Mental Health 29- Trauma

A nurse's colleague expresses sympathy for a client who is traumatized following a terrorist attack 1 week earlier. The colleague states, "I'm certain that the client has posttraumatic stress disorder (PTSD)." What is the nurse's best response? "It's more likely that the client is experiencing anxiety, which will likely decrease with time." "If the client doesn't receive treatment right away, the client might not recover from the PTSD." "Acute stress disorder is a possibility, which might develop into PTSD." "Actually, she won't meet the diagnostic criteria for PTSD until 3 months after the attack."

"Acute stress disorder is a possibility, which might develop into PTSD."

A psychiatric nurse is assessing a client with post-traumatic stress disorder (PTSD). During the psychosocial component of the assessment, what assessment question should the nurse include? "Do you feel like treatment has been beneficial so far?" "Have you been having any side effects from your medication?" "How would describe the quality of your sleep these days?" "How are your symptoms affecting your day-to-day routines?"

"How are your symptoms affecting your day-to-day routines?"

Which statement made by a client diagnosed with posttraumatic stress disorder (PTSD) leads the nurse to believe the client is experiencing dissociative symptoms? "I feel guilty that I survived the attack and my friend didn't." "It's like I'm having flashbacks every time I fall asleep." "Loud noises always make me a little jittery now." "I describe my feelings like I'm having an out-of-body experience."

"I describe my feelings like I'm having an out-of-body experience."

The nurse includes information regarding methods to enhance sleep for a client who experiences insomnia due to posttraumatic stress disorder (PTSD). Which client statement indicates a need for additional teaching regarding sleep hygiene? "I have found that drinking a glass or two of wine every night helps me to fall asleep." "I will maintain the same sleep schedule 7 days a week." "I will avoid taking naps during the day." "I will avoid caffeinated beverages during the late afternoon and early evening hours."

"I have found that drinking a glass or two of wine every night helps me to fall asleep."

The medical-surgical nurse has worked with numerous clients who have had difficult and stressful courses of treatment. What client likely faces the greatest risk for developing post-traumatic stress disorder? A client whose chronic kidney disease requires hemodialysis three times per week A client with a recent diagnosis of type 1 diabetes who is just learning to use an insulin pump A client who required a skin graft as a result of an infected surgical incision A child who has endured repeated treatments for cancer over multiple admissions

A child who has endured repeated treatments for cancer over multiple admissions

Which of the following individuals should the nurse screen most closely for signs and symptoms of post-traumatic stress disorder (PTSD)? A postpartum client who was intent on having a vaginal birth but who required an emergency cesarean section A recent immigrant who is navigating the health care system alone and who does not speak English A female client who has recently escaped from a relationship marked by intimate partner violence A client with a gastrointestinal bleed who experienced a transfusion reaction after receiving packed red blood cells

A female client who has recently escaped from a relationship marked by intimate partner violence

Three years after the nurse's father died in an intensive care unit, the nurse was reviewing a client's chart. The nurse looked at the client, who had the same diagnosis and similar features to the nurse's father. The nurse felt a sense of panic but quickly realized that the client in the bed was not their father. Which of these manifestations of PTSD did this nurse experience? Hyperarousal A flashback A dream Emotional numbing

A flashback

The nurse is providing continuing care to a client who has experienced significant trauma. When assessing the client throughout the course of care, the nurse would be alert for signs and symptoms associated with condition related to the trauma? Select all that apply. Adjustment disorder Posttraumatic stress disorder Eating disorder Reactive attachment disorder Acute stress disorder

Acute stress disorder Posttraumatic stress disorder Adjustment disorder Reactive attachment 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 posttraumatic stress disorder? An adolescent who began smoking in the weeks after discovering a dead body in a park An adolescent who states "I've lost my soulmate" after the death of a boyfriend or girlfriend in an accident An adolescent who has committed uncharacteristic acts of violence since the death of the adolescent's mother An adolescent who often redirects the conversation to the subject of the adolescent's sister's death

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

The 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's most appropriate action? Assess the client for signs and symptoms associated with post-traumatic stress disorder Educate the family about the usual emotional responses to returning home from military service Educate the family about the relationship between hyperarousal and emotional distance Organize a family meeting where family members can tell the client how they feel

Assess the client for signs and symptoms associated with post-traumatic stress disorder

