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Psychiatric Mental Health Nursing From Suffering 1st Edition Potter Moller Test Bank

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Psychiatric Mental Health Nursing From Suffering 1st Edition Potter Moller Test Bank

ISBN-13: 978-0138015589

ISBN-10: 0138015589

 

 

Description

Psychiatric Mental Health Nursing From Suffering 1st Edition Potter Moller Test Bank

ISBN-13: 978-0138015589

ISBN-10: 0138015589

 

 

 

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Psychiatric Mental Health Nursing (Potter)

Chapter 14   Somatic Symptom Disorders and Dissociative Disorders

 

1) A 29-year-old patient is admitted with nausea and diarrhea. She has not eaten anything since she learned her dog was hit by a car three days ago. She complains of “a migraine.” The patient has a flat affect and her family says she “has not shed a tear.” The patient is exhibiting which personality trait?

  1. Negative Affectivity
  2. Hypochondriasis
  3. Dysthymia
  4. Alexithymia

Answer:  4

Explanation:  4. Individuals with somatic symptom and related disorders complain of biological disorders focusing on those complaints to the extent of risking functional impairment in other domains. An individual with alexithymia is unable to identify or define feelings into words. Alexithymia has been linked to PTSD and migraine headaches. Negative affectivity is an independent risk factor for having multiple somatic symptoms; hypochondriasis refers to illness anxiety disorder; and dysthymia is a chronic depression.

Page Ref: 275

Cognitive Level:  Analyzing

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.C.1. Value seeing health care situations “through patients’ eyes” | AACN Essential Competencies: VII.1.2.5. Clinical Prevention and Population Health; Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities and populations; Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems; Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Examine the etiology of somatic symptom disorders and dissociative disorders.

MNL LO:  6.1.1. Describe the elements of self across the life span.

 

2) The nurse in a clinic is caring for a patient whom she suspects has a somatic symptom or related disorder. Which risk factors will the nurse include in the assessment? Select all that apply.

  1. Female gender
  2. High achieving
  3. Lower socioeconomic status
  4. Older age
  5. Recently divorced

Answer:  3

Explanation:  3. Within the sociological domain, patients suffering from somatic symptoms and related disorders are generally female, older, and/or of lower socioeconomic status. Patients with somatic symptom disorders feel that no one understands the physical symptoms and therefore will not help. They are unable to take part in hobbies or interests with others, so they are more likely to experience frequent unemployment than be high achieving. Divorce itself is not a risk factor for a somatic symptom or related disorder.

Page Ref: 275

Cognitive Level:  Analyzing

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.C.1. Value seeing health care situations “through patients’ eyes” | AACN Essential Competencies: VII.1.2.5. Clinical Prevention and Population Health; Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities and populations; Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems; Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Examine the etiology of somatic symptom disorders and dissociative disorders.

MNL LO:  6.1.1. Describe the elements of self across the life span.

 

3) The nurse taking care of a patient recently diagnosed with somatic symptom disorder knows that which biological symptoms are related to this disorder? Select all that apply.

  1. Pain
  2. Anxiety
  3. Gastrointestinal distress
  4. Paralysis
  5. Blindness

Answer:  1, 3, 4, 5

Explanation:  1. Patients with somatic symptom disorder have symptoms that are physical in nature and cause significant distress and inability to function in activities of daily living. These may include pain, gastrointestinal distress, paralysis, or blindness. Psychological symptoms of somatic symptom disorder include persistent anxiety about symptoms and disproportionate and persistent thoughts about symptoms that result in disruption of daily living.

