Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
When assessing for the subjective symptoms of posttraumatic stress disorder (PTSD), which question will the nurse ask a client hospitalized for severe anxiety related to a sexual assault by a family member as a teenager?
A. "On a regular basis, do you get enough restful sleep?"
Sleep disturbances are common in PTSD, but they might not address the current acute symptoms the client is experiencing.
B. "Can we discuss what triggered your angry outburst a few minutes ago?"
This question explores the immediate trigger for an outburst but might not directly address the PTSD symptoms related to the sexual assault.
C. "Are you experiencing a flashback of the rape right now?"
Inquiring about flashbacks directly relates to one of the hallmark symptoms of PTSD, especially given the recent severe anxiety related to the assault.
D. "Am I correct to say that you try to avoid certain family members?"
Avoidance behavior is a symptom of PTSD, but the question about experiencing a flashback addresses more immediate distress.
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Full Explanation
A. Sleep disturbances are common in PTSD, but they might not address the current acute symptoms the client is experiencing.
B. This question explores the immediate trigger for an outburst but might not directly address the PTSD symptoms related to the sexual assault.
C. Inquiring about flashbacks directly relates to one of the hallmark symptoms of PTSD, especially given the recent severe anxiety related to the assault.
D. Avoidance behavior is a symptom of PTSD, but the question about experiencing a flashback addresses more immediate distress.
Similar Questions
When assessing for the subjective symptoms of posttraumatic stress disorder (PTSD), which question will the nurse ask a client hospitalized for severe anxiety related to a sexual assault by a family member as a teenager?
A. "On a regular basis, do you get enough restful sleep?"
Sleep disturbances are common in PTSD but might not address the immediate distress related to the sexual assault.
B. "Can we discuss what triggered your angry outburst a few minutes ago?"
While discussing triggers is relevant, it might not directly address the current acute symptoms of reliving the traumatic event.
C. "Are you experiencing a flashback of the rape right now?"
Asking about current experiences of flashbacks directly relates to one of the hallmark symptoms of PTSD, especially given the recent severe anxiety related to the assault.
D. "Am I correct to say that you try to avoid certain family members?"
Avoidance behavior is a symptom of PTSD, but asking about flashbacks addresses more immediate distress.
Full Explanation
A. Sleep disturbances are common in PTSD but might not address the immediate distress related to the sexual assault.
B. While discussing triggers is relevant, it might not directly address the current acute symptoms of reliving the traumatic event.
C. Asking about current experiences of flashbacks directly relates to one of the hallmark symptoms of PTSD, especially given the recent severe anxiety related to the assault.
D. Avoidance behavior is a symptom of PTSD, but asking about flashbacks addresses more immediate distress.
What is the primary difference between somatic system disorders and dissociative disorders?
A. They are under voluntary control
Both somatic symptom disorders and dissociative disorders involve psychological distress but are not necessarily under voluntary control.
B. They are psychological stress expressed through somatic symptoms.
Somatic symptom disorders involve physical symptoms that are a manifestation of psychological distress, while dissociative disorders involve disruptions in memory, identity, perception, and consciousness as a response to stress.
C. They are related to resolved stress.
Dissociative disorders often occur as a response to ongoing or unresolved stress rather than resolved stress.
D. They are generally strongly culturally bound.
While both types of disorders can occur across cultures, they are not strictly bound by cultural factors.
Full Explanation
A. Both somatic symptom disorders and dissociative disorders involve psychological distress but are not necessarily under voluntary control.
B. Somatic symptom disorders involve physical symptoms that are a manifestation of psychological distress, while dissociative disorders involve disruptions in memory, identity, perception, and consciousness as a response to stress.
C. Dissociative disorders often occur as a response to ongoing or unresolved stress rather than resolved stress.
D. While both types of disorders can occur across cultures, they are not strictly bound by cultural factors.
A nurse is caring for a client who has depression. The client refuses to get out of bed, go to activities, or participate in any of the unit's programs. Which of the following responses should the nurse make?
A. "If you do not get out of bed you will not receive your meal."
Using a threat about meals isn't a therapeutic approach to encourage participation and may further distress the client.
B. "I will help you get ready and then you can rest after activities."
This response offers assistance while encouraging participation, respecting the client's autonomy by suggesting a balance between activity and rest.
C. "You really need to follow the rules of the unit and get out of bed."
Using a direct order may escalate resistance and isn't likely to be helpful.
D. "You should rest until you feel able to join the group."
This response doesn't encourage participation and may perpetuate the client's withdrawal.
Full Explanation
A. Using a threat about meals isn't a therapeutic approach to encourage participation and may further distress the client.
B. This response offers assistance while encouraging participation, respecting the client's autonomy by suggesting a balance between activity and rest.
C. Using a direct order may escalate resistance and isn't likely to be helpful.
D. This response doesn't encourage participation and may perpetuate the client's withdrawal.