Ch 40: Care of Veterans with Mental Health Needs

a) Tobacco use has increased in the veteran population Pg. 798-799 Tobacco use is higher in the veteran population than the non-veteran population, which may be due to higher stress responses. Use of tobacco is not associated with any role or position.

45. A nurse is developing an educational program for veterans who are tobacco users. Which of the following points should the nurse include in the teaching session? a) Tobacco use has increased in the veteran population b) Use of tobacco is associated with the military role and position c) Tobacco use has declined in the veteran population d) Tobacco use remains stable among the veteran population

c) The individual participates in veteran community groups Pg. 790 The concept of veteran identity can be determined by the responses to three questions graded on a 0 to 4 scale that examine the importance of being a veteran by self-reflection, thinking of one being a veteran, and the importance of others being aware of the veteran status. The individual who participates in veteran community groups is displaying agreement with all responses. Preferring not to talk about past service, focusing on present tasks, and keeping information confidential does not identify with the concept of veteran identity.

1. A nurse is reviewing the concept of veteran identity. Which finding would best support a strong association with this concept? a) The individual prefers to not talk about past service b) The individual is focused on present tasks c) The individual participates in veteran community groups d) The individual asks that all information provided be kept confidential

c) Female veterans are more likely to express suicidal ideation Pg. 794-795 Current research related to females in the military shows a more diverse population, younger age, with single deployment, less likely to abuse alcohol, but more likely to contemplate suicide and experience depression than their male counterparts.

10. A nurse is assessing a female veteran who reports to the clinic for a well checkup. Which information should the nurse include in the plan of care? a) Female veterans are more likely to have alcohol abuse problems b) Most female veterans are older than their male counterparts c) Female veterans are more likely to express suicidal ideation d) Female veterans are more likely to have multiple deployments

c) Monitor for suicide ideation Pg. 796-797 In a recent year, almost half of the service members who died by suicide had a history of at least one behavioral health disorder, such as substance use disorder, adjustment disorder, or major depression. Stressors associated with suicide included failed/failing intimate partner relationship and legal proceedings. The client going through a divorce and being sued for child support is experiencing a stressor associated with suicide. Social services would not be helpful for this client. There is no evidence that clergy should be involved. Medication therapy would be determined by the health care provider.

11. A veteran from the Iraqi War is distraught because the spouse is suing the client for divorce and child support. Which intervention should the nurse make a priority for this client's care? a) Discuss possible medication therapy b) Refer to social services c) Monitor for suicide ideation d) Ask if clergy could be helpful

d) Employment services Pg. 799-800 The VHA has multiple programs to support veterans who are homeless or at risk of being homelessness. The VA conducts coordinated outreach to seek out veterans in need of assistance. Veterans who are homeless or at risk of being homeless are connected with community employment services. There is no evidence that the client is homeless so a referral to homeless shelters is not required. There is no evidence that the client needs assistant with medications or services offered by a community health clinic.

12. During an assessment at the Veterans Hospital, a client who was recently discharged from active duty is concerned because rent is coming due and the client is unable to obtaining employment. Which referral should the nurse make for this client? a) Homeless shelters b) Medication program c) Community health clinics d) Employment services

c) Vietnam era Pg. 789 A military veteran refers to a person who served in the armed forces. The Vietnam Era lasted from 1964 to 1975 with the median age of veterans being about 71 years. The peacetime era is between the end of the Vietnam War to the post-9/11 era. World War II veterans are the oldest group in the US and have a median age of about 93 years. The post-9/11 group served in the military after September 2001 and has a median age of about 37 years.

13. The nurse is preparing a presentation for military veterans who have an average age of 71. For which conflict should the nurse incorporate specific health issue information? a) Post-9/11 group b) World War II c) Vietnam era d) Peacetime

b) "The definition of PTSD has evolved to include psychological symptoms as a result of trauma" Pg. 792 The categorization of PTSD has evolved. When the Diagnostic and Statistical Manual III was published in 1982, a stress category was included. The PTSD diagnostic criteria have evolved into the current diagnosis published in the DMS-5. PTSD is understood to be a complex interplay of biologic and psychological symptoms that is experienced as a result of traumatic experiences in addition to the trauma of war. The diagnosis of PTSD is not made because of the experience of boot camp. PTSD can apply to any psychological symptoms that occur after a traumatic experience. PTSD is not being used for other mental health conditions.

