C HAPTER 16: T RAUMA , S TRESSOR -R ELATED ,
AND D ISSOCIATIVE D ISORDERS
Halter: Varcarolis’ Foundations of Psychiatric -Mental Health Nurs ing: A
Clinical Approach, 9th Edition
MULTIPLE CHOICE
1. The gas pedal on a person’s car became stuck on a busy interstate
highway, causing the car to accelerate rapidl y. For 20 minutes, the car was
very difficult to control. In the months after this experience, afterward,
which assessment finding would the nurse expect?
a. Weight gain
b. Flashbacks
c. Headache
d. Diuresis
ANS: B
The scenario depicts a frightening, traumatic, and stressful situation.
Severe dissociation or “mind flight” may occur for those who have
suffered significant trauma. The episodic failure of dissociation causes
intrusive symptoms such as flashbacks. The problems identified in the
distracters may or may not occur.
PTS: 1 DIF: Cognitive Level: Appl y (Application)
TOP: Nursing Process: Assessment MSC: Client Needs:
Physiological Integrity
,2. A soldier returns t o the United States from active dut y in a combat zone.
The soldier is diagnosed with post -traumatic stress disorder (PTSD). The
nurse’s highest priorit y is to screen this soldier for
a. bipolar disorder.
b. schizophrenia.
c. depression.
d. dementia.
ANS: C
Comorbidities for adults with PTSD include depression, anxiety
disorders, sleep disorders, and dissociative disorders. Incidence of the
disorders identified in the distracters is similar to the general
population.
PTS: 1 DIF: Cognitive Level: Appl y (Application )
TOP: Nursing Process: Assessment MSC: Client Needs:
Psychosocial Integrity
3. Two weeks ago, a soldier returned to the United States from active dut y in
a combat zone. The soldier was diagnosed with post -traumatic stress
disorder (PTSD). Which comment by the soldier requires the nurse’s
immediate attention?
a. “It’s good to be home. I missed m y home, famil y, and friends.”
b. “I saw m y 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 m y hometown.”
, d. “I want to continue my education, but I’m not sure how I will fit in
with other college students.”
ANS: B
The correct response indicates the soldier is thinking about death and
feeling survivor’s guilt. The se emotions may accompany suicidal
ideation, which warrants the nurse’s follow -up assessment. Suicide is a
high risk among military personnel diagnosed with PTSD. One
distracter indicates flashbacks, common with persons with PTSD, but
not solel y indicative that further problems exist. The other distracters
are normal emotions associated with returning home and change.
PTS: 1 DIF: Cognitive Level: Anal yze (Anal ysis) TOP:
Nursing Process: Anal ysis | Nursing Process: Diagnosis
MSC: Client Needs: Psychoso cial Integrity
4. A soldier returned home from active duty in a combat zone and was
diagnosed with post - traumatic stress disorder (PTSD). The soldier says,
“If there’s a loud noise at night, I get under m y bed because I think we’re
getting bombed.” What t yp e of experience has the soldier described?
a. Illusion
b. Flashback
c. Nightmare
d. Auditory hallucination
ANS: B
Flashbacks are dissociative reactions in which an individual feels or
acts as if the traumatic event were recurring. Illusions are
AND D ISSOCIATIVE D ISORDERS
Halter: Varcarolis’ Foundations of Psychiatric -Mental Health Nurs ing: A
Clinical Approach, 9th Edition
MULTIPLE CHOICE
1. The gas pedal on a person’s car became stuck on a busy interstate
highway, causing the car to accelerate rapidl y. For 20 minutes, the car was
very difficult to control. In the months after this experience, afterward,
which assessment finding would the nurse expect?
a. Weight gain
b. Flashbacks
c. Headache
d. Diuresis
ANS: B
The scenario depicts a frightening, traumatic, and stressful situation.
Severe dissociation or “mind flight” may occur for those who have
suffered significant trauma. The episodic failure of dissociation causes
intrusive symptoms such as flashbacks. The problems identified in the
distracters may or may not occur.
PTS: 1 DIF: Cognitive Level: Appl y (Application)
TOP: Nursing Process: Assessment MSC: Client Needs:
Physiological Integrity
,2. A soldier returns t o the United States from active dut y in a combat zone.
The soldier is diagnosed with post -traumatic stress disorder (PTSD). The
nurse’s highest priorit y is to screen this soldier for
a. bipolar disorder.
b. schizophrenia.
c. depression.
d. dementia.
ANS: C
Comorbidities for adults with PTSD include depression, anxiety
disorders, sleep disorders, and dissociative disorders. Incidence of the
disorders identified in the distracters is similar to the general
population.
PTS: 1 DIF: Cognitive Level: Appl y (Application )
TOP: Nursing Process: Assessment MSC: Client Needs:
Psychosocial Integrity
3. Two weeks ago, a soldier returned to the United States from active dut y in
a combat zone. The soldier was diagnosed with post -traumatic stress
disorder (PTSD). Which comment by the soldier requires the nurse’s
immediate attention?
a. “It’s good to be home. I missed m y home, famil y, and friends.”
b. “I saw m y 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 m y hometown.”
, d. “I want to continue my education, but I’m not sure how I will fit in
with other college students.”
ANS: B
The correct response indicates the soldier is thinking about death and
feeling survivor’s guilt. The se emotions may accompany suicidal
ideation, which warrants the nurse’s follow -up assessment. Suicide is a
high risk among military personnel diagnosed with PTSD. One
distracter indicates flashbacks, common with persons with PTSD, but
not solel y indicative that further problems exist. The other distracters
are normal emotions associated with returning home and change.
PTS: 1 DIF: Cognitive Level: Anal yze (Anal ysis) TOP:
Nursing Process: Anal ysis | Nursing Process: Diagnosis
MSC: Client Needs: Psychoso cial Integrity
4. A soldier returned home from active duty in a combat zone and was
diagnosed with post - traumatic stress disorder (PTSD). The soldier says,
“If there’s a loud noise at night, I get under m y bed because I think we’re
getting bombed.” What t yp e of experience has the soldier described?
a. Illusion
b. Flashback
c. Nightmare
d. Auditory hallucination
ANS: B
Flashbacks are dissociative reactions in which an individual feels or
acts as if the traumatic event were recurring. Illusions are
