n448: chapter 22 (veteran's health)

A female veteran showing signs of clinical depression feels especially alone because, as a soldier, she feels she "should be tougher." What response from the nurse is most sensitive to this veteran's needs? a. "depression is common among all veterans." b. "only posttraumatic stress disorder is serious." c. "have you repressed any sexual or other trauma?" d. "it is normal for women to suffer more depression."

a. "depression is common among all veterans." rationale: Depression is common among all soldiers, and it can be as serious as posttraumatic stress disorder. There may be many types of trauma experienced by this veteran, but the nurse cannot assume any trauma, sexual or otherwise, and should be sensitive in questioning the patient on this topic. Among female veterans visiting the Veterans Affairs, the top three diagnoses are depression, posttraumatic stress, and hypertension. Although there are studies that delineate mental health into gender-specific categories, this is one area where any gender-related response is marginal.

The veterans of which war experienced heat exhaustion and exposure to sand, dust, and particulate matter, as well as chromium? a. Gulf War b. Korean War c. Vietnam War d. World War II

a. Gulf War rationale: Veterans of the Gulf War era need to be specifically assessed for health complications from repeated heat exhaustion; exposure to sand, dust, and particulate matter; and exposure to chromium. The veterans of World War II, the Korean War, and the Vietnam War were exposed to various other health threats but not to this specific combination of health threats.

When assessing history, the nurse discovers that the patient is a Vietnam veteran. Which characteristic is specific to members of this population? a. history of Agent Orange exposure b. history of exposure to extreme cold c. respiratory issues secondary to oil field fires d. high risk for amyotrophic lateral sclerosis (ALS)

a. history of Agent Orange exposure rationale: Those who served in Vietnam were potentially exposed to Agent Orange, a defoliant commonly used in jungle warfare at the time. Veterans who served in the Korean War may have been exposed to extreme cold. High risk for ALS and respiratory issues from oil field fires may be present in Gulf War veterans.

The nurse participating in the care for a veteran diagnosed with posttraumatic stress disorder can expect which interventions to be included in the treatment plan? Select all that apply. a. psychotherapy b. electroconvulsive therapy c. antipsychotic medications d. cognitive-behavioral therapy e. selective serotonin reuptake inhibitors

a. psychotherapy d. cognitive-behavioral therapy e. selective serotonin reuptake inhibitors rationale: Successful interventions to management posttraumatic stress disorder include one-on-one psychotherapy, family and group therapy, cognitive-behavioral therapy, and selective serotonin reuptake inhibitors such as sertraline (Zoloft) and paroxetine (Paxil). Electroconvulsive therapy and antipsychotic medications are not among the evidence-based interventions identified to manage posttraumatic stress disorder.

The nurse is assessing a veteran who recently returned from a combat zone for signs of posttraumatic stress disorder. Which characteristics can cause this patient population to avoid needed care? Select all that apply. a. stigma of appearing weak b. fear of confidentiality breach c. threat to career advancement d. fear of letting colleagues down e. threat of dishonorable discharge

a. stigma of appearing weak b. fear of confidentiality breach c. threat to career advancement d. fear of letting colleagues down rationale: Veterans may avoid getting the care they need because of the stigma of appearing weak, not trusting that their information will be kept confidential, fear that seeking treatment will jeopardize career advancement, or out of fear of letting their colleagues down. The concern that seeking treatment for posttraumatic stress disorder will result in a dishonorable discharge is not an accurate, identified reason veterans fail to seek healthcare treatment.

Nurses should carefully screen veterans with sexual minority status, current or past mental health conditions, a history of self-directed violence, substance abuse, poor physical health and functioning, lack of social support, and sexual trauma for which health risk? a. suicide b. military sexual trauma c. major depressive disorder d. posttraumatic stress disorder

a. suicide rationale: Risk factors that place veterans at the greatest risk for suicide include sexual minority status, current or past mental health conditions, a history of self-directed violence, substance abuse, poor physical health and functioning, lack of social support, and sexual trauma. Veterans with any of these risk factors should be carefully screened and referred for follow-up services. Military sexual trauma, major depressive disorders, and posttraumatic stress disorder are contributing factors for suicide among veterans; however, sexual minority status, current or past mental health conditions, a history of self-directed violence, substance abuse, poor physical health and functioning, lack of social support, and sexual trauma do not specifically cause these health risks.

Which health care intervention strategy will the public health nurses recommend to increase access to posttraumatic stress disorder treatment in situations where the veteran is located in a remote area or when travel is difficult? a. telemedicine b. free cell phones c. peer support specialists d. suicide prevention crisis line

a. telemedicine rationale: Home-based telemedicine is an intervention strategy currently employed to increase access to posttraumatic stress disorder treatment for veterans located in remote areas or when travel is difficult. Free cell phones, peer support specialists, and suicide prevention crisis lines are important resources, but they do not increase visual access to posttraumatic stress disorder specialists the way that telemedicine does.

Which is the biggest risk factor for homelessness among female veterans? a. unemployment b. military sexual trauma c. non transitional military job d. posttraumatic stress disorder

a. unemployment rationale: Unemployment is the biggest risk factor for homelessness among women veterans. Although military sexual trauma, a nontransitional military job, and posttraumatic stress disorder are other factors that contribute to homelessness among female veterans, they are not the biggest risk factor.

