PTSD Pearson

Render the affected individual in a near-constant state of "high alert"

Hyperarousal and hypervigilance

Children with PTSD often express PTSD in the following ways:

-Changes in mood -Nocturnal enuresis -Forgetting how to talk or not talking at all -Acting out the traumatic event during activities with other children -Being exceptionally needy or clingy

The emotional numbness associated with PTSD can lead to:

-Depression. -Alcohol abuse. -Substance abuse. -Impairment in establishing and maintaining social relationships.

Adolescents with PTSD may demonstrate the following:

-Disruptive, disrespectful, or destructive behavior -Traumatic reenactment where the traumatic events are injected into their daily lives -Impulsive and aggressive behaviors -Increased risk of suicide, substance abuse, poor social support, poor concentration, academic problems, and poor physical health

Special considerations for PTSD include the following:

-Exposure to an overwhelming stressor can occur at any age. Childhood trauma, abuse, and molestation can create enduring effects and clinical symptoms that last into adulthood. Additional factors that contribute to the development of PTSD are an individual history of a psychiatric disorder or a lack of emotional support or resources during the trauma. -Refugee trauma is a form of PTSD that is specific to the traumatic events experienced by individuals during war or persecution that may have lifelong effects. Child refugees may exhibit symptoms such as nightmares, anxiety, psychosomatic symptoms, hopelessness, and disrupted sleep patterns. -Children with PTSD may also behave recklessly or aggressively, or they may withdraw from interacting with others. Because of their undeveloped ability to express thoughts or identify emotions, expressions of PTSD in very young children often occur through changes in mood.

Nonpharmacologic therapy options for PTSD include the following:

-Eye-movement desensitization and reprocessing (EMDR) -Cognitive-behavioral training (CBT) -Body-centered therapy -Exposure therapy -Acupuncture

The nurse may be responsible for teaching PTSD patients the following:

-How to monitor the physiological level of arousal -The use of abdominal breathing at first sign of anxiety -The need to express fears that interfere with life -The need to search for, confront, and relieve the source of the original anxiety -The use of positive imagery -The use of calming techniques such as muscle relaxation -The use of positive affirmations such as "I am calm and happy" or "I am very relaxed" -The need to identify safe physical outlets for negative feelings, such as exercise

For children and vulnerable patients who are believed to be victims of abuse, the nurse should follow organizational protocols for reporting these situations. Questions may include:

-How would you describe your mood? -When do you feel most content? When do you feel least content? -What are your favorite activities? -What activities help you relax? -How often do you socialize or participate in activities with others? -Describe your sleep habits. Do you sleep soundly through the night? Do you feel rested when you awaken? -Do you have friends or other individuals with whom you can be open and honest about your thoughts and emotions? -How important is being able to share your thoughts and feelings? -Are you currently working? If so, what type of work are you engaged in?

Examples of patient goals that may be relevant to the care of the patient with PTSD include:

-Patient will remain free from injury or harm. -Patient will report a decreased perception of anxiety. -Patient will report a reduction or cessation of nightmares. -Patient will discuss emotions related to traumatic experiences with at least one trusted mental health specialist or counseling professional. -Patient will verbalize awareness of nonpharmacologic stress-reduction techniques.

Planning includes identification of measurable, realistic patient goals that are relevant to the selected nursing diagnoses. Examples of patient goals that may be relevant to the care of patients with PTSD include:

-Patient will remain free from injury or harm. -Patient will report a decreased perception of anxiety. -Patient will report a reduction or cessation of nightmares. -Patient will discuss emotions related to traumatic experiences with at least one trusted mental health specialist or counseling professional. -Patient will verbalize awareness of nonpharmacologic stress-reduction techniques.

The U.S. Department of Veterans Affairs and Department of Defense identify the following as the front-line standard approach to PTSD:

-Psychopharmacology -Stress inoculation -Exposure -Cognitive-behavioral therapy (CBT) **Complementary integrative health (CIH) approaches, such as yoga and meditation, can also be taught to the patient.

Assessing a patient for PTSD will involve both physical and psychologic approaches. Identify risk and protective factors, and assess immediate and long-term safety concerns. Multiple tools are available for use in screening for PTSD; some have been developed for use with children. Specific interview questions to ascertain the diagnosis of PTSD are aimed at the following clinical manifestations:

-Reexperiencing or flashbacks -Hyperarousal and vigilance -Exaggerated startle response -Sleep disturbance

Depending on the severity and nature of a patient's PTSD manifestations, selective serotonin reuptake inhibitors (SSRIs) are often used in conjunction with psychotherapy as a treatment. The only two SSRIs approved by the U.S. Food and Drug Administration (FDA) for the treatment of PTSD are the following:

-Sertraline (Zoloft) -Paroxetine (Paxil)

Prolonged exposure (PE) therapy is a type of exposure therapy that has four components to assist the patient in working through the feelings associated with the traumatic event:

-Teaching the patient on PTSD, including responses and symptoms -Breathing retraining that teaches the patient how to control breathing while experiencing the stressful feelings -Real-world training that helps by having the patient practice situations that the patient may have been avoiding -Talking through the trauma to assist the patient in not being fearful of memories.

