Trauma, Crisis, Disaster, and Related Disorder Assessment

A nurse is developing education for a parenting class about adverse childhood events (ACEs). Which of the following statements should the nurse include in the education?

"Children who are exposed to repeated adverse childhood events are at an increased risk for developing physical and mental health issues." This information is important to include when teaching. Exposure to repeated adverse childhood experiences has been linked to increased risk for chronic changes in physical and mental health later in life.

A nurse is preparing a teaching for high school students regarding trauma and interpersonal violence. Which of the following statements should the nurse plan to include in the teaching?

"Interpersonal violence includes physical, sexual, and emotional maltreatment, which are types of trauma." Interpersonal violence is a type of trauma where force or power is threatened or enacted against another person. This act includes physical, sexual, and emotional maltreatment and neglect.

A nurse is analyzing assessment date for a group of clients. Which of the following clients is at greatest risk of developing posttraumatic stress disorder (PTSD)?

A 36-year-old client who has a maxillofacial fracture caused by their partner Assessment findings support that this client is potentially a victim of interpersonal violence and, as a result, at high risk for developing PTSD.

A nurse is working with an interdisciplinary disaster response team planning care for a coastal community following a category 5 hurricane. Place the following steps of disaster management in the correct order.

After a disaster, those involved will require guidance and support to formulate a course of action that will meet physical and psychological needs. (1) This begins with consideration of any *challenges the individuals and the community are experiencing.* (2) Next, the nurse should complete a needs assessment of the *individuals' ability to cope and function with the current situation and going forward.* (3) Once the needs assessment is completed, a list of *resources should be determined and made available to the client and community.* (4) Finally collaboration with the client and community in reviewing the impact of the disaster and *creating of a plan* for going forward after the disaster should be made.

A nurse is working with a local crisis response team to evaluate students following a school shooting. After ensuring the safety of the students, which of the following trauma-informed approaches should the team take next?

Establish a supportive environment that facilitates trust and transparency. After ensuring the safety of the students, the team should establish a safe environment to build and maintain the students' trust.

A nurse is developing a plan of care for a 14-year-old client who has a history of child maltreatment. The staff have reported that any time an alarm occurs, the client is found sitting in a closet. Which of the following most accurately describes the client's response?

Fear conditioning The client's response is an example of fear conditioning. This is a learned response that causes the client to reexperience their trauma in response to a trigger. In this case, the alarm has made the client believe that an adverse experience is coming and they should hide. Fear extinction is the gradual reduction in the autonomic response to a perceived threat or fear-provoking stimulus. Self-regulation is the ability to modify emotional and behavioral responses to a perceived threat. Through self-regulation, the client can restore a state of autonomic equilibrium and a sense of safety. Stress resilience is the concept of "bouncing back" to an internal state of safety and well-being after experiencing a stressful event.

A nurse is providing care for a client who has PTSD. The client states, "I always have to watch my back!" Which of the following manifestations of PTSD is the client experiencing?

Hypervigilance This is an example of hypervigilance, which is a state of high and constant alertness to potential threats in their surroundings. The individual has a sense of being in constant danger.

A nurse is planning care for a client who has acute stress disorder. For each potential nursing intervention, click to specify if the potential intervention is expected, nonessential, or contraindicated for the client.

Rotate staff as often as possible. *contraindicated* Repeat vital signs every hour. *nonessential* Assess for environmental safety risks. *expected* Use screening tools to monitor manifestations. *expected* Ask close-ended questions. *contraindicated* Encourage the client to share details regarding trauma. *contraindicated*

A nurse is caring for a client who was diagnosed with adjustment disorder after losing their job 2 months ago. For which of the following manifestations should the nurse monitor the client?

Suicidal ideation This client is at greater risk for suicidal ideation. Adjustment disorders can severely affect a person's ability to function. They may find it difficult to adjust to the changes caused by the stressor, leaving them at high risk for attempted or completed suicide.

a nurse is caring for a client who recently experienced a traumatic event and is experiencing flashbacks. Which of the following client findings require immediate follow-up by the nurse? Click to highlight the chart entries that require immediate follow-up. To deselect a finding, click on the finding again.

When taking action, the nurse should immediately address the statement *"Maybe if you weren't always bothering innocent people and trying to give everyone a ticket, you wouldn't be here"* by the other employee, which indicates implicit bias against law enforcement officers on the part of that employee. Implicit biases in health care increase health inequity and stigma and decrease optimal outcomes for vulnerable populations. Additionally, implicit biases create environments that perpetuate traumatic experiences for at-risk clients by compromising psychological safety, equity, and inclusion.

