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." dropdown Complete the following sentence by using the list of options. The nurse should address the client’s dropdown followed by the client's dropdown .

• Hopelessness: The client verbalizes feelings of being “stuck in the past” and doubts that things will ever improve, reflecting profound hopelessness. Addressing hopelessness first is critical because it underlies motivation, coping, and engagement in therapy. Interventions targeting hopelessness help reduce risk for worsening mood or potential suicidal ideation, establishing a foundation for subsequent care. • Sleep disturbances: Poor sleep and nightmares interfere with emotional regulation, cognitive functioning, and overall recovery. After addressing hopelessness to improve engagement and outlook, interventions targeting sleep can enhance daytime functioning, participation in therapy, and reduce PTSD-related hyperarousal. Addressing sleep second ensures the client is prepared to participate in interventions. Rationale for Incorrect Choices • Irritability: Although irritability is present, it is a symptom secondary to PTSD and emotional dysregulation. It is less immediately dangerous than hopelessness and typically improves as mood and coping skills are addressed. Focusing on irritability first would not target the core psychological vulnerability. • Social withdrawal: Social avoidance is common in PTSD but is largely a consequence of hyperarousal, sleep disturbance, and hopelessness. While important to address, targeting social withdrawal first may be less effective until emotional and cognitive functioning are stabilized. It is secondary to the primary concern of hopelessness.