The nurse is teaching a patient with posttraumatic stress disorder (PTSD). Which action should the nurse advise the patient to perform at the first sign of anxiety? A. Abdominal breathing B. Positive imagery C. Distraction techniques D. Muscle relaxation

A. Abdominal breathing -When implementing a plan of care for a patient with PTSD, the patient should be taught to use abdominal breathing at the first sign of anxiety. Positive imagery, muscle relaxation, and distraction techniques are also useful but not at the first sign of anxiety.

The nurse is providing care for a client diagnosed with posttraumatic stress disorder​ (PTSD). The​ client's family has asked about nonpharmacologic therapies that may be appropriate. Which therapy should the nurse mention when responding to this​ family? (Select all that​ apply.) A. Acupuncture therapy B. Atypical antipsychotic therapy C. Eye movement desensitization and reprocessing therapy D. ​Cognitive-behavioral therapy E. Selective serotonin reuptake inhibitor therapy

A. Acupuncture therapy C. Eye movement desensitization and reprocessing therapy D. ​Cognitive-behavioral therapy -Rationale: Acupuncture therapy is a​ complementary, nonpharmacologic therapy that has been useful in the treatment of PTSD.​ Cognitive-behavioral therapy​ (CBT) and eye movement desensitization and reprocessing therapy​ (EMDR) are nonpharmacologic therapies used by interdisciplinary teams to treat posttraumatic stress disorder. Selective serotonin reuptake inhibitor​ (SSRI) and atypical antipsychotic therapy are both pharmacologic therapies that may be used to treat PTSD.

The nurse is providing care to the victim of a kidnapping that occurred over 1 year ago. Which clinical manifestation supports the diagnosis of posttraumatic stress disorder​ (PTSD) in this​ client? (Select all that​ apply.) A. Agitation B. Hypervigilance C. Flashbacks D. Tremors E. Depression

A. Agitation B. Hypervigilance C. Flashbacks E. Depression -Rationale: Agitation,​ flashbacks, depression, and hypervigilance are all clinical manifestations of PTSD that usually emerge within 3 months but may become evident years after the experience. Tremors are not a clinical manifestation of PTSD.

The nurse is assessing a child diagnosed with posttraumatic stress disorder (PTSD). Which finding should be the priority? A. Changes in sleeping patterns B. History of suicide attempts C. History of TBI D. Lack of social support

A. Changes in sleeping patterns -Identification of PTSD in children is improved when they are questioned directly about their experiences. Assessment of younger children involves questioning the child and/or the parents about significant changes in behavior and sleeping patterns. Lack of social support, history of traumatic brain injury, and history of suicide attempts are vital information for other patient populations but are not critical for the pediatric population.

The nurse is teaching about how to recognize those at risk for posttraumatic stress disorder​ (PTSD) to begin early intervention. Which scenario should the nurse include as an example to look for in the general​ population? (Select all that​ apply.) A. Clients who have been taken hostage and tortured B. Clients who have looked at photographs of a war zone C. Clients who watched a documentary about the terror attack of September 11 D. Clients who have engaged in military combat E. Clients who have been to prison

A. Clients who have been taken hostage and tortured D. Clients who have engaged in military combat E. Clients who have been to prison -​Rationale: To be at risk for​ PTSD, the client must have experienced direct exposure to the traumatic stressor and witnessed it in person. The client can also have had indirect exposure​ (for example, by learning that a close friend or relative was exposed to trauma such as a violent or accidental​ death), or have had repeated or extreme exposure to aversive details of the traumatic event​ (usually through professional​ duties, such as being a first​ responder). Nonprofessional exposure through electronic​ media, television,​ movies, or photographs does not qualify for a diagnosis of PTSD.

Which nonpharmacologic therapy has been found to be the most effective for posttraumatic stress disorder (PTSD)? A. Cognitive-behavioral therapy B. Antiadrenergic therapy C. Selective serotonin reuptake inhibitor (SSRI) therapy D. Acupuncture therapy

A. Cognitive-behavioral therapy -The most effective nonpharmacologic therapy for PTSD is cognitive-behavioral therapy. Acupuncture is a complementary therapy that has been found useful for PTSD, but it is not as effective as cognitive-behavioral therapy. Antiadrenergic therapy and SSRI therapy are both pharmacologic options for the treatment of PTSD.

The nurse is planning care for the combat veteran with posttraumatic stress disorder​ (PTSD). Which nursing intervention should the nurse​ include? (Select all that​ apply.) A. Connect clients with resources for​ social, occupational, and interpersonal support. B. Reduce client​ harm, anxiety, and fear. C. Limit contact with the client to reduce the occurrence of compassion fatigue. D. Improve client coping through nonpharmacologic and pharmacologic therapies. E. Remove the family from therapy so the client can focus on health.

A. Connect clients with resources for​ social, occupational, and interpersonal support. B. Reduce client​ harm, anxiety, and fear. D. Improve client coping through nonpharmacologic and pharmacologic therapies. -​Rationale: Appropriate nursing interventions for clients with PTSD aim to reduce and eliminate client​ harm, anxiety, and​ fear, and improve client​ coping, using nonpharmacologic and pharmacologic therapies. Nursing interventions also aim to connect clients and families with organizations and community resources that can provide longer term​ social, occupational, and interpersonal support. The family should be involved and included in resources for support. Compassion fatigue should be recognized but not avoided through decreasing contact with clients.

