Question 1

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

Accepted Answer

ANS: 4 Rationale: Research shows that PTSD is more common in women than in men. This student statement indicates a need for further instruction.

Question 2

Which factors differentiate the diagnosis of PTSD from the diagnosis of adjustment disorder (AD)? 1. PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to “normal” daily events. 2. AD results from exposure to an extreme traumatic event, whereas PTSD results from exposure to “normal” daily events. 3. Depressive symptoms occur in PTSD and not in AD. 4. Depressive symptoms occur in AD and not in PTSD.

Accepted Answer

ANS: 1 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.

Question 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

Accepted Answer

ANS: 3 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 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? 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.”

Accepted Answer

ANS: 2 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

As the sole survivor of a roadside bombing, a veteran is experiencing extreme guilt. Which nursing diagnosis would address this client’s symptom? 1. Anxiety 2. Altered thought processes 3. Complicated grieving 4. Altered sensory perception

Accepted Answer

ANS: 3 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 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? 1. Encourage the journaling of feelings. 2. Assess for the stage of grief in which the client is fixed. 3. Provide community resources to address the client’s concerns. 4. Encourage attending a grief therapy group.

Accepted Answer

ANS: 2 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 7

Which clinical presentation is associated with the most commonly diagnosed adjustment disorder (AD)? 1. Anxiety, feelings of hopelessness, and worry 2. Truancy, vandalism, and fighting 3. Nervousness, worry, and jitteriness 4. Depressed mood, tearfulness, and hopelessness

Accepted Answer

ANS: 4 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 8

Both situational and intrapersonal factors most likely contribute to an individual’s stress response. Which factor would a nurse categorize as intrapersonal? 1. Occupational opportunities 2. Economic conditions 3. Degree of flexibility 4. Availability of social supports

Accepted Answer

ANS: 3 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 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? 1. Rates anxiety as 4 out of 10 by discharge. 2. States anxiety level has decreased by day one. 3. Accomplishes activities of daily living independently. 4. Demonstrates ability for adequate social functioning by day three.

Accepted Answer

ANS: 1 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 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

Accepted Answer

ANS: 4 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 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? 1. Assessment phase; nursing actions have been successful in achieving the objectives of care. 2. Evaluation phase; nursing actions have been successful in achieving the objectives of care. 3. Implementation phase; nursing actions have been successful in achieving the objectives of care. 4. Diagnosis phase; nursing actions have been successful in achieving the objectives of care.

Accepted Answer

ANS: 2 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 12

By which biological mechanism does EMDR achieve its therapeutic effect? 1. EMDR achieves its therapeutic effect, but the exact biological mechanism is unknown. 2. EMDR achieves its therapeutic effect by causing a decrease in imagery vividness. 3. EMDR achieves its therapeutic effect by causing an increase in memory access. 4. EMDR achieves its therapeutic effect by decreasing trauma associated anxiety.

Accepted Answer

ANS: 1 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 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? 1. “I am thrilled that you have responded so rapidly to EMDR.” 2. “To achieve lasting results, all eight phases of EMDR must be completed.” 3. “If I were you, I would complete the EMDR and comply with doctor’s orders.” 4. “How do you feel about continuing the therapy?”

Accepted Answer

ANS: 2 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 14

A nurse would recognize which treatment as most commonly used for AD and its appropriate rationale? 1. Psychotherapy; to examine the stressor and confront unresolved issues 2. Fluoxetine (Prozac); to stabilize mood and resolve symptoms 3. Eye movement desensitization therapy; to reprocess traumatic events 4. Lorazepam (Ativan); a first-line treatment to address symptoms of anxiety

Accepted Answer

ANS: 1 Rationale: 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 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? 1. The client will have no flashbacks. 2. The client will be able to feel a full range of emotions by discharge. 3. The client will not require zolpidem (Ambien) to obtain adequate sleep by discharge. 4. The client will refrain from discussing the traumatic event.

Accepted Answer

ANS: 3 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.

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Chapter 19: Trauma and Stressor-Related Disorders Flashcards

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