delmars Dissociative disorders

20. the registered nurse is preparing to delegate nursing assignments to various team members in a psychiatric unit. which of the following assignments is appropriate for the nurse to delegate? 1. a licensed practical nurse establishes the nursing diagnoses for a client with a dissociative disorder 2. unlicensed assistive personnel provide a safe environment for a client with a dissociative disorder 3. a licensed practical nurse assesses a client for clinical manifestations of dissociative fugue 4. unlicensed assistive personnel encourage a client with a dissociative disorder to verbalize feelings of suicide

. 20. 2. unlicensed assistive personnel may provide a safe environment for a client with a dissociative disorder. only a registered nurse should write nursing diagnoses to direct a plan of care. a registered nurse should assess a client for clinical manifestations. it is inappropriate for unlicensed assistive personnel to encourage a client to verbalize feelings of suicide.

25. following a serious car accident, a client is admitted to the psychiatric unit of the hospital with memory loss. which of the following behaviors would the nurse assess that would support a diagnosis of dissociative amnesia? the client 1. has an inability to recall important information of the event. 2. experienced a flashback while high on pcp, which resulted in the accident. 3. has a seizure disorder, which precipitated the accident. 4. is not concerned about the accident.

. 25. 1. inability to recall important personal information of the event is a diagnostic criterion for dissociative amnesia. it is not precipitated by substances or a medical condition. the amnesia causes great distress to the client.

7. when treating a client with a dissociative disorder, which of the following is a priority intervention that the nurse should implement for early intervention? 1. establish a therapeutic alliance 2. complete the history that the client cannot recall 3. suggest hypnosis to uncover repressed information 4. try to establish the triggering events

. 7. 1. the nurse must establish a therapeutic alliance, so that trust may develop and the client may be able to reveal traumatic events with reduced anxiety. the nurse should not fill in the history for the client, because the client may find it frustrating and because mobilizing the memory is healing for the client. hypnosis has been used with mixed success and is now considered much less effective than initially thought. establishing the triggering event is the work of the client and the psychotherapist at the appropriate time in the therapy.

1. the nurse is assessing a client suspected of having a dissociative disorder. which of the following describes a dissociative disorder? Dissociative disorders 1. are produced by extreme anxiety. 2. appear only in schizophrenia. 3. are fixed and chronic. 4. are voluntary.

1. 1. Dissociative disorders are produced by extreme anxiety, when circumstances become overwhelming and the traditional coping mechanism cannot contain the anxiety. Dissociative disorders are not confined to schizophrenia but are a diagnostic category by themselves. Dissociative disorders are not fixed and chronic but change and can be temporary. Dissociative disorders are not voluntary.

10. which of the following is the goal of therapy that is a priority when treating a client with a dissociative disorder? 1. behavioral therapy 2. cognitive restructuring 3. family therapy 4. Safety

10. 4. safety is the priority goal when caring for a client with a dissociative disorder, because the client's natural protective instincts have been compromised. behavioral therapy is inappropriate for a dissociative disorder, because it involves cognitive restructuring. family therapy may be appropriate at a later date but is not usually indicated.

11. the nurse is recording the history of a client with a dissociative disorder. which of the following events would most likely contribute to the diagnosis? history of 1. brain tumor. 2. substance abuse. 3. child abuse. 4. seizures.

11. 3. traumatic events are often precipitating factors in dissociative disorders because they result in the individual's attempt to protect the self from remembering traumatic events. brain tumors, substance abuse, and epilepsy have not been established as positive links to dissociative disorders.

12. which of the following interventions is appropriate for the nurse to include in a plan of care for a client with a dissociative disorder? 1. avoid confirming the identity of the client 2. recall past events for the client 3. assist the client to understand the benefits of dissociation to cope 4. avoid letting the client make decisions

12. 3. the nurse should assist the client who has a dissociative disorder to understand the benefits of the dissociation to cope. the client should be reoriented to person, place, and time. the nurse should encourage and assist the client to make personal decisions.

13. the nurse is assessing the client with dissociative amnesia. which of the following clinical manifestations is most indicative of the disorder? 1. the inability to recall important personal information, usually of a traumatic nature 2. Disturbance occurs exclusively during the course of other mental disorders 3. existence of two or more subpersonalities 4. memory is retrievable at the will of the client

13. 1. the inability to recall important personal information is paramount in dissociative amnesia, because the memory does not selectively block information when attempting to suppress traumatic events. Disturbancesoccur outside the course of other mental disorders. the clinical manifestations create great distress. memory is not voluntarily retrievable. the existence of two distinct subpersonalities is a feature of dissociative identity disorder.

