A nurse on a medical-surgical unit is receiving reports for four clients. Which of the following clients should the nurse assess first?

Rationale:
A. Stagger care to avoid taking more than one specimen at a time: While staggering procedures can reduce cumulative stress, it is not a primary strategy for obtaining cooperation from a preschooler for a single blood draw.

B. Apply vapocoolant spray immediately prior to collecting the specimen: Vapocoolant sprays can help numb the skin, but their use in preschoolers requires caution, as sudden cold sensations may startle or frighten the child. Additional preparation and explanation are necessary for acceptance.

C. Ask the parents to leave the room prior to collecting the blood specimen: Preschoolers often feel more secure and cooperative when a parent is present. Removing the parent may increase anxiety and resistance to the procedure, so parental support is usually encouraged.

D. Demonstrate the use of the equipment for the child: Preschoolers benefit from simple, age-appropriate explanations and demonstrations of medical equipment. Showing how the equipment works helps reduce fear, build trust, and increase cooperation during the blood draw.

Rationale:
A. A client who describes feeling disconnected from those around him following the hurricane: Emotional detachment or a sense of estrangement from others is a hallmark symptom of posttraumatic stress disorder (PTSD).

B. A client who describes having persistent feelings of anger about the hurricane: Ongoing irritability, anger, or emotional outbursts several months after a traumatic event may indicate unresolved trauma or hyperarousal, which are common features of PTSD.

C. A client who has frequent nightmares about the hurricane: Recurrent distressing dreams or flashbacks related to the traumatic event are hallmark re-experiencing symptoms of PTSD. Such nightmares suggest the trauma continues to affect the client’s sleep and mental health, justifying referral for further assessment.

D. A client who moved to an apartment located on higher ground than her previous home: Moving to a new location demonstrates adaptive coping and an effort to regain a sense of safety. This behavior does not indicate the presence of PTSD symptoms.

E. A client who expresses a realization that life will not return to the way it was before the hurricane: Acceptance and acknowledgment of change represent a healthy adjustment process. While grief or sadness may accompany this awareness, it reflects adaptation rather than pathological stress or trauma.