Deck 38: Military Families

Question 1

Les has been referred to the VA clinic because he was recently fired from his job.His former employer reported that he was drinking on the job and had become physically aggressive with one of his coworkers.Which of the following statements during the intake assessment are consistent with common symptoms of PTSD? Select all that apply.

A) "I've been drinking and smoking pot more frequently in the past few months."
B) "I've always thought I was too good for that job anyway."
C) "Sometimes I get so angry I just want to punch someone's lights out."
D) "I haven't been getting enough sleep because the nightmares keep waking me up."
E) "I don't like authority figures."

Answer 1

"I've been drinking and smoking pot more frequently in the past few months."
"Sometimes I get so angry I just want to punch someone's lights out."
"I haven't been getting enough sleep because the nightmares keep waking me up."

Question 2

Mary is seeing her family physician for a routine checkup and mentions to the nurse that her husband just returned from active duty in the military.He was deployed to Iraq for the last 18 months,and Mary says she is very excited that they will finally be able to "pick up" where they left off.The nurse decides to ask more questions about their marital relationship in this post-deployment period.What is the best rationale for including these assessment questions?

A) The post-deployment period is often the most difficult time period for veterans and spouses to negotiate.
B) All veterans experience some PTSD and are unable to return to previous relationship patterns.
C) Denial about the impact of combat experiences is common in military spouses.
D) Mary is most likely being abused by her husband and is covering this up.

Answer 2

The post-deployment period is often the most difficult time period for veterans and spouses to negotiate.

Question 3

Joshua,a 15-year-old whose father has been suffering from PTSD since returning from combat,is now seeing a counselor himself with reports of "flashbacks" that are similar to his father's symptoms.Which of the following interpretations of Joshua's behavior is supported by evidence?

A) Military children often pretend to have symptoms of PTSD to get secondary gains.
B) This is a common symptom of substance abuse and drug-seeking behavior.
C) It is not uncommon for children of parents with PTSD to experience secondary trauma.
D) Joshua's experience is indicative of impending psychosis.

Answer 3

It is not uncommon for children of parents with PTSD to experience secondary trauma.

Question 4

Jane has begun treatment for PTSD with symptoms of depression.The nurse is reviewing the physician's orders.Which of these are evidence-based modalities for initial treatment of Jane's illnesses? Select all that apply.

A) Acupuncture
B) Electroconvulsive therapy (ECT)
C) Sertraline (Zoloft)
D) Cognitive behavior therapy (CBT)
E) Propranolol (Inderal)

Question 5

The nurse is conducting an assessment for Don,a 5-year veteran with a traumatic brain injury (TBI).He was referred to the clinic for evaluation of movement disorders.He reports taking alprazolam (Xanax)for the last 3 months and wonders if that is contributing to his tremors and shuffling gait.Which of these understandings is most important in guiding the nurse's further assessment and response to Don?

A) Alprazolam (Xanax) has a high risk potential for extrapyramidal side effects.
B) Don's symptoms are likely related to alprazolam (Xanax) addiction.
C) There is an associated risk for Parkinson's disease in patients with TBI.
D) Don's symptoms are most likely symptoms of PTSD.

Question 6

Susan returned from active duty and is being treated for PTSD.She tells the nurse that she was never in a combat zone during her deployment,and her commanding officer told her that you can't have PTSD unless you were in active combat.Which of these responses by the nurse is an accurate reflection about PTSD in military personnel?

A) Women may experience other anxiety disorders but rarely experience PTSD as a result of being in the military.
B) PTSD after serving in the military is almost always related to trauma associated with active combat.
C) Women in the military more often experience PTSD secondary to sexual assault.
D) All of the above.

Question 7

John is being treated for PTSD symptoms,which began shortly after his retirement from the military.He has had nightmares,flashbacks of traumatic events from combat,and episodes of acute anxiety.His wife is asking the nurse how he could be developing PTSD at this time when he hasn't been in a combat situation for over 10 years.Which of these teaching points are evidence-based pieces of information to share with John's wife? Select all that apply.

A) Retirement has been identified as a common precipitating factor for PTSD.
B) PTSD symptoms may develop at any time after a trauma.
C) PTSD is not the appropriate diagnosis, according to DSM-5, unless the trauma occurred greater than 5 years ago.
D) This is probably not PTSD but rather a brief adjustment reaction to retirement.

Question 8

Brian is seeking treatment for PTSD following his tour of duty in a combat zone.He reports to the assessment nurse that he has been smoking pot and drinking alcohol daily for the past 4 days because he just can't stand feeling depressed all the time.Which of these assessments is the highest priority considering Brian's symptoms?

A) Amount of current cannabis use
B) Marital status
C) Neurological assessment
D) Suicide risk assessment

Question 9

Carl is being treated for PTSD after return from military combat.He also sustained a mild traumatic brain injury secondary to an explosive device while in combat.The nurse decides to conduct additional screening assessments on the basis of common comorbidities that occur with these conditions.Which of these screening assessments would be relevant?

A) CAGE screen for alcohol abuse
B) Beck Depression Inventory
C) Mini Mental Status Exam
D) All of the above

Question 10

Sam,a 50-year-old veteran with a traumatic brain injury (TBI),was recently diagnosed with Alzheimer's disease.His sister asks the nurse,"How can this be an accurate diagnosis? There is no incidence of this in our family." Which of these teaching points is accurate for the nurse to share with Sam's sister?

A) Alzheimer's disease doesn't tend to run in families.
B) Alzheimer's disease is often misdiagnosed in patients with PTSD.
C) Alzheimer's disease is more common in patients with TBI than in the general population.
D) Alzheimer's disease in patients with TBI is not like traditional Alzheimer's disease.

Question 11

Paula's husband returned from active duty 1 month ago,and Paula is now seeing a counselor for relational conflict in her marriage.She tells the counselor she thinks her husband "can't love anything as much as he loves the military" and that "he acts like he can't wait to be redeployed." Which of these common aspects about military culture might be contributing to her husband's behavior?

A) Military mission is advanced as the highest priority.
B) Marriage is discouraged in the military.
C) Redeployment is considered the highest honor.
D) People who choose a military lifestyle often have asocial personality traits.

Question 12

Bill is an only child whose parents are both career military personnel.He is being seen by the school nurse for complaints of fever and wants to be sent home.On examination he is afebrile.He tells the nurse he doesn't like this school anyway and the nurse notes that this is his third school transition in four years.Which of these understandings about the experience of military family members is important to providing compassionate care for this child?

A) Military children are more often exposed to unusual viruses, so he should be sent for a complete evaluation and bloodwork.
B) Military children are generally healthier than their nonmilitary peers, so he should be given strict consequences for pretending to be ill.
C) Children of military personnel are often victims of physical abuse, so he should be asked direct questions about whether or not his parents have been physically aggressive with him.
D) Isolation and alienation are common experiences of military family members, so it is important to assess further his adjustment in the current school setting.