16 (Trauma, Stressor-Related, & Dissociative Disorders) Flashcards Preview

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Flashcards in 16 (Trauma, Stressor-Related, & Dissociative Disorders) Deck (25):
1

Hallie, 4 years old, is referred to the outpatient mental health clinic after being in a severe car accident during which her father was driving and her mother died. Her father states she is withdrawn, not sleeping, having nightmares, and acts out the car accident over and over again when playing. Hallie states to you, “It’s my fault because I’m bad.” You suspect:

a.) adjustment disorder.

b.) dissociative identity disorder.

c.) posttraumatic stress disorder (PTSD).

d.) acute stress disorder (ASD).

c.) posttraumatic stress disorder (PTSD).

PTSD in preschool children may manifest as repetitive play that includes aspects of the traumatic event, social withdrawal, and negative emotions such as fear, guilt, anger, horror, sadness, shame, or confusion.

Children may blame themselves for the traumatic event and manifest persistent negative thoughts about themselves.

Unlike PTSD, adjustment disorder may be diagnosed immediately or within 3 months of exposure.

Responses to the stressful event may include combinations of depression, anxiety, and conduct disturbances.

Dissociative identity disorder includes the presence of “alters” or other personalities that take over in times of stress.

As compared with PTSD that occurs a month after the trauma, ASD occurs from 3 days and up to 1 month after exposure to a highly traumatic event.

Individuals with ASD experience three or more dissociative symptoms either during or after the traumatic event, including the following: a sense of numbing, detachment, or absence of emotional responsiveness; a reduction in awareness of surroundings; derealization (a sense of unreality related to the environment); depersonalization (experience of a sense of unreality or self-estrangement); or dissociative amnesia (loss of memory).

2

Which of the following statements about dissociative disorders is true?

a.) Dissociative symptoms are under the person’s conscious control.

b.) Dissociative symptoms are not under the person’s conscious control.

c.) Dissociative symptoms are usually a cry for attention.

d.) Dissociative symptoms are always negative.

b.) Dissociative symptoms are not under the person’s conscious control.

Dissociation is involuntary and results in failure of the normal control over a person’s mental processes and normal integration of conscious awareness.

The other responses are untrue.

3

Syndromes seen in other cultures but not seen in our own, such as piblokto, Navajo frenzy witchcraft, and amok should be considered:

a.) dissociative disorders such as dissociative identify disorders.

b.) physical disorders, not mental disorders.

c.) culture-bound syndromes that are not dissociative disorders.

d.) myths, or rumors, because they have not been sufficiently studied to be classified as real.

c.) culture-bound syndromes that are not dissociative disorders.

Certain culture-bound disorders exist in which there is a high level of activity, a trancelike state, and running or fleeing, followed by exhaustion, sleep, and amnesia regarding the episode.

These syndromes, if observed in individuals native to the corresponding geographical areas, should be differentiated from dissociative disorders.

The other responses are incorrect.

4

Erin has just been diagnosed with dissociative identity disorder. She asks you, “What exactly are ‘alters’? My provider told me I have several of them.” Which statement by Erin illustrates that the education you provided has been effective?

a.) “So, alters are based in mysticism and religiosity, such as demons.”

b.) “So, alters are separate personalities with their own characteristics that take over during stress.”

c.) “So, alters are never aware of each other.”

d.) “So, alters are just like me, but they have no memory of the trauma I went through.”

b.) “So, alters are separate personalities with their own characteristics that take over during stress.”

Dissociative identity disorder appears to be associated with at least two dissociative identity states: one is a state or personality that functions on a daily basis and blocks access and responses to traumatic memories, and another state (also referred to as an alter state) is fixated on traumatic memories.

Each alter has its own memories, behavior patterns, and characteristics.

Transition from one personality to another (switching) occurs during times of stress.

The other responses are incorrect, because alters may be aware of the existence of each other to some degree, and alters are not just like the host—they have different behaviors and memories.

5

Hallie’s father, Brent, has now been diagnosed with PTSD as well as Hallie. Which of the following symptoms would lead a provider to suspect PTSD? (select all that apply):

a.) Visiting the scene of the accident over and over

b.) Talking with strangers about the events of the accident

c.) Flashbacks of the accident

d.) Hypervigilance

e.) Irritability

f.) Difficulty concentrating

g.) Mania

c, d, e, f

c.) Flashbacks of the accident

d.) Hypervigilance

e.) Irritability

f.) Difficulty concentrating

All these symptoms are signs of PTSD. The other options are not associated with signs of PTSD.

