NLE Psychiatric Disorders — Personality, Somatic, and Eating DisordersExam Answer Templates

Marks

1

Topic

Refeeding Syndrome

Difficulty

easy

Template Id

T1

Examiner Tip

Examiners specifically look for the word 'hypophosphatemia.' Hypokalemia and hypomagnesemia also occur in refeeding syndrome but they are distractors for this 1-mark question. Be specific.

Model Answer

The hallmark electrolyte imbalance in refeeding syndrome is hypophosphatemia (low serum phosphate).

Question Type

very_short_answer

Answer Structure

• Line 1: State the specific electrolyte imbalance by name — hypophosphatemia [1 mark]

Scoring Breakdown

Common Mark Deductions

• Writing 'hypokalemia' or 'hypomagnesemia' alone — these also occur but are NOT the hallmark
• Leaving the answer vague by writing only 'electrolyte imbalance' without naming the specific electrolyte
• Spelling errors on 'hypophosphatemia' that make the term unrecognizable

Key Phrases To Include

• hypophosphatemia
• refeeding syndrome
• hallmark

Marks

1

Topic

Borderline Personality Disorder

Difficulty

easy

Template Id

T2

Examiner Tip

The phrase 'all good or all bad' is the exact language examiners expect. You may also say 'idealization and devaluation' as synonyms. Either earns the mark.

Model Answer

Splitting is a defense mechanism seen in borderline personality disorder in which the client views people as either all good or all bad, with no middle ground.

Question Type

very_short_answer

Answer Structure

• Line 1: Define splitting — all good or all bad, black-and-white thinking [1 mark]

Scoring Breakdown

Common Mark Deductions

• Describing splitting as 'the client splitting from reality' — this is incorrect; splitting refers to object relations, not psychosis
• Not connecting splitting to borderline personality disorder specifically
• Vague answers such as 'the client has conflicting feelings' without explaining the all-or-nothing nature

Key Phrases To Include

• all good or all bad
• splitting
• borderline personality disorder
• black-and-white

Marks

1

Topic

Somatic Symptom and Related Disorders

Difficulty

easy

Template Id

T3

Examiner Tip

Always pair la belle indifférence with conversion disorder. Both terms must appear together in your answer to earn full credit on this type of question.

Model Answer

La belle indifférence is a surprising lack of concern or anxiety shown by the client toward their own neurological symptoms. It is seen in conversion disorder (functional neurological symptom disorder).

Question Type

very_short_answer

Answer Structure

• Line 1: Define la belle indifférence — lack of concern about symptoms [0.5 mark]
• Line 1 (continued): Identify the disorder — conversion disorder [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Associating la belle indifférence with somatic symptom disorder or hypochondriasis instead of conversion disorder
• Describing it as 'the client faking indifference' — the indifference is genuine and unconscious
• Omitting the name of the disorder

Key Phrases To Include

• la belle indifférence
• lack of concern
• conversion disorder
• neurological symptoms

Marks

2

Topic

Eating Disorders

Difficulty

medium

Template Id

T4

Examiner Tip

For differentiation questions, always present the two conditions in parallel format. Examiners track whether you have addressed BOTH conditions. A clear contrast structure (Anorexia: ... / Bulimia: ...) earns full marks more reliably.

Model Answer

Anorexia nervosa is characterized by significantly low body weight due to severe restriction of food intake. Physical findings include lanugo (fine body hair as a response to starvation) and amenorrhea (absence of menstruation due to hormonal disruption from low body fat). Bulimia nervosa is characterized by normal or slightly overweight body weight despite recurrent binge-purge cycles. Physical findings include Russell's sign (calluses on the dorsum of the hand from self-induced vomiting) and dental enamel erosion caused by repeated exposure to gastric acid during purging.

Question Type

short_answer

Answer Structure

• Sentence 1: Body weight in anorexia nervosa — significantly low [0.5 mark]
• Sentence 2: Two physical findings in anorexia nervosa — lanugo AND amenorrhea [0.5 mark]
• Sentence 3: Body weight in bulimia nervosa — normal or slightly overweight [0.5 mark]
• Sentence 4: Two physical findings in bulimia nervosa — Russell's sign AND dental erosion [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Stating that bulimia clients are always thin — they are typically normal weight or slightly overweight
• Listing the same physical findings for both disorders (e.g., writing hypokalemia for both without explaining the mechanism difference)
• Not explaining what Russell's sign is — simply naming it without a brief description may not earn the mark

Key Phrases To Include

• significantly low body weight
• normal or slightly overweight
• lanugo
• amenorrhea
• Russell's sign
• dental enamel erosion

Marks

2

Topic

Borderline Personality Disorder

Difficulty

medium

Template Id

T5

Examiner Tip

For nursing intervention questions, examiners reward answers that demonstrate clinical reasoning — not just listing what to do, but WHY. Always link your intervention to a principle: Maslow's hierarchy, therapeutic communication, or disease pathophysiology.

