Psych Ch. 16

A patient who has been diagnosed with dissociative identity disorder asks, "What exactly are 'alters'? My health care provider told me I have several of them." Which statement by the patient illustrates that the education provided has been effective?

"Alters are separate personalities that take over during stress."

A young adult diagnosed with dissociative identity disorder was hospitalized with self-inflicted lacerations. When asked about these injuries, the patient responded, "I don't know what happened. I just looked down and they were there." What is the priority nursing intervention for this patient?

Maintain continuous observation.

A patient with dissociative identity disorder is hospitalized for the fourth time after overdosing. The patient does not remember overdosing. What is the best initial nursing outcome for this situation?

Patient will inform staff when feeling the urge to harm self.

Which child is at greatest risk for developing attachment problems as a result of a neurobiological development?

A 4-year-old female

A man was killed during a robbery 10 days ago. His widow, who has a long history of mental illness, cries spontaneously when talking to the nurse about her loss. What is the nurse's most therapeutic response?

"The sudden death of your husband is hard to accept. I am glad you are able to tell me about how you are feeling."

A nurse conducts an initial interview with a veteran of two tours in the war with Afghanistan. The veteran says, "Sometimes I still hear explosions but I know I am safe in my home." What is the nurse's best response?

"You are describing flashbacks. These often happen after traumatic events such as war. I'd like to arrange for you to talk more about your feelings and reactions."

A patient who was rescued from a bomb blast has symptoms of chronic depression, irritation, and insomnia. During the discharge teaching, the nurse teaches care management guidelines to the patient's parents. Which statement of the nurse is appropriate to be included in the teaching?

"Don't allow the patient to consume alcohol."

A patient with dissociative identity disorder reports an increased awareness of his or her surroundings and a reduction in dissociative episodes. Which instruction provided by the nurse while teaching the grounding techniques helped the patient to alleviate symptoms?

"Hold an ice cube in your hand."

Which statement supports the existence of a comorbid condition characteristically associated with posttraumatic stress disorder (PTSD)? Select all that apply.

"I don't have any really good friends, just acquaintances." "Marriage doesn't work for me; I've been divorced three times." "My partner is always upset because I can't seem to keep a job." "Controlling my anger is a big problem for me."

Which statement concerning developmental assessment of a 5-year-old child is true? Select all that apply.

A concern is whether the child is functioning at his or her current chronological age The Denver II Developmental Screening tool is appropriate for this age group Stress-related behaviors that are identified may be managed by the nurse

Which intervention is focused on addressing the goals of Stage 1 of the model for trauma treatment of a child? Select all that apply.

A staff member is assigned a 1:1 monitoring situation with the child. The child is oriented to and frequently refamiliarized with his or her daily schedule. The overall treatment plan for trauma includes psychobiological, psychological, and family goals within a staged treatment protocol. The staged model of treatment for trauma includes the following: Stage 1: Providing safety and stabilization through creating a safe, predictable environment, stopping self-destructive behaviors, and providing education about trauma and its effects; Stage 2: Reducing arousal and regulating emotion through symptom reduction and memory work through reducing arousal; and Stage 3: Interventions in this phase should focus on teaching coping skills to deal with trauma, supporting efforts to achieve socially appropriate goals, and facilitating development of and integration into healthy social support systems.

Which child should be assessed for possible posttraumatic stress disorder (PTSD) as a result of exposure to major trauma in his or her life? Select all that apply.

An 8-year-old child who has a medical history that includes several broken bones and a dislocated shoulder. A 4-year-old who was hospitalized for two months after being injured in an automobile accident. A 12-year-old who has been in cancer remission for three years since finishing both chemotherapy and radiation treatments. Tragically, children are exposed to many traumatic events without the strength or coping skills to adequately defend themselves. Children who have been abused are at great risk for developing emotional, intellectual, and social handicaps as a result of their traumatic experiences. Other traumatic events for children include invasive medical procedures and critical life threatening illnesses. It is thought that the younger the child, the more seriously ill, and the more invasive the procedure, the more likely the child will develop PTSD. Research has found that those children who have survived cancer have four times the risk of developing PTSD than their siblings. Although being separated from parents and having siblings with major physical and emotional problems can be stressful, the risk to the child depends in large part on the support and care the child receives.

