Chapter 13: Trauma and Stressor-Related Disorders
1. Which statement regarding the individual responses to trauma and stressors is a positive
outcome?
A. Many individuals are unable to cope with the event, manage their stress and
emotions, or resume the daily activities of their lives.
B. Some individuals may develop enhanced coping as a result of dealing with the
stressor.
C. These events are only significant in individuals who have risk for or actual mental
health problems or issues.
D. Large numbers or groups of people may be affected by a traumatic event.
ANS: B
Rationale: Traumatic events or stressors would be expected to disrupt the life of anyone who
experienced them, not just individuals at risk for mental health problems or issues.
Unfortunately, traumatic events and stressors may affect individuals or large numbers and
groups of people. Many people work through the experience and return to their usual level
of coping and equilibrium—perhaps even enhanced coping as a result of dealing with the
event. This outcome of enhanced coping can be considered a positive outcome, whereas
each of the other outcomes is negative.
PTS: 1
REF: p. 205
OBJ: 2
NAT: Client Needs: Psychosocial Integrity | Client Needs: Safe, Effective Care
Environment: Management of Care
TOP: Chapter 13: Trauma and Stressor-Related Disorders
KEY: Integrated Process: Teaching/Learning
BLM: Cognitive Level: Understand
NOT: Multiple Choice
2. What is the major difference between posttraumatic stress disorder (PTSD) and acute stress
disorder?
A. In acute stress disorder, the client is likely to develop exacerbation of symptoms.
B. In PTSD, the recovery rate is 80% within 3 months.
C. The severity and duration of the trauma are the most important variables in acute
stress disorder.
D. In PTSD, the symptoms occur 3 months or more after the trauma.
ANS: D
Rationale: In acute stress disorder, the symptoms occur 2 days to 4 weeks after a traumatic
event and are resolved within 3 months of the event. In PTSD, the symptoms occur 3
months or more after the trauma. In PTSD, the client is likely to develop exacerbation of
symptoms. The severity and duration of the trauma and the proximity of the person to the
event are the most important factors affecting the likelihood of developing PTSD. In PTSD,
complete recovery occurs within 3 months for about 50% of people.
PTS: 1
REF: p. 206
OBJ: 1
NAT: Client Needs: Psychosocial Integrity | Client Needs: Safe, Effective Care
Environment: Management of Care
TOP: Chapter 13: Trauma and Stressor-Related Disorders
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply
NOT: Multiple Choice
3. Which statement about posttraumatic stress disorder (PTSD) is accurate?
A. Estimates are that the disorder is very rare.
B. Estimates are that up to 60% of people at risk develop PTSD.
C. Only 20% of victims of rape develop PTSD.
D. PTSD symptoms usually begin at the time of the trauma.
ANS: B
Rationale: Estimates are that up to 60% of people at risk develop PTSD. Consequently, it
would be inaccurate to characterize this disorder as rare. PTSD symptoms occur three
months or more after the traumatic event.
PTS: 1
REF: p. 206
OBJ: 1
NAT: Client Needs: Psychosocial Integrity | Client Needs: Safe, Effective Care
Environment: Management of Care
TOP: Chapter 13: Trauma and Stressor-Related Disorders
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember
NOT: Multiple Choice
4. A nurse is reviewing the medical records of several clients who have come to the
community health center. The nurse would most likely identify a client experiencing which
event as being at risk for developing posttraumatic stress disorder (PTSD)? Select all that
apply.
A. Being a survivor of a tsunami that resulted in thousands of deaths
B. Being stranded at the office during a typical winter storm that was anticipated
C. Being a marine in a combat situation where the entire platoon was wiped out,
except for one person
D. Being hidden in a closet and hearing the entire family murdered by someone who
broke into the home
E. Watching televised segments of the moment when the plane hit the second tower
on 9/11
ANS: A, C, D, E
Rationale: Examples of events that may cause PTSD include someone experiencing,
witnessing, or being confronted by a traumatic event such as a natural disaster, combat, or
an assault. Being a survivor of a tsunami that resulted in thousands of deaths, being a marine
in a combat situation where the entire platoon was wiped out except for one person, and
being hidden in a closet and hearing the entire family murdered by an intruder would be
situations where the person was exposed to an event that posed actual death or threatened
death or serious injury and responded with intense fear, helplessness, or terror. Being
stranded at the office is much less likely to be perceived as a risk for death or injury, so is
unlikely to result in PTSD.