The nurse is preparing to encounter a client who has experienced multiple violent assaults during the last month. Which priority should the nurse consider when assessing this client with possible posttraumatic stress disorder​ (PTSD)? (Select all that​ apply.) A. Ensure the safety of the client and others. B. Determine alcohol or drug use. C. Assess for indirect nonprofessional exposure. D. Establish trust. E. Lower client anxiety levels.

A. Ensure the safety of the client and others. B. Determine alcohol or drug use. D. Establish trust. E. Lower client anxiety levels. -​Rationale: When assessing a client diagnosed with​ PTSD, the nurse will ensure the safety of the client and​ others, lower the​ client's anxiety​ levels, determine the use of alcohol or​ drugs, and establish trust. Indirect nonprofessional​ exposure, such as observing a terrorist event through electronic​ media, television,​ movies, or​ photographs, is not a factor in the development of PTSD.

A patient with posttraumatic stress disorder (PTSD) wishes to include nonpharmacologic therapy as part of the treatment regimen. Which form of nonpharmacologic therapy allows the patient to develop effective coping skills in a safe, controlled environment? A. Exposure therapy B. Cognitive-behavioral therapy C. Body-centered therapy D. Dual-attention therapy

A. Exposure therapy -Exposure therapy allows the patient to develop effective coping skills in a safe, controlled environment. Cognitive-behavioral therapy, body-centered therapy, and dual-attention stimulus do not provide this for the patient. Exposure therapy assists by gradually exposing the patient to elements of the traumatic event, which enables the patient to face fears. The use of virtual reality also assists the patient in revisiting the site where the traumatic event occurred without having to go back to the real site.

The nurse is teaching the client and the family about eye movement desensitization and reprocessing​ (EMDR) therapy, which has been successful in the treatment of posttraumatic stress disorder. Which teaching should the nurse​ include? (Select all that​ apply.) A. External focus on a different stimulus B. Effective pharmacologic therapy C. Reprocessing the trauma D. Effective nonpharmacologic therapy E. Telehealth strategy

A. External focus on a different stimulus C. Reprocessing the trauma D. Effective nonpharmacologic therapy -​Rationale: The largest number of studies on psychotherapy for PTSD indicates that​ cognitive-behavioral therapy​ (CBT), as well as eye movement desensitization and reprocessing​ (EMDR), are the most effective therapies for PTSD. EMDR includes aspects of CBT and​ body-centered therapy. In this type of​ therapy, the client reprocesses the trauma by focusing internally on the traumatic event while focusing externally on a different stimulus. EMDR is a nonpharmacologic therapy that is used to treat​ PTSD, not a telehealth strategy. Telehealth is the delivery of​ health-related services and information via telecommunication technologies. Effective pharmacologic therapy is not a consideration in eye movement desensitization and reprocessing​ (EMDR) therapy.

Which symptom exhibited by a patient with posttraumatic stress disorder (PTSD) should initiate ensuring the safety of the patient as a nursing priority? A. Hyperarousal B. Depression C. Dissociation D. Depersonalization

A. Hyperarousal -The nursing priority for patients with hyperarousal and vigilance is to ensure the safety of the patient and others while quickly lowering patient anxiety levels. The nursing priorities will be different for patients experiencing depression, dissociation, or depersonalization.

The nurse is using a posttraumatic stress disorder (PTSD) measuring tool during an assessment of a 70-year-old veteran. Older patients are at an increased risk of which occurrence compared with patients of other age groups? A. Suicide B. Depression C. Violence D. Substance abuse

A. Suicide -The older patient who may be experiencing PTSD symptoms should be assessed using a valid PTSD measuring tool and be assessed for suicidal thoughts and behaviors because older adults are at an increased risk of suicide compared with middle-aged adults. Older patients with PTSD are not at an increased risk of depression, violence, or substance abuse.

The nurse is planning care for client families who are refugees from​ war-torn countries. Which client outcome would be the most appropriate for inclusion in a plan of care for a client with posttraumatic stress disorder​ (PTSD)? (Select all that​ apply.) A. The client will articulate decreased feelings of anxiety. B. The client will report no change in the occurrence of nightmares. C. The client will talk about emotions that are associated with traumatic experiences. D. The client will remain free of harm or injury to self or others. E. The client will demonstrate stress reduction techniques.

A. The client will articulate decreased feelings of anxiety. C. The client will talk about emotions that are associated with traumatic experiences. D. The client will remain free of harm or injury to self or others. E. The client will demonstrate stress reduction techniques. -​Rationale: Client goals and outcomes should be measurable. In​ addition, client goals and outcomes should be​ client-specific and tailored to meet the​ client's needs. General examples of client goals and outcomes that may be appropriate for inclusion in the plan of care for the client with PTSD​ include: The client will remain free from harm. The client will be able to talk about emotions associated with the traumatic experiences. The client will demonstrate stress reduction techniques. The client will verbalize a decrease in anxious feelings. The goal for no change in the occurrence of nightmares is inappropriate. An appropriate goal would be for the client to report a decrease in the occurrence of nightmares.

The nurse is caring for a client who is diagnosed with posttraumatic stress disorder​ (PTSD). Which outcome should the nurse include in the​ client's plan of​ care? (Select all that​ apply.) A. The client will remain free of harm or injury to self or others. B. The client will report fewer or no nightmares. C. The client will demonstrate avoidance of situations related to the trauma or general social contacts. D. The client will talk about emotions that are associated with traumatic experiences with at least one counseling professional. E. The client will demonstrate comorbidity that may include​ depression, substance​ abuse, or other anxiety disorders.

