A client is suspected to have dissociative identity disorder. Which characteristic does the nurse identify that the disturbed personal identity is most likely related to?

High risk for self-directed violence.

Chronic low self-esteem.

Childhood trauma and abuse.

Poor impulse control.

Answer and Explanation

The Correct Answer is C

Choice A reason: Self-directed violence is a risk in dissociative identity disorder but is a consequence, not the cause, of identity disruption. Trauma-induced changes in amygdala-hippocampal connectivity drive dissociation, not violence, which arises from emotional dysregulation secondary to fragmented identity states.

Choice B reason: Chronic low self-esteem may co-occur in dissociative identity disorder but is not the primary cause. Identity disruption stems from trauma-induced neural changes, particularly in the amygdala and prefrontal cortex, leading to fragmented self-states, not primarily from self-esteem deficits.

Choice C reason: Childhood trauma and abuse are the primary causes of dissociative identity disorder, disrupting neural integration in the prefrontal cortex and hippocampus via chronic cortisol elevation. This fragments identity formation, creating distinct personality states as a coping mechanism for overwhelming stress.

Choice D reason: Poor impulse control is a symptom in some dissociative identity disorder cases but not the cause. Identity disruption results from trauma-induced amygdala hyperactivity and hippocampal dysfunction, leading to dissociated states, not primarily from impulsivity, which is a secondary behavioral outcome.

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Correct Answer is D

Explanation

Choice A reason: Clomipramine, a tricyclic antidepressant, targets serotonin and norepinephrine reuptake for depression, not bipolar mood stabilization. It risks triggering mania by overstimulating monoamine pathways, making it unsuitable for rapid-cycling bipolar disorder, which requires mood-stabilizing anticonvulsants.

Choice B reason: Risperidone, an antipsychotic, blocks dopamine and serotonin receptors, managing acute mania but not rapid cycling. Anticonvulsants like carbamazepine stabilize mood by modulating sodium channels, making risperidone less effective for long-term control of bipolar mood fluctuations.

Choice C reason: Clonidine, an alpha-2 agonist, reduces norepinephrine release for hypertension or ADHD, not bipolar disorder. It lacks mood-stabilizing properties, unlike anticonvulsants, which modulate neuronal excitability, making it inappropriate for managing rapid-cycling bipolar mood changes.

Choice D reason: Carbamazepine, an anticonvulsant, stabilizes mood in rapid-cycling bipolar disorder by inhibiting voltage-gated sodium channels, reducing neuronal excitability in the limbic system. This prevents manic and depressive episodes, making it a first-line choice for stabilizing rapid mood cycles.

A. Notify the provider for a restraint order and assessment. B. Advise the cafeteria staff of plastic utensils that can be used as weapons. C. Ask staff members how the patient was able to acquire the utensil. D. Notify the house supervisor for further direction.

Correct Answer is A

Explanation

Choice A reason: Notifying the provider ensures legal and medical oversight for restraints, addressing self-harm risk driven by serotonin deficits and amygdala hyperactivity. This prioritizes patient safety and evaluates underlying psychiatric causes, ensuring appropriate intervention to stabilize neural dysregulation.

Choice B reason: Advising cafeteria staff is a preventive measure but not the priority during acute self-harm. Serotonin-driven impulsivity requires immediate medical assessment, and addressing utensil access is secondary to stabilizing the patient’s acute neurochemical crisis.

Choice C reason: Investigating utensil acquisition is important for future prevention but not urgent. The patient’s self-harm, driven by serotonin deficits and amygdala hyperactivity, requires immediate medical intervention to ensure safety and address acute psychiatric needs first.

Choice D reason: Notifying the house supervisor is administrative, not clinical, and delays direct intervention. Self-harm reflects serotonin dysregulation and amygdala-driven impulsivity, requiring immediate provider assessment for restraints and psychiatric evaluation, making this less urgent.

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A client is suspected to have dissociative identity disorder. Which characteristic does the nurse identify that the disturbed personal identity is most likely related to?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient diagnosed with bipolar disorder has rapidly changing mood cycles. The health care provider prescribes an anticonvulsant medication. Which drug should the nurse anticipate will be prescribed?

Correct Answer is D

Explanation

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Correct Answer is A

Explanation

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