Ch 13 psych

A client in the 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?

dissociative identity disorder

A nurse is working in a mental health clinic. Which client statement should the nurse recognize as describing a type a personality?

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

A nurse works in a psychiatric clinic. During a counseling session, the nurse finds that the client who has posttraumatic stress disorder is unable to identify the intensity of the clients 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 clients emotions?

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

A client has been diagnosed with PTSD after witnessing an explosion at the clients industrial worksite. The client will soon begin exposure therapy, so the nurse should prepare the client for

A visit with the therapist to the place where the explosion occurred

A client with PTSD tells the nurse, I deserve to be abuse that way. I feel I am the one responsible for that incident. I don't have any hopes in life. I no longer mean anything to anybody. Based on these statements, which is the most appropriate nursing diagnosis?

Chronic low self-esteem

A client has experienced a physical assault and states "I keep having nightmares about it." Which intervention may be most helpful for the nurse to explore with the client at this time?

Debriefing about the event

A client has been referred for care because the clients primary care provider suspect that the client has PTSD following a major motor vehicle accident. When working with this client, the psychiatric mental health nurse should begin by

Establishing therapeutic rapport with this client

The nurse is providing care for a client who is history of intimate partner violence has resulted in PTSD. The client has few friends and states that the client is estranged from the clients family. How can the nurse best enhance the client social support?

Facilitate the clients participation in a support group

A nurse is interviewing a client who is suffering from PTSD. Which intervention would help the nurse ensure the clients comfort during the interview?

Keep environmental noises to a minimum

A client with PTSD has been prescribed lorazepam 1 mg SL Q6H PRN. What assessment finding indicates that treatment is having the desired effect?

Reduced anxiety

The nurse is performing a physical health assessment of a client who has been diagnosed with PTSD. What aspect of this assessment should the nurse prioritize?

Sleep assessment

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?

Teaching the child how to interact appropriately with strangers

The nurse is assessing a six-year-old child who witnessed the murder of the child's parents. The nurse suspects that the child has developed post traumatic stress disorder. Which specific behavioral manifestation leads the nurse to interpret this?

The child is easily startled and hyper vigilant

A client with PTSD is having a flashback experience of a traumatic event. The client asked the nurse if the client can hold the nurses hand. What should the nurse interpret from this behavior?

The client benefits from supportive touch

A nurse is performing a follow-up assessment for a client who has been treated for PTSD a year ago. The client tells the nurse that the client is not able to maintain relationships and that the relationship will last for a very short time. What is the most likely reason for this problem?

The client has issues with developing trust

What assessment finding would suggest to the nurse that the client with posttraumatic stress disorder (PTSD) is experiencing disassociation?

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

A nurse is caring for a client with disassociative disorder. The nurse tells the client, hello, I am Robin, your nurse. It's 9 o'clock in the morning now. You are in room number 303. My name is Robin, I am your nurse. What is the most appropriate reason for the nurse to repeat this statement?

The client may need to be re-oriented.

Following an assessment of a client with PTSD, the nurse concludes that the client is at risk for suicide. What would be the immediate goals of management for this client?

The client will be physically safe.

The nurse is assessing a client who was sexually assaulted several months ago and who has subsequently developed PTSD. The nurse observes that the clients nonverbal's are closed and the client is reluctant to engage with the nurse. How should the nurse best interpret the clients behavior?

The clients drama likely has an impact on the clients ability to trust

A client who is being treated for post traumatic stress disorder tells the nurse, "Sometimes it's like I can't feel anything - not happiness, not sadness, not fear. Nothing." How should the nurse best interpret the client statement?

The clients emotional numbing is a protective mechanism

A client has developed posttraumatic stress disorder after a violent sexual assault committed by close family member. When planning the clients care, the nurse should follow what guidelines?

The nurse should avoid touching the client during interactions unless necessary

A client is admitted to the hospital with PTSD. When approaching the client for the first time, the nurse speak softly and gently, in a non-threatening manner. What is the most appropriate reason for this behavior of the nurse?

