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)

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 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.”

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.

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 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.

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?

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: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity 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.

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.

ANS: A