The nurse who is counseling a client with a dissociative disorder ...

[future617RT]

The nurse who is counseling a client with a dissociative disorder should understand that the
  assessment of highest priority is
 
  a. risk for self-harm.
  b. cognitive functioning.
  c. identification of drug abuse.
  d. readiness to reestablish identity or memory.

Question 2

A client, age 56 years, became severely depressed when the last of her six children moved out of the
  home 4 months ago. Since then she has neglected to care for herself, lost weight, and repeatedly
  states No one cares about me anymore..
 
  Before the onset of symptoms she had been a meticulous
  housekeeper, was neatly groomed, and often participated in community activities. She was
  noncompliant with tricyclic antidepressant therapy, so admission to the mental health unit was
  sought. After her admission, the client repeatedly tells nursing staff No one cares about me. I'm not
  worth anything.. A helpful response by the nurse would be
  a. I care about you, and I want to try to help you get better..
  b. Things will look brighter soon. Everyone feels down once in a while..
  c. It is difficult for others to care about you when you say the same negative things
  over and over..
  d. I'll sit with you for 10 minutes, I'll return for 10 minutes at lunchtime, and again
  at 2:30 this afternoon..

[fwbard]

Answer to Question 1

ANS: A
Assessments that relate to client safety take priority. Clients with dissociative disorders may be at
risk for suicide or self-mutilation, so the nurse must be alert for hints of hopelessness, helplessness
and worthlessness, low self-esteem, and impulses to self-mutilate. The other options are important
assessments but rank beneath safety.

Answer to Question 2

D
Spending time with the client at intervals throughout the day shows acceptance by the nurse and will
help the client establish a relationship with the nurse. Setting definite times for the therapeutic
contacts and keeping the appointments shows predictability on the part of the nurse, an element that
fosters trust building. Option A is difficult for a profoundly depressed person to believe. Option B
provides trite reassurance. Option C is counterproductive. The client is essentially unable to say
positive things at this point.

[future617RT]

Excellent

[debra928]

TYSM