A client with posttraumatic stress disorder (PTSD) who is having ...

[mia]

A client with posttraumatic stress disorder (PTSD) who is having recurring nightmares may be prescribed which of the following medications (as an off-label use) to treat the nightmares and improve sleep?
 
  A) Lorazepam, a benzodiazepine
  B) Prazosin, an alpha1 inhibitor
  C) Metoprolol, a b-adrenergic blocking agent
  D) Zolpidem, a sedative

Question 2

When explaining kindling to a group of nursing students in their mental health rotation, which of the following would the nurse use as the best explanation of kindling?
 
  A) With repeated reexperiencing of the traumatic event, posttraumatic stress disorder symptoms become more easily triggered with time.
  B) After combat exposure a client has little or no reaction when a car backfires on the road.
  C) The sensitized client will no longer react to later, milder stressors that are similar to their initial exposure.
  D) The symptoms associated with the stressor will correlate to a decrease in dopamine activity.

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Answer to Question 1

Ans: B
Off-label use of prazosin, an alpha1 inhibitor, has recently been shown to be effective in treating nightmares and improving sleep in clients with PTSD. Selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, and b-blockers also have been shown to be effective in reducing the symptoms of PTSD.

Answer to Question 2

Ans: A
Behavioral sensitization may be one mechanism underlying the hyperarousal seen in posttraumatic stress disorder (PTSD). This phenomenon, sometimes referred to as kindling, occurs after exposure to severe, uncontrollable stressors. A sensitized person reacts with a magnified stress response to later, milder stressors. Research shows that a single or repeated exposure to a severe stressor potentiates the capacity of a subsequent stressor to increase synaptic levels of norepinephrine and dopamine in the forebrain. This finding would account for the fact that some individuals with PTSD experience intense fear, anxiety, and panic in response to minor stimuli. One example of behavioral sensitization is that PTSD after combat exposure is more likely to develop in veterans who are survivors of childhood abuse than in those who have not experienced prior trauma.

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