NUR 253 Mental Health Nursing Concepts
Exam 3: Personality Disorders, Substance Use, Somatic
Symptom & Eating Disorders
Questions With Fully Explained Solutions
Question 1: Borderline Personality Disorder & Defense Mechanisms
A patient with Borderline Personality Disorder (BPD) is admitted to the psychiatric unit.
On day one, the patient tells the nurse, "You are the only one who understands me; you
are the best nurse here." On day two, the patient screams at the nurse, "You ar e
terrible! You don't care about me at all!" The nurse recognizes this behavior as:
A) Transference
B) Splitting
C) Projection
D) Countertransference
**Answer: B) Splitting**
**Rationale:**
* **Splitting** is a primitive defense mechanism commonly seen in BPD where the
patient cannot integrate positive and negative qualities of themselves or others. People
are viewed as "all good" or "all bad," with rapid, extreme shifts between the two.
,* *Why A is incorrect:* Transference is when the patient unconsciously redirects
feelings about a significant person in their past onto the nurse.
* *Why C is incorrect:* Projection is attributing one's own unacceptable thoughts or
feelings onto someone else (e.g., "I hate you" becomes "You hate me").
* *Why D is incorrect:* Countertransference is when the *nurse* unconsciously
redirects their own emotional reactions onto the patient.
---
### Question 2: Antisocial Personality Disorder Characteristi cs
A nurse is reviewing the medical record of a patient diagnosed with Antisocial
Personality Disorder (ASPD). Which of the following historical or behavioral findings is
the nurse MOST likely to observe?
A) Intense fear of abandonment and frantic efforts to avoid it
B) A pervasive pattern of disregard for, and violation of, the rights of others, occurring
since age 15
C) Preoccupation with orderliness, perfectionism, and control
D) A stable, long - term pattern of trusting interpersonal relationships
**Answer: B) A pervasive pattern of disregard for, and violation of, the rights of others,
occurring since age 15**
**Rationale:** ASPD is characterized by deceitfulness, manipulation, impulsivity,
irritability/aggression, reckless disregard for safety, and **lack of remorse**. A key
diagnostic criterion is that conduct disorder must have been present before age 15.
* *Why A is incorrect:* This describes Borderline Personality Disorder.
* *Why C is incorrect:* This describes Obsessive - Compulsive Person ality Disorder
(OCPD).
* *Why D is incorrect:* Individuals with ASPD are incapable of genuine intimacy and
consistently manipulate or exploit others in relationships.
, ---
### Question 3: Narcissistic Personality Disorder & Nursing Boundaries
A patient with Narcissistic Personality Disorder demands that the nurse cancel their
lunch break to sit and listen to the patient talk about their successful career. When the
nurse explains they must go to lunch, the patient becomes furious and states, "Yo u are
an incompetent nurse. I'm going to report you." What is the nurse's BEST response?
A) "I am so sorry. I will cancel my lunch and stay right here."
B) "Why are you so angry? I t's just a lunch break."
C) "I understand you are upset, but I am required to take my lunch break now. I will
return in 30 minutes and we can talk then."
D) "You have no right to threaten me. I am calling security."
**Answer: C) "I understand you are upset, but I am required to take my lunch break
now. I will return in 30 minutes and we can talk then."**
**Rationale:** Patients with Narcissistic PD expect special treatment, lack empathy for
others' needs, and react to criticism or perceived slights with ra ge. The nurse must set
**firm, consistent boundaries** without getting defensive or apologizing for having
basic needs.
* *Why A is incorrect:* This violates boundaries and reinforces the patient's grandiose
sense of entitlement.
* *Why B is incorrect:* "Why" questions are non - therapeutic and confrontational.
* *Why D is incorrect:* Escalating the situation by threatening security is unnecessary
here; the patient is just yelling, not posing a physical threat.