To prevent the risk of triggering fears in the client

When caring for a client who is experiencing the symptomology of acute stress disorder, the nurse recognizes the importance of minimizing the clients risk for developing which condition?

posttraumatic stress disorder

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 action should the nurse plan to include in the plan of care for this client? Select all that apply

-educate the client on resources available to her -consult social services -plan and interdisciplinary team meeting regarding this situation

A nurse is interviewing several clients who survived a school shooting 10 years ago when they were in high school. Which client should the nurse identify as having achieved adaptation following this event? Select all that apply

-father of two who works in a tire store and has a second job as a mechanic. -married, mother of three, who is a stay at home mother. -nurse manager for the local hospital.

A nurse is caring for a client with PTSD. Negative alterations in cognition and mood associated with the traumatic event are important features of PTSD. Knowing this, which symptoms does the nurse likely to find in such clients? Select all that apply

-getting angry with little or no provocation -inability to remember important aspects of the traumatic event -having negative beliefs about oneself

When presenting a discussion of PTSD to a group of emergency department nurses, the psychiatric mental health nurse provides examples of traumatic events that may proceed PTSD. Which example what the nurse most likely include? Select all that apply

-military combat mission where there were casualties -personal assault by a family member -surviving an EF 4 tornado

A man is discovered wandering the street, looking confused and stepping out into traffic. When emergency responders approach the man, he cannot recall his name or where he lives. The responders transport the man to the mental health crisis unit for further evaluation. Which of the following are the man most likely suffering from? Select all that apply. A) Depersonalization disorder B) Dissociative identity disorder C) Repressed memories D) Dissociative amnesia E) False memory syndrome

A) Depersonalization disorder B) Dissociative identity disorder D) Dissociative amnesia Feedback: With dissociative amnesia, the client cannot remember important personal information. With dissociative personality disorder, the client displays two or more distinct identities or personality states that recurrently take control of his or her behavior. With depersonalization disorder, the client has persistent or recurring feeling of being detached from his or her mental processes or body (depersonalization) or sensation of being in a dream-like state where the environment seems foggy or unreal (derealization). The client is not psychotic or out of touch with reality. Repressed memories are when a person is unable to consciously recall memories of childhood abuse. False memory syndrome can occur during psychotherapy when the client is encouraged to imagine false memories of childhood sexual abuse.

Which of the following statements about posttraumatic stress disorder is accurate? A) Estimates are that the disorder is very rare. B) Estimates are that up to 60% of people at risk develop PTSD. C) Only 20% of victims of rape develop PTSD. D) PTSD symptoms usually begin at the time of the trauma

ANS: B Feedback: Estimates are that up to 60% of people at risk develop PTSD.

A nurse is assessing an adult client in a psychology clinic. And obtaining the history, the nurse finds that the nurse has lost the clients job and is thus not able to meet the financial demands of the family. In the absence of other symptoms, which is the most appropriate diagnosis for this client?

Adjustment 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 post traumatic stress disorder?

An adolescent who has committed uncharacteristic acts of violence since the death of the adolescence mother

Three years after the death of her father in an ICU, the infection prevention nurse was visiting an ICU in a different hospital to complete a chart review. At one point, the nurse looked at a bed where the patient who had the same diagnosis as her father had and saw her father's facial features on the patient and had a sense of panic. In a few moments, the nurse realized that the patient in the bed was not her father. Which of these manifestations of PTSD was this nurse experiencing? A) A flashback B) Emotional numbing C) Hyperarousal D) A dream

Ans: A Feedback: This nurse was experiencing a flashback where similar circumstances triggered a sensation that the stressful experience were happening again.

Which of the following is true about the use of touch with a client with dissociative identity disorder? A) It is best not to touch the client without his or her permission. B) Make sure the client knows the touch is friendly and supportive. C) Touch the client only if you are in his or her direct line of vision. D) Touching will convey a sense of security to the client

Ans: A Feedback: Clients interpret touch differently, so it is important to assess each client's comfort with being touched; these clients often have a history of abuse, so permission should be given before touch is used

Which of the following statements by the nurse would be most appropriate to a colleague who very quietly and numbly tells the nurse that she had arrived at the scene of an automobile and pedestrian accident and unsuccessfully performed CPR on a victim 3 days ago? The nurse and her colleague are sitting in the break room and no one else is present. A) "Tell me what you saw." B) "That is horrible!" C) "Why did you perform CPR?" D) "I know how you feel; the same thing happened to me several years ago and I never recovered."

