Chapter 13 Psych nursing
3. 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.
11. 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 automobileñpedestrian 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) ìTell me what you saw.î B) ìThat is horrible!î C) ìWhy did you perform CPR?î D) ìI know how you feel; the same thing happened to me several years ago and I never recovered.î
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. ìThat is horrible,î is a judgment and is not likely to be helpful. ìWhy did you perform CPR,î might make the colleague feel defensive. ìI know how you feel; the same thing happened to me several years ago and I never recovered,î is nonsupportive and robs the colleague of any hope that he or she will recover.
7. 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.
14. 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.
17. 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.
8. 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. 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.
13. 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.
9. 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
Ans: A, B, D 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.
6. 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.
1. 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 equilibriumóperhaps even enhanced coping as a result of dealing with the event.
4. 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) Posttraumatic 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.
12. 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.
5. Which of the following would the nurse know are the major elements of posttraumatic 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.
16. 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 ìI'm fine, I'm over it.î 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.
2. 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.
15. 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.
10. 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.