Prep U Psychiatric-Mental Health Nursing Chapter 13: Trauma and Stressor-Related Disorders

The nurse is conducting a mental health assessment of a client who has been experiencing low mood, anxiety and loss of pleasure for the past month. The client tells the nurse he comes from a "really big family." Despite this, the client tells the nurse he continues to feel alone. Select the nurse's best response.

" You can have lots of people in your social network and still feel isolated."

A nurse's colleague expresses sympathy for a client who is traumatized following a terrorist attack 1 week earlier. The colleague states, "I'm certain that the client has posttraumatic stress disorder (PTSD)." What is the nurse's best response?

"Acute stress disorder is a possibility, which might develop into PTSD."

A nurse receives a referral from a health care provider to assess a male client for posttraumatic stress disorder (PTSD). The client is a military veteran and been deployed on a military assignment. He is currently working as a civilian doing security work. The client is at risk of job loss because they avoid patrolling areas that are reminders of past trauma. When forced to complete these aspects of surveillance work, the client displays hyperarousal including mild aggression. Which question by the nurse is fundamental for the assessment?

"Describe your sleep habits over the past few months"

Which statement made by a client diagnosed with posttraumatic stress disorder (PTSD) leads the nurse to believe the client is experiencing dissociative symptoms?

"I describe my feelings like I'm having an out-of-body experience."

The nurse is working with a client who is suspected of having posttraumatic stress disorder after witnessing a violent crime. What statement by the client's spouse would suggest that the client is experiencing hyperarousal?

"My spouse always seems so irritated now, which isn't like my spouse."

The nurse is working with a client who has been experiencing nightmares, hyperarousal and negative thoughts following a bomb threat at the client's workplace. The nurse's colleague states, "It turned out to be just a threat, not a bombing, so technically she can't have posttraumatic stress disorder (PTSD)." What is the nurse's best response?

"PTSD is a real possibility, even though the bombing never actually took place."

A nurse works in a psychiatric clinic. During a counseling session, the nurse finds that the client who has posttraumatic stress disorder (PTSD) is unable to identify the intensity of the client's emotions. The client states that extreme emotions appear out of nowhere and with no warning. What suggestion should the nurse provide to help the client get in touch with the client's emotions?

"Use a journal or a log to write down your feelings."

Which individual is exhibiting signs or symptoms that are characteristic of posttraumatic stress disorder (PTSD)? Select all that apply.

1. A client who has quit the client's job so that the client no longer has to go to the client's old office where the client was attacked and robbed 2. A police officer who experiences panic attacks when thinking about the time the police officer was forced to shoot a violent suspect 3. A client who has frequent nightmares about the time a fellow soldier died from an improvised explosive device 4. A client who is unable to relax without first barricading the client's home after a violent home invasion and assault

A nurse is assessing risk for trauma and stress-related disorders for a child. Which areas are important for the nurse to ask about? Select all that apply.

1. Incarceration of a parent 2. Childhood physical abuse 3. Unexpected death of a family member 4. Childhood exposure to mother experiencing violence

When presenting a discussion of posttraumatic stress disorder (PTSD) to a group of emergency department nurses, the psychiatric-mental health nurse provides examples of traumatic events that may precede PTSD. Which example would the nurse most likely include? Select all that apply.

1. Personal assault by a family member 2. Military combat mission where there were casualties 3. Surviving an EF 4 tornado

A client is diagnosed with posttraumatic stress disorder (PTSD). The client is a survivor of a bomb blast. Which symptoms of PTSD is the nurse likely to find in the client? Select all that apply.

1. Reexperiencing the trauma through dreams 2. Feeling detached from others 3. Showing irritability and outbursts of anger 4. Losing a sense of control over one's life

The nurse is planning to give health-related education to adolescents with posttraumatic stress disorder (PTSD). What topics should the nurse discuss specifically for these clients? Select all that apply.

1. Set small, specific, achievable goals 2. Have a healthy, balanced diet 3. Abuse of alcohol and drugs can cause ill effects

A psychiatric-mental health nurse is assessing a client who has been referred for care following a violent assault. Which finding would the nurse most likely document as reflecting the diagnostic criteria for posttraumatic stress disorder (PTSD)? Select all that apply.

1. The client describes oneself as being constantly "on edge." 2. The client states, "All I can think about these days is the attack." 3. The client states "completely avoiding the neighborhood where the attack occurred."

The nurse is assessing a client who was diagnosed with posttraumatic stress disorder (PTSD) several months ago. During a comprehensive follow-up assessment, what areas should the nurse assess? Select all that apply.

