Anxiety related disorders/ptsd

3 1 2 4 (The nurse should first assure the clients safety after the clients self mutilation. Another safety issue is whether the step dad possibly may be abusing younger children; if so a police report may need to be filed. Then it is important to know what the client means by "screwed up" to identify other emotions and behaviors that need attention. It is very common for survivors of childhood sexual abuse to have intense anger at those who did not stop or prevent the abuse, and once the other steps have been take, the nurse can begin to help the client manage his anger)

A 15 year old diagnosed with PTSD is admitted to the unit after slicing both arms with a razor blade. He says " Maybe my mother will listen to me now, she tells me I am crazy when I say I am screwed up because my stepdad had sex with me for years" What should the nurse do in order of priority from first to last? 1. Ask the client about the stepdad possibly abusing younger children in the family 2. Ask the client to be specific about what he means by screwed up 3 Ask the client to sign a no harm contract related to suicide and self mutilation 4. Ask the client to talk about appropriate ways to express anger toward his mother

1,2,3,5 (Anger and rage could be directed at self and others. He implies that he did nothing wrong in assaulting the woman (denial) and may try to leave without treatment. A no harm contract is essential for everyones safety. He needs safe outlets, including staff talks for his anger. Talking about his views of prostitutes in unit groups may be upsetting to female clients who have sexual abuse issues as well so this needs to occur in private)

A client has been dx with PTSD because he experienced childhood sexual abuse by his babysitter and her boyfriend from ages 4-10. He is admitted for the second time after physically assaulting a woman he said was a prostitute. She is o better than my babysitter and deserves to be dead. I would like to kill the sitter too. With the knowledge of PTSD and childhood sexual abuse, which nursing interventions should be implemented at admission? SATA 1. Institute precautions for suicide, assault, and escape 2. Ask him to sign a no harm contract 3. Provide safe outlets for anger and rage 4. Encourage him to express his attitude toward prostitutes at group sessions 5. In one to one staff talks, encourage him to safely verbalize his anger toward his babysitter and her boyfriend.

1,2,4,6 (relaxation techniques and listening to calming music decrease anxiety and promote sleep. Quetiapine is often effective in decreasing nightmares and flashbacks and has a beneficial side effect of drowsiness. Leaving her door slightly open will decrease noise of making 15 min checks at night. STaying in the dayroom in a recliner with all the noise and lights is not likely to help. Processing memories an hour or two before bedtime does not allow enough time to calm down before sleep)

A client is diagnosed with PTSD is readmitted for suicidal thoughts and continued trouble sleeping She states that when she closes her eyes she has vivid memories about being wakened at night. "My day would be on top of me trying to have sex with me. I could not breathe" Which suggestions would be appropriate for the nurse to make for the insomnia? SATA 1. trying relaxation techniques to help decrease her anxiety before bedtime 2. taking quetiapine 25 mg as needed as prescribed by the HCP 3. staying in the dayroom and trying to sleep in the recliner near staff 4. listening to calming music as she tries to fall asleep 5. processing the content of her flashbacks no less than an hour before bedtime 6 leaving her door slightly open to decrease noise during nightly checks

c (Rationale Prazosin is an​ anti-adrenergic agent that has been used to treat hypertension for many years. Recent research has found that this medication is useful in the treatment of the nightmares associated with PTSD. While the medication will reduce blood​ pressure, this is not the reason it is used for PTSD. It is not appropriate for the nurse to avoid answering the question and​ follow-up with the healthcare provider.)

