chapter 28: trauma and stressor related disorders

Jane presents in the emergency department with a friend, who reports that Jane has been sitting in her apartment "staring off into space" and doesn't seem interested in doing anything. During the assessment, Jane reveals, with little emotion, that she was raped 4 months ago. Which of these is the most appropriate interpretation of Jane's lack of emotion?

A. Jane is probably hearing voices telling her to be emotionless.

B. Jane is experiencing a numbing of emotional response, which is a common symptom of PTSD.

C. Jane is trying to be secretive, and lying is a common symptom in PTSD.

D. Jane is currently reexperiencing the traumatic event and is having a dissociative episode.

Jane is experiencing a numbing of emotional response, which is a common symptom of PTSD.

Studies have suggested that reexperiencing a traumatic event can become an addiction of sorts. The evidence suggests that the reason for this is which?

A. People with PTSD often have addictive personalities.

B. Perpetuating the traumatic experience yields secondary gains.

C. The reexperiencing of trauma enhances production of endogenous opioid peptides.

D. People with PTSD often have concurrent substance abuse issues.

c. The reexperiencing of trauma enhances production of endogenous opioid peptides.

Sandy, a rape survivor, is being treated for PTSD. Which of these statements are good indications that Sally is beginning to recover from PTSD?

A. "I still have nightmares every night, but I don't always remember them anymore."

B. "I'm not drinking as much alcohol as I had been over the last several months."

C. "This traumatic event immobilized me for a while, but I have found imagery helpful in reducing my anxiety."

D. All of the above

c. "This traumatic event immobilized me for a while, but I have found imagery helpful in reducing my anxiety."

A military veteran who recently returned from active duty in a Middle Eastern country and suffers from PTSD states he will not allow the laboratory technician, who is Iranian, to draw his blood. The patient states, "He'll probably use a contaminated needle on me." Which of these is the most appropriate nursing response by the nurse?

A. "Let me see if I can arrange for a different technician to draw your blood."

B. "Let me help you overcome your cultural bias by letting him draw your blood."

C. "There is no other technician, so you're just going to have to let him draw your blood."

D. "I don't think the technician is really Middle Eastern."

a. "Let me see if I can arrange for a different technician to draw your blood."

Which of these statements by the patient are indications of complicated grieving?

A. "I feel like I should have been the one to die in that hurricane."

B. "Last year, several of my coworkers died in a hurricane and I still can't go back to work."

C. "I've been having incapacitating migraines ever since the memorial services."

D. All of the above

A. "I feel like I should have been the one to die in that hurricane."

B. "Last year, several of my coworkers died in a hurricane and I still can't go back to work."

C. "I've been having incapacitating migraines ever since the memorial services."

All of the above

A patient treated for symptoms of PTSD following a shooting incident at a local elementary school reports, "I feel like there's no reason to go on living when so many others died." Which is the most appropriate response by the nurse now?

A. "You have lots of reasons to go on living."

B. "Are you having thoughts of hurting or killing yourself?"

C. "You're just experiencing survivor guilt."

D. "There must be something that gives you hope."

b. "Are you having thoughts of hurting or killing yourself?"

Major Smith, who is being treated for PTSD symptoms following a course of military duty, reports, "I think I was in denial about even having PTSD. I thought I was just having trouble sleeping." Which of these is an accurate evaluation of the patient's comments?

A. The patient is still in denial and unable to recognize that he is having flashbacks rather than insomnia.

B. The patient is beginning to recognize stages of grieving and reevaluating his symptoms.

C. The patient is beginning to recognize that he may be at risk for suicide.

D. The patient is trying to avoid discussing symptoms of PTSD.

b. The patient is beginning to recognize stages of grieving and reevaluating his symptoms.

Brandy is an 18-year-old being treated in the Community Mental Health Clinic for an adjustment disorder after receiving news of her parents' impending divorce. While talking about her feelings, she becomes angry and starts shouting and crying. She screams, "I wish they would both die!" Which of these is the most appropriate nursing response?

A. Contact the parents and the police to report that Brandy is expressing homicidal ideation.

B. Encourage Brandy to talk more about her anger.

C. Instruct Brandy that it's okay to cry but that it is not acceptable to talk that way about her parents.

D. Assess Brandy for suicidal ideation.

b. Encourage Brandy to talk more about her anger.

