Chapter 24: Dissociative Disorders Nursing School Test Banks

Chapter 24: Dissociative Disorders
Test Bank

MULTIPLE CHOICE

1. The father of a 6-month-old and a 3-year-old discovers that his wife, who is the mother of the children, has abandoned the family and moved to another state. During this developmental stage, this abandonment will have the strongest negative effect on the childrens:
a. Motor skills
b. Self-concept
c. Body image
d. Cognitive skills
ANS: B
Trust and consistency play a major role in the development of a childs self-concept. Abandonment provides neither. The mothers absence may not affect the motor or cognitive skills of the children. Body image is only one component of self-concept.

DIF: Cognitive Level: Comprehension REF: p. 275 OBJ: 3
TOP: Self-Concept in Childhood KEY: Nursing Process Step: Nursing Diagnosis
MSC: Client Needs: Health Promotion and Maintenance

2. Following the death of his wife of 50 years, the hospice nurse notices that the surviving husbands affect is flat, he states that he has stopped attending the weekly card club he belongs to, and he voices difficulty in making decisions on a daily basis. The caregiver knows that this client is displaying the characteristics of the dissociative disorder of:
a. Dissociative fugue
b. Dissociative amnesia
c. Dissociative identity disorder
d. Depersonalization disorder
ANS: D
Depersonalization serves as a defense mechanism in response to severe anxiety. The person often is described as working on automatic or functioning as a robot. The characteristics listed describe the behavioral or social signs and symptoms of depersonalized disorder. Fugue is characterized by traveling that occurs suddenly and unexpectedly with no recall of the traveling. Amnesia is the inability to remember personal information, and dissociative identity disorder was formerly known as multiple personality disorder.

DIF: Cognitive Level: Application REF: p. 277 OBJ: 5
TOP: Depersonalization Disorder KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Psychosocial Integrity

3. The nurse witnesses different personalities emerging in the client with dissociative identity disorder (DID). The primary personality is referred to as the:
a. Host
b. Alter
c. Ego
d. Identity
ANS: A
The host is the term for the primary personality, which may not be aware of the alters (the other personalities). Ego is one component of the three-part theory of the ego, id, and super-ego identified by Sigmund Freud when referring to his belief of how personalities are structured. Identity refers to how one sees oneself.

DIF: Cognitive Level: Knowledge REF: p. 279 OBJ: 6
TOP: Dissociative Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

4. When developing the nursing care plan for a client with dissociative identity disorder (DID), the nurse knows that one of the major goals of therapy is to assist the client in:
a. Naming all personalities for clarification
b. Integrating the personalities into one functional personality
c. Realizing when different personalities are about to emerge
d. Learning how to move from one personality to another
ANS: B
It is important for therapy to assist the client in combining the personalities into one, so that the individual is able to function and cope effectively with daily stressors. Naming the personalities might occur without thought but is not necessary. In addition, realizing when alters are about to emerge and learning how to move among personalities are not goals of treatment.

DIF: Cognitive Level: Application REF: p. 280 OBJ: 7
TOP: Dissociative Disorders KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

5. During a home visit, the client tells the nurse that she feels that her medication is no longer helping her dissociative diagnosis of depersonalization disorder because she has noticed that she is not thinking clearly, is having difficulty with her memory and judgment, and is often disoriented to the time. The nurse knows that the doctor must be contacted and that this client most likely will be:
a. Admitted to a long-term care agency because she is a threat to herself
b. Admitted to a state-psychiatric facility for an extended period for intense therapy
c. Referred to a group home setting for better supervision
d. Admitted to the hospital for evaluation and possible adjustment of her medications
ANS: D
Admission to the hospital will be necessary to safely evaluate and/or adjust her medications. Moving the client from her home to any type of long-term care or group home setting or state-psychiatric facility is not warranted from her symptoms.

DIF: Cognitive Level: Application REF: p. 280 OBJ: 9
TOP: Therapeutic Interventions KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

6. The care provider is aware that in addition to assessment, one of the first goals of therapy for the client with a dissociative disorder is:
a. Revisiting of past traumas
b. Pharmacological therapy
c. Stabilization
d. Family therapy
ANS: C
Although revisiting of past traumas, pharmacological therapy, and family therapy are all possible treatment components, stabilization must be implemented first for the client. Stabilization consists of making the patient feel safe and able to trust the treatment team.