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

4 (The nurse judges the clients request for an interruption in treatment as necessary break in treatment. A time out is common and necessary to enable the client to focus on pressing problems and solutions. It is not necessarily a method of avoidance, a detriment to progress or the end of treatment. A problem like housing can be very stressful and require all the clients energy and attention, with none left for the emotional stress of treatment)

A client with PTSD needs to find new housing and wants to wait for a month before setting another appointment to see the nurse. How should the nurse interpret this action? 1. a method of avoidance 2. a detriment to progress 3. the end of treatment 4. a necessary break in treatment

4 (Survivors of trauma/torture have a lot of difficulty with trust and do not readily talk about the horrible events. Therefore empathy and a willingness to listen without pressuring the client are crucial. Believing everything may or may not be possible and does not convey the empathy. It is sometimes difficult to believe what satanic cults can do to children. Saying that is was not right that members did not help diverts attention from the client to the member. Asking to hear about the cult shows more interest in the cult than the client)

A newly admitted 20 year old client diagnosed with PTSD reluctantly reveals that she escaped from a cult 2 years ago. The client says, "Nobody will ever believe the horrible things the men did to me, and no one ever stopped them". Which response is appropriate for the nurse to make? 1. I will believe anything you tell me, you can trust me 2. I cannot understand why members did not protect you, it is not right 3. Tell me about the cult, I did not know there were any near here 4. It must be difficult to talk about what happened, I am willing to listen

d (Rationale: The use of imagery is a distraction technique that facilitates relaxation. The client who focuses on the anxiety is not managing stress, but augmenting it. Exercising the legs should not make them ache and keep the client awake. Exercise is an appropriate relaxation technique. Deep, slow breathing is a relaxation technique; feeling energized by breathing through the nose would not be a stress management tool. )

A nurse is teaching clients with post-traumatic stress disorder (PTSD) and their families about various techniques for stress management. Which statement by a client indicates to the nurse that learning has occurred? a "Exercising my leg muscles makes them ache and keeps me awake at night." b "Writing down my feelings every day helps me focus more attention on my anxiety." c "Breathing in and out through my nose several times helps me feel energized." d "Imagining myself on a beach listening to the waves helps me sleep at night."

3 1 4 2 (Safety is the first priority in clients experiencing acute stress disorder. ASD symptoms are typical reactions to an abnormal situation that are not being handled effectively. When the client believes he is normal, being accepted, understood and supported, then he will be able to discuss his thoughts and feelings related to the trauma of the war)

A soldier on his second tour of duty was notified of the date that he will be redeployed. As this date approaches he is showing signs of excess anxiety and irritability and inability to sleep at night because of nightmares of IED tragedies, all leading to poor work performance. His commander refers him to the base hospital for evaluation. What should the nurse do in order of priority from first to last? 1. remind him that any feelings and problems he is having are typical in his situation 2. ask him to talk about the upsetting experiences 3. remove any weapons and dangerous items he has in his possession 4. acknowledge any injustices/unfairness related to his experiences, and offer empathy and support

2 (The nurse initially reassures the client that her feelings and behaviors are typical reactions to serious trauma and help decrease anxiety and maintain self-esteem. Explaining the effects of stress on the body may be helpful later. Telling the client that her symptoms are temporary is less helpful. Acknowledging the unfairness of the clients situation does not address the clients needs at this time)

A week ago a tornado destroyed a clients home and seriously injured her husband. The client has been walking around the hospital in a daze without any outward display of emotions. She tells the nurse that she feels like she is going crazy. Which intervention should the nurse use first? 1. Explain the effects of stress on the mind and body 2. REassure the client that her feelings are typical reactions to serious trauma 3. reassure the client that her symptoms are temporary 4. Acknowledge the unfairness of the clients situation

1 (The nurse states "you did what you had to do at the time" to help the client evaluate past behavior in the context of the trauma. Clients commonly feel guilty about past behaviors when viewing them in the context of current values The other statements are inappropriate because they do not help the client to evaluate past behavior in the context of the trauma)

The client who is a veteran and has PTSD tells the nurse about the horror and mass destruction of war. He states "I killed all of those people for nothing". Which response by the nurse is appropriate? 1. You did what you had to do at the time 2. Maybe you did not kill as many people as you think 3. How many people did you kill? 4. War is a terrible thing

a,c,d (Rationale Exposure to a traumatic stressor can happen at any age or time of life. Traumatic stress in childhood can create effects that persist into adulthood. PTSD is more common among individuals with a history of psychiatric disorders. Women are more susceptible to the development of PTSD than men. The incidence of PTSD among veterans is especially high.)

