A young adult says, "I was sexually abused by my older brother. During those assaults, I went somewhere else in my mind. I don't remember the details. Now, I often feel numb or unreal in romantic relationships, so I just avoid them."
Which disorders should the nurse suspect based on this history? Select all that apply.
a. Acute stress disorder
b. Depersonalization disorder
c. Generalized anxiety disorder
d. Posttraumatic stress disorder
e. Reactive attachment disorder
f. Disinhibited social engagement disorder
ANS: A, B, D
Acute stress disorder, depersonalization disorder, and posttraumatic stress disorder can involve dissociative elements, such as numbing, feeling unreal, and being amnesic for traumatic events. All three disorders are also responses to acute stress or trauma, which has occurred here. The distracters are disorders not evident in this patient's presentation. Generalized anxiety disorder involves extensive worrying that is disproportionate to the stressors or foci of the worrying. Reactive attachment disorder and disinhibited social engagement disorder are problems of childhood.
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When acting as the team leader for a patient care conference, which statement is appropriate?
1. ?We are all here to discuss the issues with this client?s discharge. Can anyone tell me what those issues are?? 2. ?The issue with this client is the time limit for Medicare to pay has almost expired, and we aren?t ready for discharge.? 3. ?I don?t really have time for this meeting today; is there anything I can do to expedite this meeting?? 4. ?I will let you all decide what might be best for this client, as I am not really as familiar with her as I should be.?
The nurse knows when communicating with a suicidal client to do which of the following? Select all that apply
A) Communicate with one another B) Communicate with hospital staff C) Contract with the client D) Work with other families E) Never lecture about the negative consequences of suicide
What is the underlying theme of Virginia Henderson's work?
1. Nurses move in stages from novice to expert in the field.
2. Nursing is best provided when culture is considered.
3. Control of the environment of healing is the most important aspect of nursing.
4. Nursing is independent from and interdependent with other health care disciplines.
A home care nurse visits a client who lives in a small apartment to perform an admission assessment. During the home safety assessment, the client asks the nurse whether it is safe to use a space heater. What is the appropriate response by the nurse?
A. "A space heater should never be used in an apartment." B. "A space heater can be used as long as it is kept at a low setting at all times." C. "A space heater can be used as long as it is kept in the bedroom at night in case a fire occurs." D. "A space heater can be used as long as it's placed at least 3 feet from anything that may ignite."