ch.19

Question 1

1. A nursing instructor is teaching about trauma and stressor-related disorders. Which
   student statement indicates that further instruction is needed?
2. “The trauma that women experience is more likely to be sexual assault and child
   sexual abuse.”
3. “The trauma that men experience is more likely to be accidents, physical assaults,
   combat, or viewing death or injury.”
4. “After exposure to a traumatic event, only 10 percent of victims develop posttraumatic
   stress disorder (PTSD).”
5. “Research shows that PTSD is more common in men than in women.”

Answer 1

4. “Research shows that PTSD is more common in men than in women.”

Question 2

2. Which factors differentiate the diagnosis of PTSD from the diagnosis of adjustment
   disorder (AD)?
3. PTSD results from exposure to an extreme traumatic event, whereas AD results from
   exposure to “normal” daily events.
4. AD results from exposure to an extreme traumatic event, whereas PTSD results from
   exposure to “normal” daily events.
5. Depressive symptoms occur in PTSD and not in AD.
6. Depressive symptoms occur in AD and not in PTSD.

Answer 2

1. PTSD results from exposure to an extreme traumatic event, whereas AD results from
   exposure to “normal” daily events.

Question 3

3. Which client would a nurse recognize as being at highest risk for the development of
an AD?
1. A young married woman
2. An elderly unmarried man
3. A young unmarried woman
4. A young unmarried man

Answer 3

3. A young unmarried woman

Question 4

nursing instructor is explaining the etiology of trauma-related disorders from a
learning theory perspective. Which student statement indicates that learning has
occurred?
1. “How clients perceive events and view the world affect their response to trauma.”
2. “The psychic numbing in PTSD is a result of negative reinforcement.”
3. “The individual becomes addicted to the trauma owing to an endogenous opioid
response.”
4. “Believing that the world is meaningful and controllable can protect an individual from
PTSD.”

Answer 4

2. “The psychic numbing in PTSD is a result of negative reinforcement.”

Question 5

5. As the sole survivor of a roadside bombing, a veteran is experiencing extreme guilt.
   Which nursing diagnosis would address this client’s symptom?
6. Anxiety
7. Altered thought processes
8. Complicated grieving
9. Altered sensory perception

Answer 5

3. Complicated grieving

Question 6

6. 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?
7. Encourage the journaling of feelings.
8. Assess for the stage of grief in which the client is fixed.
9. Provide community resources to address the client’s concerns.
10. Encourage attending a grief therapy group.

Answer 6

2. Assess for the stage of grief in which the client is fixed.

Question 7

7. Which clinical presentation is associated with the most commonly diagnosed
   adjustment disorder (AD)?
8. Anxiety, feelings of hopelessness, and worry
9. Truancy, vandalism, and fighting
10. Nervousness, worry, and jitteriness
11. Depressed mood, tearfulness, and hopelessness

Answer 7

4. Depressed mood, tearfulness, and hopelessness

Question 8

8. Both situational and intrapersonal factors most likely contribute to an individual’s
   stress response. Which factor would a nurse categorize as intrapersonal?
9. Occupational opportunities
10. Economic conditions
11. Degree of flexibility
12. Availability of social supports

Answer 8

3. Degree of flexibility

Question 9

9. 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?
10. Rates anxiety as 4 out of 10 by discharge.
11. States anxiety level has decreased by day one.
12. Accomplishes activities of daily living independently.
13. Demonstrates ability for adequate social functioning by day three.

Answer 9

1. Rates anxiety as 4 out of 10 by discharge.

Question 10

10. Eye movement desensitization and reprocessing (EMDR) has been empirically
validated for which disorder?
1. Adjustment disorder
2. Generalized anxiety disorder
3. Panic disorder
4. Post-traumatic stress disorder

Answer 10

4. Post-traumatic stress disorder

Question 11

11. 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?
12. Assessment phase; nursing actions have been successful in achieving the objectives of
    care.
13. Evaluation phase; nursing actions have been successful in achieving the objectives of
    care.
14. Implementation phase; nursing actions have been successful in achieving the
    objectives of care.
15. Diagnosis phase; nursing actions have been successful in achieving the objectives of
    care.

Answer 11

2. Evaluation phase; nursing actions have been successful in achieving the objectives of
   care.

Question 12

12. By which biological mechanism does EMDR achieve its therapeutic effect?
13. EMDR achieves its therapeutic effect, but the exact biological mechanism is unknown.
14. EMDR achieves its therapeutic effect by causing a decrease in imagery vividness.
15. EMDR achieves its therapeutic effect by causing an increase in memory access.
16. EMDR achieves its therapeutic effect by decreasing trauma associated anxiety.

Answer 12

1. EMDR achieves its therapeutic effect, but the exact biological mechanism is unknown

Question 13

13. 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?
14. “I am thrilled that you have responded so rapidly to EMDR.”
15. “To achieve lasting results, all eight phases of EMDR must be completed.”
16. “If I were you, I would complete the EMDR and comply with doctor’s orders.”
17. “How do you feel about continuing the therapy?”

Answer 13

2. “To achieve lasting results, all eight phases of EMDR must be completed.”

Question 14

14. A nurse would recognize which treatment as most commonly used for AD and its
    appropriate rationale?
15. Psychotherapy; to examine the stressor and confront unresolved issues
16. Fluoxetine (Prozac); to stabilize mood and resolve symptoms
17. Eye movement desensitization therapy; to reprocess traumatic events
18. Lorazepam (Ativan); a first-line treatment to address symptoms of anxiety

Answer 14

1. Psychotherapy; to examine the stressor and confront unresolved issues

Question 15

15. A nurse has been caring for a client diagnosed with PTSD. Which realistic goal
    should be included in this client’s plan of care?
16. The client will have no flashbacks.
17. The client will be able to feel a full range of emotions by discharge.
18. The client will not require zolpidem (Ambien) to obtain adequate sleep by discharge.
19. The client will refrain from discussing the traumatic event.

Answer 15

3. The client will not require zolpidem (Ambien) to obtain adequate sleep by discharge.

Question 16

16. A client diagnosed with PTSD is receiving paliperidone (Invega). Which symptoms
    should a nurse identify that would warrant the need for this medication?
17. Flat affect and anhedonia
18. Persistent anorexia and 10 lb weight loss in 3 weeks
19. Flashbacks of killing the enemy
20. Distant and guarded in relationships

Answer 16

3. Flashbacks of killing the enemy

Question 17

17. 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?
18. The client worries continually and appears nervous and jittery.
19. The client complains of a depressed mood, is tearful, and feels hopeless.
20. The client is belligerent, violates others’ rights, and defaults on legal responsibilities.
21. The client complains of many physical ailments, refuses to socialize, and quits her job.

Answer 17

4. The client complains of many physical ailments, refuses to socialize, and quits her job.

Question 18

18. 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?
19. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit
    symptoms within one year of the accident.
20. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit
    symptoms within three months of the accident.
21. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit
    symptoms within six months of the accident.
22. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit
    symptoms within nine months of the accident.

Answer 18

2. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit
   symptoms within three months of the accident.

Question 19

19. 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?
20. The 60-year-old, because of memory deficits.
21. The 60-year-old, because of decreased cognitive processing ability.
22. The 20-year-old, because of limited cognitive experiences.
23. The 20-year-old, because of lack of developmental maturity.

Answer 19

4. The 20-year-old, because of lack of developmental maturity.