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While the nurse at the personality disorders clinic is interviewing a patient, the patient constantly scans the environment and frequently interrupts to ask what the nurse means by certain words or phrases. The nurse notes that the patient is very sensitive to the nurse's nonverbal behavior. His responses are often argumentative, sarcastic, and hostile. He suggests that he is being hospitalized 'so they can exploit me.' The patient's behaviors are most consistent with the clinical picture of:

  • A. paranoid personality disorder.
  • B. histrionic personality disorder.
  • C. avoidant personality disorder.
  • D. narcissistic personality disorder.
Correct Answer: A

Rationale: The correct answer is A: paranoid personality disorder. The patient's behaviors align with the diagnostic criteria for paranoid personality disorder, characterized by suspicion, distrust, sensitivity to criticism, and interpreting benign interactions as threatening. The patient's constant scanning of the environment, interrupting to clarify meanings, being sensitive to nonverbal cues, and displaying argumentative and hostile responses are all indicative of paranoid traits. Additionally, the belief that hospitalization is for exploitation is consistent with paranoid beliefs.

Choices B, C, and D can be ruled out:
B: Histrionic personality disorder is characterized by attention-seeking behavior, emotional instability, and dramatic expression. The patient's behaviors are not suggestive of seeking attention or being overly dramatic.
C: Avoidant personality disorder is marked by social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. The patient's behaviors are more indicative of suspiciousness rather than avoidance.
D: Narcissistic personality disorder involves grandiosity, need for admiration, and lack of

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A 17-year-old patient with anorexia nervosa has just been released from the hospital. To facilitate recovery at home, the psychiatric-mental health nurse instructs the family to:

  • A. discourage the patient from sneaking food between meals, by unobtrusively reducing access to the kitchen
  • B. encourage the patient's interest in menu planning, food magazines, and cooking lessons, by leaving information and materials around the house
  • C. permit the patient to eat her meals privately to discourage family preoccupation with meals
  • D. recommend that the patient joins in routine family meals and clears the dishes after dinner, even if they do not eat
Correct Answer: D

Rationale: Involving the patient in family meals normalizes eating behavior and provides structure, supporting recovery without enabling secrecy or avoidance.

A major difference in assessment findings between a patient with anorexia nervosa and a patient with bulimia nervosa is the patient with bulimia:

  • A. is well nourished while the patient with anorexia nervosa is malnourished.
  • B. denies hunger while the patient with anorexia nervosa admits experiencing hunger.
  • C. is often of near-normal weight while the patient with anorexia nervosa is underweight.
  • D. has a distorted body image while the patient with anorexia nervosa has a realistic body image.
Correct Answer: C

Rationale: The correct answer is C because a major difference between anorexia nervosa and bulimia nervosa is that patients with bulimia are often of near-normal weight, while patients with anorexia are typically underweight. This is due to the different patterns of eating behaviors in the two disorders. In bulimia, individuals often engage in binge-eating episodes followed by compensatory behaviors such as purging, which may help maintain their weight. On the other hand, individuals with anorexia restrict their food intake significantly, leading to malnourishment and significant weight loss.

Choice A is incorrect because individuals with bulimia can still experience malnourishment due to the purging behaviors. Choice B is incorrect because both patients with anorexia and bulimia may deny hunger due to their disordered eating behaviors. Choice D is incorrect because both disorders involve a distorted body image, although the specific nature of the distortion may differ.

A new client admits to having been battered by her live-in boyfriend several times over the past 2 years. She states to the nurse, 'We plan to get married next June, and I think things will be better then. He is always so sorry afterward, that I think I can trust him to change.' Which intervention should be included in the client's teaching plan?

  • A. Support her hope that the battering will end after they are married.
  • B. Assist her to enroll in a class to learn techniques of self-defense.
  • C. Emphasize that the battering pattern usually remains the same in frequency and severity over time.
  • D. Assist her in developing an emergency plan, since the pattern of violence is likely to continue.
Correct Answer: D

Rationale: The correct answer is D: Assist her in developing an emergency plan, since the pattern of violence is likely to continue. This choice is correct because it focuses on safety planning, which is crucial for individuals in abusive relationships. By helping the client develop an emergency plan, the nurse is acknowledging the seriousness of the situation and providing practical strategies to ensure her safety. It is important to have a plan in place in case of future violence.

Explanation for the incorrect choices:
A: Supporting her hope that the battering will end after they are married is not appropriate as it may give false hope and does not address the immediate safety concerns.
B: Enrolling in a self-defense class may not be effective in situations of domestic violence as it can escalate the violence and may not address the underlying issues causing the abuse.
C: Emphasizing that the battering pattern usually remains the same in frequency and severity over time is not as helpful as developing a concrete safety plan to address the immediate danger.

A child, aged 11 years, stays home from school to care for his siblings while his mother works, because the family cannot afford a babysitter. The home is cluttered and dirty. When asked about his parents, the child reluctantly reveals that he thinks his father does not like him very much because he calls him 'stupid' and says he can never do anything right. This should be assessed as:

  • A. physical abuse.
  • B. sexual abuse.
  • C. emotional abuse.
  • D. economic abuse.
Correct Answer: C

Rationale: Explanation:
C: Emotional abuse is the correct assessment as the father's behavior of calling the child 'stupid' and criticizing him can cause psychological harm. This behavior undermines the child's self-esteem and mental well-being. The child's reluctance to speak about his parents also indicates emotional distress.

Incorrect choices:
A: Physical abuse involves causing physical harm, which is not evident in the scenario.
B: Sexual abuse involves inappropriate sexual behavior, which is not indicated in the scenario.
D: Economic abuse involves financial control or exploitation, which is not the primary issue in this scenario.

When planning inpatient psychotherapeutic activities for a patient who has antisocial personality disorder, the psychiatric-mental health nurse:

  • A. focuses on group, rather than individual, therapy
  • B. provides a permissive atmosphere, so the patient feels a sense of control
  • C. provides an organized, structured environment
  • D. recognizes that the disorder is characterized by social withdrawal
Correct Answer: C

Rationale: A structured environment sets clear boundaries, countering manipulative tendencies common in antisocial personality disorder.

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