The community health nurse is preparing a presentation for posttraumatic stress disorder​ (PTSD) to a group of people whose spouses have just returned from an active war zone. Which etiologies for PTSD will the nurse include in the​ presentation? Select all that apply. a Stressors can occur at any time or age of life. b Incidence among veterans is low. c History of psychiatric disorders is common. d Traumatic events in childhood can create clinical symptoms that last into adulthood. e Men are more susceptible than women.

c (Rationale: Antidepressants not only reduce symptoms of depression in the client with PTSD, but may also improve sleep and suppress intrusive thoughts, jumpiness, and anger. Antibiotics are used to treat infection. Antiemetics are not necessary for these clients. Anticonvulsants work best for clients with social anxiety disorder.)

The nurse admitting a client with symptoms of post-traumatic stress disorder (PTSD) would anticipate that the physician will order which medication for the client? a Antibiotics b Antiemetics c Antidepressants d Anticonvulsants

a (Rationale: The client with PTSD is apt to experience spiritual distress related to viewing the world as threatening after a traumatic event. Death anxiety is not associated with PTSD. Acute confusion is an appropriate diagnosis for those with dementia, but is unlikely for those with PTSD. Ineffective breathing pattern would be an appropriate diagnosis for a client with panic attacks.)

The nurse caring for a client with post-traumatic stress disorder (PTSD) would select which nursing diagnosis as a high priority? a Spiritual Distress b Acute Confusion c Death Anxiety d Ineffective Breathing Pattern

b (Rationale: Much of the care of a client experiencing the anxiety of PTSD is developing effective coping behaviors. Normal breathing is a goal for the client with panic attacks. Less compulsion is appropriate for the client with obsessive-compulsive behavior. Antisocial behavior would not be a goal for any client. )

The nurse concludes that a client with post-traumatic stress disorder (PTSD) has met an appropriate goal when the client demonstrates which behavior? a Less compulsion to wash the hands b Effective coping behaviors c Antisocial behavior d Normal breathing patterns

b,d,e (Rationale For a diagnosis of​ PTSD, the client must have experienced direct exposure to the traumatic​ stressor, witnessed it in​ person, had indirect exposure​ (for example by learning that a close friend or relative was exposed to trauma such as violent or accidental​ death), or had repeated or extreme exposure to aversive details of the traumatic event​ (usually through professional​ duties, such as being a first​ responder). Nonprofessional exposure through electronic​ media, television,​ movies, or photographs does not qualify for a diagnosis of PTSD.)

The nurse educator is teaching a group of students about posttraumatic stress disorder​ (PTSD). Which statements from the students regarding factors associated with the pathophysiology of PTSD indicate appropriate​ understanding? Select all that apply. ​a "Watching the Twin Towers fall on television on​ 9-11" ​b "Being taken hostage and​ tortured" ​c "Looking at photographs of a war​ zone" ​d "Engaging in military​ combat" ​e "Going to​ prison"

c,d,e (​Rationale: ​Depersonalization, avoidance of​ trauma-related situations, and frightening thoughts are all clinical manifestations of PTSD. Lack of social and psychological support and additional stressors that occur soon after the initial stressor are risk factors for developing​ PTSD, not clinical manifestations.)

The nurse is assessing a client diagnosed with posttraumatic stress disorder​ (PTSD). Which assessment findings support this client​'s ​diagnosis? Select all that apply. a Lack of social support b Experience of additional stressors c Avoidance of​ trauma-related situations d A frequent feeling of depersonalization e Experience of frightening thoughts

d (ationale When assessing a child who may have​ PTSD, it is helpful to use direction questioning. For​ example, it is best to question the child as if there has been a change in his or her sleeping habits. Drawing picture can often cause the child to​ re-experience the trauma. And they might not recognize when they are angry or sad. This should be used with caution in children diagnosed with PTSD.)