  1. Patients with somatic symptom disorder have symptoms that are physical in nature and cause significant distress and inability to function in activities of daily living. These may include pain, gastrointestinal distress, paralysis, or blindness. Psychological symptoms of somatic symptom disorder include persistent anxiety about symptoms and disproportionate and persistent thoughts about symptoms that result in disruption of daily living.
  2. Patients with somatic symptom disorder have symptoms that are physical in nature and cause significant distress and inability to function in activities of daily living. These may include pain, gastrointestinal distress, paralysis, or blindness. Psychological symptoms of somatic symptom disorder include persistent anxiety about symptoms and disproportionate and persistent thoughts about symptoms that result in disruption of daily living.
  3. Patients with somatic symptom disorder have symptoms that are physical in nature and cause significant distress and inability to function in activities of daily living. These may include pain, gastrointestinal distress, paralysis, or blindness. Psychological symptoms of somatic symptom disorder include persistent anxiety about symptoms and disproportionate and persistent thoughts about symptoms that result in disruption of daily living.

Page Ref: 277

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfort | AACN Essential Competencies: VII. 1.2. Clinical Prevention and Population Health; Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities and populations; Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems | NLN Competencies: Context and Environment: Read and interpret data | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Examine the etiology of somatic symptom disorders and dissociative disorders.

MNL LO:  6.1.1. Describe the elements of self across the life span.

 

4) The nurse suspects that the patient who was brought to the emergency department (ED) because of what the family describes as “a sudden case of Alzheimer disease” may have general amnesia. Which characteristics make the nurse suspect general amnesia? Select all that apply.

  1. The patient cannot remember any personal information.
  2. The patient has been wandering away from home.
  3. The patient describes a “detachment” from her mind.
  4. The patient feelings of “disconnection” with her home.
  5. The patient has developed an alternate personality.

Answer:  1, 2

Explanation:  1. General amnesia typically occurs rapidly and causes disorientation and wandering. It results in a complete loss of memory of the individual’s life history. Localized amnesia is when an individual cannot recall specific events, selective amnesia is when the individual can recall some, but not all events during a specified period of time. Depersonalization is the experience of unreality or detachment from mind, self, and/or physical body. Derealization is the experience of unreality or detachment from the person’s surroundings. Multiple personality states do not emerge with general amnesia.

  1. General amnesia typically occurs rapidly and causes disorientation and wandering. It results in a complete loss of memory of the individual’s life history. Localized amnesia is when an individual cannot recall specific events, selective amnesia is when the individual can recall some, but not all events during a specified period of time. Depersonalization is the experience of unreality or detachment from mind, self, and/or physical body. Derealization is the experience of unreality or detachment from the person’s surroundings. Multiple personality states do not emerge with general amnesia.

Page Ref: 248

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.B.4.5. 4. Assess presence and extent of pain and suffering; Assess levels of physical and emotional comfort | AACN Essential Competencies: VII.1.3. Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities and populations; Assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities and populations | NLN Competencies: Context and Environment; Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Assessment

Learning Outcome:  Examine the etiology of somatic symptom disorders and dissociative disorders.

MNL LO:  6.1.1. Describe the elements of self across the life span.

 

5) The nurse understands that the patient with somatic symptom disorder may have an increased sensitivity to pain. This explanation of the patient’s symptoms is based in which domain?

  1. Genetic domain
  2. Biologic domain
  3. Humanistic domain
  4. Psychological domain

Answer:  2

Explanation:  2. Holistically, in nursing, there are five domains of wellness: biological, psychological, sociological, cultural, and spiritual. Research has shown that patients with somatic symptom disorder and its related disorders express symptoms such as pain and other somatic experiences through their body. This heightened sense of pain and other normal body sensations occurs in the biological domain.

Page Ref: 275

Cognitive Level:  Applying

Client Need/Sub:  Physiological Integrity: Physiological Adaptation

Standards:  QSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfort | AACN Essential Competencies: III. 1. Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Knowledge; Defining the relationships between research and science building, and between research and EBP | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Summarize the impact of biological, psychological, social, cultural, and spiritual domains on somatic symptom disorders and dissociative disorders.

MNL LO:  6.1.2. Examine common alterations in self-concept across the life span.

 

 

6) The nurse is caring for a patient who is morbidly obese and who has been diagnosed with somatic symptom disorder. The patient history reveals that the patient’s mother suffered from alcohol use disorder. Which domain does the nurse recognize as the most useful in explaining the patient’s condition?

