A nurse is caring for a client who has been brought into an emergency department of a large hospital. The client's family state that the client "took some kind of drugs." The client is dizzy, has recently vomited, and is experiencing paranoia, yelling, "Stay away from me! You are going to kill me!" The client alternates yelling with mumbling and gesturing. Their eyes are darting back and forth as they are talking to the wall. The nurse should suspect the client has used which of the following substances?

Anabolic steroids

Opioids

Stimulants

Hallucinogens

Answer and Explanation

The Correct Answer is D

D. The client's symptoms, including paranoia, perceptual disturbances (such as seeing things that aren't there), erratic behavior, and disorientation, are consistent with the effects of hallucinogens. Hallucinogens are a class of drugs that alter perception, mood, and cognitive processes.

A. Anabolic steroids are synthetic variations of the male sex hormone testosterone. They are primarily used to promote muscle growth and enhance athletic performance.

B Opioids are a class of drugs that include prescription pain relievers, such as oxycodone and morphine, as well as illegal drugs like heroin.

C. Stimulants, such as cocaine and amphetamines, can cause symptoms such as paranoia, agitation, and hallucinations, particularly at high doses or with chronic use. However, the client's symptoms of darting eyes, paranoia, yelling, mumbling, and gesturing are more suggestive of hallucinogen use rather than stimulant use.

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Correct Answer is C

Explanation

C. Dissociative amnesia is characterized by difficulty remembering important personal information, typically of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. The manifestation of guilt is common in individuals experiencing dissociative amnesia, as they may feel guilty about their inability to recall events or about any actions that occurred during the period of amnesia.

A. Hallucinations involve perceiving sensations that are not present in reality, such as hearing voices or seeing things that others do not. While hallucinations can occur in various psychiatric disorders, they are not a typical manifestation of dissociative amnesia.

B. Delusions are false beliefs that are firmly held despite evidence to the contrary. Like hallucinations, delusions can occur in various psychiatric disorders, but they are not characteristic of dissociative amnesia.

D. Anhedonia refers to a reduced ability to experience pleasure or interest in previously enjoyable activities. It is not directly related to dissociative amnesia.

A. A. history of self-injurious behavior B. History of trauma during the developmental years C. Borderline personality disorder D. A history of schizophrenia

Correct Answer is B

Explanation

B. Trauma during the developmental years, especially in early childhood, is considered a significant risk factor for the development of DID. Trauma disrupts normal psychological development and can lead to the fragmentation of identity as a coping mechanism to dissociate from overwhelming or traumatic experiences.

A. A history of self-injurious behavior is often associated with various mental health conditions, such as borderline personality disorder, post-traumatic stress disorder (PTSD), or depression but it is not a primary risk factor for dissociative identity disorder (DID).

C. Individuals with BPD may experience dissociative symptoms, particularly during times of stress or intense emotional arousal but BPD itself is not considered a primary risk factor for dissociative identity disorder (DID).

D. Individuals with schizophrenia may experience dissociative symptoms, such as depersonalization or derealization but these symptoms are typically secondary to psychotic experiences rather than being indicative of dissociative identity disorder (DID).

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Naxlex Comprehensive Predictor Exams

A nurse is providing care to a client is who is recovering from an episode of dissociative amnesia. The nurse should expect the client to exhibit which of the following manifestations?

Correct Answer is C

Explanation

A nurse is preparing an in-service for a group of staff members about dissociative identity disorder. Which of the following should the nurse identify as a risk factor for this disorder?

Correct Answer is B

Explanation

A nurse is presenting an in-service about the cycle of violence to nursing staff. The nurse should include that which of the following occurs during phase 1 of the cycle of violence?

A nurse is providing discharge teaching to a client who has borderline personality disorder. The client reports being a single parent caring for two toddlers. Which of the following actions should the nurse take?

A nurse is discussing schizophrenia spectrum disorders with a client. The client states, "My friend says that before I started hearing voices. I stopped hanging out with them. Why is that?" Which of the following responses should the nurse make?

A nurse is presenting information about the prevention of sexually transmitted infections to a group of high school students. The nurse should identify that this is an example of which of the following types of prevention?

A nurse is teaching a newly licensed nurse about the needs of clients who are a part of a vulnerable population. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?

A nurse is caring for a client who is experiencing fluctuating cognition and visual hallucinations. Which of the following types of dementia should the nurse expect this client to have?