(Select all that apply): A nurse is conducting an assessment of a client with acute stress disorder (ASD). Which physical signs might the nurse find in the client?
Gastrointestinal problems.
Cardiovascular problems.
Chronic pain.
Substance use disorder.
Eating disorders.
Correct Answer : A,B
Choice A rationale:
Gastrointestinal problems, such as nausea, vomiting, and diarrhea, can be physical signs of acute stress disorder. The stress response can impact the gastrointestinal system due to the activation of the "fight or flight" response.
Choice B rationale:
Cardiovascular problems, such as increased heart rate and blood pressure, are also common physical signs of acute stress disorder. The body's physiological response to stress can lead to cardiovascular changes.
Choice C rationale:
Chronic pain is not typically considered a primary physical sign of acute stress disorder. While stress can exacerbate existing pain conditions, it is not among the hallmark physical symptoms of this disorder.
Choice D rationale:
Substance use disorder might develop as a maladaptive coping mechanism in response to stress, but it is not a direct physical sign that a nurse would observe upon assessment.
Choice E rationale:
Eating disorders are not typically considered a primary physical sign of acute stress disorder. While stress can affect eating habits, it is not one of the characteristic physical symptoms associated with this disorder.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
"I keep having nightmares about the accident."
Choice A rationale:
Feeling detached from others is a characteristic of the numbing/avoidance cluster of PTSD symptoms, not intrusion symptoms.
Choice C rationale:
Involuntary, distressing thoughts about the traumatic event are indicative of intrusion symptoms, which are encapsulated by Choice B.
Choice D rationale:
Feeling irritable and on edge falls under the hyperarousal symptom category. Choice B, the correct choice, relates to nightmares about the traumatic incident, a classic intrusion symptom. These nightmares can re-traumatize the individual, making sleep challenging and contributing to the overall distress associated with PTSD.
Correct Answer is C
Explanation
The answer is choice C
Choice A rationale:
Assisting the client in identifying and challenging negative thoughts might be more appropriate for addressing cognitive distortions in conditions like depression or anxiety disorders, but it might not directly address the alterations in arousal and reactivity characteristic of PTSD.
Choice B rationale:
Encouraging the client to discuss their traumatic experience in detail could potentially trigger retraumatization and exacerbate the symptoms. Exposure therapy, which involves discussing the trauma, is generally done in a controlled and gradual manner under the guidance of a therapist.
Choice C rationale:
Teaching the client grounding techniques to manage anxiety is the most appropriate option. Grounding techniques help individuals stay connected to the present moment, reduce feelings of detachment, and manage anxiety. Techniques might include deep breathing, mindfulness, or using sensory cues to anchor oneself.
Choice D rationale:
Providing the client with a list of community resources for support is important, but it does not directly address the specific symptom cluster of alterations in arousal and reactivity. This intervention might be more relevant for overall support and coping, but not for managing the specific symptoms mentioned.
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