NUR 256 – Concepts of Mental Health Nursing |
Exam 3 Comprehensive Review Package (2025/2026
Academic Year)
DOMAIN 1: TRAUMA, STRESSOR-RELATED & DISSOCIATIVE DISORDERS (20 Questions)
Question 1 A 28-year-old military veteran presents to the mental health clinic reporting
recurrent nightmares about combat experiences, flashbacks when hearing loud noises, and
persistent avoidance of crowded places. He states these symptoms began 3 months after
returning from deployment 8 months ago. Which DSM-5 criterion cluster is MOST specifically
demonstrated by his avoidance of crowded places?
A. Intrusion symptoms
B. Avoidance symptoms
C. Negative alterations in cognition and mood
D. Alterations in arousal and reactivity
Correct Answer: B
Rationale: Avoidance symptoms in PTSD involve persistent avoidance of stimuli associated with
the traumatic event, including internal memories/thoughts or external reminders (people,
places, activities). The veteran's avoidance of crowded places represents avoidance of external
reminders that resemble the combat environment.
Question 2 A nurse is assessing a 7-year-old child who witnessed a house fire 6 weeks ago.
Which finding would be MOST consistent with PTSD in children?
A. Detailed verbal recounting of the traumatic event to strangers
B. Increased engagement in imaginative play with fire themes
C. Reduction in play activities and reenactment of the fire during play
D. Development of advanced drawing skills depicting the event
Correct Answer: C
Rationale: Children with PTSD may express intrusion symptoms through repetitive play that
includes aspects of the trauma (reenactment) and may exhibit social withdrawal manifested as
,reduced participation in play activities. Unlike adults, children may not have frightening dreams
with recognizable content but rather generalized nightmares.
Question 3 A client presents to the emergency department 3 weeks after surviving a severe
motor vehicle accident. She reports experiencing recurrent intrusive memories, nightmares, and
hypervigilance, but states she cannot remember several hours of the accident itself. She asks if
she has PTSD. What is the nurse's MOST accurate response?
A. "You meet criteria for PTSD; the memory loss is a common symptom."
B. "Your symptoms suggest Acute Stress Disorder, which may or may not progress to PTSD."
C. "Memory loss indicates Dissociative Amnesia rather than a trauma-related disorder."
D. "You cannot have PTSD because you don't remember the traumatic event."
Correct Answer: B
Rationale: Acute Stress Disorder develops immediately after trauma and is diagnosed when
symptoms persist from 3 days to 1 month after exposure. If symptoms persist beyond 1 month,
the diagnosis becomes PTSD. The client's timeline (3 weeks post-trauma) fits Acute Stress
Disorder criteria.
Question 4 A 35-year-old client is unable to recall any events from a 2-week period surrounding
her sister's death in a hiking accident, though she remembers events before and after this
period. This presentation is MOST consistent with which type of dissociative amnesia?
A. Generalized amnesia
B. Continuous amnesia
C. Localized amnesia
D. Systematized amnesia
Correct Answer: C
Rationale: Localized amnesia involves inability to recall all events during a specific circumscribed
period of time, typically surrounding a traumatic event. The client cannot recall the 2-week
period around her sister's death but retains memory for other time periods.
Question 5 A client is found working in a restaurant in a different state, using a different name,
with no memory of his previous identity or how he arrived there. He had disappeared 3 months
earlier after his wife filed for divorce. This presentation is characteristic of:
,A. Dissociative Identity Disorder
B. Dissociative Amnesia with Fugue
C. Depersonalization/Derealization Disorder
D. Post-Traumatic Stress Disorder
Correct Answer: B
Rationale: Dissociative Fugue is a subtype of Dissociative Amnesia characterized by sudden,
unexpected travel away from home or customary places with inability to recall one's identity or
the assumption of a new identity. This is distinct from DID, which involves distinct personality
states rather than travel/identity confusion.
Question 6 A nurse is assessing a client with suspected Dissociative Identity Disorder. Which
assessment finding would be MOST important to prioritize in the care plan?
A. History of childhood abuse or trauma
B. Presence of two or more distinct personality states
C. Current risk for self-harm or suicide
D. Level of anxiety during personality transitions
Correct Answer: C
Rationale: While all options are relevant to DID assessment, safety is always the priority. Clients
with DID often have histories of self-harm and suicide attempts; assessing current risk is
essential for immediate safety planning. The presence of distinct personality states confirms
diagnosis but does not indicate immediate danger.
