The PMHNP is evaluating a 27-year-old woman who has been diagnosed with posttraumatic stress disorder due to a childhood history of sexual trauma. Today she has brought her husband with her. He reports that he sometimes feels he has "two wives who have different likes and dislikes, different tastes in food, clothing, and entertainment, and even talk in different voices." The patient says she has periods in which she has no memory of what took place. As an example, she says she may be dining out with her husband and have no recollection of how she got there. The PMHNP will evaluate for which of the following disorders?
Dissociative identity disorder (DID)
Adjustment disorder
Schizotypal personality disorder
Malingering
The Correct Answer is A
Choice A reason: Dissociative identity disorder is characterized by the presence of two or more distinct identities or personality states and amnesia for daily events, which aligns with the patient’s symptoms.
Choice B reason: Adjustment disorder involves emotional or behavioral symptoms in response to a stressor but does not include dissociation or multiple identities.
Choice C reason: Schizotypal personality disorder involves eccentric behavior, perceptual distortions, and odd beliefs but does not include distinct identities or memory gaps.
Choice D reason: Malingering is intentional production of false symptoms for external gain, whereas this patient demonstrates involuntary dissociative experiences.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Claustrophobia may cause discomfort or anxiety during MRI, but it is not an absolute contraindication; sedation or open MRI can be used.
Choice B reason: Essential hypertension is not a contraindication; blood pressure is monitored but MRI can still be performed safely.
Choice C reason: Implanted defibrillators can malfunction or pose a serious risk in the strong magnetic field of MRI, making this an absolute contraindication unless the device is MRI-compatible.
Choice D reason: Intrauterine devices are generally safe for MRI; they may cause minor artifact but do not pose significant risk.
Correct Answer is D
Explanation
Choice A reason: Hydrocodone is an opioid analgesic and may be considered for severe pain, but it is not first-line for chronic neuropathic pain due to risk of dependence and side effects.
Choice B reason: Acetaminophen is effective for mild to moderate nociceptive pain but has limited efficacy in neuropathic pain.
Choice C reason: Amitriptyline is a tricyclic antidepressant effective for neuropathic pain and could be considered, but switching to pregabalin is often preferred for patients already partially responsive to gabapentin due to similar mechanisms but potentially better efficacy.
Choice D reason: This choice is correct because pregabalin is a first-line agent for neuropathic pain and can be considered when gabapentin provides only partial relief. It works similarly but has different pharmacokinetics and dosing flexibility, making it an appropriate next step.
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