Deck 19: Trauma and Stressor-Related Disorders

Question 1

Which factors differentiate the diagnosis of PTSD from the diagnosis of adjustment disorder (AD)?

A) PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to "normal" daily events.
B) AD results from exposure to an extreme traumatic event, whereas PTSD results from exposure to "normal" daily events.
C) Depressive symptoms occur in PTSD and not in AD.
D) Depressive symptoms occur in AD and not in PTSD.

Answer 1

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

Question 2

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?

A) "I am thrilled that you have responded so rapidly to EMDR."
B) "To achieve lasting results, all eight phases of EMDR must be completed."
C) "If I were you, I would complete the EMDR and comply with doctor's orders."
D) "How do you feel about continuing the therapy?"

Answer 2

"To achieve lasting results, all eight phases of EMDR must be completed."

Question 3

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?

A) Encourage the journaling of feelings.
B) Assess for the stage of grief in which the client is fixed.
C) Provide community resources to address the client's concerns.
D) Encourage attending a grief therapy group.

Answer 3

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

Question 4

Eye movement desensitization and reprocessing (EMDR) has been empirically validated for which disorder?

A) Adjustment disorder
B) Generalized anxiety disorder
C) Panic disorder
D) Posttraumatic stress disorder

Question 5

A nursing instructor is explaining the etiology of trauma-related disorders from a learning theory perspective. Which student statement indicates that teaching has been effective?

A) "How clients perceive events and view the world affect their response to trauma."
B) "The psychic numbing in PTSD is a result of negative reinforcement."
C) "The individual becomes addicted to the trauma owing to an endogenous opioid response."
D) "Believing that the world is meaningful and controllable can protect an individual from PTSD."

Question 6

Which clinical presentation is associated with the most commonly diagnosed adjustment disorder (AD)?

A) Anxiety, feelings of hopelessness, and worry
B) Truancy, vandalism, and fighting
C) Nervousness, worry, and jitteriness
D) Depressed mood, tearfulness, and hopelessness

Question 7

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?

A) Assessment phase; nursing actions have been successful in achieving the objectives of care.
B) Evaluation phase; nursing actions have been successful in achieving the objectives of care.
C) Implementation phase; nursing actions have been successful in achieving the objectives of care.
D) Diagnosis phase; nursing actions have been successful in achieving the objectives of care.

Question 8

As the sole survivor of a roadside bombing, a veteran is experiencing extreme guilt. Which nursing diagnosis would address this client's symptom?

A) Anxiety
B) Altered thought processes
C) Complicated grieving
D) Altered sensory perception

Question 9

A nurse has been caring for a client diagnosed with PTSD. Which realistic goal should be included in this client's plan of care?

A) The client will have no flashbacks.
B) The client will be able to feel a full range of emotions by discharge.
C) The client will not require zolpidem (Ambien) to obtain adequate sleep by discharge.
D) The client will refrain from discussing the traumatic event.

Question 10

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?

A) The client worries continually and appears nervous and jittery.
B) The client complains of a depressed mood, is tearful, and feels hopeless.
C) The client is belligerent, violates others' rights, and defaults on legal responsibilities.
D) The client complains of many physical ailments, refuses to socialize, and quits her job.

Question 11

A client diagnosed with an adjustment disorder says to the nurse, "Tell me about medications that will cure this problem." Which of the following are appropriate nursing responses?

A) "Medications can interfere with your ability to find a more permanent solution."
B) "Medications may mask the real problem at the root of this diagnosis."
C) "Adjustment disorders are not commonly treated with medications."
D) "Psychoactive drugs carry the potential for physiological and psychological dependence."
E) "Psychoactive drugs will be prescribed only if your problems persist for more than three months."

Question 12

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?

A) To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within 1 year of the accident.
B) To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within 3 months of the accident.
C) To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within 6 months of the accident.
D) To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within 9 months of the accident.

Question 13

Which client would a nurse recognize as being at highest risk for the development of an adjustment disorder?

