Physiological reactions to reminders of the event that include persistent avoidance of stimuli associated with the trauma results in the individual’s avoiding talking about the event or avoiding activities, people, or places that arouse memories of the trauma. Avoidance is exemplified by a sense of foreshortened future and estrangement. There is no evidence this soldier is having hyperarousal or reexperiencing war-related traumas. Psychosis is not evident. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 16-29 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 22. A soldier returned home last year after deployment to a war zone. The soldier’s spouse
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complains, “We were going to start a family, but now he won’t talk about it. He will not look at children. I wonder if we’re going to make it as a couple.” Select the nurse’s best response. a. “Posttraumatic stress disorder (PTSD) often changes a person’s sexual functioning.” b. “I encourage you to continue to participate in social activities where children are present.” c. “Have you talked with your spouse about these reactions? Sometimes we just need to confront behavior.” d. “Posttraumatic stress disorder often strains relationships. Here are some community resources for help and support.”
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ANS: D
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PTSD precipitates changes that can lead to divorce. It is important to provide support to both the veteran and spouse. Confrontation will not be effective. While it is important to provide information, on-going support will be more effective.
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PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 16-24, 31, 51 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
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23. Which assessment finding best supports dissociative fugue? The patient states a. “I cannot recall why I’m living in this town.” b. “I feel as if I’m living in a fuzzy dream state.” c. “I feel like different parts of my body are at war.” d. “I feel very anxious and worried about my problems.” ANS: A
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The patient in a fugue state frequently relocates and assumes a new identity while not recalling previous identity or places previously inhabited. The distracters are more consistent with depersonalization disorder, generalized anxiety disorder, or dissociative identity disorder.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 16-49 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
24. After major reconstructive surgery, a patient’s wounds dehisced. Extensive wound care was
required for 6 months, causing the patient to miss work and social activities. Which physiological response would be expected for this patient? a. Vital signs return to normal. b. Release of endogenous opioids would cease.
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