A. The client will remain free of harm or injury to self or others. B. The client will report fewer or no nightmares. D. The client will talk about emotions that are associated with traumatic experiences with at least one counseling professional. -​Rationale: General examples of client goals and outcomes that may be appropriate for inclusion in the plan of care for the client with PTSD​ include: The client will remain free of harm or injury to self or others. The client will articulate decreased feelings of anxiety. The client will talk about emotions that are associated with traumatic experiences with at least one counseling professional or other mental health care provider. The client will report fewer or no nightmares. The client will articulate awareness of stress reduction techniques that are not pharmacologic. Demonstrating comorbidity or avoidance are clinical manifestations of the​ disorder, and not client goals and outcomes.

The nurse is preparing a presentation on posttraumatic stress disorder​ (PTSD) to a group of people whose spouses have just returned from an active war zone. Which information about PTSD should the nurse include in the​ presentation? (Select all that​ apply.) A. Traumatic events in childhood can create clinical symptoms that last into adulthood. B. History of psychiatric disorders is common. C. Incidence among veterans is low. D. Stressors can occur at any time or age of life. E. Men are more susceptible than women.

A. Traumatic events in childhood can create clinical symptoms that last into adulthood. B. History of psychiatric disorders is common. D. Stressors can occur at any time or age of life. -PTSD is more common among individuals with a history of psychiatric disorders. Exposure to a traumatic stressor can happen at any age or time of life. Traumatic stress in childhood can create effects that persist into adulthood. The incidence of PTSD among veterans is especially high. Women are more susceptible to the development of PTSD than are men.

The nurse is caring for a client in law enforcement diagnosed with posttraumatic stress disorder​ (PTSD). Which finding in the​ client's health history places the client at risk for this​ disorder? (Select all that​ apply.) A. Witnessing the death of a friend B. Preexisting mental illness C. Losing a job after a traumatic event D. ​Adult-onset diabetes mellitus E. Experiencing difficulty sleeping

A. Witnessing the death of a friend B. Preexisting mental illness C. Losing a job after a traumatic event -​Rationale: Risk factors for developing PTSD include preexisting mental​ illness, direct exposure to a traumatic event such as witnessing a​ death, and experiencing loss after a traumatic event. Difficulty sleeping is a clinical manifestation of​ PTSD, not a risk factor. A concurrent diagnosis of diabetes mellitus is not a risk factor for PTSD.

The nurse is assessing an adolescent foster child diagnosed with posttraumatic stress disorder​ (PTSD). Which question is most beneficial for the nurse to ask the adolescent with​ PTSD? A. ​"Have you had thoughts of hurting​ yourself?" B. ​"Are you napping during the​ day?" C. ​"Are you wetting the bed at​ night?" D. ​"Do you know what year it​ is?"

A. ​"Have you had thoughts of hurting​ yourself?" -​Rationale: The adolescent with PTSD is at an increased risk for​ suicide, and reduction of harm is a priority for the client with PTSD. Mental orientation should be performed with the older adult client. A​ follow-up question about napping may be asked to assess​ sleep, but it does not take precedence over suicide and​ self-harm. Bedwetting should be assessed in a child with PTSD.

The client with posttraumatic stress disorder​ (PTSD) states they are experiencing undesirable adverse effects from sertraline​ (Zoloft). Which is the most appropriate response by the​ nurse? A. ​"These effects are​ expected, but they should not stop you from continuing your​ medication." B. ​"You may be overdosing on your​ medication." C. ​"Divide the doses in half to decrease the side​ effects." D. ​"It is OK to stop any medication that does not agree with​ you."

A. ​"These effects are​ expected, but they should not stop you from continuing your​ medication." -​Rationale: Selective serotonin reuptake inhibitors​ (SSRIs) like sertraline have known adverse effects that should be discussed with the client to improve adherence to prescribed pharmacologic treatment. Overdosing is not the cause of adverse effects. Decreasing or stopping medication should not be done without the order from the healthcare provider.​ However, since SSRIs carry a black box warning for increased​ suicidality, the nurse should question the client about experiencing any increase in suicidal ideation and follow up appropriately.

The nurse is providing care to a client who is diagnosed with posttraumatic stress disorder​ (PTSD). Which factor could interfere with the nurse establishing trust during a therapeutic encounter with this​ client? (Select all that​ apply.) A. Ineffective coping B. Depersonalization C. Hypervigilance D. Nightmares E. Aggressiveness

B. Depersonalization C. Hypervigilance E. Aggressiveness -​Rationale: Clients with PTSD have experienced traumatization and may be physically and emotionally isolated. They may be​ irritable, aggressive, emotionally​ numb, frightened, experiencing​ flashbacks, and on high physical and emotional alert during an appointment with the nurse. They may be reluctant to share their thoughts and feelings and should not be pressured to until they feel ready. These clinical manifestations of PTSD make establishing trust with the client a challenge for the nurse. Nightmares are a clinical manifestation of PTSD that do not take place during therapeutic encounters between the client and nurse. Ineffective coping is a problem that may be included in the nursing plan of care for a client with PTSD.