Model Answer

1. Ensure client safety by assessing for self-harm risk and removing harmful objects from the environment. Rationale: Self-mutilation in borderline personality disorder is associated with emotional dysregulation and suicidal behavior, making safety the Maslow-based physiological and safety priority. 2. Set clear, firm, and consistent limits on self-harming behavior using a unified team approach. Rationale: A consistent team response prevents the client from using splitting — playing one staff member against another — which could otherwise undermine the therapeutic plan.

Question Type

short_answer

Answer Structure

• Intervention 1: Safety assessment and environmental modification [0.5 mark]
• Rationale 1: Link to Maslow safety priority and self-harm/suicidal risk in BPD [0.5 mark]
• Intervention 2: Consistent limit-setting with unified team approach [0.5 mark]
• Rationale 2: Link to prevention of splitting behavior [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Stating 'establish rapport' as a priority without addressing the immediate safety concern — rapport is important but not the first priority
• Not providing a rationale — the question explicitly asks for one, and omitting it loses 0.5 mark per intervention
• Using a punitive approach in the rationale (e.g., 'to punish the behavior') — this is clinically incorrect

Key Phrases To Include

• safety
• self-harm risk
• consistent limits
• unified team approach
• splitting
• Maslow
• borderline personality disorder

Marks

3

Topic

Personality Disorders

Difficulty

easy

Template Id

T6

Examiner Tip

Memorize the cluster descriptors as a mnemonic: A = Awkward/Aloof, B = Bold/Bad, C = Careful/Clingy. Examiners frequently test whether you can correctly assign disorders to their clusters and distinguish OCPD from OCD.

Model Answer

Personality disorders are classified into three clusters based on their predominant characteristics: 1. Cluster A — 'Odd or Eccentric': Includes paranoid personality disorder (pervasive distrust and suspiciousness of others' motives), schizoid personality disorder, and schizotypal personality disorder. Example: Paranoid personality disorder. 2. Cluster B — 'Dramatic, Emotional, or Erratic': Includes borderline, antisocial, histrionic, and narcissistic personality disorders. Example: Borderline personality disorder (characterized by fear of abandonment, splitting, and self-mutilation). 3. Cluster C — 'Anxious or Fearful': Includes avoidant, dependent, and obsessive-compulsive personality disorder (OCPD). Example: Dependent personality disorder (excessive need to be taken care of, difficulty making independent decisions).

Question Type

short_answer

Answer Structure

• Point 1: Cluster A — name, descriptor ('odd/eccentric'), one example disorder [1 mark]
• Point 2: Cluster B — name, descriptor ('dramatic/erratic'), one example disorder [1 mark]
• Point 3: Cluster C — name, descriptor ('anxious/fearful'), one example disorder [1 mark]

Scoring Breakdown

Common Mark Deductions

• Assigning a disorder to the wrong cluster — for example, placing antisocial personality disorder in Cluster C
• Omitting the cluster descriptor — examiners expect the adjective label (odd/eccentric, dramatic/erratic, anxious/fearful)
• Confusing OCPD (obsessive-compulsive personality disorder, Cluster C) with OCD (obsessive-compulsive disorder, an anxiety spectrum condition) — these are different diagnoses

Key Phrases To Include

• Cluster A
• odd or eccentric
• Cluster B
• dramatic emotional erratic
• Cluster C
• anxious or fearful
• borderline
• paranoid
• dependent

Marks

2

Topic

Eating Disorders — Pharmacology

Difficulty

medium

Template Id

T7

Examiner Tip

This is a high-yield pharmacology question. Examiners want the mechanism (lowers seizure threshold), the patient-specific risk factor (electrolyte imbalance from purging), AND the safe alternative (fluoxetine). Missing any one of these components costs you marks.

