Chapter 13: Trauma and Stressor-Related Disorders PREP U

A client has been referred for care because the client's primary care provider suspects that the client has posttraumatic stress disorder (PTSD) following a motor vehicle accident. When working with this client, the psychiatric-mental health nurse should begin by: reassuring the client that the client is having an expected response to such an incident. establishing therapeutic rapport with the client. eliciting the objective facts about the incident. gently encouraging the client to talk about the incident.

establishing therapeutic rapport with the client.

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

Dissociative identity disorder

A nurse's colleague expresses sympathy for a client who is traumatized following a terrorist attack 1 week earlier. The colleague states, "I'm certain that the client has posttraumatic stress disorder (PTSD)." What is the nurse's best response? "Acute stress disorder is a possibility, which might develop into PTSD." "If the client doesn't receive treatment right away, the client might not recover from the PTSD." "It's more likely that the client is experiencing anxiety, which will likely decrease with time." "Actually, she won't meet the diagnostic criteria for PTSD until 3 months after the attack."

"Acute stress disorder is a possibility, which might develop into PTSD." A diagnosis of PTSD requires 1 month of symptoms. Acute stress disorder exists closer to the traumatic event and may develop into PTSD if not resolved. Anxiety is not necessarily self-limiting.

The nurse assesses a new client's social network. Which question does the nurse ask to determine the client's level I contacts? "Do you have friends whom you see on a regular basis?" "Do you engage with the cashier when you are at the store?" "Do you have anyone whom you consider as a close personal contact?" "Do you see your mail carrier on Saturdays when you are not at work?"

"Do you have anyone whom you consider as a close personal contact?" A social network may be large, consisting of numerous family and community contacts, or small, consisting of few members. Contacts can be categorized according to three levels: (1) level I consists of 6 to 12 people with whom the person has close contact; therefore, the question the nurse asks to determine the client's level I contacts is "Do you have anyone whom you consider a close personal contact?" Level II consists of a larger number of contacts whom the client sees regularly; therefore, the question "Do you have friends that you see on a regular basis?" assesses this level of contacts. Engaging with the cashier at a store or seeing a mail carrier on Saturdays are examples of level III contacts.

When providing care for a client diagnosed with posttraumatic stress disorder (PTSD), the psychiatric nurse assesses for comorbid mental health disorders by asking what? Select all that apply. "Do you ever think about committing suicide?" "Do you ever hear voices telling you want to do?" "Do you often socialize with friends?" "Is depression a problem for you?" "Has anyone ever suggested that you have an alcohol problem?"

"Do you often socialize with friends?" "Is depression a problem for you?" "Has anyone ever suggested that you have an alcohol problem?" Do you ever think about committing suicide?"

The nurse is performing an assessment of a client who has experienced a traumatic event. In understanding the client's ability to cope with the event, what question would the nurse ask first? "Have you taken anti-anxiety medication in the past?" "Has your family been supportive of you?" "How have you managed a stressful event before?" "Have you been able to go back to work?"

"How have you managed a stressful event before?"

The nurse assesses a client's ability to cope with stress. Which client statement indicates a type B personality, thus decreasing the likelihood for risky health behaviors in response to stress?

"I take a relaxed approach to most issues." Personality influences the appraisal process and the ability to cope with stress. There are four general personality types. Clients who exhibit type B personality traits are generally more relaxed, easygoing, and easily satisfied. Type B personalities are less likely than type A [a means without so risk ]personalities to engage in risky health behaviors, such as alcohol consumption and smoking. Type B [B for good relaxation boobs?]personalities are also more likely to practice preventative care measures and wellness activities. Type B personalities are described as being accepting and relaxed. They are unlikely to experience a lack of time for commitments and are able to commit time for relaxation. AVOIDING conflict is a characteristic of an individual with a type C personality. Pessimism, which is exemplified by the statement, "I am used to the cup of my life being half empty," is indicative of a type D [for down on self ]personality, and feelings of restlessness with a competitive nature is indicative of a type A personality.

A nurse is working in a mental health clinic. Which client statement should the nurse recognize as describing a type A personality? "I just agree with whatever my co-workers say so nobody will be upset with me." "I don't let my emotions out around my co-workers or family. Nothing ever goes right for me!" "I'm a very relaxed person. Whatever everybody else wants is fine with me." "I work harder than anybody else in my job. I am not satisfied until I achieve each goal I set for myself."

