Chapter 29 - Trauma- and Stressor-Related Disorders: Nursing Care of Persons with Posttraumatic Stress and Other Trauma-Related Disorders

A nurse in the emergency department (ED) is aware that seven people were involved in a construction accident and one person was killed. Which intervention is a priority health promotion strategy for the survivors?

A) Enhance resilience

B) Provide family therapy

C) Promote safety in the workplace

D) Address substance abuse patterns

A

A nurse receives a referral from a health care provider to assess a military veteran for posttraumatic stress disorder (PTSD). The client is currently working as a civilian doing security work and consistently avoids patrolling areas that are reminders of past trauma. When forced to complete these aspects of surveillance work, the client displays hyperarousal including mild aggression. Which question by the nurse is fundamental for the assessment?

A) "Have you been avoiding any duties at work?"

B) "Describe your sleep habits over the past few months"

C) "Tell me more about your experiences in the Middle East."

D) "What are the triggers for your aggressive outbursts at work"

B

A client informs the nurse that while on vacation at a theme park, the sound of fireworks triggered an intense reminder of a house fire experienced as a child. The client describes experiencing the smells from the fire, choking sensations, burning eyes, and images of the flames destroying the insides of the home. Which symptom is experienced by the client?

A) Flashback

B) Dissociation

C) Hallucination

D) Derealization

A

A nurse is teaching a family about altered thinking patterns with posttraumatic stress disorder (PTSD). Which pattern is accurate regarding the thinking of a client who has PTSD?

A) Trust of people

B) Expressions of joy

C) Grandiose perceptions

D) Negative personal beliefs

D

The nurse assesses a 6-year-old child for posttraumatic stress disorder (PTSD). The caregiver explains that the child witnessed the mother being stabbed by a neighbor. Which behavior is consistent with the child's diagnosis?

A) A 2-week history of depressed mood

B) A 2-week history of resistance to attend school

C) A 2-month history of excessive interest in violent games

D) A 2-month history of angry outbursts with minor provocation

D

An adult client with a history of PTSD is brought to the emergency department (ED). The client was startled by a dog while out for a walk and kicked it. The client was calm and apologetic when presenting to the triage nurse. Which intervention is a priority for the nurse?

A) Observe in a locked interview room.

B) Explore the origins of the client's PTSD.

C) Administer a benzodiazepine medication.

D) Identify risks for self-harm and aggression.

D

A sexual assault survivor diagnosed with posttraumatic stress disorder is brought to the emergency department following an overdose. Which statement by the nurse assists with the development of a therapeutic relationship?

A) "Why did you overdose?"

B) "I'd like to understand the details about your rape."

C) "You've been hurt ... I'd like to give you an opportunity to share with me."

D) "I have some coping strategies to suggest for people who have been raped."

C

The nurse caring for a client diagnosed with posttraumatic stress disorder (PTSD) targets an approach consistent with trauma-informed care. The nurse works collaboratively with the client to achieve which outcome?

A) Understand the client's behaviors.

B) Determine the client's symptoms of the condition.

C) Respect the client's meaning of the traumatic experience.

D) Clarify the client's decisions that contributed to the trauma.

C

The nurse is assessing a client diagnosed with posttraumatic stress disorder (PTSD). Which symptom would the nurse categorize as reflecting intrusion? Select all that apply.

A) Irritability

B) Difficulty sleeping

C) Flashbacks

D) Short-term memory deficits

E) Aggressive behavior

B,C

The nurse in an occupational health setting assesses an employee's capacity to withstand the stress of working in a country affected by famine and civil war. Which factors support the client's resiliency? Select all that apply.

A) Living in foster care as an infant

B) Adaptive problem-solving ability

C) Supportive family and community

D) Parents/caregivers with substance use disorder

E) Parenting with authoritative versus permissive or indifferent style

B,C,E

A nurse is assessing a child for risk for trauma and stress-related disorders. Which areas are important for the nurse to ask about? Select all that apply.

A) Incarceration of a parent

B) Childhood physical abuse

C) Unexpected death of a family member

D) Consistent parenting reinforcing established rules

E) Childhood exposure to mother experiencing violence

A,B,C,E

The nurse is assessing an older adult client who was involved in a traffic accident. The client's brother dies in the accident. Which are the priority assessment areas? Select all that apply.

A) Having a sense of humor

B) Past exposure to trauma

C) Past sexual abuse history

D) Previous death of family members

E) Participation in a weekly social group

B,C,D

A nurse is teaching a client about how traumatic events affect a person. Which examples are included in the teaching plan? Select all that apply.

A) Witnessing a fatal shooting

B) Having family responsibilities

C) Being trapped inside a capsized boat

D) Observing cultural or religious traditions

E) Receiving word of a terrorist attack in a nearby community

A,C,E

A nurse is caring for a child diagnosed with posttraumatic stress disorder (PTSD). Which assessments are a priority? Select all that apply.

A) Poverty of speech

B) Hair pulling or eating wall board material

C) Acting out a traumatic event through play

D) Bedwetting after a previous pattern to using a toilet

E) Increased dependence and need for attention from caregivers

A,D,E

A client who was raped while a student at college seeks support from a nurse. Which responses are consistent with the client's experience? Select all that apply.

A) Feeling numb in social situations with men

B) Establishing emotional awareness with men

C) Seeking intimate social experiences with men

D) Listening attentively during conversations with men

E) Experiencing memory gaps while at social events with men

A,E

Which common signs and symptoms would a nurse assess to determine hyperarousal in a client with PTSD? Select all that apply.

A) Interrupted sleep

B) Urges to defecate

C) Dilation of the pupil

D) Low startle threshold

E) Irritability to mild stimuli

A,D,E

The nurse reviews the medications prescribed for an individual diagnosed with posttraumatic stress disorder (PTSD). Which medications are effective with managing the symptoms of PTSD? Select all that apply.

A) Sertraline

B) Paroxetine

C) Prazosin

D) Risperidone

E) Hydromorphone

A,B,C

A client diagnosed with posttraumatic stress disorder (PTSD) is brought to the nurse in a primary care setting with lower back pain after falling from a ladder. The client became aggressive with a partner before agreeing to come to the setting. The nurse smells alcohol on the person's breath and the client does not make eye contact or respond openly to assessment questions. Which assessment is a priority for the nurse? Select all that apply.

A) Risk for self-injury

B) Risk for aggression

C) Risk for substance abuse

D) Risk for sexual dysfunction

E) Risk for body image disturbance

A,B,C

A client diagnosed with posttraumatic stress disorder (PTSD) is hospitalized on a medical unit due to unstable blood sugars. The nurse identifies a sleep pattern disturbance in the client's admission documentation. Which consistent problems are associated with a sleep pattern disturbance? Select all that apply.

A) Narcolepsy

B) Nightmares

C) Difficulty falling asleep

D) Being easily startled and awakened

E) Difficulty arousing from sleep

B,C,D