Question 7 A client describes feeling detached from her own body, as if watching herself from
outside during stressful situations. She reports that her surroundings often feel "foggy" or
"unreal." These symptoms have persisted for 8 months. This presentation is MOST consistent
with:
A. Depersonalization/Derealization Disorder
B. Dissociative Identity Disorder
C. Acute Stress Disorder
D. PTSD with dissociative features
Correct Answer: A
, Rationale: Depersonalization involves persistent experiences of unreality or detachment from
one's self (feeling like an outside observer). Derealization involves experiences of unreality of
surroundings (foggy, dreamlike). When these symptoms cause distress/impairment and are not
better explained by another disorder, Depersonalization/Derealization Disorder is diagnosed.
Question 8 A 42-year-old client presents after being laid off from a job he held for 15 years. He
reports feeling overwhelmed, experiencing outbursts of anger toward family members, and
having difficulty sleeping for the past 3 weeks. He denies suicidal ideation. Which diagnosis is
MOST likely?
A. Major Depressive Disorder
B. Adjustment Disorder with disturbance of conduct
C. Adjustment Disorder with mixed anxiety and depressed mood
D. Acute Stress Disorder
Correct Answer: B
Rationale: Adjustment Disorders involve emotional or behavioral symptoms in response to an
identifiable stressor occurring within 3 months of stressor onset. Anger is an expected emotion
in Adjustment Disorders. With disturbance of conduct involves behavioral violations of rights of
others or major age-appropriate societal norms.
Question 9 A nurse is implementing trauma-informed care principles on an inpatient psychiatric
unit. Which action BEST demonstrates the principle of "resist retraumatization"?
A. Conducting thorough assessments of all trauma histories on admission
B. Using seclusion and restraint when clients become agitated
C. Providing single rooms to all clients with trauma histories
D. Reviewing policies to eliminate potentially triggering practices
Correct Answer: D
Rationale: The four R's of trauma-informed care are: Realize (understand trauma prevalence),
Recognize (identify trauma signs), Respond (integrate trauma knowledge into practice), and
Resist Retraumatization (avoid practices that could retraumatize). Reviewing and modifying
policies prevents institutional practices from causing further trauma.
Exam 3 Comprehensive Review Package (2025/2026
Academic Year)
DOMAIN 1: TRAUMA, STRESSOR-RELATED & DISSOCIATIVE DISORDERS (20 Questions)
Question 1 A 28-year-old military veteran presents to the mental health clinic reporting
recurrent nightmares about combat experiences, flashbacks when hearing loud noises, and
persistent avoidance of crowded places. He states these symptoms began 3 months after
returning from deployment 8 months ago. Which DSM-5 criterion cluster is MOST specifically
demonstrated by his avoidance of crowded places?
A. Intrusion symptoms
B. Avoidance symptoms
C. Negative alterations in cognition and mood
D. Alterations in arousal and reactivity
Correct Answer: B
Rationale: Avoidance symptoms in PTSD involve persistent avoidance of stimuli associated with
the traumatic event, including internal memories/thoughts or external reminders (people,
places, activities). The veteran's avoidance of crowded places represents avoidance of external
reminders that resemble the combat environment.
Question 2 A nurse is assessing a 7-year-old child who witnessed a house fire 6 weeks ago.
Which finding would be MOST consistent with PTSD in children?
A. Detailed verbal recounting of the traumatic event to strangers
B. Increased engagement in imaginative play with fire themes
C. Reduction in play activities and reenactment of the fire during play
D. Development of advanced drawing skills depicting the event
Correct Answer: C
Rationale: Children with PTSD may express intrusion symptoms through repetitive play that
includes aspects of the trauma (reenactment) and may exhibit social withdrawal manifested as
,reduced participation in play activities. Unlike adults, children may not have frightening dreams
with recognizable content but rather generalized nightmares.
Question 3 A client presents to the emergency department 3 weeks after surviving a severe
motor vehicle accident. She reports experiencing recurrent intrusive memories, nightmares, and
hypervigilance, but states she cannot remember several hours of the accident itself. She asks if
she has PTSD. What is the nurse's MOST accurate response?
