22 minute read
Chapter 24: Dissociative Disorders
from TEST BANK for Foundations of Mental Health Care 7th Edition Morrison-Valfre. All 33 Chapters.
by ACADEMIAMILL
Morrison-Valfre: Foundations of Mental Health Care, 7th Edition
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 children’s: 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 child’s self-concept. Abandonment provides neither. The mother’s 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. 279 OBJ: 3
TOP: Self-Concept in Childhood
KEY: Nursing Process Step: Nursing Diagnosis
MSC: Client Needs: Health Promotion and Maintenance
2. The hospice nurse notices that, following the death of his wife of 50 years, a surviving husband’s affect is anxious, and he reports a feeling of detachment from his body, stating, “I feel like I am seeing myself from outside of my body.” 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. 281 OBJ: 5
TOP: Depersonalization/Derealization 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
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. 283
OBJ: 6
TOP: Dissociative Identity Disorder 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. 283
OBJ: 7
TOP: Dissociative Identity Disorder 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. 284
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. 284 OBJ: 7
TOP: Treatments and Therapies KEY: Nursing Process Step: Planning
MSC: Client Needs: Psychosocial Integrity a. manipulate b. harm c. date d. persecute
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.
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. 285 OBJ: 9
TOP: Treatments and Therapies KEY: Nursing Process Step: Planning
MSC: Client Needs: Psychosocial Integrity a. Self-esteem, low b. Personal identity, disturbed c. Role performance, ineffective d. Anxiety
8. Which of the following is considered a primary nursing diagnosis for a client with a dissociative disorder?
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. 285 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 client’s 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 to seek 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. 284 | p. 285
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. 285
OBJ: 9
TOP: Treatments and Therapies KEY: Nursing Process Step: Planning
MSC: Client Needs: Psychosocial Integrity a. Self-esteem, low b. Social isolation c. Body-image, disturbed d. Memory, impaired
11. 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?
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. 285 OBJ: 8
TOP: Treatments and Therapies
KEY: Nursing Process Step: Nursing Diagnosis
MSC: Client Needs: Psychosocial Integrity 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.
12. What is the first nursing priority in a client with the nursing diagnosis of “Personal identity, disturbed”?
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. 285 OBJ: 9
TOP: Treatments and Therapies KEY: Nursing Process Step: Planning
MSC: Client Needs: Psychosocial Integrity
13. 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 “piblokto,” 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. 281
OBJ: 5
TOP: Dissociative Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity a. Begin taking antidepressant medication. b. Move with his wife to an assisted living community. c. Get involved in a retired businessmen’s group providing assistance to new companies. d. Taking up a less strenuous activity to decrease stress and information overload.
14. 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?
ANS: C
A threat to the stability of one’s 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 which allows the person to adapt to change and regain a sense of self-esteem and self-worth will enhance the expression of self-concept. 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. 280
OBJ: 3
TOP: Self Concept in Older Adulthood KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity a. Psychoeducation b. Art therapy c. Joint stabilization plan d. Development of coping strategies
15. A family adopts a 7-year-old boy from an international adoption agency with little information on the child’s 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?
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 occur.
DIF: Cognitive Level: Application REF: p. 284 OBJ: 9
TOP: Treatments and Therapies KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity a. Self-esteem, low b. Personal identity, disturbed c. Body image, disturbed d. Anxiety
16. 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 coworker 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?
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. Low self-esteem and disturbed body image may be contributing factors to this diagnosis.
DIF: Cognitive Level: Application REF: p. 285 OBJ: 8
TOP: Treatments and Therapies KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity a. Dissociative amnesia b. Dissociative identity disorder c. Dissociative fugue d. Obsessive-compulsive disorder
17. Which dissociative disorder is a result of a disturbance of identity?
ANS: B
Dissociative identity disorder is a disturbance of identity. Dissociative amnesia and dissociative fugue are disturbances of memory. Obsessive-compulsive disorder is a mood disorder.
DIF: Cognitive Level: Application REF: p. 285 OBJ: 5
TOP: Characteristics KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
Multiple Response
1. 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 client’s 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 client’s 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. 285
OBJ: 9
TOP: Treatments and Therapies KEY: Nursing Process Step: Implementation
MSC: Client Needs: Psychosocial Integrity 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
2. 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.)
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. 285 OBJ: 5
TOP: Dissociative Disorders
MSC: Client Needs: Psychosocial Integrity
KEY: Nursing Process Step: Assessment a. Body image b. Self-esteem c. Identity diffusion d. Self-ideal e. Personal identity
3. A person’s self-concept, or how a person sees himself or herself, comprises which of the following? (Select all that apply.)