PTS: 1
REF: p. 205
OBJ: 3
NAT: Client Needs: Psychosocial Integrity | Client Needs: Safe, Effective Care
Environment: Management of Care
TOP: Chapter 13: Trauma and Stressor-Related Disorders
KEY: Integrated Process: Communication and Documentation
BLM: Cognitive Level: Analyze
NOT: Multiple Select
5. Three years after the nurse's father died in an intensive care unit, the nurse was reviewing a
client's chart. The nurse looked at the client, who had the same diagnosis and similar
features to the nurse's father. The nurse felt a sense of panic but quickly realized that the
client in the bed was not their father. Which of these manifestations of PTSD did this nurse
experience?
A. A flashback
B. Emotional numbing
C. Hyperarousal
D. A dream
ANS: A
Rationale: This nurse was experiencing a flashback, whereupon similar circumstances
triggered a sensation that the stressful experience was happening again. Hyperarousal is the
general sense of sympathetic stimulation that accompanies PTSD and emotional numbing is
a blunting of affective responses. Dreams occur during sleep.
PTS: 1
REF: p. 212
OBJ: 6
NAT: Client Needs: Psychosocial Integrity | Client Needs: Safe, Effective Care
Environment: Management of Care
TOP: Chapter 13: Trauma and Stressor-Related Disorders
KEY: Integrated Process: Teaching/Learning
BLM: Cognitive Level: Apply
NOT: Multiple Choice
6. A client is seeking counseling due to difficulty coping with being a victim of a violent attack
16 months ago. The initial medical diagnosis is to rule out posttraumatic stress disorder
(PTSD). Which would the nurse assess for when determining the major elements of PTSD?
Select all that apply.
A. Reexperiencing the trauma through dreams or recurrent and intrusive thoughts
B. Showing emotional numbing such as feeling detached from others
C. Being on guard, irritable, or experiencing hyperarousal
D. Feeling mildly anxious
E. Occurring 2 weeks after the trauma
ANS: A, B, C
Rationale: The three major elements of PTSD are reexperiencing the trauma through dreams
or recurrent and intrusive thoughts; showing emotional numbing such as feeling detached
from others; and being on guard, irritable, or experiencing hyperarousal. Feeling mildly
anxious is not a major element of PTSD as the person is likely to feel very anxious.
Occurring 2 weeks after the trauma would likely be acute stress disorder, as PTSD
symptoms occur 3 months or more after the trauma.
PTS: 1
REF: p. 218
OBJ: 5
NAT: Client Needs: Psychosocial Integrity | Client Needs: Safe, Effective Care
Environment: Management of Care
TOP: Chapter 13: Trauma and Stressor-Related Disorders
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze
NOT: Multiple Select
7. A client is discovered wandering the street, looking confused and stepping out into traffic.
When emergency responders approach the client, the client cannot recall the client's name or
where the client lives. The responders transport the client to the mental health crisis unit for
further evaluation. Which is the client likely potentially suffering from? Select all that apply.
A. Depersonalization disorder
B. Dissociative identity disorder
C. Repressed memories
D. Dissociative amnesia
E. False memory syndrome
ANS: A, B, D
Rationale: With dissociative amnesia, the client cannot remember important personal
information, such as name or residence. With dissociative personality disorder, the client
displays two or more distinct identities or personality states that recurrently take control of
his or her behavior; memory lapses would also be associated with this disorder. With
depersonalization disorder, the client has a persistent or recurring feeling of being detached
from his or her mental processes or body (depersonalization), or has a sensation of being in
a dream-like state where the environment seems foggy or unreal (derealization). Wandering
aimlessly would be a plausible manifestation of this disorder. Repressed memories are when
a person is unable to consciously recall memories of childhood abuse. False memory
syndrome can occur during psychotherapy when the client is encouraged to imagine false
memories of childhood sexual abuse.