14. a client is admitted to the psychiatric ward of a hospital with complaints of a loss of a sense of self. the nurse treating the client anticipates which of the following clinical manifestations? 1. the presence of a change in voice and mannerism when under stress 2. the presence of active hallucinations 3. the inability of the client to follow simple directions 4. a history of substance abuse

14. 1. the presence of alternate personalities with different affective states and changes in mannerisms, voice, and gender may appear under stress in a client with a dissociative disorder. there is no presence of hallucinations as there is in schizophrenia. the client can follow directions because the ability to understand instructions is not impaired. the etiology of the disorder is not due to substance abuse or a medical condition.

15. when planning the care of a client with a dissociative disorder, the nurse should include which of the following interventions? 1. aid the client to learn to deal constructively with stress 2. instruct the client to suppress anxietyproducing thoughts 3. encourage the client to ignore the personalities 4. assist the client to maintain occupational pursuits

15. 1. stress precipitates the splitting off of personalities in a client with a dissociative disorder. constructive reintegration relies on the ability to deal with stress. the client should not suppress anxiety, because it will reemerge in the subpersonality. clients cannot ignore the alternative personalities, even though they lie outside of the client's control. clients are often unable to maintain occupational functioning due to the intensity of the disorder.

16. the nurse is working with a client who has a dissociative disorder. which of the following would indicate to the nurse that the client's condition is deteriorating? 1. expressions of suicide and hopelessness 2. expressions of forgetfulness 3. the presence of substance abuse 4. the inability to take care of basic needs

16. 1. expressions of suicidal ideation and feelings of hopelessness and worthlessness are critical markers for impending suicide attempts in a client who has a dissociative disorder. they indicate that the client's condition is deteriorating and that intervention is imperative. forgetfulness is not in itself a dangerous risk. substance abuse may preclude the diagnosis of a dissociative disorder because the substance masks the disorder. the client with a dissociative disorder maintains the ability to conduct activities of daily living.

17. the nurse evaluating the progress of a client with a dissociative disorder should consider which of the following behaviors as significant? 1. the client can voluntarily call up all of the subpersonalities 2. the client successfully suppresses feelings about events in the past 3. the client has difficulty recognizing the environment 4. the client identifies significant others

17. 4. as personality disturbances clear with a dissociative disorder, the client will regain the ability to identify and recognize significant others. there will be an absence of subpersonalities. feelings will not be suppressed but will become available for recall. the client can identify and recognize the environment.

18. the client with clinical manifestations of a dissociative disorder may develop secondary manifestations. which of the following behaviors should be a priority for the nurse to consider? 1. the client's confusion clears after identity is reestablished 2. the client decreases assaultive behavior 3. the client controls panic during a depersonalization experience 4. the client attempts self-harm from alternate personalities

18. 4. the client's attempt of self-harm is a secondary manifestation in a dissociative disorder. the client's confusion and assaultive behavior may worsen. the client is likely to experience an escalation in panic.

19. the nurse is caring for a client with a dissociative disorder. which of the following is a priority to include in the client's health teaching? 1. prevent dissociative episodes by becoming aware of triggers 2. avoid outside activities that divert the focus of care from the disorder 3. avoid focusing on delusional processes 4. Delegate stressful tasks away from the client and to other family members

19. 1. awareness of the triggers of the dissociative process allows the client the control to reduce the occurrence of episodes. outside activities are encouraged, such as music, physical activity, and socialization. therapy involves the free exchange of communication, including any existence of delusions. the client's recovery depends on the ability of the client to deal with the stressors in life

2. when assessing a client who is experiencing dissociative fugue, the nurse should assess for which of the following clinical manifestations? select all that apply: [ ] 1. travel away from common locations [ ] 2. chronic long-term state [ ] 3. recollection of the fugue after an acute phase [ ] 4. not preceded by a stress event [ ] 5. unable to recall past identity [ ] 6. assumes new identity

2. 1. 5. 6. clinical manifestations of dissociative fugue include travel away from common locations, inability to recall past identity, and assuming a new identity. Dissociative fugue is not long term and can remit spontaneously. there is no recollection of the fugue state. Dissociative fugue is precipitated by stress.

21. the nurse assesses which of the following clinical manifestations in a client suspected of depersonalization disorder? select all that apply: [ ] 1. thoughts of being someone else [ ] 2. sensations of not being human [ ] 3. intact reality testing [ ] 4. impaired social and occupational functioning [ ] 5. indifference to personal condition [ ] 6. onset before the age of 20 years

21. 2. 3. 4. sensations of not being human or alive are common in depersonalization disorders. the thought of being someone else is not characteristic. the incidence of depersonalization disorder decreases as the client ages. there is great distress associated with a depersonalization episode.

22. the nurse is caring for a client who has amnesia related to a traumatic event. which of the following nursing diagnoses would be most appropriate for the client? 1. Disturbed body image 2. ineffective coping 3. anxiety 4. Disturbed personal identity

22. 4. the appropriate nursing diagnosis for a client who is experiencing amnesia related to a traumatic event would be disturbed personal identity.

