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 posttraumatic stress disorder? (Select all that apply).

Rationale: A. A client who moved to an apartment located on higher ground than her previous home: Relocating to a safer area demonstrates adaptive coping and proactive problem-solving. It does not indicate symptoms of posttraumatic stress disorder (PTSD) and does not require a referral for mental health assessment. B. A client who has frequent nightmares about the hurricane: Recurrent intrusive thoughts or nightmares about a traumatic event are hallmark symptoms of PTSD. This client should be referred for further evaluation and possible treatment. C. A client who expresses a realization that life will not return to the way it was before the hurricane: Accepting permanent changes after a disaster reflects normal adjustment and resilience. This insight alone does not suggest PTSD. D. A client who describes feeling disconnected from those around him following the hurricane: Emotional numbing or detachment from others is a common PTSD symptom. This client should be referred for assessment to address potential social and emotional impairments. E. A client who describes having persistent feelings of anger about the hurricane: Persistent irritability or anger is another symptom associated with PTSD. Referral is appropriate to evaluate for underlying trauma-related disorder and provide supportive interventions.