Chapter 28-T Flashcards
- A mother brings her son to the Emergency Department and tells the nurse that her son must have PTSD, because 2 days ago he witnessed a car accident 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 men.
C. Medications have been found to be effective in treating symptoms of depression or anxiety but do not represent a cure for the disorder.
D. Fewer than 10% of trauma victims develop PTSD.
ANS: B, C, D
Items B, C, and D are evidence-based pieces of information. Item A is incorrect since, in fact, dangerous consequences of unmanaged PTSD may include depression and/or suicide.
- A patient is admitted to the community mental health center for outpatient therapy with a diagnosis of Adjustment Disorder. Which of the following subjective statements by the patient support this diagnosis? Select all that apply.
A. “I was divorced 3 months ago and I can’t seem to cope.”
B. “I was a victim of date rape 15 years ago when I was in college.”
C. “My partner came home last week and told me he just didn’t love me anymore.”
D. “I failed one of my classes last month and I can’t get motivated to register for my next semester.”
ANS: A, C, D
A diagnosis of Adjustment Disorder is appropriate when the stressors are related to relational conflict, where there are significant emotional or behavioral symptoms, and when the response occurs within 3 months after the onset of the stressor (and persists no longer than 6 months). Item B would be more aptly described as a traumatic event.
- A military veteran is being assessed for outpatient therapy after he reports having problems at home and at work. Which of the symptoms that he describes are commonly associated with PTSD? Select all that apply.
A. “I’ve been drinking and smoking pot daily.”
B. “I’ve been having trouble sleeping and I think I’ve been having nightmares but I can’t remember them.”
C. “I slapped my wife when she was trying to hug me.”
D. “I’ve been having intense pain in the leg where I sustained a combat wound.”
ANS: A, B, C
Common symptoms associated with PTSD include substance abuse, sleep disturbances, nightmares, and aggression. Whereas the combat exposure and wounding could be described as traumas, the patient’s complaint of pain requires further physical assessment rather than assuming this symptom is related to PTSD.
- A patient’s wife reports to the nurse that she was told her husband’s PTSD may be related to cognitive problems. She is asking the nurse to explain what that means. Which of the following are accurate statements about the cognitive theory as it applies to PTSD? Select all that apply.
A. People are vulnerable to trauma-related disorders when their fundamental beliefs are invalidated.
B. Cognitive theory addresses the importance of how people think (or cognitively appraise) events.
C. Dementia is a common symptom of PTSD.
D. Amnesia is the biggest cognitive problem in PTSD and is the primary cause of trauma-related disorders.
ANS: A, B
Both A and B address aspects of cognitive theory and its relevance in PTSD. Dementia includes cognitive symptoms but is not a symptom of PTSD. Amnesia does not cause PTSD but is a symptom of PTSD.
- A nurse who works on an inpatient psychiatric unit is working on developing a treatment plan for a patient admitted with PTSD. The patient, 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 interventions by the nurse are evidence-based responses? Select all that apply.
A. Collaborate with the patient about how he would like staff to respond when he has episodes of re-experiencing traumatic events.
B. Tell the patient it is not appropriate to hit other patients or staff and if that occurs he will have to be discharged from the hospital.
C. Contact the doctor and recommend that the patient be ordered an antipsychotic medication.
D. Refer the patient to a support group with other military veterans.
ANS: A, D
Collaborating with the patient demonstrates an environment of mutual respect and is helpful in establishing a trusting relationship. Both of these are identified as essential in effective treatment of PTSD. Evidence also supports that a group with other people who have experienced similar traumas is helpful in reducing the sense of isolation that some people with PTSD experience. Items B and C are incorrect since they both reflect an inaccurate understanding of the dynamics of PTSD.
6. A patient admitted to the hospital with PTSD is ordered the following medications. Which of these medications has a direct use in treating symptoms that are common in PTSD? Select all that apply. A. Alprazolam B. Propanolol C. Colace D. Dulcolax
ANS: A, B
Alprazolam is an antianxiety agent and anxiety symptoms are common in PTSD. Propanolol is an antihypertensive medication and evidence has demonstrated its effectiveness in treating symptoms of PTSD, including nightmares, intrusive recollections, and insomnia. The last two medications are used to treat constipation, and this symptom is not directly related to PTSD.
- A patient who is being seen in the community mental health center for PTSD is being considered for EMDR (Eye Movement Desensitization and Reprocessing) therapy. The nurse is being asked to conduct an assessment to validate the patient’s appropriateness for this treatment. Which of the following pieces of data, collected by the nurse, are most important to document when determining appropriateness for treatment with EMDR? Select all that apply.
A. The patient has a history of a seizure disorder.
B. The patient has a history of ECT.
C. The patient reports suicidal ideation with a plan.
D. The patient has been using alcohol in increasing quantities over the last 3 months.
ANS: A, C, D
Items A, C, and D are all factors that would contraindicate the use of EMDR. A history of ECT is not directly relevant in determining appropriateness for EMDR.
- Joe, a patient being treated for PTSD, tells the nurse that his therapist is recommending cognitive therapy. He asks the nurse how that’s supposed to help his 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 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.
ANS: A, B
Both A and B are desired outcomes in cognitive therapy. Item C more aptly describes prolonged exposure therapy. D is incorrect because exploration and awareness (rather than repression) are fundamental to cognitive therapy.