PTS: 1
REF: p. 212
OBJ: 3
NAT: Client Needs: Psychosocial Integrity | Client Needs: Safe, Effective Care
Environment: Management of Care
TOP: Chapter 13: Trauma and Stressor-Related Disorders
KEY: Integrated Process: Communication and Documentation
BLM: Cognitive Level: Analyze
NOT: Multiple Select
8. A nurse is talking to a provider, who quietly and numbly tells the nurse about arriving at the
scene of an automobile–pedestrian accident 3 days ago. The provider performed CPR on a
victim, but it was unsuccessful. Which statement by the nurse would be most appropriate?
A. "Tell me what you saw."
B. "That is horrible!"
C. "Why did you perform CPR?"
D. "I know how you feel; the same thing happened to me several years ago and I
never recovered."
ANS: A
Rationale: One of the most effective ways of avoiding pathologic responses to trauma is
effectively dealing with the trauma soon after it occurs. Describing what the colleague saw
may be very helpful. "That is horrible," is a judgment and is not likely to be helpful. "Why
did you perform CPR," might make the colleague feel defensive. "I know how you feel; the
same thing happened to me several years ago and I never recovered," is nonsupportive and
robs the colleague of any hope that he or she will recover.
PTS: 1
REF: p. 211
OBJ: 5
NAT: Client Needs: Psychosocial Integrity | Client Needs: Safe, Effective Care
Environment: Management of Care
TOP: Chapter 13: Trauma and Stressor-Related Disorders
KEY: Integrated Process: Caring
BLM: Cognitive Level: Apply
NOT: Multiple Choice
9. A firefighter survived a fire after escaping a blaze. Several other firefighters were trapped in
the burning building and died. After working with this firefighter in counseling, the nurse
evaluates which as positive outcomes for this client? Select all that apply.
A. The client will verbalize feelings of stress related to returning to work.
B. The client will express guilt openly through nondestructive means.
C. The client will identify a social support system within the community.
D. The client will report nightmares and flashbacks of the fire.
ANS: A, B, C
Rationale: Treatment outcomes for clients who have survived trauma or abuse may include
verbalizing feelings, expressing emotions nondestructively, and establishing a social support
system in the community. An absence of stress is an unrealistic outcome. Reporting
symptoms of posttraumatic stress disorder such as nightmares and flashbacks suggests an
exacerbation of symptoms and does not indicate positive treatment outcomes.
PTS: 1
REF: p. 213
OBJ: 4
NAT: Client Needs: Psychosocial Integrity | Client Needs: Safe, Effective Care
Environment: Management of Care
TOP: Chapter 13: Trauma and Stressor-Related Disorders
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze
NOT: Multiple Select
10. The traumatized client has suddenly changed demeanor and voice pitch. Which is true about
the use of touch with a client with dissociative identity disorder?
A. It is best not to touch the client without his or her permission.
B. Make sure the client knows the touch is friendly and supportive.
C. Touch the client only if you are in his or her direct line of vision.
D. Touch will convey a sense of security to the client.
ANS: A
Rationale: Clients interpret touch differently, so it is important to assess each client's
comfort with being touched; these clients often have a history of abuse, so permission
should be given before touch is used. The nurse cannot guarantee that touch will be
interpreted as being friendly or supportive, even when the nurse is in the line of the client's
sight.
PTS: 1
REF: p. 216
OBJ: 3
NAT: Client Needs: Psychosocial Integrity | Client Needs: Safe, Effective Care
Environment: Management of Care
TOP: Chapter 13: Trauma and Stressor-Related Disorders
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply
NOT: Multiple Choice
11. Which intervention would be most effective for friends and family members to implement
in order to boost the self-esteem of a person who has just experienced trauma or abuse?
A. To identify a list of support people or activities in the community
B. To remind them to calm down when they appear to be experiencing a flashback
C. To encourage them to tell their story repeatedly to everyone they meet
D. To help them to refocus their view of themselves from being victims to being
survivors
ANS: D
Rationale: Often it is useful to view the client as a survivor of trauma or abuse rather than as
a victim. Defining themselves as survivors allows them to see themselves as strong enough
to survive their ordeal. It is a more empowering image than seeing oneself as a victim. It
would be beneficial for the client to identify a list of support people or activities in the
community, but this would be to establish social support and not promote their self-esteem.
