Chapter 19 - Trauma & Stressor Related Disorders

John, a veteran of the war in Iraq, is diagnosed with PTSD. He experiences a nightmare during his first night in the hospital. He explains to the nurse that he was dreaming about gunfire all around and people being killed. Which of the following is the nurse's most appropriate initial intervention? a. Administer alprazolam as ordered prn for anxiety. b. Call the physician and report the incident. c. Stay with John and reassure him of his safety. d. Have John listen to a tape of relaxation exercises.

C

Nina has been hospitalized with adjustment disorder with depressed mood following the breakup of her marriage. Which of the following is true regarding the diagnosis of adjustment disorder? a. Nina will require long-term psychotherapy to achieve relief. b. Nina likely inherited a genetic tendency for the disorder. c. Nina's symptoms will likely remit once she has accepted the change in her life. d. Nina probably would not have experienced adjustment disorder if she had a higher level of intelligence.

C

Which of the following may be influential in the predisposition to PTSD? a. Unsatisfactory parent-child relationship b. Excess of the neurotransmitter serotonin c. Distorted, negative cognitions d. Severity of the stressor and availability of support systems

D

John, a veteran of the war in Iraq, is diagnosed with PTSD. Which of the following therapy regimens would most appropriately be ordered for John? a. Paroxetine and group therapy b. Diazepam and implosion therapy c. Alprazolam and behavior therapy d. Carbamazepine and cognitive therapy

A

Shane, a patient diagnosed with PTSD tells the nurse that his social worker is recommending EMDR and asks the nurse to describe this treatment. Which of these is the most accurate response? a. EMDR is a therapy designed to help you process thoughts and emotions related to the trauma you've experienced. b. EMDR is a treatment to cure insomnia using hypnosis. c. EMDR is a treatment that uses electrical stimulation to induce a seizure and is beneficial in relieving depression associated with PTSD. d. EMDR is an acronym that stands for Emotional Motivation to Decrease Responsiveness and it will help you forget the trauma.

A

The physician orders sertraline (Zoloft) for a client who is hospitalized with adjustment disorder with depressed mood. What is this medication intended to do? a. Increase energy and elevate mood b. Stimulate the central nervous system c. Prevent psychotic symptoms d. Produce a calming effect

A

Trauma-informed care is a philosophical approach that includes which of the following principles? (Select all that apply.) a. Nurses need to be aware of the potential for trauma in any patient and provide care that minimizes the risk of revictimization or retraumatization. b. Medications need to be given before any other interventions are considered. c. Trauma-informed care highlights the importance of providing care that protects the physical, psychological, and emotional safety of the patient. d. Trauma-informed care is based on the principle that traumas are not correlated with depression or increased risk for suicide.

AC

Nina, who is depressed following the breakup of a very stormy marriage, says to the nurse, "I feel so bad. I thought I would feel better once I left, but I feel worse!" Which is the best response by the nurse? a. "Cheer up, Nina. You have a lot to be happy about." b. "You are grieving the loss of your marriage. It's natural for you to feel bad." c. "Try not to dwell on how you feel. If you don't think about it, you'll feel better." d. "You did the right thing, Nina. Knowing that should make you feel better."

B

Which information will help the nurse differentiate the diagnosis of posttraumatic stress disorder (PTSD) from the diagnosis of adjustment disorder (AD)? 1.PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to "normal" daily events. 2.AD is more common in women, whereas PTSD is more common in men. 3.AD can occur from severe motor vehicle accidents, while PTSD can occur from the birth of a stillborn. 4.PTSD occurs more often when compared to AD.

Answer: 1 1 - PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to "normal" daily events or "less extreme" events, such as being a victim of bullying or being incarcerated. 2 - Both PTSD and AD occur more often in women. 3 - An example of a situation causing PTSD is a severe motor vehicle accident, whereas an example of a situation causing AD is birth of a stillborn. 4 - AD is more common than PTSD. Less than 10% of patients develop PTSD, while research has indicated that AD disorders are quite common.