"I work harder than anybody else in my job. I am not satisfied until I achieve each goal I set for myself."

A nurse is working in a mental health clinic. Which client statement should the nurse recognize as describing a type A personality? "I don't let my emotions out around my co-workers or family. Nothing ever goes right for me!" "I just agree with whatever my co-workers say so nobody will be upset with me." "I work harder than anybody else in my job. I am not satisfied until I achieve each goal I set for myself." "I'm a very relaxed person. Whatever everybody else wants is fine with me."

"I work harder than anybody else in my job. I am not satisfied until I achieve each goal I set for myself." A person who is pessimistic, negative, and refuses to show emotions to others has a type D personality. A person who is introverted, conforming, and avoids conflict has a type C personality. A person who is competitive, impatient, and aggressive has a type A personality. A person who is relaxed, easygoing, and easily satisfied has a type B personality.

The nurse provides care to a client who states, "I recently separated from my spouse." Which response by the nurse is appropriate when assessing the client's emotional state during the psychosocial assessment? "Are you having trouble sleeping?" "Let's discuss your dietary intake." "Let's discuss how you have been feeling." "Have you recently lost or gained weight?"

"Let's discuss how you have been feeling." Using therapeutic communication techniques, a person's emotional state is assessed in a nurse-client interview. A lead in statement such as "Let's discuss how you have been feeling." allows the nurse can elicit[obtain,bring out] the feelings that the client has been experiencing. "Are you having trouble sleeping?" and "Have you recently lost or gained weight?" are both examples of close-ended questions, which should avoided during the psychosocial assessment interview. The statement "Let's discuss your dietary intake." does not focus on the client's emotional state but rather the physical state.

The nurse provides education to a group within the community regarding social networks. Which participant statement indicates a need for additional education? "I have an identity within my social network." "My social network will not influence the course my diabetes takes." "My social network enhanced my ability to cope with my recent divorce." "I have a large social network that increases the support that is available to me."

"My social network will not influence the course my diabetes takes." A social network consists of linkages among a defined set of people with whom an individual has personal contacts. Social networks tend to influence the course of disease processes; therefore, the participant statement that indicates a need for additional education is, "My social network will not influence the course my diabetes takes." The other participant statements indicate a correct understanding of social networks: people have identities within their social networks, social networks enhance coping abilities, and large social networks increase available support.

A nurse is teaching a group of nursing students about the concept that long term stress causes an increase in the wear and tear on the brain and body. Which statement by the nursing student indicates understanding of this concept? "Adaptation is the result of the chronic stress on the body." "This process is called homeostasis." "The long term wear and tear on the body by stress is reversed as the stress decreases." "The increase in the wear and tear on the body from stress is allostatic load."

"The increase in the wear and tear on the body from stress is allostatic load."

Question 13 of 20 A nurse works in a psychiatric clinic. During a counseling session, the nurse finds that the client who has posttraumatic stress disorder (PTSD) is unable to identify the intensity of the client's emotions. The client states that extreme emotions appear out of nowhere and with no warning. What suggestion should the nurse provide to help the client get in touch with the client's emotions? "Practice relaxation techniques to reduce intensity or diminish the feelings." "Use a journal or a log to write down your feelings." "Use grounding techniques to diminish the feelings." "Practice deep-breathing exercises to distract yourself from the feelings."

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

Which client should the nurse assess most closely for signs and symptoms of posttraumatic stress disorder (PTSD)? A service member in the military who has recently returned from two tours of duty A registered nurse who has provided care in an urban emergency department for several years A client who has recently undergone radiotherapy and chemotherapy for cancer A business owner who has just gone through bankruptcy

A service member in the military who has recently returned from two tours of duty A wide variety of stressors can cause PTSD. However, members of the military are at particularly high risk.

