A nurse assesses an individual who commonly experiences anxiety. Which comment by this person indicates the possibility of obsessive-compulsive disorder?

Correct Answer: A

Rationale: Recurring doubt (obsessive thinking) and the need to check (compulsive behavior) suggest obsessive-compulsive disorder. The repetitive behavior is designed to decrease anxiety but fails and must be repeated. Stating 'My legs feel weak most of the time' is more in keeping with a somatic disorder. Being embarrassed to go out in public is associated with an avoidant personality disorder. Reliving a traumatic event is associated with posttraumatic stress disorder.

Correct Answer: C

Rationale: The correct answer is C) depression. When a soldier returns from active duty in a combat zone and is diagnosed with PTSD, the nurse's highest priority is to screen for depression because PTSD and depression commonly co-occur. Depression is a common mental health issue among individuals with PTSD due to the traumatic experiences they have faced. Screening for depression is crucial as it can significantly impact the soldier's overall well-being and quality of life. Option A) bipolar disorder and option B) schizophrenia are not the highest priority in this scenario because PTSD is more commonly associated with depression than these disorders. Bipolar disorder involves mood swings between mania and depression, while schizophrenia involves a distorted perception of reality. These conditions are not the primary concerns when a soldier with PTSD is being screened. Option D) dementia is also not the highest priority for screening in this case. Dementia is a neurocognitive disorder characterized by a decline in memory, thinking, behavior, and the ability to perform everyday activities. It is not typically associated with PTSD in returning soldiers from combat zones. In an educational context, understanding the importance of screening for comorbid conditions like depression in individuals with PTSD is crucial for nurses and healthcare professionals working with this population. By recognizing the interconnectedness of mental health conditions, nurses can provide comprehensive care and support to help improve the outcomes and well-being of their patients.

Correct Answer: D

Rationale: In this scenario, the correct answer is option D: cognitive distortions associated with unresolved childhood abuse issues. This option aligns with the etiology of disturbed personal identity commonly seen in individuals with dissociative identity disorder. Option A, obsessive fears of harming self or others, is more indicative of conditions like obsessive-compulsive disorder rather than dissociative identity disorder. Option B, poor impulse control and lack of self-confidence, is more aligned with impulse control disorders or personality disorders rather than dissociative identity disorder. Option C, depressed mood secondary to nightmares and intrusive thoughts, is more characteristic of post-traumatic stress disorder or mood disorders, not dissociative identity disorder. Educationally, understanding the rationale behind selecting the correct etiology for a nursing diagnosis is crucial for nurses caring for patients with complex mental health conditions. By differentiating between various etiologies, nurses can provide targeted and effective interventions to address the specific needs of individuals with dissociative identity disorder. This knowledge enhances the quality of care and promotes better patient outcomes.

Correct Answer: C

Rationale: Shifting the focus from somatic symptoms to feelings or to neutral topics conveys interest in the patient as a person rather than as a condition. The need to gain attention with the use of symptoms is reduced over the long term. A desired outcome would be that the patient would express feelings, including anger if it is present. Once physical symptoms are investigated, they do not need to be reinvestigated each time the patient reports them.

Correct Answer: B

Rationale: In this scenario, option B, "Let's see if there are any other possible explanations for your vomiting," is the best response to foster cognitive reframing in the patient. This response encourages the patient to consider alternative explanations for their symptoms, which can help challenge and reframe their belief about having a brain tumor. Option A is incorrect because dismissing the patient's belief outright can lead to resistance and does not address the underlying issue. It may also reinforce the patient's conviction. Option C is less effective as it focuses more on the emotional aspect rather than challenging the patient's cognitive distortion. Option D is not helpful as it avoids addressing the patient's concerns altogether. Educationally, this question highlights the importance of therapeutic communication in nursing practice. Nurses play a crucial role in supporting patients' mental well-being by using techniques like cognitive reframing to help patients challenge and reevaluate their thoughts and beliefs. Encouraging patients to explore alternative perspectives can lead to more positive outcomes and improved coping mechanisms.