Sammy is diagnosed with a trauma disorder and is being treated at an inpatient psychiatric unit. Which nursing short-term goal is most appropriate for Sammy?

A. Sammy resolves all feelings of survivor's guilt within 1 week.

B. Sammy demonstrates three relaxation techniques upon discharge.

C. Sammy moves through all stages of grief within 1 month.

D. Sammy agrees to seek community resources upon admission.

b. Sammy demonstrates three relaxation techniques upon discharge.

Lucia's 8-year-old son went missing 1 year ago. The police have few leads and have lost interest in the case. Lucia visits an outpatient mental health clinic to determine the treatment options available to help her cope with her grief. As Lucia begins speaking with the nurse, she begins sobbing uncontrollably. Which statement made by the nurse demonstrates support of Lucia?

A. "Please don't cry. It will make me cry to see you so upset."

B. "I'll be right back with some tissues and a glass of water."

C. "Kidnapping is a terrible thing, but maybe your son will be returned home."

D. "I think you need a long vacation to help you forget all about this situation."

b. "I'll be right back with some tissues and a glass of water."

A client is diagnosed with PTSD. Which treatment modality exposes the client to repeated and prolonged mental recounting of the traumatic event?

A. Cognitive therapy

B. Prolonged exposure therapy

C. Group therapy

D. Eye movement desensitization and reprocessing

b. Prolonged exposure therapy

A mother brings her son to the emergency department and tells the nurse that her son must have posttraumatic stress disorder (PTSD), because 2 days ago, he witnessed a car accident in which there were fatalities. She is convinced that her son has PTSD because he has been crying when he talks about the incident. She believes that boys are at greater risk for PTSD because they don't typically cry. She read on the Internet that PTSD can have dangerous consequences, so she wants her son to get some medication "to cure the PTSD before it gets too bad." Which of these statements by the nurse would accurately correct this mother's misunderstanding about PTSD? Select all that apply.

A. "There are no long-term or dangerous consequences from PTSD."

B. "Women appear to be at greater risk of this disorder than are men."

C. "Medications have been found to be effective in treating symptoms of depression or anxiety but do not represent a cure for the disorder."

D. "Fewer than 10 percent of trauma victims develop PTSD."

B. "Women appear to be at greater risk of this disorder than are men."

C. "Medications have been found to be effective in treating symptoms of depression or anxiety but do not represent a cure for the disorder."

D. "Fewer than 10 percent of trauma victims develop PTSD."

A patient is admitted to the community mental health center for outpatient therapy with a diagnosis of Adjustment Disorder. Which of the following subjective statements by the patient support this diagnosis? Select all that apply.

A. "I was divorced 3 months ago, and I can't seem to cope."

B. "I was a victim of date rape 15 years ago, when I was in college."

C. "My partner came home last week and told me he just didn't love me anymore."

D. "I failed one of my classes last month and I can't get motivated to register for my next semester."

A. "I was divorced 3 months ago, and I can't seem to cope."

C. "My partner came home last week and told me he just didn't love me anymore."

D. "I failed one of my classes last month and I can't get motivated to register for my next semester."

A military veteran is assessed for outpatient therapy after he reports having problems at home and at work. Which of the symptoms that he describes are commonly associated with PTSD? Select all that apply.

A. "I've been drinking and smoking pot daily."

B. "I've been having trouble sleeping and I think I've been having nightmares but I can't remember them."

C. "I slapped my wife when she was trying to hug me."

D. "I've been having intense pain in the leg where I sustained a combat wound."

A. "I've been drinking and smoking pot daily."

B. "I've been having trouble sleeping and I think I've been having nightmares but I can't remember them."

C. "I slapped my wife when she was trying to hug me."

A patient's wife reports to the nurse that she was told her husband's PTSD may be related to cognitive problems. She is asking the nurse to explain what that means. Which of the following are accurate statements about the cognitive theory as it applies to PTSD? Select all that apply.

