A nurse is caring for a client who was involved in heavy combat and observed war casualties. The nurse should suspect that the client is suffering from posttraumatic stress disorder (PTSD) if the client makes which of the following statements?
"My child was born with a birth defect due to an exposure I had overseas."
I check any room I enter because the enemy is still after me and could be hiding anywhere."
"In my dreams, all I can see are the wounded reaching out and trying to grab me."
"I killed four enemy soldiers with my bare hands and saved my entire battalion."
The Correct Answer is C
A) "My child was born with a birth defect due to an exposure I had overseas."
This statement does not directly relate to the core symptoms of PTSD. While exposure to trauma can have a variety of consequences, including potential exposure-related health issues, this statement does not necessarily indicate the re-experiencing, avoidance, or hyperarousal symptoms characteristic of PTSD.
B) "I check any room I enter because the enemy is still after me and could be hiding anywhere."
This statement is more indicative of hyperarousal and hypervigilance, which are common symptoms of PTSD. However, it does not explicitly involve re-experiencing the traumatic event through nightmares or intrusive memories, as described in the correct answer.
C) "In my dreams, all I can see are the wounded reaching out and trying to grab me."
Explanation:
The statement "In my dreams, all I can see are the wounded reaching out and trying to grab me" indicates symptoms commonly associated with posttraumatic stress disorder (PTSD). This statement reflects the re-experiencing symptom cluster of PTSD, where individuals may have distressing and intrusive memories, nightmares, or flashbacks related to the traumatic event they experienced. The imagery of wounded individuals trying to grab the person suggests a strong emotional impact and ongoing distress related to the traumatic experience.
D) "I killed four enemy soldiers with my bare hands and saved my entire battalion."
While this statement might reflect exposure to a traumatic event and could contribute to symptoms of PTSD, it is presented in a way that seems more like a narrative of heroic actions rather than a symptom of distress or re-experiencing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Gabapentin and phenytoin are not directly associated with causing vitamin B deficiencies. However, certain antiseizure medications could potentially affect nutrient absorption over time.
B) A client who has chronic alcohol use disorder.
Explanation:
Chronic alcohol use disorder can lead to a deficiency in several B vitamins, particularly vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B3 (niacin), vitamin B6 (pyridoxine), vitamin B9 (folate), and vitamin B12 (cobalamin). Alcohol interferes with the absorption and utilization of these vitamins in the body, and individuals with alcohol use disorder are often at risk for malnutrition and vitamin deficiencies.
C) A client who takes heparin to prevent deep vein thrombosis:
Heparin is an anticoagulant and does not directly impact the absorption or utilization of vitamin B.
D) A client who has asthma:
Asthma itself does not significantly increase the risk of vitamin B deficiencies. Vitamin B deficiencies are more commonly associated with factors like malnutrition, certain medical conditions, or medications that impact absorption, as seen in chronic alcohol use disorder.
Correct Answer is C
Explanation
A. "This medication may increase your blood pressure."
This statement is incorrect. Risperidone is not typically associated with significant increases in blood pressure. One of the potential side effects of risperidone is orthostatic hypotension, which is a drop in blood pressure when changing positions (e.g., standing up quickly). Therefore, this choice is not the best instruction to include in the teaching.
B. "Flu-like symptoms are an expected adverse effect of this medication."
This statement is incorrect. While risperidone can have side effects, flu-like symptoms are not commonly associated with it. Common side effects of risperidone may include dizziness, drowsiness, weight gain, and movement disorders. Flu-like symptoms are not a typical adverse effect of this medication.
C. "Avoid becoming overheated while taking this medication."
This statement is correct. Risperidone, like many other antipsychotic medications, can interfere with the body's ability to regulate temperature. This can lead to an increased risk of overheating, especially in hot weather or during vigorous physical activity. Therefore, it's important for patients taking risperidone to be cautious and avoid becoming overheated, as this could potentially lead to heat-related complications.
D. "Muscle twitches can occur the first few weeks while taking this medication."
This statement is incorrect. Muscle twitches are not a common side effect of risperidone. While it's true that some movement disorders can occur with antipsychotic medications, the statement is too specific to muscle twitches and does not accurately reflect the typical side effect profile of risperidone.
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