Chapter 16 Trauma, Stressor-Related, and Dissociative Disorders PDF

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Varcarolis' Foundations of Psychiatric-Mental Health Nursing 8th Edition Test Banks...

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VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

Chapter 16: Trauma, Stressor-Related, and Dissociative Disorders Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition MULTIPLE CHOICE 1. A nurse works with a patient diagnosed with posttraumatic stress disorder (PTSD) 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. ANS: B

Persons with PTSD often experience somatic symptoms or sympathetic nervous system arousal that can be confusing and distressing. Explaining that these are the body’s responses to psychological trauma helps the patient understand how such symptoms are part of the illness and something that will respond to treatment. This decreases powerlessness over the symptoms and helps instill a sense of hope. It also helps the patient to understand how relaxation, breathing exercises, and imagery can be helpful in symptom reduction. The goal of treatment for PTSD is to come to terms with the event so treatment efforts would not include repression of memories or numbing. Triggering flashbacks would increase patient distress. PTS: 1 DIF: Cognitive Level: Apply (Application) NURSINGTB.COM REF: Pages 16-29, 32 (Case Study and Nursing Care Plan) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 2. 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. ANS: D

Resilience refers to positive adaptation or the ability to maintain or regain mental health despite adversity. Loss of a child is among the highest risk situations for maladaptive grieving. The parents who create a scholarship fund are openly expressing their feelings and memorializing their child. The other parents in this question are isolating themselves and/or denying their feelings. Visiting the grave daily shows active continued mourning but is not as strongly indicative of resilience as the correct response. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 16-17, 18, 32 (Case Study and Nursing Care Plan) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 3. 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.

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

a. b. c. d.

“Each day will get a little better.” “Her death is a terrible loss for you.” “It’s important to recognize that she is no longer suffering.” “Your friends will help you cope with this change in your life.”

ANS: B

Adjustment disorders may be associated with grief. A statement that validates a bereaved person’s loss is more helpful than false reassurances and clichés. It signifies understanding. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 16-42, 43, 55 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 4. 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. ANS: C

Symptoms of adjustment disorder run the gamut of all forms of distress including guilt, depression, and anger. Anger may protect the bereaved from facing the devastating reality of loss. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 16-42 TOP: NursingNURSINGTB.COM Process: Assessment MSC: Client Needs: Psychosocial Integrity 5. 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. ANS: A

The nurse builds trust and shows compassion in the face of adjustment disorders. Therapeutic responses provide comfort. The nurse should show patience and tact while offering sympathy and warmth. The distracters are defensive, evasive, or placating. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 16-32 (Case Study and Nursing Care Plan), 42, 43, 55 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 6. 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

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

a. b. c. d.

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

ANS: D

Resilience refers to positive adaptation or the ability to maintain or regain mental health despite adversity. Loss of a child is among the highest risk situations for an adjustment disorder and maladaptive grieving. The parents who throw flowers on the lake on each anniversary date of the accident are openly expressing their feelings. The other behaviors are maladaptive because of isolating themselves and/or denying their feelings. After 2 years, the frequency of visiting the grave should have decreased. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 16-17, 18, 32 (Case Study and Nursing Care Plan) TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity 7. 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.” NURSINGTB.COM ANS: D

The patient is expressing feelings related to the loss, and this is an expected and healthy behavior. This patient is at risk for a maladaptive response because of the history of a serious mental illness, but the nurse’s priority intervention is to form a therapeutic alliance and support the patient’s expression of feelings. Crying at 2 weeks after his death is expected and normal. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 16-55 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 8. 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. ANS: A

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

The patient in a dissociative fugue state relocates and lacks recall of his life before the fugue began. Often fugue states follow traumatic experiences and sometimes involve assuming a new identity. Such persons at some point find themselves in their new surroundings, unable to recall who they are or how they got there. A feeling of detachment from one’s body or from the external reality is an indication of depersonalization disorder. Losing track of several minutes when highly anxious is not an indication of a dissociative disorder and is common in states of elevated anxiety. Finding evidence of having bought clothes or gone to restaurants without any explanation for these is suggestive of dissociative identity disorder, particularly when periods are “lost” to the patient (blackouts). PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 16-49 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 9. 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. ANS: A

