NLE Psychiatric Disorders Reviewer 2026

Answer: B. Splitting

Step 1 — Identify the behavior: The client views one nurse as 'all good' and the other as 'all bad.' This is the hallmark of Splitting. Step 2 — Define Splitting: Splitting is the inability to integrate positive and negative qualities of a person into a whole. Clients with BPD see people as either completely good or completely bad — there is no middle ground. Step 3 — Eliminate wrong options: Projection means attributing one's own feelings to others. Denial means refusing to acknowledge a painful reality. Regression means reverting to an earlier developmental behavior. None of these match the scenario. Step 4 — Clinical significance: Splitting is dangerous in a team setting because it can cause staff conflict. The nursing team must use a consistent, unified care plan to prevent the client from playing one staff member against another.

Answer: C. Schizoid Personality Disorder

Step 1 — Focus on the key words: 'detachment from social relationships' and 'restricted emotional expression.' These are the defining features of Schizoid PD. Step 2 — Compare with similar disorders: Paranoid PD involves suspiciousness and distrust, not detachment. Schizotypal PD involves social discomfort PLUS cognitive-perceptual distortions and eccentric behavior. Avoidant PD involves social withdrawal due to FEAR of rejection — the client wants connection but avoids it. Step 3 — Key difference: Schizoid clients prefer solitude and genuinely do not desire social relationships; Avoidant clients desire relationships but are too afraid. Step 4 — All three (Paranoid, Schizoid, Schizotypal) are Cluster A — 'odd or eccentric.'

Answer: B. Ensure client safety and assess for suicidal ideation

Step 1 — Apply Maslow's Hierarchy: Safety is a second-level need (Safety and Security), which takes priority over psychosocial interventions. In a client with self-mutilation history, physical safety is always the FIRST priority. Step 2 — BPD and self-harm: Clients with BPD are at high risk for self-mutilation AND suicidal behavior. Self-harm may be used as an emotion-regulation strategy, but it can escalate to suicide attempts. Step 3 — Eliminate the distractors: Journaling is a good coping strategy but not the priority action. Group therapy is a long-term intervention. Medications may be prescribed but are not the immediate nursing priority — the nurse's first action is safety assessment. Step 4 — NLE priority tip: When in doubt, choose the option that addresses safety first before any psychosocial or comfort measures.

Answer: C. Preoccupation with orderliness, perfectionism, and rigid control

Step 1 — Know the key feature of OCPD: It is characterized by a pervasive preoccupation with orderliness, perfectionism, and mental and interpersonal control. The client is rigid and inflexible. Step 2 — Distinguish from OCD: OCD (Obsessive-Compulsive Disorder) involves ego-dystonic obsessions and compulsions — the client recognizes the behavior as intrusive and distressing (Option A). OCPD is ego-syntonic — the client sees the perfectionism as correct and even desirable. Step 3 — Eliminate other options: Option B describes Dependent PD. Option D describes Avoidant PD. Step 4 — Cluster C reminder: Avoidant, Dependent, and OCPD are all Cluster C — 'anxious or fearful.'

Answer: C. Conversion Disorder

Step 1 — Identify the clues: (1) Neurologic symptoms (paralysis) with no medical cause; (2) the client is calm and unconcerned — this is the classic 'la belle indifférence.' Step 2 — Define Conversion Disorder: Also called Functional Neurological Symptom Disorder, it presents with neurological symptoms (paralysis, blindness, seizures, aphonia) that cannot be explained by neurological disease. The hallmark sign is la belle indifférence — a lack of concern about a potentially disabling symptom. Step 3 — Eliminate distractors: Somatic Symptom Disorder involves excessive worry about physical symptoms. Illness Anxiety Disorder involves fear of having a serious illness with minimal physical symptoms. Factitious Disorder involves deliberate fabrication of symptoms to assume the sick role — symptoms are intentional, unlike Conversion Disorder. Step 4 — Key nursing point: Symptoms are real and involuntary — do not dismiss or confront the client.

Answer: B. Acknowledge that the symptoms are real to the client and limit secondary gain

Step 1 — Understand the nature of somatic disorders: The symptoms are NOT intentionally produced and are real to the client. Telling the client 'it's all in your head' is harmful and damages trust. Step 2 — The therapeutic approach has two components: (a) Validate the client's experience without reinforcing the sick role; and (b) Limit secondary gain — avoid excessive attention to symptoms that reinforces illness behavior. Step 3 — Why is confrontation wrong? Confronting the client causes defensiveness and destroys the therapeutic relationship. It is not evidence-based nursing. Step 4 — Why is excessive attention wrong? Giving too much attention to symptoms reinforces sick-role behavior and increases symptom reporting. Step 5 — Key nursing goal: Help the client connect emotional stress to physical symptoms over time and develop healthy coping skills.