The psychiatric mental health nurse is working with a client who has been diagnosed with posttraumatic stress disorder (PTSD). Assessment reveals that the client is experiencing frequent episodes of intrusion. The nurse should consequently prioritize what assessment? Assessing the client's communication skills Assessing the client's vital signs Assessing the quality of the client's support network Assessing the quantity and quality of the client's sleep

Assessing the quantity and quality of the client's sleep

A nurse is reviewing the medical records of several clients who have come to the community health center. The nurse would most likely identify a client experiencing which event as being at risk for developing posttraumatic stress disorder (PTSD)? Select all that apply. Watching televised segments of the moment when the plane hit the second tower on 9/11 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 Being hidden in a closet and hearing the entire family murdered by someone who broke into the home Being stranded at the office during a typical winter storm that was anticipated

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 Being hidden in a closet and hearing the entire family murdered by someone who broke into the home

Which statement regarding posttraumatic stress disorder (PTSD) and children is accurate? Children who were abused during childhood are more likely to be diagnosed with obsessive-compulsive disorder rather than PTSD. Best practices demonstrate that adolescents who have PTSD are at increased risk of drug abuse. In a family unit where one child is diagnosed with cancer, all the children in the household are at increased risk for developing PTSD. The risk of developing PTSD following leukemia treatment is about the same as all children of the same age.

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 Decreased risk for personality disorders Decreased risk for somatic symptom disorders Hyperarousal and enhanced coping for participants

Enhanced resilience for the participants

The nurse is providing care for a client whose history of intimate partner violence has resulted in posttraumatic stress disorder (PTSD). The client has few friends and states that the client is estranged from the client's family. How can the nurse best enhance the client's social support? Facilitate the client's participation in a support group Facilitate a meeting between the client and the client's family members Encourage the client to make new friends Provide the client with educational resources that promote the client's self-worth

Facilitate the client's participation in a support group

When lecturing about dissociative disorders to a group of nursing students, a nurse states that an essential feature of these disorders involves what? Disinhibited social engagement, being overly friendly with strangers Total amnesia of the events that caused the disorder Overuse of sedatives like alcohol Failure to integrate identity, memory, and consciousness

Failure to integrate identity, memory, and consciousness

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

In PTSD, the symptoms occur 3 months or more after the trauma.

A client with post-traumatic stress disorder (PTSD) tells the nurse, "Every morning I wake up with a vicious hangover and swear I'll never drink like that again. Yet, every night I some how end up at the bar." The nurse should consider the possibility of what nursing diagnosis? Ineffective impulse control Complicated grieving Defensive coping Impaired social interaction

Ineffective impulse control

A client with posttraumatic stress disorder (PTSD) has begun to stay out late every night and "party" with their friends. When family members ask about when the client is going to return to work, they become extremely irritated and verbal lashes out, saying some very hurtful things. The priority NANDA for this client would be which of the following? Ineffective impulse control Anxiety Ineffective activity planning Risk of relocation stress syndrome

Ineffective impulse control

A client with a history of intimate partner violence has been diagnosed with posttraumatic stress disorder. The client is wholly unwilling to discuss any aspects of personal history or current mental status with the nurse. What is the nurse's best initial action? Arrange for the client to receive cognitive processing therapy Avoid communicating with the client until the client initiates Facilitate cognitive restructuring therapy Make efforts to demonstrate empathy to the client

Make efforts to demonstrate empathy to the client

When caring for a client who is experiencing the symptomology of acute stress disorder, the nurse recognizes the importance of minimizing the client's risk for developing which condition? Emotional numbness Dissociative amnesia Posttraumatic stress disorder Paranoia

Posttraumatic stress disorder

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. Occuring 2 weeks after the trauma Showing emotional numbing such as feeling detached from others Feeling mildly anxious Being on guard, irritable, or experiencing hyperarousal Reexperiencing the trauma through dreams or recurrent and intrusive thoughts

Reexperiencing the trauma through dreams or recurrent and intrusive thoughts Showing emotional numbing such as feeling detached from others Being on guard, irritable, or experiencing hyperarousal

The nurse is performing a physical health assessment of a client who has been diagnosed with posttraumatic stress disorder (PTSD). What aspect of this assessment should the nurse prioritize? Sleep assessment Nutrition assessment Bowel sounds and last bowel movement Respiratory rate and breath sounds

