disorder
B. Oppositional defiant disorder
C. Antisocial personality disorder
D. Intermittent explosive disorder
Oppositional defiant disorder
Rationale: ODD involves an ongoing pattern of defiant, argumentative, hostile, and irritable behavior. Conduct disorder is more severe and includes behaviors that violate the rights of others.
A client who has been taking opioids daily abruptly stops using them. Which findings should the nurse expect? Select all that apply.
A. Dilated pupils
B. Diarrhea
C. Severe respiratory depression
D. Muscle aches
E. Rhinorrhea
F. Pinpoint pupils
A, B, D, E
Rationale: Opioid withdrawal causes increased sympathetic activity and commonly produces dilated pupils, sweating, rhinorrhea, diarrhea, abdominal cramping, muscle aches, anxiety, restlessness, and insomnia. Respiratory depression and pinpoint pupils are associated with opioid intoxication rather than withdrawal.
A client tells the nurse, "I don't want to kill myself, but cutting myself is the only way I can handle my emotions." Which response is most appropriate?
A. "You shouldn't hurt yourself."
B. "Why would you do something like that?"
C. "Tell me what you experience before and after you hurt yourself."
D. "If you don't want to die, then you aren't at risk."
C
Rationale: The nurse should use a nonjudgmental approach and assess the function and circumstances of the self-harm while also assessing suicide risk. NSSI does not necessarily involve suicidal intent but is associated with increased suicide risk.
A client frequently reports abdominal pain and fatigue. Multiple diagnostic tests are negative, but the client spends significant time worrying about the symptoms and repeatedly seeks medical care. Which nursing approach is appropriate?
A. Tell the client the symptoms are imaginary
B. Tell the client nothing is physically wrong
C. Acknowledge the symptoms and focus on coping and functioning
D. Encourage the client to seek additional diagnostic tests
C
Rationale: Somatic symptoms are real and distressing to the client. The nurse should avoid dismissing the symptoms while helping the client develop healthier coping strategies and reduce excessive health-related behaviors.
A client taking lithium has been experiencing excessive sweating and diarrhea during a heat wave. Which teaching is most important?
A. "Increase your caffeine intake."
B. "Avoid all fluids."
C. "Maintain adequate fluid and sodium intake."
D. "Take an extra lithium dose if you sweat."
C
Rationale: Lithium levels are affected by fluid and sodium balance. Dehydration and sodium depletion can increase lithium levels and increase the risk of toxicity.
A client becomes extremely angry after being asked to wait for an appointment. The client suddenly throws a chair and punches a wall. Afterward, the client states, "I don't know why I did that. I just lost control." Which disorder should the nurse suspect?
A. Conduct disorder
B. Borderline personality disorder
C. Intermittent explosive disorder
D. Narcissistic personality disorder
Intermittent explosive disorder
Rationale: Intermittent explosive disorder involves recurrent, impulsive aggressive outbursts that are disproportionate to the situation. The aggression is generally not premeditated.
A client with a substance use disorder says, "I know using this drug is hurting me, but when I use it, I finally feel normal." Which brain process best explains this behavior?
A. Decreased activation of the reward system
B. Activation of the brain's reward pathway and reinforcement of substance use
C. Permanent elimination of dopamine
D. Increased functioning of the frontal lobe
B — Activation of the brain's reward pathway and reinforcement of substance use
Rationale: Addictive substances can activate the brain's reward circuitry, particularly pathways involving dopamine. Repeated activation can reinforce substance-seeking behavior and contribute to changes in motivation and decision-making.
A client lost their spouse 18 months ago and continues to experience intense grief that significantly interferes with daily functioning. The client states, "I feel like my life stopped the day my spouse died." Which condition should the nurse suspect?
A. Normal grief
B. Anticipatory grief
C. Prolonged grief disorder
D. Disenfranchised grief
C — Prolonged grief disorder
Rationale: Prolonged grief disorder involves persistent, intense grief and significant impairment that continues beyond the expected cultural and social context of bereavement.
A client suddenly develops paralysis of one arm after experiencing severe emotional stress. Diagnostic testing does not identify a neurological cause. Which condition should the nurse suspect?
A. Illness anxiety disorder
B. Conversion disorder
C. Factitious disorder
D. Malingering
B — Conversion disorder
Rationale: Conversion disorder involves neurological symptoms, such as weakness, paralysis, sensory changes, or seizures, that are incompatible with recognized neurological conditions and are associated with psychological factors.
The nurse is caring for four clients. Which client should the nurse assess first?
A. A client with Alzheimer's disease who is asking the same question repeatedly
B. A client with bulimia who reports feeling ashamed after eating
C. A client taking lithium who has vomiting, severe tremors, and confusion
D. A client with ODD who refuses to participate in group therapy
C — The client taking lithium
Rationale: This client is displaying possible lithium toxicity, which can become life-threatening. NCLEX priority questions require the nurse to address the client with the greatest immediate physiological risk first.