Client: A.S., 34-year-old male Setting: Outpatient Veterans Affairs Mental Health Clinic Presenting Complaint: "I can't sleep and I keep reliving what happened." History: A.S. is a recently discharged military veteran who survived an improvised explosive device (IED) attack during deployment. He reports persistent nightmares, emotional numbing, and avoiding crowded environments. His spouse notes increased irritability and detachment from family members. A.S. denies substance use and suicidal ideation but expresses "hopelessness about things ever changing." Exhibits Based on the client's current behavior and medication timeline, which actions should the nurse take? Select all that apply.

A. Limit therapy discussion to surface-level topics to avoid emotional distress: Avoiding meaningful discussion can reinforce avoidance coping and hinder progress in trauma-focused therapy. Clients with PTSD benefit from gradual exposure to trauma-related content in a safe, structured setting rather than superficial conversations, making this approach inappropriate. B. Provide coping tools such as mindfulness or grounding to manage sleep fears: Teaching mindfulness, grounding, and relaxation techniques helps the client manage hyperarousal, intrusive thoughts, and sleep-related anxiety. These skills support emotional regulation and reduce distress during exposure to trauma-related cues. C. Suggest temporarily discontinuing sertraline due to persistent nightmares: Discontinuing sertraline prematurely is not advised, as SSRIs often take 2–4 weeks to achieve therapeutic effects. Abruptly stopping the medication may worsen mood and anxiety, and persistent nightmares in the first few days are common during initial dosing. D. Normalize survivor guilt as a common PTSD reaction and recommend exploring it in therapy: Acknowledging that survivor guilt is a typical response to trauma validates the client’s experience and encourages engagement in therapy. Addressing guilt within TF-CBT helps reduce self-blame and promotes emotional processing. E. Encourage continued group participation while respecting emotional pacing: Supporting gradual re-engagement in group therapy provides social exposure, peer support, and modeling of coping strategies. Respecting pacing prevents overwhelming the client while still promoting therapeutic participation. F. Reassure client that therapeutic effects of SSRIs may take several weeks: Educating the client about the delayed onset of SSRIs like sertraline sets realistic expectations, reduces frustration with initial symptom persistence, and encourages adherence, which is essential for achieving therapeutic benefit.