Sleep assessment

Eight months ago, a client was in a hotel fire and was the last person to be rescued from the roof. The client watched the client's spouse burn to death from the helicopter. The client continues to have nightmares and is fearful that the client will die in a fire. An appropriate nursing diagnosis for the client is what? Anxiety related to illusions Sleep pattern disturbance related to recurrent nightmares Unrealistic fear of fire related to conversion reaction Ego disintegration related to severe anxiety

Sleep pattern disturbance related to recurrent nightmares

A college student who was the victim of an attempted sexual assault has sought care due to anxiety that is affecting every aspect of the client's life. Which characteristic of the client's situation and the client's anxiety would suggest a diagnosis of posttraumatic stress disorder (PTSD) rather than acute stress disorder? Complementary and alternative therapies have failed to resolve the client's anxiety. The attack took place several months ago, and the client's anxiety has been continuous. The attack was an isolated, rather than ongoing, event. Concerns for the client's safety have caused the client to change daily routines.

The attack took place several months ago, and the client's anxiety has been continuous.

The nurse is interviewing a client who witnessed a fatal accident at the workplace and was unable to save a colleague. What assessment findings would support a diagnosis of posttraumatic stress disorder (PTSD)? Select all that apply. Management is blaming the client for the accident The accident took place 2 weeks ago The client says the client is "unable to face that place again" The client says the client's family describes the client now as "edgy" and "irritable" The client has nightmares about the accident

The client has nightmares about the accident The client says the client is "unable to face that place again" The client says the client's family describes the client now as "edgy" and "irritable"

The nurse is interviewing a client who has been diagnosed with posttraumatic stress disorder (PTSD) after being randomly attacked with a gun. The client describes a recent event where the client panicked and jumped for cover when a car backfired on the street. How should the nurse best interpret this event? The client experienced an episode of derealization The client temporarily dissociated with the traumatic event The client is experiencing hyperarousal The client lacks effective coping strategies

The client is experiencing hyperarousal

A client with a diagnosis of posttraumatic stress disorder (PTSD) tells the nurse, "When things get really bad, it sometimes feels like I'm not even in my body, like I'm floating around and watching myself." How should the nurse best interpret this client's statement? The client's perception is a result of hyperarousal and sympathetic nervous stimulation There is a need for constant supervision because of heightened suicide risk The client is likely experiencing depersonalization as a result of PTSD The client is likely to require temporary inpatient treatment

The client is likely experiencing depersonalization as a result of PTSD

A male combat veteran with a diagnosis of post-traumatic stress disorder has been prescribed prazosin. What outcome would most clearly indicate the effectiveness of this treatment? The client reports greater energy for accomplishing daily tasks. The client's family describes him as "more relaxed". The client states that he is more willing to discuss his trauma. The client reports fewer and less intense nightmares.

The client reports fewer and less intense nightmares.

The psychiatric mental health nurse is assessing a client who was diagnosed with posttraumatic stress disorder (PTSD) after the death of the client's child from a medical error. What assessment finding would most warrant interventions aimed at addressing the client's dissociation? The client reports crying at unpredictable times The client reports large gaps in memory of the traumatic event The client states that the client has been neglecting business in recent weeks The client's family members describe the client as irritable and agitated

The client reports large gaps in memory of the traumatic event

The nurse is dialoguing with a client who has been referred after witnessing a workplace accident several weeks ago that resulted in a coworker's death. What assessment finding would support a diagnosis of posttraumatic stress disorder (PTSD)? The client states that the client is often "awake for hours and hours each night." The client's work performance has suffered after the event. The client had to take several sick days in the days after the event. The client avoided the coworker's family in the days after the event.

The client states that the client is often "awake for hours and hours each night."

A psychiatric-mental health nurse is developing a plan of care for a client who has survived trauma. Which outcomes would the nurse identify as the immediate priorities? Select all that apply. The client will establish a social support system in the community. The client will distinguish between ideas of self-harm and taking action on those ideas. The client will demonstrate healthy, effective ways of dealing with the stress. The client will express emotions nondestructively. The client will be physically safe.

The client will be physically safe. The client will distinguish between ideas of self-harm and taking action on those ideas.