ANS: A, B, D, E
Body image (one’s feelings about his or her body), self-esteem (one’s judgment of his or her own worth), self-ideal (one’s personal standards on appropriate behavior), and personal identity (one’s awareness of himself as an individual) constitute a person’s self-concept. Identity diffusion refers to a person’s not being sure of who he really is.
DIF: Cognitive Level: Knowledge REF: p. 278
OBJ: 1
TOP: Self-Concept KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity 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.
4. Dissociative fugue is identified by which characteristics? (Select all that apply.)
ANS: B, C, D
The main characteristic of dissociative fugue is sudden, unexpected travel with an inability 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
TOP: Dissociative Fugue
MSC: Client Needs: Psychosocial Integrity
REF: p. 281
OBJ: 5
KEY: Nursing Process Step: Assessment
Chapter 25: Anger and Aggression
Morrison-Valfre: Foundations of Mental Health Care, 7th Edition
Multiple Choice
1. The use of inappropriate, harmful, or destructive behaviors to express current or past emotions is defined as: a. anger. b. assault. c. acting out. d. aggression.
ANS: C
Acting out is the use of inappropriate, detrimental, or destructive behaviors to express current or past emotions. Anger is a normal emotional response in certain situations; assault is a threat for bodily injury; and aggression is a forceful attitude or action.
DIF: Cognitive Level: Knowledge REF: p. 288
OBJ: 1
TOP: Anger and Aggression KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
2. Toddlers often express their anger through: a. crying. b. manipulation. c. temper tantrums. d. direct aggression.
ANS: C
Toddlers engage in temper tantrums when they learn to focus their aggression on what they believe is responsible for their anger.
DIF: Cognitive Level: Knowledge REF: p. 290
TOP: Aggression Throughout the Life Cycle
OBJ: 2
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
3. In the assault cycle, people are unable to listen to reason, follow directions, or engage in mental exercises during the stage of: a. crisis. b. trigger. c. recovery. d. escalation.
ANS: A
Assault is an aggressive behavior that violates another’s person or property. Crisis describes the behaviors in the question. Trigger refers to the phase when a stress-producing event occurs; recovery is described as the cooling-down period of the assault cycle; and escalation is characterized by a behavioral response that is approaching loss of control.
DIF: Cognitive Level: Comprehension REF: p. 292
OBJ: 5
TOP: The Cycle of Assault KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity a. crisis b. trigger c. depression d. escalation
4. Crisis interventions are very successful if begun early in the assault cycle, in the stage.
ANS: B
Crisis intervention works best in this stage because coping mechanisms can be implemented that are effective rather than allowing behavior to continue to the next phase of escalation.
DIF: Cognitive Level: Knowledge REF: p. 292
OBJ: 5
TOP: The Cycle of Assault KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity a. conduct b. adjustment c. impulse-control d. oppositional defiant
5. Persons who naturally relate aggressively to others, seldom have empathy, and lack appropriate guilt feelings are given the diagnosis of disorder.
ANS: A
These are characteristics of conduct disorders. Adjustment disorders are characterized by a psychological response from an identifiable stressor or group of stressors that causes significant emotional or behavioral symptoms that do not meet criteria for more specific disorders; impulse-control disorders are characterized by a failure to resist impulses or temptations that are harmful to the person or to others; and oppositional defiant disorder refers to a pattern of negative, aggressive behaviors that is seen most commonly in children who focus on authority figures.
DIF: Cognitive Level: Comprehension REF: p. 293
TOP: Aggressive Behavioral Disorders of Childhood
OBJ: 6
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity a. conduct b. adjustment c. impulse-control d. oppositional defiant
6. Emotional or behavioral problems that develop in response to an identifiable source and last no longer than 6 months are called disorders.
ANS: B
This is the criterion for adjustment disorders. Conduct disorders are characterized by individuals who naturally relate aggressively to others, seldom have empathy, and lack appropriate guilt feelings; impulse-control disorders are characterized by failure to resist an impulse, drive, or temptation; and oppositional defiant disorder refers to a pattern of negative, aggressive behaviors that is seen most commonly in children who focus on authority figures.
DIF: Cognitive Level: Knowledge REF: p. 294 OBJ: 6
TOP: Adjustment Disorders
MSC: Client Needs: Psychosocial Integrity
KEY: Nursing Process Step: Assessment
7. Level one interventions for potentially assaultive clients should be practiced as: a. therapy. b. control methods. c. assessment measures. d. preventive measures.