14. The nurse is asked how a veteran client develops posttraumatic stress disorder (PTSD) but did not engage in active duty. In which way should the nurse respond? a) "Many health care providers use PTSD when there isn't another diagnosis for a mental health condition" b) "The definition of PTSD has evolved to include psychological symptoms as a result of trauma" c) "The client most likely does not have PTSD because it is used to describe psychological symptoms from war" d) "Some veterans who enlisted in the military were traumatized by the expectations of boot camp"

a) Ask for clarification of events Pg. 794 Although military sexual trauma (MST) should be reported, there is insufficient information for the nurse to make either medical/counseling referrals and/or initiate the process for follow-up evaluation of MST. Rather the nurse should attempt to obtain further information to clarify the nature of the comment.

15. A nurse is assessing an active-duty military service client in the clinic. The client reports feelings of uneasiness when surrounded by superior officers even though there has been no physical contact. What is the best nursing response? a) Ask for clarification of events b) Refer the client for counseling c) Refer the client for additional psychological screening d) Report the information because it is suggestive of military sexual trauma (MST)

c) Microaggression Pg. 793 An example of microaggression is a behavior that can be intentional or unintentional, verbal or nonverbal, but conveys hostility or negativity to another. The behavior identified has no physical contact; therefore, it is not a physical assault. One cannot determine whether the behavior is intentional based on the information provided. The nurse would not categorize this as indifference based on the provided information.

16. A nurse is interviewing a veteran client in the clinic whose responses are somewhat hostile and condescending. How would the nurse classify this interaction? a) Physical assault b) Indifference c) Microaggression d) Abusive and intentional

c) Focusing on promotion of cultural identity Pg. 789 The US military has developed a series of strategies that can be used to promote inclusion of racial and ethnic diversity within the military. These include but are not limited to addressing issues of recruitment accessions, retention, barriers, career development, organizational climate and culture, worldview, and identity. Focusing on promotion of cultural identity addresses one of these strategies. The ability to schedule visits on a daily basis does not specifically address this issue. Maintaining existing organizational structure and addressing issues based on military ranking will not help solve these issues.

17. Nurses in a veterans clinic are planning ways to improve access to care that reflects inclusion of racial and ethnic diversity. Which strategy would best accomplish this goal? a) Addressing issues based on military ranking b) Maintaining existing organizational structure c) Focusing on promotion of cultural identity d) The ability to schedule visits on a daily basis

a) Increased minority stress Pg. 793 Minority stress represents high levels of stress seen in stigmatized populations. The notation of transgender on the client's medical record in the context of a combat veteran should alert the nurse to potential impact of increased stress. There is no indication that the client will have decreased compliance, a lower financial status, or evidence of physical defects.

18. A combat veteran client notes transgender on the medical record. Which finding should the nurse anticipate may play a role in the plan of care? a) Increased minority stress b) Potential for physical deficits c) Decreased financial status d) Decreased compliance

c) Reports difficult family relationships Pg. 790 Enlisted personnel consistently report poorer health, vocational, and social outcomes compared to their officer counterparts. Therefore, the nurse would identify the reporting of difficult family relationships as being significant.

19. A nurse is performing a screening assessment on an enlisted military client. Which finding should the nurse expect when obtaining a health history in comparison to an officer military client? a) Strong spiritual identity b) Reports a strong work ethic c) Reports difficult family relationships d) Reports fewer problems

b) Yells at their child to not play outside alone Pg. 792-793 The consequences of moral injury are apparent in the lives of the veterans. If the veteran experienced the killing of children, they may fear harm to their own children as a reminder of those who were killed. The client yelling at their child to not play outside alone demonstrates the client's fear that harm may come to their own child. Offering a beverage to the nurse, asking the spouse to stay during the visit, and wanting to meet in the kitchen while preparing dinner do not describe consequences of moral injury.

2. The nurse visits the home of a client who was in active duty during the Gulf War. Which client action indicates to the nurse that the client is experiencing the effects of a moral injury? a) Offers the nurse a beverage b) Yells at their child to not play outside alone c) Asks the spouse to stay while the nurse visits d) Wants to talk in the kitchen to help prepare dinner

a) Client reports an incident of sexual assault Pg. 794 Because the client indicated that there was physical contact, this should be noted as an incident of sexual assault. Sexual harassment focuses on verbal interactions. There is insufficient information to document this as a groping incident and/or as sexual contact. Additional information is needed to clarify the nature of the report.