Which individual is exhibiting signs or symptoms that are characteristic of posttraumatic stress disorder (PTSD)? Select all that apply. A client who is fixated on getting revenge on the business partner whom the client blames for the client's bankruptcy A client who has frequent nightmares about the time a fellow soldier died from an improvised explosive device A client who is unable to relax without first barricading the client's home after a violent home invasion and assault A client who has quit the client's job so that the client no longer has to go to the client's old office where the client was attacked and robbed A police officer who experiences panic attacks when thinking about the time the police officer was forced to shoot a violent suspect

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

A client was physically assaulted 1 week ago. While interviewing the client, the client reports having trouble remembering the event and feeling as if the client is walking around in a dreamlike state. The psychiatric-mental health nurse interprets these findings as most likely associated with which condition? Acute stress disorder Dissociative stress disorder Amnesic stress disorder Posttraumatic stress disorder

Acute stress disorder Acute stress disorder occurs within the first month of exposure to extreme trauma: combat, rape, physical assault, near-death experience, or witnessing a murder. Symptoms begin during or shortly after the event. The symptom of dissociation, a state of detachment in which people experience the world as dreamlike and unreal, is a primary feature. Poor memory of specific events surrounding the trauma also may accompany the dissociative state. When symptoms of acute stress disorder continue for more than 1 month and are accompanied by functional impairment or stress, the diagnosis changes to acute posttraumatic stress disorder.

The advanced practice psychiatric mental health registered nurse is leading a support group for adolescents who have recently experienced disruptions in their life. What participant most warrants further assessment for posttraumatic stress disorder? An adolescent who has committed uncharacteristic acts of violence since the death of the adolescent's mother An adolescent who often redirects the conversation to the subject of the adolescent's sister's death An adolescent who states "I've lost my soulmate" after the death of a boyfriend or girlfriend in an accident An adolescent who began smoking in the weeks after discovering a dead body in a park

An adolescent who has committed uncharacteristic acts of violence since the death of the adolescent's mother Adolescents with PTSD may act out by engaging in disruptive behavior. The adolescent redirecting discussion to the dead sister and the adolescent who lost a relationship because of death from an accident are expressing uncomplicated grief. The adolescent who began smoking requires intervention but is not necessarily experiencing PTSD.

The psychiatric mental health nurse is working with a client who has been diagnosed with posttraumatic stress disorder (PTSD). Assessment reveals that the client is experiencing frequent episodes of intrusion. The nurse should consequently prioritize what assessment? Assessing the client's communication skills Assessing the quality of the client's support network Assessing the client's vital signs Assessing the quantity and quality of the client's sleep

Assessing the quantity and quality of the client's sleep

On observing a client diagnosed with posttraumatic stress disorder (PTSD), the nurse suspects that the client is dissociating. What questions should the nurse ask the client to confirm the suspicion? Select all that apply. "Can you see me?" "Are you able to hear me?" "Have you been taking drugs recently?" "How many hours do you sleep a day?" "Are you woken up by nightmares?"

Can you see me?" "Are you able to hear me?"

A client developed posttraumatic stress disorder (PTSD) after a motor vehicle accident and is scheduled to begin cognitive processing therapy. What outcome should the advanced practice nurse identify when planning this type of therapy? Client will demonstrate breathing exercises that reduce stress and anxiety Client will describe the effects of PTSD on the client's activities of daily living Client will verbalize feelings to close family members Client will describe complete control over the client's fear response

Client will describe the effects of PTSD on the client's activities of daily living

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

Cognitive behavioral therapy

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

Cognitive behavioral therapy Generally, cognitive behavior therapy is given to clients with acute stress disorder to avoid progression to PTSD. Cognitive processing therapy and exposure therapy are specialized treatments given to clients with PTSD to help them overcome problems such as self-blame, guilt, and avoidance behavior. Antidepressants are given to clients to overcome severe depression.

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

Dissociative identity disorder Dissociative identity disorder is one of the dissociative disorders characterized by disruption of the integrated functions of consciousness, memory, identity, or environmental perception. In dissociative identity disorder, the client may assume two or more distinct identities that recurrently take control of the client's behavior. The client may also be unable to remember important personal information that is of a stressful nature. Dissociative amnesia is characterized by a fugue experience in which the client moves to a new geographical location, with no memory of past events. Derealization disorder is characterized by a feeling of being detached from one's mental processes or body. Acute stress response occurs in response to a stressful event and is characterized by reexperiencing, hyperarousal, and avoidance.

