A nurse is assessing a client who has posttraumatic stress disorder (PTSD) following a sexual assault. Which of the following is an expected finding?
Increasing feelings of anger.
Sleeping 12 hours or more each day.
Increasing sense of attachment to others.
Constant need to talk about the event.
The Correct Answer is A
Choice A rationale:
Anger is a common and expected response to trauma, including sexual assault. It can stem from various sources, including:
Feelings of violation and powerlessness: Survivors may feel intense anger towards the perpetrator for taking control of their bodies and lives.
Betrayal: If the assault was committed by someone they knew or trusted, survivors may feel intense anger towards that person for breaking their trust.
Frustration and injustice: Survivors may feel angry at the injustice of the situation, the lack of control they had, and the ongoing impact of the trauma.
Difficulty processing other emotions: Anger can sometimes mask other emotions that are difficult to deal with, such as fear, sadness, or guilt.
Anger can manifest in various ways, including:
Irritability and outbursts: Survivors may have a short temper, snap at others easily, or have difficulty controlling their anger. Aggression: In some cases, anger can lead to physical or verbal aggression towards others or self-harming behaviors.
Withdrawal and isolation: Some survivors may withdraw from social interactions and relationships to avoid potential triggers for their anger.
Substance abuse: Some survivors may turn to alcohol or drugs to numb their feelings or cope with their anger.
Choice B rationale:
Sleeping 12 hours or more each day can be a symptom of PTSD, but it is not a specific indicator of anger. It can also be a sign of depression, anxiety, or hypersomnia, a sleep disorder characterized by excessive daytime sleepiness.
Choice C rationale:
PTSD can sometimes lead to an increased sense of detachment from others, rather than attachment. Survivors may feel emotionally numb, have difficulty trusting others, or withdraw from relationships.
Choice D rationale:
While some survivors of sexual assault may feel a need to talk about the event, it is not a universal symptom of PTSD. Some survivors may avoid talking about the event altogether due to the distress it causes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"B"},"E":{"answers":"A"},"F":{"answers":"A"}}
Explanation
The correct answer/s is Choice/s.
Choice A rationale: Requesting to decrease the dose of oral glycemic medication might not be the most appropriate action for the nurse to take. The client reports overeating since they were 14 years old, which could potentially lead to obesity and related health issues such as type 2 diabetes. However, without more information about the client’s current health status and blood glucose levels, it’s not clear whether a decrease in oral glycemic medication is warranted. It’s important for healthcare providers to monitor and adjust medication dosages based on individual patient needs and responses.
Choice B rationale: Encouraging the client to eat small, frequent meals could be a beneficial strategy. Overeating can lead to weight gain and related health problems. Eating smaller meals more frequently throughout the day can help to control hunger and manage portion sizes, which could potentially help the client to reduce overeating.
Choice C rationale: Instructing the client to weigh themselves daily might not be the best approach. While it’s important for individuals to be aware of their weight as part of overall health management, daily weighing can become a source of stress and anxiety. It might be more helpful to focus on promoting healthy behaviors and coping strategies to manage overeating.
Choice D rationale: Anticipating a potassium supplement for the client might not be necessary. While potassium is an essential nutrient, there’s no indication from the information provided that the client has a potassium deficiency. Overeating does not necessarily lead to nutrient deficiencies, and supplementation should be based on individual needs and medical advice.
Choice E rationale: Teaching the client to plan meals ahead could be a very helpful strategy. Meal planning can help individuals manage portion sizes, ensure a balanced diet, and avoid impulsive eating decisions. This could potentially help the client manage their overeating.
Choice F rationale: Recommending that the client journal about their feelings could be a beneficial strategy. Emotional eating, or eating in response to feelings rather than hunger, is a common issue. Journaling can help individuals identify emotional triggers for overeating and develop healthier coping strategies.
Correct Answer is D
Explanation
Choice A: History of bulimia nervosa: While eating disorders can be comorbid with self-harm, bulimia nervosa specifically is not a strong independent risk factor for self-harm. The focus of bulimia nervosa lies on purging behaviors to counteract weight gain, and while self-harm can co-occur, it's not directly linked to the core symptoms of the eating disorder.
Choice B: Parent with dependent personality disorder: Personality disorders in family members can create complex family dynamics and contribute to emotional distress, but inheriting a personality disorder is not possible.
Additionally, dependent personality disorder specifically is characterized by excessive reliance on others, not behaviors associated with increased risk for self-harm.
Choice C: Recent promotion at work: Positive life events like a promotion are unlikely to directly increase the risk of self-harm. In fact, achieving goals and milestones can be protective factors for mental health.