Model Answer

Bupropion (an antidepressant) is contraindicated in bulimia nervosa because it significantly lowers the seizure threshold. Clients with bulimia nervosa who engage in purging (self-induced vomiting, laxative or diuretic misuse) develop electrolyte imbalances — particularly hypokalemia and metabolic alkalosis — which already predispose them to seizures. Administering bupropion to these clients further increases seizure risk, making it unsafe. The preferred antidepressant for bulimia nervosa is fluoxetine (an SSRI), which is both effective and safer in this population.

Question Type

short_answer

Answer Structure

• Sentence 1: State the contraindication — bupropion lowers the seizure threshold [0.5 mark]
• Sentence 2: Explain the mechanism — purging causes electrolyte imbalances (hypokalemia) that predispose to seizures [0.5 mark]
• Sentence 3: State the combined risk — bupropion + electrolyte imbalance = high seizure risk [0.5 mark]
• Sentence 4: Name the preferred alternative — fluoxetine [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Stating bupropion is contraindicated without explaining the mechanism (seizure threshold) — rationale is required for full marks
• Failing to mention the role of purging-induced electrolyte imbalances in increasing seizure risk
• Not naming fluoxetine as the safer alternative — this demonstrates incomplete knowledge of pharmacological management

Key Phrases To Include

• bupropion
• lowers seizure threshold
• purging
• hypokalemia
• electrolyte imbalance
• contraindicated
• fluoxetine
• bulimia nervosa

Marks

3

Topic

Refeeding Syndrome

Difficulty

hard

Template Id

T8

Examiner Tip

Structure your answer in three clear parts: Definition → Electrolyte (hypophosphatemia) → Complications. Examiners follow this sequence when awarding marks, so a logical structure helps them credit you efficiently.

Model Answer

Refeeding syndrome is a potentially fatal metabolic complication that occurs when nutrition is reintroduced too rapidly to a severely malnourished client. It is most commonly seen in clients with anorexia nervosa. As the body transitions from a catabolic (starvation) state to an anabolic state, a surge in insulin drives electrolytes — especially phosphate — from the bloodstream into the cells, causing profound hypophosphatemia, which is the hallmark electrolyte imbalance. Hypokalemia and hypomagnesemia also occur, along with fluid shifts. Clinical complications include: 1. Cardiac arrhythmias and cardiac failure — due to hypophosphatemia and electrolyte disturbances impairing cardiac muscle function. 2. Respiratory failure — due to respiratory muscle weakness caused by phosphate depletion.

Question Type

short_answer

Answer Structure

• Sentence 1–2: Definition of refeeding syndrome — too-rapid reintroduction of nutrition in malnourished client, most common in anorexia nervosa [1 mark]
• Sentence 3: Pathophysiology and hallmark — insulin surge drives phosphate into cells → hypophosphatemia [1 mark]
• Points 1–2: Two clinical complications — cardiac arrhythmia/failure AND respiratory failure (or seizures/death) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Describing refeeding syndrome as a complication of bulimia rather than anorexia nervosa (though it can technically occur in any malnourished state)
• Listing only hypokalemia as the hallmark electrolyte disturbance instead of hypophosphatemia
• Omitting the mechanism (insulin surge driving phosphate into cells) — a definition without pathophysiology earns only partial credit

Key Phrases To Include

• refeeding syndrome
• hypophosphatemia
• hallmark
• anorexia nervosa
• insulin surge
• catabolic to anabolic
• cardiac arrhythmias
• respiratory failure
• malnourished

Marks

3

Topic

Antisocial Personality Disorder

Difficulty

medium

Template Id

T9

Examiner Tip

In case study questions, always link your nursing interventions to specific characteristics of the disorder described in the scenario. Here, the client's 'charming and manipulative' behavior should trigger your response about consistent limits and unified team approach — show the examiner you made that clinical connection.

Model Answer

The appropriate nursing approach for a client with antisocial personality disorder centers on firm, consistent limit-setting and a unified team approach. 1. Establish and enforce clear, non-negotiable limits: All staff must agree on and consistently enforce unit rules without exception. Rationale: Clients with antisocial personality disorder use manipulation and charm to exploit inconsistencies among staff. Consistent enforcement removes opportunities for rule-bending. 2. Use a unified team approach with clear communication: All nurses and the multidisciplinary team must communicate the care plan to each other and present the same response to the client. Rationale: This prevents the client from selectively approaching different staff members — a behavior analogous to splitting — to obtain different outcomes. 3. Hold the client accountable for behavior in a matter-of-fact, non-punitive manner: Consequences of rule violations should be applied consistently and without anger or emotional reaction. Rationale: Antisocial personality disorder involves a lack of remorse and disregard for others' rights. Punitive responses escalate conflict, while a calm, firm approach models appropriate boundaries without reinforcing negative attention-seeking.

