Nokea
A soldier returned home last year after deployment to a war zone. The soldier's spouse reports, '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.' What response best addresses the spouse's concerns?
- A. Posttraumatic stress disorder 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. I will suggest some community resources for help and support.'
Correct Answer: D
Rationale: Posttraumatic stress disorder (PSTD) precipitates changes that often lead to divorce. Providing support to both the veteran and spouse is important. Confrontation will not be effective. Although providing information is important, ongoing support is more effective.
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A soldier returns to the United States from active duty in a combat zone. The soldier is diagnosed with posttraumatic stress disorder (PTSD). Which comment by the soldier requires the nurse's immediate attention?
- A. It's good to be home. I missed my family and friends.'
- B. I saw my best friend get killed by a roadside bomb. It should have been me instead.'
- C. Sometimes I think I hear bombs exploding, but it's just the noise of traffic in my hometown.'
- D. I want to continue my education but I'm not sure how I will fit in with other college students.'
Correct Answer: B
Rationale: The correct response indicates the soldier is thinking about death and feeling survivor's guilt. These emotions may accompany suicidal ideation, which warrants the nurse's follow-up assessment. Suicide is a high risk among military personnel diagnosed with PTSD. One distractor indicates flashbacks, which is common with individuals with PTSD but is not solely indicative of further problems. The other distractors are normal emotions associated with returning home and change.
A nurse designs a plan of exercise for a patient experiencing stress. What rationale should the nurse cite when presenting this plan to the treatment team?
- A. Exercise will stimulate endorphins and improve the patient's feelings of well-being.
- B. Exercise prevents damage from overstimulation of the sympathetic nervous system.
- C. Exercise detoxifies the body by removing metabolic wastes and other toxins.
- D. Exercise will prevent exacerbation of the stress by the limbic system.
Correct Answer: A
Rationale: Exercise is a stress reduction strategy that stimulates endorphins and improves patient's feelings of well-being. The other options are not accurate.
A family member asks the nurse, 'Do you think stress and physical illness are connected? Since my father's death, my mother has had shingles and the flu, but she's usually not one who gets sick.' Which answer by the nurse best reflects current knowledge about long term effects of stress?
- A. It is probably a coincidence. Emotions and physical responses travel on different tracts of the nervous system.'
- B. You may be paying more attention to your mother since your father died and noticing more things such as minor illnesses.'
- C. So far, research on emotions or stress and becoming ill more easily is unclear. We do not know for sure if there is a link.'
- D. Negative emotions and stress may interfere with the body's ability to protect itself and can increase the likelihood of infection.'
Correct Answer: D
Rationale: The correct answer best explains the research. Research supports a link between negative emotions and/or prolonged stress and impaired immune system functioning. Activation of the immune system signals the central nervous system to initiate myriad responses to stress. Prolonged stress suppresses the immune system and lowers resistance to infections.
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.
A soldier who served in a combat zone returned to the United States. The soldier's spouse complains to the nurse, 'We had planned to start a family, but now he won't talk about it. He won't even look at children.' The spouse is describing which symptom associated with posttraumatic stress disorder (PTSD)?
- A. Re-experiencing
- B. Hyperarousal
- C. Avoidance
- D. Psychosis
Correct Answer: C
Rationale: Physiological reactions to reminders of the event include a persistent avoidance of the stimuli associated with the trauma; the individual avoids talking about the event or avoids activities, people, or places that arouse memories of the trauma. Avoidance is exemplified by a sense of foreshortened future and estrangement. No evidence suggests that this soldier is having a hyperarousal reaction or is re-experiencing war-related traumas. Psychosis is not evident.