  1. Cultural domain
  2. Spiritual domain
  3. Biological domain
  4. Psychological domain

Answer:  4

Explanation:  4. Research into the emotional responses of individuals in their relation to their physical state lies within the psychological domain. Early childhood distress is associated with adult obesity and other physical illnesses. In the cultural domain somatic concerns vary depending on the culture or the country. In the spiritual domain, individuals may seek meaning and/or solace in their symptoms, or they may feel spiritually and emotionally disengaged. In the biological domain body sensations become the individual’s focus and concern.

Page Ref: 275-276

Cognitive Level:  Applying

Client Need/Sub:  Physiological Integrity: Physiological Adaptation

Standards:  QSEN Competencies: I.A.3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfort | AACN Essential Competencies: III. 1. Explain the interrelationships among theory, practice, and research | NLN Competencies: Knowledge and Science: Knowledge; Defining the relationships between research and science building, and between research and EBP | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Summarize the impact of biological, psychological, social, cultural, and spiritual domains on somatic symptom disorders and dissociative disorders.

MNL LO:  6.1.2. Examine common alterations in self-concept across the life span.

 

7) The nurse is caring for a 40-year-old patient suspected of having a somatic symptom or related disorder. Which symptoms within the psychological domain would suggest that the patient does not have a somatic symptom or related disorder? Select all that apply.

  1. Hallucinations
  2. Compulsions
  3. Flashbacks
  4. Irritability
  5. Withdrawal

Answer:  2, 3

Explanation:  2. Individuals with somatic symptom and related disorders may exhibit the following psychological symptoms: dissociation; hallucinations; crying; decreased interest; decreased productivity; depression; difficulty concentrating; feelings of apprehension, helplessness, worthlessness; focusing on the past; hypercritical; irritability; persistent worrying preoccupation with negatives; and withdrawal. Flashbacks are associated with dissociative disorders and posttraumatic stress disorder (PTSD). Compulsions are associated with obsessive-compulsive disorder (OCD).

  1. Individuals with somatic symptom and related disorders may exhibit the following psychological symptoms: dissociation; hallucinations; crying; decreased interest; decreased productivity; depression; difficulty concentrating; feelings of apprehension, helplessness, worthlessness; focusing on the past; hypercritical; irritability; persistent worrying preoccupation with negatives; and withdrawal. Flashbacks are associated with dissociative disorders and posttraumatic stress disorder (PTSD). Compulsions are associated with obsessive-compulsive disorder (OCD).

Page Ref: 275

Cognitive Level:  Analyzing

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.C.1. Value seeing health care situations “through patients’ eyes” | AACN Essential Competencies: VII.2. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Summarize the impact of biological, psychological, social, cultural, and spiritual domains on somatic symptom disorders and dissociative disorders.

MNL LO:  6.1.2. Examine common alterations in self-concept across the life span.

 

8) A patient has had what appeared to be an epileptic seizure; however, the patient’s MRI and EEG results that do not show seizure activity. After a thorough assessment and appropriate tests by the patient’s health care professional, the nurse begins to suspect which psychological disorder?

  1. Factitious disorder
  2. Conversion disorder
  3. Illness anxiety disorder
  4. Somatic symptom disorder

Answer:  2

Explanation:  2. Patients who have symptoms of conversion disorder experience one or more changes in voluntary motor or sensory function, changes that are not recognized as neurologic or medical in origin. Some patients may experience symptoms that mimic seizure. Factitious disorder is characterized by patients falsifying an illness. Somatic symptom disorder refers to emotional distress that exhibits through somatic or physiological symptoms. Illness anxiety disorder refers to patients who experience preoccupation with having an illness, though there are typically no physical symptoms.

Page Ref: 277

Cognitive Level:  Analyzing

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.C.1. Value seeing health care situations “through patients’ eyes” | AACN Essential Competencies: VII.2. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Summarize the impact of biological, psychological, social, cultural, and spiritual domains on somatic symptom disorders and dissociative disorders.