For patients diagnosed with posttraumatic stress disorder (PTSD), which medical condition may accompany PTSD, as well as other anxiety disorders? A. Eating disorder B. Depression C. Schizophrenia D. Bipolar disorder

B. Depression -As with other anxiety disorders, depression may accompany PTSD. PTSD is generally not associated with the development of eating disorders, schizophrenia, or bipolar disorder.

The nurse is caring for a patient with posttraumatic stress disorder (PTSD) who is blocking emotions related to the traumatic event. Which clinical manifestation is the patient experiencing? A. Dissociative amnesia B. Dissociation C. Hypervigilance D. Depersonalization

B. Dissociation -For patients with PTSD, dissociation may occur, in which the individual blocks emotions related to the traumatic event. This patient is not experiencing signs of depersonalization, hypervigilance, or dissociative amnesia.

A patient with posttraumatic stress disorder (PTSD) reports having repetitive negative thoughts and emotions. Which action should the nurse suggest to alleviate negative thoughts and feelings? A. Muscle relaxation B. Exercise C. Positive imagery D. Distraction techniques

B. Exercise -When implementing a nursing care plan for a patient with PTSD, the nurse should help the patient to identify safe physical outlets for negative feelings, such as exercise. Distraction techniques, muscle relaxation, and positive imagery are useful for other aspects associated with PTSD, but not for negative feelings and emotions.

The most effective nonpharmacologic therapy for posttraumatic stress disorder (PTSD) is cognitive-behavioral therapy (CBT). Which form of nonpharmacologic psychotherapy contains elements of CBT and body-centered therapy? A. Exposure therapy B. Eye-movement desensitization and reprocessing (EMDR) C. Support therapy D. Acupuncture

B. Eye-movement desensitization and reprocessing (EMDR) -EMDR is a form of psychotherapy that contains elements of several types of therapy, including CBT and body-centered therapy. Exposure therapy, support therapy, and acupuncture do not incorporate CBT and body-centered therapy.

The nurse is teaching a group of parents whose children have been diagnosed with posttraumatic stress disorder (PTSD). Which symptoms should the nurse include in the teaching about PTSD in adolescents? A. Social withdrawal B. Impulsive and aggressive behavior C. Somatic symptoms D. Being exeptionally needy or clingy

B. Impulsive and aggressive behavior -Adolescents may engage in traumatic reenactment where the traumatic events are injected into their daily lives. Impulsive and aggressive behaviors are more typical in this age group as well. Children under 6 may socially withdraw or become exceptionally needy or clingy. Older patients may experience somatic symptoms. Older children and adolescents have manifestations similar to those that the adult experiences; however, they may also demonstrate disruptive, disrespectful, or destructive behaviors. Furthermore, there is an increased risk of suicide, substance abuse, poor social support, poor concentration, academic problems, and poor physical health with adolescents diagnosed with PTSD.

A patient recently experienced a traumatic event. Which intervention, if started immediately after the exposure to trauma, prevents the normal stress reactions from developing into acute stress disorder or long-term posttraumatic stress disorder (PTSD)? A. Revisiting the site of the trauma B. Obtaining help and support C. Initiating treatment with selective serotonin reuptake inhibitors (SSRIs) D. Initiating cognitive-behavioral therapy

B. Obtaining help and support -Obtaining help and support as soon as possible after exposure is integral in preventing normal stress reactions from developing into acute stress disorder or longer-term PTSD. Initiating SSRI therapy for depression (if present), initiating cognitive-behavioral therapy, and revisiting the site of the trauma may all be beneficial to patients with PTSD but can be initiated later in the treatment regimen.

The nurse is working with a child suspected of having posttraumatic stress disorder who has been removed from the home because of neglect. Which manifestation may the nurse observe with the young child that conveys a message about the traumatic​ event? (Select all that​ apply.) A. Dreaming B. Playing C. Drawing D. Crying E. Jumping

B. Playing C. Drawing -​Rationale: Young children with posttraumatic stress disorder often recreate a traumatic event by playing and drawing.​ Jumping, dreaming, and crying do not give a coherent message.

The nurse is providing care to a child diagnosed with posttraumatic stress disorder (PTSD) who is experiencing frequent nightmares. Which medication should the nurse anticipate being prescribed for this patient? A. Setraline B. Prazosin C. Paroxetine D. Risperidone

B. Prazosin -Although sertraline, paroxetine, and risperidone are appropriate for a patient diagnosed with PTSD, the only medication that has shown effectiveness in reducing nightmares associated with PTSD is prazosin, an antihypertensive agent.

The nurse is caring for an older patient who is a veteran with posttraumatic stress disorder (PTSD). Which manifestation is reported more often by older veteran patients compared with younger veterans? A. Depression B. Somatic symptoms C. Hostility D. Guilt

B. Somatic symptoms -Older veteran patients report more somatic complaints; fewer typical PTSD general symptoms; and less depression, hostility, and guilt than younger veterans do. A complete mental status exam, including cognitive screening, is recommended when assessing older patients. Assessment of the history of trauma and symptomatology should be performed routinely because these patients may minimize the significance of this history or not report it at all because it likely occurred a long time ago.