Which risk factors will the nurse look for while assessing veterans for suicide risk? Select all that apply. a. white males b. substance use c. hispanic females d. sexual minority status e. history of self-directed violence f. current mental health condition

a. white males b. substance use d. sexual minority status e. history of self-directed violence f. current mental health condition rationale: Risk factors for suicide among veterans include non-Hispanic white males, substance use, sexual minority status, history of self-directed violence, and current mental health conditions. Hispanic females are not identified as being at the greatest risk for suicide among veterans.

Which are the primary factors that contribute to a veteran developing posttraumatic stress disorder (PTSD)? Select all that apply. a. sleeplessness b. combat injury c. feeling helpless d. viewing dead bodies e. surviving a traumatic event

b. combat injury c. feeling helpless d. viewing dead bodies e. surviving a traumatic event rationale: The primary factors that contribute to the development of PTSD in veterans include combat injuries, feeling helpless, viewing dead bodies, and surviving a traumatic event. Sleeplessness is a manifestation of PTSD, but it does not cause the condition.

Veterans serving abroad have additional health issues because of the environment and characteristics of the area in which they served. Which is an example of such a health issue? a. HIV b. malaria c. syphilis d. salmonella

b. malaria rationale: Although members of the military are given extensive vaccinations and prophylactic treatments for disease, there is always a risk for contagion. Malaria is one such risk that can be associated with a particular region of the world. Once contracted, malaria can have lingering physical effects. HIV and syphilis are a result of lifestyle choices, not service in general. Salmonella exposure is not limited to international travel and is treatable with no likely long-term complications.

Which population is most likely to be homeless? a. single females b. military veterans c. single-parent families d. former foster children

b. military veterans rationale: Point-in-time studies from more than one source indicate that military veterans and the chronically homeless make up the greatest subpopulations of homeless persons overall. Single females and single-parent families do make up a portion of the statistics but not to the same degree as veterans. The study did not include specific data on former foster children.

An Army veteran, who has chronic back pain from previous shrapnel injuries, parks in a handicapped spot and while exiting the vehicle hears a stranger yell, "You're not disabled! You can't park in a handicapped spot!" What best explains the stranger's reaction? a. there is widespread antipathy for veterans' health issues. b. there is a common myth that all disabilities must be visible. c. handicapped spots are reserved for people who use wheelchairs. d. the stranger is correct that the veteran should not park in a handicapped spot.

b. there is a common myth that all disabilities must be visible. rationale: There are many myths surrounding mental and physical disabilities. The stranger's remark in this situation is an example of the myth that all disabilities must be visible to be legitimate. Although there may be varying attitudes about veterans and their health, there is no indication that the stranger actually knew the patient had served in the military. Official handicap parking permits are issued for many reasons, not just for those using wheelchairs. The veteran has a legitimate reason to use the reserved space.

Which characteristics describe the homeless veteran population in the United States? Select all that apply. a. they reside in rural areas. b. they are more commonly seen in urban settings. c. homelessness is often accompanied by a mental health disorder. d. the majority of this population are males aged 31-50. e. more Asian veterans are homeless than Hispanic veterans. f. there is a large population of homeless female veterans.

b. they are more commonly seen in urban settings. c. homelessness is often accompanied by a mental health disorder. d. the majority of this population are males aged 31-50. rationale: The U.S. Department of Housing and Urban Development reports that the majority of homeless veterans are urban residents, single males ages 31-50, and have mental health disorders. Africans or Hispanics, but not Asians, comprise the majority of homeless veterans. Females only comprise 9% of homeless veterans.

Nurses providing care for veterans of which war era will assess specifically for health threats related to Agent Orange exposure? a. Gulf War b. Korean War c. Vietnam War d. World War II

c. Vietnam War rationale: In addition to the common health risks of noise and occupational hazards, veterans of the Vietnam War era need to be assessed for health disorders related to Agent Orange exposure. These include cancer, stroke, hypertension, and lung conditions. Veterans of World War II, the Korean War, and the Gulf War were exposed to various other health threats but not to Agent Orange.

Women veterans are three to four times more likely than nonveteran women to experience which social problem? a. alcoholism b. depression c. homelessness d. substance abuse

c. homelessness rationale: Women veterans are three to four times more likely be homeless than their nonveteran counterparts in virtually all age groups. Problems with alcohol or other drugs affect female veterans at about the same rates as the general population. Female veterans's rates are less than three to four times greater than the rate of the general population to experience problems with depression.

A veteran who spent several deployments in extremely cold environments has a history of frostbite, immersion foot, and hypothermia. The nurse providing care for a patient at this clinic visit assesses for which signs and symptoms at the sites of exposure? Select all that apply. a. tinnitus b. balance problems c. pain in extremities d. Raynaud phenomenon e. hot tingling in extremities f. skin cancer in frostbite scars

c. pain in extremities d. Raynaud phenomenon e. hot tingling in extremities f. skin cancer in frostbite scars rationale: Cold injuries may result in long-term health problems including pain in extremities, Raynaud phenomenon, hot tingling in extremities, and skin cancer in frostbite scars. Tinnitus and balance problems are related to traumatic brain injury, not cold injuries.