MNL LO:  6.1.2. Examine common alterations in self-concept across the life span.

 

9) The nurse is caring for a patient who has been diagnosed with a dissociative disorder after being missing for two weeks and returning home, not knowing any time had passed. The nurse recognizes the patient is experiencing which condition associated with dissociative disorders?

  1. Fugue
  2. Amnesia
  3. Alexithymia
  4. Derealization

Answer:  1

Explanation:  1. Individuals with dissociative fugue wander, usually far from home and for days, perhaps even weeks or months, at a time. During this period, patients completely forget their past life and associations, but unlike people with amnesia, they are unaware of having forgotten anything. Individuals do not recall the fugue period when they return to consciousness. Alexithymia is the inability to label feelings with words. Derealization is the experience of unreality or detachment from the individual’s surroundings.

Page Ref: 284-286

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: VII.2. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Contrast the symptoms of somatic symptom disorders and dissociative disorders.

MNL LO:  6.1.2. Examine common alterations in self-concept across the life span.

 

 

10) The nurse is caring for a patient with somatic symptom disorder. What information is most important for the nurse to include in the report to the staff on the next shift?

  1. The trigger for the patient’s worries
  2. The original source of the patient’s anxiety
  3. The amount of time the patient talked about physical complaints
  4. The patient’s use of abdominal breathing at the first sign of anxiety

Answer:  3

Explanation:  3. Patients with somatic symptom disorder exhibit excessive focus on their physical symptoms. It is essential the staff on the next shift know how much time the patient talks about physical complaints in order to evaluate whether the patient meets the goal of decreasing that time spent on talking about the physical complaints. While the other information may be helpful to other staff members, it is not as important as how much time the patient has spent focusing on physical complaints.

Page Ref: 274-275

Cognitive Level:  Analyzing

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: VII.2. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems | NLN Competencies: Relationship Centered Care: Effective Communication | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Contrast the symptoms of somatic symptom disorders and dissociative disorders.

MNL LO:  6.1.2. Examine common alterations in self-concept across the life span.

 

11) The nurse is taking care of patient admitted with a diagnosis of dissociative identity disorder. The nurse knows that which symptoms differentiate dissociative disorders from somatic symptom disorder? Select all that apply.

  1. Flashbacks
  2. Self-mutilation
  3. Dissociation
  4. Struggling with faith
  5. Lack of connectedness

Answer:  1, 2

Explanation:  1. Individuals with dissociative disorders exhibit symptoms of alterations in sensory or motor functioning; alterations in memory; changes in consciousness; inability to recall autobiographical information; self-mutilation; flashbacks; and functional neurologic symptoms. These symptoms are not seen in somatic symptom disorder. Dissociation, struggling with faith, and lack of connectedness may be seen in individuals suffering from either disorder.

  1. Individuals with dissociative disorders exhibit symptoms of alterations in sensory or motor functioning; alterations in memory; changes in consciousness; inability to recall autobiographical information; self-mutilation; flashbacks; and functional neurologic symptoms. These symptoms are not seen in somatic symptom disorder. Dissociation, struggling with faith, and lack of connectedness may be seen in individuals suffering from either disorder.

Page Ref: 275 and 283

Cognitive Level:  Analyzing

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: VII.2. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Contrast the symptoms of somatic symptom disorders and dissociative disorders.

MNL LO:  6.1.2. Examine common alterations in self-concept across the life span.

 

12) A patient diagnosed with dissociative identity disorder is in the emergency department after attempting suicide. After a thorough assessment the nurse determines the attempted suicide was in response to which event?

  1. Drug abuse and living homeless on streets
  2. Childhood sexual abuse by biological father
  3. Unidentified continuous abdominal and neck pain
  4. Multiple somatic and psychological issues over the past 6 months

Answer:  2

Explanation:  2. Patients with dissociative identity disorder have sustained horrific physical and psychological abuse over time. These events lead to the patient experiencing multiple ego states that help the patient survive the trauma. Suicidal ideation is common among patients with this disorder. The other answer choices are not indicative of dissociative identity disorder.

Page Ref: 285

Cognitive Level:  Analyzing

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient centered care | AACN Essential Competencies: VII.2. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Contrast the symptoms of somatic symptom disorders and dissociative disorders.

MNL LO:  6.1.2. Examine common alterations in self-concept across the life span.

 

 

13) The nurse is caring for a patient diagnosed with dissociative identity disorder (DID). Which statements by the patient best describes the manifestations of this disorder? Select all that apply.

  1. “I feel like my body is here but my mind is not.”
  2. “I have chronic pain, not a psychological problem.”
  3. “I can’t really find any words to describe my feelings.”
  4. “I sometimes feel like I am floating in the air looking down at myself.”
  5. “I cannot recall the events that happened during certain periods of time.”

Answer:  1, 4, 5

Explanation:  1. Dissociative disorders are characterized by a combination of fragmented memories (which may result in fragmented personalities), difficulties with memory recall, and dissociative behavior patterns. Depersonalization, a manifestation of dissociative disorders, is the experience of unreality or detachment from the individual’s mind, sense of self, and/or physical body. Dissociations are unwelcome intrusions that occur with losses of continuity of time, changes in ability to relate to others, and amnesia, or the inability to recall what the person was doing during the dissociation. The client stating physical pain, not psychological suffering, is manifesting a somatic symptom. Difficulty describing or discussing feelings is seen in somatic symptom and related disorders.

  1. Dissociative disorders are characterized by a combination of fragmented memories (which may result in fragmented personalities), difficulties with memory recall, and dissociative behavior patterns. Depersonalization, a manifestation of dissociative disorders, is the experience of unreality or detachment from the individual’s mind, sense of self, and/or physical body. Dissociations are unwelcome intrusions that occur with losses of continuity of time, changes in ability to relate to others, and amnesia, or the inability to recall what the person was doing during the dissociation. The client stating physical pain, not psychological suffering, is manifesting a somatic symptom. Difficulty describing or discussing feelings is seen in somatic symptom and related disorders.
  2. Dissociative disorders are characterized by a combination of fragmented memories (which may result in fragmented personalities), difficulties with memory recall, and dissociative behavior patterns. Depersonalization, a manifestation of dissociative disorders, is the experience of unreality or detachment from the individual’s mind, sense of self, and/or physical body. Dissociations are unwelcome intrusions that occur with losses of continuity of time, changes in ability to relate to others, and amnesia, or the inability to recall what the person was doing during the dissociation. The client stating physical pain, not psychological suffering, is manifesting a somatic symptom. Difficulty describing or discussing feelings is seen in somatic symptom and related disorders.

Page Ref: 276 and 282

Cognitive Level:  Applying

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essential Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment: Chronic Disease Management | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Appraise key symptoms and characteristics of dissociative disorders and how they affect care for patients in medical settings.

MNL LO:  6.1.3. Differentiate focused assessment procedures used to examine clients of diverse backgrounds.

14) When assessing patients with dissociative disorders, the nurse knows that which assessments are most important?

  1. Pain, bowel sounds, behaviors
  2. Anxiety, B12 level, heart sounds
  3. LOC, patient safety, and level of anxiety
  4. Facial expression, body image, pupillary reactivity

Answer:  3

Explanation:  3. When assessing patients with dissociative symptom disorders, it is important to assess patient safety, level of consciousness, and anxiety level. The other choices are more appropriate for assessing the patient with a somatic symptom or related disorder.

Page Ref: 279

Cognitive Level:  Analyzing

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.B.4. Assess presence and extent of pain and suffering | AACN Essential Competencies: VII.2. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems | NLN Competencies: Context and Environment: Chronic Disease Management | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Appraise key symptoms and characteristics of dissociative disorders and how they affect care for patients in medical settings.