A patient wishes to incorporate complementary integrative health (CIH) approaches in the treatment regimen for posttraumatic stress disorder (PTSD). Which type of CIH approach enables the patient to have an effective plan to address the negative obstacles that may be encountered? A. Breathing retraining B. Stress inoculation C. Real-world training D. Prolonged exposure training

B. Stress inoculation -Stress inoculation is a form of psychotherapy in which the therapist teaches the patient on the stress that may be endured, including the negative outcomes. This enables the patient to have an effective plan to address the negative obstacles that may be encountered. Prolonged exposure training, breathing retraining, or real-world training will not enable the patient to have an effective plan to address the potential negative obstacles.

The nurse is providing discharge teaching for a patient diagnosed with posttraumatic stress disorder (PTSD). Which patient statement indicates the need for further teaching? A. "I will use abdominal breathing at the first sign of anxiety." B. "I will use distraction techniques when I feel moderate stress." C. "I will drink a few beers when I am anxious." D. "I will go to the gym for kickboxing class when I have negative feelings."

C. "I will drink a few beers when I am anxious." -Using alcoholic beverages as a means of controlling anxiety indicates the need for further teaching. The other patient statements indicate understanding of the discharge teaching provided by the nurse.

The nurse is using open-ended questions during an assessment of a patient with PTSD. Which is a benefit of this therapeutic technique? A. Pushes the limits of the patient's personal boundaries B. Provokes frustration and anger in the patient C. Allows the patient to express thoughts and feelings comfortably D. Forces the patient to reveal information the individual may not be ready to share

C. Allows the patient to express thoughts and feelings comfortably -Through the inclusion of open-ended questions, the nurse affords the patient the opportunity to express thoughts and feelings to the degree with which the patient is comfortable while demonstrating respect for the patient's personal boundaries. Open-ended questions do not push the limits of the patient's personal boundaries, provoke frustration and anger in the patient, or force the patient to reveal information the patient is not ready to share. Because of the trauma experienced by patients with PTSD, as well as the subsequent potential for emotional and physical isolation, establishment of trust can be especially challenging. **For example, many military personnel and veterans are resistant to openly sharing their thoughts and emotions even with their colleagues and fellow veterans. During the assessment and throughout the care of all patients with PTSD, the nurse should be aware that direct questioning of the patient with regard to traumatic experiences may inhibit establishment of a trusting relationship and can even provoke frustration and anger in the patient.

The nurse is caring for a patient recently diagnosed with posttraumatic stress disorder (PTSD). His mental health provider is providing eye-movement desensitization and reprocessing (EMDR) and cognitive-behavioral therapy (CBT). The patient has demonstrated good progress but presents at the clinic with reports of an inability to sleep due to nightmares and difficulty meeting his daily obligations. Which intervention best addresses this symptom of PTSD? A. Monitor physiological level of arousal. B. Exercise daily. C. Begin pharmacotherapy. D. Use positive affirmation.

C. Begin pharmacotherapy. -This patient is already actively engaged in nonpharmacologic therapies. At this time, the patient may benefit from adding a medication to the treatment regimen. The antihypertensive medication prazosin inhibits the brain's response to norepinephrine, and it may be prescribed for treatment and prevention of nightmares. Teaching patients with PTSD to monitor their physiological level of arousal, encouraging them to exercise, and teaching them how to use positive affirmation techniques are all helpful therapies. However, they do not specifically address the nightmares that are recurring despite this patient's active participation in the plan of care and the progress the patient is making in life. Selective serotonin reuptake inhibitors (SSRIs) may produce undesirable side effects. Therefore, it is important to teach the patient that most side effects will diminish after the first few weeks. If the patient does not understand this, the risk of nonadherence to the medication regimen increases, leaving the patient untreated and susceptible to decompensation of illness.

Which behavior is a characteristic of dissociation experienced by patients with posttraumatic stress disorder (PTSD)? A. Emotional numbing and loss of sense of reality B. Blocking certain elements of the traumatic event C. Blocking emotions related to the traumatic event D. Strong sense of agitation and poor concentration

C. Blocking emotions related to the traumatic event -Dissociation, in which the individual blocks emotions related to the traumatic event, may occur in patients with PTSD. Dissociation is not associated with a strong sense of agitation and poor concentration, emotional numbing and loss of sense of reality, or blocking certain elements of the traumatic event altogether.

Evaluating assessment data for an individual with posttraumatic stress disorder (PTSD) can be challenging. Which condition can compound the manifestations of PTSD for some patients? A. Hyperthyroidism B. Schizophrenia C. Insomnia D. Eating disorders

C. Insomnia -For some patients with PTSD, manifestations of the disorder can be compounded by substance abuse, depression, and insomnia. Hyperthyroidism, schizophrenia, or eating disorders usually will not compound manifestations of PTSD.

Which cause should the nurse associate with a higher incidence of posttraumatic stress disorder (PTSD)? A. Natural disasters B. MVCs C. Intentional infliction of violence D. Imprisonment

C. Intentional infliction of violence -Intentional infliction of harm or violence, such as torture or rape, is associated with a higher incidence of PTSD. PTSD can also be triggered by natural disasters, motor vehicle crashes, and imprisonment, but these triggers are less prevalent than intentional infliction of harm or violence.