DIF: Cognitive Level: Application REF: p. 280 OBJ: 7
TOP: Treatments and Therapies KEY: Nursing Process Step: Planning
MSC: Client Needs: Psychosocial Integrity

7. Those who care for individuals with dissociative disorders must be aware that they often will try to __________ the staff members who are caring for them.
a. Manipulate
b. Harm
c. Date
d. Persecute
ANS: A
As with many individuals with mental health disorders, clients with a dissociative disorder frequently will try to manipulate the staff to benefit themselves. Harming, dating, or persecuting the staff is not typical behavior of a person with a dissociative disorder.

DIF: Cognitive Level: Comprehension REF: p. 281 OBJ: 9
TOP: Treatments and Therapies KEY: Nursing Process Step: Planning
MSC: Client Needs: Psychosocial Integrity

8. Which of the following is considered a primary nursing diagnosis for a client with a dissociative disorder?
a. Self-esteem, low
b. Personal identity, disturbed
c. Role performance, ineffective
d. Anxiety
ANS: B
Although all of the nursing diagnoses listed are related to dissociative disorders, Personal identity, disturbed is the only one listed that is a primary nursing diagnosis for these disorders.

DIF: Cognitive Level: Application REF: p. 281 OBJ: 8
TOP: Treatments and Therapies KEY: Nursing Process Step: Nursing Diagnosis
MSC: Client Needs: Psychosocial Integrity

9. During assessment of a client with a dissociative disorder, the nurse notices that the client has been cutting herself on both arms. After talking with the client, the nurse, along with other members of the treatment team, decides that the best intervention at this time to prevent further self-destructive behavior would be:
a. Establishing a signed contract with the client to tell a team member when she is having self-destructive thoughts
b. Isolating the client from all other clients and activities until she is no longer having self-destructive thoughts
c. Administering medications that will reduce the clients anxiety levels
d. Involving the client in activities as a diversion from self-destructive thoughts
ANS: A
Contracts are effective in building trust between the client and the treatment team, as well as in making the client responsible for seeking assistance at crucial times. Isolating a client, administering antianxiety medications, and providing diversional activities would not address the self-destructive thoughts.

DIF: Cognitive Level: Application REF: p. 281 OBJ: 9
TOP: Treatments and Therapies KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

10. A client with the diagnosis of depersonalization disorder notices that he experiences periods of depersonalization when confronted with certain stressors. When developing the care plan, the nurse is aware that one of the most helpful activities in self-control for this client is for the client to:
a. Contact a treatment team member to discuss his thoughts and feelings every time he is confronted with a stressor.
b. Keep a daily journal of his thoughts and feelings, paying special attention to thoughts and feelings during stressful times.
c. Recall periods of stressful times in his life during his clinic visit.
d. Join an exercise program that will help to decrease his stress level.
ANS: B
Daily journals will allow the client to vent his feelings, will enable reflection on events that led to depersonalization episodes, and will assist the treatment team in collaborating with the client on self-control measures to help prevent episodes in the future. Contacting a team member with every stressor or trying to recall episodes is unrealistic. Although an exercise program may help to decrease stress levels, it does not deal directly with episodes.

DIF: Cognitive Level: Application REF: p. 281 OBJ: 9
TOP: Treatments and Therapies KEY: Nursing Process Step: Planning
MSC: Client Needs: Psychosocial Integrity

11. The 15-year-old son of a single, full-time working mother frequently is left at home alone to care for himself. According to Eriksons theory, the nurse is aware that this adolescent most likely would have difficulty in developing a comfortable:
a. Body image
b. Self-ideal
c. Self-concept
d. Role performance
ANS: C
Body image, self-ideal, and role performance are all components of self-concept. Therefore, the best answer to this question is the sum of all these parts. Adolescents have difficulty developing a comfortable self-concept when they lack nurturing and guidance.

DIF: Cognitive Level: Application REF: p. 275 OBJ: 3
TOP: Self-Concept KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

12. A female client with a diagnosis of a dissociative disorder who attends group meetings at a community mental health clinic often voices that her boss at work frequently complains that she is working at a level below her capabilities. The client also states that she feels that she never gets anything done. Which nursing diagnosis best addresses these issues?
a. Self-esteem, low
b. Social isolation
c. Body-image, disturbed
d. Memory, impaired
ANS: A
The client is exhibiting characteristics typical of low self-esteem. She is not isolating herself from others, does not indicate a distorted perception of her body, and shows no sign of problems with her memory.

