Pass the Shift

Psych / Mental Health · Trauma & Crisis

Trauma, PTSD & Crisis Intervention

Last reviewed October 15, 2026 by Pending RN review

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On this page
  1. 1. Overview
  2. 2. Trauma-Informed Care (principles)
  3. 3. Crisis & Crisis Intervention
  4. 4. Priority Nursing Actions for PTSD
  5. 5. Medications
  6. 6. Agitation, Violence & Restraint Safety
  7. 7. Intimate Partner Violence & Assault (quick hits)
  8. 8. Memory Aids
  9. 9. NCLEX-Style Practice Questions
  10. References

Prepared for Pass the Shift (owner: Kristina, RN). Always follow your facility’s protocols, provider orders, and current references.

If you or someone you know is in crisis: call or text 988 (Suicide & Crisis Lifeline, U.S.) or call 911 for immediate danger. This guide is for exam study, not for diagnosing or treating anyone.

1. Overview

Trauma is exposure to actual or threatened death, serious injury, or sexual violence — directly, as a witness, by learning it happened to someone close, or by repeated exposure to details (e.g., first responders). Most people recover; some develop:

  • Acute stress disorder: trauma symptoms from 3 days to 1 month after the event
  • : symptoms lasting > 1 month that impair functioning (may have delayed onset)

Four PTSD symptom groups (conceptual):

  1. Intrusion: flashbacks, nightmares, intrusive memories, distress at reminders
  2. Avoidance: of thoughts, people, places linked to the trauma
  3. Negative changes in thinking/mood: guilt, blame, detachment, inability to feel positive emotions, memory gaps
  4. Arousal/reactivity: hypervigilance, exaggerated startle, irritability, poor sleep/concentration, reckless behavior

Common co-occurring problems: depression, substance use, suicide risk, chronic pain.

2. Trauma-Informed Care (principles)

Safety · trustworthiness & transparency · peer support · collaboration · empowerment & choice · cultural, historical, and gender awareness (SAMHSA). Practical: explain before touching, ask permission, offer choices, avoid retraumatizing procedures, don’t force disclosure.

3. Crisis & Crisis Intervention

A crisis is a short-term state (usually resolves within ~4–6 weeks) when usual coping fails. Types: maturational (developmental — e.g., retirement), situational (job loss, illness), adventitious (disasters, violence).

steps:

  1. Assess safety first — suicide/homicide risk, medical needs
  2. Identify the problem and the person’s perception of it
  3. Assess support systems and coping strengths
  4. Plan immediate, concrete steps (the nurse is more directive than usual)
  5. Implement, then evaluate and refer (follow-up, therapy, shelters, 988)

Goal: return to the pre-crisis level of functioning (not personality change).

4. Priority Nursing Actions for PTSD

  1. Safety: suicide/self-harm screen; substance use screen
  2. Calm, predictable environment; consistent caregivers
  3. During flashbacks/dissociation: grounding — use name, orient to time/place, “You are safe in the hospital,” 5-4-3-2-1 senses; don’t touch without warning
  4. Support sleep hygiene; teach relaxation and grounding skills
  5. Encourage evidence-based therapy: trauma-focused CBT, cognitive processing therapy, prolonged exposure, EMDR

5. Medications

  • SSRIs (sertraline, paroxetine) and SNRI venlafaxine — first-line meds
  • Prazosin may be used off-label for trauma nightmares — monitor for orthostatic hypotension (first dose)
  • Avoid routine benzodiazepines — they may worsen outcomes and carry misuse risk

6. Agitation, Violence & Restraint Safety

  • Escalation signs: pacing, clenched fists, loud voice, staring, threats
  • first: calm low voice, open posture, stand at an angle, keep exit access for both, offer choices, reduce stimuli, PRN meds offered orally
  • Restraint/seclusion: last resort when imminent danger; need provider order (time-limited per regulations/policy), frequent monitoring (circulation, skin, vitals, hydration, toileting, mental status), release as soon as safe, debrief afterward. Never used as punishment or for staff convenience

7. Intimate Partner Violence & Assault (quick hits)

  • Screen privately (partner not present); use professional interpreters, not family
  • Cycle of violence: tension-building → acute battering → honeymoon (remorse)
  • Highest danger when the victim tries to leave — help create a safety plan; National Domestic Violence Hotline 1-800-799-7233
  • Sexual assault: preserve evidence (no showering, changing, or urinating if possible before exam, per protocol), SANE nurse referral, emotional support, STI/pregnancy prophylaxis per provider
  • Know your state’s mandatory reporting rules (children, older/vulnerable adults; adult IPV rules vary)

8. Memory Aids

  • PTSD = “I AM Aroused”: Intrusion, Avoidance, Mood/thinking changes, Arousal
  • Crisis = “Safety, Situation, Supports, Steps”
  • ASD < 1 month < PTSD

9. NCLEX-Style Practice Questions

1. A veteran suddenly crouches and shouts during a thunderstorm. What should the nurse do first?

A. Restrain the patient for safety
B. Approach calmly, call him by name, and orient him to where he is
C. Ask him to describe his combat experience
D. Leave him alone until the storm ends

Answer: B. Grounding and orientation help during a flashback.

2. Which is the first step in crisis intervention?

A. Explore childhood experiences
B. Assess for safety, including suicide and homicide risk
C. Refer to long-term psychotherapy
D. Teach stress-management techniques

Answer: B.

3. A patient with PTSD is prescribed prazosin for nightmares. Which teaching is most important?

A. Take it in the morning
B. Rise slowly; it can cause dizziness and low blood pressure
C. Avoid tyramine-rich foods
D. Have blood levels checked weekly

Answer: B. Orthostatic hypotension is the key risk.

4. A patient is in restraints for imminent violence. Which nursing actions are appropriate? Select all that apply.

A. Monitor circulation and skin integrity frequently
B. Offer fluids and toileting
C. Keep restraints on until the end of the shift regardless of behavior
D. Remove restraints as soon as the patient meets release criteria
E. Ensure there is a valid provider order

Answer: A, B, D, E.

5. A patient discloses that her partner hits her. When is she at the highest risk?

A. During the honeymoon phase
B. When she attempts to leave the relationship
C. Right after a hospital visit
D. During the tension-building phase only

Answer: B.

References

Torrico, T. J., Mann, S. K., & Marwaha, R. (2024). Posttraumatic stress disorder. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559129/

National Institute of Mental Health. (n.d.). Post-traumatic stress disorder. Retrieved October 15, 2026, from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd

Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach (HHS Publication No. SMA 14-4884). https://store.samhsa.gov/product/samhsas-concept-trauma-and-guidance-trauma-informed-approach/sma14-4884

U.S. Department of Veterans Affairs, National Center for PTSD. (n.d.). PTSD basics. Retrieved October 15, 2026, from https://www.ptsd.va.gov/understand/what/ptsd_basics.asp

National Council of State Boards of Nursing. (2026). 2026 NCLEX-RN test plan. https://www.nclex.com/test-plans.page