23. the nurse is teaching a client with dissociative identity disorder about the disorder. which of the following interventions would be a priority? 1. make a suicide contract with the client 2. explain the client's behavior to other clients 3. inform the client of the forgotten material 4. encourage anxiety-producing activities to bring out subpersonalities

23. 1. one-to-one supervision and making a suicide contract with a client who has a dissociative disorder are priorities to meet the safety needs of the client under distress. confidentiality is of the utmost importance. never try to force recallof information the client is not prepared to know. reduction of anxiety helps avoid the emergence of subpersonalities.

24. the nurse should include which of the following interventions in the plan of care for a client with a dissociative disorder? 1. avoid placing the client in group therapy 2. provide the client with complex instructions for maintenance of activities of daily living 3. Decrease the confusion and noise in the environment 4. avoid social interaction with other clients

24. 3. nursing interventions appropriate for a client with a dissociative disorder include decreasing confusion and noise in the environment. this will decrease anxiety. group therapy is recommended. simple instructions for grooming and activities of daily living are recommended. social interaction is encouraged to avoid withdrawal and isolation

26. the nurse understands which of the following to be a manifestation of dissociative identity disorder? 1. the personalities are all aware of one another 2. the disorder is never chronic 3. the recall of traumatic events is intact 4. the client was confronted with an intolerable terror event

26. 4. the initial event of a dissociative disorder was an event the client confronted and found so intolerable that the client's memory split off into another personality. the personalities are often out of the awareness of the primary personality. the disorder can be episodic or chronic. recall of the traumatic event is not available to the primary personality.

3. the nurse admitting a client suspected of dissociative amnesia would report which of the following manifestations? 1. the client's inability to recall personal information 2. the amnesia has its etiology in a medical condition 3. the amnesia is the result of prolonged substance abuse 4. the client exhibits common forgetfulness

3. 1. a client with dissociative amnesia is unable to recall familiar personal information. the amnesia is not associated with a medical condition, such as brain injury, trauma, or toxicity of substances. the amnesia is beyond common forgetfulness.

4. the nurse identifies which of the following as the primary feature of dissociative identity disorder (DiD)? 1. the presence of alternating control by two or more personalities 2. the personalities are always unaware of each other 3. the condition is unique to schizophrenia 4. all of the personalities possess similar sexual, racial, and intellectual characteristics

4. 1. the presence of multiple personalities is a classic feature of dissociative identity disorder. the personalities are sometimes aware of each other but often out of the awareness of the primary personality. Dissociative identity disorder is a condition in a diagnostic category by itself and is not necessarily tied to schizophrenia. the personalities may possess different sexual, racial, and intellectual characteristics.

5. which of the following is the priority goal for a client with dissociative identity disorder? 1. meet safety and security needs 2. reorient the client to the true identity 3. assist the client to forget the stressproducing events 4. avoid discussing stress-producing subjects

5. 1. ensuring the safety and security needs of the client are the priority goals for a client experiencing dissociative identity disorder, because the normal protective processes for the client are impaired. reorientation of the client to the identity is done with a therapist at the appropriate time in the therapy. the client will need to understand the stress-producing events in the course of therapy in order to deal with the anxiety. the client will need to discuss stress-producing subjects to help develop methods of dealing appropriately with the stress.

6. when establishing a diagnosis of a dissociative disorder for a client, what information is a priority for the nurse to assess? 1. conduct an interview until all lost information is available 2. rule out the use of substances or the existence of a medical condition 3. the client has been treated for depression 4. the client's ability to recall the precipitating event

6. 2. it is essential that the use of substances and the existence of a medical condition are ruled out, because they may cause the same type of clinical manifestations. the client cannot recall all lost information. the client may or may not be depressed, which is not a precondition for a dissociative disorder. the client may not remember what precipitated the dissociative event

8. which of the following clinical manifestations should the nurse assess in a client with depersonalization disorder? 1. anger 2. a loss of reality testing ability 3. mechanical dreamy or detached feelings 4. ambivalence

8. 3. a client with depersonalization disorder has a mechanical dreamy or detached feeling. client anger is not a cardinal sign. the client does not lose the ability to perform reality tests. ambivalence is not a criterion for the diagnosis of depersonalization disorder.

9. the nurse assesses a client with dissociative amnesia to have which of the following clinical manifestations? select all that apply: [ ] 1. sudden unexpected travel away from customary location [ ] 2. alternating control of the client's behavior [ ] 3. inability to recall important personal information of a traumatic event [ ] 4. cause significant distress or impairment in social, occupational, or other important areas of functioning [ ] 5. primary personality is usually not aware of others [ ] 6. memory involves certain features of an event but eliminating some traumatic details

9. 3. 4. 6. assessments for dissociative amnesia include inability to recall important personal information of a traumatic event, causes significant distress or impairment in social, occupational, or other important areas of functioning, and memory involves certain features of an event but eliminating some traumatic details. sudden unexpected travel away from customary location is clinical manifestation of dissociative fugue. alternating control of the client's behavior is an assessment finding for dissociative identity disorder.