Chapter 39: The Military and Their Families My Nursing Test Banks

Chapter 39: The Military and Their Families

Test Bank

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 Im getting.

c.

I didnt think my nightmares would ever stop but now Im 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

5. Which assessment question is particularly important to ask of a veteran of the Iraq conflict?

a.

Have you ever experienced a migraine headache?

b.

Could you ever see yourself considering suicide?

c.

Do you feel anxious when you find yourself in a confined space like an elevator?

d.

Would you say that your sleep patterns provide you with sufficient amounts of recuperative rest?

ANS: B

It has been estimated that as many as 20% of all suicides in this country are documented among veterans. In the first half of 2009, more American soldiers committed suicide than died in combat with continued high rates for veterans of Iraq and Afghanistan deployments.

DIF: Cognitive Level: Application REF: Text Page: 756

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

6. A military veteran being treated for substance abuse shares that the family is experiencing financial problems since being discharged. In order to assess the individuals coping skills, the nurse asks:

a.

Do you have any idea about how your finances got out of your control?

b.

How well were you at managing your finances before leaving the military?

c.

Can you give me some idea of the kind of financial help you feel you need?

d.

Have your financial expenses increased dramatically since being discharged?

ANS: B

The nurse must be mindful that substance abuse is a disease and individuals may return to previous ways when coping with stressful and unplanned events. Assessing previous coping skills will provide insight into the way current stresses will be managed. The remaining options provide opportunities to assess the financial problem itself.

DIF: Cognitive Level: Application REF: Text Page: 756

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

7. The nurse is about to assess the possible incidence of sexual abuse. Based on an understanding of how males and females experience and internalize sexual trauma differently, the nurse would ask the male soldier:

a.

Have you ever been sexually abused?

b.

Have you ever felt victimized sexually by anyone?

c.

Has an unwanted sexual advance by anyone ever made you feel harassed or confused?

d.

Has a superior officer ever made an unwanted sexual advancement that you felt you had to agree to?

ANS: C

Males and females may experience sexual trauma in different ways. Males typically do not view themselves as being potential victims of sexual abuse and are not likely to admit to being a victim of sexual abuse. They may therefore experience it as a narcissistic insult, causing confusion and even questioning their masculinity or sexual preference. Asking the question in this context is a more effective questioning technique.

DIF: Cognitive Level: Analysis REF: Text Page: 756

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

8. A member of the military shares that he has been a victim of sexual trauma during his enlistment. Which question will the nurse ask to best assess the individuals degree of self-blame?

a.

Were you physically hurt as a result of sexual abuse?

b.

Have you confided this information with family or a trusted friend?

c.

What occurred when you reported the attack to your military superior?

d.

Have you been tested for sexually transmitted diseases since the attack?

ANS: C

Military sexual trauma (MST) survivors may experience self-blame and doubt, and even have feelings of guilt that they somehow brought on the assault. This situation can result in an emotional invalidation of their traumatic experience when they report these incidents to superiors, only to be discouraged from following up on their claim or told that the abuse never happened. Having their report taken seriously and resulting in appropriate actions has a positive bearing on the victims sense of validation. The remaining options lack the opportunity to open up discussion on that topic.

DIF: Cognitive Level: Analysis REF: Text Page: 756

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

9. Which statement made by a female military personnel currently deployed in a war zone provides the best evidence that the soldier is not feeling any unhealthy guilt over being separated from family?

a.

My family back home realizes I miss and love them but leaving them was a part of my job.

b.

When I get back, I will make up for the time Ive been away from my family, especially my children.

c.

The guilt I feel for leaving my family is offset by the pride they have for me serving my country like this.

d.

Being away from my children and spouse is too hard to do again; when my enlistment is finished, Im leaving the military.

ANS: A

Women traditionally serve in the role of family matriarch. Following deployment, they may have a particularly difficult time adjusting to a new role including being separated from home, family, and children. This may cause feelings of guilt and inadequacy that can lead to depression and anxiety. The correct option demonstrates a healthy balance of concern and acceptance for and by the individual and her family. The remaining options lack that sense of balance.

DIF: Cognitive Level: Analysis REF: Text Pages: 756-757

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

10. Which intervention will best establish a military personnels mental health fitness for deployment to a war zone?

a.

Conducting a predeployment mental health screening as part of the general physical examination

b.

Reviewing the military performance records prior to deployment for identification of possible risk factors

c.

Providing each military personnel with the opportunity to confidentially discuss their individual concerns with a mental health professional

d.

Asking the military personnel to identify in writing any history of mental illness including depression, anxiety, or substance dependency issues

ANS: A

The use of a predeployment mental health screening can reduce mental health problems, medical evacuations from war zones for mental health problems, and suicidal ideation.

DIF: Cognitive Level: Analysis REF: Text Page: 757

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

11. A combat experienced military veteran with a diagnosis of depression is concerned about adjusting to civilian life and reconnecting with family and friends. In assisting the individuals long-term readjustment, the mental health nurse would suggest a referral to:

a.

job retraining programs.

b.

family and marital counseling sessions.

c.

civilian employment assistance services.

d.

support groups comprised of combat veterans.

ANS: D

Upon returning home the combat veteran finds that he no longer has the psychological and emotional support of his comrades in arms. He finds little solace from family and friends who cannot share his experiences and often has difficulty assimilating to his previous life. A support group comprised of fellow military personnel would be the most positive form of assistance to provide long-term positive readjustment to civilian life.