It would not be helpful for anyone to tell the client to calm down when he or she appears to
be experiencing a flashback or to encourage him or her to tell his or her story repeatedly;
these actions could exacerbate the client's symptoms.
PTS:
NAT:
TOP:
KEY:
BLM:
1
REF: p. 206
OBJ: 5
Client Needs: Psychosocial Integrity
Chapter 13: Trauma and Stressor-Related Disorders
Integrated Process: Nursing Process
Cognitive Level: Analyze
NOT: Multiple Choice
12. A nurse is providing education about trauma and its effects to a community group in a
community that has just been hit by a devastating tornado. One of the participants asks
about what kind of support a survivor of the tornado will need. Which would be the best
response of the nurse?
A. If a person is willing to share his or her feelings about what has happened, he or
she is not dealing with their feelings effectively.
B. It is counterproductive for people to share what has happened to them and their
feelings about it as there is nothing more to be done.
C. If a person is reluctant to share his or her feelings, he or she may be denying his or
her importance and may be at increased risk for future problems such as
posttraumatic stress disorder (PTSD).
D. It is best to wait until a survivor's life has returned to normal before dealing with
the trauma.
ANS: C
Rationale: Some people more easily express their feelings and talk about stressful, upsetting,
or overwhelming events. They may do so with family, friends, or professionals. Others are
more reluctant to open up and disclose their personal feelings. They are more likely to
ignore the feelings, deny their importance, or insist "I'm fine, I'm over it." By doing that,
they increase the risk for future problems such as PTSD. One of the most effective ways of
avoiding pathologic responses to trauma is effectively dealing with the trauma soon after it
occurs.
PTS:
NAT:
TOP:
KEY:
NOT:
1
REF: p. 206
OBJ: 5
Client Needs: Psychosocial Integrity
Chapter 13: Trauma and Stressor-Related Disorders
Integrated Process: Caring
BLM: Cognitive Level: Apply
Multiple Choice
13. The nurse is having feelings of judgement regarding a client's contributory behavior to an
automobile accident that resulted in deaths. Which action would the nurse take?
A. Discussing the nurse's personal feelings with a peer or a counselor
B. Acknowledging to the client the judgment regarding his or her contributory
behavior
C. Sharing the client's horror and encouraging him or her to avoid thinking about it
D. Letting the client know that he or she is now traumatized beyond repair
ANS: A
Rationale: Remaining nonjudgmental of the client is important, but does not happen
automatically. The nurse may need to deal with personal feelings by talking to a peer or
counselor. It is inappropriate and unprofessional to share these feelings with the client or to
try to "share" the client's horror. Telling anyone that they are traumatized beyond repair is
nontherapeutic and inaccurate.
PTS: 1
REF: p. 211
OBJ: 6
NAT: Client Needs: Psychosocial Integrity | Client Needs: Safe, Effective Care
Environment: Management of Care
TOP: Chapter 13: Trauma and Stressor-Related Disorders
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply
NOT: Multiple Choice
14. A nurse is caring for a client who is a veteran with thoughts of missiles screaming and
exploding. The client reexperiences feelings of terror first experienced in combat. Upon
assessment, the nurse knows these recurrent events are part of which disorder?
A. Acute stress disorder
B. Generalized anxiety disorder
C. Adjustment disorder
D. Posttraumatic stress disorder (PTSD)
ANS: D
Rationale: The effects of the trauma at the time, such as being directly involved,
experiencing physical injury, or loss of loved ones in the event, are powerful predictors of
PTSD for most people. Acute stress disorder occurs after a traumatic event and is
characterized by reexperiencing, avoidance, and hyper arousal that occur from 3 days to 4
weeks following a trauma. Adjustment disorder is a reaction to a stressful event that causes
problems for the individuals. Typically, the person has more than the expected difficulty
coping with or assimilating the event into his or her life. Generalized anxiety disorder does
not involve flashbacks and reexperiencing a severe stressor.