ANS: D
Level one interventions focus on the prevention of violence.
DIF: Cognitive Level: Knowledge REF: p. 295 OBJ: 8
TOP: Level One Interventions
KEY: Nursing Process Step: Planning
MSC: Client Needs: Safe and Effective Care Environment a. one b. two c. three d. four
8. Interventions for assaultive clients that focus on protecting the client and others from potential harm are level interventions.
ANS: B
Level two interventions focus on protecting the client and others from potential harm. Level one interventions focus on preventing violence, and level three is the last level of interventions that are implemented for clients whose behaviors reflect a loss of control.
DIF: Cognitive Level: Knowledge REF: p. 296 OBJ: 8
TOP: Level Two Interventions
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment a. 15 b. 30 c. 60 d. 90
9. Restrained clients must be monitored and their condition documented at least every minutes.
ANS: A
The use of restraints is governed by federal and state laws, institutional policies, and special procedures.
DIF: Cognitive Level: Knowledge REF: p. 296
OBJ: 8
TOP: Level Three Interventions KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
10. As long as the client is limiting her behaviors to verbal assaults and harmless physical movements, a. she is placed in seclusion. b. the acting out may continue. c. the caregiver is prepared to apply restraints. d. she is reminded of the inappropriateness of her behavior.
ANS: B
Allow clients to act out as long as they limit their behaviors to verbal assaults and harmless physical movements. However, it is important for the caregiver to maintain control of the situation and set limits on the client’s behavior.
DIF: Cognitive Level: Application REF: p. 296
OBJ: 8
TOP: Level Two Interventions KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
11. Interventions that help caregivers the most in coping with their own anger focus on: a. learning to effectively interact with clients. b. assessing which stressors and coping skills are being used. c. learning to effectively control feelings of anger. d. establishing a trusting therapeutic relationship via clear communications.
ANS: C
Although all these interventions are necessary when one is dealing with clients, this intervention allows caregivers to be most effective in caring for individuals who express emotions of anger.
DIF: Cognitive Level: Application REF: p. 298
OBJ: 9
TOP: Therapeutic Interventions KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity a. Marrying her partner she has lived with for 5 years. b. Beginning college after graduating from high school 12 years ago. c. Being promoted in the company at which she has worked for the past 10 years. d. Meeting with a friend with whom she keeps in contact but has not seen for 8 years.
12. Which situation would most negatively affect a female client with a diagnosis of adjustment disorder?
ANS: B
Individuals with adjustment disorders have the greatest difficulty in adapting to new situations. Therefore, beginning college has the most stress potential because it has no familiar aspect to it, as the other options do.
DIF: Cognitive Level: Analysis REF: p. 294
OBJ: 6
TOP: Adjustment Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
13. A married couple is seeking counseling for domestic abuse issues. The husband states that he can’t control his anger when his wife constantly nags at him. In the assault cycle, the wife’s behavior in this situation is the stage known as: a. recovery. b. crisis. c. escalation. d. trigger.
ANS: D
The nagging is the trigger to the assault in this situation. The trigger stage should not be confused as being a justified reason for an assault to occur.
DIF: Cognitive Level: Application REF: p. 292 OBJ: 5
TOP: The Cycle of Assault
MSC: Client Needs: Psychosocial Integrity
KEY: Nursing Process Step: Assessment
14. A male client is being seen for anger management issues following an incident in which he was late for work, became angry at the driver in front of him for not driving faster, and intentionally ran into the car at a stop sign. This client is displaying actions most typical of: a. intermittent explosive disorder. b. passive aggressive behavior. c. oppositional defiant disorder. d. adjustment disorder with anxiety.
ANS: A
The main characteristic of intermittent explosive disorder is the failure to resist aggressive impulses that result in assault of another individual or property. Passive aggressive behavior, oppositional defiant disorder, and adjustment disorder with anxiety do not result in injury or harm to persons or property.
DIF: Cognitive Level: Application REF: p. 294 OBJ: 6
TOP: Impulse-Control Disorders
MSC: Client Needs: Psychosocial Integrity
KEY: Nursing Process Step: Assessment a. One b. Two c. Three d. Four
15. An intramuscular injection of an antianxiety agent is administered to a client who has become violent toward the staff in the emergency room. This is an example of what level of therapeutic intervention?
ANS: C
Level three interventions also include seclusion and restraints and are used only for clients who are out of control. Level one is the prevention stage of interventions, and level two is focused on protection of the client and others from potential harm. Level four does not exist.
