A nurse is counseling a group of clients from a town that was affected by a hurricane 6 months ago. For which of the following clients should the nurse initiate a referral to assess for the presence of post-traumatic stress disorder? (Select all that apply)

Choice A reason: Avoiding eye contact with a client experiencing auditory hallucinations may increase feelings of isolation or mistrust. Appropriate eye contact fosters therapeutic communication, conveying empathy and engagement. This action is not evidence-based for managing hallucinations, as it fails to address the client’s experience or build trust, making it inappropriate.
Choice B reason: Encouraging the client to lie down in a quiet room may reduce stimuli but does not directly address auditory hallucinations. This approach is more suitable for sensory overload or anxiety, not for engaging with or understanding the client’s hallucinations, which requires active communication to assess and manage symptoms effectively.
Choice C reason: Asking the client directly what they are hearing is a therapeutic approach that validates their experience and helps assess the nature and impact of hallucinations. This facilitates reality orientation, builds trust, and informs treatment, such as adjusting antipsychotics. It aligns with evidence-based care for schizophrenia, making it the correct action.
Choice D reason: Administering antianxiety medication immediately is not the first step for auditory hallucinations, which are primarily managed with antipsychotics. Without assessing the hallucinations’ content or severity, this action is premature and may not address the underlying psychotic symptoms, making it less appropriate than engaging the client directly.

• A. Maternal fever Maternal fever typically causes fetal tachycardia (elevated baseline >160/min), not bradycardia. Fever increases maternal metabolic rate and fetal heart rate.

• B. Chorioamnionitis This intrauterine infection also leads to fetal tachycardia, due to inflammatory stress and maternal fever. It is not a cause of bradycardia.

• C. Maternal hypoglycemia ✅ Low maternal glucose levels can reduce fetal energy supply and oxygenation, leading to fetal bradycardia (baseline <110/min). This is a recognized cause of sustained bradycardia.

• D. Fetal anemia Fetal anemia usually results in tachycardia as the fetus compensates for reduced oxygen‑carrying capacity by increasing heart rate. It does not cause bradycardia.