PTSD Patient Safety & Risk Management 2 — Questions and Answers
Question 1: A PTSD patient discloses a specific plan to harm a coworker. Under the Tarasoff duty-to-protect standard, the clinician's FIRST obligation is to:
- Notify law enforcement and warn the identifiable victim (Correct answer)
- Document the threat in the chart and continue therapy
- Hospitalize the patient immediately without notification
- Consult a supervisor before taking any action
Correct answer: Notify law enforcement and warn the identifiable victim
Tarasoff requires clinicians to warn identifiable third parties and notify law enforcement when a patient poses a credible, specific threat.
Question 2: Which medication class is associated with the highest risk of QTc prolongation when used in PTSD patients who are also prescribed antipsychotics?
- SSRIs such as sertraline (Correct answer)
- Alpha-1 blockers such as prazosin
- Benzodiazepines such as clonazepam
- SNRIs such as venlafaxine
Correct answer: SSRIs such as sertraline
SSRIs, particularly citalopram and escitalopram, can prolong the QTc interval, increasing cardiac risk when combined with antipsychotics that also affect cardiac conduction.
Question 3: A veteran with PTSD is found unconscious with an empty pill bottle. After medical stabilization, the MOST important next step for ongoing safety is:
- Conduct a comprehensive suicide risk reassessment before any discharge planning (Correct answer)
- Immediately discharge to an outpatient PTSD program
- Provide psychoeducation about medication lethality
- Document the incident and resume prior treatment plan
Correct answer: Conduct a comprehensive suicide risk reassessment before any discharge planning
A thorough risk reassessment is essential following any suicide attempt to determine the appropriate level of care and update the safety plan.
Question 4: Which documentation element is MOST critical when a clinician decides NOT to hospitalize a high-acuity PTSD patient against the patient's wishes?
- A detailed clinical rationale including risk-benefit analysis and patient protective factors (Correct answer)
- A brief note stating the patient refused voluntary admission
- Signed informed consent for outpatient treatment
- A copy of the patient's insurance authorization
Correct answer: A detailed clinical rationale including risk-benefit analysis and patient protective factors
Thorough documentation of clinical reasoning, identified risk and protective factors, and the decision-making process protects the clinician and demonstrates standard of care.
Question 5: A PTSD patient on prazosin for nightmares reports frequent dizziness when standing. Which safety risk does this MOST directly represent?
- Orthostatic hypotension increasing fall risk (Correct answer)
- Serotonin syndrome from drug interaction
- Adrenergic rebound causing hypertensive crisis
- Paradoxical stimulant effect disrupting sleep
Correct answer: Orthostatic hypotension increasing fall risk
Prazosin is an alpha-1 blocker that lowers blood pressure and commonly causes orthostatic hypotension, elevating fall risk especially in older patients.
Question 6: When developing a safety plan for a PTSD patient with chronic suicidal ideation, which element is evidence-based as MOST protective?
- Lethal means counseling and restricting access to firearms or medications (Correct answer)
- Scheduling a follow-up appointment within 30 days
- Providing a crisis hotline number as the sole contact resource
- Recommending daily journaling to process suicidal thoughts
Correct answer: Lethal means counseling and restricting access to firearms or medications
Means restriction—particularly securing or removing firearms—is one of the strongest evidence-based suicide prevention strategies.
Question 7: A PTSD patient's family member contacts the clinic requesting information about the patient's treatment. Without a signed release, the clinician may ONLY disclose:
- General crisis resources and how to access emergency services (Correct answer)
- Diagnosis, medications, and treatment plan with verbal consent
- Session frequency and therapeutic progress notes
- Risk level and safety plan details to help with monitoring
Correct answer: General crisis resources and how to access emergency services
HIPAA permits sharing only general safety and crisis resource information with third parties in the absence of a valid patient authorization.
PTSD Patient Safety & Risk Management 2
A PTSD patient discloses a specific plan to harm a coworker.
Under the Tarasoff duty-to-protect standard, the clinician's FIRST obligation is to: