Chapter 28. Trauma- and Stressor-Related Disorders

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

1. The client is probably hearing voices telling her to be emotionless.

2. The client is experiencing a common symptom of numbing of emotional response.

3. The client is attempting to be secretive and lying, which are common symptoms in posttraumatic stress disorder (PTSD).

4. The client is having a dissociative episode and revisiting the traumatic event.

ANS 2. The client is experiencing a common symptom of numbing of emotional response.

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

1. Those with addictive personalities tend to experience PTSD more often.

2. Perpetuating the traumatic experience yields secondary gains.

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

4. Concurrent substance abuse issues are symptoms of PTSD

ANS 3. The reexperiencing of trauma enhances production of endogenous opioid peptides.

The client, a rape survivor, is being treated for PTSD. Which of these statements is a good indication that the client is beginning to recover from PTSD?

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

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

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

4. "Whenever I am reminded of the rape, I have to hide until the memory goes away."

ANS 3. "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 that he will not allow the laboratory technician, who is Iranian, to draw his blood. The client states, "He'll probably use a contaminated needle on me." Which of these is the most appropriate nursing response by the nurse?

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

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

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

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

ANS 1. "Let me see if I can arrange for a different technician to draw your blood."

The nurse is conducting a grief counseling session for those who have survived a national disaster. Which of the following group member statements shows effective resolution of their complicated grief?

1. "Had I not taken that phone call away from them, I could have saved them."

2. "I only wish I did not call in sick so I could have died with them."

3. "I cannot drive past the building without crying."

4. "I have started to jog every day to help get rid of this tense energy."

ANS 4. "I have started to jog every day to help get rid of this tense energy."

A client 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 are dead." Which is the most appropriate response by the nurse now?

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

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

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

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

ANS 2. "Are you having thoughts of hurting or killing yourself?"

The nurse discovers that the client who has been admitted to the facility with depression has been a victim of childhood trauma. The nurse reports this discovery to the health-care provider and the staff. What is the rationale for the nurse to inform the staff of the trauma?

1. Interventions that may mimic the childhood trauma may retraumatize the adult client.

2. The client may start to act out during group sessions.

3. The client may have other underlying health concerns.

4. This should be a part of the family therapy session

ANS 1. Interventions that may mimic the childhood trauma may retraumatize the adult client.

The client is an 18-year-old college student 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?

1. Contact the parents and the police to report that the client is expressing homicidal ideation.

2. Encourage the client to talk more about her anger.

3. Instruct the client that it is not acceptable to talk that way about her parents.

4. Assess the client for harming herself or others.

ANS 2. Encourage the client to talk more about her anger.

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

1. The client resolves all feelings of survivor's guilt within 1 week.

2. The client demonstrates three relaxation techniques upon discharge.

3. The client moves through all stages of grief within 1 month.

4. The client agrees to seek community resources upon admission.

ANS 2. The client demonstrates three relaxation techniques upon discharge.

The client's 8-year-old child went missing 1 year ago. The police have few leads and have lost interest in the case. The client visits an outpatient mental health clinic to determine the treatment options available to help cope with the grief. The client begins to sob uncontrollably when attempting to speak to the nurse. Which statement made by the nurse demonstrates support of the client?

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

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

3. "Kidnapping is a terrible thing, but maybe your child will be returned home."

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

ANS 2. "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?

1. Cognitive behavior therapy

2. Prolonged exposure therapy 3. Group therapy

4. Eye movement desensitization and reprocessing (EMDR)

ANS 2. Prolonged exposure therapy

A mother brings her son to the emergency department and tells the nurse that her son must have PTSD because he witnessed a car accident 2 days ago 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.

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

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

3. "Medications have been found to be effective in treating symptoms but do not cure the disorder."

4. "Fewer than 10% of trauma victims develop PTSD." '

5. "PTSD occurs when there are other underlying mental health issues, such as depression."

ANS 2. "Women appear to be at greater risk of this disorder than are men."

3. "Medications have been found to be effective in treating symptoms but do not cure the disorder."

4. "Fewer than 10% of trauma victims develop PTSD." '

A client 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 client supports this diagnosis? Select all that apply.

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

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

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

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

5. "I can't go back to work; my new boss constantly bullies me and enjoys it when I cry."

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

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

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

5. "I can't go back to work; my new boss constantly bullies me and enjoys it when I cry."

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 is commonly associated with PTSD? Select all that apply.

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

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

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

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

5. "I realize now that I was just a kid in the war and could not control what happened."

ANS 1. "I've been drinking and smoking pot daily."