The nurse is working with a client who has been under extreme stress. In order to enhance the client's social functioning, the nurse should provide what intervention? Introduce the client to other clients who have similar circumstances Encourage the client to maintain daily activities involving other people Teach the client skills for enhancing communication Educate the client about the need to make new friends and acquaintances

Encourage the client to maintain daily activities involving other people

A client with posttraumatic stress disorder (PTSD) has been unable to have restful sleep since being the victim of a robbery and assault. What should the nurse recommend? Exercising regularly, but not close to bedtime Limiting naps to times earlier than 3:00 p.m. Temporarily moving to a new bedroom, if possible Adopting later times for going to bed and waking up

Exercising regularly, but not close to bedtime Exercise enhances sleep, but the hours within 3 hours of bedtime should be avoided. Naps should be avoided completely. Choosing new bedtimes and a new bedroom are not actions that are noted to improve sleep hygiene.

The nurse is providing care for a client whose history of intimate partner violence has resulted in posttraumatic stress disorder (PTSD). The client has few friends and states that the client is estranged from the client's family. How can the nurse best enhance the client's social support? Encourage the client to make new friends Facilitate the client's participation in a support group Provide the client with educational resources that promote the client's self-worth Facilitate a meeting between the client and the client's family members

Facilitate the client's participation in a support group

The nurse is caring for a client who is a rape victim. The client has been undergoing psychotherapy for the stress the client is experiencing as a result of this incident. The client has started making accusations against family members of abusing the client. Family members insist the accusations are groundless. What may the client be experiencing? Fugue Dissociative identity disorder False memory syndrome Posttraumatic stress disorder

False memory syndrome

A nurse is caring for clients with posttraumatic stress disorder (PTSD). Negative alterations in cognition and mood associated with the traumatic event are important features of PTSD. Knowing this, which symptoms is the nurse likely to find in such clients? Select all that apply. Inability to remember important aspects of the traumatic event Trying to help people who have been victims of the traumatic incident Seeking company of others Having negative beliefs about oneself Getting angry with little or no provocation

Having negative beliefs about oneself Getting angry with little or no provocation Inability to remember important aspects of the traumatic event Clients with PTSD have persistent and exaggerated negative beliefs or expectations about themselves. They have a persistent inability to experience positive emotions, that is, inability to experience happiness, satisfaction, or loving feelings. These clients have hyperarousal and get angry with little provocation. They are unable to remember important aspects of the traumatic event because of dissociative amnesia. Such patients have feelings of detachment from others and do not seek the company of others. Trying to help people who have been victims of the traumatic incident is a positive behavior that is not commonly seen in clients with PTSD.

A nurse is interviewing a client who is suffering from posttraumatic stress disorder (PTSD). Which intervention would help the nurse ensure the client's comfort during the interview? Instruct the client not to move around in the room. Ask the client to describe the traumatic event in detail. Keep environmental noises to a minimum. Sit close to the client to facilitate effective communication.

Keep environmental noises to a minimum.

A client with a history of intimate partner violence has been diagnosed with posttraumatic stress disorder. The client is wholly unwilling to discuss any aspects of personal history or current mental status with the nurse. What is the nurse's best initial action? Make efforts to demonstrate empathy to the client Avoid communicating with the client until the client initiates Facilitate cognitive restructuring therapy Arrange for the client to receive cognitive processing therapy

Make efforts to demonstrate empathy to the client

Question 2 of 20 A nurse is interviewing several clients who survived a school shooting ten years ago when they were in high school. Which clients should the nurse identify as having achieved adaptation following this event? Select all that apply. Married, mother of three, who is a stay at home mother. Local lawyer with a history of drug addiction. Father of two who works in a tire store and has a second job as a mechanic. Single father with a history of spousal abuse. Nurse manager for the local hospital.

Nurse manager for the local hospital. Married, mother of three, who is a stay at home mother. Father of two who works in a tire store and has a second job as a mechanic.

A nurse is caring for a client in the hospital who was admitted for injuries sustained from an abusive spouse. The client says she's scared to leave her husband for fear he will hurt her. Which actions should the nurse plan to include in the plan of care for this client? Select all that apply. Consult social services. Educate the client and husband on the effects of spousal abuse. Confront the husband about the abuse. A client with posttraumatic stress disorder (PTSD) is treated with psychotherapy. Which behaviors would indicate that the client is well stabilized? Select all that apply. Plan an interdisciplinary team meeting regarding this situation. educate the client on resources available to her

Plan an interdisciplinary team meeting regarding this situation. educate the client on resources available to her Consult social services.