A. People are vulnerable to trauma-related disorders when their fundamental beliefs are invalidated.

B. Cognitive theory addresses the importance of how people think (or cognitively appraise) events.

C. Dementia is a common symptom of PTSD.

D. Amnesia is the biggest cognitive problem in PTSD and is the primary cause of trauma-related disorders.

A. People are vulnerable to trauma-related disorders when their fundamental beliefs are invalidated.

B. Cognitive theory addresses the importance of how people think (or cognitively appraise) events.

The nurse who works on an inpatient psychiatric unit is working on developing a treatment plan for a patient admitted with PTSD. The patient, a military veteran, reports that sometimes he thinks he sees bombs exploding and the enemy rushing toward him. He has had aggressive outbursts and was hospitalized after assaulting a coworker during one of these episodes. Which of these nursing interventions are evidence-based responses? Select all that apply.

A. Collaborate with the patient about how he would like staff to respond when he has episodes of reexperiencing traumatic events.

B. Tell the patient it is not appropriate to hit other patients or staff and if that occurs, he will have to be discharged from the hospital.

C. Contact the doctor and recommend that the patient be ordered an antipsychotic medication.

D. Refer the patient to a support group with other military veterans.

A. Collaborate with the patient about how he would like staff to respond when he has episodes of reexperiencing traumatic events.

D. Refer the patient to a support group with other military veterans.

A patient admitted to the hospital with PTSD is ordered the following medications. Which of these medications has a direct use in treating symptoms that are common in PTSD? Select all that apply.

A. Alprazolam (Xanax)

B. Propanolol (Inderal)

C. Docusate sodium (Colace)

D. Docusate (Dulcolax)

A. Alprazolam (Xanax)

B. Propanolol (Inderal)

A patient who is being seen in the community mental health center for PTSD is being considered for EMDR (eye movement desensitization and reprocessing) therapy. The nurse is asked to conduct an assessment to validate the patient's appropriateness for this treatment. Which of the following data, collected by the nurse, are most important to document when determining appropriateness for treatment with EMDR? Select all that apply.

A. The patient has a history of a seizure disorder.

B. The patient has a history of electroconvulsive therapy (ECT).

C. The patient reports suicidal ideation with a plan.

D. The patient has been using alcohol in increasing quantities over the last 3 months.

A. The patient has a history of a seizure disorder.

C. The patient reports suicidal ideation with a plan.

D. The patient has been using alcohol in increasing quantities over the last 3 months.

Joe, a patient being treated for PTSD, tells the nurse that his therapist is recommending cognitive therapy. He asks the nurse how that's supposed to help his nightmares. Which of these responses by the nurse provides accurate information about the benefits of this type of therapy? Select all that apply.

A. "The nightmares may be related to troubling thoughts and feelings; cognitive therapy will help you explore and modify those thoughts and feelings."

B. "It is designed to help you cope with anxiety, anger, and other feelings that may be related to your symptoms."

C. "It is designed to repeatedly expose you to the trauma you experienced so you can regain a sense of safety."

D. "Once you learn to repress these troubling feelings, the nightmares should cease."

A. "The nightmares may be related to troubling thoughts and feelings; cognitive therapy will help you explore and modify those thoughts and feelings."

B. "It is designed to help you cope with anxiety, anger, and other feelings that may be related to your symptoms."

Joshua recently moved into a dormitory to begin his first year in college. The dormitory supervisor reprimanded him for not disposing of food items properly, and he responded by throwing all of his belongings from a second-story window while shouting obscenities. The campus police escorted him to campus health services, where he was diagnosed with an Adjustment Disorder With Disturbance of Conduct. Which of the following items in Joshua's history predispose him to this disorder? Select all that apply.

A. Joshua reports that he doesn't have any friends in the dormitory.

B. Joshua's family currently lives out of the country and is often difficult to reach.

C. Joshua was notified the same day that he would have to withdraw from one of his classes because he didn't have the prerequisite credits needed to register for the class.

D. Joshua has a higher than average grade point average and is a member of the National Honor Society.

A. Joshua reports that he doesn't have any friends in the dormitory.

B. Joshua's family currently lives out of the country and is often difficult to reach.

C. Joshua was notified the same day that he would have to withdraw from one of his classes because he didn't have the prerequisite credits needed to register for the class.

Louisa recently experienced surviving a plane crash and is assessed by the nurse. Which statements made by Louisa indicate that she may be experiencing PTSD? Select all that apply.