A) A young married woman
B) An elderly unmarried man
C) A young unmarried woman
D) A young unmarried man

Question 14

A nursing instructor is teaching about trauma and stressor-related disorders. Which statement by one of the students indicates that further instruction is needed?

A) "The trauma that women experience is more likely to be sexual assault and child sexual abuse."
B) "The trauma that men experience is more likely to be accidents, physical assaults, combat, or viewing death or injury."
C) "After exposure to a traumatic event, only 10 percent of victims develop posttraumatic stress disorder (PTSD)."
D) "Research shows that PTSD is more common in men than in women."

Question 15

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?

A) The 60-year-old, because of memory deficits
B) The 60-year-old, because of decreased cognitive processing ability
C) The 20-year-old, because of limited cognitive experiences
D) The 20-year-old, because of lack of developmental maturity

Question 16

A nurse is admitting a client who has been diagnosed with PTSD. Which of the following symptoms might the nurse expect to assess?

A) Feelings of guilt that precipitate social isolation
B) Aggressive behavior that affects job performance
C) Relationship problems
D) High levels of anxiety
E) Escalating symptoms lasting less than one month

Question 17

Both situational and intrapersonal factors most likely contribute to an individual's stress response. Which factor would a nurse categorize as intrapersonal?

A) Occupational opportunities
B) Economic conditions
C) Degree of flexibility
D) Availability of social supports

Question 18

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?

A) Rates anxiety as 4 out of 10 by discharge
B) States anxiety level has decreased by day one
C) Accomplishes activities of daily living independently
D) Demonstrates ability for adequate social functioning by day three

Question 19

By which biological mechanism does EMDR achieve its therapeutic effect?

A) EMDR achieves its therapeutic effect, but the exact biological mechanism is unknown.
B) EMDR achieves its therapeutic effect by causing a decrease in imagery vividness.
C) EMDR achieves its therapeutic effect by causing an increase in memory access.
D) EMDR achieves its therapeutic effect by decreasing trauma associated anxiety.

Question 20

A nurse recognizes which treatment as most commonly used for AD and its appropriate rationale?

A) Psychotherapy; to examine the stressor and confront unresolved issues
B) Fluoxetine (Prozac); to stabilize mood and resolve symptoms
C) Eye movement desensitization therapy; to reprocess traumatic events
D) Lorazepam (Ativan); a first-line treatment to address symptoms of anxiety

Question 21

A nurse recognizes which of the following as the best predictors of PTSD in Vietnam veterans?

A) The severity of the stressor
B) The degree of ego strength
C) The degree of psychosocial isolation in the recovery environment
D) The attitudes of society regarding the experience
E) The presence of preexisting psychopathology

Question 22

A client diagnosed with posttraumatic stress disorder (PTSD) states, "Why did my doctor prescribe an antidepressant rather than an antianxiety drug for me?" Which of the following are the most appropriate nursing responses?

A) "I'm not sure, because antianxiety drugs have been approved by the FDA for PTSD."
B) "Antidepressants are now considered first-line treatment choice for PTSD."
C) "Many people have adverse reactions to antianxiety drugs."
D) "Because of their addictive properties, antianxiety drugs are less desirable."
E) "There have been no controlled studies on the effect of antianxiety drugs on PTSD."
Other

Question 23

Order the eight-phase process of eye movement desensitization and reprocessing (EMDR).
________ Instillation
________ Body scan
________ Closure
________ Reevaluation
________ Preparation
________ History and treatment planning
________ Desensitization
________ Assessment

Question 24

A family asks the nurse why their son was diagnosed with PTSD and others in the accident were not. Which of the following information should the nurse offer?

A) An individual's religious affiliation can affect response to trauma.
B) Responses are affected by how an individual handled previous trauma.
C) Protectiveness of family and friends can help an individual deal with trauma.
D) Control over the possibility of recurrence can affect the response to trauma.
E) The time in which the trauma occurred can affect the individual's response.

Question 25

An extremely distressing experience that causes severe emotional shock and may have long-lasting psychological effects is called _________________.