Chapter 16 Flashcards
- A nurse works with a patient diagnosed with posttraumatic stress disorder 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 posttraumatic stress disorder 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 posttraumatic stress disorder 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.
- 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.
- 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.
a. “Each day will get a little better.”
b. “Her death is a terrible loss for you.”
c. “It’s important to recognize that she is no longer suffering.”
d. “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.
- 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.
- 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.
- 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:
a. visit their child’s grave daily.
b. maintain their child’s room as the child left it 2 years ago.
c. keep a place set for the dead child at the family dinner table.
d. 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.
- 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.”
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.
- 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
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). See relationship to audience response question.
- 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. c. memory impairment.
b. cognitive function. 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.
- 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 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.
- 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.
- 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 anti-anxiety 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.
- 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?
a. Limbic system
b. Peripheral nervous system
c. Sympathetic nervous system
d. 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.
- The gas pedal on a person’s car stuck on a busy interstate highway, causing the car to accelerate rapidly. For 20 minutes, the car was very difficult to control. Afterward, this person’s cortisol regulation was compromised. Which assessment finding would the nurse expect associated with the dysregulation of cortisol?
a. Weight gain c. Headache
b. Flashbacks 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 symptoms such as flashbacks, thus dysregulating cortisol. The cortisol level may go up or down, so diuresis and/or weight gain may or may not occur. Answering this question correctly requires that the student apply prior learning regarding the effects of cortisol.
- A soldier returns to the United States from active duty in a combat zone in Afghanistan. The soldier is diagnosed with posttraumatic stress disorder (PTSD). The nurse’s highest priority is to screen this soldier for:
a. bipolar disorder. c. depression.
b. schizophrenia. 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.