A. "I keep having these thoughts about the crash that just pop into my mind at random times."

B. "I am so afraid that I will never be able to fly again. I worry about it constantly."

C. "I have nightmares every night about the crash where I picture myself dying."

D. "I believe that I was meant to survive this accident so that I can focus on the important things in life."

A. "I keep having these thoughts about the crash that just pop into my mind at random times."

B. "I am so afraid that I will never be able to fly again. I worry about it constantly."

C. "I have nightmares every night about the crash where I picture myself dying."

Thomas is a Marine who has recently returned from a military battle in the Middle East. The nurse is assessing Thomas to develop a plan of care. The nurse evaluates the assessment data to determine the variables associated with Thomas's response to trauma. Which variables should the nurse consider to make this determination? Select all that apply.

A. The resources Thomas uses to cope with trauma

B. The outcomes Thomas previously experiences with trauma

C. The location and duration of the traumatic event experienced by Thomas

D. The temperament Thomas displays in the presence of trauma

A. The resources Thomas uses to cope with trauma

B. The outcomes Thomas previously experiences with trauma

D. The temperament Thomas displays in the presence of trauma

George recently lost his wife and two small children in a house fire. George did not return to work after the trauma and thus lost his job. George also withdrew from family and friends. George's pastor reached out and encouraged George to seek psychiatric help, which he did. George is currently a patient at a psychiatric facility. The nurse assigned to George is evaluating the plan of care. Which statements made by George would require the nurse to reevaluate George's care plan? Select all that apply.

A. "I keep going over in my mind what I could have done to prevent the fire."

B. "I know I will see my family again someday. I can feel them watching over me."

C. "I've lost everything and don't wish to be around others, especially if they are happy."

D. "I would like to drink scotch all day until I pass out, so I don't have to feel anything."

A. "I keep going over in my mind what I could have done to prevent the fire."

C. "I've lost everything and don't wish to be around others, especially if they are happy."

D. "I would like to drink scotch all day until I pass out, so I don't have to feel anything."

Samuel, a 19-year-old high school student, has been admitted to the psychiatric unit with a diagnosis of Adjustment Disorder With Disturbance of Conduct. He assaulted a teacher when he was told he was receiving detentions for a pattern of tardiness. The nurse, while completing rounds, finds the patient in his room crying, and one of his wrists is bleeding from a self-inflicted cut made by a piece of metal from an unknown source. Prioritize each of the following nursing interventions from 1 to 5, with 1 being the highest priority.

___ 1. Obtain the patient's vital signs.

___ 2. Assess the wound site.

___ 3. Contact the parents.

___ 4. Discuss with Samuel what precipitated this event.

___ 5. Cleanse and treat the wound site to prevent infection.

3, 1, 5, 4, 2

there’s no way this is right

Natalia is a 38-year-old Army sergeant who has been admitted to the psychiatric unit with a diagnosis of PTSD. Natalia witnessed her combat partner step on an explosive device that caused the combat partner's body to explode. Natalia tells the nurse that she has a headache and is going to stay in her room instead of going to the dining room for dinner. When the nurse later checks on Natalia, she finds her on the bathroom floor. The nurse quickly determines that Natalia is not conscious. Prioritize each of the following nursing interventions from 1 to 5, with 1 being the highest priority.

___ 1. Begin cardiopulmonary resuscitation (CPR).

___ 2. Assess airway, breathing, and circulation.

___ 3. Notify the patient's family.

___ 4. Cut down the patient.

___ 5. Call for help.

4, 2, 5, 1, 3

da fuk is cut down the pt? SHe’s on the bathroom floor?

According to NANDA (2012), a disorder that occurs after the death of a significant other or any loss perceived as significant to the individual, in which the experience of distress accompanying bereavement fails to follow normative expectations and manifests in functional impairment, is referred to as __________ __________.

complicated grieving

Joe, who recently lost both parents in a tragic automobile accident, has been diagnosed with an adjustment disorder after he struck a friend who told him he needed to "get his feelings out." The stage of grieving that Joe is struggling with is ____________________.

anger

Exposure to trauma has been associated with hyperarousal of the sympathetic nervous system, excessive amygdala activity, and decreased volume of the ____________________.

hippocampus

A sustained maladaptive response to a traumatic, overwhelming event is defined as ____________________.

post-trauma syndrome

Susan is diagnosed with PTSD and informs the nurse that she is experiencing nightmares. The pharmacological intervention that will most benefit Susan is ____________________.

prazosin (Minipress)

Prazosin