The client diagnosed with posttraumatic stress disorder (PTSD) has a nursing diagnosis of posttrauma syndrome R/T surviving a workplace shooting. Which nursing intervention would the nurse add to this client's plan of care? 1.Monitor for substance use 2.Alternate staff members 3.Use a firm approach 4.Offer social skill training

Answer: 1 1 - The nurse must monitor for substance use, as this can be a maladaptive form of coping clients with PTSD employ. 2 - The nurse should assign the same staff as often as possible to facilitate a trusting relationship, as post-trauma clients may be suspicious of others. 3 - The nurse should use a nonthreatening, matter-of-fact, but friendly approach, not a firm approach, for clients with PTSD. 4 - In clients with PTSD, the issue is not social skill training but establishing adaptive coping strategies and finding their "place" in the world following the trauma.

The nursing instructor is explaining the etiology of trauma-related disorders from a learning theory perspective. Which student statement indicates teaching has been effective? 1."How clients perceive events and view the world affects their response to trauma." 2."Psychic numbing in PTSD is a result of negative reinforcement." 3."The individual becomes addicted to the trauma owing to an endogenous opioid response." 4."Believing that the world is meaningful and controllable can protect an individual from PTSD."

Answer: 2 1 - This statement indicates that further education is necessary. This statement describes cognitive theory, not learning theory. 2 - This statement indicates effective teaching. Learning theorists view negative reinforcement as behavior that leads to a reduction in an aversive experience, thereby reinforcing and resulting in repetition of the behavior. Psychic numbing decreases or protects an individual from emotional pain and, therefore, the learned response is the repetition of this behavior. 3 - This statement is incorrect, indicating that further teaching is needed. This statement focuses on biological responses, not learning theory. 4 - This statement indicates that teaching has not been effective. This statement describes cognitive theory, not learning theory.

The client has a nursing diagnosis of complicated grieving related to the death of multiple family members from a tornado. Which action should the nurse take first? 1.Encourage the journaling of feelings. 2.Assess for the stage of grief in which the client is fixed. 3.Provide community resources to address the client's concerns. 4.Suggest attending a grief therapy group.

Answer: 2 1 - While encouraging the client to journal feelings is appropriate, it is not the first action. 2 - Prior to implementing all other nursing interventions presented, the nurse must assess the stage of grief in which the client is fixed. Appropriate nursing interventions are always based on accurate assessments. 3 - While providing community resources is appropriate, it is not the first action the nurse should take. 4 - While grief therapy is important, it is not the first intervention. Grief therapy will come later in the healing process.

As the sole survivor of a roadside bombing, a veteran is experiencing extreme guilt. Which nursing diagnosis would address this client's symptom? 1.Anxiety 2.Altered thought processes 3.Complicated grieving 4.Altered sensory perception

Answer: 3 1 - Although the client may also experience anxiety, the symptom presented in the question is extreme guilt. 2 - There is no evidence presented in the question to indicate altered thought processes. 3 - The client's survivor guilt is disrupting the normal process of grieving, indicating complicated grieving as the nursing diagnosis. 4 - There is no evidence presented in the question to indicate altered sensory perception.

The nurse is describing the Transactional Model of Stress and Adaptation. When using this model, which factor would the nurse categorize as intrapersonal? 1.Occupational opportunities 2.Economic conditions 3.Degree of flexibility 4.Availability of social supports

Answer: 3 1 - Occupational opportunities are categorized as situational, not intrapersonal. 2 - Economic conditions would not be categorized as intrapersonal. Economic conditions are classified as situational factors. 3 - Degree of flexibility is an intrapersonal factor in this model. Intrapersonal factors that might influence an individual's ability to adjust to a painful life change include social skills, coping strategies, the presence of psychiatric illness, degree of flexibility, and level of intelligence. 4 - Availability of social supports would be categorized as situational, not intrapersonal.

Which action would the nurse take to provide trauma-informed care to a homeless client who is combative? 1.Place the client in seclusion 2.Apply soft wrist restraints 3.Allow the client some control 4.Encourage dependent behavior

Answer: 3 1 - Placing the client in seclusion is the last resort and is avoided because it can retraumatize the client. This action is not reflective of trauma-informed care. 2 - Applying restraints is not reflective of trauma-informed care. Applying restraints can retraumatize the client with a history of trauma. 3 - Empowering the trauma survivor to guide and direct his or her recovery plan by providing input is reflective of trauma-informed care. 4 - Encouraging dependent behavior is not reflective of trauma-informed care. The goal is to rebuild a sense of hope, control, and empowerment, not dependency.

