Nursing Elites

1. In dissociative identity disorder, a patient exhibits different personalities, each with distinct behaviors and memories. The nurse recognizes that this fragmentation of identity serves as a coping mechanism for:

• A. Current stressors
• B. Developmental issues
• C. Traumatic experiences
• D. Family dynamics

Correct answer: C

Rationale: In dissociative identity disorder, the fragmentation of identity serves as a coping mechanism for traumatic experiences. Individuals may develop different identities to help them manage and cope with overwhelming and traumatic events from their past. These distinct personalities often emerge as a way to protect the individual from the emotional pain associated with their traumatic experiences. Choices A, B, and D are incorrect because dissociative identity disorder is primarily associated with coping mechanisms related to past traumatic experiences, rather than current stressors, developmental issues, or family dynamics.

2. A healthcare professional is planning care for a client who has a mental health disorder. Which of the following actions should the professional include as a psychobiological intervention?

• A. Assist the client with systematic desensitization therapy
• B. Teach the client appropriate coping mechanisms
• C. Assess the client for comorbid health conditions
• D. Monitor the client for adverse effects of medications

Correct answer: D

Rationale: Monitoring the client for adverse effects of medications is considered a psychobiological intervention because it involves the physiological aspect of mental health treatment. It focuses on the biological impact of medications on the client's mental health condition, emphasizing the interplay between biological and psychological factors in managing mental health disorders. Choices A, B, and C are not psychobiological interventions. Choice A, systematic desensitization therapy, is a psychological intervention aimed at reducing anxiety by gradually exposing the client to feared stimuli. Choice B, teaching appropriate coping mechanisms, is a psychosocial intervention focusing on behavioral strategies to manage stress. Choice C, assessing for comorbid health conditions, pertains to identifying other medical issues that may coexist with the mental health disorder but does not directly address the biological effects of medications on mental health.

3. Which individual is likely experiencing symptoms of derealization?

• A. I just feel like I’m looking at life through a fog and that can’t be my face in the mirror.
• B. I cannot recall why I’m living in this town or how I got here.
• C. There are just too many people living in my head now.
• D. I feel like I’m going to die, I’m having a heart attack.

Correct answer: A

Rationale: The individual describing feeling like they are looking at life through a fog and questioning their reflection in the mirror is likely experiencing symptoms of derealization. Derealization involves feelings of detachment from one's surroundings, which can manifest as a sense of unreality or distortion of the environment. Choice B describes dissociative amnesia, which involves memory loss related to personal information or traumatic events. Choice C suggests dissociative identity disorder (DID), where a person experiences two or more distinct identities or personality states. Choice D indicates symptoms of a panic attack, such as fearing imminent death and physical sensations like a heart attack.

4. What principle about patient communication should guide a nurse's fear of 'saying the wrong thing' to a patient?

• A. Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation.
• B. Patients are more interested in talking to you than listening to what you have to say, so they are not likely to be offended.
• C. Considering the patient's history, there is little chance that the comment will do any actual harm.
• D. Most people with a mental illness have, by necessity, developed a high tolerance for forgiveness.

Correct answer: A

Rationale: Effective patient communication is guided by the principle that patients value genuine acceptance, respect, and concern from their caregivers. This approach helps to build trust and fosters effective communication, enhancing the nurse-patient relationship. Choice B is incorrect because patients value both talking and listening in effective communication. Choice C is incorrect because a nurse should always consider the impact of their words on the patient, regardless of the patient's history. Choice D is incorrect as it generalizes about people with mental illness and forgiveness, which is not directly relevant to patient communication.

5. What is the primary benefit of using cognitive-behavioral therapy (CBT) for treating anxiety disorders?

• A. It focuses on long-term use of medications.
• B. It helps patients understand and change their thought patterns.
• C. It primarily addresses childhood traumas.
• D. It encourages patients to avoid anxiety-provoking situations.

Correct answer: B

Rationale: The primary benefit of using cognitive-behavioral therapy (CBT) for treating anxiety disorders is that it helps patients understand and change their thought patterns. By addressing maladaptive thought processes and behaviors, CBT can effectively reduce anxiety symptoms and improve coping mechanisms. This approach empowers individuals to develop healthier responses to anxiety triggers, leading to long-lasting benefits beyond solely relying on medications or avoiding anxiety-provoking situations. Choices A, C, and D are incorrect because CBT does not primarily focus on long-term use of medications, addressing childhood traumas, or encouraging avoidance of anxiety-provoking situations. While medications may be used in conjunction with CBT, the main focus of CBT is on cognitive restructuring and behavioral interventions to alleviate anxiety symptoms.

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