uworld ptsd
A person suffering from post-traumatic stress disorder experiences 3 categories of symptoms:
-re-experiencing the traumatic event -avoiding reminders of the trauma -hyper-arousal
The nurse should encourage clients with posttraumatic stress disorder to:
-talk about the experience at their own pace -listen actively to build trust -allow clients to vent. This will assist in decreasing their feelings of isolation.
Clients with acute stress disorder (ASD) should be encouraged to discuss the traumatic event and explore the associated feelings. The nurse should:
-validate the client's feelings -assess risk for self-harm and ineffective coping (eg, drug and alcohol use) -evaluate the impact of ASD on the client's sleep, occupation, and relationships
The nurse performs an initial assessment on a client with suspected post-traumatic stress disorder. Which assessments would support this diagnosis? Select all that apply. 1. Difficulty concentrating 2. Feeling detached from others 3. Feeling lethargic and apathetic 4. Flashbacks of the traumatic event 5. Persistent angry, fearful mood
Ans: 1, 2, 4, 5 Rationale: There are 3 categories of PTSD symptoms: Reexperiencing the traumatic event, examples include: intrusive memories, flashbacks, recurring nightmares, and feelings of intense distress/loss of control or strong physical reactions to event reminders (eg, rapid, pounding heart; gastrointestinal distress; diaphoresis) (Option 4) Avoiding reminders of the trauma, examples include: avoidance of activities, places, thoughts, or other triggers that could serve as reminders; feeling detached and emotionally numb; loss of interest in life; inability to set goals; and amnesia about important details of the event (Option 2) Increased anxiety and emotional arousal, examples include insomnia, irritability, outbursts of rage, persistent anger and/or fear, difficulty concentrating, hypervigilance, and exaggerated startle response (Options 1 and 5) (Option 3) Persons with PTSD are typically restless and hypervigilant and have trouble falling or staying asleep.
The nurse cares for a client newly diagnosed with acute stress disorder following a traumatic event. Which of the following communications by the nurse are appropriate? Select all that apply. 1. "How has this situation affected your relationships with family and friends?" 2. "It is important to focus on coping strategies and not dwell on the event." 3. "It is normal to experience difficult symptoms after a traumatic event." 4. "Please tell me about your current use of alcohol and any drugs." 5. "Share with me any thoughts or plans of self-harm that you have had."
Ans: 1, 3, 4, 5 Rationale: Acute stress disorder (ASD) occurs following a traumatic or extremely stressful event. ASD is characterized by intrusive memories of the event, negative mood, dissociative symptoms (eg, altered sense of reality), and arousal and reactivity symptoms (eg, hyperactive sensory state, sleep disturbances, difficulty concentrating, easily startled). If these symptoms continue beyond a month after the event, the diagnosis becomes post-traumatic stress disorder. Nursing interventions for a client with ASD include: Assessing for ideas and plans to commit self-harm (Option 5) Assessing for ineffective coping (eg, use of drugs and alcohol) (Option 4) Assessing impact of ASD on the client's job performance, relationships, sleep pattern, and ability to perform activities of daily living (Option 1) Explaining that feelings and/or symptoms occurring after traumatic events are normal, as this can help alleviate the client's anxiety (Option 3) Exploring coping strategies used in previous stressful situations (Option 2) The client should be encouraged to discuss the traumatic event. As part of the debriefing process, the nurse should acknowledge and validate the associated feelings and behaviors.
The registered nurse is leading a support group for partners of military veterans suffering from posttraumatic stress disorder (PTSD). A participant asks the nurse how to identify the typical symptoms of PTSD. The nurse responds that most individuals with PTSD report which symptoms? 1. Auditory hallucinations, feelings of paranoia, isolation from others 2. Increased anxiety, reliving the event, feeling detached from others 3. Rapidly changing emotions, delusions, lethargy 4. Recurring nightmares, uncontrollable anger, daytime sleepiness
Ans: 2 Rationale: (Option 1) Auditory hallucinations and feelings of paranoia are not characteristic symptoms of PTSD. These are characteristic of schizophrenia. (Option 3) Rapidly changing emotions, delusions, and lethargy are not characteristic symptoms of PTSD. (Option 4) Daytime sleepiness is not characteristic of PTSD.