The nurse is assessing a​ 5-year-old client who is diagnosed with posttraumatic stress disorder​ (PTSD). The child is accompanied by his parents. Which assessment question is most​ appropriate? a Does your child appear ​sad? b Does your child appear ​angry? c Can you draw me a picture of what happened to ​you? d Can you tell me what happens while you are asleep at ​night?

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

The nurse is caring for a client who is diagnosed with posttraumatic stress disorder. Which goals and outcomes may be appropriate for the nurse to include in the client​'s plan of​ care? Select all that apply. a The client will demonstrate comorbidity that may include​ depression, substance​ abuse, or other anxiety disorders. b The client will remain free of harm or injury to himself or others. c The client will talk about emotions that are associated with traumatic experiences with at least one counseling professional. d The client will report fewer or no nightmares. e The client will demonstrate avoidance of situations related to the trauma or general social contacts.

c ( Rationale A history of suicide attempts places this client at an increased risk of injury and would take priority. Having a history of traumatic brain injury is a risk factor for PTSD. While recently losing a job and a lack of social support can affect both the client​'s symptoms and​ recovery, a history of suicide attempts is the priority.)

The nurse is conducting a nursing assessment for a client diagnosed with posttraumatic stress disorder​ (PTSD). Which finding is the priority for this​ client? a Loss of job two weeks ago b No social support c History of suicide attempts d History of traumatic brain injury

c (Rationale: This statement indicates a denial of the need to verbalize the trauma and cope with the adverse effects of the experience. Post-traumatic stress disorder (PTSD) can cause insomnia. Being reminded of the war by hearing certain sounds is a normal response. Writing thoughts about the traumatic experience is a therapeutic method for getting at one's deepest feelings.)

The nurse is leading a group of clients who are combat veterans. Which client statement indicates the need for further teaching? a "I know I am not in danger now, but certain sounds remind me of war." b "I slept 7 hours last night and did not wake up once." c "I need to forget the war and get used to life at home now." d "I am writing down my thoughts about my experiences in Iraq."

b (Rationale During the physical examination portion of the nursing​ assessment, the nurse would assess the​ client's pain rating using an appropriate pain scale. Alcohol​ use, current​ job, and type of trauma experienced would be assessed during the psychosocial health history portion of the nursing assessment.)

The nurse is preparing to complete a nursing assessment for a client who is diagnosed with posttraumatic stress disorder​ (PTSD). Which data will the nurse collect during the physical examination portion of the​ assessment? a Alcohol use b Pain rating c Current job d Type of trauma experienced

a,b,d (Rationale CBT​ (cognitive behavioral​ therapy) and EMDR​ (eye movement desensitization and reprocessing​ therapy) are nonpharmacologic therapies used by interdisciplinary teams to treat posttraumatic stress disorder. Acupuncture therapy is a​ complementary, nonpharmacologic therapy that has been useful in the treatment of PTSD. SSRI​ (selective serotonin/noreprinephrine reuptake​ inhibitor) and atypical antipsychotic therapy are both pharmacologic therapies that may be used to treat PTSD.)

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

c,d,e (Rationale Risk factors for developing PTSD include direct exposure to a traumatic​ event, losing a job after the​ event, and preexisting mental illness. Difficulty sleeping is a clinical manifestation of​ PTSD, not a risk factor. A concurrent diagnosis of diabetes mellitus is not a risk factor for PTSD.)

The nurse is providing care to a client diagnosed with posttraumatic stress disorder​ (PTSD). Which items in the client​'s health history place the client at risk for this​ disorder? Select all that apply. a Being diagnosed with diabetes mellitus b Experiencing difficulty sleeping c Losing a job after a traumatic event. d Preexisting mental illness e Witnessing the death of a friend

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

The nurse is providing care to a client who is diagnosed with posttraumatic stress disorder​ (PTSD). Which factors could interfere with the nurse establishing trust during a therapeutic encounter with this​ client? Select all that apply. a Ineffective coping b Nightmares c Hypervigilance ​d Irritability, aggressiveness e Depersonalization

b (Rationale While​ Sertraline, paroxetine and risperidone are appropriate for a client diagnosed with​ PTSD, the only medication that has shown effectiveness in reducing nightmares associated with PTSD is​ prazosin, an antiadrenergic agent.)

