A nurse is planning care for a client who has a gambling disorder. Which of the following actions should the nurse include in the plan of care?

Rationale for correct choices:

• Irritability: Irritability is a common symptom of posttraumatic stress disorder (PTSD), often resulting from the heightened arousal and anxiety that individuals with PTSD experience after trauma. This is frequently seen in clients who have undergone significant emotional distress.
• Feelings of emptiness: A sense of emptiness or detachment is often associated with PTSD. This is related to the emotional numbness and avoidance that individuals may experience as a result of trauma, leading them to feel disconnected or emotionally "empty."
• Sleep disturbance: Sleep problems, such as insomnia or nightmares, are hallmark symptoms of PTSD. Clients often struggle with restful sleep due to anxiety, hypervigilance, or intrusive thoughts related to the traumatic event.
• Guilt: Guilt is a common emotion experienced by individuals with PTSD, especially following trauma such as sexual assault. Survivors may blame themselves for not preventing the event, which can contribute to their emotional distress and symptoms of PTSD.

Rationale for incorrect choices:

• Hallucinations: Hallucinations are not typically associated with PTSD. While PTSD can cause intense emotional reactions, hallucinations are more commonly seen in conditions such as schizophrenia or severe substance intoxication, not in PTSD.
• Echopraxia: Echopraxia, which involves mimicking another person's movements, is generally associated with conditions such as autism or certain neurological disorders, not PTSD.

A. Encourage the client to reframe their perception of stress: Reframing can be a helpful strategy for less severe anxiety, but during a panic attack, the client may be too overwhelmed to engage in cognitive techniques like reframing. Immediate support is needed first.

B. Guide the client to a location that is quiet and stay with the client: This is the best intervention. A quiet environment helps reduce external stimuli, and staying with the client provides reassurance and safety, helping to calm the overwhelming anxiety during a panic attack.

C. Help the client identify factors that are contributing to the anxiety: While identifying triggers is important for long-term management, during a panic attack, the priority is immediate relief and safety. The client may not be able to engage in reflection during peak anxiety.

D. Ask questions to clarify how the client feels and what they are thinking: During a panic attack, the client is likely to be too overwhelmed to respond meaningfully to questions. The priority is to offer comfort and a calm presence rather than focusing on understanding their thoughts at that moment.