20. A veteran presents to the clinic with a report of inappropriate physical contact from another person. How should the nurse document this statement in the client's chart? a) Client reports an incident of sexual assault b) Client reports a groping incident c) Client reports a sexual contact d) Client reports an incident of sexual harassment

c) Attends a weekly support group Pg. 791 Involvement in community groups and activities that foster a sense of belonging and identity has been shown to be a protective factor for depression and PTSD in veterans. An optimistic disposition appears to be protective of depression. Veterans who are optimistic are more likely to use adaptive and problem-focused coping strategies, such as positive reframing of problems and seeking social support. Attending a weekly support group is a proactive activity to prevent the development of depression. Playing video games, spending time alone, and ingesting alcohol are not identified as activities to prevent the development of depression.

21. The nurse is reviewing data collected during an assessment with a veteran recently discharged from the Gulf War. Which finding indicates to the nurse that the client is actively preventing the development of depression? a) Ingests alcohol before bedtime b) Spends most time alone c) Attends a weekly support group d) Plays video games

b) Prefers to remain alone Pg. 790 A strong veteran identity is associated with positive self-esteem and self-definition and affords protective factors as they relate to mental health issues. An individual with a weak veteran identity is at risk for mental health issues; therefore, the nurse would expect that the individual might prefer to remain alone. Compliance with health care, willingness to participate in community groups ,and adequate functional ability would be aligned with a strong veteran's identity.

22. A veteran client presents with a weak veteran identity. What type of behavior should the nurse anticipate? a) Willingness to participate in community groups b) Prefers to remain alone c) Compliance with health care d) Adequate functional ability

c) Mental health issues on return to civilian life Pg. 790 A service-connected disability represents an injury, disease, or disability that active duty either caused or activated. Research has shown that the highest number of veterans with a service-connected disability served in the Gulf War and/or following 9/11. A history of hypertension 10 years following deployment may not be related to active duty but rather a consequence of aging and/or genetic history. The fact that the active military services years were during the Gulf War does not specifically indicate the presence of a service-connected disability. Having an appendectomy during years of military service is an example of an intervention for an acute illness. Having mental health issues on return to civilian life is indicative of a service-connected disability.

23. A nurse is taking care of a veteran client with multiple health issues at the clinic. Which of the following would be considered as a service-connected disability? a) Had an appendectomy during years of military service b) Active military service years during the Gulf War c) Mental health issues on return to civilian life d) History of hypertension 10 years after deployment

a) Ability to participate in community groups d) Entering into a new partner relationship e) Headaches becoming less frequent Pg. Survivor reactions to MST include strong emotions; feelings of numbness; trouble sleeping; difficulties with attention, concentration, and memory; problems with alcohol or other drugs difficulties with reminders of experience and relationships; and physical problems. The ability to participate in community groups, entering into a new partner relationship, and headaches becoming less frequent are evidence of resolved survivor reactions.

24. A veteran with a past history of military sexual trauma (MST) presents to the clinic for a follow-up visit. Which finding(s) should the nurse anticipate as being evident of resolved survivor reactions? Select all that apply. a) Ability to participate in community groups b) Sleep disturbances c) Heightened awareness of surroundings d) Entering into a new partner relationship e) Headaches becoming less frequent

c) Perform a focused screening Pg. 795 Based on the provided client comments, the nurse should perform a focused screening for military sexual trauma (MST) because these behaviors can be representative of survivor reactions. More information is needed before a referral for counseling or a reporting of findings to authorities. Bloodwork may be needed but it is not the priority at this time.

25. A nurse is working with a veteran client who reports difficulty sleeping, increasing mood swings, and irritability with a recent onset. Which priority action should the nurse implement? a) Obtain order for bloodwork b) Refer for counseling c) Perform a focused screening d) Report findings to authorities

c) They are treated equally based on abilities Pg. 789 The current military policy related to the transgender population is that they can serve openly in the military. They are not excluded from combat and/or assigned specifically to noncombat areas. Although their medical records may be needed on file as part of a history and physical, they do not have to have proof of surgical transformation procedures.