A nurse is caring for a client who has depression, diabetic polyneuropathy, and significant neuropathic pain. The nurse hears assistive personal say, "They are admitted frequently and always report being in pain. I think they are just a drug seeker." Which of the following responses should the nurse make?

"It is not appropriate to stereotype clients. It seems like you may have bias which could affect client care." Being direct and explaining the effect of bias is an appropriate response. Bias creates barriers to client care, and the health care team should pause and consider how bias affects client care.

A nurse has attended an in-service education regarding trauma-informed care approach. Which of the following statements by the nurse reflects an accurate description for the goal of a trauma-informed approach?

"Nurses should understand the effects of trauma and structure client care to promote positive outcomes." A trauma-informed approach focuses on understanding the impact of trauma and addressing client needs so as to promote positive client health outcomes.

A nurse is caring for client who was recently diagnosed with posttraumatic stress disorder (PTSD). The client asks, "What is the difference between acute stress disorder and PTSD?" Which of the following responses should the nurse make?

"PTSD is diagnosed if the symptoms persist for longer than 1 month." Acute stress disorder is diagnosed when symptoms occur from 3 days to 1 month past the traumatic experience, while symptoms of PTSD persist for longer than 1 month and can continue throughout someone's life.

A nurse overhears a coworker say, "I get that some people have a hard childhood, but eventually they need to get over it." Which of the following responses should the nurse make?

"People who experience adverse childhood events are changed biologically and genetically." Exposure to adverse childhood events has been linked to biological changes to the brain of the child, which can result in chronic physical and mental health conditions later in life. Research also has identified that early child experiences can result in genetic changes, which can then be passed down to future generations.

A nurse is providing care to a 4-year-old who has recently been diagnosed with reactive attachment disorder. Which of the following statements by the nurse accurately describes this disorder?

"Reactive attachment disorder can occur when there is an absence of adequate caregiving, including the child going many hours without being held or touched as an infant." This statement accurately describes reactive attachment disorder. This disorder can develop when an infant or young child does not turn to the caregiver and does not respond to comforting to their unmet needs.

A nurse is caring for a client following a suicide attempt. Which of the following statements by the nurse reflects a trauma-informed approach?

"This must be difficult. Can you tell me about what has happened to you?" This response is therapeutic and reflects a trauma-informed approach, allowing the nurse to consider the client's cultural context and how they may express trauma or describe a traumatic experience.

A nurse has attended an in-service regarding nursing care for clients who have experienced trauma. Which of the following statements by the nurse represents an understanding of trauma?

"Trauma is a broad term that refers to a person's physical, psychological, or emotional response to an adverse event." Trauma is a broad term that describes an experience of physical, emotional, or psychological adversity. Trauma can occur as a single event or be the result of exposure to multiple adverse events or conditions.

A nurse is providing care for an adolescent who sustained injuries in assault. Which of the following actions should the nurse take?

Provide a safe, secure environment for the adolescent. Establishing a secure and safe environment is the first step in trauma-informed nursing practice.

A nurse is caring for a client who was brought to the ER following displacement from their home due to a flood. When assessing the client, which of the following clinical manifestations would the nurse anticipate are related to the experience of trauma?

*Anxiety is correct.* Clinical manifestations such as anxiety are common in clients who have experienced a disaster such as a flood. *Sleep disturbance is correct.* Clinical manifestations such as sleep disturbances are common in clients who have experienced a disaster such as a flood. *Anger is correct.* Clinical manifestation of anger is common in persons who have experienced a traumatic event or disaster such as a flood. *Depression is correct.* Clinical manifestations of depression are common in clients who have experienced a traumatic event or disaster such as a flood. Hallucinations is incorrect. Hallucinations are a clinical manifestation of psychosis and can occur with schizophrenia. Elevated mood is incorrect. An elevated mood is a clinical manifestation of mania and can occur with bipolar disorder.

A nurse is caring for a newly admitted client who has experienced a traumatic event. Which of the following 2 client findings require the nurse to immediately follow-up?

