The nurse is caring for a client admitted with severe exacerbation of posttraumatic stress disorder that is experiencing flashbacks and hypervigilance. Which is the priority for the nurse to address when caring for this client?
Promote the client’s safety
Help to promote the client's self-esteem
Help the client cope with stress and emotions
Establish a support system in the client's community
The Correct Answer is A
Choice A reason: In severe PTSD exacerbation, flashbacks and hypervigilance indicate amygdala hyperactivity and impaired prefrontal cortex regulation, increasing risk of impulsive or self-harming behaviors. Ensuring safety addresses immediate dangers, as heightened arousal can lead to disorientation or panic, necessitating a secure environment to stabilize the client’s neurobiological stress response.
Choice B reason: Promoting self-esteem is valuable in PTSD but secondary to safety. Low self-esteem may stem from trauma-related guilt, linked to serotonin dysregulation, but does not pose immediate risk. Flashbacks and hypervigilance, driven by amygdala overactivity, require urgent safety measures to prevent harm during acute episodes.
Choice C reason: Helping cope with stress and emotions is important in PTSD management, addressing cortisol dysregulation and amygdala hyperactivity. However, during severe exacerbation with flashbacks, safety is the priority, as acute episodes can lead to disorientation or self-harm. Coping strategies are secondary to stabilizing the immediate neurobiological crisis.
Choice D reason: Establishing a community support system aids long-term PTSD recovery by enhancing oxytocin-mediated emotional regulation. However, during acute exacerbation with flashbacks, immediate safety is critical due to heightened amygdala-driven arousal. Community support is a secondary intervention, as it does not address the urgent risk of harm in acute episodes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Seasonal Affective Disorder (SAD) is a subtype of major depressive disorder with a seasonal pattern, requiring at least two major depressive episodes in a seasonal pattern over two years, not necessarily five key features for two weeks. The diagnostic criteria involve symptoms like low mood, anhedonia, and fatigue, but the two-week duration with five symptoms applies to major depression generally, not specifically SAD, which emphasizes seasonal recurrence.
Choice B reason: The statement is false because Seasonal Affective Disorder is defined by recurrent depressive episodes tied to specific seasons, typically winter, rather than a strict requirement of five key features for two weeks. SAD involves symptoms like hypersomnia and carbohydrate craving, but the diagnostic focus is on the seasonal pattern, not the exact symptom count or duration stated.
Correct Answer is C
Explanation
Choice A reason: Administering 2 teaspoons (10 mL) would deliver 500 mg of Amoxicillin, as the concentration is 250 mg/5 mL, and 1 teaspoon equals 5 mL. This dose is double the prescribed 250 mg, risking overdose. Amoxicillin overdose can cause gastrointestinal distress or, in rare cases, renal toxicity, making this choice scientifically inappropriate for the prescribed dose.
Choice B reason: Giving 3 teaspoons (15 mL) would deliver 750 mg of Amoxicillin, far exceeding the prescribed 250 mg dose. The concentration is 250 mg/5 mL, so 15 mL contains three times the required amount. This could lead to adverse effects like diarrhea or allergic reactions, as excessive antibiotic levels disrupt gut flora and increase toxicity risks.
Choice C reason: One teaspoon (5 mL) delivers exactly 250 mg of Amoxicillin, matching the prescribed dose, as the concentration is 250 mg/5 mL. This ensures therapeutic efficacy for treating infections like otitis media in children, maintaining serum levels within the therapeutic range (MIC for common pathogens like Streptococcus pneumoniae), minimizing side effects, and adhering to pediatric dosing guidelines.
Choice D reason: Four teaspoons (20 mL) would deliver 1000 mg of Amoxicillin, four times the prescribed dose. At 250 mg/5 mL, this excessive dose risks severe side effects, including nephrotoxicity or hepatotoxicity, and disrupts microbial balance, potentially causing antibiotic resistance. This is scientifically inappropriate, as it deviates significantly from the therapeutic dose for an 8-year-old.
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