Question 1

Which student statement indicates an understanding regarding dissociative identity disorder (DID)?&#10;A) &#34;I suspect my client inherited this disease from his parent.&#34;&#10;B) &#34;It is unlikely my client had a diagnosis of schizophrenia before DID, since the two do not go hand in hand.&#34;&#10;C) &#34;My client experiences periods of blackouts, or lost time where he doesn't know what happened during that time frame.&#34;&#10;D) &#34;I assume my client has other personalities because he doesn't want to deal with real life.&#34;&#10;

Accepted Answer

1.This is incorrect. The student does not understand the teaching if they think DID is genetic.
2.This is incorrect. The student does not understand the teaching if they think schizophrenia is not typically a prior diagnosis preceding DID.
3.This is correct. A client with DID typically has gaps in time, or blackouts, where they may wake up and not know what happened when they have personality splits. The student understands the teaching when they make this statement.
4.This is incorrect. This statement requires further teaching; a client develops DID to deal with past trauma.

Question 2

A client has been diagnosed with somatic symptom disorder. As the nurse is talking with this client and her family, which statement suggests primary or secondary gains that the physical symptoms are providing for the client?

A) The family agrees that the client began having physical symptoms after she lost her job.
B) The client states that even though medical tests have not found anything wrong, she is convinced her headaches are indicative of a brain tumor.
C) The client's mother reports that someone from the family stays with her each night because the physical symptoms are incapacitating.
D) The client states she noticed feeling hotter than usual the last time she had a headache.

The client's mother reports that someone from the family stays with her each night because the physical symptoms are incapacitating.

Accepted Answer

1.This is incorrect. Describing the onset of symptoms does not describe the primary and secondary gains that the illness provides for the client.
2.This is incorrect. This statement does not describe the primary and secondary gains that the illness provides for the client.
3.This is correct. The mother's report that someone from the family stays with Carly each night because the physical symptoms are incapacitating indicates that Carly may be receiving primary and/or secondary gains that reinforce illness behavior and enable her to avoid stressful situations or postpone unwelcome challenges.
4.This is incorrect. This statement does not describe any gains that the illness provides for the client.

Question 3

Which student statement about clients diagnosed with this disorder indicates that learning has occurred regarding the etiology of dissociative disorders from a psychoanalytical perspective?&#10;A) &#34;Dissociative behaviors occur when individuals repress distressing mental information from their conscious awareness.&#34;&#10;B) &#34;When their physical symptoms relieve them from stressful situations, their amnesia is reinforced.&#10;C) &#34;People with dissociative disorders typically have strong egos.&#34;&#10;D) &#34;There is clear and convincing evidence of a familial predisposition to this disorder.&#34;&#10;

Accepted Answer

1.This is correct. The psychoanalytical perspective is that dissociative behaviors occur when individuals repress distressing mental contents from conscious awareness.
2.This is incorrect. Amnesia is not reinforced when physical symptoms relieve the client from a stressful situation.
3.This is incorrect. People with dissociative disorders do not typically have a strong ego.
4.This is incorrect. There is no evidence supporting familial predispositions to this disorder.

Question 4

A healthy adolescent client with no history of substance abuse presents to the mental health clinic. This client tells the nurse that she has experienced several episodes where she feels like she is watching a movie of herself where she is floating above and watching herself as an outside observer. She asks the nurse what is wrong with her. Which statement made by the nurse is most appropriate?

A) "You have derealization disorder and must be treated for this immediately."
B) "These may be symptoms of depersonalization disorder, but I'm going to suggest you meet with the psychiatrist for a diagnosis."
C) "You must be schizophrenic. I'm going to ask the psychiatrist to run some tests on you."
D) "I wouldn't worry about these symptoms. These are typical for female teenagers who are experiencing hormonal changes."

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Accepted Answer

1.This is incorrect. Derealization disorder describes an alteration of perception of the external environment. Objects in the environment are perceived as altered in size and shape. Other people in the environment may seem automated or mechanical. Not only is the nurse giving the client false information, but she is also practicing outside the scope of nursing by offering a client a diagnosis.
2.This is correct. Depersonalization disorder is characterized by a temporary change in the quality of self-awareness. The client may have feelings of unreality and may experience changes in body image, feelings of detachment from the environment, or a sense of observing oneself from outside the body. The nurse is correct to refer her to a psychiatrist who can make a diagnosis.
3.This is incorrect. Even though schizophrenics may have out-of-body experiences, this is not enough information to confirm a diagnosis. It is outside of the scope of nursing to diagnose clients.
4.This is incorrect. Hormonal changes in adolescent females are not responsible for the client having out-of-body experiences.

Question 5

Which scenario best describes Munchausen by proxy?&#10;A) A wife makes her husband ill so she can be seen as the hero when bringing him to the emergency department.&#10;B) A client uses three personalities to block out the trauma of sexual abuse experienced as a child.&#10;C) A former soldier thinks back to an experience and sees himself observing from a distance and wonders what he would do in that situation.&#10;D) A client has a strong desire to be pregnant and has morning sickness and symptoms associated with pregnancy but has a negative pregnancy test.&#10;

Accepted Answer

1.This is correct. A client with Munchausen by proxy induces physical symptoms in another individual for personal attention.
2.This is incorrect. This statement describes DID.
3.This is incorrect. This statement describes derealization disorder.
4.This is incorrect. This statement describes conversion disorder (specifically pseudocyesis).

Question 6

A client diagnosed with DID has likely been diagnosed with which disorders in the past? Select all that apply.&#10;A) Attention deficit-hyperactivity disorder&#10;B) Depression&#10;C) Bipolar Disorder&#10;D) Epilepsy&#10;E) Oppositional Defiant Disorder&#10;F) Schizophrenia&#10;

Accepted Answer

1.This is incorrect. Clients do not necessarily have a history of ADHD prior to being diagnosed with DID.
2.This is correct. Clients are typically diagnosed with depression prior to being diagnosed with DID.
3.This is correct. Clients are typically diagnosed with bipolar disorder prior to being diagnosed with DID.
4.This is correct. Clients are typically diagnosed with epilepsy prior to being diagnosed with DID.
5.This is incorrect. Clients are not usually diagnosed with oppositional defiant disorder prior to being diagnosed with DID.
6.This is correct. Clients diagnosed with DID may have a diagnosis of schizophrenia beforehand.

Question 7

A 56-year-old is brought to the emergency department by the police because she was found wandering confusedly in a busy shopping center several miles from her home. The nurse assesses the client and finds that she has been the victim of domestic violence for 32 years and has recently been beaten by her spouse. Her recollection of current events is hazy and she is not able to give the nurse a detailed account of the abuse. Which of the client's symptoms cause the nurse to suspect that she is suffering from dissociative fugue? Select all that apply.

A) Her trip to a shopping center several miles from her home
B) The client's confused wandering
C) Her ability to stay with an abuser all these years
D) The client's inability to offer details about the domestic abuse
E) Her inability to focus on the questioning

Accepted Answer

1.This is correct. Dissociative fugue can cause the client to travel suddenly and unexpectedly away from customary places.
2.This is correct. Clients who exhibit dissociative fugue may engage in confused or bewildered wandering.
3.This is incorrect. The client's ability to sustain abuse is not associated with dissociative fugue.
4.This is correct. Clients with dissociative fugue are often unable to recall some or all of their past. These clients may not be able to recall personal identity and sometimes assume a new identity.
5.This is incorrect. Clients who experience dissociative fugue are able to focus on tasks, but they may not have the memory to offer details about their past.

Deck 13: Somatic Symptom and Dissociative Disorders