A nurse is caring for a veteran of the war in Iraq who is diagnosed with posttraumatic stress disorder (PTSD). He experiences a nightmare during his first night in the hospital and explains to the nurse that he was dreaming about gunfire all around and people being killed. The nurse’s most appropriate initial intervention is to:

Risk for suicideis the priority nursing diagnosis when a client with PTSD has engaged in a potentially lethal act such as ingesting a handful of medication. This diagnosis reflects immediate danger, requiring urgent intervention to ensure safetyand prevent recurrence. PTSD increases suicide risk due to hopelessness, emotional dysregulation, and intrusive trauma-related thoughts. Veterans are particularly vulnerable due to combat exposure, survivor guilt, and limited support systems. Suicide risk must be addressed before other psychosocial or cognitive concerns.

Rationale for correct answers

2. Risk for suicideThis diagnosis takes precedence due to the client’s recent overdose, indicating active suicidal intent and immediate threat to life.

Rationale for incorrect answers

1.Post-trauma syndrome is relevant but not the priority when the client has demonstrated suicidal behavior requiring immediate safety interventions.

3.Complicated grieving may be present but does not supersede the urgency of suicide risk following a self-harm attempt.

4.Disturbed thought processes may contribute to PTSD symptoms but are not the most critical concern when suicide risk is evident.

Take Home Points

• Suicide risk is the highest priority in clients with PTSD who engage in self-harm.
• PTSD increases vulnerability to suicide due to emotional dysregulation and trauma-related distress.
• Post-trauma syndrome and complicated grieving are important but secondary to immediate safety concerns.
• Nursing care must prioritize stabilization and suicide prevention before addressing long-term psychological recovery.

Risk for injuryis a priority nursing diagnosis when a client’s physiological or psychological state places them in danger of harm. In posttraumatic stress disorder (PTSD), sustained hyperarousal leads to sleep deprivation, impaired concentration, and exhaustion. These symptoms compromise physical safety and increase vulnerability to accidents, self-harm, or aggression. Sleep disruption in PTSD is linked to elevated cortisol and norepinephrine levels, which impair restorative sleep and heighten reactivity. Clients may experience dissociation, impulsivity, or poor judgment, especially when fatigued, making injury risk a critical concern.

Rationale for correct answers

4. Risk for injuryis the priority because sleep deprivation from nightmares and hyperarousal leads to physical exhaustion and impaired cognition. This increases the likelihood of falls, accidents, or impulsive behaviors, making safety the most urgent concern.

Rationale for incorrect answers

1.Posttrauma syndrome is a valid diagnosis but not the priority. It addresses emotional and psychological symptoms, which are secondary to immediate safety risks posed by exhaustion.

2.Social isolation is relevant but not life-threatening. While it affects emotional well-being, it does not pose an immediate physical danger compared to injury risk from sleep deprivation.

3.Ineffective coping due to alcohol use is serious but not the most acute concern in this scenario. The stem emphasizes exhaustion and flashbacks, not substance abuse behaviors.

Take Home Points

• Risk for injury is prioritized when PTSD symptoms impair physical safety, especially due to sleep deprivation and hyperarousal.
• PTSD clients may experience dissociation, impulsivity, and poor judgment, increasing injury risk.
• Posttrauma syndrome addresses emotional trauma but is secondary to physiological safety needs.
• PTSD must be differentiated from depression and substance use disorders when prioritizing nursing diagnoses.