MNL LO:  6.1.3. Differentiate focused assessment procedures used to examine clients of diverse backgrounds.

 

15) The nurse is caring for a patient with dissociative identity disorder who has been admitted to the hospital for dehydration. Which question is the priority for including in the assessment?

  1. “Do you remember what you were doing today?”
  2. “Do you look in the mirror and not recognize yourself?”
  3. “Do you ever think about harming yourself?”
  4. “Do you find new things among your belongings that you don’t recall obtaining?”

Answer:  3

Explanation:  3. Patients with dissociative disorders have a high risk for suicide. It is important to ask these patients direct questions about risk for suicide and self-harm. The other questions may be appropriate, but they are not the priority. Assessing for safety always takes priority.

Page Ref: 280

Cognitive Level:  Analyzing

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.B.4. Assess presence and extent of pain and suffering | AACN Essential Competencies: VII.2. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Appraise key symptoms and characteristics of dissociative disorders and how they affect care for patients in medical settings.

MNL LO:  6.1.3. Differentiate focused assessment procedures used to examine clients of diverse backgrounds.

16) Which nursing intervention helps promote stress reduction and healthy coping in a patient diagnosed with a dissociative disorder?

  1. Perform safety checks at each health care interaction.
  2. Discuss activities that patients can do that eliminate the need for safety provisions.
  3. Review the patient’s daily personal journal to assess appetite.
  4. Teach nonpharmacologic strategies for reducing pain.

Answer:  1

Explanation:  1. Performing safety checks at each health care interaction helps ensure patient safety and provides an opportunity to discuss triggers and promote healthy coping mechanisms. Discussing activities to reduce the need for safety provisions, teaching nonpharmacologic methods of reducing pain, and reviewing the patient’s daily journal to assess appetite are appropriate interventions for somatic symptom disorders.

Page Ref: 280

Cognitive Level:  Analyzing

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.B.4. Assess presence and extent of pain and suffering | AACN Essential Competencies: VII.2. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome:  Appraise key symptoms and characteristics of dissociative disorders and how they affect care for patients in medical settings.

MNL LO:  6.1.3. Differentiate focused assessment procedures used to examine clients of diverse backgrounds.

 

 

17) The nurse caring for a patient admitted with somatic symptom disorder questions the health care provider about which orders? Select all that apply.

  1. Morphine 4 mg PO prn pain
  2. Alprazolam 2 mg PO prn anxiety
  3. Teach patient breathing techniques
  4. Psychotherapy with family involvement
  5. Walk 15-30 minutes per day in neighborhood

Answer:  1, 2

Explanation:  1. Medication is not advised for individuals with somatic symptom and related disorders. The most effective ways of treating this disorder are cognitive-behavioral therapy and complementary/alternative therapies.

  1. Medication is not advised for individuals with somatic symptom and related disorders. The most effective ways of treating this disorder are cognitive-behavioral therapy and complementary/alternative therapies.

Page Ref: 279

Cognitive Level:  Analyzing

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needs | AACN Essential Competencies: VII.2. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems | NLN Competencies: Context and Environment: Chronic Disease Management | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  Differentiate pharmacologic and nonpharmacologic therapies used for the treatment of somatic symptom disorders and dissociative disorders.

MNL LO:  6.1.4. Compare common independent and collaborative interventions for individuals and families.

 

18) A patient suffering from dissociative identity disorder complains of intrusive thoughts. The anticipates an order for which medication?

  1. Insulin
  2. Epinephrine
  3. Beta-blocker
  4. Benzodiazepine

Answer:  3

Explanation:  3. Guidelines by the International Society for the Study of Trauma and Dissociation suggest that medications used in the treatment of patients with dissociative disorders should target the symptoms that are disturbing to the patient. SSRIs and beta-blockers are used to treat hyperarousal and intrusive thoughts, depressive symptoms, obsessive-compulsive thoughts and behaviors, and sleep disturbances. Benzodiazepines should not be used as they increase the risk of further dissociation; epinephrine is a catecholamine, and insulin is a hormone.

