The nurse is reviewing the chart of a patient who has a history of physical
trauma.
Which clinical manifestation should the nurse anticipate observing in the
patient?
Difficulty problem solving
Decreased awareness of surroundings
Muted emotional reactions
Resistance - correct answer ✔Difficulty problem solving
A clinical manifestation associated with physical trauma is difficulty problem
solving. The person who has experienced physical trauma will not have a
decreased awareness of surroundings, but rather be hypervigilant. Emotional
reactions will be intense, not muted. Resistance is a stage of the stress cycle,
not a reaction to physical trauma.
A patient with a history of type 1 diabetes mellitus and coronary artery disease
receives injuries from a motor vehicle crash.
Which question should the nurse make a priority?
"Are you having any chest pain?"
"Do you use an insulin pump?"
,"Are you experiencing difficulty breathing?"
"Do you have any abdominal discomfort?" - correct answer ✔"Are you
having any chest pain?"
The fight-or-flight response occurs after a trauma. A patient who has a history
of type 1 diabetes mellitus and coronary artery disease may be at risk for a
myocardial infarction due to the acute stress that results from the fight-or-flight
response. Questions about an insulin pump, difficulty breathing, and
abdominal discomfort can be asked afterwards.
The nurse is caring for a patient who states, "I did not handle that crisis very
well. I do not know what I was thinking at the time."
Which best describes the influence on the patient's self-efficacy?
Emotional state
Vicarious experience
Social persuasion
Mastery experience - correct answer ✔Emotional state
Based on the patient's statement, emotional state influenced the patient's self-
efficacy. Emotional states are best described as an individual who is self-
critical of their stress response or sense of tension when faced with stressors;
in turn, these same individuals may perceive their physical response to stress
as rendering them susceptible to failure. The patient's statement does not
reflect a vicarious experience, social persuasion, or mastery experience.
, The nurse is caring for a child who is displaced after their home caught fire.
The parent states to the nurse, "I am concerned that my child has begun
wetting the bed."
Which is the most appropriate response by the nurse?
"I will speak with the healthcare provider regarding this issue."
"Bedwetting often occurs after trauma."
"There is no need to worry; the issue will resolve itself."
"Keep reassuring your child that they are safe and the bedwetting will
eventually stop." - correct answer ✔"I will speak with the healthcare provider
regarding this issue."
Bedwetting is a signal of a poor coping response to the trauma that the child
experienced and needs to be addressed. Ignoring the poor coping behavior
will not resolve the issue. It is important to reassure the child the they are
safe, but the circumstances surrounding the abnormal coping mechanism
need to be addressed.
After experiencing a traumatic event, a patient expresses feelings of distress.
Which should the nurse assess first with this patient?
Obtain the patient's vital signs.
Ask the patient to describe the event.