Choice D: Borderline personality disorder: Borderline personality disorder (BPD) is a well-established risk factor for self-harm. Individuals with BPD often experience emotional dysregulation, impulsivity, and fear of abandonment, which can lead to self-injurious behaviors as a coping mechanism. The intense emotions and unstable interpersonal relationships associated with BPD make individuals more vulnerable to engaging in self-harm to manage overwhelming distress.
Further Explanation:
BPD is characterized by a pattern of five or more of the following symptoms:
Fear of abandonment: Frantic efforts to avoid real or imagined abandonment.
Unstable relationships: Intense and unstable relationships with a pattern of idealization and devaluation. Identity disturbance: Markedly unstable sense of self-image or self-worth.
Impulsivity: In at least two areas that are potentially damaging (e.g., spending, unsafe sex, substance abuse). Suicidality: Recurrent suicidal threats, gestures, or attempts, or self-mutilating behavior.
Affective instability: Marked mood swings (e.g., intense episodes of anger, dysphoria, anxiety, or despair lasting a few hours and up to a few days).
Chronic emptiness: Feelings of emptiness or boredom.
Dissociation: Transient, stress-related episodes of derealization or depersonalization.
Research indicates that individuals with BPD have a significantly higher risk of self-harm compared to the general population, with estimates ranging from 70% to 90%. This increased risk is attributed to several factors associated with BPD, such as:
Emotional dysregulation: Difficulty managing intense emotions, leading to self-harm as a way to cope with overwhelming distress.
Impulsivity: Engaging in harmful behaviors without considering the consequences, including self-harm.
Fear of abandonment: Self-harm can be used as a way to punish oneself or manipulate others to prevent perceived abandonment.
Negative self-image: Low self-esteem and feelings of worthlessness can contribute to self-harming behaviors as a form of self-punishment.
Conclusion:
While other factors may contribute to self-harm risk, borderline personality disorder remains a significant and well- established risk factor. A mental health nurse reviewing a client's medical record should prioritize identifying BPD as a potential indicator of increased risk for self-harm behaviors.
Choice A: History of bulimia nervosa: While eating disorders can be comorbid with self-harm, bulimia nervosa specifically is not a strong independent risk factor for self-harm. The focus of bulimia nervosa lies on purging behaviors to counteract weight gain, and while self-harm can co-occur, it's not directly linked to the core symptoms of the eating disorder.
Choice B: Parent with dependent personality disorder: Personality disorders in family members can create complex family dynamics and contribute to emotional distress, but inheriting a personality disorder is not possible.
Additionally, dependent personality disorder specifically is characterized by excessive reliance on others, not behaviors associated with increased risk for self-harm.
Choice C: Recent promotion at work: Positive life events like a promotion are unlikely to directly increase the risk of self-harm. In fact, achieving goals and milestones can be protective factors for mental health.
Choice D: Borderline personality disorder: Borderline personality disorder (BPD) is a well-established risk factor for self-harm. Individuals with BPD often experience emotional dysregulation, impulsivity, and fear of abandonment, which can lead to self-injurious behaviors as a coping mechanism. The intense emotions and unstable interpersonal relationships associated with BPD make individuals more vulnerable to engaging in self-harm to manage overwhelming distress.
Further Explanation:
BPD is characterized by a pattern of five or more of the following symptoms:
Fear of abandonment: Frantic efforts to avoid real or imagined abandonment.
Unstable relationships: Intense and unstable relationships with a pattern of idealization and devaluation. Identity disturbance: Markedly unstable sense of self-image or self-worth.
Impulsivity: In at least two areas that are potentially damaging (e.g., spending, unsafe sex, substance abuse). Suicidality: Recurrent suicidal threats, gestures, or attempts, or self-mutilating behavior.
Affective instability: Marked mood swings (e.g., intense episodes of anger, dysphoria, anxiety, or despair lasting a few hours and up to a few days).
Chronic emptiness: Feelings of emptiness or boredom.
Dissociation: Transient, stress-related episodes of derealization or depersonalization.
Research indicates that individuals with BPD have a significantly higher risk of self-harm compared to the general population, with estimates ranging from 70% to 90%. This increased risk is attributed to several factors associated with BPD, such as:
Emotional dysregulation: Difficulty managing intense emotions, leading to self-harm as a way to cope with overwhelming distress.
Impulsivity: Engaging in harmful behaviors without considering the consequences, including self-harm.
Fear of abandonment: Self-harm can be used as a way to punish oneself or manipulate others to prevent perceived abandonment.
Negative self-image: Low self-esteem and feelings of worthlessness can contribute to self-harming behaviors as a form of self-punishment.
Conclusion:
While other factors may contribute to self-harm risk, borderline personality disorder remains a significant and well- established risk factor. A mental health nurse reviewing a client's medical record should prioritize identifying BPD as a potential indicator of increased risk for self-harm behaviors.
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