Deck 16: Trauma, Stressor-Related, and Dissociative Disorders

Question 1

A soldier returned home from active duty in a combat zone in Afghanistan and was diagnosed with posttraumatic stress disorder (PTSD).The soldier says,"If there's a loud noise at night,I get under my bed because I think we're getting bombed." What type of experience has the soldier described?

A) Illusion
B) Flashback
C) Nightmare
D) Auditory hallucination

Answer 1

Flashback

Question 2

A soldier served in combat zones in Iraq during 2010 and was deployed to Afghanistan in 2013.When is it most important for the nurse to screen for signs and symptoms of posttraumatic stress disorder (PTSD)?

A) Immediately upon return to the U.S. from Afghanistan
B) Before departing Afghanistan to return to the U.S.
C) One year after returning from Afghanistan
D) Screening should be on-going

Answer 2

Screening should be on-going

Question 3

A soldier returns to the United States from active duty in a combat zone in Afghanistan.The soldier is diagnosed with posttraumatic stress disorder (PTSD).The nurse's highest priority is to screen this soldier for:

A) bipolar disorder.
B) schizophrenia.
C) depression.
D) dementia.

Answer 3

depression.

Question 4

A wife received news that her husband died of heart failure and called her family to come to the hospital.She angrily tells the nurse who cared for him,"He would still be alive if you had given him your undivided attention." Select the nurse's best intervention.

A) Say to the wife, "I understand you are feeling upset. I will stay with you until your family comes."
B) Say to the wife, "Your husband's heart was so severely damaged that it could no longer pump."
C) Say to the wife, "I will call the health care provider to discuss this matter with you."
D) Hold the wife's hand in silence until the family arrives.

Question 5

Which scenario demonstrates a dissociative fugue?

A) After being caught in an extramarital affair, a man disappeared but then reappeared months later with no memory of what occurred while he was missing.
B) A man is extremely anxious about his problems and sometimes experiences dazed periods of several minutes passing without conscious awareness of them.
C) A woman finds unfamiliar clothes in her closet, is recognized when she goes to new restaurants, and complains of "blackouts" despite not drinking.
D) A woman reports that when she feels tired or stressed, it seems like her body is not real and is somehow growing smaller.

Question 6

After the sudden death of his wife,a man says,"I can't live without her…she was my whole life." Select the nurse's most therapeutic reply.

A) "Each day will get a little better."
B) "Her death is a terrible loss for you."
C) "It's important to recognize that she is no longer suffering."
D) "Your friends will help you cope with this change in your life."

Question 7

A child drowned while swimming in a local lake 2 years ago.Which behavior indicates the child's parents have adapted to their loss? The parents:

A) visit their child's grave daily.
B) maintain their child's room as the child left it 2 years ago.
C) keep a place set for the dead child at the family dinner table.
D) throw flowers on the lake at each anniversary date of the accident.

Question 8

A nurse works with a patient diagnosed with posttraumatic stress disorder who has frequent flashbacks as well as persistent symptoms of arousal.Which intervention should be included in the plan of care?

A) Trigger flashbacks intentionally in order to help the patient learn to cope with them.
B) Explain that the physical symptoms are related to the psychological state.
C) Encourage repression of memories associated with the traumatic event.
D) Support "numbing" as a temporary way to manage intolerable feelings.

Question 9

A patient states,"I feel detached and weird all the time.It is as though I am looking at life through a cloudy window.Everything seems unreal.It really messes up things at work and school." This scenario is most suggestive of which health problem?

A) Acute stress disorder
B) Dissociative amnesia
C) Depersonalization disorder
D) Disinhibited social engagement disorder

Question 10

A soldier in a combat zone tells the nurse,"I saw a child get blown up over a year ago,and I still keep seeing bits of flesh everywhere.I see something red,and the visions race back to my mind." Which phenomenon associated with posttraumatic stress disorder (PTSD)is the soldier describing?

