Test Bank - Varcarolis' Foundations of Psychiatric Mental Health Nursing (8th Edition) {Chapters 16-20}

Test Bank - Varcarolis\' Foundations of
Psychiatric Mental Health Nursing
(8th Edition) {Chapters 16-20}

C HAPTER 16: T RAUMA , S TRESSOR -R ELATED ,
AND D ISSOCIATIVE D ISORDERS


MULTIPLE CHOICE


1. The gas pedal on a persons car stuck on a busy interstate highway, causing
the car to accelerate rapidl y. For 20 minutes, the car was very difficult to
control. Afterward, t his persons 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


ANS: B


Cortisol is a hormone released in response to stress. Severe
dissociation or mindflight occurs for those who have suffered
significant trauma. The episodic failure of dissociation causes intrusive
s ymptoms such as flashbacks, thus dysregulating cortisol. The cortisol
level may go up or down, so diuresis and/or weig ht gain may or may
not occur. Answering this question correctl y requires that the student
appl y prior learning regarding the effects of cortisol.


PTS: 1 DIF: Cognitive Level: Appl y (Application)
REF: 296 TOP: Nursing Process: Assessment MSC:
Client Needs: Physiological Integrit y

,2. A soldier returns to the United States from active dut y in a combat zone in
Afghanistan. The soldier is diagnosed with posttraumatic stress disorder
(PTSD). The nurses 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 genera l
population.


PTS: 1 DIF: Cognitive Level: Appl y (Application)
REF: 300 TOP: Nursing Process: Assessment MSC:
Client Needs: Psychosocial Integrit y


3. Two weeks ago, a soldier returned to the U.S. from active duty in a
combat zone in Afghanistan. The sol dier was diagnosed with posttraumatic
stress disorder (PTSD). Which comment by the soldier requires the nurses
immediate attention?
a. Its 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 dont
understand why it wasnt me.
c. Sometimes I think I hear bombs exploding, but its just the noise of
traffic in m y hometown.
d. I want to continue my education, but Im not sure how I will fit in
with other college students.


ANS: B


The correct response indicates the s oldier is thinking about death and
feeling survivors guilt. These emotions may accompany suicidal
ideation, which warrants the nurses follow -up assessment. Suicide is a
high risk among military personnel diagnosed with posttraumatic stress
disorder. One di stracter 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) REF: 300
TOP: Nursing Process: Anal ysis/Diagnosis MSC: Client
Needs: Psychosocial Integrit y


4. 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 theres a loud noise at night, I get under m y bed because I think
were getting bombed. What t ype 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 feel s or
acts as if the traumatic event were recurring. Illusions are
misinterpretations of stimuli, and although the experience is similar, it
is better termed a flashback because of the diagnosis of PTSD.
Auditory hallucinations have no external stimuli. Nig htmares
commonl y accompany PTSD, but this experience was stimulated by an
actual environmental sound.


PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: 297 TOP: Nursing Process: Assessment MSC:
Client Needs: Psychosocial Integrit y


5. 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 famil y outing to the seashore
d. Fireworks display on July 4th

, ANS: D


The exploding noises associated with fireworks are likel y to provoke
exaggerated responses for this soldier. The distracters are not
associated with offensive sounds.


PTS: 1 DIF: Cognitive Level: Anal yze (Anal ysis) REF: 297
TOP: Nursing Process: Assessment MSC: Client Needs:
Psychosocial Integrity


6. 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. Immediatel y 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


ANS: D


PTSD can have a very long lag time, months to years. Screening should
be on-going.


PTS: 1 DIF: Cognitive Level: Appl y (Application)
REF: 300 TOP: Nursing Process: Assessment MSC:
Client Needs: Psychosocial Integrit y


7. A soldier in a combat zone tells the nurs e, 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 m y mind. Which phenomenon
associated with posttraumatic stress disorder (PTSD) is the soldier
describing?
a. Reexperiencing
b. Hyperarousal
c. Avoidance
d. Psychosis