Nursing Elites

1. A client is undergoing systematic desensitization for an extreme fear of elevators. Which of the following actions should be implemented with this form of therapy?

• A. Demonstrate riding in an elevator, then ask the client to imitate the behavior.
• B. Advise the client to say “stop” out loud every time they begin to feel an anxiety response related to an elevator.
• C. Gradually expose the client to an elevator while practicing relaxation techniques.
• D. Stay with the client in an elevator until the anxiety response diminishes.

Correct answer: C

Rationale: Systematic desensitization is a type of therapy used to help individuals overcome phobias or anxieties. It involves gradually exposing the client to the feared object or situation, in this case, an elevator, while simultaneously practicing relaxation techniques. This process helps the client associate relaxation with the previously feared stimulus, gradually reducing anxiety levels over time. Choice A is incorrect as it involves imitation rather than gradual exposure. Choice B is incorrect as it focuses on a verbal response rather than the systematic process of exposure and relaxation. Choice D is incorrect as it does not involve the systematic approach of gradually exposing the client while teaching relaxation techniques.

2. A patient diagnosed with dissociative identity disorder has been undergoing therapy for several months. Which outcome indicates that the patient is progressing in therapy?

• A. The patient has developed a strong therapeutic relationship with the therapist.
• B. The patient’s different personalities are beginning to merge.
• C. The patient is able to recall traumatic events without dissociating.
• D. The patient reports fewer gaps in memory.

Correct answer: B

Rationale: In dissociative identity disorder, the merging of different personalities is a crucial indicator of progress in therapy. As the different identities merge, it signifies that the patient is integrating fragmented aspects of their self, leading to a more cohesive sense of identity and a reduction in dissociative symptoms. This process is a significant therapeutic milestone in the treatment of dissociative identity disorder as it promotes internal cohesion and decreases internal conflict. Choices A, C, and D are incorrect because while developing a strong therapeutic relationship, recalling traumatic events without dissociating, and reporting fewer gaps in memory are important aspects of therapy, the merging of different personalities is specifically indicative of substantial progress in treating dissociative identity disorder.

3. What is the priority intervention for a patient admitted for an overdose of sedatives and diagnosed with dissociative identity disorder?

• A. Conducting a suicide assessment
• B. Arranging for placement in a group home
• C. Providing a low-stimulation environment
• D. Establishing trust and rapport

Correct answer: A

Rationale: Conducting a suicide assessment is the priority intervention for a patient admitted for an overdose of sedatives and diagnosed with dissociative identity disorder. In this scenario, the immediate concern is to assess the risk of harm to the patient's life. It is crucial to determine if the overdose was intentional and if the patient has suicidal ideation or intent. Arranging for placement in a group home (choice B) may be necessary at a later stage depending on the patient's needs, but it is not the priority in this urgent situation. Providing a low-stimulation environment (choice C) and establishing trust and rapport (choice D) are important aspects of care but addressing the immediate risk of suicide takes precedence in this case.

4. After a severe automobile accident, Mr. and Mrs. Johnson were brought to the hospital. Mrs. Johnson is unable to remember anything about the accident or the two days preceding it. The nurse recognizes this as:

• A. Generalized amnesia
• B. Localized amnesia
• C. Selective amnesia
• D. Continuous amnesia

Correct answer: B

Rationale: Localized amnesia refers to an inability to recall specific events, often traumatic, within a particular time frame. In this case, Mrs. Johnson's memory loss about the accident and the preceding two days aligns with the characteristics of localized amnesia. Generalized amnesia involves a more extensive memory loss, often encompassing a person's entire life, which is not the case here. Selective amnesia involves forgetting specific details but not a whole chunk of time like in this scenario. Continuous amnesia is not a recognized term in psychology.

5. Which therapeutic intervention is most appropriate for a patient diagnosed with dissociative amnesia?

• A. Cognitive-behavioral therapy
• B. Hypnotherapy
• C. Electroconvulsive therapy
• D. Pharmacotherapy

Correct answer: B

Rationale: Hypnotherapy is the most appropriate therapeutic intervention for a patient diagnosed with dissociative amnesia. This approach aims to help the patient recover lost memories in a controlled environment, allowing them to process and integrate their memories effectively. Hypnotherapy can assist in uncovering and addressing the underlying issues contributing to dissociative amnesia. Cognitive-behavioral therapy focuses on changing negative patterns of thinking or behavior and may not directly address memory recovery. Electroconvulsive therapy is typically used for severe depression or certain mental disorders, not dissociative amnesia. Pharmacotherapy involves medication and is not the primary intervention for dissociative amnesia.

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