DIF: Cognitive Level: Application REF: p. 281 OBJ: 8
TOP: Treatments and Therapies KEY: Nursing Process Step: Nursing Diagnosis
MSC: Client Needs: Psychosocial Integrity

13. What is the first nursing priority in a client with the nursing diagnosis of Personal identity, disturbed?
a. Promote wellness.
b. Assist the client to manage any threatening feelings.
c. Assess causative and/or contributing factors.
d. Determine which medications will work most effectively.
ANS: C
Causative and/or contributing factors would be the first priority in guiding the rest of the care planning process. The second priority for a client with this nursing diagnosis would be to assist the client to manage any threatening feelings, followed by promoting wellness. Determining which medications are effective is not a nursing priority for this nursing diagnosis; rather, this is more of a physician-initiated action.

DIF: Cognitive Level: Application REF: p. 280 OBJ: 9
TOP: Treatments and Therapies KEY: Nursing Process Step: Planning
MSC: Client Needs: Psychosocial Integrity

14. A spell is a culturally defined mental health disorder or a dissociative state seen in African Americans, Europeans, and Americans from southern U.S. cultures. This state is characterized by:
a. Sudden collapsing with eyes open and inability to see, while still hearing and understanding without being able to move
b. Seizure activity and coma for up to 12 hours preceded by extreme excitement or irrational behavior
c. A state in which spirit possession interferes with daily activities
d. Communication with deceased relatives or spirits that occurs during a trancelike state
ANS: D
A spell is seen in these cultures and is characterized by the behaviors listed. Sudden collapsing with eyes open and inability to see but ability to hear and understand describes the state of falling out seen in members of some cultures living in the southern United States and in certain Caribbean groups. Seizure activity and coma preceded by extreme excitement or irrational behavior describes pibloktoq seen in some Arctic and sub-Arctic Eskimos; a state in which spirit possession interferes with daily activities describes zar seen in cultures of individuals originating from Egypt, Ethiopia, Iran, and Sudan.

DIF: Cognitive Level: Comprehension REF: p. 277 OBJ: 5
TOP: Dissociative Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

15. The wife of a 70-year-old man is concerned that her husband refuses to participate in any activities with her since his retirement 2 years ago. He is often short tempered and sees any type of hobby as a waste of time. Which intervention or activity would help him enhance his feelings of self worth?
a. Begin taking antidepressant medication.
b. Move with his wife to an assisted living community.
c. Get involved in a retired businessmens group providing assistance to new companies.
d. Taking up a less strenuous activity to decrease stress and information overload.
ANS: C
Threats to the stability of ones lifestyle (such as change in employment) can lead to changes in self-concept, as it affects personal identity, self-esteem, and role performance. An activity that allows the person to adapt to change and regain a sense of self-esteem and self-worth will accomplish this. Taking antidepressants, moving to an assisted living community, and taking up a less strenuous mental and physical activity do not provide the same degree of expression of self-concept.

DIF: Cognitive Level: Application REF: p. 276 OBJ: 3
TOP: Self Concept in Older Adulthood KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

16. A family adopts a 7-year-old boy from an international adoption agency with little information on the childs history. They bring the child to a therapist because the child is withdrawn, destroys things in the house, and hits his adoptive siblings without provocation. As the therapist develops a trusting relationship with the child, what type of intervention would be initially used to gain input from the child?
a. Psychoeducation
b. Art therapy
c. Joint stabilization plan
d. Development of coping strategies
ANS: B
During the stabilization phase, the diagnosis is established as the client reveals the complexities of his nature. In a child who is withdrawn, art therapy can be used as a means of communication and expression. Psychoeducation would not be the strategy to use at this stage. A joint stabilization plan and development of coping strategies occur after a trusting relationship and client input occurs.

DIF: Cognitive Level: Application REF: p. 280 OBJ: 9
TOP: Treatments and Therapies KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

17. A woman has had several episodes where she finds new clothes in her closet that are much more colorful than the style she usually buys. Today, a co-worker approached her to thank her for hosting a dinner party that she had no recollection of hosting. What is the most appropriate nursing diagnosis for this client?
a. Self-esteem, low
b. Personal identity, disturbed
c. Body image, disturbed
d. Anxiety
ANS: B
Nursing diagnoses for clients with dissociative disorders are related to self-concept responses and depend on identified problems of each client. In this case, the description the client gives relates to personal identity. Self-esteem, body image, may be contributing factors to this diagnosis.