6

Use of dissociation most closely resembles

a.) performing mundane tasks on autopilot.

b.) developing a headache to avoid an unpleasant task.

c.) feeling angry with a co-worker who shirks work.

d.) finding a socially acceptable reason to meet a need.

a.) performing mundane tasks on autopilot.

Mild, fleeting dissociative experiences are relatively common to all of us; for example, we say we are on “automatic pilot” when we drive home from work and cannot recall the last 15 minutes before reaching the house.

7

Dissociative identity disorder is characterized by

a.) the inability to recall important information.

b.) sudden, unexpected travel away from home and inability to remember the past.

c.) the existence of two or more subpersonalities, each with its own patterns of thinking.

d.) recurring feelings of detachment from one’s body or mental processes.

d.) recurring feelings of detachment from one’s body or mental processes.

Dissociation is an unconscious defense mechanism that protects the individual against overwhelming anxiety through an emotional separation. However, this separation results in disturbances in memory, consciousness, self-identity, and perception.

8

What information should the nurse give to the family of a client who has had a dissociative episode?

a.) Dissociation is a method for coping with severe stress.

b.) Dissociation suggests the possibility of early dementia.

c.) Brief periods of psychotic behavior may occur.

d.) Ways to intervene to prevent self-mutilation and suicide attempts.

a.) Dissociation is a method for coping with severe stress.

Childhood physical, sexual, or emotional abuse and other traumatic events are associated with adults experiencing dissociative symptoms.

9

A child who was physically and sexually abused is at great risk for

a.) depression.

b.) suicide attempts.

c.) bullying and abusing others.

d.) becoming active in a gang.

c.) bullying and abusing others.

Children who have been abused are at risk for abusing others, as well as for developing dysfunctional patterns in close interpersonal relationships.

10

Which behavior best supports the diagnosis of posttraumatic stress disorder (PTSD) in a 4-year-old child?

a.) Overeating

b.) Hypervigilance

c.) A drive to be perfect

d.) Passivity

b.) Hypervigilance

PTSD in preschool children may manifest as irritability, aggressive or self-destructive behavior, sleep disturbances, problems concentrating, and hypervigilance.

11

A nurse who is caring for traumatized children of various cultural backgrounds must first

a.) become familiar with the various cultures.

b.) gain the children’s trust.

c.) become aware of any personal biases.

d.) convince the parents that their children require care.

c.) become aware of any personal biases.

Working with children and adolescents from diverse backgrounds requires an increased awareness of one’s own biases, as well as the patient’s needs.

12

Empathic listening is therapeutic because it focuses on

a.) enhancing self-esteem.

b.) lessening feelings of isolation.

c.) reducing anxiety.

d.) encouraging resilience.

b.) lessening feelings of isolation.

Empathic listening can be healing because it can help minimize feelings of isolation.

13

An appropriate intervention for stage 2 of the staged model of trauma treatment is

a.) re-enforcing social skills training.

b.) providing a predictable environment.

c.) engaging in memory work.

d.) role-modeling problem-solving skills.

c.) engaging in memory work.

Appropriate interventions for stage 2 of the staged model of trauma treatment include reducing arousal and regulating emotion through symptom reduction; engaging in memory work while reducing arousal; finding comfort from others; tolerating affect; integrating disavowed emotions and accepting ambivalence, overcoming avoidance; improving attention and decreasing dissociation; working with memories; and transforming memories.
 

14

When discussing the symptoms of PTSD, the nurse correctly states

a.) “The symptoms can occur almost immediately or can take years to manifest.”

b.) “PTSD causes agitation and hypervigilance but rarely chronic depression.”

c.) “When experiencing a flashback, the client generally experiences a slowing of responses.”

d.) “PTSD is an emotional response that does not cause significant changes in brain chemistry.”

a.) “The symptoms can occur almost immediately or can take years to manifest.”

The onset of PTSD symptoms can occur as early as a month after exposure, but a delay of months or years is not uncommon.

15

A client diagnosed with PTSD shows little symptom improvement after being prescribed a selective serotonin reuptake inhibitor (SSRI). The nurse expects that the next medication to be prescribed will be a

a.) beta blocker.

b.) barbiturate.

c.) tricyclic antidepressant (TCA).

d.) sedative.

c.) tricyclic antidepressant (TCA).

TCAs or mirtazapine (Remeron) maybe be prescribed if SSRIs or SNRIs are not tolerated or do not work.

16

Which statement about structural dissociation of the personality is true?

a.) An organic basis exists for this type of disorder.

b.) Nurses perceive clients with this disorder as easy to care for.

c.) No known link exists between this disorder and early childhood loss or trauma.

d.) This disorder results in a split in the personality causing a lack of integration.

d.) This disorder results in a split in the personality causing a lack of integration.