The nurse on the mental health unit received report on 4 clients. Which client should the nurse see first? 1. Client diagnosed with major depressive disorder who has consumed no food from the past 3 meal trays 2. Client diagnosed with post-traumatic stress disorder who reports an anxiety level of 8/10 and is pacing in the room 3. Client newly admitted with bipolar mania who reports sleeping only 4 hours last night 4. Client newly admitted with obsessive-compulsive disorder who has spent the last hour counting socks
Ans: 2 Rationale: Post-traumatic stress disorder (PTSD) may occur in people who have seen or experienced a terrifying, traumatic event (eg, war, tornado, rape, plane crash). Symptoms of PTSD include re-experiencing the traumatic event via flashbacks, nightmares, and feelings of distress in reaction to reminders; avoiding reminders of the trauma (eg, places, activities, thoughts, other triggers); and increased anxiety and emotional arousal (eg, insomnia, hypervigilance, outbursts of rage, irritability). Clients with an anxiety level of 8/10 and pacing behavior are demonstrating distress and require immediate attention as they might harm themselves or others.
A female client who was the victim of acquaintance rape 2 months ago is receiving therapy for posttraumatic stress disorder (PTSD). She says to the nurse, "It's all my fault. I should have known not to accept a drink from someone I just met in a bar." What is the best response by the nurse? 1. "It may take time to overcome those thoughts and feelings." 2. "Those kinds of thoughts are self-destructive. You should stop thinking about it." 3. "You could not have anticipated the rape. You did not deserve or ask for it." 4. "You have to stop blaming yourself so you can move on with your life."
Ans: 3 Rationale: Providing a realistic perspective of the rape may help clients develop a more objective view of their perceived role in the traumatic event and may reduce feelings of self-blame and guilt. The nurse needs to reinforce repeatedly that rape is never the victim's fault.
The nurse is providing care to a client experiencing posttraumatic stress disorder following a terrorist attack at the client's place of worship. What is the priority nursing action? 1. Acknowledge the client's feelings of anger 2. Assess the client's support system 3. Encourage the client to talk about the trauma 4. Offer the client a PRN sleep medication
Ans: 3 Rationale: The first step toward resolution of posttraumatic stress disorder (PTSD) is the client's readiness (ability and willingness) to discuss the details of the traumatic event without experiencing high levels of anxiety. The nurse must assess clients with PTSD for their readiness to talk about the experience and encourage them to discuss the trauma at their own pace. The nurse should also use active listening as a therapeutic approach to build trust and allow clients to vent. This will assist in decreasing their feelings of isolation. The nurse can also guide the client in identifying event details that are most troubling and trigger a sense of loss of control. The effectiveness of the client's coping mechanisms can be identified, and alternate strategies to replace maladaptive ones can be explored.
Clients with post-traumatic stress disorder have periods of ________ and ______ during which they can be a danger to themselves or others.
extreme anxiety and emotional arousal
therapeutic communication techniques
listening: Lean forward, maintain eye contact, nod appropriately restating: "You say that your coworkers never invite you to lunch." broad openings: "What are you contemplating now?" clarification: "I'm not sure I understand. Could you repeat that?" reflection: "You're feeling anxious because of your job?" sharing perceptions: "You say that you don't care, but I sense that you are upset." suggesting: "Have you considered using sleep hygiene techniques?" focusing: "I think we should talk more about the pain you have." theme identification: "I've noticed that you fear areas with crowds."
Clients who suffer from PTSD often experience feelings of guilt and shame; they believe that they are responsible for what happened and that, somehow, they could have prevented the traumatic event. Using _________ the nurse needs to convey that what happened was not their fault.
therapeutic communication