Question 1

Eye movement desensitization and reprocessing (EMDR)has been empirically validated for which disorder?

Accepted Answer

Rationale: EMDR has been used for depression,adjustment disorder,phobias,addictions,generalized anxiety disorder,and panic disorder.However,at present,EMDR has only been empirically validated for trauma-related disorders such as PTSD and acute stress disorder.

Question 2

Which clinical presentation is associated with the most commonly diagnosed adjustment disorder (AD)?

Accepted Answer

Rationale: 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.

Question 3

A nurse has been caring for a client diagnosed with PTSD.Which realistic goal should be included in this client's plan of care?

Accepted Answer

Rationale: Obtaining adequate sleep without zolpidem by discharge is a goal that should be included in the client's plan of care.Having no flashbacks and experiencing a full range of emotions by discharge are unrealistic goals.Clients are encouraged,not discouraged,to discuss the traumatic event.

Question 4

A nursing instructor is explaining the etiology of trauma-related disorders from a learning theory perspective.Which student statement indicates that learning has occurred?

Accepted Answer

Rationale: 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.

Question 5

A nurse would recognize which treatment as most commonly used for AD and its appropriate rationale?

Accepted Answer

Psychotherapy is the most common treatment used for AD.AD is not commonly treated with medications.Anxiolytic and antidepressant medications may be prescribed as adjuncts to psychotherapy but should not be given as the first line of treatment.Eye movement desensitization and reprocessing therapy is not used to treat adjustment disorders.

Question 6

By which biological mechanism does EMDR achieve its therapeutic effect?

Accepted Answer

Rationale: Some studies have indicated that eye movements cause a decrease in imagery vividness and distress,as well as an increase in memory access.EMDR is thought to relieve anxiety associated with the traumatic event.However,the exact biological mechanisms by which EMDR achieves its therapeutic effects are unknown.

Question 7

A client has been assigned a nursing diagnosis of complicated grieving related to the death of multiple family members in a motor vehicle accident.Which intervention should the nurse initially employ?

Accepted Answer

Rationale: 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.

Question 8

A 20-year-old client and a 60-year-old client have had drunk driving accidents and are both experiencing extreme anxiety.From a psychosocial theory perspective,which of these clients would be predisposed to the diagnosis of adjustment disorder?

Accepted Answer

Rationale: Research indicates that there is a predisposition to the diagnosis of adjustment disorder when there is limited developmental maturity.By comparison,the 20-year-old does not have the developmental maturity,life experiences,and coping mechanisms that the 60-year-old might possess.

Question 9

A client,who recently delivered a stillborn baby,has a diagnosis of adjustment disorder unspecified.The nurse case manager should expect which client presentation that is characteristic of this diagnosis?

Accepted Answer

Rationale: The diagnosis of adjustment disorder unspecified is assigned when the maladaptive reaction is not consistent with any of the other categories.Manifestations may include physical complaints,social withdrawal,or work or academic inhibition,without significant depressed or anxious mood.

Question 10

A client diagnosed with PTSD is receiving paliperidone (Invega).Which symptoms should a nurse identify that would warrant the need for this medication?

Accepted Answer

Rationale: The nurse should identify that a client who has flashbacks of killing the enemy may need paliperidone.Paliperidone is an antipsychotic medication that will address the symptoms of psychosis.

Question 11

Both situational and intrapersonal factors most likely contribute to an individual's stress response.Which factor would a nurse categorize as intrapersonal?

Accepted Answer

Rationale: 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.

Question 12

As the sole survivor of a roadside bombing,a veteran is experiencing extreme guilt.Which nursing diagnosis would address this client's symptom?

Accepted Answer

Rationale: The client's survivor guilt is disrupting the normal process of grieving.Although the client may also experience anxiety,the symptom presented in the question is extreme guilt.There is no evidence presented in the question to indicate altered thought or altered sensory perception.

Question 13

Which client would a nurse recognize as being at highest risk for the development of an AD?

Accepted Answer

Rationale: Adjustment disorders are more common in women,unmarried persons,and younger people.Although more common in the young,it can occur at any age.

Question 14

After a teaching session about grief,a client says to the nurse,"I seem to be stuck in the anger stage of grieving over the loss of my son." How would the nurse assess this statement,and in what phase of the nursing process would this occur?

Accepted Answer

Rationale: In the evaluation phase of the nursing process,reassessment is conducted to determine if the nursing actions have been successful in achieving the objectives of care.The implementation of client teaching has enabled the client to verbalize an understanding of the grief process and his or her position in the process.Therefore,the nurse's actions can be evaluated as successful.

Question 15

A nursing instructor is teaching about trauma and stressor-related disorders.Which student statement indicates that further instruction is needed?

Accepted Answer

Rationale: Research shows that PTSD is more common in women than in men.This student statement indicates a need for further instruction.

Question 16

A client has been extremely nervous ever since a person died as a result of the client's drunk driving.When assessing for the diagnosis of AD,within what time frame should the nurse expect the client to exhibit symptoms?

Accepted Answer

Rationale: According to the DSM-5 diagnostic criteria for adjustment disorders,the development of emotional or behavioral symptoms in response to an identifiable stressor occurs within three months of the onset of the stressor.

Question 17

A client receiving EMDR therapy says,"After only two sessions of my therapy,I am feeling great.Now I can stop and get on with my life." Which of the following nursing responses is most appropriate?

Accepted Answer

Rationale: Clients often feel relief quite rapidly with EMDR.However,to achieve lasting results,it is important that each of the eight phases be completed.The nurse's most appropriate response should be to give information to correct the client's misconceptions about the therapy.In answer 3 the nurse is subjectively giving advice rather than providing objective information.

Question 18

A client diagnosed with an adjustment disorder says to the nurse,"Tell me about medications that will cure this problem." Which of the following are appropriate nursing responses? (Select all that apply.)

Accepted Answer

Rationale: Adjustment disorders are not commonly treated with medications because of temporary effects,masking the real problem,interfering with finding a permanent solution,and the potential for addiction.

Question 19

A client diagnosed with AD has been assigned the nursing diagnosis of anxiety R/T divorce.Which correctly written outcome addresses this client's problem?

Accepted Answer

Rationale: An outcome statement must be client-centered,specific,measurable,and contain a time frame,so that it can be evaluated effectively.A "decrease" in anxiety is vague rather than specific,and expecting an anxiety decrease by day one may also be unrealistic.Accomplishing activities of daily living independently and demonstrating the ability for adequate social functioning do not address the anxiety nursing diagnosis.

Question 20

Which factors differentiate the diagnosis of PTSD from the diagnosis of adjustment disorder (AD)?

Accepted Answer

Rationale: PTSD results from exposure to an extreme traumatic event,whereas AD results from exposure to "normal" daily events,such as divorce,failure,or rejection.Depressive symptoms can occur in both PTSD and AD.

Quiz 19: Trauma and Stressor-Related Disorders

Eye movement desensitization and reprocessing (EMDR) has been empirically validated for which disorder?

Which clinical presentation is associated with the most commonly diagnosed adjustment disorder (AD) ?