A) Reexperiencing
B) Hyperarousal
C) Avoidance
D) Psychosis

Question 11

A patient diagnosed with depersonalization disorder tells the nurse,"It's starting again.I feel as though I'm going to float away." Which intervention would be most appropriate at this point?

A) Notify the health care provider of this change in the patient's behavior.
B) Engage the patient in a physical activity such as exercise.
C) Isolate the patient until the sensation has diminished.
D) Administer a PRN dose of anti-anxiety medication.

Question 12

Four teenagers died in an automobile accident.One week later,which behavior by the parents of these teenagers most clearly demonstrates resilience? The parents who:

A) visit their teenager's grave daily.
B) return immediately to employment.
C) discuss the accident within the family only.
D) create a scholarship fund at their child's high school.

Question 13

A store clerk was killed during a robbery 2 weeks ago.His widow,who has a long history of schizoaffective disorder,cries spontaneously when talking about his death.Select the nurse's most therapeutic response.

A) "Are you taking your medications the way they are prescribed?"
B) "This loss is harder to accept because of your mental illness. Do you think you should be hospitalized?"
C) "I'm worried about how much you are crying. Your grief over your husband's death has gone on too long."
D) "The unexpected death of your husband is very painful. I'm glad you are able to talk about your feelings."

Question 14

Two weeks ago,a soldier returned to the U.S.from active duty in a combat zone in Afghanistan.The soldier was diagnosed with posttraumatic stress disorder (PTSD).Which comment by the soldier requires the nurse's immediate attention?

A) "It's good to be home. I missed my home, family, and friends."
B) "I saw my best friend get killed by a roadside bomb. I don't understand why it wasn't me."
C) "Sometimes I think I hear bombs exploding, but it's just the noise of traffic in my hometown."
D) "I want to continue my education, but I'm not sure how I will fit in with other college students."

Question 15

A woman just received notification that her husband died.She approaches the nurse who cared for him during his last hours and says angrily,"If you had given him your undivided attention,he would still be alive." How should the nurse analyze this behavior?

A) The comment suggests potential allegations of malpractice.
B) In some cultures, grief is expressed solely through anger.
C) Anger is an expected emotion in an adjustment disorder.
D) The patient had ambivalent feelings about her husband.

Question 16

A soldier returned 3 months ago from Afghanistan and was diagnosed with posttraumatic stress disorder (PTSD).Which social event would be most disturbing for this soldier?

A) Halloween festival with neighborhood children
B) Singing carols around a Christmas tree
C) A family outing to the seashore
D) Fireworks display on July 4th

Question 17

A person runs from a crowded nightclub after a pyrotechnics show causes the building to catch fire.Which division of the autonomic nervous system will be stimulated in response to this experience?

A) Limbic system
B) Peripheral nervous system
C) Sympathetic nervous system
D) Parasympathetic nervous system

Question 18

The unlicensed assistive personnel (UAP)says to the nurse,"That patient with amnesia looks fine,but when I talk to her,she seems vague.What should I be doing for her?" Select the nurse's best reply.

A) "Spend as much time with her as you can and ask questions about her life."
B) "Use short, simple sentences and keep the environment calm and protective."
C) "Provide more information about her past to reduce the mysteries that are causing anxiety."
D) "Structure her time with activities to keep her busy, stimulated, and regaining concentration."

Question 19

The gas pedal on a person's car stuck on a busy interstate highway,causing the car to accelerate rapidly.For 20 minutes,the car was very difficult to control.Afterward,this person's cortisol regulation was compromised.Which assessment finding would the nurse expect associated with the dysregulation of cortisol?

A) Weight gain
B) Flashbacks
C) Headache
D) Diuresis

Question 20

The nurse who is counseling a patient with dissociative identity disorder should understand that the assessment of highest priority is:

A) risk for self-harm.
B) cognitive function.
C) memory impairment.
D) condition of self-esteem.

