NCLEX Personality Disorders

Question 1

When analyzing the behaviors of a 23-year-old who meets the criteria for antisocial personality disorder, the nurse recognizes that which nursing diagnosis would be pertinent to his care?

a. Risk for self-mutilation
b. Disturbed personal identity
c. Impaired social interaction
d. Social isolation

Answer 1

ANS: C
The patient with antisocial personality disorder is impulsive, manipulative, and dishonest. Patients with this disorder are frequently involved in illegal matters. Self-mutilation and disturbed identity are more appropriate for patients with borderline personality disorder. Social isolation would apply more readily to Cluster A disorders.

Question 2

Which observation is supportive of a diagnosis of avoidant personality disorder?

a. Talks about “my three failed marriages”
b. Cries loudly whenever requests are denied
c. Fears criticism from others, including staff
d. Shows no remorse when accidentally breaking another patient’s bracelet

Answer 2

ANS: C
Symptoms suggesting an avoidant personality disorder include fear of rejection, avoidance of relationships, and censorship of expression of thoughts and feelings because of fear of a negative reaction. Borderline personality disorder presents with unstable interpersonal relationships, labile affect, and complaints of emptiness. Patients with histrionic personality disorders are overly dramatic, manipulative, and attention-seeking. Patients with schizoid personality disorder are indifferent to and lack concern for interpersonal contacts

Question 3

Which behavior is supportive of a diagnosis of dependent personality disorder?

a. Perceives personal behavior to be embarrassing
b. Believes they are incapable of functioning independently
c. Tends to exaggerate the potential dangers of ordinary situations
d. Demands excessive attention from others whenever in a group situation

Answer 3

ANS: B
The dependent person must rely on others to make decisions and assume responsibility of major areas of his or her life. Low self-esteem and exaggeration are seen in avoidant personality disorder. Attention seeking is seen in narcissistic personality disorder.

Question 4

When planning care for a patient with antisocial personality disorder, which consideration has greatest importance?

a. Addressing the demand for constant attention
b. Teaching coping skills related to frustration tolerance
c. Identifying behaviors related to well-developed superegos
d. Managing the manipulative behaviors resulting from a charming persona

Answer 4

ANS: D
Patients with antisocial personality disorder are described as charming because of their ability to size up and manipulate others. Narcissistic patients demand constant attention. Patients with histrionic personality disorder do not tolerate delay of gratification or frustration. Patients with personality disorder have poorly developed superegos.

Question 5

When a patient diagnosed with borderline personality disorder experiences the death of a beloved parent, which characteristic response will the nurse anticipate?

a. Denies the death for a protracted period of time
b. Exhibits several different psychotic thought processes
c. Expresses extreme anger and rage by burning the parent’s clothes
d. Becomes uncharacteristically helpful and attends to the funeral arrangements

Answer 5

ANS: C
If a significant person in the patient’s life dies, the patient with borderline personality disorder cannot mourn but often exhibits one or more of the six constituent states that include anger and rage. The other options are not characteristically seen as mourning behaviors in individuals with this diagnosis.

Question 6

A 27-year-old woman diagnosed with borderline personality disorder displays a labile affect, impulsivity, frequent angry outbursts, and difficulty tolerating her angry feelings without self-injury. A priority nursing diagnosis for this patient is:

a. Anxiety
b. Risk for self-mutilation
c. Risk for other-directed violence
d. Ineffective coping

Answer 6

ANS: B
Patients with borderline personality disorder frequently engage in self-mutilation in an attempt to manage chaotic feelings. The important clue to this diagnosis is that the patient is having difficulty tolerating feelings without self-injuring. There is no data to support anxiety or ineffective coping. The risk is greater for violence toward self.

Question 7

Which outcome has priority for a patient with borderline personality disorder being discharged from an outpatient treatment environment?

a. Patient demonstrates control over self-destructive impulses.
b. Patient can identify symptoms that indicate a need for psychotherapy.
c. Patient demonstrates an understanding of the importance of medication compliance.
d. Patient actively participates in a community 12-step group related to relevant care.

Answer 7

ANS: A
The patient’s ability to control self-destructive impulses has priority over the other options because doing so will affect patient safety.

Question 8

A patient who is diagnosed with schizoid personality disorder is isolative, does not speak to her peers, and sits through the community meeting without speaking. Her mother describes her as shy and having few friends. Which would be an appropriate nursing diagnosis for this patient?

a. Anxiety related to a new environment as evidenced by isolation and not talking with peers
b. Ineffective coping related to new environment as evidenced by isolation and minimal interaction with others
c. Impaired social interaction related to unfamiliar environment as evidenced by isolation and not talking with peers
d. Disturbed thought processes related to a new environment as evidenced by isolation and minimal interactions with others

Answer 8

ANS: C
This nursing diagnosis relates directly to her symptoms and their underlying pathology. Data are not present to support the other options.