26. A nurse is obtaining a health history from an active military client in the clinic. Which statement best identifies the current practice related to the transgender population in the military? a) They are not assigned to combat areas b) They must have proof of surgical transformation procedures c) They are treated equally based on abilities d) They are assigned to noncombat areas

d) The client wears a military service hat on a daily basis Pg. 790 Research on veterans' identity concept focuses on three areas: the importance of reflection of being a veteran, thinking of oneself as a veteran, and the importance of others knowing about one's veteran's status. The client wearing a military service hat on a daily basis indicates all three areas. Expressing ambivalence about military service does not align with a strong veteran identity. Not talking much about military service or indicating veteran status on a history form does not align with a strong veteran identity.

27. A nurse is assessing a client's veteran identity. Which findings best support a strong veteran identity? a) The client indicates veteran status on a history form b) The client does not talk much about military service c) The client expresses ambivalence about time spent in the service d) The client wears a military service hat on a daily basis

b) Navy Pg. 787-788 The US military has three departments. The Navy and the Marines fall under the Department of the Navy. No additional branch of the military falls under the Army. The Air Force and Space Force fall under the Department of Air Force. The Army, Navy, Marine Corps, Air Force, and Coast Guard reserves are under federal control and are activated when they are needed. The Army National and Air National Guards are under the authority of their respective states, with the exception of the District of Columbia National Guard, which is exclusively a federal organization.

28. While completing a health history, a client who was honorably discharged from the Marines reports having had many health treatments and counseling sessions but cannot remember the reasons. Which department of the military will the nurse recommend to the client to contact to learn more information? a) Army b) Navy c) Air Force d) Reserves

c) "I will be eligible for a pension when I retire" Pg. 788 Before World War II, the role of females in the military were limited; however, in 1948 the Women's Armed Services Integration Act became a law that recognized females as full members of the armed forces, allowing them to claim the same benefits as males and make a career in the armed forces. The client's statement of being eligible for a pension indicates the client is recognized as a full member of the armed services. The client's statements of enjoying serving the country, having a good position, and seeing different countries do not support being recognized as a full member of the armed services.

29. The nurse is completing a health history with a female client who is home for a short while before reenlisting in the Navy. Which statement indicates that the client is recognized as a full member of the armed services? a) "I enjoy serving my country" b) "I have a good position on my ship" c) "I will be eligible for a pension when I retire" d) "I get to see many different countries"

c) Recent return from deployment d) Solitary lifestyle Pg. 798 Risk factors for AUD include but are not limited to trauma, exposure to military stress, and return to civilian life. Protective factors for AUD include but are not limited to resilience, purpose in life, dispositional gratitude, religiosity/spirituality, and secure attachment. A solitary lifestyle and recent return from deployment would be considered risk factors.

3. A nurse is counseling a veteran with alcohol use disorder (AUD). Which factor(s) should the nurse identify as the highest risk factor(s) for the development of AUD? Select all that apply. a) Cultural beliefs b) Attends religious services c) Recent return from deployment d) Solitary lifestyle e) Family social support

a) Weber test b) Migraine disability assessment test d) Rinne test e) Mini mental status examination Pg. 800 Hearing disturbances and headaches are the most commonly reported adverse effects from a TBI. The nurse by performing the Rinne and Weber tests will assess for hearing deficits (bone/air conduction and lateralization). The migraine disability assessment test will address symptoms of headaches. The mini mental status examination will address cognitive function. The Braden scale is not needed as it relates to skin integrity status.

30. A nurse is caring for a veteran client with a past traumatic brain injury (TBI). What priority assessment should the nurse include in the plan of care? Select all that apply. a) Weber test b) Migraine disability assessment test c) Braden scale d) Rinne test e) Mini mental status examination

a) Asked to remain in a different room from others c) Being told that they were not worthy by others e) Being overlooked for promotions despite qualifications Pg. 793 Microaggression represents actions, whether intentional or unintentional, that include but are not limited to verbal, behavioral, or environmental indignities that communicate hostile, derogatory, or negative slights and insults. Being told that one is not worthy is an example of verbal microaggression. Being overlooked for promotions despite being qualified is an example of a behavioral microaggression. Being asked to remain in a different room from others is an example of an environmental indignity microaggression. Participating in group activities and being offered additional training to stay up-to-date are not aspects of microaggression.