Assessments that relate to patient safety take priority. Patients with dissociative disorders may be at risk for suicide or self-mutilation, so the nurse must be alert for indicators of risk for self-injury. The other options are important assessments but rank below safety. Treatment motivation, while an important consideration, is not necessarily a part of the nursing assessment. NURSINGTB.COM PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 16-53, 54 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 10. 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 ANS: C

Depersonalization disorder involves a persistent or recurrent experience of feeling detached from and outside oneself. Although reality testing is intact, the experience causes significant impairment in social or occupational functioning and distress to the individual. Dissociative amnesia involves memory loss. Children with disinhibited social engagement disorder demonstrate no normal fear of strangers and are unusually willing to go off with strangers. Individuals with ASD (Acute Stress Disorder) experience three or more dissociative symptoms associated with a traumatic event, such as a subjective sense of numbing, detachment, or absence of emotional responsiveness; a reduction in awareness of surroundings; derealization; depersonalization or dissociative amnesia. In the scenario, the patient experiences only one symptom.

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 16-68 (Table 16-1) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 11. 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.” ANS: B

Disruptions in ability to perform activities of daily living, confusion, and anxiety are often apparent in patients with amnesia. Offering simple directions to promote activities of daily living and reduce confusion helps increase feelings of safety and security. A calm, secure, predictable, protective environment is also helpful when a person is dealing with a great deal of uncertainty. Recollection of memories should proceed at its own pace, and the patient should only gradually be given information about her past. Asking questions that require recall that the patient does not possess will only add frustration. Quiet, undemanding activities should be provided as the patient tolerates them and should be balanced with rest periods; the patient’s time should not be loaded with demanding or stimulating activities. PTS: 1 DIF: Cognitive Level: Apply (Application) NURSINGTB.COM REF: Pages 16-68 (Table 16-2) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 12. 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 antianxiety medication. ANS: B

Helping the patient apply a grounding technique, such as exercise, assists the patient to interrupt the dissociative process. Medication can help reduce anxiety but does not directly interrupt the dissociative process. Isolation would allow the sensation to overpower the patient. It is not necessary to notify the health care provider. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 16-8, 10, 48, 69 (Table 16-2) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 13. 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?

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

a. b. c. d.

Limbic system Peripheral nervous system Sympathetic nervous system Parasympathetic nervous system

ANS: C

The autonomic nervous system is comprised of the sympathetic (fight or flight response) and parasympathetic nervous system (relaxation response). In times of stress, the sympathetic nervous system is stimulated. A person would experience stress associated with the experience of being in danger. The peripheral nervous system responds to messages from the sympathetic nervous system. The limbic system processes emotional responses but is not specifically part of the autonomic nervous system. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 16-15, 16, 67 (Fig 16-1) TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity 14. The gas pedal on a person’s car became stuck on a busy interstate highway, causing the car to

accelerate rapidly. 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 thoseNURSINGTB.COM 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: Apply (Application) REF: Page 16-45 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity 15. A soldier returns to the United States from active duty in a combat zone. The soldier is

diagnosed with PTSD. The nurse’s highest priority 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: Apply (Application) REF: Pages 16-16, 29 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

16. Two weeks ago, a soldier returned to the United States from active duty in a combat zone. The

soldier was diagnosed with 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.” ANS: B

The correct response indicates the soldier is thinking about death and feeling survivor’s guilt. These 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 solely indicative that further problems exist. The other distracters are normal emotions associated with returning home and change. PTS: REF: TOP: MSC:

1 DIF: Cognitive Level: Analyze (Analysis) Pages 16-29, 32 (Case Study and Nursing Care Plan) Nursing Process: Analysis/Diagnosis Client Needs: Psychosocial Integrity

17. A soldier returned home from active duty in a combat zone and was diagnosed with 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? NURSINGTB.COM 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 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. Nightmares commonly accompany PTSD, but this experience was stimulated by an actual environmental sound. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 16-6, 43, 44 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 18. A soldier returned 3 months ago from a combat zone and was diagnosed with 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 ANS: D

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

The exploding noises associated with fireworks are likely to provoke exaggerated responses for this soldier. The distracters are not associated with offensive sounds. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 16-6, 43, 44 TOP: Nursing Process: Assessment MS...