Question Type

case_study

Answer Structure

• Point 1: Consistent limit-setting — state the intervention and rationale linking to manipulation behavior [1 mark]
• Point 2: Unified team approach and communication — state intervention and rationale about preventing exploitation of inconsistency [1 mark]
• Point 3: Non-punitive accountability — state intervention and rationale connecting to antisocial traits (no remorse, boundary violations) [1 mark]

Scoring Breakdown

Common Mark Deductions

• Describing the approach as primarily empathic or rapport-building without addressing the manipulation — while therapeutic alliance matters, limit-setting is the priority here
• Recommending punitive approaches (e.g., isolation, anger from staff) — this is clinically inappropriate and loses marks
• Omitting rationale — case study questions require you to explain WHY the intervention is appropriate

Key Phrases To Include

• consistent limits
• unified team approach
• manipulation
• non-punitive
• hold accountable
• antisocial personality disorder
• lack of remorse

Marks

2

Topic

Somatic Symptom and Related Disorders

Difficulty

medium

Template Id

T10

Examiner Tip

A common NLE trap for somatic disorders is to choose answers that either dismiss the client ('it's not real') or excessively validate by ordering more tests. The correct approach is always: validate the distress, do not confront, and gradually connect symptoms to emotional stress.

Model Answer

The primary nursing intervention is to acknowledge that the client's symptoms are real and distressing to them without reinforcing excessive sick-role behavior or dismissing their experience. The nurse should: (1) Validate the client's distress — state that the discomfort they feel is real and taken seriously — while providing factual, calm information about the normal test results. (2) Avoid confrontation (do not tell the client 'it's all in your head') as this damages trust and increases anxiety. Over time, the nurse should gently help the client make the connection between emotional stress and physical symptoms, and redirect toward adaptive coping strategies and stress management.

Question Type

short_answer

Answer Structure

• Sentence 1: Acknowledge and validate the reality of the symptoms [0.5 mark]
• Sentence 2: Avoid confrontation — do not dismiss or challenge the client [0.5 mark]
• Sentence 3: Gently connect stress/emotions to physical symptoms over time [0.5 mark]
• Sentence 4: Redirect to adaptive coping and stress management [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Stating the nurse should 'tell the client the pain is not real' — this is therapeutically incorrect and earns zero for that component
• Recommending only further medical testing — this reinforces sick-role behavior and doctor-shopping
• Not addressing the need to limit secondary gain from the sick role

Key Phrases To Include

• symptoms are real
• avoid confrontation
• not all in your head
• validate
• stress and physical symptoms
• adaptive coping
• somatic symptom disorder

Marks

5

Topic

Anorexia Nervosa

Difficulty

hard

Template Id

T11

Examiner Tip

For 5-mark long-answer questions in the NLE, examiners reward three things: breadth (covering enough findings), depth (pathophysiology for each), and clinical application (nursing priority). Aim for 4 findings with pathophysiology plus a nursing implication paragraph to maximize your score.

Model Answer

Anorexia nervosa results in severe malnutrition due to extreme restriction of food intake. The physical manifestations reflect the body's response to prolonged starvation: 1. Amenorrhea (absence of menstruation): Severe reduction in body fat disrupts the hypothalamic-pituitary-ovarian axis. Insufficient leptin and estrogen levels prevent normal menstrual cycling. This is a direct consequence of the body conserving resources during starvation. 2. Bradycardia (heart rate below 60 bpm): Starvation causes the heart muscle to weaken (cardiac muscle atrophy). The body also decreases metabolic rate to conserve energy, resulting in a decreased heart rate. This places the client at risk for cardiac arrhythmias and sudden cardiac death. 3. Lanugo (fine, downy body hair): When the body loses subcutaneous fat (a key insulator), it grows lanugo as a thermoregulatory mechanism to retain body heat. This is a regression to a fetal hair pattern and is a classic sign of severe starvation. 4. Hypothermia (low body temperature): The loss of subcutaneous fat combined with a lowered metabolic rate reduces the body's ability to generate and retain heat, resulting in abnormally low core body temperature. Additional findings the nurse should monitor include: hypotension, dry skin and hair, electrolyte imbalances (especially hypokalemia), and osteoporosis from calcium and estrogen deficiency. Nursing Priority: Because of the risk of cardiac arrhythmias and sudden cardiac death from electrolyte disturbances and cardiac muscle atrophy, medical stabilization — including cardiac monitoring and electrolyte correction — is the FIRST priority of care in anorexia nervosa, before psychological interventions.