*Client's statement regarding harming others is correct.* The nurse should assess the client's behavior for indications of violence or self-harm and notify the health care provider to ensure client's safety and the safety of others. Client's inability to relax is incorrect. Feelings of tense muscles is a common manifestation following exposure to a traumatic experience. Lack of physical injury to client is incorrect. The lack of injury to the client during the traumatic event is not relevant to the client's current safety status. *Client's statement regarding feelings when awakening is correct.* The nurse should assess the client's behavior for indications of violence or self-harm and notify the health care provider to ensure client's safety and the safety of others. Client's reluctance to speak to friends is incorrect. Lack of interest in previously enjoyed activities and friends is a common manifestation following exposure to a traumatic experience.

A nurse is preparing educational material for guardians on trauma prevention, and developing childhood resilience. Which of the following techniques should the nurse include?

*Foster a hopeful perspective of the future is correct.* Fostering a hopeful perspective of the future allows the child the deal with the present situation and look forward to future events. *Encourage development of thinking and learning is correct.* Encouraging a child to continue to learn and think provides the opportunity for growth and cognitive development. *Provide secure and supportive relationships and places is correct.* Positive relationships and places ensure a sense of security and promote development of a resilient child. Ignore tantrums is incorrect. A child's ability to self-regulate can be altered if they are exposed to trauma. Education regarding trauma and resilience should include that fits and tantrums may be a symptom of trauma in children and that the caregiver should not ignore them. Discourage expression of anger is incorrect. A child is learning to self-regulate, and a part of this is learning to understand their own emotions. If the child is expressing an

A nurse is assigned to triage clients following an explosion at an oil refinery. Which of the following symptoms are consistent with a trauma response involving the sympathetic nervous system?

*Increased heart rate is correct.* Increased heart rate is a stress response that is triggered by the sympathetic nervous system. *Shallow breathing is correct.* Shallow breathing is a stress response that is triggered by the sympathetic nervous system. *Muscle tension is correct.* Muscle tension is a stress response that is triggered by the sympathetic nervous system. Immobility is incorrect. Immobility is triggered by the parasympathetic nervous system, rather than the sympathetic nervous system. *Anxiety is correct.* Anxiety is a stress response that is triggered by the sympathetic nervous system. Fatigue is incorrect. Fatigue is triggered by the parasympathetic nervous system, rather than the sympathetic nervous system.

A community health nurse observes an 8-month-old child being reunited with their parent after being found alone in an automobile. Which of the following responses should the nurse identify as an indication that the child might be experiencing poor attachment?

*The child continues to play with a toy when their parent steps into the room is correct.* Not responding to the parent is an example of inadequate bonding between the parent and child. A child with secure bonding would be happy when reunited with their parent or regular caregiver. *The child does not respond when held and embraced by the parent is correct.* The child's response is a result of inadequate or poor bonding between the parent and child. When bonding is missing or is replaced by adverse experiences, the child's reward system is not initiated, resulting in inadequate attachment, an avoidant or ambivalent connection to their parent. ---- The child cries when the nurse tries to give the child to the parent is correct. The child avoiding their parent can be indicative of inadequate attachment, an avoidant or ambivalent parent-child bond.

A nurse at a clinic is screening clients for trauma. The nurse should identify that which of the following factors increases a client's risk for developing trauma-related disorder?

*The client has a history of physical abuse is correct.* The nurse should identify those clients who have experienced physical abuse are at greater risk for developing a trauma-related disorder. *The client belongs to a marginalized group is correct.* The nurse should identify those clients who belong to a marginalized group and have experienced health disparity due to their race, religion, culture, or social group are at greater risk for developing a trauma-related disorder. *The client was active military during the Iraq war is correct.* Military personnel who have experienced combat are at greater risk for developing a trauma-related disorder. The client is from a large family is incorrect. Family size is not a risk factor for developing a trauma-related disorder. The client is male is incorrect. Being male does not indicate a greater risk factor for developing a trauma-related disorder. Female clients are at greater risk for developing a trauma-related disorder. The client h

A nurse is providing parenting education to a group of new patents at the area community center. Which of the following types of trauma prevention is the nurse providing?

Primary prevention This is an example of primary prevention. Primary prevention focuses on preventing adverse experiences before they occur. This can include providing parenting classes to new parents to enhance positive parenting skills and create protective factors for their children. *Secondary prevention focuses on screening to identify and follow up with those who have experienced past trauma or are at high risk for developing mental health problems. Tertiary prevention focuses on helping those who have been diagnosed with a mental health condition. This can include improving their current quality of life and well-being, as well as preventing future complications. Primordial prevention focuses on helping the population as a whole. This can include support of public health policies and identification of environmental and behavioral risk factors.