Exhibits

The nurse receives the prescription for sertraline and prepares to give the medication.
The nurse reviews the current medication prescription. Click to specify if the intervention is indicated or not indicated. Each row must have only one response selected.

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. Confirm that the desired effect of the medication has been achieved: Trazodone is prescribed to improve mood and aid sleep, not to enhance cognitive function. Since the caregiver reports improvement in those areas, the medication is achieving its intended therapeutic outcomes.

B. Explain that it may take several weeks for the medication to be effective: While some antidepressants require time to reach full effectiveness, the caregiver already reports improved mood and sleep. There is no indication of delayed onset.

C. Evaluate when and how the medication is being administered to the client: No signs of improper administration or ineffective dosing are indicated. The caregiver's feedback suggests the medication is being given correctly and is having a beneficial effect.

D. Notify the healthcare provider that a change in dosage may be needed: Cognitive decline in Alzheimer's disease is progressive and not expected to improve with trazodone, so no dosage change is warranted based on this feedback.