Four days after exposure to COVID-19 a client has a negative COVID-19 test result. Eight days after the negative test result, the client presents with fever, fatigue, and cough and the nurse performs a second COVID-19 test. Which action is most important for the nurse to take?

Rationale for Correct Choices:

• Rupture: Aneurysm rupture is the most serious and immediate complication of an abdominal aortic aneurysm (AAA). The client’s gnawing back and abdominal pain, along with a pulsatile abdominal mass and bruit, suggest that the aneurysm is unstable.
• Hypertension: Chronic high blood pressure exerts continuous force on arterial walls, weakening the aortic structure and promoting aneurysm formation and progression. It significantly increases the likelihood of rupture once an aneurysm is present.

Rationale for Incorrect Choices:

• Dissection: Dissection involves a tear in the intimal layer of the artery, creating a false lumen. Although serious, it is more commonly associated with thoracic aortic aneurysms rather than abdominal ones. The client's symptoms and findings are more consistent with rupture.
• Occlusion: Aneurysm-related occlusion refers to blockage of blood flow, which is less common in abdominal aneurysms. The client’s peripheral pulses are normal (2+), indicating adequate distal perfusion. There’s no sign of limb ischemia or thrombotic complications.
• Smoking: Smoking is a known risk factor for developing aneurysms but is not the most direct or strongest predictor of rupture. Its role is more associated with aneurysm formation and progression. Hypertension more specifically correlates with increased rupture risk.
• Hyperlipidemia: High lipid levels contribute to atherosclerosis, which can lead to aneurysm development over time. However, like smoking, it is not as strongly associated with aneurysm rupture as hypertension.

Rationale for Correct Choices

• 4 to 8 weeks: Sertraline, an SSRI, typically requires 4 to 8 weeks to reach its full therapeutic effect. This time frame allows for sufficient serotonin modulation, necessary for symptom improvement in conditions like PTSD and depression.
• Eye movement desensitization: Eye Movement Desensitization and Reprocessing (EMDR) is specifically recommended for PTSD. It involves guided eye movements that help the brain reprocess traumatic events and reduce emotional disturbance.
• Deep breathing: Deep breathing promotes parasympathetic nervous system activation, helping reduce anxiety and hyperarousal. It is a simple, accessible coping strategy to complement therapy and medication.

Rationale for Incorrect Choices

• 1 to 2 days: This timeframe is too short for an SSRI to have significant therapeutic effects. Any changes in mood or anxiety within this period are typically not due to the medication’s primary mechanism of action.
• 10 to 14 days: Although some mild improvement may begin, full therapeutic benefits of sertraline are not typically seen within this period. Clients are advised to continue consistent use for several weeks.
• Cognitive behavioural therapy: CBT is effective for many mental health disorders, including PTSD, but it does not involve the “reprocessing” component referenced.
• Prolonged exposure therapy: Prolonged exposure is used for PTSD treatment but focuses on gradually confronting trauma-related memories. It lacks the reprocessing element emphasized in the question.
• Progressive muscle relaxation: While useful for anxiety reduction, it is more complex and less immediate than deep breathing. It also requires a quiet space and more time, which may limit spontaneous use.
• Guided imagery: Guided imagery can reduce anxiety but involves visualization, which may not be suitable for individuals with intrusive trauma-related images. Deep breathing is simpler and more universally applicable.