A client has just adopted a child whose traumatic history resulted in a diagnosis of reactive attachment disorder. What nursing action best addresses this child's diagnosis? Modeling interactions that address disruptive behavior disorders Planning activities where the client and the child can bond Teaching the client how to provide culturally safe care for the child Teaching the client about the factors that cause resilience

Planning activities where the client and the child can bond Reactive attachment disorder is characterized by the inability to form positive attachments due to prior neglect. Culturally safe care is always necessary but does not address this child's diagnosis. Teaching about resilience is also relevant but similarly does not address this particular diagnosis that the child already has. Disruptive behavior disorder is not a primary consideration.

When caring for a client who is experiencing the symptomology of acute stress disorder, the nurse recognizes the importance of minimizing the client's risk for developing which condition? Emotional numbness Paranoia Posttraumatic stress disorder Dissociative amnesia

Posttraumatic stress disorder When caring for a client who is experiencing the symptomology of acute stress disorder, the nurse recognizes the importance of minimizing the client's risk for developing posttraumatic stress disorder, not emotional numbness, dissociative amnesia, or paranoia.

A nurse is developing a care plan for a client who has post-traumatic stress disorder. Which intervention by the nurse is a priority? Promote discussion of the client's thoughts and feelings about the stressful event. Guide the client to let go of the events of the traumatic event. Encourage the client to utilize distraction when remembered experiences come to their mind. Encourage the client to delay discussing the stressful event until coping can occur.

Promote discussion of the client's thoughts and feelings about the stressful event. In order to adequately assess the client and plan for interventions, the nurse must understand the client's thoughts and feelings about the stressful event. Delaying coping measures can result in maladaptation, which may cause illness, a lowered self-concept, and decrease in social functioning. The client must learn coping strategies to deal with the memory of a stressful event. Distractions will not allow the client to resolve emotional issues with the stressor.

The nurse caring for a client with posttraumatic stress disorder (PTSD) targets an approach consistent with trauma-informed care. The nurse works collaboratively with the client to achieve which outcome? Understand the client's behaviors. Determine the client's symptoms of the condition. Respect the client's meaning of the traumatic experience. Clarify the client's decisions that contributed to the trauma.

Respect the client's meaning of the traumatic experience. [don't judge] Trauma-informed care requires the nurse to approach the client safely to avoid secondary trauma and to mindfully consider the circumstances of the client's traumatic experiences. One component of this intervention is to seek to understand the meaning of the traumatic experience for the client. The focus of trauma informed care is not on understanding behaviors or symptoms nor if there are actions that the client could have taken to avoid the traumatic experience.

The nurse is planning to give health-related education to adolescents with posttraumatic stress disorder (PTSD). What topics should the nurse discuss specifically for these clients? Select all that apply. Have a healthy, balanced diet Avoid social gatherings with strangers Be spontaneous, look for new experiences Set small, specific, achievable goals Abuse of alcohol and drugs can cause ill effects

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

A 14-year-old survived a house fire in which a younger sibling died. What assessment finding would support a diagnosis of posttraumatic stress disorder (PTSD)? The adolescent expresses intense guilt for the inability to save the sibling The adolescent idealizes the relationship that the adolescent had with the sibling The adolescent often begins crying when discussing the tragedy The adolescent is fixated on having a fire escape plan in the family's new home

The adolescent expresses intense guilt for the inability to save the sibling

The nurse's assessment of a child from a dysfunctional family background suggests that the child lacks resilience. What outcome should the nurse identify after performing appropriate interventions? The child is able to set appropriate boundaries with people the child has recently met The child states that the child is comfortable being alone for short periods of time The child states that the child's current stress levels are manageable The child demonstrates that the child is empowered to solve life problems

The child demonstrates that the child is empowered to solve life problems Resilience is enhanced by empowerment that leads to self-worth and self-concept. It is not directly related to boundary setting in relationships comfort in solitude. High resilience confers protection against stress, but it is only one component of coping and stress management.

What action by a 6-year-old child would most strongly suggest a diagnosis of disinhibited social engagement disorder? The child claims to have dozens of friends but no "best friend" The child gives adults enthusiastic hugs immediately after meeting them The child has several friends that are much older or much younger than the child The child tells the nurse "secrets" during their initial meetings

The child gives adults enthusiastic hugs immediately after meeting them Disinhibited social engagement disorder is characterized by being overly familiar with strangers. It is not associated with having a large number of diverse friends. The child's willingness to confide in the nurse is not necessarily inappropriate or problematic.