If a patient diagnosed with a disorder resulting from trauma is within the window of tolerance, there is:

Balance between sympathetic and parasympathetic arousal. Many psychiatric disorders have trauma as a precipitant. Treatment strategies are designed to modulate arousal so that the person is able to stay within a window of tolerance. Window of tolerance means there is balance between sympathetic and parasympathetic arousal. Hypervigilance is associated with dominance by the sympathetic nervous system. Avoidance of stimuli associated with the trauma is a common assessment finding for persons diagnosed with disorders resulting from trauma. Self-disclosure is a psychosocial phenomenon.

A nurse who is caring for traumatized children of various cultural backgrounds must first

Become aware of any personal biases

Following the intravenous administration of an anxiety medication, a patient with dissociative amnesia has sudden memory retrieval and started identifying family members. Which class of medication did the nurse administer to the patient?

Benzodiazepines

A patient who is a victim of sexual assault has insomnia, reduced concentration, anxiety, and recurring thoughts of the event. Which medication does the nurse anticipate to be prescribed for the patient?

Clonidine (Catapres) A patient who is the victim of sexual assault has posttraumatic stress disorder. The patient may be prescribed clonidine (Catapres) which is a centrally acting alpha agonist. It helps to treat recurring thoughts, insomnia, decreased concentration, and hypervigilance. Propranolol (Inderal) is a beta blocker which is used to treat anxiety and panic. Desipramine (Norpramin) is a trycyclic antidepressant prescribed to treat depression. Citralopram (Celexa) is a selective serotonin reuptake inhibitor prescribed to treat anxiety and depression.

After a sexual assault, a college student was treated in the emergency department, diagnosed with acute stress disorder, and referred for counseling. Which approach to counseling is most likely for this patient?

Cognitive-behavioral therapy Cognitive-behavioral therapy uses a range of strategies such as psychoeducation, behavior modification, cognitive therapy, exposure therapy, and stress management to help the victim manage behavior and change maladaptive beliefs and thoughts resulting from the traumatic experience. Psychoanalysis is long-term therapy that focuses on early life development of pathology. Aversion therapy uses unpleasant conditioning or reinforcement, so it is not appropriate in this scenario. Stress-reduction therapy is one component of cognitive-behavioral therapy.

An appropriate intervention for stage 2 of the staged model of trauma treatment is

Engaging in memory work

A nurse prepares the plan of care for a school age child diagnosed with reactive attachment disorder. Which initial outcome should be the focus of the nurse's intervention? The child will:

Express feelings through journaling

Which symptoms would lead a health care provider to suspect posttraumatic stress disorder (PTSD) in an adult patient? Select all that apply.

Flashbacks of the accident Hypervigilance Irritability Difficulty concentrating

What symptoms of an adjustment disorder are included? Select all that apply.

Guilt Social withdrawal Anger Depression

Which behavior best supports the diagnosis of posttraumatic stress disorder (PTSD) in a 4-year-old child?

Hypervigilance

Which statement is true regarding psychopharmacological therapy for posttraumatic stress disorder (PTSD)? Select all that apply.

Initial therapy may include fluoxetine (Prozac). Mirtazapine (Remeron) may be prescribed if the original prescription is not effective. Clonidine (Catapress) is prescribed to help manage intrusive symptoms. Panic attacks are addressed through the prescription of propranolol (Inderol).

Empathic listening is therapeutic because it focuses on

Lessening feelings of isolation

When a toddler's mother is hospitalized for several months, the nursing diagnosis risk for impaired parent/child attachment is related to prolonged separation, which has been included into a child's plan of care. The most appropriate outcome would be that

Mother and child show signs of healthy bonding

After reviewing the following information, which activity will a unit's nurse manager implement to best address the unit's evidence-based practice needs?

Organizing monthly in-service meetings for nursing staff to discuss their ongoing experiences with work-related stress.

The nurse is planning care for a patient diagnosed with a dissociative disorder. Which intervention is directed primarily towards minimizing the patient's anxiety level? Select all that apply.