A client who has been diagnosed with post-traumatic stress disorder is scheduled to begin stress inoculation training. The nurse should document what desired outcome related to this therapy? The client will express a willingness to visit the site of the trauma The client will acknowledge his diagnosis to family and close friends The client will demonstrate anxiety-reduction strategies The client will use benzodiazepines and SSRIs safely

The client will demonstrate anxiety-reduction strategies

A client who is being treated for posttraumatic 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's statement? The client's emotional numbing is a protective mechanism The client would likely benefit from anxiolytic medications The client has unrealistic expectations of his level of emotional functioning The client's depersonalization is an ominous sign

The client's emotional numbing is a protective mechanism

The nurse is assessing a client who was sexually assaulted several months ago and who has subsequently developed posttraumatic stress disorder (PTSD). The nurse observes that the client's nonverbals are closed and the client is reluctant to engage with the nurse. How should the nurse best interpret this client's behavior? The client's PTSD is affecting the client's cognition and information processing The client has likely had a series of negative interactions with health providers The client's trauma likely has an impact on the client's ability to trust The client has likely responded poorly to prior treatments

The client's trauma likely has an impact on the client's ability to trust

A client has developed posttraumatic stress disorder (PTSD) after a violent sexual assault committed by a close family member. When planning this client's care, the nurse should follow what guideline? The nurse should avoid touching the client during interactions unless necessary The nurse should ensure that a colleague is present when the client is assessed The nurse should encourage limiting contact with friends and family until the client's mood improves The nurse should encourage the client to use progressive relaxation techniques rather than prescribed medications

The nurse should avoid touching the client during interactions unless necessary

A nurse is contributing to the interdisciplinary care plan for a client who has been diagnosed with PTSD. Which should be included in the care plan? Education to the client about appropriate social interactions Vigilant monitoring for potential indications of self-harm Frequent assessment for delusional thinking or hallucinations Administration of monoamine oxidase inhibitors (MAOIs) as prescribed

Vigilant monitoring for potential indications of self-harm

A client has been diagnosed with posttraumatic stress disorder (PTSD) after witnessing an explosion at the client's industrial worksite. The client will soon begin exposure therapy, so the nurse should prepare the client for: a visit to a support group created for victims of the tragedy. a family meeting where each member will describe the effects of the client's PTSD. a visit with the therapist to the place where the explosion occurred. a critical examination of the ways the client's PTSD has affected the client's life.

a visit with the therapist to the place where the explosion occurred.

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 (PTSD). The nurse should encourage the client's family to: expect that the client will sleep for short periods of time, several times per day. create social interaction for the client even if the client is actively opposed to socializing. anticipate that the client is likely to be irritable and withdrawn at times. ensure the client takes benzodiazepines at the same time each day.

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

A client with post-traumatic stress disorder is found to have a high propensity for fear. This characteristic is most likely the result of: characteristics of the client's amygdala and hippocampus. pituitary hypofunction combined with overstimulation of the thalamus. deficient levels of the neurotransmitter N-methyl-D-aspartate (NMDA). hypofunction of the client's parasympathetic nervous system.

characteristics of the client's amygdala and hippocampus.

A client who is a bus driver was involved in an accident in which two of her passengers died. The client blames herself for their death even though she was exonerated in the follow-up investigation. To help the client see the event more realistically, the nurse should: discuss the possibility of benzodiazepines with the primary care provider. arrange for the client to receive eye movement, desensitization, and reprocessing (EMDR) therapy facilitate a referral for cognitive restructuring therapy. discuss the possibility of SSRIs with the primary care provider.

facilitate a referral for cognitive restructuring therapy.

A nurse is working with a patient who is experiencing large amounts of stress due to relational, financial, and physiologic factors. The nurse can best enhance this patient's resilience by: assessing the patient's family history of maladaptive coping. helping the patient to think about herself in a positive way. exploring the patient's major childhood events during cognitive-behavioral therapy. connecting the patient with individuals who have similar or greater levels of stress.

helping the patient to think about herself in a positive way.

The nurse is assessing a client who has recently received a diagnosis of posttraumatic stress disorder. When conducting this assessment, the nurse should: try to identify any strengths or skills that can be applied during recovery. prioritize psychological findings over physical findings. corroborate the client's statements with a trusted friend or family member. reassure the client that the client will eventually have a full recovery.

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

A client who experienced serious and repeated traumas has been diagnosed with dissociative identity disorder after being rescued from an abuser. Before caring for this client, the nurse should be prepared for: childlike intellectual development and problem-solving skills. wide variations in the personality that the client exhibits. hostility and possibly violence. states of catatonia alternating with mania.

wide variations in the personality that the client exhibits.