PTSD on the NCLEX
Symptom clusters, grounding during flashbacks, nursing approach, medication overview.
PTSD is trauma symptoms lasting more than a month. Under a month is acute stress disorder.
Four symptom clusters
Re-experiencing: flashbacks, nightmares, intrusive memories. Avoidance: of reminders, places, conversations. Negative mood and cognition: guilt, detachment, numbing, distorted blame. Hyperarousal: exaggerated startle, hypervigilance, irritability, insomnia. Symptoms persist more than 1 month and impair function.
During a flashback: grounding
The patient is reliving the event, not remembering it. Say their name, identify yourself, state where they are and that they are safe now. Use the 5-4-3-2-1 senses technique. Speak calmly. Do not touch without warning and permission, and do not crowd or block the exit. Reduce stimulation.
Nursing approach
Safety and trust first. Be predictable: explain procedures before doing them, knock before entering, keep commitments. Trauma-informed care means asking 'what happened to you', not 'what is wrong with you'. Do not press for trauma details; disclosure happens on the patient's timeline in therapy.
Medications
SSRIs are first-line (sertraline and paroxetine carry FDA approval for PTSD). Prazosin is used for trauma nightmares. Avoid benzodiazepines: no efficacy for core PTSD symptoms, dependence risk, and they can interfere with trauma processing. First-line treatment overall is trauma-focused psychotherapy.
Frequently asked
Flashback vs hallucination?
A flashback replays a real event and is trauma-driven. A hallucination has no external source event. Both feel real in the moment; grounding works for flashbacks.
Best initial response to a hypervigilant veteran who won't sit with his back to the door?
Accommodate it. Offer a seat facing the door. It is a symptom, not defiance.
Quick check
Loading a question…
How ready are you right now?
10 real NCLEX questions, free, in your browser. See how close you are to ready and which subjects are costing you.
Try 10 questions free