Ans: A Feedback: One of the most effective ways of avoiding pathologic responses to trauma is effectively dealing with the trauma soon after it occurs. Describing what the colleague saw may be very helpful to him or her. "That is horrible," is a judgment and is not likely to be helpful. "Why did you perform CPR," might make the colleague feel defensive. "I know how you feel; the same thing happened to me several years ago and I never recovered," is nonsupportive and robs the colleague of any hope that he or she will recover

Which of the following should be an action of a nurse who is having feelings of judgment regarding a client's contributory behavior to an automobile accident that resulted in deaths? A) Discussing the nurse's personal feelings with a peer or a counselor B) Acknowledging the judgment regarding the client's contributory behavior to the client C) Sharing the client's horror and encouraging him or her to avoid thinking about it D) Letting the client know that he or she is now traumatized beyond repair

Ans: A Feedback: When the traumatized client causes a car accident that injured or killed others, it may be more challenging to provide unconditional support and withhold judgment of the client's contributory behavior. Remaining nonjudgmental of the client is important, but does not happen automatically. The nurse may need to deal with personal feelings by talking to a peer or counselor. If the nurse is overwhelmed by the violence or death in a situation, the client's feelings of being victimized to traumatized beyond repair are confirmed. Conveying empathy and validating client's feelings and experiences in a calm, yet caring professional, manner are more helpful than sharing the client's horror

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 post-traumatic stress disorder (PTSD). Which would the nurse assess for when determining the major elements of PTSD? Select all that apply. A) Reexperiencing the trauma through dreams or recurrent and intrusive thoughts B) Showing emotional numbing such as feeling detached from others C) Being on guard, irritable, or experiencing hyperarousal D) Feeling mildly anxious E) Occurs 2 weeks after the trauma

Ans: A, B, C Feedback: The three major elements of PTSD are reexperiencing the trauma through dreams or recurrent and intrusive thoughts, showing emotional numbing such as feeling detached from others, and being on guard, irritable, or experiencing hyperarousal. Feeling mildly anxious is not a major element of PTSD as the person is likely to feel very anxious. Occurring 2 weeks after the trauma would likely be acute stress disorder as PTSD symptoms occur 3 months or more after the trauma

A fireman survived a fire after escaping a blaze. Several other firefighters were trapped in the burning building and died. After working with this firefighter in counseling, the nurse evaluates which of the following as positive outcomes for this client? Which will the nurse evaluate as positive outcomes for this client? Select all that apply. A) The client will verbalize feelings of stress related to returning to work. B) The client will express guilt openly through nondestructive means. C) The client will identify a social support system within the community. D) The client will report nightmares and flashbacks of the fire.

Ans: A, B, C Feedback: Treatment outcomes for clients who have survived trauma or abuse may include verbalizing feelings, expressing emotions nondestructively, and establishing a social support system in the community. An absence of stress is an unrealistic outcome. Reporting symptoms of PTSD such as nightmares and flashbacks does not indicate positive treatment outcomes

Which of the following are events that a person may experience, witness, or be confronted by that may trigger posttraumatic stress disorder (PTSD)? Select all that apply. A) Being a survivor of a tsunami that resulted in thousands of deaths B) Being stranded at the office during a typical winter storm that was anticipated C) Being a marine in a combat situation where the entire platoon was wiped out except for one person D) Being hidden in a closet and hearing the entire family murdered by someone who broke into the home E) Watching televised segments of the moment when the plane hit the second tower on 9/11

Ans: A, C, D, E Feedback: Examples of events that may cause PTSD include someone experiencing, witnessing, or being confronted by a traumatic event such as a natural disaster, combat, or an assault. The person with PTSD was exposed to an event that posed actual or threatened death or serious injury and responded with intense fear, helplessness, or terror. Being a survivor of a tsunami that resulted in thousands of deaths, being a marine in a combat situation where the entire platoon was wiped out except for one person, and being hidden in a closet and hearing the entire family murdered by someone who broke into the house would be situations where the person was exposed to an event that posed actual or threatened death or serious injury and responded with intense fear, helplessness, or terror