The client is receiving eye movement desensitization and reprocessing (EMDR) treatments. The nurse is most likely caring for which client? 1.One with schizophrenia 2.One with borderline personality disorder 3.One with manic episodes 4.One with posttraumatic stress disorder

Answer: 4 1 - EMDR is not used for schizophrenia. 2 - EMDR has not been approved for use with borderline personality disorders. 3 - While EMDR has been used for depression, it has not been empirically validated for manic episodes. 4 - EMDR is used for posttraumatic stress disorder (PTSD). It has been used for depression, adjustment disorder, phobias, addictions, generalized anxiety disorder, and panic disorder, but it has only been empirically validated for PTSD.

Which clinical presentation is associated with the most commonly diagnosed adjustment disorder (AD)? 1.Anxiety, feelings of hopelessness, and worry 2.Truancy, vandalism, and fighting 3.Nervousness, worry, and jitteriness 4.Depressed mood, tearfulness, and hopelessness

Answer: 4 1 - This clinical presentation is associated with adjustment disorder with mixed anxiety and depressed mood, which is not the most commonly diagnosed adjustment disorder. 2 - Truancy, vandalism, and fighting are associated with adjustment disorder with disturbance of conduct, which is not the most commonly diagnosed adjustment disorder. 3 - Nervousness, worry, and jitteriness are associated with adjustment disorder with anxiety, which is not the most commonly diagnosed adjustment disorder. 4 - AD with depressed mood is the most commonly diagnosed adjustment disorder. The clinical presentation is one of predominant mood disturbance, although less pronounced than that of major depression. The symptoms—such as depressed mood, tearfulness, and feelings of hopelessness—exceed what is an expected or normative response to an identified stressor.

Nina recently left her husband of 10 years. She was very dependent on her husband and is having difficulty adjusting to an independent lifestyle. She has been hospitalized with a diagnosis of adjustment disorder with depressed mood. Which of the following is the priority nursing diagnosis for Nina? a. Risk-prone health behavior related to loss of dependency b. Complicated grieving related to breakup of marriage c. Ineffective communication related to problems with dependency d. Social isolation related to depressed mood

B

The nurse is teaching about trauma- and stressor-related disorders. Which statement by one of the staff members indicates that follow-up instruction is needed? 1."The trauma that women experience is more likely to be sexual assault and child sexual abuse." 2."The trauma that men experience is more likely to be accidents, physical assaults, combat, or viewing death or injury." 3."After exposure to a traumatic event, less than 10 percent of victims develop posttraumatic stress disorder (PTSD)." 4."Research shows that PTSD is more common in men than in women."

Answer:4 1 - This statement indicates that teaching has been effective and no further instruction is needed. 2 - This statement is correct, indicating that no further teaching is needed. 3 - This statement is accurate, indicating the teaching has been effective. 4 - This statement indicates a need for further instruction. Research shows that PTSD is more common in women than in men.

John, a veteran of the war in Iraq, is diagnosed with PTSD. He says to the nurse, "I can't figure out why God took my buddy instead of me." From this statement, the nurse assesses which of the following in John? a. Repressed anger b. Survivor's guilt c. Intrusive thoughts d. Spiritual distress

B

Emma, age 16, has recently been diagnosed with diabetes mellitus. She must watch her diet and take an oral hypoglycemic medication daily. She has become very depressed, and her mother reports that Emma refuses to change her diet and often skips her medication. Emma has been hospitalized for stabilization of her blood sugar. The psychiatric nurse practitioner has been called in as a consultant. Which of the following nursing diagnoses by the psychiatric nurse would be a priority for Emma at this time? a. Anxiety related to hospitalization evidenced by noncompliance b. Low self-esteem related to feeling different from her peers evidenced by social isolation c. Risk for suicide related to new diagnosis of diabetes mellitus d. Risk-prone health behavior related to denial of seriousness of her illness evidenced by refusal to follow diet and take medication

D