---
### Question 4: Alcohol Withdrawal & CIWA
A patient with a history of heavy alcohol use was admitted to the medical unit 24 hours
ago. The nurse enters the room and notes the patient is anxious, diaphoretic, has a
Exam 3: Personality Disorders, Substance Use, Somatic
Symptom & Eating Disorders
Questions With Fully Explained Solutions
Question 1: Borderline Personality Disorder & Defense Mechanisms
A patient with Borderline Personality Disorder (BPD) is admitted to the psychiatric unit.
On day one, the patient tells the nurse, "You are the only one who understands me; you
are the best nurse here." On day two, the patient screams at the nurse, "You ar e
terrible! You don't care about me at all!" The nurse recognizes this behavior as:
A) Transference
B) Splitting
C) Projection
D) Countertransference
**Answer: B) Splitting**
**Rationale:**
* **Splitting** is a primitive defense mechanism commonly seen in BPD where the
patient cannot integrate positive and negative qualities of themselves or others. People
are viewed as "all good" or "all bad," with rapid, extreme shifts between the two.
,* *Why A is incorrect:* Transference is when the patient unconsciously redirects
feelings about a significant person in their past onto the nurse.
* *Why C is incorrect:* Projection is attributing one's own unacceptable thoughts or
feelings onto someone else (e.g., "I hate you" becomes "You hate me").
* *Why D is incorrect:* Countertransference is when the *nurse* unconsciously
redirects their own emotional reactions onto the patient.
---
### Question 2: Antisocial Personality Disorder Characteristi cs
A nurse is reviewing the medical record of a patient diagnosed with Antisocial
Personality Disorder (ASPD). Which of the following historical or behavioral findings is
the nurse MOST likely to observe?
A) Intense fear of abandonment and frantic efforts to avoid it
B) A pervasive pattern of disregard for, and violation of, the rights of others, occurring
since age 15
C) Preoccupation with orderliness, perfectionism, and control
D) A stable, long - term pattern of trusting interpersonal relationships
**Answer: B) A pervasive pattern of disregard for, and violation of, the rights of others,
occurring since age 15**
**Rationale:** ASPD is characterized by deceitfulness, manipulation, impulsivity,
irritability/aggression, reckless disregard for safety, and **lack of remorse**. A key
diagnostic criterion is that conduct disorder must have been present before age 15.
* *Why A is incorrect:* This describes Borderline Personality Disorder.
* *Why C is incorrect:* This describes Obsessive - Compulsive Person ality Disorder
(OCPD).
* *Why D is incorrect:* Individuals with ASPD are incapable of genuine intimacy and
consistently manipulate or exploit others in relationships.
, ---
### Question 3: Narcissistic Personality Disorder & Nursing Boundaries
A patient with Narcissistic Personality Disorder demands that the nurse cancel their
lunch break to sit and listen to the patient talk about their successful career. When the
nurse explains they must go to lunch, the patient becomes furious and states, "Yo u are
an incompetent nurse. I'm going to report you." What is the nurse's BEST response?
A) "I am so sorry. I will cancel my lunch and stay right here."
B) "Why are you so angry? I t's just a lunch break."
C) "I understand you are upset, but I am required to take my lunch break now. I will
return in 30 minutes and we can talk then."
D) "You have no right to threaten me. I am calling security."
**Answer: C) "I understand you are upset, but I am required to take my lunch break
now. I will return in 30 minutes and we can talk then."**
**Rationale:** Patients with Narcissistic PD expect special treatment, lack empathy for
others' needs, and react to criticism or perceived slights with ra ge. The nurse must set
**firm, consistent boundaries** without getting defensive or apologizing for having
basic needs.
* *Why A is incorrect:* This violates boundaries and reinforces the patient's grandiose
sense of entitlement.
* *Why B is incorrect:* "Why" questions are non - therapeutic and confrontational.
* *Why D is incorrect:* Escalating the situation by threatening security is unnecessary
here; the patient is just yelling, not posing a physical threat.
---
### Question 4: Alcohol Withdrawal & CIWA
A patient with a history of heavy alcohol use was admitted to the medical unit 24 hours
ago. The nurse enters the room and notes the patient is anxious, diaphoretic, has a