The pediatric nurse welcomes the parents of a child adopted from an international agency. The child was orphaned after a border war and still has nightmares. Which diagnosis should the pediatric nurse be prepared to explain to the family? A. Anxiety disorder B. Phobia C. Posttraumatic stress disorder (PTSD) D. Insomnia

C. Posttraumatic stress disorder (PTSD) -The nurse should be prepared to explain a diagnosis of PTSD to the family. That is a more likely diagnosis than anxiety disorder, phobia, or insomnia.

The nurse is planning care for the older veteran with posttraumatic stress disorder​ (PTSD). Which understanding should the nurse apply to the care of this​ client? A. The older veteran with PTSD will report emotional symptoms. B. The older veteran with PTSD is likely to be hostile. C. The older veteran with PTSD is at an increased risk of suicide. D. The older veteran with PTSD will have significant depression.

C. The older veteran with PTSD is at an increased risk of suicide. -​Rationale: The older veteran with PTSD is at increased risk of suicide compared to a​ middle-aged veteran. The older veteran with PTSD is less likely to be​ hostile, has less​ depression, and complains of somatic issues instead of emotional issues when compared to the younger veteran.

The nurse is discussing treatment options with a client with posttraumatic stress disorder​ (PTSD). The client asks the nurse how the PTSD will be cured. How should the nurse​ respond? A. There are medications that can cure PTSD. B. PTSD will reoccur if you skip group counseling. C. Treatment and therapies are done with and without medication. D. We will try the therapies that your insurance company covers.

C. Treatment and therapies are done with and without medication. -​Rationale: The client with PTSD will be treated holistically with pharmacologic and nonpharmacologic therapies to obtain the best results. The​ nurse's response would not focus on medication​ alone, therapy​ alone, or concerns over insurance​ coverage, because it is better to avoid them as therapeutic responses.

The nurse is caring for a combat veteran client with posttraumatic stress disorder​ (PTSD). Which condition can be ideal for acupuncture to be an effective​ treatment? (Select all that​ apply.) A. When solely used as a primary therapy B. When used as a​ short-term therapy for a period of no more than a month C. When used as an adjunct to​ cognitive-behavioral therapy​ (CBT) and other traditional therapies D. When used regularly E. When used for a period of 3 months or more

C. When used as an adjunct to​ cognitive-behavioral therapy​ (CBT) and other traditional therapies D. When used regularly E. When used for a period of 3 months or more -​Rationale: Preliminary research shows that acupuncture may be an effective treatment for PTSD only if the treatment is regular and lasts for at least 3​ months, and is used as an additional treatment with CBT and other more traditional​ therapies, including pharmacologic agents.

Which statement should the nurse expect to hear from a client with posttraumatic stress disorder​ (PTSD)? (Select all that​ apply.) A. ​"I feel very optimistic and positive about the future and what I can​ accomplish." B. ​"I'm a​ high-stress person. I feel content most of the​ time." C. ​"There is no one I can really talk to. I​ don't feel close to​ anyone." D. ​"I have trouble sleeping at night and​ don't feel rested in the​ morning." E. ​"I can't remember the last time I enjoyed​ myself."

C. ​"There is no one I can really talk to. I​ don't feel close to​ anyone." D. ​"I have trouble sleeping at night and​ don't feel rested in the​ morning." E. ​"I can't remember the last time I enjoyed​ myself." -​Rationale: Clients with PTSD experience​ recurrent, involuntary, and intrusive​ memories, traumatic​ nightmares, and flashbacks. They have negative alterations in cognition and mood that began or worsened after the traumatic event. Examples are an inability to experience positive emotions and persistent blame of self or others for causing the trauma or its consequences. Clients may have trouble sleeping and may become emotionally numb or have trouble with​ affection, impairing their relationships. Clients with PTSD typically do not express feelings of optimism and contentment.

The nurse is reviewing a plan of care for a patient diagnosed with posttraumatic stress disorder (PTSD). Which intervention should the nurse question? A. Assist the patient in reducing nightmares. B. Help the patient to discuss emotions related to the traumatic experience. C. Keep the patient free from injury or harm. D. Administer fluoxetine as ordered.

D. Administer fluoxetine as ordered. -Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor (SSRI) not approved by the U.S. Food and Drug Administration (FDA) for use in treating PTSD. The only two SSRIs approved by the FDA for the treatment of PTSD are sertraline (Zoloft) and paroxetine (Paxil). All the other interventions are appropriate for this patient.

Some patients with posttraumatic stress disorder (PTSD) experience hyperarousal and vigilance. Which intervention should be the nursing priority for patients experiencing these symptoms? A. Providing immediate pharmacologic intervention B. Getting the patient to a calm environment C. Teaching the patient new coping mechanisms D. Ensuring the safety of the patient

D. Ensuring the safety of the patient -Nursing priorities for patients with PTSD exhibiting hyperarousal and vigilance are ensuring the safety of the patient and others while quickly lowering patient anxiety levels. Patients experiencing extreme anxiety also require pharmacologic intervention, a quiet and calm environment, and reassurance about personal safety. Once anxiety levels are reduced, the health team can help the patient learn a new process of appraisal and coping mechanisms.

