A nurse is caring for a client who witnessed her brother's homicide and has posttraumatic stress disorder (PTSD). Which of the following findings should the nurse expect?

The client talks constantly about the traumatic experience.

The client is constantly drowsy and sleeps 11-12 hr daily.

The client reports satisfying personal relationships with family and close friends.

The client is easily startled by loud voices.

Answer and Explanation

The Correct Answer is D

The client is easily startled by loud voices. Clients with posttraumatic stress disorder (PTSD) may exhibit hyperarousal symptoms, including exaggerated startle responses and hypervigilance. The client talking constantly about the traumatic experience is a possible finding in PTSD but not specific. The client is constantly drowsy and sleeping 11-12 hours daily is more associated with depression than PTSD. While the client may have satisfying personal relationships, it does not address the question of what finding to expect with PTSD, making choice C incorrect.

Reasons why the other choices are not answers:

Choice A, the client talking constantly about the traumatic experience, is a possible symptom of PTSD, but it is not specific to the disorder and may also indicate other disorders.

Choice B, the client being constantly drowsy and sleeping 11-12 hours daily, is more indicative of depression than PTSD and also does not address the question of finding expected with PTSD.

Choice C, the client reports satisfying personal relationships with family and close friends, does not address what finding is expected with PTSD, making it an incorrect answer.

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Correct Answer is C

Explanation

choice C, "I have heard that abusers think of themselves as important and have high self-esteem." This statement is incorrect and shows the nurse may need further education on the characteristics of an abuser. Abusers often lack self-esteem and feel powerless, using abuse as a way to gain control and confidence. Choices A, B, and D are all accurate statements and do not indicate the need for further education.

For choice A, abusers often isolate their partner to gain control over them. For choice B, abusers may lack social support and social skills, leading to violent behavior.

For choice D, abusers use intimidation tactics to maintain power in the relationship.

A. Remotivation B. Orientation to reality C. Guided imagery D. Validation

Correct Answer is D

Explanation

Validation. Validation is a therapeutic technique that involves acknowledging and accepting the feelings and emotions of the person with dementia, even if they are not based on reality. Validation helps to reduce agitation and anxiety and promotes dignity and respect.

The other choices are not correct for the following reasons:

Remotivation is a technique that aims to stimulate the person's interest in the present and future, by providing factual information and encouraging participation in activities. Remotivation may not be appropriate for someone who is agitated and living in the past.

Orientation to reality is a technique that involves correcting the person's misperceptions and confusions, by providing factual information about time, place, and identity. Orientation to reality may increase agitation and frustration and may damage the person's self-esteem.

Guided imagery is a technique that involves using mental images to promote relaxation and well-being. Guided imagery may not be effective for someone who has difficulty with attention, concentration and memory.

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A nurse is caring for a client who witnessed her brother's homicide and has posttraumatic stress disorder (PTSD). Which of the following findings should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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