10 Personality and Mood Disorders Nclex Practice Quiz update

1. 1. Question

The nursing diagnosis that would be most appropriate for a 22-year 

old client who uses ritualistic behavior would be:

o A. Ineffective coping

o B. Impaired adjustment

o C. Personal identity disturbance

o D. Sensory/perceptual alterations

Incorrect

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. o 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. o 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. o 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 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.

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:

o A. fluvoxamine (Luvox)

o B. benztropine (Cogentin)

o C. amantadine (Symmetrel)

o 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. o 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 preferable drug of choice for geriatric patients. Moreover, benztropine is FDA approved as adjunctive therapy of all forms of 

parkinsonism. o 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. o Option D: Diphenhydramine, which is available as an overthe-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.

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.

o A. Impulsiveness

o B. Lability of mood

o C. Ritualistic behavior

o D. Psychomotor retardation

o E. Self-destructive behavior

Incorrect

: 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. o 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. o 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. o 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. o 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, decreased 

movement, and impaired cognitive function. It is common in 

patients with melancholic depression and those with psychotic 

features. o 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.

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:

o A. Control anger

o B. Reduce anxiety

o C. Set realistic goals

o 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. o 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 lowself-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. o 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. o 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.