1. The client's use of alcohol or other drugs 2. Characteristics of the client's sleep 3. The effect of the client's PTSD on the family

A nurse is teaching a client about how traumatic events affect a person. Which examples are included in the teaching plan? Select all that apply.

1. Witnessing a fatal shooting 2. Being trapped inside a capsized boat 3. Receiving word of a terrorist attack in a nearby community

Which individual is most likely to be diagnosed with posttraumatic stress disorder (PTSD)?

A middle-aged woman with a history of anxiety who suffered a random physical assault

The nurse assesses a 6-year-old child for posttraumatic stress disorder (PTSD). The caregiver explains that the child witnessed the mother being stabbed by a neighbor. Which is a behavior consistent with the child's diagnosis?

A two-month history of angry outbursts with minor provocation

The family members of a military veteran are distraught that he has withdrawn from them emotionally after returning home from a tour of duty. What is the nurse's most appropriate action?

Assess the client for signs and symptoms associated with post-traumatic stress disorder

A client with a diagnosis of posttraumatic stress disorder (PTSD) has been brought to the emergency department (ED) by concerned family members, who state that the client is experiencing a "nervous breakdown." The ED nurse should prioritize what aspect of care during the initial care of the client?

Assessing the client's risk for self-harm and ensuring safety

The psychiatric mental health nurse is working with a client who has been diagnosed with posttraumatic stress disorder (PTSD). Assessment reveals that the client is experiencing frequent episodes of intrusion. The nurse should consequently prioritize what assessment?

Assessing the quantity and quality of the client's sleep

Which statement regarding posttraumatic stress disorder (PTSD) and children is accurate?

Best practices demonstrate that adolescents who have PTSD are at increased risk of drug

A nurse is caring for a client with acute stress disorder. The main goal of therapy for this client is prevention of the progression of this condition to posttraumatic stress disorder (PTSD). Which therapy would the client most likely be referred for?

Cognitive behavioral therapy

A nurse is caring for a client with posttraumatic stress disorder (PTSD). On reassessing the client, the nurse finds that the client shows signs of another psychiatric disorder as well. Signs of which psychiatric disorders would the nurse likely see in this client? Select all that apply.

Depression Anxiety disorder

A client in a psychiatric clinic has a history of two distinct personality states. The client is also unable to remember important personal information. What is the client likely to be suffering from?

Dissociative identity disorder

A nurse is caring for a client with posttraumatic stress disorder (PTSD). During the assessment interview, the nurse finds that the normally calm client at times becomes very aggressive and uses abusive language. When in the aggressive state, the client fails to recognize personal information. What is this behavior indicative of?

Dissociative identity disorder

The family members of a client with posttraumatic stress disorder (PTSD) state that they are "constantly walking on eggshells" because the client reacts so strongly to stressors that seem inconsequential to them. What is the nurse's best response?

Educate the family about the client's hyperarousal

A group of at-risk teenagers have successfully completed an outdoor training program in which they had to collaborate and conquer a number of challenges. The nurse should identify what likely outcome of this program?

Enhanced resilience for the participants

The nurse is preparing to perform the initial interview of a client who has been diagnosed with posttraumatic stress disorder (PTSD). What action should the nurse prioritize during this interaction?

Establishing therapeutic rapport with the client

The nurse is providing care for a client whose history of intimate partner violence has resulted in posttraumatic stress disorder (PTSD). The client has few friends and states that the client is estranged from the client's family. How can the nurse best enhance the client's social support?

Facilitate the client's participation in a support group

When lecturing about dissociative disorders to a group of nursing students, a nurse states that an essential feature of these disorders involves what?

Failure to integrate identity, memory, and consciousness

A client informs the nurse that while on vacation at a theme park, the sound of fireworks triggered an intense reminder of a house fire experienced as a child. The client describes experiencing the smells from the fire, choking sensations, burning eyes and images of the flames destroying the insides of his home. Which symptom is experienced by the client?

Flashback

A client has posttraumatic stress disorder (PTSD) following a disaster that resulted in mass casualties. What question should the nurse prioritize when exploring the physical dimensions of this client's PTSD?

How would you describe the quality and quantity of your sleep since the incident?

An adult male client with a history of PTSD is brought to the emergency department (ED). The client was startled by a dog while out for a walk and kicked it. He was calm and apologetic when he presented to the triage nurse. Which is a priority nursing intervention?

Identify risks for self-harm and aggression

A nurse is interviewing a client who is suffering from posttraumatic stress disorder (PTSD). Which intervention would help the nurse ensure the client's comfort during the interview?