The nurse is assessing a 6-year-old child who witnessed the murder of the child's parents. The nurse suspects that the child has developed posttraumatic stress disorder (PTSD). Which specific behavioral manifestation leads the nurse to interpret this? The child avoids eating. The child constantly weeps. The child enjoys watching violent scenes on television. The child is easily startled and hyper-vigilant.

The child is easily startled and hyper-vigilant. In children with PTSD, after a specific traumatic event it is common to observe the child being easily startled and hypervigilant as there is a substantially decreased sense of safety for the child. Avoiding eating food, weeping constantly, or enjoying watching violent scenes on television are not specific manifestations related to PTSD in children.

A nurse finds that a client with posttraumatic stress disorder (PTSD) is behaving abnormally and suspects that the client has had a flashback of the traumatic event. Which behavioral manifestations of the client would lead the nurse to make this interpretation? Select all that apply. The client appears terrified. The client is crying loudly. The client complains of severe pain. The client looks extremely fatigued. The client attempted to run away.

The client appears terrified. The client is crying loudly. The client attempted to run away.

A client with posttraumatic stress disorder (PTSD) is admitted to a psychiatric unit. Which is the most appropriate reason for the head nurse to appoint one nurse to provide complete care for the client? The client would be able to express feelings better. The client does not need much care. The client would be more responsive to therapy. The client has difficulty with familiarizing and trusting people.

The client has difficulty with familiarizing and trusting people.

A nurse is performing a follow-up assessment of a client who had been treated for posttraumatic stress disorder (PTSD) a year ago. The client tells the nurse that the client is not able to maintain relationships and that the relationships last for a very short time. What is the most likely reason for this problem? The client is extremely irritable in nature. The client has extremely negative notions about the self. The client has issues with developing trust. The client has dissociative identity disorder.

The client has issues with developing trust. A client with PTSD usually has difficulties in maintaining relationships. This occurs because the ability to build trust is severely impaired in them. Issues such as irritability, negativity, and having dissociative disorder would have already been treated if the client has had proper treatment.

A client who has been admitted for an appendectomy states, "I'm really afraid of the surgery because my mother died when she was admitted for an emergency surgery." When preparing to work with the client concerning this anxiety about the surgery, the nurse recognizes what? The client is expressing fear about the surgery. The client's fear is the body's physiologic and emotional response to a known danger. The client has "signal anxiety," which is always the first symptom of anxiety. The client has "trait anxiety," and this reflects the client's anger toward the client's mother's surgeon. The client is expressing "free-floating anxiety" and needs to have medication in order to bring it under control.

The client is expressing fear about the surgery. The client's fear is the body's physiologic and emotional response to a known danger. Fear is different from anxiety. It is the body's physiologic and emotional response to a known or recognized danger. Signal anxiety is a response to an anticipated event, but it is not always the first symptom of anxiety. Trait anxiety is a component of personality that has been present over a long period and is measurable by observing the person's physiologic, emotional, and cognitive behaviors. Free-floating anxiety is anxiety that is always present and accompanied by a feeling of dread.

A client with a diagnosis of posttraumatic stress disorder (PTSD) tells the nurse, "When things get really bad, it sometimes feels like I'm not even in my body, like I'm floating around and watching myself." How should the nurse best interpret this client's statement? The client's perception is a result of hyperarousal and sympathetic nervous stimulation There is a need for constant supervision because of heightened suicide risk The client is likely to require temporary inpatient treatment The client is likely experiencing depersonalization as a result of PTSD

The client is likely experiencing depersonalization as a result of PTSD The client's statement suggests depersonalization, which is an avoidance response to PTSD. This needs to be directly addressed but not necessarily in an inpatient setting. Assessment for suicide risk is necessary for all clients with PTSD, but the presence of derealization does not indicate an acute risk. Depersonalization is not a direct result of hyperarousal, though the two phenomena can certainly coexist.