PTS:
NAT:
TOP:
KEY:
BLM:
1
REF: p. 206
OBJ: 3
Client Needs: Psychosocial Integrity
Chapter 13: Trauma and Stressor-Related Disorders
Integrated Process: Nursing Process
Cognitive Level: Apply
NOT: Multiple Choice
15. When working with a client with post traumatic stress disorder (PTSD), who has frequent
flashbacks, the nurse should include which intervention?
A. encouraging repression of memories associated with the traumatic event
B. explaining that physical symptoms are unrelated to the psychological state
C. teaching various relaxation techniques
D. discussing the event has no real meaning
ANS: C
Rationale: The client needs to confront the feared emotions, situations, and thoughts
associated with the trauma rather than attempting to avoid them. Various relaxation
techniques are employed to help the client tolerate and manage the anxiety response. The
event has an intensely real meaning for the client which can often manifest in physical
symptoms related to sympathetic stimulation.
PTS:
NAT:
TOP:
KEY:
BLM:
1
REF: p. 206
OBJ: 4
Client Needs: Psychosocial Integrity
Chapter 13: Trauma and Stressor-Related Disorders
Integrated Process: Communication and Documentation
Cognitive Level: Apply
NOT: Multiple Choice
16. A client tells a nurse about recent episodes of strange behavior that the client cannot recall
but has discussed with family. The client reports being told of going out late at night
dressed, but not in the usual wardrobe. Upon return, the client cannot recall any of the event.
The nurse suspects the client is dealing with which personality disorder?
A. Antisocial personality
B. Borderline personality
C. Dissociative identity disorder
D. Body dysmorphic disorder
ANS: C
Rationale: With dissociative identity disorder (formerly multiple personality disorder), the
client displays two or more distinct identities or personality states that recurrently take
control of his or her behavior. This is accompanied by the inability to recall important
personal information. Antisocial personality disorder involves conflict with others and
borderline personality disorder does not involve dissociation. Body dysmorphic disorder
focuses on the client's perception of his or her appearance.
PTS:
NAT:
TOP:
KEY:
NOT:
1
REF: p. 212
OBJ: 3
Client Needs: Psychosocial Integrity
Chapter 13: Trauma and Stressor-Related Disorders
Integrated Process: Caring
BLM: Cognitive Level: Apply
Multiple Choice
17. For a client with dissociative identity disorder, the nurse understands that the disturbed
personal identity is most likely related to which characteristic?
A. Poor impulse control
B. Chronic low self-esteem
C. High risk for self-directed violence
D. Unresolved childhood abuse issues
ANS: D
Rationale: With dissociative identity disorder (formerly multiple personality disorder), the
client displays two or more distinct identities or personality states that recurrently take
control of his or her behavior. Nearly all clients with dissociative identity disorder, resulting
in disturbance of personal identity, have a history of having been abused in childhood.
Disruptions to impulse control, low self-esteem and risk for self-harm are effects, not
causes, of dissociative identity disorder.
PTS:
NAT:
TOP:
KEY:
BLM:
1
REF: p. 212
OBJ: 3
Client Needs: Psychosocial Integrity
Chapter 13: Trauma and Stressor-Related Disorders
Integrated Process: Nursing Process
Cognitive Level: Apply
NOT: Multiple Choice
18. A nurse reviews the client’s history prior to being seen by a clinician. The nurse identifies
that the client had changed jobs a few times in the last several months and was recently
divorced. Which treatment option would be the most successful for the client?
A. Counseling services
B. Medication directed toward relieving depression
C. Hospital admission
D. Group therapy for job placement
ANS: A
Rationale: Outpatient counseling or therapy is the most common and successful treatment
for a client experiencing adjustment disorder, a stressful event that has expected difficult
coping related to financial, relationship, and work-related stressors. There is no indication
that the client is experiencing depression; therefore, medication is not warranted. The client
does not need hospital admission as the client has not indicated harm to oneself or others.
Group therapy provides support for members of the group and not necessarily used for job
placement.
PTS:
NAT:
TOP:
KEY:
BLM:
1
REF: p. 208
OBJ: 5
Client Needs: Psychosocial Integrity
Chapter 13: Trauma and Stressor-Related Disorders
Integrated Process: Nursing Process
Cognitive Level: Apply
NOT: Multiple Choice
19. A nurse is caring for an adolescent who has been hospitalized after experiencing a rape and
having difficulty sleeping. The nurse is developing a plan of care. Which others area(s)
should the nurse assess? Select all that apply.