Question 9

The nurse is careful to provide a quiet, comfortable, safe environment when conducting an assessment interview. What is the reason this is particularly important when working with a patient believed to be exhibiting characteristics of a personality disorder?

a. These patients are generally experiencing chronic depression and are severely impaired socially.
b. A high stimulus environment will cause the patient to exhibit exacerbated behaviors that are loud and attention seeking.
c. The patient is easily intimidated and may become so withdrawn that the assessment will be difficult if not impossible to complete.
d. This disorder produces defensive, guarded, and impulsive behavior that is easily provoked into anger when the patient feels threatened.

Answer 9

ANS: D
Individuals with these disorders are often withdrawn, defensive, guarded, and impulsive, and may demonstrate an escalation of anger or make hostile or threatening comments. The remaining options are specific to certain types of personality disorders.

Question 10

When facilitating change in the behavior of a patient diagnosed with a personality disorder, which intervention will have the greatest impact on success?

a. Collaborating with the patient when establishing treatment goals
b. Educating the patient to the importance of complying with treatment interventions
c. Evaluating the patient’s understanding of the etiology of the prescribed medications
d. Conducting regular assessments so the treatment can be changed when necessary

Answer 10

ANS: A
When planning interventions with a patient who has a personality disorder, it is important to recognize that the person has disturbed values that do not reflect the views held by the general population. Because of these disturbances, the nurse needs to collaborate with the patient regarding the goals that are identified during treatment. The remaining options although appropriate will not be attainable if the patient does not recognize the interventions as being useful and personally applicable.

Question 11

A patient with antisocial personality disorder yells, “Shut up about that, or I’ll punch you in the nose!” and shakes his fist at another patient in a group meeting after the patient speaks negatively of illicit drug use. The nurse quickly determines that the patient is at risk to act violently against others as evidenced by his aggressive behavior, verbal threats, and a history of impulsivity. Which is the best approach for the nurse to use?

a. Secluding the patient to protect the other patients and staff
b. Putting the patient in restraints to protect the entire milieu
c. Exploring alternate ways to handle frustrating topics in the group
d. Telling the patient to leave the group until he can behave appropriately

Answer 11

ANS: C
Discussing angry feelings in a group setting that is focused on exploring alternative problem-solving options will both distract the patient from angry feelings and help to focus energy on constructive activities. Seclusion and restraints are not necessary until verbal interventions prove unsuccessful. Making the patient leave the group is not an approach that will lead to meaningful learning.

Question 12

A patient with borderline personality disorder is having difficulty with memories of sexual abuse and reports vague, generalized pains, menstrual problems, and headaches that severely impact her ability to function independently. Which collaborative consult will have the greatest impact on the patient’s health and wellness?

a. Occupational therapist exploring ways to reduce stress
b. Neurologist to evaluate the patient’s reports of headaches
c. Acupuncturist exploring ways to reduce the generalized pain
d. Gynecologist to assess the patient’s dysmenorrheal symptoms

Answer 12

ANS: A
An occupational therapist can determine ways to increase adaptive functioning and independent living skills. Groups on stress reduction, self-awareness, and feelings are often co-led by occupational therapists. Although appropriate, the remaining options are all a result of unmanaged stress.

Question 13

Which intervention will best ensure a nonjudgmental evaluation of a patient’s noncompliance with the treatment plan for management of his antisocial behaviors?

a. Re-evaluating the patient’s understanding of the goals of the prescribed treatment plan
b. Asking questions that focus on his perception of why he can follow his treatment plan
c. Expressing concern about the patient’s long-term prognosis if his noncompliance continues
d. Re-assessing the patient for changes that may require the revision of his current treatment plan

Answer 13

ANS: B
The nurse asking questions to determine possible reasons for the outcome criteria not being met would exhibit a nonjudgmental approach to this patient’s assessment interview. While appropriate, the remaining options are not nonjudgmental in nature.

Question 14

The nurse counsels a mother to allow her 2-year-old child to keep a blanket that he uses to comfort himself. The basis for this counseling is:

a. Sullivan’s theory of “good me”
b. Freud’s developmental theory
c. Mahler’s theory of object relations
d. Kernberg’s conceptualization object constancy

Answer 14

ANS: C
Mahler’s theory of object relations suggests that the child at his age has a beginning sense of object constancy and can use a representation of the mother for comfort. The child may use a blanket or other object to remind himself of the mother. The other theories mentioned are not as clearly related as Mahler’s.