31. A veteran client states to the nurse that they have undergone a great deal of stress in their previous deployments. Which factor(s) should the nurse identify as contributing to the presence of microaggression? Select all that apply. a) Asked to remain in a different room from others b) Participating in group activities c) Being told that they were not worthy by others d) Offered additional training to stay up to date e) Being overlooked for promotions despite qualifications

d) Suicide screening tool Pg. 797 The nurse should screen for suicidal ideation based on the fact that the veteran client was admitted for a potential drug overdose. It would be critical to obtain information about the mindset of the individual because findings suggest that the client is awake and not in any apparent physical distress. Vital signs, obtaining blood for toxicology, and inquiring about allergies can be accomplished at a later time.

32. A nurse is performing a triage assessment on a veteran who has been brought into the emergency department with a potential drug overdose. The client is awake and not in any apparent physical distress. Which priority assessment should the nurse perform? a) Inquire about allergies b) Obtain blood for toxicology c) Vital signs d) Suicide screening tool

d) Back Pg. 799-800 The prevalence of chronic pain, or pain lasting longer than 3-6 months, occurs more frequently in veterans than non-veterans. Chronic back pain in veterans is the most frequently reported type of pain followed by jaw pain, severe headaches or migraine, and neck pain.

33. A client who is a veteran of a foreign war reports having pain for more than "half a year." Which body area should the nurse anticipate the client is experiencing discomfort? a) Jaw b) Neck c) Head d) Back

b) Exaggerated startle Pg. 792-793 An exaggerated startle response is when there is an exaggerated response to what is typically normal stimuli that extends beyond a reasonable time frame and continues despite reoccurrence. It can be seen in response to sounds and/or what is perceived by the individual as an intense stimulus. Although the individual may be anxious, the presentation does not provide enough information to document anxiety. There is no evidence of codependence or mania provided.

34. A nurse is assessing a veteran client who becomes very agitated in response to a fire alarm while in the clinic setting. Which finding should the nurse document in the medical record? a) Anxiety b) Exaggerated startle c) Codependence d) Mania

a) Likelihood of comorbid conditions such as PTSD that lead to being homeless d) Limited financial resources that lead to being homeless e) Potential for opioid use that leads to being homeless Pg. 792 Research indicates multiple factors leading to an increase in veterans becoming homeless, which can include but are not limited to testing positive for PTSD as well as other comorbidities, opioid/substance use, and/or limited financial resources. In terms of gender inequity, there are more males than females that are homeless. The preference to remain isolated indicates implicit bias because this is a choice rather than a response to the ability to cope with life circumstances.

35. A group of nurses are trying to provide community resources for veterans who are homeless. What factor(s) should the nurses identify as leading to an increased risk for homelessness? Select all that apply. a) Likelihood of comorbid conditions such as PTSD that lead to being homeless b) Preference to remain isolated that leads to being homeless c) Gender inequity that promotes more females than males to become homeless d) Limited financial resources that lead to being homeless e) Potential for opioid use that leads to being homeless

c) Suicide ideation e) Posttraumatic stress disorder (PTSD) Pg. 796 Depression is more common in the veteran population than in the general US population. An increasing number of veterans are reporting depressive symptoms. Depression is highly comorbid with suicidal ideation and posttraumatic stress disorder. Schizophrenia, bipolar disorders, and personality disorder are not conditions identified as occurring in the veteran population.

36. During an assessment, a veteran who was recently discharged from a foreign war reports feeling depressed. For which additional conditions should the nurse assess this client? Select all that apply. a) Bipolar disorders b) Schizophrenia c) Suicide ideation d) Personality disorder e) Posttraumatic stress disorder (PTSD)

c) Address the client by rank when asking questions Pg. 788 Awareness of the military culture involves honor, pride, discipline and loyalty, warrior beliefs, and self-sacrifice. By addressing the client by rank the nurse shows deference to the military culture. Telling the client to sit down or stand up does not correlate with acknowledgment of the military culture. Clarifying the stated health concern of the client is necessary for the health history but it does not correlate with acknowledgment of the military culture.79

37. A nurse is working with a military client to obtain a health history. Which nursing action best represents awareness of the military culture? a) Ask the client to remain standing during the health history b) Tell the client to sit down while questions are being asked c) Address the client by rank when asking questions d) Clarify the stated health concern of the client

a) Client doesn't find pleasure in life experiences Pg. 792 An index trauma represents either the worst event or closely related events that an individual has either undergone or witnessed. The client who doesn't find pleasure in life experiences is displaying anhedonia with detachment. All of the other options are not correlated with index trauma.