The nurse is providing care to a​ client, diagnosed with posttraumatic stress disorder​ (PTSD), who is experiencing frequent nightmares. Which medication does the nurse anticipate will be prescribed for this​ client? a Risperidone b Prazosin c Sertraline d Paroxetine

c

The nurse is providing discharge teaching for a client diagnosed with posttraumatic stress disorder​ (PTSD). Which statement by the client indicates the need for further​ education? a I will use distraction techniques when I feel moderate stress. b I will go to the gym for kick boxing class when I have negative feelings. c I will drink a few beers when I am anxious. d I will use abdominal breathing at the first sign of anxiety.

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

The nurse is teaching the client and family about eye movement desensitization and reprocessing therapy​ (EMDR), which has been successful in the treatment of posttraumatic stress disorder. Which teaching points will the nurse include in the session with the client and​ family? Select all that apply. a Effective pharmacologic therapy b Reprocesses the trauma c External focus is on a different stimulus d Effective nonpharmacologic therapy e Telehealth strategy

a (Rationale: Clients with PTSD often resort to addictive behaviors to try to rid their minds of visions of the trauma. PTSD is not associated with the development of schizophrenia, OCD, or phobias.)

The nurse is working with clients who are experiencing post-traumatic stress disorder (PTSD) and plans to teach them that they are at risk for developing which condition? a Addictive behaviors b Obsessive-compulsive disorder (OCD) c Schizophrenia d Phobias

a,d (Rationale: Those at a higher risk of developing PTSD include children from a divorced family or children who experience childhood sexual abuse. Other risk factors include a history of mental illness and low social support. A child who falls off a bike is not very likely to be at risk for PTSD.)

The nurse planning a class about post-traumatic stress disorder (PTSD) would identify which individual as being at a higher risk for developing PTSD? (Select all that apply.) a Victim of childhood sexual abuse b Child who fell off a bike at age 7 c Client with no history of mental illness d Child from a divorced family e Client with an extended family

1 (combining a benzo with an antacid impairs the absorption rate of the benzo.)

The nurse should warn a client who is taking a benzodiazepine about using which medication in combiination with his current medication? 1. antacids 2. acetaminophen 3. vitamins 4. aspirin

c (Rationale: People who survive a traumatic event in which others died often experience guilt as part of the PTSD disorder. Wanting to harm others, hoarding, and panic attacks are not characteristic of PTSD)

The nurse, caring for a client who is experiencing post-traumatic stress disorder (PTSD) associated with the death of family members during a house fire, would plan interventions to help the client with which behavior? a Feelings of wanting to harm others b Hoarding behaviors c Feelings of guilt d Panic attacks

b (Rationale The student nurse would not include administering anticonvulsants in the plan of care for this client. Propranolol is a beta blocker that is not a pharmacologic therapy for PTSD. All the other interventions are appropriate for this client.)

The student nurse has completed a care plan for a client diagnosed with posttraumatic stress disorder. Which intervention is not appropriate for the student to include in the plan of care for this​ client? a Identify safe physical outlets for negative feelings b Administer propranolol as ordered c Teach the client the use of positive imagery d Help the client to express fears that interfere with daily life

a,c,d (Preliminary research shows that acupuncture may be an effective treatment for PTSD if treatment is​ regular, lasts at least three​ months, and is used as an additional treatment with CBT and other more traditional​ therapies, including pharmacologic agents.)

Under which conditions can acupuncture be an effective treatment for posttraumatic stress disorder​ (PTSD)? Select all that apply. a When used for a period of three months or more b When used alone as a primary therapy c When used regularly d When used as an adjunct to CBT and other traditional therapies e When used as a​ short-term therapy for a period of no more than a month

b,c,d,e (When assessing a client diagnosed with​ PTSD, the nurse will ensure the safety of the client and​ others, lower the​ client's anxiety​ levels, determine the use of alcohol or​ drugs, and establish trust. Indirect​ non-professional exposure, such as observing a terrorist event through electronic​ media, television,​ movies, or​ photographs, is not a factor in the development of PTSD.)

