A client with eczema is experiencing severe pruritus. Which PRN prescription(s) should the nurse administer? Select all that apply.

Rationale for Correct Choices:

• Cortisol, epinephrine, and norepinephrine: These are key stress hormones activated during the fight-or-flight response. In PTSD, their persistent elevation is associated with symptoms like anxiety, agitation, and increased alertness, especially during perceived threats.
• Hypervigilance: Hypervigilance refers to an enhanced state of sensory sensitivity and constant scanning of the environment for threats. It is a hallmark of PTSD, evident in the client's easily startled behavior and environmental scanning.

Rationale for Incorrect Choices:

• Acetylcholine, epinephrine, and norepinephrine: Acetylcholine plays a greater role in attention and memory, not the stress response. Cortisol, not acetylcholine, is a more relevant hormone in PTSD-related hyperarousal and stress regulation.
• Dopamine, norepinephrine, and epinephrine: While dopamine influences motivation and pleasure, cortisol is more directly tied to the physiological stress response seen in PTSD. Omitting cortisol weakens the connection to stress-induced hyperalertness.
• Bradyphrenia: Bradyphrenia refers to slowed thinking, which is not typical in hyperaroused PTSD states. The client shows heightened awareness, not cognitive slowing.
• Hypoactivity: Hypoactivity implies reduced movement or response, which does not align with the client’s constant environmental scanning and heightened alertness. Hyperactivity, not hypoactivity, is more consistent with hypervigilance.

Rationale:

A. Indigestion: Although indigestion may mimic early symptoms of abdominal pathology, the client has not explicitly described heartburn or acid-related symptoms. It is a non-specific complaint and less concerning than the signs suggesting a vascular emergency.

B. Tiredness: Fatigue in older adults is often non-specific and may be related to underlying chronic conditions like atrial fibrillation or age-related decline. However, it is not as urgent or directly life-threatening as other findings suggesting vascular compromise.

C. Extremity pulse 2+: Pulses rated 2+ are considered normal and symmetric, indicating that peripheral perfusion is currently intact. This finding is stable and does not require immediate follow-up in the context of this clinical picture.

D. Pain level in abdomen and back: Severe, gnawing abdominal and back pain raises concern for a potentially rupturing or expanding abdominal aortic aneurysm (AAA). This symptom needs immediate evaluation due to the risk of hemodynamic collapse.

E. Pulsatile mass: A pulsatile abdominal mass is a hallmark sign of an AAA. When found on physical exam, especially with accompanying pain, it indicates a life-threatening condition that can lead to sudden rupture and requires emergency imaging and surgical consultation.

F. Liquid diarrhea: Although a change in bowel pattern may be relevant, the client reports that this is not unusual for him. Diarrhea is not immediately threatening in this context and is unlikely to be the primary cause of the abdominal symptoms.

G. Abdominal bruit: A bruit over a pulsatile abdominal mass indicates turbulent blood flow, further supporting suspicion of aortic aneurysm. This is a critical sign that suggests vascular pathology and requires urgent diagnostic confirmation and intervention.