38. A nurse is obtaining information from a veteran client in order to assess for index trauma. Which finding should alert the nurse to a potential problem? a) Client doesn't find pleasure in life experiences b) Client is a light sleeper and wakes easily c) Client was discharged with honors from the service d) Client doesn't identify any concerns about past military experiences

c) Alcohol Pg. 798 Alcohol use disorder (AUD) is one of the most prevalent mental disorders in the United States. Veterans are more likely to use alcohol than other substances. They also are more likely to use alcohol than their non-veteran counterparts. While in the military, service members can face dishonorable discharge or criminal prosecution for a positive drug test. Within one year of deployment, 39% of veterans screen positive for AUD. There is no evidence that the client would be using the substances of heroin, opioids, or marijuana.

39. The nurse is completing a health history on a client who was deployed during the Gulf War. For the use of which substance should the nurse assess this client? a) Heroin b) Opioids c) Alcohol d) Marijuana

c) Ask the client to expand on feelings Pg. 794 The client statement indicates the presence of numbing symptoms (flat affect and unable to participate fully either physically or emotionally in life). It would be important to ask the client to expand on feelings so as to get a better idea of the extent of the problem. Although the use of therapeutic touch may be needed eventually, to a client who reports detachment with avoidance of eye contact the use of touch may be viewed as confrontational. Modifications to one's routine and inclusion of daily exercise may eventually be needed, but the priority is to determine the etiology of the problem.

4. A veteran client reports to the nurse with feelings of detachment during daily activities of life and avoids eye contact during the interview. Which priority action should the nurse implement? a) Encourage the client to do daily exercise b) Use therapeutic touch to convey support c) Ask the client to expand on feelings d) Tell the client to change their daily routine

a) Encourage the client to take a moment to breathe Pg. 792 The client is experiencing physiological reactivity when being reminded of the event. The nurse should encourage the client to take a moment to breathe. Continuing the conversation, even with offering of support, will not address this symptomatic presentation of PTSD. Telling the client that these feelings will subside in a few minutes or switching the topic of the conversation can lead to further agitation and/or be perceived as lack of support.

40. A nurse is working with a veteran client diagnosed with posttraumatic stress disorder (PTSD). The client is becoming apprehensive when talking about military life. How should the nurse best respond? a) Encourage the client to take a moment to breathe b) Tell the client that these feelings will subside in a few minutes c) Switch the topic of the conversation d) Continue the conversation and offer support

c) Served multiple tours Pg. 790 A strong veteran identity contributes to a positive self-esteem and self-definition and can prevent mental health problems. One protective factor is having served in multiple tours. Additional protective factors include being married, living in a rural area, and having a rank as an officer.

41. The nurse reviews data collected during the assessment of a client who was recently discharged from active duty in the military. Which information will the nurse identify as a factor to protect the client from developing a mental health problem? a) Non-officer ranking b) Unmarried c) Served multiple tours d) Lives in the city

b) Obtain information about the type and frequency of drinking Pg. 798 The priority assessment should focus on the type and frequency of drinking in order to determine what the client means by "an increase." The nurse will then be able to clarify alcohol use in more objective terms. Inquiring about other social habits should also be done but it is not the priority at this time. Providing educational information about AA and/or other community organizations may be appropriate, but it is not the priority at this time. Telling the client to become more of a social drinker does not address the critical issue of alcohol use disorder (AUD).

42. A veteran client reports to the clinic after being discharged from service and indicates that there has been an increase in drinking alcohol since retiring. What priority information should the nurse include in the plan of care? a) Provide educational information related to Alcoholic Anonymous (AA) b) Obtain information about the type and frequency of drinking c) Encourage the client to become more of a social drinker d) Inquire about other social habits that may contribute to alcohol use

a) Transgender c) Gay d) Lesbian e) Bisexual Pg. 794-795 Military sexual trauma (MST) refers to sexual assault and sexual harassment experienced during a veteran's military service. MST occurs primarily to women, but also to men. LGBTQ individuals are at an increased risk for sexual harassment, and there is an increased risk of sexual harassment and assault for those who identify as transgender. The assessment tool should be used for veterans who identify as gay, lesbian, bisexual, and transgender.