Page Ref: 286

Cognitive Level:  Analyzing

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needs | AACN Essential Competencies: VII.2. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems | NLN Competencies: Context and Environment: Chronic Disease Management | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  Differentiate pharmacologic and nonpharmacologic therapies used for the treatment of somatic symptom disorders and dissociative disorders.

MNL LO:  6.1.4. Compare common independent and collaborative interventions for individuals and families.

 

 

19) The nurse knows that which modality is the best for patients with dissociative disorders?

  1. Group therapy
  2. Support groups
  3. Individual psychotherapy
  4. Dialectical behavior therapy

Answer:  3

Explanation:  3. Patients with dissociative disorders require long-term therapy. The best modality for this type patient is individual psychotherapy. Group therapy, support groups, and dialectical behavior therapy are not typically recommended for patients with dissociative disorders.

Page Ref: 287

Cognitive Level:  Analyzing

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needs | AACN Essential Competencies: VII.2. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems | NLN Competencies: Context and Environment: Chronic Disease Management | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  Differentiate pharmacologic and nonpharmacologic therapies used for the treatment of somatic symptom disorders and dissociative disorders.

MNL LO:  6.1.4. Compare common independent and collaborative interventions for individuals and families.

 

20) The nurse knows that which types of complementary and alternative therapy may be helpful for patients with dissociative identity disorder (DID)? Select all that apply.

  1. Hypnosis
  2. Art therapy
  3. Music therapy
  4. Dance therapy
  5. Acupuncture

Answer:  1, 2, 3, 4

Explanation:  1. Hypnosis is an effective modality for patients with DID, helping with affective regulation, modulating anxiety, and promoting self-soothing. Additional therapies for dissociative disorders are art, music, and dance therapies; these therapies help the patient to improve concentration, work through affective material, and enhance problem-solving skills. Acupuncture is not commonly used in the treatment of DIDs.

  1. Hypnosis is an effective modality for patients with DID, helping with affective regulation, modulating anxiety, and promoting self-soothing. Additional therapies for dissociative disorders are art, music, and dance therapies; these therapies help the patient to improve concentration, work through affective material, and enhance problem-solving skills. Acupuncture is not commonly used in the treatment of DIDs.
  2. Hypnosis is an effective modality for patients with DID, helping with affective regulation, modulating anxiety, and promoting self-soothing. Additional therapies for dissociative disorders are art, music, and dance therapies; these therapies help the patient to improve concentration, work through affective material, and enhance problem-solving skills. Acupuncture is not commonly used in the treatment of DIDs.
  3. Hypnosis is an effective modality for patients with DID, helping with affective regulation, modulating anxiety, and promoting self-soothing. Additional therapies for dissociative disorders are art, music, and dance therapies; these therapies help the patient to improve concentration, work through affective material, and enhance problem-solving skills. Acupuncture is not commonly used in the treatment of DIDs.

Page Ref: 287

Cognitive Level:  Analyzing

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needs | AACN Essential Competencies: VII.2. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  Differentiate pharmacologic and nonpharmacologic therapies used for the treatment of somatic symptom disorders and dissociative disorders.

MNL LO:  6.1.4. Compare common independent and collaborative interventions for individuals and families.

 

21) What is the most appropriate initial nursing intervention, which promotes stress reduction and healthy coping in a patient who is diagnosed with a dissociative disorder?

  1. Encourage the patient to increase contact with friends and family.
  2. Disregard the patient’s other personalities.
  3. Help the patient create distance from family members who do not believe the patient is sick.
  4. Determine patient’s level of safety and encourage the patient to recognize triggers.

