Chapter 39: The Military and Their Families

Chapter 39: The Military and Their Families

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. Six months after returning from a combat zone, a discharged Marine reports having both memory and concentration problems that resulted in earning failing grades in two college courses. An understanding of the pathophysiology of traumatic brain injury would prompt the nurse to initially ask:

a.	“Were you ever treated for a traumatic brain injury?”
b.	“Were you ever hit on the head during your military deployment?”
c.	“Has a blow to the head ever resulted in you being unconscious for more than 20 minutes?”
d.	“When did the memory problems and difficulty with concentration begin to affect your schoolwork?”

 

 

ANS:  C

Many cases of traumatic brain injury (TBI) may be overlooked as the symptoms are diffuse and may not initially suggest any specific brain injury as the primary cause. Often symptoms do not surface until well after the initial injury, which can further complicate accurate diagnosis of TBI. Also, mild TBI may not be the primary or most urgent injury that occurs in the field, and it may be missed during triage. The question of whether the individual has ever experienced a blow to the head that resulted in unconsciousness lasting 20 minutes or more would be the most probative question to ask.

 

DIF:    Cognitive Level: Analysis                REF:   Text Pages: 752-754

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Physiological Integrity

 

2. Which information noted on a psychosocial assessment is of greatest concern when identifying risk factors for the possible development of posttraumatic stress disorder (PTSD) for a soldier about to be deployed to a war zone?

a.	A parent has been diagnosed with severe and persistent anxiety
b.	The soldier had an extended tour of duty in a war zone previously
c.	As a child the soldier survived a major hurricane that killed a sibling
d.	The spouse has suggested that their relationship may not survive this separation

 

 

ANS:  C

There is evidence that the potential to develop PTSD may be influenced by earlier life experience such as the exposure to a traumatic experience as a child. While the other options suggest stressors, they are not as personally impactful or as traumatic as the correct option.

 

DIF:    Cognitive Level: Analysis                REF:   Text Page: 753

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Psychosocial Integrity

 

3. Which statement by a military veteran being treated for posttraumatic stress disorder (PTSD) is the strongest evidence that the condition is being managed?

a.	“My mother said that I am much more like my old self.”
b.	“I hope my buddies get the type of professional help I’m getting.”
c.	“I didn’t think my nightmares would ever stop but now I’m not so sure.”
d.	“My children and I went to the fireworks display and we all really enjoyed it.”

 

 

ANS:  D

A hyperactive startle reflex is a common characteristic of PTSD. Being able enjoy a noisy, explosive display of fireworks would be the best indicator of the disorder presented by the options. The other options demonstrate hope and confidence in treatment but not actual behavioral changes.

 

DIF:    Cognitive Level: Analysis                REF:   Text Page: 753

TOP:   Nursing Process: Evaluation

MSC:  NCLEX: Psychosocial Integrity: Physiological Integrity

 

4. When educating an individual diagnosed with posttraumatic stress disorder (PTSD) regarding prescribed medication therapy, the nurse should include that:

a.	selective serotonin reuptake inhibitors (SSRIs) like escitalopram (Lexapro) have failed to prove effective in managing PTSD-related depression.
b.	the prescribed selective serotonin reuptake inhibitor (SNRI) venlafaxine (Effexor) is intended to help lessen intrusive thoughts.
c.	benzodiazepines like alprazolam (Xanax) are safe and have very good results in managing avoidance symptoms.
d.	mood stabilizers like valproic acid (Depakote) are effective in managing mood swings that occur with PTSD.

 

 

ANS:  B

Pharmacological interventions have been found to be useful in the treatment of the positive symptoms of PTSD including hyperarousal and reexperiencing phenomenon, and to a lesser extent the negative symptoms of PTSD, including avoidance symptoms. Selective serotonin reuptake inhibitors (SSRIs) are generally considered the first line of pharmacological treatment for individuals diagnosed with PTSD. These medications help with symptoms including depression, irritability, anxiety, and intrusive thoughts. The SNRI venlafaxine also has been found to be helpful in the management of this disorder. Benzodiazepines may be helpful in managing anxiety, insomnia, and hyperarousal, but they should be used cautiously due to the high degree of comorbid substance abuse in veterans. Mood stabilizers have not been demonstrated to be effective in the management of PTSD symptoms.

 

DIF:    Cognitive Level: Application           REF:   Text Pages: 754-755

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Psychosocial Integrity: Pharmacological and Parenteral Therapies