Trauma, Crisis, Disaster, and Related Disorders Assessment

A nurse has attended an in-service regarding nursing care for clients who have experienced trauma. Which of the following statements by the nurse represent an understanding of trauma?

"Trauma is a broad term that refers to a person's physical, psychological, and emotional response to an adverse event."

A nurse is caring for a client who has depression, diabetic polyneuropathy, and significant neuropathic pain. The nurse hears an assistive personel say, "They are admitted frequently and always report being in pain. I think they are just a drug seeker." Whuch of the following responses should the nurse make?

"It's not appropriate to stereotype clients. It seems like you might have bias which could affect client care."

A nurse is caring for a client who was recently diagnosed posttraumatic stress disorder (PTSD). The client asks, "What is the difference between acute stress disorder and PTSD?" Which of the following responses should the nurse make?

"PTSD is diagnosed if the symptoms persist for longer than 1 month."

A community health nurse observes an 8 month old child being reunited with their parent after being found alone in an automobile. Which of the following responses should the nurse identify as an indication that she child might be experiencing poor attachment? (Select all that apply.)

Answer: The child continues to play with a toy when their parent steps into the room The child does not respond when held and embraced by the parent The child cries when the nurse tries to give the child to the parent

A nurse is working with an interdisciplinary disaster response team planning care for a coastal community following a category 5 hurricane. Place the following steps of disaster management in the correct order.

Determine the challenges the community is facing Determine the client's ability to function and cope with the current situation Determine the resources the client has available to them Partner with the client to develop a plan

A nurse is providing care to a 4 year old who has been recently diagnosed with reactive attachment disorder. Which of the following statements by the nurse accurately describes this disorder?

"Reactive attachment disorder can occur when there is an absent of adequate caregiving, including the child going many hours without being held or touched as an infant."

A nurse is assisting with developing education for a parenting class about adverse childhood events (ACEs). Which of the following statements should the nurse include in the education?

Answer: "Children who are exposed to repeated adverse childhood events are at an increased risk for developing physical and mental issues."

A nurse is assisting with preparing teaching for high school students regarding trauma and interpersonal violence. Which of the following statements should the nurse plan to include in the teaching?

Answer: "Interpersonal violence includes physical, sexual, and emotional maltreatment, which are types of trauma."

A nurse has attended an in-service education regarding trauma-informed care approach. Which of the following statements by the nurse reflects an accurate description for the goal of a trauma-informed approach?

Answer: "Nurses should understand the effects of trauma and structure client care to promote positive outcomes."

A nurse overhears a coworker say, "I get that some people have a hard childhood, bur eventually they need to get over it." Which of the following responses should the nurse make?

Answer: "People who experience adverse childhood events are changed biologically and genetically."

A nurse is caring for a client following a suicide attempt. Which of the following statements by the nurse reflects a trauma-informed approach?

Answer: "This must be difficult. Can you tell me about what has happened to you?"

A nurse at a clinic is assisting with screening clients for trauma. The nurse should identify that which of the following factors increases a client's risk for developing a trauma-related disorder? (Select all that apply.) ​

The client has a history of physical abuse The client belongs to a marginalized group The client was active military during the Iraq war ​

A nurse is assisting in the care of a client who has acute stress disorder. For each potential nursing intervention, click to specify if the potential intervention is expected, nonessential, or contraindicated for the client.

Answer: Encourage the client to share details regarding trauma - contraindicated Ask close ended questions - contraindicated Repeat vital signs every hour - nonessential Collect data about environmental safety risks - expected Use screening tools to monitor manifestations - expected Rotate staff as often as possible - contraindicated ​

A nurse is assisting with a parenting class for a group of new parents at the area community center. Which of the following types of trauma prevention is the nurse assisting?

Answer: Primary prevention

A nurse is caring for a client who was diagnosed with adjustment disorder after losing their job 2 months ago. For which of the following manifestations should the nurse monitor the client?

Answer: Suicidal ideation

A nurse is assisting with the planning care for a group of clients. Which of the following clients is at greatest risk for developing posttraumatic stress disorder (PTSD)?

Answer: A 36-year-old who has a maxillofacial fracture caused by their partner

A nurse is assisting with the plan of care for a client who was brought to the emergency room following displacement from their home due to a flood. When collecting data, which of the following clinical manifestations would the nurse anticipate are related to the experience of trauma? (Select all that apply.)

Answer: Anxiety, Sleep disturbance, Anger, Depression

A nurse is assisting in the care of a newly admitted client who has experienced a traumatic event. When collecting data, which of the 2 client findings require the nurse to immediately follow up?

Answer: Client's statement regarding feelings when awakening Client's statement regarding harming others

A nurse is working with a local crisis response team to evaluate students following a school shooting. After ensuring the safety of the students, which of the following trauma-informed approaches should the team take next?

Answer: Establish a supportive environment that facilitates trust and transparency

A nurse is assisting with the plan of care for a 14 year old client who has a history of child maltreatment. The staff have reported that any time an alarm occurs. the client is found sitting in the closet. Which of the following most accurately describes the client's response?

Answer: Fear conditioning

A nurse is reinforcing teaching with a group of parents about trauma prevention and developing childhood resilience. Which of the following techniques should the nurse include? (Select all that apply.)

Answer: Foster a hopeful perspective of the future Encourage development of thinking and learning Provide secure supportive relationships and places

A nurse is assisting in the care of a client who recently experienced a traumatic event and is experiencing flashbacks. Which of the following findings require immediate follow-up by the nurse?

Answer: Has a sad expression, eyes downcast, and does not react to others trying to speak to them. Shared in group therapy session how their job as a law enforcement officer exposes them to many "bad situations, like parents hurting their children and seeing dead people." Overheard another employee saying to the client, "Maybe if you weren't always bothering innocent people and trying to give everyone a ticket, you wouldn't be here." Client left area and returned to their room

A nurse is providing care for a client who has posttraumatic stress disorder (PTSD). The client states, "I always have to watch my back!" Which of the following manifestations of PTSD is the client experiencing?

Answer: Hyperviglance

A nurse is assisting with the triage of clients following an explosion at an oil refinery. Which of the following symptoms should be reported as a trauma response involving the sympathetic nervous system? (Select all that apply.)

Answer: Increased heart rate, Shallow breathing, Mueller tension, Anxiety

A nurse is providing care for an adolescent who sustained injuries in assault. Which of the following actions should the nurse take first?

Answer: Provide a safe, secure environment for the adolescent