chapter 19

The advanced practice psychiatric mental health nurse is preparing to begin stress inoculation training with a client who has post-traumatic stress disorder. What should the nurse teach the client about this therapy?

"We're going to work to help you develop a new perspective on your traumatic memories."

A client is seeking counseling due to difficulty coping with being a victim of a violent attack 16 months ago. The initial medical diagnosis is to rule out posttraumatic stress disorder (PTSD). Which would the nurse assess for when determining the major elements of PTSD? Select all that apply.

-Reexperiencing the trauma through dreams or recurrent and intrusive thoughts. -Showing emotional numbing such as feeling detached from others. -Being on guard, irritable, or experiencing hyperarousal

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

The nurse is working with two children who have been apprehended from a neglectful and abusive home. Initial assessments reveal that one child is much more traumatized than the other, despite similarities in their circumstances. The nurse should consider what possible explanation for their differing responses?

The children have differing levels of resilience

A male combat veteran with a diagnosis of post-traumatic stress disorder has been prescribed prazosin. What outcome would most clearly indicate the effectiveness of this treatment?

The client reports fewer and less intense nightmares

A nurse is contributing to the interdisciplinary care plan for a client who has been diagnosed with PTSD. Which should be included in the care plan? a. administration of monoamine oxidase inhibitors (MAOIs) as prescribed b. Frequent assessment for delusional thinking or hallucinations c. Vigilant monitoring for potential indications of self-harm d. Education to the client about appropriate social interactions

c. Vigilant monitoring for potential indications of self-harm

The nurse is working with a client who is suspected of having posttraumatic stress disorder after witnessing a violent crime. What statement by the client's spouse would suggest that the client is experiencing hyperarousal? a. "My spouse always seems so irritated now, which isn't like my spouse." b. "My spouse seems to overeat at almost every meal, and then snack all the time too." c. "My spouse seems to sleep and sleep, even when there's no reason why my spouse should be tired." d. "My spouse's libido has completely dropped off, and that's not at all like my spouse."

a. "My spouse always seems so irritated now, which isn't like my spouse."

Which individual is exhibiting signs or symptoms that are characteristic of posttraumatic stress disorder (PTSD)? Select all that apply. a. A police officer who experiences panic attacks when thinking about the time the police officer was forced to shoot a violent suspect b. A client who has frequent nightmares about the time a fellow soldier died from an improvised explosive device c. 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 d. A client who is unable to relax without first barricading the client's home after a violent home invasion and assault e. A client who is fixated on getting revenge on the business partner whom the client blames for the client's bankruptcy

b. A client who has frequent nightmares about the time a fellow soldier died from an improvised explosive device d. A client who is unable to relax without first barricading the client's home after a violent home invasion and assault c. 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. A police officer who experiences panic attacks when thinking about the time the police officer was forced to shoot a violent suspect

A school nurse is conducting a workshop that has the goal of promoting children's resilience. Which activity would be most important for the nurse to include to promote resilience? Select all that apply. Have a client with a diagnosis of post-traumatic stress disorder (PTSD) speak to the children a. Provide the children with activities that will promote their self-concept b. Give the children exercises that allow them to exercise their autonomy c. Teach the children that each of them possesses inherent self-worth d. Teach the children about the need to report violations of any sort to a trusted authority figure

b. Give the children exercises that allow them to exercise their autonomy a. Provide the children with activities that will promote their self-concept c. Teach the children that each of them possesses inherent self-worth

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? a. Teaching the client how to provide culturally safe care for the child b. Planning activities where the client and the child can bond c. Teaching the client about the factors that cause resilience d. Modeling interactions that address disruptive behavior disorders

b. Planning activities where the client and the child can bond

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? a. The child is able to set appropriate boundaries with people the child has recently met b. The child demonstrates that the child is empowered to solve life problems c. The child states that the child's current stress levels are manageable d. The child states that the child is comfortable being alone for short periods of time

b. The child demonstrates that the child is empowered to solve life problems

The nurse is performing a physical health assessment of a client who has been diagnosed with posttraumatic stress disorder (PTSD). What aspect of this assessment should the nurse prioritize? a. Nutrition assessment b. Sleep assessment c. Bowel sounds and last bowel movement d. Respiratory rate and breath sounds

b. sleep assessment

A psychiatric nurse is assessing a client with post-traumatic stress disorder (PTSD). During the psychosocial component of the assessment, what assessment question should the nurse include? a. "How would describe the quality of your sleep these days?" b. "Have you been having any side effects from your medication?" c. "How are your symptoms affecting your day-to-day routines?" d. "Do you feel like treatment has been beneficial so far?"

c. "How are your symptoms affecting your day-to-day routines?"

