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Situation: A young man is brought to the local emergency department by the police. He approached a police officer in a large metropolitan bus depot stating "I don't know who or where am I am. I have no identification with me. Can you help me?" The young man appears to be in good physical health and between age 18 to 22. He is clean and neatly groomed. The physical examination reveals no evidence of trauma or other abnormal findings. Staff members refer to him as X.
20. In the absence of physical findings to explain X.'s memory loss, the most likely diagnosis is:
a) schizophrenia
b) personality disorder
c) somatoform disorder
d) dissociative disorder
21. X. is admitted to the psychiatric unit for further evaluation and treatment. He probably will react to his inability to recall his identity by exhibiting:
a) intense preoccupation with discovering who he is
b) depression
c) anger and frustration
d) complacency
22. In working with X., the nurse should direct her first intervention toward:
a) establishing a climate of trust and acceptance
b) identifying the cause of the patient's memory loss
c) encouraging the patient to remember events leading to the memory loss
d) helping the patient recall his first name
23. Nursing interventions for X. should be based on the understanding that:
a) once the patient's anxiety is alleviated, his memory will return
b) memory loss usually is precipitated by severe psychologic stress
c) the patient could remember his identity if he really wanted to
d) the patient probably will regain his memory slowly but have an incomplete recall of immediate events
Situation: P., a 40 year old mother of two children ages 6 and 9, is admitted for a surgical biopsy of a suspicious lump in her left breast.
24. The admitting nurse wants to assess P.'s perceptions about her admission and proposed treatment. Which question is the best way to initiate such a discussion?
a) what has your physician told you about the reason for your admission
b) have you discussed the treatment alternatives available to you if the lump is malignant
c) what questions do you have about your admission and treatment?
d) what is your understanding of the reasons for your admission and the possible courses of treatment?
25. P. says to the nurse, "I don't want to be put to sleep for this biopsy. I want to be awake and aware of what's happening. That's the best way to do this, isn't it?" How should the nurse respond?
a) everyone reacts differently, but I agree with you. I'd want to be awake, too
b) you will be medicated to help you feel relaxed. I wouldn't worry about it
c) that's really between you and your surgeon. You'd better discuss this with him
d) tell me more about your thoughts on being awake or asleep during the biopsy
26. When the nurse comes to take P. to surgery, she finds her tearfully finishing a letter to her children. P. says "I want to leave this for them in case anything goes wrong today." The nurse's best answer would be:
a) in case anything goes wrong? What are your thoughts right now?
b) I can understand that you're nervous, but this is really a minor procedure. You'll be back in your room before you know it
c) try and take a few deep breaths and relax. I have some medication that will help[
d) I'm sure your children know how much you love them. You'll be able to talk to them on the phone in a few hours
ANSWERS AND RATIONALE
20) D
- the patient in this situation is probably suffering from a dissociative disorder, which is characterized by a temporary alteration in consciousness, identity, or motor behavior in response to stress, anxiety, or perceived danger. Psychogenic amnesia, a sudden inability to recall extensive amounts of personal data because of a physical or psychological trauma, is an example of this type of disorder. Schizophrenia, a type of psychosis in which the patient responds to overwhelming anxiety through a disintegration of ego functioning, is characterized by impaired communication and loss of contact with reality. X. shows no evidence of thought disorder or other psychotic symptoms, so a diagnosis of schizophrenia is not indicated. A personality disorder typically originates within the character structure of the individual and is evidences by a life-long pattern of maladaptive behavior rather one or acute onset. Examples include such conditions as antisocial and borderline personality. A somatoform disorder is characterized by multiple physiological complaints or symptoms having no organic basis.
21) D
- because a patient with psychogenic amnesia is successfully blocking a traumatic or severe anxiety-producing event, he will probably react to his inability to recall his identity with complacency. he will not have an intense desire to discover who he is because learning his identity would force him to remember the event and confront the anxiety he so fears. For the same reason, X. will not exhibit depression or anger, both of which are associated with anxiety-producing events.
22) A
- because the patient is defending himself against severe anxiety, the nurse must first establish a warm, trusting, and accepting climate. After gaining the patient's trust, the nurse can help him learn ways to deal with his anxiety. Prodding X. to recall events or remember his name is not helpful at this time. Identifying the cause of the patient's memory loss may be impossible.
23) B
- psychogenic amnesia usually is precipitated by severe psychologic stress that causes the patient to repress (block out) painful events or experiences. Both the stressful event and the anxiety that it produced have been blocked from X.'s memory. Until the stressful event is identified, the accompanying anxiety cannot be alleviated. Forgetting one's identity is an unconscious act, and willing oneself to remember is not enough to be successful. Slow return of memory with impaired recall of the amnesia period is characteristic of memory loss caused by head injury.
24) D
- by asking the patient to explain her understanding of the situation, the nurse can assess both her knowledge and her emotional reactions. Often, the anxiety produced by being told one might have cancer is so great that the patient cannot absorb further details given by a physician. Asking P. what the physician has said or what questions she might have can be done later to clarify and evaluate her initial responses.
25) D
- the nurse needs to explore the patient's statement further before responding. The nurse's role is not to agree or disagree with the patient's choices. Telling the patient not to worry about the procedure would be inappropriate; the nurse should explore the patient's concerns, not minimize them. Although the final decision is between the patient and her surgeon, the nurse can help the patient explore and clarify her feelings at this time.
26) A
- by acknowledging how the patient feels, the nurse encourages further expression of the patient's thoughts. Minimizing feelings or offering empty reassurance is not therapeutic or helpful. Deep breathing or preoperative medications are appropriate after the patient's fears have been expressed and dealt with.
Related Topics:
- Go back to Online Nursing Practice Test about Anxiety Disorders (1-9) to start the test from the beginning.
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