The theory of structural dissociation of the personality proposes that patients with complex trauma have different parts of their personality, the apparently normal part and the emotional part, that are not fully integrated with each other.

Each part has its own responses, feelings, thoughts, perceptions, physical sensations, and behaviors.

These different parts may not be aware of each other, with only one dominant personality operating depending on the situation and circumstance of the moment.

17

Which item of data routinely gathered during assessment of a client with dissociative disorder would be of least relevance to planning?

a.) Voluntary control of symptoms

b.) Ability to remember

c.) Level of anxiety

d.) Evidence of disorientation

a.) Voluntary control of symptoms

Clients with dissociative disorders do not have voluntary control of symptoms. Voluntary control of symptoms has greater relevance when the nurse is assessing clients with somatoform disorders.

18

The symptom the nurse can expect a client with depersonalization disorder to manifest is

a.) aimless wandering with confusion and disorientation.

b.) a feeling of detachment from one's body or mental processes.

c.) existence of two or more personalities that take control of behavior.

d.) worry about having a serious disease based on symptom misinterpretation.

b.) a feeling of detachment from one's body or mental processes.

Depersonalization is characterized by a sense of unreality or self-estrangement.
 

19

A child who is able to regain mental stability after a traumatic event is said to be

a.) autonomous.

b.) resilient.

c.) mature.

d.) independent.

b.) resilient.

The term resilience refers to positive adaptation, or the ability to maintain or regain mental health despite adversity.

20

A child reared in a minority culture is at greatest risk for

a.) eating- and sleep-related disorders.

b.) traumatic experiences in early childhood.

c.) bullying.

d.) homicidal thoughts.

b.) traumatic experiences in early childhood.

Poverty, parental substance abuse, and exposure to violence have received increasing attention and place minority children at greater risk for trauma and stress.

21

When a toddler’s mother is hospitalized for several months, the nursing diagnosis Risk for impaired parent/child attachment related to: prolonged separation has been included into a child’s plan of care. The most appropriate outcome would be that

a.) the mother is discharged and returned home as soon as possible.

b.) mother and child show signs of healthy bonding.

c.) the father is able to assume the mother’s role in her absence.

d.) the child is able to transfer nuturing needs to another available adult.

b.) mother and child show signs of healthy bonding.

An overall attachment outcome would be for the parent and infant/child to demonstrate an enduring affectionate bond.

22

Parents express concern when their 5-year-old child, who is receiving treatment for cancer, keeps referring to an imaginary friend, Candy. The nurse explains that

a.) children this age usually have imaginary friends.

b.) it is nothing to worry about unless the child starts to socially isolate.

c.) the child needs more of their one-on-one attention.

d.) the imaginary friend is a coping mechanism the child is using.

d.) the imaginary friend is a coping mechanism the child is using.

Often traumatized children feel responsible for what happened to them and are frightened by flashbacks, amnesia, or hallucinations that may be due to trauma. For example, a child may use imaginary friends as a coping mechanism.
 

23

Which child is at greatest risk for developing attachment problems as a result of a neurobiological development?

a.) A 13-year-old male

b.) A 10-year-old female

c.) A 7-year-old male

d.) A 4-year-old female

d.) A 4-year-old female

The developing brain is particularly vulnerable to adverse events because the most rapid brain development occurs in the first five years of life.

The right hemisphere is involved in processing social-emotional information, promoting attachment functions, regulating body functions, and in supporting the individual in survival and in coping with stress.

Since the right brain develops first and is involved with developing templates for relationships and regulation of emotion and bodily function, early attachment relationships are particularly important for healthy development and life-long health.

24

According to the Attachment Theory, relationship disorders are related to trauma associated with

a.) insufficient food and/or shelter.

b.) siblings and/or strangers.

c.) caregivers and/or parents.

d.) culture and/or religion.

c.) caregivers and/or parents.

Attachment patterns or schemas are formed early in life through interaction and experiences with caregivers, and this relationship is embedded in implicit emotional and somatic memories.

25

The symptoms of an adjustment disorder can include (Select all that apply.)

a.) Guilt

b.) Social withdrawal

c.) Overachieving

d.) Anger

e.) Depression

a, b, d, e

a.) Guilt

b.) Social withdrawal

c.) Overachieving

d.) Anger

e.) Depression

In contrast to acute stress disorder responses, which are quite severe and include anxiety and fear, symptoms of an adjustment disorder can run the gamut of all forms of distress including guilt, depression, and anger.

These feelings may be combined with other manifestations of distress, including physical complaints, social withdrawal, or work or academic inhibition.