Nokea
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.
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A person with a fear of closes spaces enters into an elevator. Which division of the autonomic nervous system is stimulated in response to this experience?
- A. Limbic system
- B. Peripheral nervous system
- C. Sympathetic nervous system
- D. Parasympathetic nervous system
Correct Answer: C
Rationale: The autonomic nervous system is made up of the sympathetic (fight-or-flight response) and parasympathetic (relaxation response) nervous systems. In times of stress, the sympathetic nervous system is stimulated. A person fearful of heights would experience stress associated with the experience of driving across a high bridge. The peripheral nervous system responds to messages from the sympathetic nervous system. The limbic system processes emotional responses but is not specifically part of the autonomic nervous system.
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 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.
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.
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.