What should the nurse consider when assessing clients with posttraumatic stress disorder​ (PTSD)? Select all that apply. a Assessing for indirect​ non-professional exposure b Determining alcohol or drug use c Lowering client anxiety levels d Establishing trust e Ensuring the safety of the client and others

a,b,c (Rationale For the client with PTSD who successfully achieves the identified client goals and​ outcomes, examples of nursing observations during the evaluation phase may include​ that: the client has fewer experiences of​ flashbacks, dissociation, negative​ thoughts, and other clinical manifestations of​ PTSD; the client uses​ self-soothing techniques; and the client spends less time obsessively worrying and articulates more accurate predictions of events to come. Disrupted sleep at night would indicate the client​'s plan of care is not effective in treating impaired sleep patterns and would require a revised plan of care. Continued avoidance of reminders of the event would indicate the client​'s plan of care needs to be revised.)

What would the nurse observe in the client with posttraumatic stress disorder PTSD who successfully achieves the identified client goals and​ outcomes? Select all that apply. a The client has fewer experiences of​ dissociation, negative thoughts. b The client uses​ self-soothing techniques. c The client spends less time obsessively worrying. d The client demonstrates​ persistent, effortful avoidance. e The client reports disrupted sleep at night.

d (Acute stress disorder and PTSD are two separate and distinct disorders. Clients with acute stress disorder experience signs and symptoms that endure for 3 days to one month following exposure to a traumatic event. Clients with PTSD experience symptoms for more than one​ month, and the onset of symptoms usually occurs three months after exposure to the trauma.)

Which characteristic best describes acute stress​ disorder? a Symptoms may last for several years. b Symptoms last for more than one month. c Symptoms usually start three months after the event. d Symptoms last three days to one month after the event.

a,b,c,e (Client goals and outcomes should be measurable. In​ addition, client goals and outcomes should be​ client-specific and tailored to meet the client​'s needs. General examples of client goals and outcomes that may be appropriate for inclusion in the plan of care for the client with PTSD​ include: the client will remain free from​ harm; the client will be able to talk about emotions associated with the traumatic​ experiences; the client will demonstrate stress reduction​ techniques; and the client will verbalize a decrease in anxious feelings. The goal for no change in the occurrence of nightmares is inappropriate. An appropriate goal would be for the client to report a decrease in the occurrence of nightmares.)

Which client outcomes would be the most appropriate for inclusion in a plan of care for a client with posttraumatic stress disorder​ (PTSD)? Select all that apply. a The client will articulate decreased feelings of anxiety. b The client will talk about emotions that are associated with traumatic experiences. c The client will remain free of harm or injury to self or others. d The client will report no change in the occurrence of nightmares. e The client will demonstrate stress reduction techniques.

2 (Do not stop abruptly. Must be tapered off med to decrease withdrawal symptoms)

Which client statement indicates the need for further teaching about benzodiazepines? 1. I cannot drink alcohol while taking diazepam 2. I can stop taking the drug anytime I want 3. Diazepam can make me drowsy, so I should not drive for awhile 4. Diazepam will help my tight muscles feel better

a,b,e (To meet the​ DSM-5 criteria for a diagnosis of​ PTSD, a client must demonstrate symptoms that include​ persistent, frightening thoughts and memories or flashbacks of the​ event, avoidance of situations related to the​ trauma, and significant​ symptom-related distress or functional impairment. Clients with PTSD sometimes demonstrate drug or alcohol​ abuse, but substance abuse is not among the symptoms required for a PTSD diagnosis. Recurrent compulsive behaviors are associated with​ obsessive-compulsive disorder, not PTSD.)