43. The nurse is creating a tool to use when assessing veterans in the community clinic for military sexual trauma (MST). For which biodemographic data would the nurse expect the tool to be used? Select all that apply. a) Transgender b) Heterosexual c) Gay d) Lesbian e) Bisexual

b) Posttraumatic stress disorder (PTSD) Pg.799-800 There are multiple factors that contribute to homelessness in the veteran population. There is research to support that one-third of veterans screened positive for lifetime posttraumatic stress disorder (PTSD). Compared with veterans who are not homeless, veterans who were homeless, especially underrepresented groups such as Blacks and Hispanics, were likely to screen positive for PTSD. There is no evidence to support that veterans who are homeless have a higher incidence of alcohol use disorder, musculoskeletal pain, or communicable diseases.

44. The nurse is caring for a veteran who uses the community homeless shelter. For which condition should the nurse assess the veteran? a) Alcohol use disorder b) Posttraumatic stress disorder (PTSD) c) Musculoskeletal pain d) Communicable disease

a) Female gender with one deployment Pg. 792 Risk factors for the development of PTSD include but are not limited to high combat exposure, concussion history, high exposure to stress in the last year with limited social support. Other predictors include female gender, high lifetime trauma, and low social support. Median income above the poverty level may still present an issue, but being female with one deployment would be considered as an increased risk factor. Participation in community involvement reflects adequate social support.

5. A nurse is reviewing risk factors that lead to the development of posttraumatic stress disorder (PTSD) in the veteran population. Which finding would lead to an increased risk for development of PTSD? a) Female gender with one deployment b) Participation in community involvement c) Median income above the poverty level d) Male gender with one deployment

c) AUD is associated with other mental health issues Pg. 798 AUD is correlated with other mental health issues such as PTSD, depression, and major depressive disorder. Presence of comorbidities varies across ethnicity and racial groups. AUD is more prevalent in Hispanic veterans and veteran populations of African descent.

6. A nurse is developing an educational program for veterans who have alcohol use disorder (AUD). Which information should the nurse include in the teaching session? a) AUD is more prevalent in the White veteran population b) Depression is rarely seen in AUD as a comorbidity c) AUD is associated with other mental health issues d) Presence of comorbidities are equivalent across ethnicity and racial groups

a) Assist the client in identifying potential concerns prior to meeting with the family Pg. 792-793 Experiencing moral injury can have a significant impact on the veteran and family members. It would be important for the nurse to help identify any potential concerns prior to meeting with the family because this would help focus the direction of the assistance. Suggesting that the client have supervised visits with family may lead to increased stress. Referring the client for counseling sessions may be warranted, but without sufficient assessment, that may delay communications between the veteran and the family. Suggesting medication therapy would not be appropriate at this time based on limited information.

7. A veteran who has experienced moral injury is fearful about returning to family life. What is the best action for the nurse to include in the plan of care? a) Assist the client in identifying potential concerns prior to meeting with the family b) Suggest medication therapy may be needed to mitigate stress c) Refer the client for counseling sessions prior to meeting with the family d) Suggest that the client have supervised visits with family

c) "Were you injured during the war?" Pg. 798 Opioid use in the military often begins with a prescription following an injury. Asking if the client was injured during the war would help determine the reason for the client to use an opioid for pain management. Asking about employment, deployment, or location for care would not help determine the reason for the client to use opioids.

8. A client who is a veteran from a foreign war routinely uses an opioid for pain management. Which question should the nurse ask during the assessment of this client? a) "Are you employed?" b) "How long were you deployed?" c) "Were you injured during the war?" d) "Do you receive care at a VA hospital?"

c) AUD is considered to be more prevalent in veterans than other types of substance abuse Pg. 798 AUD is the most prevalent mental health disorder in the veteran population. Current research shows that the veteran population meets the lifetime criteria of AUD at 42.2%. Veterans are more likely to have AUD than their non-veteran counterparts. There is no reported research related to urban versus rural demographics for AUD.

9. A nurse is reviewing research statistics related to alcohol use disorder (AUD) in veterans. Which statement is accurate as it relates to current research findings? a) AUD is seen more in urban areas than rural communities in the veteran population b) The veteran population with AUD exceeds more than 50% c) AUD is considered to be more prevalent in veterans than other types of substance abuse d) Veterans are just as likely as non-veterans to have AUD