Question 15

Which behavior supports the failure to successfully achieve the oral stage of Freud’s psychosexual stages of development?

a. An adult’s excessive dependency on parents
b. A history of multiple, simultaneous sex partners
c. A need to ritualistically turn the lights off repeatedly
d. A lack of guilt when responsible for mistreating others

Answer 15

ANS: A
Individuals who have difficulty with the oral stage are often dependent. The other options reflect behavior not grounded in this stage.

Question 16

A patient with borderline disorder tells the nurse, “It’s hard to figure out who I am. Sometimes I’m sexually attracted to women and sometimes to men.” The nurse using Freudian concepts can analyze this as a developmental problem related to:

a. Lack of separation-individuation
b. Isolation of affect during latency
c. Impaired development of sexual identity during the phallic stage
d. Overdevelopment of latency stage traits related to control issues

Answer 16

ANS: C
According to Freud, identifying one’s sexual identity takes place during the phallic stage of development. When sexual identity is not clearly established, the individual may express confusion in sexual preference. The other options do not relate to information given in the scenario.

Question 17

The patient tells the nurse, “I thought my doctor understood me completely. Now, I hate him! He doesn’t understand me at all.” The nurse assesses the patient’s description of feelings about the physician as evidence of the use of:

a. Splitting
b. Dissociation
c. Isolation of affect
d. Projective identification

Answer 17

ANS: A
Splitting is the inability to synthesize the positive and negative aspects of self and others. It manifests as idealization and devaluation. Definitions of the other defenses listed do not fit the description of the behavior in the scenario.

Question 18

The nurse conducts milieu therapy based on the understanding that:

a. Therapy is grounded in the milieu routine.
b. The milieu is a substitute for the patient’s family.
c. Staff represents the authority within the milieu.
d. The milieu provides realistic community interactions.

Answer 18

ANS: D
The purpose of milieu therapy is to recreate a community setting on these units so that the patient is able to interact with other patient peers to identify and problem-solve issues that occur when relating to others. The milieu does not replace the patient’s family. The remaining options are not true.

Question 19

A patient with a borderline personality disorder tells the nurse, “My doctor tells me there’s something wrong with the hard wiring of my brain, and that’s why I’m so impulsive and get so many mood swings. He said he’s going to prescribe some medication.” Being aware of current practice guidelines, the nurse will prepare a teaching plan for:

a. Lithium (Lithobid)
b. Fluoxetine (Prozac)
c. Lorazepam (Ativan)
d. Haloperidol (Haldol)

Answer 19

ANS: B
Fluoxetine is an SSRI. SSRIs are the medications of choice for patients with personality disorder who have affect dysregulation and impulsivity. SSRIs have a low incidence of side effects. Lithium may be used in instances of severe mood disorder. Lorazepam is used to help manage high anxiety, while haloperidol is prescribed in cases of violent behavior.

Question 20

Which self-reflective intervention is most appropriate for the nurse to engage in when managing care for patients who exhibit characteristics of personality disorders?

a. Reinforcing the therapeutic boundaries between the nurse and patient as often as needed
b. Requesting a temporary transfer to a medical unit periodically to help minimize burn-out
c. Frequently self-assessing for biases and prejudices that result in patient care that is compromised
d. Arriving at a personal decision regarding the use of both chemical and physical restraints to assure milieu safety.

Answer 20

ANS: A
Patients with personality disorders have difficulty relating to others. As a consequence, these individuals have difficulty defining boundaries between themselves and others. Part of nursing care is to define boundaries within the therapeutic relationship in order to develop safe, patient-centered therapeutic relationships. The use of chemical and/or physical restraints is determined by institutional policies, not personal decision. The remaining options are appropriate for all patient care, not specifically care of patients with personality disorders.

Question 21

Which statement correctly describes the schizotypal personality disorder?

a. Psychotic behavior will require a long hospitalization.
b. There may be misinterpretation of events but not psychosis.
c. There is greater personality disorganization than in schizophrenia.
d. The patient will be outgoing, actively seeking interactions with others.

Answer 21

ANS: B
Patients with schizotypal personality disorder may have problems thinking and accurately perceiving events, but symptoms of psychosis such as delusional thinking and hallucinations will be absent. Personality disorganization is greater in schizophrenia. Psychosis will require longer hospitalization. Patients with schizotypal personality disorder are not generally outgoing and social.

Question 22

A psychiatric technician remarks to the nurse, “That patient with dependent personality disorder is so clingy!” The response by the nurse that will be helpful to the technician is:

a. “I think everyone feels that way. It’s difficult to have someone clinging.”
b. “Patients with personality disorders have little regard for the rights of others.”
c. “The patient fears having to function independently without direction from someone else.”
d. “The patient is so preoccupied with perfection and structure that she’s afraid to do anything at all.”