DIF: Cognitive Level: Analysis REF: Text Pages: 757-758

TOP: Nursing Process: Implementation

MSC: NCLEX: Psychosocial Integrity: Management of Care

12. Several nurses are newly assigned to a hospital unit that focuses on the care of military personnel who have sustained severe brain injuries and their families. The nurse manager would initially suggest that they:

a.

focus on honing their therapeutic communication and assessment skills.

b.

self-reflect concerning their feelings about working with the disabled.

c.

learn to recognize and act upon the emotional needs of the family.

d.

review the physical needs of the traumatic brain injured client.

ANS: B

It is critical that providers working with survivors of trauma be aware of their personal feelings and vulnerabilities to provide quality clinical care. The remaining options are needs that can be addressed in the near future.

DIF: Cognitive Level: Application REF: Text Page: 758

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

MULTIPLE RESPONSE

1. A military veteran is diagnosed with heart disease. With this medical history and a military background that included two tours of duty in a combat zone abroad, the nurse assesses for related psychiatric disorders by asking: (Select all that apply.)

a.

When was the last time you accidentally hurt yourself?

b.

Have you ever experienced a migraine headache?

c.

Do you have problems falling asleep at inappropriate times?

d.

Can you describe your usual pattern of bowel elimination?

e.

Would you describe yourself as forgetful or absentminded?

ANS: A, B, C, E

Returning veterans may experience cognitive difficulties such as concentration problems and memory loss. Other complications can include sleep deprivation, migraine headaches, or insomnia. Poor concentration can also result in an increase in trauma from accidents. Constipation and diarrhea are not commonly associated with this population.

DIF: Cognitive Level: Application REF: Text Page: 752

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

2. A military veteran is diagnosed with tinnitus. The educational material provided by the nurse related to the condition should include: (Select all that apply.)

a.

exposure to repeated loud noises is often the cause of the disorder.

b.

the primary characteristic is a persistent ringing in the ears.

c.

tinnitus may be either temporary or chronic.

d.

the symptoms can be expected to worsen over time.

e.

surgery on the eardrum is usually recommended.

ANS: A, B, C

Hearing problems may develop as the result of traumatic injury or repeated exposure to noise hazards including gunfire, explosions, and loud equipment. Examples of hearing problems include partial or total hearing loss and tinnitus or ringing of the ears. Each of these may be temporary or permanent. The remaining options are not generally applied to tinnitus.

DIF: Cognitive Level: Application REF: Text Page: 752

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

3. A military veteran is being evaluated for traumatic brain injury (TBI). Which nursing assessment data supports such a diagnosis? (Select all that apply.)

a.

Baseline blood pressure is 148/96

b.

Has been treated for bronchitis twice in the last 8 months

c.

Patient reports experiencing an average of 3 headaches per week

d.

Petit mall seizure activity well controlled with antiseizure medication therapy

e.

Patient reports a weight gain of 15 pounds since returning from deployment 12 months ago.

ANS: C, D, E

Physiological problems related to TBI can include headache, seizures, as well as appetite and weight changes. The remaining options, hypertension and respiratory infections, are not generally occasioned with TBI.

DIF: Cognitive Level: Analysis REF: Text Pages: 752-753

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

4. Female military personnel who have recently returned from deployment in a war zone are being assessed for potential physical and sexual assault as well as for an increased risk for developing posttraumatic stress disorder (PTSD). During the assessment, the nurse would ask: (Select all that apply.)

a.

How safe did you feel while you were deployed?

b.

Did you have much contact with potential enemy soldiers?

c.

Have you ever experienced physical abuse as either a child or an adult?

d.

Do you feel the military is prepared to help you reenter a noncombat environment?

e.

What is your greatest fear regarding your personal safety as a member of the military community?

ANS: A, B, C

The role of female soldiers has expanded into the realm of hostile environments. In the current military arena, nearly everyone is vulnerable to attack at any given time and female soldiers may even be singled out and targeted by enemy combatants.

Women are more likely to suffer childhood abuse or other types of trauma compared to men. Survivors of multiple traumas may experience cumulative effects from re-victimization. These individuals may be less resilient and more vulnerable to develop psychiatric disorders including depression, PTSD, and other anxiety disorders. Questions related to their perception of military support or their safety in general is not related to assessing for the conditions mentioned.

DIF: Cognitive Level: Analysis REF: Text Pages: 756-757

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

5. Which interventions address the most commonly identified sources of risk to the mental health of military personnel and their dependents? (Select all that apply.)

a.

Depression support groups for adolescent dependents of military personnel

b.

Outpatient mental health services conveniently located near on-base housing

c.

Low-interest loans to assist dependent families in the payment of relocation expenses

d.

Relocation orders being delayed for families with school-age children so the move can occur during the summer months

e.

Access to on-base Internet communication resources to facilitate communication between deployed personnel and their families

ANS: A, B, D, E

These five areas challenge the ability to provide mental health care to military personnel and their families: psychological health, access to services and support, communication challenges, deployment, and frequent relocation. While a stressor, financial aid is not a recognized mental health-related service the military provides.

DIF: Cognitive Level: Analysis REF: Text Page: 757

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

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