Provide a simple, predictable daily routine. Allow the patient to progress at his or her own pace as memories are recovered. Teach and reinforce relaxation and deep breathing techniques.

The nurse is caring for a child who is demonstrating posttraumatic stress behaviors related to possibly being sexually abused. Which intervention will the nurse include in the child's plan of care? Select all that apply.

Providing the child with puppets to facilitate communication about the possible abuse. Introducing and practicing relaxation techniques with the child.

A mental health nurse plans care for four patients. These patients are diagnosed with reactive attachment disorder, disinhibited social engagement disorder, adjustment disorder, and acute stress disorder. The nurse will plan interventions designed to assist these patients to cope with:

Reactions to trauma

Dissociative identity disorder is characterized by

Recurring feelings of detachment from one's body or mental processes

Which behavior would support a diagnosis of posttraumatic stress disorder (PTSD) in a preschool child? Select all that apply.

Reluctant to engage in previously enjoyed activities Frequent displays of irritability and negativity Expresses concern that "something bad is going to happen"

A nurse is formulating nursing diagnoses after the assessment of a child. The nurse formulates the nursing diagnosis as "risk of impaired parent and child attachment." Which risk factors can be associated with this diagnosis? Select all that apply.

Separation Parental conflict Anxiety with parental role

In which stage of the treatment for posttraumatic stress disorder (PTSD) does the patient have reduced signs and symptoms of anxiety and start interacting with others?

Stage 2

While caring for a patient with emotional trauma, which nursing interventions must be employed during the first stage of the treatment plan?

Stopping self-destructive behavior of the patient The nurse follows a three-stage treatment plan while caring for a patient with trauma. In stage 1, the nurse encourages the patient to overcome self-destructive behavior to remain safe and to avoid suicidal intentions. In stage 2, the nurse follows the interventions for treating anxiety and stress, thereby helping the patient to improve attention. In stage 3, the nurse teaches coping skills to enhance decision-making ability and problem-solving skills in the patient.

A nurse is planning care management for a traumatized child. Which soothing strategies should the nurse include to help in the recovery of the child? Select all that apply.

Talk in a low, calming voice. Provide the child with his or her favorite music. Provide distraction through books.

A nurse is performing an assessment of a child diagnosed with disinhibited social engagement disorder. Which behavior should the nurse expect to find in the child?

The child willingly goes with a stranger.

A nurse is evaluating the effects of treatment for a patient with dissociative identity disorder. Which factor would indicate success of the treatment?

The patient has integrated past events.

A nurse has been caring for a patient with posttraumatic stress disorder. Which patient behaviors indicate an improved ability to cope? Select all that apply.

The patient has less physical complaints. The patient asks for help when required. The patient tries to find information about treatment.

A nurse is caring for an adult patient who has trauma-related disorder. The patient reports to the nurse that he has started using relaxation techniques and is sleeping better. What should the nurse interpret this as?

The patient is able to manage anxiety.

Which statement concerning syndromes seen in other cultures, such as piblokto, Navajo frenzy witchcraft, and amok, is true?

They are culture-bound syndromes that are not dissociative disorders.

A patient diagnosed with posttraumatic stress disorder shows little symptom improvement after being prescribed a selective serotonin reuptake inhibitor (SSRI). The nurse expects that the next medication to be prescribed will be a

Tricyclic antidepressant (TCA)

A nurse is assessing a child for a possible risk of delayed development. Which factor should the nurse identify as being associated with a possible risk of delayed development? Select all that apply.

Unstable home Failure to thrive Unwanted pregnancy An unstable home can cause impairment in social, cognitive, language, and behavioral development and increases the risk of delayed development. Failure to thrive can be a risk factor for delayed development as it can cause impaired social, cognitive, language, and behavioral development. Unwanted pregnancy can be a risk factor for delayed development. Parents unable to meet personal needs can affect the interactive process between the child and parent and increases the risk of impaired parent and child attachment. Anxiety related to parental role devoids the child of a protective and nurturing relationship.

When does the nurse ideally conduct the initial debriefing for a patient who is admitted for severe injuries due to an accident?

Within two days of the accident