Answer: B. Bradycardia and amenorrhea

Step 1 — Recall the pathophysiology of Anorexia Nervosa: The body is in a starvation state. All metabolic processes slow down to conserve energy. Step 2 — Expected findings include: Bradycardia (slow heart rate due to decreased metabolic demand), Hypotension (not hypertension), Hypothermia, Amenorrhea (loss of menstrual period due to low body weight and hormonal disruption), dry skin, lanugo (fine downy hair), and electrolyte imbalances. Step 3 — Eliminate wrong options: Hypertension and tachycardia are NOT expected — the opposite is true (hypotension and bradycardia). Russell's sign and parotid swelling are signs of Bulimia Nervosa (from purging). Normal weight and dental erosion also point to Bulimia, not Anorexia. Step 4 — Memory tip: In Anorexia, everything 'slows down' — heart rate, blood pressure, temperature, and hormonal function.

Answer: C. Russell's sign

Step 1 — Define Russell's sign: It refers to calluses or scarring on the knuckles or back of the hand, caused by repeatedly inserting fingers into the throat to induce vomiting. Step 2 — This is a specific physical assessment finding for Bulimia Nervosa and is important for nurses to recognize during a head-to-toe assessment. Step 3 — Eliminate distractors: Lanugo is fine downy body hair seen in Anorexia Nervosa due to starvation. La belle indifférence is the emotional unconcern seen in Conversion Disorder. Chvostek's sign is facial muscle twitching when the facial nerve is tapped — a sign of hypocalcemia. Step 4 — Other purging signs in Bulimia: Dental enamel erosion (from stomach acid), parotid gland swelling, esophagitis, electrolyte imbalances (especially hypokalemia and metabolic alkalosis).

Answer: C. Hypophosphatemia

Step 1 — Understand Refeeding Syndrome: When a severely malnourished client is fed too rapidly, the body shifts from a catabolic to an anabolic state. Insulin is released, which drives glucose, phosphate, potassium, and magnesium INTO cells. Step 2 — The hallmark electrolyte abnormality is hypophosphatemia (dangerously low phosphate levels). Phosphate is critical for energy metabolism (ATP production), and its sudden shift into cells depletes serum levels rapidly. Step 3 — Other electrolyte changes: Hypokalemia and hypomagnesemia also occur. These can trigger cardiac arrhythmias, heart failure, respiratory failure, and seizures — all life-threatening. Step 4 — Nursing responsibility: Reintroduce nutrition SLOWLY per protocol. Monitor electrolytes — especially phosphate, potassium, and magnesium — and replace as needed. Monitor cardiac rhythm and fluid balance daily.

Answer: B. Bupropion (Wellbutrin)

Step 1 — Know the contraindication: Bupropion is contraindicated in clients with eating disorders — especially those who purge — because it significantly lowers the seizure threshold. Clients who purge are already at risk for electrolyte imbalances (especially hypokalemia), which can further predispose them to seizures. Step 2 — What IS used: Fluoxetine (an SSRI) is the preferred antidepressant for Bulimia Nervosa and is FDA-approved for this indication. It helps reduce binge-purge episodes and depressive symptoms. Step 3 — Why are Sertraline and Amitriptyline not the answer? They are not specifically contraindicated in eating disorders the way Bupropion is. Bupropion's seizure risk in purging clients is a well-established, high-yield NLE fact. Step 4 — Memory tip: Bupropion + Purging = Seizure risk. Always choose fluoxetine over bupropion in eating disorder clients.

Answer: C. Severe anxiety

Step 1 – Recall the anxiety continuum: mild, moderate, severe, and panic. Step 2 – Severe anxiety is characterized by a greatly reduced perceptual field, inability to focus on details, and prominent physical symptoms such as headache, palpitations, and tremors – all present in this scenario. Step 3 – Mild anxiety enhances learning; moderate anxiety narrows the perceptual field but the client can still attend when redirected. Step 4 – Panic involves complete loss of rational thought, disorganized behavior, and a sense of terror – not yet described here. Step 5 – Therefore, severe anxiety is the correct level because the cluster of physical complaints and the scattered attention match its defining features.

Answer: B. Stay with the client, remain calm, and use short, clear directions.

Step 1 – During a panic attack, the client's perceptual field is severely impaired and judgment is compromised, making safety the top priority. Step 2 – The nurse must NEVER leave a panicking client alone – abandonment increases terror and risk of harm. Step 3 – A calm nurse presence and short, simple directives help the client regain a sense of control and reduce stimulation. Step 4 – Detailed teaching (Option A) and therapeutic discussion of triggers (Option D) are impossible during peak panic because the client cannot process complex information. Step 5 – Leaving the client alone (Option C) is contraindicated; the nurse's calm, steady presence is the single most therapeutic intervention at this point.