Answer 22

ANS: C
Patients with dependent personality disorder have an all-encompassing need to be taken care of. This need causes submissive, clinging behaviors. By helping the technician understand that the patient’s behavior is need-based rather than purposely annoying, the technician will be better able to respond with empathy and care. Validating the remark shows neither acceptance nor empathy for the patient. The remaining options do not provide accurate learning for the technician.

Question 23

Which behavior is of particular concern to the nurse when managing the care of a patient diagnosed with a personality disorder?

a. Reporting a staff member for ‘wanting to hurt me’
b. Shoplifting two candy bars from the hospital’s gift shop
c. Asking much more frequently to be allowed to ‘smoke a cigarette’
d. Refusing for three days to either bathe or change into clean clothing

Answer 23

ANS: B
Patients with personality disorders often exhibit self-destructive behaviors that result in getting themselves in trouble with the law, such as shoplifting. The remaining options are not generally considered characteristic behaviors of the patient diagnosed with a personality disorder

Question 24

Which intervention will provide the most information regarding a patient’s self-perception of their role in their environment?

a. Asking the patient to keep a journal about things they enjoy doing
b. Observing the patient interact with family members at a unit picnic
c. Encouraging the patient to discuss the successes they have experienced
d. Helping the patient select appropriate, attractive clothing for family visitation day

Answer 24

B
How the patient interacts within the family system and the role that the patient takes (e.g., victim, placater) will offer the nurse the most insight into the patient’s self-perception. The other options are focused on assessing and/or affecting self-esteem.

Question 25

A psychiatric technician mentions to the nurse, “All these patients with Axis II problems! It makes me wonder how so many mothers could have been such poor parents and messed up their kids so badly!” The response by the nurse that helps put the development of personality disorders into perspective is:

a. “Parenting is the responsibility of fathers, too, so don’t blame only mothers.”
b. “Personality disorder is often related to sexual abuse that occurs without parental knowledge.”
c. “There is some evidence to suggest a biologic component to personality disorders.”
d. “Peer interactions may be more important in child development than parental involvement.”

Answer 25

ANS: C
Tests show that schizotypal and schizoid disorders may reflect neurointegrative or neurochemical dysfunction and that affective dysregulation found in a number of personality disorders may be a function of serotonin abnormalities and may be implicated in impulsivity, aggression, and suicidal tendencies. The other options are either untrue or unhelpful.

Question 26

Which behavior is supportive of a histrionic personality disorder?

a. Withholding of feelings and low self-esteem
b. Insistence on others conforming to own methods
c. Engaging in impulsive acts like unprotected sex
d. Initial charm dissolving into coldness and blaming others

Answer 26

ANS: C
Impulsive sexual activities are characteristic of histrionic personality disorder. Low self-esteem is more indicative of avoidant behaviors. Inflexible methods are usually seen in obsessive-compulsive personality disorders. Alternating between charming and blaming describes some behaviors commonly seen in antisocial personality disorders.

Question 27

A patient with a personality disorder asks the nurse, “Is it true I have an inherited brain disorder?” The nurse replies, knowing that:

a. There is proof that personality disorders are inherited.
b. All persons with personality disorders display brain abnormalities.
c. Individuals with personality disorders manifest some biological markers.
d. Individuals with personality disorders show an error in brain glucose metabolism.

Answer 27

ANS: C
There is a need for more research relating genetics and brain dysfunction to personality disorders. Although there are some biologic markers, none of the other options are true.

Question 28

Which assessment data is supportive of a diagnosis of antisocial personality disorder? Select all that apply.

a. Was reprimanded to a juvenile correction facility at age 14
b. Mother reports characteristic behaviors as early as age 7
c. Is below age-appropriate norms for both weight and height
d. Patient states, “I don’t like school and skip whenever I feel like it.”
e. Has been admitted to a drug rehabilitation program twice in 4 years

Answer 28

ANS: A, B, E
Patients diagnosed with antisocial personality disorder have a history of conduct disorders before the age of 15 years, prison or juvenile detention experiences, and substance abuse. There is no research that supports the remaining options as being characteristic of this disorder.

Question 29

When implementing Freud’s theory of human psychosexual development, the nurse observes for behaviors that are characteristic of successful completion of stages that include (select all that apply):

a. Anal, where self-confidence is formed
b. Oral, where the ability to trust is developed
c. Latency, where a person learns inner control
d. Adjustment, where developmental failures are re-addressed
e. Phallic, where the ability to interact with others is grounded

Answer 29

ANS: A, B, C, E
Freud’s stages of psychosexual development include in order of completion: oral, anal, phallic, latency, and genital. There is no adjustment stage in Freud’s theory.