Which of the following statements regarding the individual responses to trauma and stressors is a positive outcome? A) Many individuals are unable to cope with the event, manage their stress and emotions, or resume the daily activities of their lives. B) Some individuals may develop enhanced coping as a result of dealing with the stressor. C) These events are only significant in individuals who have risk for or actual mental health problems or issues. D) Large numbers or groups of people may be affected by a traumatic event

Ans: B Feedback: People may experience events in their lives that are extraordinary in intensity or severity, well beyond the stress of daily life. These traumatic events or stressors would be expected to disrupt the life of anyone who experienced them, not just individuals at risk for mental health problems or issues. These events and stressors may affect individuals or large numbers and groups of people. While all persons experiencing events such as these manifest anxiety, insomnia, difficulty coping, grief, or any variety of responses, most work through the experience and return to their usual level of coping and equilibrium perhaps even enhanced coping as a result of dealing with the event

Which of the following might the nurse recognize as longer-term responses to trauma and stress? Select all that apply. A) Acute stress disorder B) Post traumatic stress disorder C) Adjustment disorder D) Reactive attachment disorder E) Dissociative disorder

Ans: B, C, D, E Feedback: Acute stress disorder usually occurs from 2 days to 4 weeks after a trauma. Posttraumatic stress disorder usually begins 3 months after the trauma. All of the rest of these are longer-term responses to trauma and stress.

Which of the following outcomes would take priority for a client who has survived trauma or abuse? Select all that apply. A) The client will demonstrate healthy, effective ways of dealing with the stress. B) The client will be physically safe. C) The client will establish a social support system in the community. D) The client will distinguish between ideas of self-harm and taking action on those ideas. E) The client will express emotions nondestructively.

Ans: B, D Feedback: It is the highest priority that the client be physically safe. Because persons who have survived trauma or abuse may have thoughts of self-harm, it is also critical that the client will distinguish between ideas of self-harm and taking action on those ideas. The other objectives are not as high a priority as safety and ideas of self-harm

Which of the following would the nurse know are the major elements of post traumatic stress disorder (PTSD)? Select all that apply. A) Trying to avoid any places or people or situations that may trigger memories of the trauma B) Reexperiencing the trauma through dreams or recurrent and intrusive thoughts C)Becoming increasingly more isolated D)Emotional numbing such as feeling detached from others E) Being on guard, irritable, or experiencing hyperarousal

Ans: B, D, E Feedback: The three major elements of PTSD are reexperiencing the trauma through dreams or recurrent and intrusive thoughts, showing emotional numbing such as feeling detached from others, and being on guard, irritable, or experiencing hyperarousal. The client may also experience a numbing of general responsiveness and may try to avoid any places or people or situations that may trigger memories of the trauma, but these are not the major elements of PTSD

A nurse is providing education about trauma and its effects to a community group in a community that has just been hit by a devastating tornado. One of the participants asked about what kind of support a survivor of the tornado will need. Which would be the best response of the nurse? A) If a person is willing to share his or her feelings about what has happened, he or she is not dealing with their feelings effectively. B) It is counterproductive for people to share what has happened to them and their feelings about it as there is nothing more to be done. C) If a person is reluctant to share his or her feelings, he or she may be denying his or her importance and may be at increased risk for future problems such as PTSD. D) It is best to wait until a survivor's life has returned to normal before dealing with the trauma

Ans: C Feedback: Some people more easily express their feelings and talk about stressful, upsetting, or overwhelming events. They may do so with family, friends, or professionals. Others are more reluctant to open up and disclose their personal feelings. They are more likely to ignore the feelings, deny their importance, or insist "I'm fine, I'm over it." By doing that, they increase the risk for future problems such as PTSD. One of the most effective ways of avoiding pathologic responses to trauma is effectively dealing with the trauma soon after it occurs