Which individual is most likely to be diagnosed with posttraumatic stress disorder (PTSD)? a. A 12-year-old girl who has recently moved cross-country and desperately misses her old friends b. An adult male client who has been admitted to the hospital three times for complications of surgery c. A middle-aged woman with a history of anxiety who suffered a random physical assault d. A teenage boy who has begun to be the object of bullying inside and outside the classroom

c. A middle-aged woman with a history of anxiety who suffered a random physical assault

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? a. Client will verbalize feelings to close family members b. Client will describe complete control over the client's fear response c. Client will describe the effects of PTSD on the client's activities of daily living d. Client will demonstrate breathing exercises that reduce stress and anxiety

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

A client with posttraumatic stress disorder (PTSD) tells the nurse that the client's recent cognitive behavioral therapy has been difficult. The client states that the client's therapist has the client visualize the sights and sounds from the time that the client was assaulted. This client is likely receiving: a. stress inoculation training. b. cognitive restructuring. c. cognitive processing therapy. d. exposure therapy.

d. exposure therapy.

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? a. Provide the client with educational resources that promote the client's self-worth b. Encourage the client to make new friends c. Facilitate the client's participation in a support group d. Facilitate a meeting between the client and the client's family members

c. Facilitate the client's participation in a support group

The psychiatric-mental health nurse is providing care for a child who has been diagnosed with disinhibited social engagement disorder. What intervention best addresses the characteristics of this disorder? a. Role modeling conflict management with the child b. Teaching the child how to set boundaries in familial relationships c. Teaching the child how to interact appropriately with strangers d. Teaching the child how to manage disruptive thoughts of trauma

c. Teaching the child how to interact appropriately with strangers

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

c. The client is often "staring into space" and has no idea how much time has passed

A client with posttraumatic stress disorder (PTSD) has been prescribed lorazepam 1 mg SL q6h PRN. What assessment finding indicates that treatment is having the desired effect? a. Increased energy b. Improved mood c. Decreased nightmares d. Reduced anxiety

d. reduced anxiety

A female client with post-traumatic stress disorder (PTSD) has just completed a session of eye movement, desensitization, and reprocessing (EMDR) therapy and exposure therapy. The client states that she is exhausted because she has been: a. learning a new set of coping skills and stress management techniques. b. interacting with other people who were similarly impacted by the traumatic event. c. imagining the details of the traumatic event with the therapist. d. taking ownership of ways she could have prevented the event.

c. imagining the details of the traumatic event with the therapist.

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? a. An adolescent who began smoking in the weeks after discovering a dead body in a park b. An adolescent who states "I've lost my soulmate" after the death of a boyfriend or girlfriend in an accident c. An adolescent who has committed uncharacteristic acts of violence since the death of the adolescent's mother d. An adolescent who often redirects the conversation to the subject of the adolescent's sister's death

d. An adolescent who has committed uncharacteristic acts of violence since the death of the adolescent's mother

The nurse is assessing a client who was sexually assaulted several months ago and who has subsequently developed posttraumatic stress disorder (PTSD). The nurse observes that the client's nonverbals are closed and the client is reluctant to engage with the nurse. How should the nurse best interpret this client's behavior? a. The client has likely responded poorly to prior treatments b. The client has likely had a series of negative interactions with health providers c. The client's PTSD is affecting the client's cognition and information processing d. The client's trauma likely has an impact on the client's ability to trust

d. The client's trauma likely has an impact on the client's ability to trust

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. a. Assessment for extrapyramidal symptoms b. Characteristics of the client's sleep c. Assessment for tardive dyskinesia d. The effect of the client's PTSD on the family e. The client's use of alcohol or other drugs

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