A store clerk was killed during a robbery 2 weeks ago. His widow, ...

[Redwolflake15]

A store clerk was killed during a robbery 2 weeks ago. His widow, who has a long history of schizoaffective disorder, cries spontaneously when talking about his death. Select the nurse's most therapeutic response.
 
  a. Are you taking your medications the way they are prescribed?
  b. This loss is harder to accept because of your mental illness. Do you think you should be hospitalized?
  c. I'm worried about how much you are crying. Your grief over your husband's death has gone on too long.
  d. The unexpected death of your husband is very painful. I'm glad you are able to talk about your feelings.

Question 2

Which scenario demonstrates a dissociative fugue?
 
  a. After being caught in an extramarital affair, a man disappeared but then reappeared months later with no memory of what occurred while he was missing.
  b. A man is extremely anxious about his problems and sometimes experiences dazed periods of several minutes passing without conscious awareness of them.
  c. A woman finds unfamiliar clothes in her closet, is recognized when she goes to new restaurants, and complains of blackouts despite not drinking.
  d. A woman reports that when she feels tired or stressed, it seems like her body is not real and is somehow growing smaller.

[onowka]

Answer to Question 1

ANS: D
The patient is expressing feelings related to the loss, and this is an expected and healthy behavior. This patient is at risk for a maladaptive response because of the history of a serious mental illness, but the nurse's priority intervention is to form a therapeutic alliance and support the patient's expression of feelings. Crying at 2 weeks after his death is expected and normal.

Answer to Question 2

ANS: A
The patient in a dissociative fugue state relocates and lacks recall of his life before the fugue began. Often fugue states follow traumatic experiences and sometimes involve assuming a new identity. Such persons at some point find themselves in their new surroundings, unable to recall who they are or how they got there. A feeling of detachment from one's body or from the external reality is an indication of depersonalization disorder. Losing track of several minutes when highly anxious is not an indication of a dissociative disorder and is common in states of elevated anxiety. Finding evidence of having bought clothes or gone to restaurants without any explanation for these is suggestive of dissociative identity disorder, particularly when periods are lost to the patient (blackouts). See relationship to audience response question.

[Redwolflake15]

Excellent

[zacnyjessica]

Gracias!