What is the major difference between posttraumatic stress disorder (PTSD) and acute stress disorder? A) In acute stress disorder, the client is likely to develop exacerbation of symptoms. B) In PTSD, the recovery rate is 80% within 3 months. C) The severity and duration of the trauma are the most important variables in acute stress disorder. D) In PTSD, the symptoms occur 3 months or more after the trauma

Ans: D Feedback: In acute stress disorder, the symptoms occur 2 days to 4 weeks after a traumatic event and are resolved within 3 months of the event. In PTSD, the symptoms occur 3 months or more after the trauma. In PTSD, the client is likely to develop exacerbation of symptoms. The severity and duration of the trauma and the proximity of the person to the event are the most important factors affecting the likelihood of developing PTSD. In PTSD, complete recovery occurs within 3 months for about 50% of people

Which of the following interventions would be most effective for friends and family members to implement in order to boost the self-esteem of a person who has just experienced trauma or abuse? A) To identify a list of support people or activities in the community B) To remind them to calm down when they appear to be experiencing a flashback C) To encourage them to tell their story repeatedly to everyone they meet D) To help them to refocus their view of themselves from being victims to being survivors

Ans: D Feedback: Often it is useful to view the client as a survivor of trauma or abuse rather than as a victim. For these clients, who believe they are worthless and have no power over the situation, it helps to refocus their view of themselves from being victims to being survivors. Defining themselves as survivors allows them to see themselves as strong enough to survive their ordeal. It is a more empowering image than seeing oneself as a victim. It would be beneficial for the client to identify a list of support people or activities in the community, but this would be to establish social support and not promote their self-esteem. It would not be helpful for anyone to tell the client to calm down when he or she appears to be experiencing a flashback or to encourage him or her to tell his or her story repeatedly

The police find a woman wandering around a parking lot, singing very loudly. They bring her to the hospital; she has no knowledge of what she has been doing for the past 12 hours and is dressed in unfamiliar clothing. This is an example of A) dissociation. B) manipulation. C) psychosis. D) regression.

Ans:A Feedback: The client experienced a temporary alteration in conscious awareness. This situation is not an example of manipulation. The woman is not experiencing psychosis. Regression occurs when there is a retreat to an earlier stage of development and comfort.

A psychiatric mental health nurse is teaching the family members of a client about strategies for engaging with their family member who has recently been diagnosed with posttraumatic stress disorder. The nurse should encourage the clients family to:

Anticipate that the client is likely to be irritable and withdrawn at times

Family members of a military veteran are distraught that he has withdrawn from them emotionally after returning home from a tour of duty. What is the nurse is most appropriate action?

Assess the client for signs and symptoms associated with PTSD

A client with a diagnosis of PTSD has been brought to the emergency department by concern family members, who states that the client is experiencing a nervous breakdown. The ED nurse should prioritize what aspect of care during the initial care of the client?

Assessing the clients risk for self harm and ensuring safety

Which statement regarding PTSD and children is accurate?

Best practices demonstrate that adolescents who have PTSD are at increased risk of drug abuse

A group of at-risk teenagers have successfully completed an outdoor training program in which they had to collaborate and conquer a number of challenges. The nurse should identify what likely outcome of this program?

Enhanced resilience for the participants

A client informs the nurse that while on vacation at a theme park, the sound of fireworks triggered an intense reminder of a house fire experienced as a child. The client describes experiencing the smells from the fire, choking sensation, burning eyes and images of the flames destroying the insides of his home. Which symptom is experienced by the client?

Flashback

An adult male client with a history of PTSD is brought to the emergency department. The client was startled by a dog while out for a walk and kicked it. He was calm and apologetic when he presented to the triage nurse. Which is a priority nursing intervention?

Identify risks for self harm and aggression

A client with a history of intimate partner violence has been diagnosed with PTSD. The client is wholly unwilling to discuss any aspects of personal history or current mental status with the nurse. What is the nurses best initial action?

Make efforts to demonstrate empathy to the client

The nurse is assessing a client who has recently received a diagnosis of PTSD. When conducting this assessment, the nurse should

Try to identify any strengths or skills that can be applied during recovery

Which of the following disorders involves the emergence of varying personalities in a person that is associated with stress and conflict?

dissociative identity disorder