- Joshua recently moved into a dormitory to begin his freshman year in college. He was reprimanded by the dormitory supervisor for not properly disposing of food items and responded by throwing all of his belongings from a second story window while shouting obscenities. The campus police escorted him to campus health services, where he was diagnosed with an Adjustment Disorder with Disturbance of Conduct. Which of the following items in Joshua’s history predispose him to this disorder? Select all that apply.
A. Joshua reports that he doesn’t have any friends in the dormitory.
B. Joshua’s family currently lives out of the country and are often difficult to reach.
C. Joshua was notified the same day that he would have to withdraw from one of his classes because he didn’t have the prerequisite credits needed to register for the class.
D. Joshua has a higher than average GPA and is a member of The National Honor Society.
ANS: A, B, C
Items A and B may suggest lack of available support systems, which is identified as a predisposing factor for Adjustment Disorders. Item C presents evidence of another stressor occurring in proximity to the reprimand from the dormitory supervisor, which may also predispose to the development of an Adjustment Disorder.
- Jane presents in the Emergency Department with a friend, who reports that Jane has been sitting in her apartment “staring off into space” and doesn’t seem interested in doing anything. During the assessment Jane reveals, with little emotion, that she was raped 4 months ago. Which of these is the most appropriate interpretation of Jane’s lack of emotion?
A. Jane is probably hearing voices telling her to be emotionless.
B. Jane is experiencing numbing of emotional response, which is a common symptom of PTSD.
C. Jane is trying to be secretive, and lying is a common symptom in PTSD.
D. Jane is currently re-experiencing the traumatic event and is having a dissociative episode.
ANS: B
General numbing of emotional response is a common symptom of PTSD. Items A and D are not the most appropriate interpretations because the data are inadequate to make that inference. Item C is incorrect; lying is not a common symptom in PTSD.
- Studies have suggested that re-experiencing a traumatic event can become an addiction of sorts. The evidence suggests that the reason for this is:
A. People with PTSD often have addictive personalities.
B. Perpetuating the traumatic experience yields secondary gains.
C. The re-experiencing of trauma enhances production of endogenous opioid peptides.
D. People with PTSD often have concurrent substance abuse issues.
ANS: C
Hollander and Simeon (2008) report on studies suggesting that the release of endogenous opioid peptides can produce an “addiction to the trauma.” There is no evidence suggesting that addictive personality traits are responsible for chronicity in PTSD symptoms. Items B and D are possible outcomes in any individual with PTSD, but neither has been correlated to an “addiction” to re-experiencing trauma.
- Sandy, a rape survivor, is being treated for PTSD. Which of these statements are good indications that Sally is beginning to recover from PTSD?
A. “I still have nightmares every night, but I don’t always remember them anymore.”
B. “I’m not drinking as much alcohol as I had been over the last several months.”
C. “This traumatic event immobilized me for awhile, but I have found imagery helpful in reducing my anxiety.”
D. All of the above.
ANS: C
Item C demonstrates evidence of awareness of the impact the trauma had on Sandy’s life and demonstrates evidence of effective coping skills. Item A indicates continued presence of symptoms and possibly amnesia. Although item B may be evidence of a positive coping strategy, evaluation of recovery from PTSD must also include assessment for less symptoms such as nightmares and flashbacks.
- A military vet who recently returned from active duty in a Middle Eastern country and suffers from PTSD states he will not allow the lab tech, who is Iranian, to draw his blood. The patient states “He’ll probably use a contaminated needle on me”. Which of these is the most appropriate response by the nurse?
A. “Let me see if I can arrange for a different technician to draw your blood.”
B. “Let me help you overcome your cultural bias by letting him draw your blood.”
C. “There is no other technician, so you’re just going to have to let him draw your blood.”
D. “I don’t think the technician is really Middle Eastern.”
ANS: A
Item A demonstrates acceptance of the patient and attempts to create a less threatening situation for the patient. Item B makes an unsubstantiated assumption about the patient’s biases. Item C will not contribute to the patient’s sense of control, and sense of comfort and control is important in managing symptoms of PTSD. Item D minimizes the patient’s concerns rather than responding empathically to them.
- Which of these statements by the patient are indications of complicated grieving?
A. “I feel like I should have been the one to die in that hurricane.”
B. “Last year, several of my coworkers died in a hurricane and I still can’t go back to work.”
C. “I’ve been having incapacitating migraines ever since the memorial services.”
D. All of the above
ANS: D
Item A indicates survivor guilt, and items B and C are both indications that the trauma has contributed to functional impairment. All three are symptoms of complicated grieving.
- A patient being treated for symptoms of PTSD following a shooting incident at a local elementary school reports “I feel like there’s no reason to go on living when so many others died.” Which of these is the most appropriate response by the nurse at this juncture?
A. “You’ve got lots of reasons to go on living”
B. “Are you having thoughts of hurting or killing yourself?”
C. “You’re just experiencing survivor guilt.”
D. “There must be something that gives you hope.”
ANS: B
This patient is expressing hopelessness, and it is a priority to assess for suicide ideation in these circumstances. Items A and D minimize the patient’s experience of feeling hopelessness. Item C may be a useful strategy to encourage the patient that this is a common experience of trauma survivors, but the immediate priority is determining patient safety.