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

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

A client'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 cognitive theory as it applies to PTSD? Select all that apply.

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

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

3. Dementia is a common symptom of PTSD.

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

5. Cognitive behavior therapy not only works with how individuals think but also with how their body responds.

ANS 1. People are vulnerable to trauma-related disorders when their fundamental beliefs are invalidated.

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

5. Cognitive behavior therapy not only works with how individuals think but also with how their body responds.

The nurse who works on an inpatient psychiatric unit is working on developing a treatment plan for a client admitted with PTSD. The client, 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.

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

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

3. Contact the doctor and recommend that the client be ordered an antipsychotic medication.

4. Refer the client to a peer-advocate support group with other military veterans.

5. Request antidepressant medications when he starts to experience a flashback of the trauma.

ANS

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

4. Refer the client to a peer-advocate support group with other military veterans.

A client 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.

1. Alprazolam (Xanax)

2. Propranolol (Inderal)

3. Docusate sodium (Colace)

4. Docusate (Dulcolax)

5. Prazosin (Minipress)

ANS

1. Alprazolam (Xanax)

2. Propranolol (Inderal)

5. Prazosin (Minipress)

A client who is being seen in the community mental health center for PTSD is being considered for EMDR. The nurse is asked to conduct an assessment to validate the client'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

1. The client has a history of a seizure disorder.

2. The client has a history of electroconvulsive therapy (ECT).

3. The client reports suicidal ideation with a plan.

4. The client has been using alcohol in increasing quantities over the past 3 months.

5. The client has been treated for detached retina.

ANS

1. The client has a history of a seizure disorder. 3. The client reports suicidal ideation with a plan. 4. The client has been using alcohol in increasing quantities over the past 3 months. 5. The client has been treated for detached retina.

The client being treated for PTSD tells the nurse that their therapist is recommending cognitive behavior therapy. The client asks the nurse how that is supposed to help with nightmares. Which of these responses by the nurse provides accurate information about the benefits of this type of therapy? Select all that apply.

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

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

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

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

5. "Cognitive behavior therapy will help distract you from the issues."

ANS 1. "The nightmares may be related to troubling thoughts and feelings; cognitive behavior therapy will help you explore and modify those thoughts and feelings."

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

The client recently moved into a dormitory to begin their first year in college. The dormitory supervisor reprimanded the client for not disposing of food items properly, and the client responded by throwing all their belongings from a second-story window while shouting obscenities. The campus police escorted the client to campus health services, where the client was diagnosed with an adjustment disorder with disturbance of conduct. Which of the following items in the client's history reflects a predisposition to this disorder? Select all that apply.

1. The client reports that they have no friends in the dormitory.

2. The client's family currently lives out of the country and is often difficult to reach.

3. The client was notified the same day that they would have to withdraw from one of their classes due to poor grades.

4. The client has a higher-than-average grade point average and is a member of the National Honor Society.

5. The client has a scholarship due to excellent grades and athletic ability on the field.

ANS 1. The client reports that they have no friends in the dormitory.

2. The client's family currently lives out of the country and is often difficult to reach.

3. The client was notified the same day that they would have to withdraw from one of their classes due to poor grades.

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

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

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

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

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

5. "I have started going to church to show gratitude for surviving the crash."

ANS 1. "I keep having these thoughts about the crash that just pop into my mind at random times."

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

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

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

1. The resources the client uses to cope with trauma

2. The outcomes the client previously experiences with trauma.

3. The location and duration of the traumatic event experienced by the client

4. The temperament the client displays in the presence of trauma

5. The client's childhood, specifically any history of childhood trauma

1. The resources the client uses to cope with trauma

2. The outcomes the client previously experiences with trauma.

4. The temperament the client displays in the presence of trauma

5. The client's childhood, specifically any history of childhood trauma

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

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

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

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

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

5. "I have decided to do more physical work to help me get rid of this tension."

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

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

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

According to NANDA International (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

An adolescent client who recently lost both parents in a tragic automobile accident has been diagnosed with an adjustment disorder after striking a friend who told the client that they needed to "get their feelings out." The stage of grieving that this client is struggling with is ____________________.

ANS: ANGER

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

ANS: hippocampus

. ____________________-informed care generally describes a philosophical approach that values awareness and understanding of trauma when assessing, planning, and implementing care. This approach realizes the widespread impact of trauma and various paths for recovery, recognizes signs and symptom of trauma, responds by fully integrating knowledge about trauma in policies and practice, and seeks to resist retraumatization in an active way.

ANS: Trauma

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

ANS: prazosin (Minipress)