Review Practice Exercise 3

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Practice Exercise 3

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Total Questions : 5

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Question 1:

A nurse is caring for a client who has a dissociative disorder. What should the nurse do to assist the client in goal achievement?

A. Provide opportunities for the client to experience success. B. Praise the client frequently, whether warranted or not. C. Evaluate components of the client’s self-concept. D. Discuss with the client three categories of behavior commonly associated with an altered self-concept.

Answer and Explanation

Choice A:

Facilitating success builds self-esteem and reinforces adaptive functioning. It helps the client reconnect with their capabilities, fostering confidence and motivation toward recovery and goal achievement.

Choice B:

Excessive or unwarranted praise may appear insincere, undermining therapeutic trust. It can distort reality testing and hinder the development of authentic self-worth.

Choice C:

Evaluating self-concept is an assessment activity, not a direct intervention for goal achievement. It provides insight, but does not actively promote progress or behavioral change.

Choice D:

Discussing behavioral categories is educational, not therapeutic. It may overwhelm the client or reinforce pathology without offering actionable steps toward goal-directed outcomes.

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Question 2:

The ultimate goal of therapy for a client with DID is:

A. Integration of the personalities into one B. For the client to have the ability to switch from one personality to another voluntarily C. For the client to select which personality he or she wants to be the dominant self D. For the client to recognize that the various personalities exist

Answer and Explanation

Choice A:

Integration of personalities into one cohesive identity is the therapeutic endpoint. It allows the client to function with unified memory, emotional regulation, and self-awareness, eliminating dissociative switching and internal conflict.

Choice B:

Voluntary switching maintains fragmentation and does not resolve the underlying dissociation. It may offer temporary control but does not promote long-term psychological integration.

Choice C:

Selecting a dominant personality reinforces hierarchy among alters and may increase internal conflict. Therapy focuses on merging identities, not choosing between them.

Choice D:

Recognition of personalities is an early therapeutic milestone, not the ultimate goal. It facilitates insight but does not address the need for full integration and resolution of trauma.

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Question 3:

Which of the following interventions would be most helpful for a client with a dissociative disorder having difficulty expressing feelings?

A. Distraction B. Reality orientation C. Journaling D. Grounding techniques

Answer and Explanation

Choice A:

Distraction may shift attention away from painful thoughts temporarily, but it does not promote integration of dissociated feelings or help the client learn adaptive emotional expression.

Choice B:

Reality orientation is appropriate for cognitive disorders such as dementia, not dissociative conditions. The problem is emotional disconnection, not confusion about time or place.

Choice C:

Journaling encourages expression but may overwhelm clients with trauma if used before stabilization. Without grounding first, it can increase vulnerability and worsen dissociation rather than resolve it.

Choice D:

Grounding techniques help reconnect the individual with reality when dissociation occurs. By focusing on sensory experiences or immediate surroundings, they reduce detachment and aid emotional regulation, allowing safe expression of feelings.

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Question 4:

A newly admitted client is diagnosed with dissociative identity disorder. Which nursing intervention is a priority?

A. Establish an atmosphere of safety and security. B. Identify relationships among subpersonalities and work with each equally. C. Teach new coping skills to replace dissociative behaviors. D. Process events associated with the origins of the disorder.

Answer and Explanation

Choice A:

Creating safety and security is the priority intervention because clients with dissociative identity disorder often experience high vulnerability, self-harm risk, and fear. A safe environment allows stabilization before deeper therapeutic work.

Choice B:

Working with each subpersonality equally and identifying relationships among them is important later in therapy, but it is not the immediate priority upon admission, when safety must come first.

Choice C:

Teaching coping skills is a valuable long-term strategy to reduce dissociation, but these interventions require stability and readiness, which cannot be achieved without first ensuring safety.

Choice D:

Processing traumatic origins too early can overwhelm the client and trigger further dissociation or crisis. Trauma exploration is a later therapeutic stage once safety and stabilization have been secured.

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Question 5:

Which of the following nursing evaluations for a hospitalized client diagnosed with dissociative identity disorder would lead the treatment team to consider discharge? SELECT ALL THAT APPLY.

A. The client is able to recall events associated with a traumatic or stressful situation. B. The client is able to communicate increased levels of anxiety before dissociation occurs. C. The client is able to demonstrate more adaptive coping strategies to avert dissociative behaviors. D. The client is able to verbalize the existence of multiple personalities and the purposes they serve. E. The client demonstrates continued use of alternate personalities to deal with stressful situations.

Answer and Explanation

Choice A:

Recalling traumatic events reflects improved integration and emotional processing. It indicates that the client is beginning to confront and work through previously dissociated material.

Choice B:

Communicating anxiety before dissociation shows increased self-awareness and emotional regulation. It allows for early intervention and reduces the likelihood of dissociative episodes.

Choice C:

Demonstrating adaptive coping strategies reflects behavioral stability and psychological resilience. It shows the client can manage stress without reverting to dissociative defenses.

Choice D:

Verbalizing the existence and function of alters indicates insight and internal cooperation. It supports therapeutic progress and readiness for outpatient continuation of care.

Choice E:

Continued use of alternate personalities to manage stress reflects persistent fragmentation. It suggests the client is still relying on dissociative mechanisms and is not yet ready for discharge.

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Practice Exercise 3

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