A. "You meet criteria for PTSD; the memory loss is a common symptom."
B. "Your symptoms suggest Acute Stress Disorder, which may or may not progress to PTSD."
C. "Memory loss indicates Dissociative Amnesia rather than a trauma-related disorder."
D. "You cannot have PTSD because you don't remember the traumatic event."
Correct Answer: B
Rationale: Acute Stress Disorder develops immediately after trauma and is diagnosed when
symptoms persist from 3 days to 1 month after exposure. If symptoms persist beyond 1 month,
the diagnosis becomes PTSD. The client's timeline (3 weeks post-trauma) fits Acute Stress
Disorder criteria.
Question 4 A 35-year-old client is unable to recall any events from a 2-week period surrounding
her sister's death in a hiking accident, though she remembers events before and after this
period. This presentation is MOST consistent with which type of dissociative amnesia?
A. Generalized amnesia
B. Continuous amnesia
C. Localized amnesia
D. Systematized amnesia
Correct Answer: C
Rationale: Localized amnesia involves inability to recall all events during a specific circumscribed
period of time, typically surrounding a traumatic event. The client cannot recall the 2-week
period around her sister's death but retains memory for other time periods.
Question 5 A client is found working in a restaurant in a different state, using a different name,
with no memory of his previous identity or how he arrived there. He had disappeared 3 months
earlier after his wife filed for divorce. This presentation is characteristic of:
,A. Dissociative Identity Disorder
B. Dissociative Amnesia with Fugue
C. Depersonalization/Derealization Disorder
D. Post-Traumatic Stress Disorder
Correct Answer: B
Rationale: Dissociative Fugue is a subtype of Dissociative Amnesia characterized by sudden,
unexpected travel away from home or customary places with inability to recall one's identity or
the assumption of a new identity. This is distinct from DID, which involves distinct personality
states rather than travel/identity confusion.
Question 6 A nurse is assessing a client with suspected Dissociative Identity Disorder. Which
assessment finding would be MOST important to prioritize in the care plan?
A. History of childhood abuse or trauma
B. Presence of two or more distinct personality states
C. Current risk for self-harm or suicide
D. Level of anxiety during personality transitions
Correct Answer: C
Rationale: While all options are relevant to DID assessment, safety is always the priority. Clients
with DID often have histories of self-harm and suicide attempts; assessing current risk is
essential for immediate safety planning. The presence of distinct personality states confirms
diagnosis but does not indicate immediate danger.
Question 7 A client describes feeling detached from her own body, as if watching herself from
outside during stressful situations. She reports that her surroundings often feel "foggy" or
"unreal." These symptoms have persisted for 8 months. This presentation is MOST consistent
with:
A. Depersonalization/Derealization Disorder
B. Dissociative Identity Disorder
C. Acute Stress Disorder
D. PTSD with dissociative features
Correct Answer: A
, Rationale: Depersonalization involves persistent experiences of unreality or detachment from
one's self (feeling like an outside observer). Derealization involves experiences of unreality of
surroundings (foggy, dreamlike). When these symptoms cause distress/impairment and are not
better explained by another disorder, Depersonalization/Derealization Disorder is diagnosed.
Question 8 A 42-year-old client presents after being laid off from a job he held for 15 years. He
reports feeling overwhelmed, experiencing outbursts of anger toward family members, and
having difficulty sleeping for the past 3 weeks. He denies suicidal ideation. Which diagnosis is
MOST likely?
A. Major Depressive Disorder
B. Adjustment Disorder with disturbance of conduct
C. Adjustment Disorder with mixed anxiety and depressed mood
D. Acute Stress Disorder
Correct Answer: B
Rationale: Adjustment Disorders involve emotional or behavioral symptoms in response to an
identifiable stressor occurring within 3 months of stressor onset. Anger is an expected emotion
in Adjustment Disorders. With disturbance of conduct involves behavioral violations of rights of
others or major age-appropriate societal norms.
Question 9 A nurse is implementing trauma-informed care principles on an inpatient psychiatric
unit. Which action BEST demonstrates the principle of "resist retraumatization"?
A. Conducting thorough assessments of all trauma histories on admission
B. Using seclusion and restraint when clients become agitated
C. Providing single rooms to all clients with trauma histories
D. Reviewing policies to eliminate potentially triggering practices
Correct Answer: D
Rationale: The four R's of trauma-informed care are: Realize (understand trauma prevalence),
Recognize (identify trauma signs), Respond (integrate trauma knowledge into practice), and
Resist Retraumatization (avoid practices that could retraumatize). Reviewing and modifying
policies prevents institutional practices from causing further trauma.