Question Type

long_answer

Answer Structure

• Introduction sentence: Link findings to malnutrition/starvation pathophysiology [0.5 mark]
• Finding 1: Amenorrhea — with pathophysiology (hypothalamic-pituitary axis disruption, low estrogen) [1 mark]
• Finding 2: Bradycardia — with pathophysiology (cardiac muscle atrophy, decreased metabolic rate, arrhythmia risk) [1 mark]
• Finding 3: Lanugo — with pathophysiology (loss of subcutaneous fat, thermoregulatory response) [1 mark]
• Finding 4: Hypothermia — with pathophysiology (loss of fat insulation, decreased metabolism) [1 mark]
• Nursing priority statement: Medical stabilization and cardiac monitoring first [0.5 mark]

Scoring Breakdown

Common Mark Deductions

• Listing physical findings without explaining the pathophysiology — a 5-mark question requires depth, not just enumeration
• Omitting the nursing priority statement — in a 5-mark question, examiners expect clinical application, not just knowledge recall
• Confusing anorexia findings with bulimia findings — for example, attributing Russell's sign or parotid swelling to anorexia
• Not addressing cardiac risk — this is one of the most life-threatening aspects and its omission signals a knowledge gap to examiners

Key Phrases To Include

• amenorrhea
• bradycardia
• lanugo
• hypothermia
• starvation
• cardiac arrhythmias
• subcutaneous fat
• hypothalamic-pituitary axis
• medical stabilization
• electrolyte imbalance

Marks

5

Topic

Anorexia Nervosa and Refeeding Syndrome

Difficulty

hard

Template Id

T12

Examiner Tip

This type of integrative case study is common in the NLE. Examiners award marks in layers: medical → refeeding syndrome → eating plan → psychological. Answering in this logical sequence — following Maslow's hierarchy — signals both clinical competence and exam sophistication. Mention RA 11036 in every psychiatric nursing case study for that extra mark.

Model Answer

This client presents with severe anorexia nervosa and requires immediate medical stabilization before psychological or nutritional rehabilitation can safely begin. Priority 1 — Medical Stabilization (Maslow: Physiological and Safety Needs): Assess vital signs, cardiac rhythm (ECG monitoring), and baseline electrolytes — particularly potassium, phosphate, and magnesium. Correct any existing electrolyte imbalances before initiating refeeding. Monitor for bradycardia, hypotension, and hypothermia, which are signs of cardiovascular compromise from starvation. Priority 2 — Prevention of Refeeding Syndrome: Refeeding syndrome is a life-threatening complication that occurs when nutrition is reintroduced too rapidly to a severely malnourished client. As the body shifts from catabolic starvation to anabolic feeding, insulin surges and drives phosphate, potassium, and magnesium from the blood into the cells. The hallmark is profound hypophosphatemia, which can trigger cardiac arrhythmias, cardiac failure, respiratory failure, and seizures. Nursing interventions to prevent refeeding syndrome: - Reintroduce nutrition SLOWLY and advance caloric intake gradually per the physician/dietitian protocol — do not rush refeeding. - Monitor electrolytes closely — especially serum phosphate, potassium, and magnesium — at scheduled intervals and replace as ordered. - Monitor fluid balance, daily weight, and signs of fluid overload (edema, respiratory difficulty). - Maintain continuous cardiac monitoring and report any arrhythmias immediately. Priority 3 — Structured Eating Plan and Behavioral Management: Implement a structured meal plan supervised by the dietitian. Observe the client during meals and for approximately one hour after eating to prevent purging, food-hiding, or food disposal. Use a matter-of-fact, non-punitive approach — avoid power struggles over food. Priority 4 — Psychological and Family Support: Once medically stable, refer to therapy — including cognitive-behavioral therapy and family therapy (particularly important for adolescents). Bupropion must be avoided due to its seizure risk in malnourished clients; fluoxetine may be considered adjunctively once medically stable. All care is delivered in adherence with the Philippine Mental Health Act (RA 11036), which protects the client's right to humane, dignity-preserving, and community-integrated mental health care.