Keep environmental noises to a minimum.

A client with a history of intimate partner violence has been diagnosed with posttraumatic stress disorder. The client is wholly unwilling to discuss any aspects of personal history or current mental status with the nurse. What is the nurse's best initial action?

Make efforts to demonstrate empathy to the client

A combat veteran with posttraumatic stress disorder has been admitted to the psychiatric unit after consuming a large number of antidepressants and drinking half a quart of whiskey 2 days earlier. What aspect of care should the nurse prioritize?

Monitoring the client for suicidal ideation

A client with posttraumatic stress disorder (PTSD) has been prescribed lorazepam 1 mg SL q6h PRN. What assessment finding indicates that treatment is having the desired effect?

Reduced anxiety

A client with PTSD is brought to the nurse in a primary care setting with lower back pain after falling from a ladder. The client became aggressive with their partner before agreeing to come to the setting. The nurse smells alcohol on the person's breath and the client does not make eye contact or expand openly to assessment questions. Which are priority nursing assessments? Select all that apply.

Risk for self-injury Risk for aggression Risk for substance abuse

The nurse is performing a physical health assessment of a client who has been diagnosed with posttraumatic stress disorder (PTSD). What aspect of this assessment should the nurse prioritize?

Sleep assessment

Eight months ago, a client was in a hotel fire and was the last person to be rescued from the roof. The client watched the client's spouse burn to death from the helicopter. The client continues to have nightmares and is fearful that the client will die in a fire. An appropriate nursing diagnosis for the client is what?

Sleep pattern disturbance related to recurrent nightmares

A nurse is caring for a client who has a diagnosis of posttraumatic stress disorder (PTSD) and has been referred for care. During the client interview, what statement by the client should the nurse prioritize for follow-up?

Sometimes I feel like I can't even cope unless I've had a few drinks to calm my nerves.

The psychiatric-mental health nurse is providing care for a child who has been diagnosed with disinhibited social engagement disorder. What intervention best addresses the characteristics of this disorder?

Teaching the child how to interact appropriately with strangers

A college student who was the victim of an attempted sexual assault has sought care due to anxiety that is affecting every aspect of the client's life. Which characteristic of the client's situation and the client's anxiety would suggest a diagnosis of posttraumatic stress disorder (PTSD) rather than acute stress disorder?

The attack took place several months ago, and the client's anxiety has been continuous.

The nurse's assessment of a child from a dysfunctional family background suggests that the child lacks resilience. What outcome should the nurse identify after performing appropriate interventions?

The child demonstrates that the child is empowered to solve life problems

What action by a 6-year-old child would most strongly suggest a diagnosis of disinhibited social engagement disorder?

The child gives adults enthusiastic hugs immediately after meeting them

The nurse is assessing a 6-year-old child who witnessed the murder of the child's parents. The nurse suspects that the child has developed posttraumatic stress disorder (PTSD). Which specific behavioral manifestation leads the nurse to interpret this?

The child is easily startled and hyper-vigilant.

The pediatric nurse is caring for a child who comes from an abusive background and who has been diagnosed with reactive attachment disorder. What behavior should the nurse anticipate when planning this child's care?

The child will be reluctant to engage with the nurse

A police officer was diagnosed with posttraumatic stress disorder after attending to a violent crime scene. What aspect of the client's current health status would most likely warrant inpatient treatment?

The client alluded to "ending this misery" in a conversation with a colleague

A client with posttraumatic stress disorder (PTSD) is having a flashback experience of a traumatic event. The client asks the nurse if the client can hold the nurse's hand. What should the nurse interpret from this behavior?

The client benefits from supportive touch.

A nurse is performing a follow-up assessment of a client who had been treated for posttraumatic stress disorder (PTSD) a year ago. The client tells the nurse that the client is not able to maintain relationships and that the relationships last for a very short time. What is the most likely reason for this problem?

The client has issues with developing trust.

A client suffered a gunshot injury in a robbery and subsequently developed posttraumatic stress disorder (PTSD). What aspect of the client's current condition was confirm that the client is experiencing hyperarousal?

The client is easily startled by sudden noises

A client who has been admitted for an appendectomy states, "I'm really afraid of the surgery because my mother died when she was admitted for an emergency surgery." When preparing to work with the client concerning this anxiety about the surgery, the nurse recognizes what?

The client is expressing fear about the surgery. The client's fear is the body's physiologic and emotional response to a known danger.

A nurse observes that a client who has posttraumatic stress disorder (PTSD) is startled even by small noises. What is this behavior indicative of?

