Question 1

A military member has returned from active duty and is being treated for post-traumatic stress disorder (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 response by the nurse is an accurate reflection about PTSD in military personnel?

A) Women may experience other anxiety disorders more often than PTSD from military service.
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) Due to the recent changes in combat, women experience PTSD more often than men.

Women in the military more often experience PTSD secondary to sexual assault.

Accepted Answer

1.This is incorrect. Women in the military often suffer higher-than-average rates of PTSD. The leading cause of PTSD for women in the military is sexual trauma.
2.This is incorrect. The leading cause of PTSD for women in the military is sexual trauma.
3.This is correct. Women who were sexually harassed while in the military suffer higher-than-average rates of PTSD. The leading cause of PTSD for women in the military is sexual trauma.
4.This is incorrect. There is no correlation between combat and PTSD, and there is no research noted in this chapter correlating the two.

Question 2

The client's spouse returned from active duty 1 month ago, and she is now seeing a counselor for relational conflict in her marriage. She tells the counselor that she thinks her spouse "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 might be contributing to her spouse's behavior?

A) The 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.

The military mission is advanced as the highest priority.

Accepted Answer

1.This is correct. Although the military works hard to value the family lives of service members and their welfare, the nature of the job is that the mission trumps all other concerns.
2.This is incorrect. Marriage is not discouraged in the military. It was stated that the health of our military fighting force is directly related to the health of our military marriages.
3.This is incorrect. Redeployment is characterized by excitement and apprehension associated with the soldier's homecoming.
4.This is incorrect. Isolation and alienation are facets of military life. To compensate for the extreme mobility, the focus of military lifestyle turns inward to the military world rather than outward to the local community.

Question 3

Research has shown that there are many factors that affect military life. Which one is considered an irony or paradox of military life?&#10;A) Opportunities to see different areas of the world&#10;B) Job security with guaranteed paycheck&#10;C) Frequent familial relocations, separations, and reunions&#10;D) Military members defend democratic values while in a rigid hierarchy&#10;

Accepted Answer

1.This is incorrect. This can be seen as an advantage.
2.This is incorrect. There is no paradox in this situation; this is one advantage, especially during economic declines and layoffs.
3.This is incorrect. Although this can be seen as both an advantage and disadvantage, it is not a paradox.
4.This is correct. Per a study, "The great paradox of the military is that its members, the self-appointed frontline guardians of our cherished American democratic values, do not live in democracy themselves."

Question 4

The client is accompanied to the clinic for rehabilitation after extensive TBI injuries from combat with his spouse. The client's spouse reports feelings of being overwhelmed with the constant care for the injured veteran. Which of the following would be the most appropriate nursing intervention for the caregiver of an injured service member?

A) Ensure the caregiver encourages the injured service member to be independent as possible.
B) Identify additional needs and ensure resources are provided.
C) Assess for abuse of the injured service member by the spouse.
D) Encourage the importance of continuous open communication between the spouse and service member.

Accepted Answer

1.This is incorrect. Encouraging the service member to be more independent is not assisting caregiver with feeling overwhelmed at this moment.
2.This is correct. Providing resources to help the spouse may relieve some of the feeling of being overwhelmed.
3.This is incorrect. There is no indication of abuse at this time.
4.This is incorrect. Although open communication facilitates the family process, it will not help with the feeling of being overwhelmed.

Question 5

The client is seeing her family physician for a routine checkup and mentions to the nurse that her spouse just returned from active duty in the military. He was deployed to Iraq for the last 18 months, and the client 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. Which is the best rationale for including these assessment questions?

A) The post-deployment period is often the most difficult time 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 among military spouses.
D) The client is most likely being abused by her husband and is covering this up.