The nurse is caring for a 30-year-old woman 3 months after the woman's assault. Her symptoms include a sense of detachment, altered sense of reality, spontaneous memories of the assault, recurring distressing dreams, psychological distress, and an inability to return to her apartment. Which risk factor should lead the nurse to suspect that the patient is experiencing posttraumatic stress disorder (PTSD)? A. Exhibiting depersonalization B. Avoiding situations related to the trauma C. Experiencing flashbacks D. Experiencing an extremely stressful event

D. Experiencing an extremely stressful event -Risk factors for PTSD include the severity of the stressor event and additional stressors immediately following the event. Depersonalization, avoiding situations related to the trauma, and flashbacks are clinical manifestations of PTSD, not risk factors.

All patients with posttraumatic stress disorder (PTSD) should be assessed using valid PTSD measuring tools. In addition to assessment of psychological and emotional symptoms, which age group also needs cognitive screening? A. Women B. Children C. Adolescents D. Older patients

D. Older patients -The older patient who may be experiencing PTSD symptoms should be assessed using a valid PTSD measuring tool and be assessed for suicidal thoughts and behaviors because older adults are at an increased risk of suicide compared with middle-aged adults. A complete mental status exam, including cognitive screening, is also recommended when assessing the older adult. The other groups are not as likely to require extensive cognitive screening. Older patients may report somatic symptoms as opposed to emotional symptoms and are at an increased risk of suicide.

A patient with posttraumatic stress disorder (PTSD) wishes to add acupuncture to the treatment regimen. Which information on acupuncture should the nurse include while teaching the patient? A. Do not use acupuncture for more than 3 months. B. Do not use acupuncture in conjunction with cognitive-behavioral therapy (CBT). C. Do not use acupuncture in conjunction with traditional therapies. D. Use acupuncture as an adjunctive therapy.

D. Use acupuncture as an adjunctive therapy. -Nurses working with patients who are interested in trying acupuncture as a treatment for PTSD should encourage the patients to add acupuncture as an adjunctive therapy and not to abandon CBT and therapies that are more traditional. Patients may need to participate in acupuncture on a regular basis for a period of 3 months or more.

A client is prescribed​ prazosin, an antihypertensive​ medication, for the pharmacologic treatment of posttraumatic stress disorder​ (PTSD). The client asks how a blood pressure medication will help with symptoms. Which response by the nurse is the most​ appropriate? A. ​"The medication reduces your blood​ pressure, which decreases the symptoms of​ PTSD." B. ​"I am not sure why this medication has been​ prescribed, so I will follow up with your healthcare​ provider." C. ​"Your medical record indicates elevated blood pressure during the last two​ visits." D. ​"The medication has been found quite useful to reduce the nightmares associated with​ PTSD."

D. ​"The medication has been found quite useful to reduce the nightmares associated with​ PTSD." -​Rationale: Prazosin is an antiadrenergic agent that has been used to treat hypertension for many years. Recent research has found that this medication is useful in the treatment of the nightmares associated with PTSD through its action of inhibiting the​ brain's response to norepinephrine. While the medication will reduce blood​ pressure, this is not the reason it is used for PTSD. It is inappropriate for the nurse to avoid answering the question and to instead promise to follow up with the healthcare provider.

Blocking of emotions related to the traumatic event

Dissociation

Certain elements of the traumatic event blocked altogether

Dissociative amnesia

Losing touch with reality and cognitively returning to the traumatic event as if it were happening again

Flashbacks

Risk factors for PTSD include the following:

-The severity of the event itself, including whether or not the individual was harmed or watched others be harmed or killed -Little or no social or psychologic support following the trauma -Additional stressors immediately following the event, such as loss of a spouse or family member or loss of employment -Presence of preexisting mental illness

The most effective way to prevent the development of PTSD is for the individual to use a support system after exposure to a traumatic event.

-This may mean reaching out to family and friends or seeking professional help. -Obtaining support will aid the individual in using positive, effective coping skills and prevent the individual from succumbing to ineffective coping skills such as self-medicating with drugs and alcohol.

Appropriate diagnoses for the patient with PTSD may include the following:

-Violence: Self-Directed, Risk for -Violence: Other-Directed, Risk for -Post-Trauma Syndrome -Anxiety -Fear -Coping, Ineffective -Coping: Family, Compromised -Sleep Pattern, Disturbed

Traumatic events that may trigger PTSD include the following:

-Violent personal assaults -Natural or human-caused disasters -Motor vehicle crashes -Military combat -Being taken hostage or being tortured -Imprisonment -Dismemberment -Incest -Child abuse. **PTSD can also stem from sexual assault or being subjected to sexual experiences during childhood. Even threats of violence or injury may prompt the development of PTSD.

The nurse is assessing a 5-year-old patient who is diagnosed with posttraumatic stress disorder (PTSD). The child is accompanied by both parents. Which assessment question by the nurse is most appropriate? A. "Do you sleep all the way through the night?" B. "Can you draw me a picture of what happened to you?" C. "Do you feel sad often?" D. "Do you get angry easily?"

A. "Do you sleep all the way through the night?" -When assessing a child who has or may have PTSD, it is helpful to use direct questioning. Assessment of younger children involves questioning the child and/or the parents about significant changes in behavior and sleeping patterns. For example, it may be best to question the child to determine if there has been a change in the individual's sleeping habits. Drawing a picture can often cause children to reexperience the trauma. This should be used with caution in children diagnosed with PTSD. Moreover, children might not recognize when they are angry or sad.

An emotional numbing and a loss of the sense of reality, feelings, and sense of self in relation to others

Depersonalization