Answer:  4

Explanation:  4. Determining patients’ level of safety and encouraging patients to recognize triggers are an important initial intervention to ensure safety and promote stress reduction and healthy coping. The nurse should not encourage the patient to increase contact with friends and family or assist the patient in distancing from family members until there is a clarification of the relationships and their role in the patient’s life. Disregarding the patient’s other personalities does not promote effective role performance and is not the correct answer.

Page Ref: 289-291

Cognitive Level:  Applying

Client Need/Sub:  Physiological Integrity

Standards:  QSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needs | AACN Essential Competencies: VII.2. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  Plan evidence-based nursing care for patients with somatic symptom disorders and dissociative identity disorders.

MNL LO:  6.1.4. Compare common independent and collaborative interventions for individuals and families.

 

22) What is the best action by the nurse to intervene effectively with patients who have been diagnosed with somatic symptom disorder?

  1. Address patient’s anxiety at a later time.
  2. Help the patient express a decreased degree of comfort regarding physical symptoms.
  3. Encourage the patient’s expression of feelings symbolically through physical symptoms.
  4. Recognize and understand the patient conceptualizes the symptoms to be physical in nature.

Answer:  4

Explanation:  4. The nurse should recognize and understand the patient conceptualizes the symptoms to be physical in nature. The nurse should not encourage expression of feelings symbolically through physical symptoms. Patient anxiety should be addressed immediately, not at a later time. The patient should express an increased, not decreased, degree of comfort regarding physical symptoms.

Page Ref: 281

Cognitive Level:  Applying

Client Need/Sub:  Physiological Integrity: Physiological Adaptation

Standards:  QSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needs | AACN Essential Competencies: VII.2. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  Plan evidence-based nursing care for patients with somatic symptom disorders and dissociative identity disorders.

MNL LO:  6.1.4. Compare common independent and collaborative interventions for individuals and families.

 

23) The nurse taking care of a patient with a diagnosis of dissociative identity disorder is developing a plan of care. The nurse knows that which nursing diagnoses relate to the patient’s diagnosis?

  1. Nutrition, Impaired
  2. Parenting, Impaired
  3. Body Image, Disturbed
  4. Pain, Related to violence

Answer:  2

Explanation:  2. Nursing diagnoses for patients with dissociative disorder are based on safety level and patient’s current intensity of dissociation and amnesia. Patients who are parents may experiencing impairment of their parenting abilities as a result of the disorder. Other appropriate nursing diagnoses include: Suicide, Risk for; Violence: Self-Directed, Risk for; Self-Mutilation; Personal Identity: Disturbed; Fear; Hopelessness; and Powerlessness. All other answer choices are not related to dissociative disorder.

Page Ref: 289

Cognitive Level:  Analyzing

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needs | AACN Essential Competencies: VII.2. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome:  Plan evidence-based nursing care for patients with somatic symptom disorders and dissociative identity disorders.

MNL LO:  6.1.4. Compare common independent and collaborative interventions for individuals and families.

 

24) When planning care for a client with somatic symptom disorder the nurse knows that which activity is the most important?

  1. Determine patient needs in each of the five domains.
  2. Determine patient willingness to try new interventions.
  3. Review patient daily journal to obtain a realistic view of the patient’s activities.
  4. Encourage interactions with family and friends to keep the patient’s mind off of somatic issues.

Answer:  1

Explanation:  1. When planning nursing care, determining the patient’s needs in each of the five domains is important to help reassure the patient, provide periodic assessment, and promote therapeutic relationships. This approach also helps to involve the patient in the planning process. The other answer choices occur during implementation of the plan of care.

Page Ref: 289

Cognitive Level:  Analyzing

Client Need/Sub:  Psychosocial Integrity

Standards:  QSEN Competencies: I.B.7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences and expressed needs | AACN Essential Competencies: VII.2. Conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems | NLN Competencies: Context and Environment: Apply health promotion/disease prevention strategies; apply health policy | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome:  Plan evidence-based nursing care for patients with somatic symptom disorders and dissociative identity disorders.

MNL LO:  6.1.4. Compare common independent and collaborative interventions for individuals and families.