A. Suicide risk
B. Substance use disorder
C. Social support
D. School grades
E. Use of smart phone applications
F. Height and weight
ANS: A, B, C, D, F
Rationale: The client is experiencing posttraumatic stress disorder (PTSD). Adolescents
with PTSD are at increased risk for suicide, substance use disorder, poor social support,
academic problems such as decreased school grades, and poor physical health such as low
weight for height. Assessing the client’s use of smart phone applications such as social
media sites may not indicate if there is poor social support. If the client is viewing text
messages or applications related to social media including Facebook, twitter, or snap chap,
this may indicate social support.
PTS:
NAT:
TOP:
KEY:
BLM:
1
REF: p. 208
OBJ: 2
Client Needs: Safe, Effective Care Environment: Management of Care
Chapter 13: Trauma and Stressor-Related Disorders
Integrated Process: Nursing Process
Cognitive Level: Apply
NOT: Multiple Select
20. A nurse is caring for four pediatric clients on an acute care division of a hospital. Which
client would the nurse expect to be sad or irritable, to not engage with children in the
playroom but watches them, and to have a listless appearance?
A. A 5-year-old child with antisocial personality disorder
B. A 6-year-old child with reactive attachment disorder
C. A 7-year-old child with generalized anxiety disorder
D. An 8-year-old child with an acute stress disorder
ANS: B
Rationale: The client with reactive attachment disorder elicits minimal social and emotional
responses to others, lacks a positive affect, and may be sad, irritable, or afraid of engaging
with strangers for no apparent reason. A child with antisocial personality disorder will
disregard right and wrong, persistently lie or deceive to exploit others, and is callous,
cynical and disrespectful of others. A child with generalized anxiety disorder symptoms will
exhibit constant worry, restlessness, and trouble with concentration. A child with acute stress
disorder is characterized by reexperiencing, avoidance, and hyperarousal for 1 to 3 weeks
following a trauma.
PTS:
NAT:
TOP:
KEY:
BLM:
1
REF: p. 208
OBJ: 4
Client Needs: Safe, Effective Care Environment: Management of Care
Chapter 13: Trauma and Stressor-Related Disorders
Integrated Process: Nursing Process
Cognitive Level: Apply
NOT: Multiple Choice
21. A nurse is caring for a client hospitalized after a traumatic event. The client states not
sleeping and feeling anxious. Which therapy is indicated?
A. Selective serotonin reuptake inhibitor (SSRI)
B. Tricyclic
C. Stimulant
D. Triptan
ANS: A
Rationale: The client is experiencing posttraumatic stress disorder (PTSD). Medications
such as an SSRI or a serotonin and norepinephrine reuptake inhibitor (S/NRI) are most
effective for clients with the PTSD symptoms of insomnia and anxiety. Benzodiazepines and
second-generation antipsychotics are often used. Stimulants such as amphetamines and
dexmethylphenidate are used in attention deficit disorder (ADD). Tricyclic use is rare in
current practice, but they may be prescribed for depression, not PTSD. Triptans are
migraine-specific medications.
PTS:
NAT:
TOP:
KEY:
BLM:
1
REF: p. 211
OBJ: 1
Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Chapter 13: Trauma and Stressor-Related Disorders
Integrated Process: Nursing Process
Cognitive Level: Understand
NOT: Multiple Choice
22. A nurse is providing discharge instructions to a client who was hospitalized for a suicide
attempt. Which information is included in the instructions?
A. Get adequate sleep and eat healthy.
B. Occasional use of alcohol during the holidays is acceptable.
C. Join a local gym and visit the trainer twice per week.
D. When stressed, write down the emotions and reflect on them.
ANS: A
Rationale: After a traumatic event, the nurse should teach about many self-care
interventions to promote physical and emotional well-being. These include getting adequate
sleep, eating healthy, joining a support group, following a daily routine, avoiding alcohol
and other drugs, and practicing stress-reduction techniques. If a client is not physically
active prior to the suicide attempt, then the client needs to be evaluated prior to starting a
workout regimen at a gym. When stressed, the client should share emotions and experiences
with others and the health care provider.
