Nokea
A nurse assesses the health status of veterans of the war in Afghanistan. Screening will be a priority for signs and symptoms of which health problems? (Select all that apply.)
- A. Schizophrenia
- B. Eating disorder
- C. Traumatic brain injury
- D. Seasonal affective disorder
- E. Posttraumatic stress disorder
Correct Answer: C,E
Rationale: TBI and PTSD each occur in approximately 20% of soldiers who experienced combat. Some soldiers have both problems. The incidence of disorders identified in the distractors would be expected to parallel the general population.
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Cortisol is released in response to a patient's prolonged stress. Which initial effect would the nurse expect to result from the increased cortisol level?
- A. Diuresis and electrolyte imbalance
- B. Focused and alert mental status
- C. Drowsiness and lethargy
- D. Restlessness and anxiety
Correct Answer: B
Rationale: Cortisol is the primary stress hormone and is released in response to prolonged stress. Cortisol helps supply cells with amino acids and fatty acids for energy supply, as well as diverting glucose from muscles for use by the brain. As a result, the brain stays alert and focused. The distractors present effects that would not be expected.
A professor's 4-year-old child has a temperature of 101.6°F, diarrhea, and complains of stomach pain. The professor is scheduled to teach three classes today. Which actions by the professor demonstrate effective parenting? (Select all that apply.)
- A. Telephoning a grandparent to stay with the child at home for the day
- B. Telephoning a colleague to teach his classes and staying home with the sick child
- C. Taking the child to the university and keeping the child in a private office for the day
- D. Taking the child to a day care center and hoping day care workers will not notice the child is sick
- E. Giving the child one dose of ibuprofen (Motrin) and taking the child to the day care center
Correct Answer: A,B
Rationale: The correct responses demonstrate fulfillment of the role as a parent. The distractors indicate the professor has not cared for the sick child in an effective way. Taking the child to a day care center exposes other children to a potential infection. Taking the child to one's office does not keep the child comfortable or provide for the child while the professor is teaching.
A veteran of military combat tells the nurse, 'I saw a child get blown up over a year ago, and now I keep seeing bits of flesh everywhere. I see something red and the visions race back to my mind.' Which phenomenon associated with posttraumatic stress disorder (PTSD) is this veteran describing?
- A. Re-experiencing
- B. Hyperarousal
- C. Avoidance
- D. Psychosis
Correct Answer: A
Rationale: Spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic events are often associated with PTSD. The veteran has described intrusive thoughts and visions associated with re-experiencing the traumatic event. This description does not indicate psychosis, hypervigilance, or avoidance.
Which experiences are most likely to precipitate posttraumatic stress disorder (PTSD)? (Select all that apply.)
- A. An 8-year-old child watches an R-rated movie with both parents.
- B. A young adult jumps from a bridge with a bungee cord with a best friend.
- C. An adolescent is kidnapped and held for 2 years in the home of a sexual predator.
- D. A passenger is in a bus that overturns on a sharp curve in the road, tumbling down an embankment.
- E. An adult is trapped for 3 hours at an angle in an elevator after a portion of the supporting cable breaks.
Correct Answer: C,D,E
Rationale: PTSD usually follows a traumatic event that is outside the range of usual experience. Examples are childhood physical abuse, torture or kidnapping, military combat, sexual assault, and natural disasters such as floods, tornados, earthquakes, and tsunamis; human disasters such as a bus or elevator accident or crime-related events such being taken hostage are additional examples. The common element in these experiences is the individual's extraordinary helplessness or powerlessness in the face of such stressors. Bungee jumping by adolescents is part of the developmental task and might be frightening but in an exhilarating way rather than a harmful way. A child may be disturbed by an R-rated movie, but the presence of the parents would modify the experience in a positive way.
A nurse talks with the caregiver of a combat veteran diagnosed with severe traumatic brain injuries. The caregiver says, 'I don't know how much longer I can do it. My whole life is consumed with taking care of my partner.' Which response best addresses the needs of the caregiver?
- A. How are you taking care of yourself?'
- B. Let's review your partner's diagnostic results.'
- C. I have some web-based programs for you to visit.'
- D. Your partner is lucky to have someone so devoted.'
Correct Answer: A
Rationale: The caregiver is the focus of the nurse's attention. The caregiver is suffering. The nurse must be empathetic and assess how the caregiver is caring for self. Reassurance and isolated computer activities do not help. The partner is already aware of the diagnostic results.