What assessment finding would suggest to the nurse that the client with posttraumatic stress disorder (PTSD) is experiencing dissociation? The client is often "staring into space" and has no idea how much time has passed The client states that usual coping mechanisms are ineffective The client states that the client's mood is "alright" when appearing to be in some distress The client experiences awakenings during the night and is unable to fall asleep again

The client is often "staring into space" and has no idea how much time has passed "Spacing out" is an example of dissociation (depersonalization). It is not uncommon for the client with PTSD to experience failure of coping skills, sleep disturbances, and reluctance to acknowledge moods, but these are not evidences of dissociation.

A nurse is caring for a client with dissociative disorder. The nurse tells the client, "Hello, I'm Robin, your nurse. It is 9 o'clock in the morning now. You are in room number 303. My name is Robin, I'm your nurse." What is the most appropriate reason for the nurse to repeat this statement? The client may have difficulty hearing. The client may not understand the language. The client may have short-term memory loss. The client may need to be reoriented.

The client may need to be reoriented.

The psychiatric mental health nurse is assessing a client who was diagnosed with posttraumatic stress disorder (PTSD) after the death of the client's child from a medical error. What assessment finding would most warrant interventions aimed at addressing the client's dissociation? The client reports large gaps in memory of the traumatic event The client states that the client has been neglecting business in recent weeks The client's family members describe the client as irritable and agitated The client reports crying at unpredictable times

The client reports large gaps in memory of the traumatic event Amnesia about traumatic events is characteristic of dissociation. Emotional lability, apathy, and agitation are not unusual in a client dealing with PTSD, but these do not directly indicate the presence of dissociation.

The nurse is interviewing a client who witnessed a fatal accident at the workplace and was unable to save a colleague. What assessment findings would support a diagnosis of posttraumatic stress disorder (PTSD)? Select all that apply. The client says the client is "unable to face that place again" The client says the client's family describes the client now as "edgy" and "irritable" The client has nightmares about the accident Management is blaming the client for the accident The accident took place 2 weeks ago

The client says the client is "unable to face that place again" The client says the client's family describes the client now as "edgy" and "irritable" The client has nightmares about the accident

The nurse is assessing a client who was diagnosed with posttraumatic stress disorder (PTSD) several months ago. During a comprehensive follow-up assessment, what areas should the nurse assess? Select all that apply. The effect of the client's PTSD on the family Characteristics of the client's sleep The client's use of alcohol or other drugs Assessment for extrapyramidal symptoms Assessment for tardive dyskinesia

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

A nurse is counseling a client who was diagnosed with posttraumatic stress disorder (PTSD). During the session, the client states that the client feels worthless and starts crying. The nurse reassures the client that the client is a survivor rather than a victim. What intervention is the nurse using? The nurse is using grounding techniques. The nurse is distracting the client. The nurse is promoting the client's self-esteem. The nurse is using supportive touch.

The nurse is promoting the client's self-esteem. By reassuring the client and considering the client as a survivor, the nurse is promoting the client's self-esteem. A client with PTSD usually feels hopeless and worthless because of low self-esteem. By using reassuring and explaining that the client is strong enough to survive the traumatic event, the nurse induces a feeling of self-worth in the client. Grounding techniques are used when the client exhibits dissociative symptoms. Distraction techniques are used when the client has intrusive and persistent thoughts about the traumatic event. A supportive touch is helpful when the client has flashbacks of the stressful events.

A client is admitted to the hospital with posttraumatic stress disorder (PTSD). When approaching the client for the first time, the nurse speaks softly and gently, in a nonthreatening manner. What is the most appropriate reason for this behavior of the nurse? To prevent the risk of triggering fears in the client To calm the client and prevent an outburst of anger To help the client sleep better To learn about the client's experience

To prevent the risk of triggering fears in the client

A client with dissociative disorder is referred for psychotherapy. What would be the main focus of therapy for this client? To help the client face troublesome thoughts To have a positive outlook toward life To combat feelings such as guilt and self-blame To reassociate with conciousness

To reassociate with conciousness

A client with dissociative disorder is referred for psychotherapy. What would be the main focus of therapy for this client? To reassociate with conciousness To have a positive outlook toward life To combat feelings such as guilt and self-blame To help the client face troublesome thoughts

To reassociate with conciousness The main focus of therapy in dissociative clients is to reassociate and put consciousness back together. Having a positive outlook toward life is a long-term goal for these clients and is not the main focus of therapy. Combating feelings such as guilt and self-blame and helping the client face troublesome thoughts are the goals of treatment for clients with posttraumatic stress disorder.

