MHTB ch 14

1. A client is brought to the emergency department by her spouse. The spouse tells the nurse that when they woke up that morning, his wife did not know who she was. The nurse knows that a differential diagnosis for this client would be what? A) Dissociative disorder B) Trauma-induced amnesia C) Intracranial bleed D) Conversion disorder

A

10. A client with a dissociative disorder is undergoing treatment. Why is diagnostic testing done with these clients? A) To determine if there are any coexisting mental health conditions B) To identify which dissociative disorder the client has C) To identify treatment methods used in integrating fragmented personalities D) To determine if there are any coexisting physical conditions

A

21. When caring for a client with a dissociative disorder, what is the best nursing intervention to aid in preventing the clients regression further into the dissociative state? A) Avoid flooding the client with details of past traumatic events. B) Use stimuli that stimulate pleasant memories and pleasurable feelings for the client. C) Model positive and desired behaviors. D) Develop a contract between the client and the staff for dealing with self-destructive behaviors.

A

26. During the evaluation and revision process, the nurse needs to consider the clients progress toward understanding the relationship between the dissociative state and the increased anxiety that is felt as repressed past trauma is triggered by environmental factors. What would the nurse use to evaluate the clients progress toward this understanding so that revisions can be made if necessary? A) Ability to recall past traumatic events B) A decrease in self-destructive behaviors C) Imitation of the behaviors modeled by the nurse D) Acceptance by the family of the clients dissociative state

A

8. After a tornado flattens her home, a 65-year-old female is brought to the local clinic by her son. He tells the nurse that his mother cannot remember anything that has happened since the storm hit and has forgotten pieces of her identity such as having lived in the house she lost for 10 years. What would the nurse know is wrong with this patient? A) Localized amnesia B) Selective amnesia C) Generalized amnesia D) Continuous amnesia

A

30. What are the signs and symptoms of dissociative fugue? (Mark all that apply.) A) Most cases last only hours or days B) Recovery is typically abrupt with the client in a state of disorientation C) Occurs most often in adolescents D) Usually caused by a traumatic event that has resulted in severe psychologic stress E) Generally occurs during times of transition in the clients life, such as midlife crisis

A B D

24. A client with a dissociative identity disorder tells the nurse that he or she is having thoughts of self-injury. The nurse knows that it is important to assist the client to identify alternative actions to self-injury. What are these actions? (Mark all that apply.) A) Written methods of expression B) Describing what he or she wants to do to the nurse C) Physical exercise D) Asking for medicine to decrease anxiety E) Task-oriented activities

A C E

11. A client with a dissociative disorder is being seen in the mental health clinic. Pharmacotherapy is being discussed with the client. What classifications of drug does the nurse know that are used to treat these disorders? A) Antianxiety drugs and nonnarcotic pain relievers B) Antianxiety drugs and antidepressants C) Antidepressants and antiseizure drugs D) NSAIDS and mood-stabilizing drugs

B

14. You have just admitted a client to your unit diagnosed with depersonalization disorder. What would be the most appropriate nursing diagnosis for this client when developing the clients care plan? A) Self-care deficit, related to mechanical trance-like state or aimless wandering B) Sensory perceptual alteration, related to depersonalization and view of self C) Anxiety, related to repressed traumatic events or loss of identity D) Family coping ineffective, related to loss of identity

B

15. A nurse working in a small rural hospital is on duty when a fire breaks out in the local movie theater. The hospital emergency department is used to triage and stabilize many of the townspeople before having them transported to trauma centers and burn units in neighboring cities. Shortly after the last client is transported, the nurse asks one of the physicians what happened to all the townspeople. She tells the physician that she remembers the hospital was notified of a fire in the movie theater and she remembered receiving four clients into the emergency department who had been injured in the fire, but she thought there should have been many more clients admitted. This nurse was exhibiting signs and symptoms of what? A) Localized amnesia B) Selective amnesia C) Generalized amnesia D) Continuous amnesia

B

18. When caring for a client with a dissociative disorder, the mental health nurse knows that the family must be included in the plan of care. What is an appropriate outcome for the family of a client with a dissociative disorder? A) Demonstrates unconditional support of the client and of the family unit B) Verbalizes realistic expectations for the clients behavior and treatment process C) Willingly participates in pharmacotherapy of the client D) Supports the client in all stages of recovery process including cure

B

22. The mental health nurse spends a great deal of time with clients diagnosed with a dissociative disorder. Because of this fact, what is it important for the nurse to do? A) Promote a safe environment to protect the client from self-injury or injury to others. B) Model positive and desired behaviors. C) Develop a contract between the client and the staff for dealing with self-destructive behaviors. D) Decrease anxiety-producing stimuli.