PTS:
NAT:
TOP:
KEY:
BLM:
1
REF: p. 211
OBJ: 2
Client Needs: Psychosocial Integrity
Chapter 13: Trauma and Stressor-Related Disorders
Integrated Process: Teaching/Learning
Cognitive Level: Apply
NOT: Multiple Choice
23. A nurse is caring for a client who was hospitalized for a traumatic event. Which action
reflects that the client is transitioning to outcomes related to stabilization?
A. The client needs a sleep medication because the client is dreaming about the event.
B. The client participates in group therapy for 30 minutes twice per day.
C. The client expresses feelings related to the event in nondestructive ways.
D. The client implements plans for ongoing therapy with a therapist outside the
hospital.
ANS: C
Rationale: The client with posttrauma syndrome has ongoing, maladaptive pattern of
behavior. There are two phases of treatment outcomes: immediate and stabilization.
Immediate outcomes have a time focus. These include the client identifying the traumatic
event within 24 to 48 hours and participating in group therapy for 30 minutes twice per day.
Needing a sleep medication occurs in the immediate outcome phase. Stabilization occurs
when the client expresses feelings related to the event in nondestructive ways. A community
focus outcome occurs when the client implements plans for follow-up or ongoing therapy
and is not related to the treatment outcomes of immediate or stabilization.
PTS:
NAT:
TOP:
KEY:
BLM:
1
REF: p. 213
OBJ: 3
Client Needs: Psychosocial Integrity
Chapter 13: Trauma and Stressor-Related Disorders
Integrated Process: Nursing Process
Cognitive Level: Apply
NOT: Multiple Choice
24. A nurse is caring for a client who was recently hospitalized after witnessing gun violence.
The nurse and client were engaged in a conversation when the client starts to stare off in the
distance and stops participating in the conversation. Which statement by the nurse is
appropriate?
A. “Are you ok?”
B. “Can you see me and the room we are in?”
C. “I am going to call the health care provider.”
D. “Tell me what you are hearing.”
ANS: B
Rationale: The client is likely experiencing a flashback from the traumatic event. The nurse
should use grounding techniques to remind the client that he or she is in the present, is with
an adult and is safe. Asking if the client if he or she can see the nurse and the room is the
appropriate response because it increases contact with reality. Asking the client if he or she
is ok does not ground the client. Telling the client to express what is being heard is not
grounding the client. The nurse’s first response is to assess the client and focus on grounding
techniques, then the nurse may call the health care provider if a medication or safety
concern is identified.
PTS:
NAT:
TOP:
KEY:
NOT:
1
REF: p. 217
OBJ: 3
Client Needs: Safe, Effective Care Environment: Management of Care
Chapter 13: Trauma and Stressor-Related Disorders
Integrated Process: Caring
BLM: Cognitive Level: Apply
Multiple Choice
25. A nurse is caring for clients who have experienced trauma and other stress-related disorders.
Which intervention(s) is appropriate to promote positive self-care for nurses caring for
clients exposed to trauma? Select all that apply.
A. Managing feelings and reactions about traumatic events.
B. Expressing feelings about the clients’ disorders in group therapy.
C. Listening to clients’ expression of depression associated with the trauma.
D. Engaging in stress-reduction techniques such as exercise and healthy eating.
E. Attempting to fix problems with clients to assist in alleviating their stress.
ANS: A, C, D
Rationale: It is important that nurses who care for the clients that experience trauma are
aware of their own stressors. Nurses should manage their own feelings and reactions about
traumatic events, remain nonjudgmental regardless of circumstances, and listen to the
clients’ expressions of despair or distress. Engaging in stress-reduction techniques such as
exercise and healthy eating is essential. The nurse should not express his or her feelings in
group therapy about the clients the nurse cares for nor fix the problems with clients because
this does not assist clients in learning to manage anxiety and problem solving after a
traumatic event.
PTS:
NAT:
TOP:
KEY:
BLM:
1
REF: p. 219
OBJ: 6
Client Needs: Psychosocial Integrity
Chapter 13: Trauma and Stressor-Related Disorders
Integrated Process: Nursing Process
Cognitive Level: Apply
NOT: Multiple Select