Question Type

case_study

Answer Structure

• Priority 1: Medical stabilization — vital signs, cardiac monitoring, electrolyte correction [1 mark]
• Priority 2 definition: Define refeeding syndrome and its mechanism (hypophosphatemia, insulin surge) [1 mark]
• Priority 2 interventions: Slow reintroduction, electrolyte monitoring, fluid balance, cardiac monitoring [1 mark]
• Priority 3: Structured eating plan, meal supervision, one-hour post-meal observation [1 mark]
• Priority 4: Psychological support, therapy, pharmacology (fluoxetine yes / bupropion no), RA 11036 reference [1 mark]

Scoring Breakdown

Common Mark Deductions

• Beginning with psychological interventions before medical stabilization — this violates Maslow's hierarchy and is a serious clinical reasoning error
• Omitting refeeding syndrome entirely — this is the most critical complication in this scenario and its omission may result in losing 2 marks
• Not specifying slow/gradual reintroduction of nutrition — saying 'start feeding' without specifying the gradual approach misses the prevention point
• Recommending bupropion — this is a direct contraindication and shows pharmacological knowledge deficit
• Not mentioning post-meal observation (approximately one hour) — this is a specific and testable NLE point

Key Phrases To Include

• refeeding syndrome
• hypophosphatemia
• slowly advance nutrition
• electrolyte monitoring
• cardiac monitoring
• one hour after meals
• fluoxetine
• bupropion contraindicated
• RA 11036
• medical stabilization first
• Maslow

Marks

2

Topic

Somatic Symptom and Related Disorders

Difficulty

medium

Template Id

T13

Examiner Tip

Remember the three-way distinction tested on the NLE: Somatic symptom disorder = symptoms NOT intentional; Factitious disorder = intentional, for sick role (internal); Malingering = intentional, for external gain. This triad is frequently tested.

Model Answer

Factitious disorder is the deliberate falsification or induction of physical or psychological symptoms in order to assume the sick role and receive care — the motivation is internal (emotional need). The client does not gain tangible external rewards. Mailingering is the intentional feigning or exaggeration of symptoms for an identifiable external gain — such as avoiding military service, obtaining financial compensation, evading legal consequences, or obtaining prescription medications. The motivation is external. Key distinction: Both involve intentional symptom production, but factitious disorder is motivated by the psychological need to be a patient (sick role), while malingering is motivated by concrete external benefits.

Question Type

short_answer

Answer Structure

• Definition of factitious disorder — deliberate symptom falsification for sick role / internal motivation [0.5 mark]
• Definition of malingering — intentional symptom feigning for external gain [0.5 mark]
• Key distinction — internal (sick role) vs. external (tangible gain) motivation [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating that factitious disorder is not intentional — it IS intentional; what distinguishes it from somatic symptom disorder is that somatic symptoms are NOT intentionally produced
• Confusing factitious disorder with somatic symptom disorder — in somatic, symptoms are unintentional; in factitious, they are deliberate
• Not specifying the nature of the external gain in malingering

Key Phrases To Include

• factitious disorder
• sick role
• internal motivation
• malingering
• external gain
• intentional
• deliberate

Marks

2

Topic

Borderline Personality Disorder — Treatment

Difficulty

easy

Template Id

T14

Examiner Tip

For therapy questions, always name the therapy, describe what it does (skills it teaches), and state which disorder it is used for. This three-part structure consistently earns full marks.

Model Answer

Dialectical behavior therapy (DBT) is a structured psychotherapy developed specifically for borderline personality disorder. It teaches clients four core skill sets: distress tolerance (managing crisis without self-harm), emotion regulation (identifying and managing intense emotions), mindfulness (present-moment awareness), and interpersonal effectiveness (building healthier relationships). DBT is considered the treatment of choice for borderline personality disorder, particularly because it directly addresses the disorder's hallmark features: emotional dysregulation, impulsivity, self-mutilation, and unstable relationships.

