Deck 12: Trauma- and Stressor-Related Disorders

Question 1

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?

A) The client is probably hearing voices telling her to be emotionless.
B) The client is experiencing a common symptom of numbing of emotional response.
C) The client is attempting to be secretive and lying, which are common symptoms in post-traumatic stress disorder (PTSD).
D) The client is having a dissociative episode and revisiting the traumatic event.

Answer 1

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

Question 2

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?

A) "Had I not taken that phone call away from them, I could have saved them."
B) "I only wish I did not call in sick so I could have died with them."
C) "I cannot drive past the building without crying."
D) "I have started to jog every day to help get rid of this tense energy."

Answer 2

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

Question 3

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?

A) Interventions that may mimic the childhood trauma may retraumatize the adult client.
B) The client may start to act out during group sessions.
C) The client may have other underlying health concerns.
D) This should be a part of the family therapy session.

Answer 3

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

Question 4

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?

A) Contact the parents and the police to report that the client is expressing homicidal ideation.
B) Encourage the client to talk more about her anger.
C) Instruct the client that it is not acceptable to talk that way about her parents.
D) Assess the client for harming herself or others.

Question 5

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?

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 child will be returned home."
D) "I think you need a long vacation to help you forget all about this situation."

Question 6

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.

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 but do not cure the disorder."
D) "Fewer than 10% of trauma victims develop PTSD."
E) "PTSD occurs when there are other underlying mental health issues, such as depression."

Question 7

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.

A) Collaborate with the client about how he would like staff to respond when he has episodes of reexperiencing traumatic events.
B) 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.
C) Contact the doctor and recommend that the client be ordered an antipsychotic medication.
D) Refer the client to a peer-advocate support group with other military veterans.
E) Request antidepressant medications when he starts to experience a flashback of the trauma.

Question 8

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.

A) The client has a history of a seizure disorder.
B) The client has a history of electroconvulsive therapy (ECT).
C) The client reports suicidal ideation with a plan.
D) The client has been using alcohol in increasing quantities over the past 3 months.
E) The client has been treated for detached retina.

Question 9

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.

A) "The nightmares may be related to troubling thoughts and feelings; cognitive behavior 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."
E) "Cognitive behavior therapy will help distract you from the issues."

Question 10

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.

A) The client reports that they have no friends in the dormitory.
B) The client's family currently lives out of the country and is often difficult to reach.
C) The client was notified the same day that they would have to withdraw from one of their classes due to poor grades.
D) The client has a higher-than-average grade point average and is a member of the National Honor Society.
E) The client has a scholarship due to excellent grades and athletic ability on the field.

Question 11

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.

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

Question 12

The client is a 19-year-old high school student who has been admitted to the psychiatric unit with a diagnosis of adjustment disorder with disturbance of conduct. The client assaulted a teacher after being informed of imminent detentions for a pattern of tardiness. The nurse, while completing rounds, finds the client in their room crying, and one of their 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 client's vital signs.
___ 2. Assess the wound site.
___ 3. Contact the health-care provider.
___ 4. Discuss with the client what precipitated this event.
___ 5. Cleanse and treat the wound site to prevent infection.

Question 13

The client is a 38-year-old Army sergeant who has been admitted to the psychiatric unit with a diagnosis of PTSD. The client witnessed combat partner step on an explosive device that caused the combat partner's body to explode. The client tells the nurse that they have a headache and are going to stay in their room instead of going to the dining room for dinner. When the nurse later checks on the client, the nurse finds them hanging from a fixture in the bathroom. The nurse quickly determines that the client 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 client's family.
___ 4. Cut down the client.
___ 5. Call for help.

Question 14

____________________-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.