A nurse is working in a mental health clinic and cares for various clients. Which client should the nurse recognize as having the greatest risk for the development of drug dependence? a 35 year-old woman who is going through a divorce due to her husband's extra-marital affair an 80 year old man who just lost his wife of 45 years a 50 year old man who just lost his job a 12 year old girl who was raped by a family friend

a 12 year old girl who was raped by a family friend [bc she is going to suffer from ptsd] Adverse and traumatic events that occur during childhood increase the risk for drug and alcohol dependence, eating disorders, affective disorders, posttraumatic stress disorder, and suicide. Therefore the 12 year old girl who was raped should be recognized as the highest risk for drug dependence. Losing a job, going through a divorce, and the loss of a family member are all stress events for clients. However, they are not at the highest risk in this situation.

A client has been diagnosed with posttraumatic stress disorder (PTSD) after witnessing an explosion at the client's industrial worksite. The client will soon begin exposure therapy, so the nurse should prepare the client for: a visit to a support group created for victims of the tragedy. a visit with the therapist to the place where the explosion occurred. a critical examination of the ways the client's PTSD has affected the client's life. a family meeting where each member will describe the effects of the client's PTSD.

a visit with the therapist to the place where the explosion occurred.

The nurse is seeing a client who reports recent difficulty with sleep and decreased appetite. The client reports having pressure from work due to an upcoming deadline and moving to a different house at the same time. What is the client most likely experiencing? acute stress diathesis chronic stress type A personality

acute stress

A nurse is at the scene of a physical attack on a client and has observed that the client is having a fight or flight response. Which signs or symptoms should the nurse expect to find during the initial assessment? Select all that apply. heart rate 115 beats per minute blood pressure 88/56 mm Hg blood glucose 162 mg/dl respiratory rate 12 breaths per minute potassium level 3.5 mmol/L

blood glucose 162 mg/dl heart rate 115 beats per minute

A client has been referred for care because the client's primary care provider suspects that the client has posttraumatic stress disorder (PTSD) following a motor vehicle accident. When working with this client, the psychiatric-mental health nurse should begin by: establishing therapeutic rapport with the client. gently encouraging the client to talk about the incident. eliciting the objective facts about the incident. reassuring the client that the client is having an expected response to such an incident.

establishing therapeutic rapport with the client. Therapeutic rapport is absolutely foundational to all other interactions between the client and the nurse. As such, it must precede the details of assessment. The nurse must be careful not to provide false reassurance, and any reassurance that is given must exist in a context of rapport.

A nurse refers a client with posttraumatic stress disorder (PTSD) to group therapy. Group therapy will likely be more beneficial than individual therapy for this client because group therapy may: prevent reinforcement of the sense of self-blame. help the client better express feelings. help alleviate anxiety and induce relaxation. induce a sense of trust toward the staff.

help the client better express feelings. Clients with PTSD should be helped to understand that their feelings are acceptable to others and can be shared. This would help the client better express feelings. Group therapy would not directly alleviate anxiety and induce relaxation in the client, nor would it prevent reinforcement of the sense of self-blame or induce a sense of trust toward the health care team.

The nurse is seeing a school-aged child who has been the victim of physical abuse by a parent. The nurse recognizes that the client is more likely to experience which mental health issues in adulthood? Select all that apply. schizophrenia bipolar disorder major depressive disorder substance misuse anorexia

major depressive disorder substance misuse anorexia Adverse events during childhood increase risk of alcohol and drug dependence, eating disorders, affective disorders, posttraumatic stress disorder (PTSD), and suicidal behavior. There is no evidence that supports the correlation of childhood abuse and schizophrenia and bipolar disorder. These mental health problems are caused by multiple factors; however, a genetic predisposition is one of the strongest factors.

A client who experienced serious and repeated traumas has been diagnosed with dissociative identity disorder after being rescued from an abuser. Before caring for this client, the nurse should be prepared for: wide variations in the personality that the client exhibits. states of catatonia alternating with mania. hostility and possibly violence. childlike intellectual development and problem-solving skills.

wide variations in the personality that the client exhibits. Dissociative identity disorder is characterized by the presence of more than one distinct personality or identity state. Clients are not typically catatonic or manic and there is no notable risk for violence. Intellectual development is not affected.