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: Measuring the apical pulse (at the heart) simultaneously with the radial pulse (at the wrist) by two nurses accurately detects a pulse deficit, which occurs when heartbeats do not translate to peripheral pulses, often in arrhythmias like atrial fibrillation. This method quantifies the difference, aiding diagnosis and treatment, making it the correct approach.
Choice B reason: Comparing carotid pulses at rest and after standing assesses orthostatic changes, not a pulse deficit. A pulse deficit reflects a discrepancy between central and peripheral pulses, not positional changes. This action is irrelevant to detecting pulse deficits, as it does not compare simultaneous heart and peripheral pulse rates.
Choice C reason: Deflating a blood pressure cuff while palpating the brachial pulse is used to measure blood pressure, not to assess a pulse deficit. This method does not compare central and peripheral pulses simultaneously, which is necessary to identify a deficit, making it an incorrect approach for this assessment.
Choice D reason: Assessing both radial pulses simultaneously evaluates symmetry but not a pulse deficit, which requires comparing the apical (heart) pulse with a peripheral pulse. This method misses the central-peripheral comparison critical for detecting discrepancies caused by arrhythmias, making it inadequate for assessing a pulse deficit.

Choice A reason: Marking drainage output every 48 hours is too infrequent to accurately assess drainage in a closed wound drainage system. Frequent monitoring (e.g., every shift) is needed to track output, detect complications like excessive bleeding, and ensure system functionality, making this intervention inadequate for assessment.
Choice B reason: Stripping the chest tube vigorously is not recommended, as it can increase intrathoracic pressure, risking tissue damage or bleeding. It does not assess drainage amount but manipulates the tube, potentially causing harm. Assessment requires observing output in the collection chamber, making this action incorrect.
Choice C reason: Maintaining the collection chamber below the client’s chest ensures proper drainage by gravity in a closed wound drainage system, like a chest tube. This position prevents backflow and allows accurate measurement of drainage output in the chamber, essential for assessing fluid loss and detecting complications like hemothorax.
Choice D reason: Adding water to the water seal chamber maintains system function but does not directly assess drainage amount. The water seal prevents air re-entry, not measures output. Assessment involves observing and recording drainage in the collection chamber, making this action irrelevant to the question’s focus.