B

27. You are evaluating the progress on a care plan for a client with dissociative identity disorder. What does evaluation center on for this client? A) The clients understanding of how the various states function as triggers to traumatic memories B) The clients acknowledgment of the existence of more than one personality C) The clients ability to control self-destructive behaviors D) The clients aggressive tendencies toward others

B

3. After a train accident, a 19-year-old male is admitted to a local hospital unable to remember any personal information covering the entire scope of his life. What diagnosis would the nurse expect this patient to have? A) Depersonalization disorder B) Dissociative amnesia C) Dissociative identity disorder D) Dissociative fugue

B

5. A female client, aged 27, is being seen at the clinic. The client describes her symptoms as auditory hallucinations, memory gaps, and sudden breaks in the continuity of her thought process. The nurse recognizes that the client is describing symptoms for what dissociative disorder? A) Dissociative amnesia B) Dissociative identity disorder C) Depersonalization disorder D) Dissociative fugue

B

2. When a client has a dissociative disorder, the ordinarily organized functions become disturbed. What are these functions? (Mark all that apply.) A) Mobility B) Memory C) Identity D) Conscious awareness E) Pain awareness

B C D

7. A client has a differential diagnosis of dissociative fugue. What signs and symptoms would the nurse know to assess for? (Mark all that apply.) A) Inability to recall relevant personal information B) Mood swings C) Flashbacks D) Suicidal behaviors E) Assumption of a new identity

B D E

13. A client has been diagnosed with dissociative fugue. What would be an appropriate nursing diagnosis for this client? A) Risk for violence, related to repressed anger B) Altered thought processes, related to pseudoparalysis C) Self-care deficit, related to aimless wandering D) Personality identity disturbance, related to derealization

C

16. You are developing a care plan for a client diagnosed with dissociative amnesia. What nursing diagnosis would you be sure to include in this clients plan of care? A) Sensory perceptual alteration, related to depersonalization and view of self B) Self-care deficit, related to mechanical trance-like state or aimless wandering C) Altered thought processes, related to memory loss and repressed trauma D) Ineffective individual coping, related to travel away from home

C

17. Which of the following would be the least likely expected outcome for a client with a diagnosis of dissociative identity disorder? A) Demonstrates self-control over behaviors toward self and others B) Performs self-care activities independently C) Verbalizes perceptions of environmental stimuli that are different from what others experience when faced with stressful situations D) Associates memory deficit with past stressful events

C

19. When caring for clients with dissociative disorders, the mental health nurse knows that a trusting and therapeutic relationship with the client must first be established. Why are active listening and communication techniques that encourage verbalization of feelings, conflicts, and information regarding the traumatic events that led to the current dissociative state important parts of this process? A) Creates a sympathetic relationship with the client B) Assists the client in accepting advice from the nurse C) Assists the client to develop personal insight D) Creates an atmosphere where self-defeating and damaging behaviors are more acceptable

C

23. When engaging in a therapeutic relationship with a client diagnosed with a dissociative disorder, it is important to use stimuli that stimulate pleasant memories and pleasurable feelings for the client. Why? A) Stops the regression of the client into further self-destructive behaviors B) Develops a contract between the client and the staff for dealing with self-destructive behaviors C) Assists the client to remember past experiences without the risk of precipitating increased trauma D) Helps the client to understand that periods of imbalance are to be expected and will decrease as the personal identity is restored

C

28. What can the nurse provide that allows the client a positive forward progression in the treatment process? A) A therapeutic relationship B) Alternative activities to thoughts of self-injury C) A safe and trusting environment D) A sense of power and self-control

C

4. A client presents at the mental health clinic with complaints of experiencing a feeling of being unreal. The client is a 37-year-old female who lost her husband and two children in an automobile accident 3 months ago. The client retains insight and is aware that the experience is not real. The nurse knows that this client is displaying signs and symptoms of what? A) Dissociative amnesia B) Dissociative identity disorder C) Depersonalization disorder D) Dissociative fugue

C

12. A client has been diagnosed with a dissociative disorder. What treatments would the nurse know could be used for this client? (Mark all that apply.) A) Electroconvulsive therapy B) Seclusion therapy C) Hypnosis D) Creative art processes E) Cognitive techniques

C D E

20. A mental health nurse is developing a plan of care for a new client diagnosed with a dissociative disorder. A nursing intervention that is important to include in the plan of care for this client is to encourage and support the client in the achievement of control over anxiety and previous dissociative response to those situations that trigger the symptoms. Why is this intervention so important? A) Clients are afraid of their self-destructive behaviors. B) These clients need a safe environment to protect themselves from self-injury. C) Use stimuli that stimulate pleasant memories and pleasurable feelings for the client. D) Clients are overwhelmed with fear of not knowing or being out of control.

D

25. When evaluating the clients progress toward identifying and demonstrating a more adaptive response to stressful stimuli, the nurse knows that this step is what? A) Necessary to increase the clients functioning B) Important to enlist the familys support in the treatment C) Integral in the adjustment of pharmacotherapeutic dosing D) Helpful in decreasing the dissociative response

D

29. The repressed memories associated with dissociative disorders are usually triggered by what? A) Early childhood traumas B) Clients inability to deal with anxiety C) Nonsupportive family D) Environmental factors

D

6. A 42-year-old male is brought to the emergency department by his brother. The brother tells the nurse that the client has traveled across the country to attend the funerals of their parents who died in a car accident a week ago. The brother tells the nurse that the client claims to be someone he is not but otherwise seems quite normal. What would the nurse suspect that this client has? A) Dissociative amnesia B) Dissociative identity disorder C) Depersonalization disorder D) Dissociative Fugue

D

9. A client with a dissociative disorder is going through the therapeutic process. What is the ultimate goal of the therapeutic process for this patient? A) To identify the traumatic event that caused the dissociation B) To get the client in touch with his or her negative feelings about the traumatic event C) To assist in diagnosing which dissociative disorder the client has D) To integrate the fragmented personalities into one identity

D