The client is hypervigilant.

A client with a diagnosis of posttraumatic stress disorder (PTSD) tells the nurse, "When things get really bad, it sometimes feels like I'm not even in my body, like I'm floating around and watching myself." How should the nurse best interpret this client's statement?

The client is likely experiencing derealization as a result of PTSD

What assessment finding would suggest to the nurse that the client with posttraumatic stress disorder (PTSD) is experiencing dissociation?

The client is often "staring into space" and has no idea how much time has passed

A client with posttraumatic stress disorder (PTSD) is treated with exposure therapy. What change is most likely expected in the client after receiving this therapy?

The client may be able to control thoughts and feelings about the event.

A nurse is assessing a victim of rape with a diagnosis of posttraumatic stress disorder (PTSD). The client is trying to recall and express the trauma. The nurse finds that, at times, the client is unable to remember certain facts associated with the trauma. What would the nurse interpret from this finding?

The client may have repressed memories.

A nurse is caring for a client with dissociative disorder. The nurse tells the client, "Hello, I'm Robin, your nurse. It is 9 o'clock in the morning now. You are in room number 303. My name is Robin, I'm your nurse." What is the most appropriate reason for the nurse to repeat this statement?

The client may need to be reoriented.

The nurse is dialoguing with a client who has been referred after witnessing a workplace accident several weeks ago that resulted in a coworker's death. What assessment finding would support a diagnosis of posttraumatic stress disorder (PTSD)?

The client states that the client is often "awake for hours and hours each night."

A client with posttraumatic stress disorder (PTSD) has been referred for employment. Why might the nurse fear that the client will not be capable of sustaining the job long term?

The client may not be able to get along with coworkers

The psychiatric mental health nurse is assessing a client who was diagnosed with posttraumatic stress disorder (PTSD) after the death of the client's child from a medical error. What assessment finding would most warrant interventions aimed at addressing the client's dissociation?

The client reports large gaps in memory of the traumatic event

The nurse is reviewing the health record of a client who developed posttraumatic stress disorder (PTSD) following a spouse's cardiac arrest and death. The health record states that the client experienced derealization during the traumatic event. What assessment finding would substantiate this statement?

The client states that the client cannot remember what happened during and immediately after the event

The nurse is working with a 17-year-old client with a complex and dysfunctional family background. What aspect of this client's history should the nurse identify as the most significant risk factor for posttraumatic stress disorder (PTSD)?

The client was sexually abused by the mother's boyfriend at a young age

A client who is being treated for posttraumatic stress disorder tells the nurse, "Sometimes it's like I can't feel anything—not happiness, not sadness, not fear. Nothing." How should the nurse best interpret the client's statement?

The client's emotional numbing is a protective mechanism

The nurse is assessing a client who was sexually assaulted several months ago and who has subsequently developed posttraumatic stress disorder (PTSD). The nurse observes that the client's nonverbals are closed and the client is reluctant to engage with the nurse. How should the nurse best interpret this client's behavior?

The client's trauma likely has an impact on the client's ability to trust

A client has developed posttraumatic stress disorder (PTSD) after a violent sexual assault committed by a close family member. When planning this client's care, the nurse should follow what guideline?

The nurse should avoid touching the client during interactions unless necessary

A client is admitted to the hospital with posttraumatic stress disorder (PTSD). When approaching the client for the first time, the nurse speaks softly and gently, in a nonthreatening manner. What is the most appropriate reason for this behavior of the nurse?

To prevent the risk of triggering fears in the client

A nurse working in a psychiatric unit is counseling a rape survivor. How can the nurse use cognitive processing therapy for the client?

Use structured sessions to focus on examining beliefs that interfere with daily life.

A nurse is contributing to the interdisciplinary care plan for a client who has been diagnosed with PTSD. Which should be included in the care plan?

Vigilant monitoring for potential indications of self-harm

A psychiatric-mental health nurse is teaching the family members of a client about strategies for engaging with their family member who has recently been diagnosed with posttraumatic stress disorder (PTSD). The nurse should encourage the client's family to:

anticipate that the client is likely to be irritable and withdrawn at times.

A client has been referred for care because the client's primary care provider suspects that the client has posttraumatic stress disorder (PTSD) following a motor vehicle accident. When working with this client, the psychiatric-mental health nurse should begin by:

establishing therapeutic rapport with the client.

The nurse is assessing a client who has recently received a diagnosis of posttraumatic stress disorder. When conducting this assessment, the nurse should:

try to identify any strengths or skills that can be applied during recovery.