DIF: Cognitive Level: Application REF: p. 281 OBJ: 8
TOP: Treatments and Therapies KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

18. Which dissociative disorder is a result of a disturbance of identity?
a. Dissociative amnesia
b. Dissociative identity disorder
c. Dissociative fugue
d. Obsessive-compulsive disorder
ANS: B
Dissociative identity disorder is a disturbance of identity. Dissociative amnesia and dissociative fugue are disturbances of memory. Obsessive-compulsive disorder is mood disorder.

DIF: Cognitive Level: Application REF: p. 279 OBJ: 5
TOP: Characteristics KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

19. A client with a dissociative disorder has the nursing diagnosis of disturbed body image. Which nursing interventions would address the nursing priority of determining the coping abilities and skills of this client? (Select all that apply.)
a. Assess the clients current level of adaptation.
b. Help the client differentiate between isolation and loneliness.
c. Note the use of addictive substances.
d. Identify previously used coping strategies and their effectiveness.
ANS: A, C, D
The clients current level of adaptation must be assessed as a baseline for the plan of care. Noting the use of addictive substances may reflect dysfunctional coping mechanisms. Identifying whether previously used coping strategies were effective will reveal whether any of them can be used again. Helping the client differentiate between isolation and loneliness is an intervention that is directed toward the nursing diagnosis of social isolation.

DIF: Cognitive Level: Application REF: p. 280 OBJ: 9
TOP: Treatments and Therapies KEY: Nursing Process Step: Implementation
MSC: Client Needs: Psychosocial Integrity

20. A male client with a dissociative disorder copes with his low self-esteem by displaying behaviors associated with an exaggerated sense of self-importance. Which behaviors would this client most likely exhibit? (Select all that apply.)
a. Bragging about special abilities
b. Setting unrealistic goals
c. Having unrealistic dreams
d. Having a view of life that everything is either right or wrong
ANS: A, B, C
The client with an exaggerated sense of self-importance often brags about his special abilities, sets unrealistic goals because he feels he is capable of anything, and sets unrealistic dreams for himself for the same reason. The belief that everything in life is either right or wrong is a polarized view that is seen in clients with a negative outlook about life.

DIF: Cognitive Level: Application REF: p. 276 OBJ: 5
TOP: Dissociative Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

21. A persons self-concept, or how a person sees himself or herself, comprises which of the following? (Select all that apply.)
a. Body image
b. Self-esteem
c. Identity diffusion
d. Self-ideal
e. Personal identity
ANS: A, B, D, E
Body image (ones feelings about his or her body), self-esteem (ones judgment of his or her own worth), self-ideal (ones personal standards on appropriate behavior), and personal identity (ones awareness of himself as an individual) constitute a persons self-concept. Identity diffusion refers to a persons not being sure of who he really is.

DIF: Cognitive Level: Knowledge REF: p. 274 OBJ: 1
TOP: Self-Concept KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

22. Dissociative fugue is identified by which characteristics? (Select all that apply.)
a. Presence of two or more distinct personalities
b. Sudden travel with inability to recall the past
c. Behave normally during travel but confused by own identity
d. May assume a new life
ANS: B, C, D
The main characteristic of dissociative fugue is sudden, unexpected travel with an ability to recall the past. This occurs in response to an overwhelmingly stressful or traumatic event. Some individuals assume entirely new identities. The presence of two or more distinct personalities is a characteristic of dissociative identity disorder, not dissociative fugue.

DIF: Cognitive Level: Application REF: p. 277 OBJ: 5
TOP: Dissociative Fugue KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

COMPLETION

23. Of the four types of dissociative disorders identified by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), the disorder that formerly was called multiple personality disorder is now called __________.

ANS:
dissociative identity disorder
The diagnosis of dissociative identity disorder (DID) is made when two or more identities can be identified in an individual that have the characteristic of repeatedly controlling the persons behavior. This disorder formerly was known as multiple personality disorder.

DIF: Cognitive Level: Knowledge REF: p. 279 OBJ: 6
TOP: Dissociative Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

24. When a person is unable to bring his various childhood identifications into one effective adult personality, the individual is said to have identity _______________.

ANS:
diffusion
Identity diffusion prevents a person from knowing who he is or having a clear picture of himself. These individuals have difficulty developing meaningful relationships or knowing what they want to do with their lives.

DIF: Cognitive Level: Knowledge REF: p. 277 OBJ: 4
TOP: Dissociative Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

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