Which clinical manifestations must the client demonstrate to meet the​ DSM-5 criteria for a PTSD​ diagnosis? Select all that apply. a Avoidance of situations related to the trauma ​b Persistent, frightening thoughts and memories of the event c Recurrent compulsive behaviors d Demonstrated drug or alcohol abuse e Significant​ symptom-related distress or functional impairment

b (The most effective nonpharmacologic therapy for PTSD is​ cognitive-behavioral therapy. Acupuncture is a complementary therapy that has been found useful for​ PTSD, but it is not as effective as​ cognitive-behavioral therapy.​ Anti-adrenergic therapy and SSRI therapy are both pharmacologic options for the treatment of PTSD.)

Which nonpharmacologic therapy has been found to be the most effective for posttraumatic stress disorder​ (PTSD)? a SSRI therapy ​b Cognitive-behavioral therapy c Acupuncture therapy ​d Anti-adrenergic therapy

a,d,e (Appropriate nursing interventions for clients with PTSD aim to reduce and eliminate client​ harm, anxiety, and​ fear, and improve client​ coping, using nonpharmacologic and pharmacologic therapies. Nursing interventions also aim to connect clients and families with organizations and community resources that can provide​ longer-term social,​ occupational, and interpersonal support. The planning phase of the nursing process includes formulating client goals and outcomes. Understanding that some clients may be aided by brief interventions and not develop PTSD is important to nursing practice but is not itself an intervention.)

Which nursing interventions are appropriate for the client with posttraumatic stress disorder​ (PTSD)? Select all that apply. a Connecting clients and families with resources for​ social, occupational, and interpersonal support. b Understanding that some clients may be aided by brief interventions and not develop PTSD c Formulating client goals and outcomes d Improving client​ coping, using nonpharmacologic and pharmacologic therapies e Reducing and eliminating client​ harm, anxiety, and fear

1 (Buspirone a nonbenzodiazepine anxiolytic is particularly effective in treating the cognitive symptoms of anxiety, such as worry, apprehension, difficulty with concentration and irritability. Buspirone is not effective for the somatic symptoms of anxiety (muscle tension). Therapeutic effects may be experienced in 7-10 days. with full effects in 3-4 weeks. This drug is not known to cause physiological dependence and can be taken with food or small meals to reduce GI upset)

Which statement by a client who has been taking buspirone as prescribed for 2 days indicates the need for further teaching? 1 this medication will help my tight aching muscles 2. I may not feel better for 7-10 days 3. The drug does not cause physical dependence 4. I can take the med with food

a,b,d (Clients with PTSD experience​ recurrent, involuntary, and intrusive​ memories, traumatic​ nightmares, and flashbacks. Clients may have trouble sleeping and may become emotionally numb or have trouble with​ affection, impairing their relationships. They have negative alterations in cognition and mood that began or worsened after the traumatic event. Examples are an inability to experience positive​ emotions, and persistent blame of self or others for causing the trauma or its consequences. Clients with PTSD typically do not express feelings of optimism and contentment.)

Which statements might the nurse expect to hear from a client with posttraumatic stress disorder​ (PTSD)? Select all that apply. ​a "There is no one I can really talk to. I​ don't feel close to​ anyone." ​b "I can't remember the last time I enjoyed myself. All I do is think about what happened and how I caused​ it." c ​"I feel very optimistic and positive about the future and what I can​ accomplish." ​d "I have trouble sleeping at night. I keep waking up because of​ nightmares, and I​ don't feel rested in the​ morning." ​e "I'm a high stress person. I feel content most of the​ time."

b (An independent nursing intervention that is appropriate for this client is to recommend participation in an interpersonal support group. It is outside the scope of nursing practice to initiate EMDR therapy or to prescribe pharmacologic therapy. The nurse would want to increase contact with the​ client's family as long as it is done in a safe environment.)