Accepted Answer

1.This is correct. Post-deployment is probably the most important stage for both soldier and spouse. The returning service member may encounter resistance from the spouse who is reluctant to relinquish the independence and autonomy to which he or she has become accustomed.
2.This is incorrect. Post-deployment is probably the most important stage for both soldier and spouse. The returning service member may encounter resistance from the spouse who is reluctant to relinquish the independence and autonomy to which he or she has become accustomed. Not all veterans experience PTSD.
3.This is incorrect. Post-deployment is probably the most important stage for both soldier and spouse. The returning service member may encounter resistance from the spouse who is reluctant to relinquish the independence and autonomy to which he or she has become accustomed.
4.This is incorrect. Post-deployment is probably the most important stage for both soldier and spouse. The returning service member may encounter resistance from the spouse who is reluctant to relinquish the independence and autonomy to which he or she has become accustomed. There are no data in the client's current assessment to indicate that she is experiencing intimate partner violence.

Question 6

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

A) The client is at high-risk for extrapyramidal symptoms (EPS).
B) The client's symptoms are likely related to an alprazolam (Xanax) addiction.
C) The client is at risk for Parkinson's disease.
D) The client's symptoms are most likely symptoms of PTSD.

Accepted Answer

1.This is incorrect. There is an association between TBI and the development of Parkinson's disease. Alprazolam (Xanax) is a benzodiazepine and does not cause EPS. EPS are associated with antipsychotic medications.
2.This is incorrect. The client's symptoms are consistent with Parkinson's disease, the symptoms of which include tremors, shuffling gait, and drooling. There is an association between TBI and the development of Parkinson's disease. Benzodiazepine withdrawal symptoms include tremors, sweating, headache, and nausea.
3.This is correct. The client's symptoms are consistent with Parkinson's disease, the symptoms of which include tremors, shuffling gait, and drooling. There is an association between TBI and the development of Parkinson's disease.
4.This is incorrect. The client's symptoms are consistent with Parkinson's disease, the symptoms of which include tremors, shuffling gait, and drooling. There is an association between TBI and the development of Parkinson's disease. Symptoms of PTSD include hypervigilance, nightmares, problems with concentration, and sleep disturbances.

Question 7

The client is a 50-year-old veteran with a TBI was recently diagnosed with Alzheimer's disease. The client's sibling 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 both the client and the sibling?

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

Accepted Answer

1.This is incorrect. Some forms of Alzheimer's disease can be hereditary.
2.This is incorrect. None of the data about the client indicate PTSD.
3.This is correct. Neurocognitive disorders, such as Alzheimer's disease and Parkinson's disease, are related to TBI. The risk for Alzheimer's disease in individuals with moderate TBI is 2.3 times greater than that of the general population.
4.This is incorrect. This information is not accurate to share with the client and the sibling.

Question 8

A client is 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 spouse 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 teaching points are evidence-based pieces of information to share with the client's spouse? 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, unless the trauma occurred more than 5 years ago.
D) This is probably not PTSD, but rather a brief adjustment reaction to retirement.
E) Concurrent disorders are common in individuals with PTSD, which includes anxiety disorders.

Accepted Answer

1.This is correct. PTSD symptoms can emerge at any time. Langer (2011) reported that, decades after returning from war, retirement was the most significant precipitant of PTSD symptoms. The DSM-5 criteria for PTSD indicate symptoms occur and/or persist beyond 3 months following a trauma.
2.This is correct. PTSD symptoms can emerge at any time.
3.This is incorrect. The DSM-5 criteria for PTSD indicate that symptoms occur and/or persist beyond 3 months following a trauma.
4.This is incorrect. PTSD symptoms are not normally a part of "readjustment" to a new life.
5.
This is correct. The concurrent symptom of anxiety may be a component of the PTSD.

Question 9

The client was referred to the Department of Veterans Affairs clinic because he was recently fired from his job. His former employer reported that he was drinking on the job and became 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."

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Accepted Answer

1.This is correct. Substance abuse is a common symptom of PTSD.
2.This is incorrect. This is not an adaptive response but is not correlated with PTSD.
3.This is correct. Aggression is a common symptom of PTSD.
4.This is correct. Insomnia and nightmares are common symptoms of PTSD.
5.This is incorrect. This is a maladaptive response but is not indicative of PTSD.

Deck 20: Military Families