Nokea
A patient is brought to the emergency department after a motorcycle accident. The patient is alert, responsive, and diagnosed with a broken leg. The patient's vital signs are temperature (T), $98.6^{\circ} \mathrm{F}$; pulse (P), 72 beats/min (bpm); and respirations (R), 16 breaths per minute. After being informed that surgery is required for the broken leg, which vital sign readings would be expected?
- A. T, 98.6°; P, 64; R, 14
- B. T, 98.6°; P, 68; R, 12
- C. T, 98.6°; P, 62; R, 16
- D. T, 98.6°; P, 84; R, 22
Correct Answer: D
Rationale: The patient would experience stress associated with the anticipation of surgery. In times of stress, the sympathetic nervous system takes over (fight-or-flight response) and sends signals to the adrenal glands, thereby releasing epinephrine. The circulating epinephrine increases the heart rate. Respirations increase, bringing more oxygen to the lungs.
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A soldier returned 1 year ago from Afghanistan and was diagnosed with posttraumatic stress disorder (PTSD). Which social event would most likely be disturbing for this soldier?
- A. Halloween festival with neighborhood children
- B. Singing carols around a Christmas tree
- C. Family outing to the seashore
- D. Fireworks display on July 4th
Correct Answer: D
Rationale: Exploding noises associated with fireworks are most likely to provoke exaggerated responses for this soldier. The distractors are not associated with offensive sounds.
As part of the stress response, the HPA axis is stimulated. Which structures make up this system?
- A. Hippocampus, parietal lobe, and amygdala
- B. Hypothalamus, pituitary gland, and adrenal glands
- C. Hind brain, pyramidal nervous system, and anterior cerebrum
- D. Hepatic artery, parasympathetic nervous system, and acoustic nerve
Correct Answer: B
Rationale: As part of the physiological response of stress, the hypothalamus stimulates the HPA axis, which is made up of the hypothalamus, pituitary gland, and adrenal glands.
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.
An individual has been diagnosed with a dissociative disorder. Which comorbid psychiatric disorders are most likely to accompany this type of mental illness? (Select all that apply.)
- A. Substance abuse disorders
- B. Depression
- C. Eating disorders
- D. Personality disorders
- E. Schizophrenia
Correct Answer: A,B,C,D
Rationale: Comorbid psychiatric disorders associated with dissociative disorders include: substance use disorders, depression and anxiety disorders, eating disorders, PTSD, and personality disorders. Schizophrenia is not associated with this type of disorder.