Question 21

Select the correct etiology to complete this nursing diagnosis for a patient with dissociative identity disorder.Disturbed personal identity related to:

A) obsessive fears of harming self or others.
B) poor impulse control and lack of self-confidence.
C) depressed mood secondary to nightmares and intrusive thoughts.
D) cognitive distortions associated with unresolved childhood abuse issues.

Question 22

A 10-year-old child was placed in a foster home after being removed from parental contact because of abuse.The child has apprehension,tremulousness,and impaired concentration.The foster parent also reports the child has an upset stomach,urinates frequently,and does not understand what has happened.What helpful measures should the nurse suggest to the foster parents? The nurse should recommend: (select all that apply)

A) conveying empathy and acknowledging the child's distress.
B) explaining and reinforcing reality to avoid distortions.
C) using a calm manner and low, comforting voice.
D) avoiding repetition in what is said to the child.
E) staying with the child until the anxiety decreases.
F) minimizing opportunities for exercise and play.

Question 23

A soldier returned home last year after deployment to a war zone.The soldier's spouse complains,"We were going to start a family,but now he won't talk about it.He will not look at children.I wonder if we're going to make it as a couple." Select the nurse's best response.

A) "Posttraumatic stress disorder often changes a person's sexual functioning."
B) "I encourage you to continue to participate in social activities where children are present."
C) "Have you talked with your spouse about these reactions? Sometimes we just need to confront behavior."
D) "Posttraumatic stress disorder often strains relationships. Here are some community resources for help and support."

Question 24

The nurse interviewing a patient with suspected posttraumatic stress disorder should be alert to findings indicating the patient: (select all that apply)

A) avoids people and places that arouse painful memories.
B) experiences flashbacks or reexperiences the trauma.
C) experiences symptoms suggestive of a heart attack.
D) feels driven to repeat selected ritualistic behaviors.
E) demonstrates hypervigilance or distrusts others.
F) feels detached, estranged, or empty inside.

Question 25

A soldier who served in a combat zone returned to the U.S.The soldier's spouse complains to the nurse,"We had planned to start a family,but now he won't talk about it.He won't even look at children." The spouse is describing which symptom associated with posttraumatic stress disorder (PTSD)?

A) Reexperiencing
B) Hyperarousal
C) Avoidance
D) Psychosis

Question 26

Which assessment finding best supports dissociative fugue? The patient states:

A) "I cannot recall why I'm living in this town."
B) "I feel as if I'm living in a fuzzy dream state."
C) "I feel like different parts of my body are at war."
D) "I feel very anxious and worried about my problems."

Question 27

A young adult says,"I was sexually abused by my older brother.During those assaults,I went somewhere else in my mind.I don't remember the details.Now,I often feel numb or unreal in romantic relationships,so I just avoid them." Which disorders should the nurse suspect based on this history? Select all that apply.

A) Acute stress disorder
B) Depersonalization disorder
C) Generalized anxiety disorder
D) Posttraumatic stress disorder
E) Reactive attachment disorder
F) Disinhibited social engagement disorder

Question 28

Relaxation techniques help patients who have experienced major traumas because they:

A) engage the parasympathetic nervous system.
B) increase sympathetic stimulation.
C) increase the metabolic rate.
D) release hormones.

Question 29

Which experiences are most likely to precipitate posttraumatic stress disorder (PTSD)? Select all that apply.

A) A young adult bungee jumped from a bridge with a best friend.
B) An 8-year-old child watched an R-rated movie with both parents.
C) An adolescent was kidnapped and held for 2 years in the home of a sexual predator.
D) A passenger was in a bus that overturned on a sharp curve and tumbled down an embankment.
E) An adult was trapped for 3 hours at an angle in an elevator after a portion of the supporting cable breaks.

Question 30

After major reconstructive surgery,a patient's wounds dehisced.Extensive wound care was required for 6 months,causing the patient to miss work and social activities.Which pathophysiology would be expected for this patient? Dysfunction of the:

A) pons.
B) occipital lobe.
C) hippocampus.
D) hypothalamus.