Nurses providing health care for veterans should be aware of which potential health problem related to a disruption of brain function caused by an external mechanical force sustained in battle? a. tinnitus b. hearing loss c. traumatic brain injury d. posttraumatic stress disorder

c. traumatic brain injury rationale: Nurses should be aware that complications related to traumatic brain injury from blunt force trauma, penetration by a foreign object, acceleration or deceleration movements, or pressure waves from explosive blasts are often seen in veterans. Tinnitus and hearing loss are both common among veterans, but neither are related to the disruption of brain function. Posttraumatic stress disorder is a mental illness that develops in some individuals who have experienced a shocking, frightening, or dangerous event, but it is not related to a disruption of brain function caused by a traumatic injury.

Veterans of which war era need to be assessed by the nurse for radiation exposure, extreme cold injuries, and mustard gas exposure? a. Gulf War b. Korean War c. Vietnam War d. World War II

d. World War II rationale: World War II veterans were exposed to radiation at Hiroshima and Nagasaki, severe cold on the battlefield, and mustard gas experiments conducted by the military. Veterans of the Korean War, the Vietnam War, and the Gulf War were exposed to various other health threats but not to this specific combination of health threats.

Which behaviors that compromise health and well-being among both the male and female veteran populations are most prevalent? Select all that apply. a. heroin injection b. cocaine inhalation c. marijuana smoking d. binge drinking e. cigarette smoking

d. binge drinking e. cigarette smoking rationale: Binge drinking and cigarette smoking are the most prevalent behaviors that compromise the health and well-being of both male and female veterans, affecting 11% of the population. Heroin, cocaine, and marijuana are examples of illegal drugs, whose use results in marked distress or impairment, but are not among the most prevalently used substances among veteran populations.

Among veterans there is a strong relationship between substance use disorders and which other health condition? a. social phobia b. traumatic brain injury c. major depressive episode d. posttraumatic stress disorder

d. posttraumatic stress disorder rationale: Although problems with alcohol and other drugs affect veterans at about the same rates as the general population, there is a strong relationship between substance use disorders and posttraumatic stress disorder. More than 2 out of 10 veterans with substance use disorder also have posttraumatic stress disorder. Social phobia, traumatic brain injury, and a major depressive episode are more prevalent in veterans than in the general population, but there is no specifically demonstrated strong correlation between substance use and these disorders in veterans.

Which disorder is characterized by flashbacks, being easily startled, nightmares, anxiety, and angry outbursts? a. suicidality b. depression c. chronic fatigue syndrome d. posttraumatic stress disorder

d. posttraumatic stress disorder rationale: Typically, posttraumatic stress disorder begins within 3 months of a traumatic incident, such as the shocking and frightening events of combat. Posttraumatic stress disorder manifests with flashbacks, being easily startled, nightmares, anxiety, angry outbursts, frightening thoughts, and feeling tense or on edge. Suicidality, depression, and chronic fatigue syndrome can all be consequences of posttraumatic stress disorder, but they typically do not manifest by flashbacks, being easily startled, nightmares, anxiety, and angry outbursts.

During a routine gynecological evaluation, the nurse assesses that the patient is in the military. How might this affect the assessment? a. the patient is likely over the age of 65. b. as a female, the patient likely did not see combat. c. military service would have no particular effect on the history. d. the patient should be screened for military-related sexual trauma.

d. the patient should be screened for military-related sexual trauma. rationale: Statistics show that one out of five women in the military have experienced some sort of military sexual trauma. The average age of female veterans is 48. Gender does not necessarily determine a soldier's role, either in or out of combat. Military service would have an effect upon patient care, as this group often has specific health concerns.

A veteran who served combat duty in Iraq presents to the Veterans Administration health clinic reporting headaches, tinnitus, sleep problems, memory disturbances, and balance problems. The nurse screens the patient for which combat-related condition? a. depression b. hearing loss c. survivor's guilt d. traumatic brain injury

d. traumatic brain injury rationale: A traumatic brain injury (TBI) is a disruption of brain function caused by external mechanical force, including blunt force trauma, penetration by a foreign object, acceleration or deceleration movements and pressure waves from explosions — all of which military personnel are exposed to in combat zones such as Iraq and Afghanistan. The symptoms of traumatic brain injury include headaches, tinnitus, sleep disorders, memory problems, dizziness, and balance problems. Although depression, hearing loss, and survivor's guilt are combat-related conditions, they are not among the symptoms reported by a patient.

Nurses providing care for veterans with chronic pain find that pain is often comorbid with which other health conditions? Select all that apply. a. diabetes b. hypertension c. thyroid disease d. traumatic brain injury e. posttraumatic stress disorder

d. traumatic brain injury e. posttraumatic stress disorder rationale: Chronic pain is often comorbid with traumatic brain injury and posttraumatic stress disorder (PTSD) including those with muscle tension associated with PTSD. Chronic pain is not comorbid with diabetes, hypertension, and thyroid disease.