DIF: Cognitive Level: Application REF: p. 296 OBJ: 8
TOP: Level Three Interventions KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment a. The woman who willingly volunteers to help out at her child’s school play. b. The woman who says no when asked to go to a charity event. c. The woman who asks a coworker to cover her shift. d. The woman who agrees to cover a coworker’s shift and complains to customers that she is supposed to be home.
16. Which of the following persons is exhibiting passive aggression?
ANS: D
A person demonstrating passive aggressive actions expresses anger in indirect ways. Instead of declining to cover the shift, the person complains to others. The other examples do not demonstrate this indirect anger.
DIF: Cognitive Level: Application REF: p. 288
TOP: Introduction KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
OBJ: 1 a. Fights in schoolyards b. Organized sports c. Joining gangs d. Verbal abuse
17. Children in preadolescence have started to channel aggression through which positive activity?
ANS: B
By preadolescence, most children stop hitting and learn to channel their aggression into physical activities, such as competitive sports or physical conditioning. Fighting, gangs, and verbal abuse are not positive activities.
DIF: Cognitive Level: Application REF: p. 289
TOP: Introduction KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
OBJ: 1 a. Behavior, risk-prone health b. Spiritual distress c. Social interaction, impaired d. Family processes, interrupted
18. A 15-year-old female is seen in the clinic for episodes of cutting herself since her parents divorced 6 months ago. Which nursing diagnosis is a priority for this client?
ANS: A
The client is demonstrating anger turned inward demonstrated by self-mutilation. The priority would be to prevent the client from further harming herself. Dealing with spiritual distress, impaired social interaction, and interrupted family processes is accomplished after this.
DIF: Cognitive Level: Application REF: p. 295
TOP: Introduction KEY: Nursing Process Step: Intervention
OBJ: 1
MSC: Client Needs: Safe and Effective Care Environment a. Trigger stage b. Escalation stage c. Recovery stage d. Depression stage
19. A man who hit his wife yesterday, causing her to fall and break her arm, has called out of work today to take care of her and buy her flowers. He repeatedly tells her how horrible he feels and promises this will never happen again. What stage of the assault is he demonstrating?
ANS: D
The depression stage involves a period of guilt and attempts to reconcile (make up) with others. Aggressors are aware of the assault and genuinely feel bad about it. They may apologize frequently or provide loving care for the victim. The trigger stage occurs prior to the assault when the stress-producing event occurs. The escalation stage is when actions move closer to a loss of control, and the recovery stage occurs after the violence and injuries are assessed.
DIF: Cognitive Level: Application REF: p. 293 OBJ: 5
TOP: The Cycle of Assault KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
Multiple Response
1. Which mental health problems are categorized as anger control disorders? (Select all that apply.)
a. Conversion disorder b. Conduct disorder c. Dissociative disorder d. Impulse-control disorder e. Dysthymic disorder f. Adjustment disorder g. Oppositional defiant disorder
ANS: B, D, F, G
Conduct disorder, impulse-control disorder, adjustment disorder, and oppositional defiant disorder are all examples of anger control disorders.
DIF: Cognitive Level: Comprehension REF: p. 293 OBJ: 6
TOP: Anger Control Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity a. Coping skills b. General appearance c. Value and belief systems d. Cultural, spiritual, and occupational interests e. Potential for engaging in inappropriate behavior
2. During the psychosocial portion of the assessment of a client with anger, aggression, or violent behavior issues, the nurse will assess which of the following? (Select all that apply.)
ANS: A, C, D
Assessing coping skills, whether the client has a value and belief system, and cultural, spiritual, and occupational interests are components of the psychosocial portion of the assessment. Assessing potential for engaging in inappropriate behavior and general appearance occur during the initial portion of the assessment and during the mental status assessment, respectively.
DIF: Cognitive Level: Knowledge REF: p. 295
OBJ: 7
TOP: Assessing Anger and Aggression KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity a. Anxiety b. Violence, risk for other-directed c. Hopelessness d. Violence, risk for self-directed e. Coping ineffective, individual f. Fear
3. Which of the following psychosocial nursing diagnoses is related to anger and aggression? (Select all that apply.)
ANS: A, C, E, F
Anxiety, hopelessness, ineffective coping, and fear are all potential nursing diagnoses related to anger and aggression. Violence, risk for other-directed, and violence, risk for self-directed, are diagnoses in the physical realm.
DIF: Cognitive Level: Knowledge REF: p. 293
OBJ: 7
TOP: Assessing Anger and Aggression KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