You are caring for Mr. Joaquim​ Parker, a​ 55-year-old client who is recovering from burns he sustained in a fire in his apartment building two months ago. His elderly​ mother, who lived with​ him, died after he managed to rescue her. He has been unable to work at his hourly restaurant job and has no health insurance. Mr. Parker is about to be discharged from the hospital. He is​ sad, has no relatives in the​ area, but is looking to move on with his life. Which independent nursing interventions could you include in Mr.​ Parker's plan of​ care? a Prescribing SSRI therapy b Recommending an interpersonal support group c Reducing contact with the family d Initiating Eye Movement Desensitization and Reprocessing​ (EMDR) therapy

b (This client already is actively engaged in nonpharmacologic therapies. At this time he may benefit from adding a medication to his treatment regimen. The antihypertensive​ medication, prazosin, inhibits the​ brain's response to​ norepinephrine, and may be prescribed for treatment and prevention of nightmares. Teaching the client to monitor his physiological level of​ arousal, encouraging him to​ exercise, and teaching him how to use positive affirmation techniques are all helpful therapies.​ However, they do not specifically address the nightmares that are recurring despite the​ client's active participation in his plan of​ care, and the progress he is making in life. )

You are caring for Mr. Tyshawn​ Clemmons, a​ 28-year-old client who recently served in the U.S. Armed Forces in Afghanistan. Mr. Clemmons received a diagnosis of Posttraumatic Stress Disorder ​ (PTSD) a year ago. He has a supportive​ family, has found​ work, and is actively participating in his plan of care. His mental health provider is providing Eye Movement Desensitization and Reprocessing​ (EMDR) and Cognitive Behavioral Therapy​ (CBT). Mr. Clemmons has demonstrated good outcomes in the use of​ self-calming techniques, expressing his​ feelings, thinking positively about the present and the​ future, and experiencing few cognitive distortions and obsessions. He presents at the clinic with reports of an inability to sleep due to​ nightmares, and difficulty meeting his daily obligations. What therapy would best address this symptom of posttraumatic stress disorder​ (PTSD)? a Use positive affirmation b Begin pharmacotherapy c Exercise daily d Monitor physiological level of arousal

c (Risk factors for PTSD include the severity of the stressor event and additional stressors immediately following the event.​ Depersonalization, avoiding situations related to the​ trauma, and flashbacks are clinical manifestations of​ PTSD, not risk factors. )

You are caring for Ms. Andrea​ Helmer, a​ 30-year-old client who is admitted to the emergency department three months after being assaulted in the elevator of her apartment building. The assault was​ severe; Ms. Helmer is still recovering from her injuries and lost her job as a waitress because she was unable to return to work. Her symptoms include a sense of​ detachment, altered sense of​ reality, spontaneous memories of the​ assault, recurring distressing​ dreams, psychological​ distress, and an inability to return to her apartment. You treated Ms. Helmer on the day of the assault and the symptoms you observe today were not present then. You are concerned that she could be experiencing posttraumatic stress disorder​ (PTSD). What risk factor might lead you to suspect Ms. Helmer is experiencing​ PTSD? a Avoiding situations related to the trauma b Exhibiting depersonalization c Experiencing an extremely stressful event d Experiencing flashbacks

a (The nurse would want to include​ open-ended questions during the assessment process in order to allow the client to discuss her feelings regarding the diagnosis. Asking how the client feels upon waking is a question that cannot be answered with a yes or no and is therapeutic. The other questions are not​ open-ended questions or the most therapeutic regarding the​ client's situation.)

You are caring for Ms. Elise​ Jones, who has been hospitalized after attempting suicide on the​ one-year anniversary of an automobile accident in which her husband and children were killed. Although Ms. Jones was​ driving, the accident was the fault of the other driver. Since the​ accident, she has continually experienced flashbacks of the accident and nightmares. Before the​ accident, she was happy and content with her life. Based on the diagnosis of posttraumatic stress disorder​ (PTSD), which assessment question is the most appropriate for the nurse to ask Ms.​ Jones? ​a "How do you feel after a night of​ sleep?" ​b "Was the driver of the car put in​ jail?" ​c "Do you miss your​ family?" ​d "Are you in any physical​ pain?"