A charge nurse on a medical-surgical unit is anticipating an emergency response plan following an external disaster in the community. Which of the following current clients should the nurse recommend for early discharge?

Choice A reason: Persistent anger about the hurricane is a PTSD symptom, reflecting emotional dysregulation and hyperarousal post-trauma. This ongoing distress, per DSM-5 criteria, warrants referral for mental health evaluation to address potential PTSD, making it a correct indicator for intervention.
Choice B reason: Realizing life will not return to normal is a realistic adjustment, not necessarily a PTSD symptom. Without additional distress indicators, this does not meet diagnostic criteria for PTSD, making it incorrect for requiring a referral in this context.
Choice C reason: Moving to higher ground is a practical response to reduce future risk, not a PTSD symptom. It reflects adaptive coping rather than psychological distress, so it does not warrant a referral for PTSD assessment, making it incorrect.
Choice D reason: Frequent nightmares about the hurricane are a hallmark PTSD symptom, classified as intrusive re-experiencing per DSM-5. This significant distress disrupts sleep and daily functioning, necessitating a referral for mental health evaluation, making it a correct choice.
Choice E reason: Feeling disconnected from others indicates emotional numbing, a PTSD avoidance symptom per DSM-5. This social withdrawal post-hurricane suggests significant psychological impact, warranting a referral for PTSD assessment to address underlying trauma, making it correct.

Choice A reason: Catheter placement for a nontunneled central venous access device is typically confirmed by X-ray, not a CT scan, to verify tip placement in the superior vena cava. CT scans are less common due to higher radiation and cost, making this statement inaccurate for standard practice.
Choice B reason: Elevating the head as high as possible during insertion is incorrect, as the Trendelenburg position (head down) is often used to distend veins and reduce air embolism risk. High head elevation could complicate insertion and increase complications, making this instruction inappropriate.
Choice C reason: Flushing the catheter with saline daily maintains patency, preventing clots and ensuring functionality of the nontunneled central venous access device. This is a standard care instruction, reducing infection and occlusion risks, and aligns with evidence-based protocols for central line maintenance, making it correct.
Choice D reason: Lying flat for 24 hours post-procedure is not required for nontunneled central venous catheters. Patients may need brief bed rest (e.g., 30 minutes) to prevent bleeding, but 24 hours is excessive and not evidence-based, making this instruction incorrect and overly restrictive.