Question Type

short_answer

Answer Structure

• Sentence 1: Define DBT — structured psychotherapy for BPD [0.5 mark]
• Sentence 2: Name the four skill sets (distress tolerance, emotion regulation, mindfulness, interpersonal effectiveness) [0.5 mark]
• Sentence 3: Identify BPD as the primary indication and link to BPD features [1 mark]

Scoring Breakdown

Common Mark Deductions

• Stating DBT is used for all personality disorders — it is specifically the treatment of choice for borderline PD
• Naming only one DBT skill component when the question or mark value implies more detail is needed
• Confusing DBT with cognitive-behavioral therapy (CBT) — while related, DBT is the specific therapy for BPD

Key Phrases To Include

• dialectical behavior therapy
• DBT
• borderline personality disorder
• distress tolerance
• emotion regulation
• mindfulness
• interpersonal effectiveness
• treatment of choice

Marks

5

Topic

Bulimia Nervosa

Difficulty

hard

Template Id

T15

Examiner Tip

In 5-mark nursing management questions, present your interventions in order of priority — physiological safety first (electrolytes/cardiac), then behavioral monitoring, then psychological. This Maslow-based sequencing signals clinical reasoning competence and consistently earns higher marks than a randomly ordered list.

Model Answer

Bulimia nervosa is characterized by recurrent binge-purge cycles and carries significant physical complications from purging behavior. Nursing management in an inpatient setting focuses on physical safety, behavioral monitoring, and therapeutic support: 1. Monitor electrolytes — especially serum potassium, sodium, and chloride — at regular intervals, as ordered. Rationale: Repeated purging (vomiting, laxative/diuretic use) causes hypokalemia and metabolic alkalosis. Hypokalemia can precipitate life-threatening cardiac arrhythmias. This is the highest physiological priority per Maslow's hierarchy. 2. Observe the client during meals and for approximately one hour after each meal. Rationale: Post-meal supervision prevents the client from purging after eating. One hour is the standard time frame used because the urge to purge is highest immediately after intake. This must be done consistently and without accusation to maintain the therapeutic relationship. 3. Monitor daily weight using a consistent method (same time of day, same scale, same clothing). Rationale: Consistent weighing detects fluid shifts, signs of purging, and treatment response. Inconsistent methods produce inaccurate data and unreliable trends. 4. Implement a structured meal plan developed with a registered dietitian and provide a matter-of-fact, non-punitive approach during mealtimes. Rationale: Eating disorder clients are highly sensitive to food-related power struggles. A matter-of-fact approach reduces anxiety and avoids reinforcing disordered behaviors. The structured plan establishes predictable, safe eating patterns. 5. Build therapeutic rapport and address distorted body image using cognitive-behavioral techniques; facilitate referral to individual and group therapy. Rationale: Bulimia nervosa is driven by distorted body image, low self-esteem, and maladaptive coping. Therapy addresses the psychological root of binge-purge cycles. Fluoxetine (SSRI) is used adjunctively; bupropion is contraindicated due to seizure risk in purging clients. All interventions are implemented within the framework of the Philippine Mental Health Act (RA 11036), which mandates humane, rights-based psychiatric care.

Question Type

long_answer

Answer Structure

• Intervention 1: Electrolyte monitoring — with rationale (hypokalemia, cardiac arrhythmia risk) [1 mark]
• Intervention 2: Meal supervision and one-hour post-meal observation — with rationale (prevent purging) [1 mark]
• Intervention 3: Consistent daily weight monitoring — with rationale (detect fluid shifts/purging) [1 mark]
• Intervention 4: Structured meal plan with non-punitive approach — with rationale (reduce power struggles, establish safe patterns) [1 mark]
• Intervention 5: Therapeutic relationship, body image work, therapy, pharmacology (fluoxetine/bupropion), RA 11036 [1 mark]

Scoring Breakdown

Common Mark Deductions

• Listing interventions without rationale — a 5-mark question requires both action and reasoning for each point
• Omitting post-meal observation (one hour) — this is a high-yield NLE-specific detail that examiners explicitly look for
• Recommending bupropion — this is a direct contraindication in bulimia
• Not addressing electrolytes and cardiac risk — these are the physiological priorities and their omission signals poor prioritization

Key Phrases To Include

• electrolyte monitoring
• hypokalemia
• cardiac arrhythmias
• one hour after meals
• daily weight
• structured meal plan
• non-punitive
• body image
• fluoxetine
• bupropion contraindicated
• RA 11036