A 27-year-old woman is seen in clinic for ongoing management of her juvenile myoclonic epilepsy. Her seizures have been well controlled on lamotrigine, with no seizures in the past 2 years. She does report some symptoms of depression, as well as anticipatory anxiety regarding the possibility of future seizures. Which of the following options is the best next step in management?

Correct Answer: B

Rationale: The correct next step in management for the 27-year-old woman with juvenile myoclonic epilepsy who is experiencing symptoms of depression and anticipatory anxiety is option B) citalopram. Citalopram is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat depression and anxiety disorders. In this case, citalopram is appropriate as it can help alleviate the woman's depressive symptoms and anxiety without interfering with her seizure control provided by lamotrigine. Option A) bupropion is not the best choice in this scenario because bupropion is contraindicated in patients with a history of seizures due to its potential to lower the seizure threshold, which could worsen the woman's epilepsy. Option C) nortriptyline is a tricyclic antidepressant with anticholinergic effects that can lower the seizure threshold, making it a less suitable choice for a patient with epilepsy. Option D) tapering off lamotrigine, the antiepileptic medication that has been effectively controlling her seizures, and starting levetiracetam is not recommended as it could increase the risk of breakthrough seizures and disrupt the woman's current seizure control. Educationally, understanding the interactions between psychotropic medications and antiepileptic drugs is crucial for healthcare providers managing patients with epilepsy and comorbid psychiatric conditions. It is important to consider the patient's overall health, medication interactions, and individual needs when making treatment decisions to ensure optimal outcomes and quality of life.

Correct Answer: A

Rationale: The correct answer is A) The HIPAA law prevents me from disclosing any information about any patient. This response is appropriate because it upholds patient confidentiality, a fundamental ethical principle in healthcare. By not disclosing any information about Rachael, the nurse is respecting her privacy and complying with legal requirements under the Health Insurance Portability and Accountability Act (HIPAA). Option B is incorrect because specifying that Rachael is seeing Dr. Leone still discloses confidential information about a patient, which is a violation of HIPAA. Option C is incorrect because revealing Rachael's specific mental health concerns breaches her privacy rights. Option D is also wrong as it discloses the purpose of Rachael's visit, which is confidential information. In an educational context, understanding and practicing patient confidentiality are crucial for healthcare professionals, especially in the field of mental health where stigma and privacy concerns are significant. Reinforcing the importance of respecting patient confidentiality through scenarios like this quiz question helps students develop a strong ethical foundation in their practice.

Correct Answer: D

Rationale: Rationale: The correct answer is D) Re-experiencing the trauma in dreams or flashback. This symptom is a hallmark of PTSD and distinguishes it from anxiety disorders. Individuals with PTSD often have intrusive memories, nightmares, or flashbacks of the traumatic event, leading to significant distress and impairment in daily functioning. This re-experiencing of the trauma is a key diagnostic criterion for PTSD according to the DSM-5. Option A) Avoiding situations and certain activities that resemble any type of stress is a common symptom in both PTSD and anxiety disorders. While avoidance behavior can be present in PTSD, it is not unique to this disorder and can be seen in various anxiety disorders as well. Option B) Demonstrating a blunted affect when discussing the traumatic situations may occur in some individuals with PTSD, but it is not a defining symptom that distinguishes PTSD from anxiety disorders. A blunted affect can be seen in various mental health conditions, not specific to PTSD. Option C) Having a minimum interest in family and others is a symptom that is not specific to PTSD. It may occur in various mental health disorders and is not a distinguishing feature of PTSD compared to anxiety disorders. Educational context: Understanding the distinct symptoms of PTSD compared to other mental health conditions is crucial for healthcare professionals, especially nurses, who may encounter individuals with trauma histories. Recognizing the specific diagnostic criteria for PTSD can help in accurate assessment, diagnosis, and treatment planning. By differentiating between PTSD and anxiety disorders, healthcare providers can provide appropriate care and support tailored to the individual's needs.

Correct Answer: C

Rationale: The correct answer is C) Claustrophobia. Claustrophobia is an anxiety disorder characterized by an irrational fear of confined or enclosed spaces. In the provided scenario, the client's fear of getting on an elevator or being in a small room leading them to avoid leaving the house unless accompanied by their spouse is indicative of claustrophobia. This fear is specific to situations involving enclosed spaces, which aligns with the client's avoidance behaviors. Option A) Agoraphobia is incorrect because agoraphobia involves a fear of situations or places where escape might be difficult or help might not be available in the event of a panic attack. The client in the question does not exhibit a fear of leaving the house per se but rather a fear related to enclosed spaces. Option B) Hematophobia is incorrect as it refers to a specific phobia related to blood. The scenario does not mention any fear or avoidance related to blood. Option D) Hypochondriasis is incorrect as it involves a preoccupation with having a serious illness despite reassurance from medical professionals that one is healthy. The client's fear in the scenario is not related to health concerns but rather to enclosed spaces. Educationally, understanding different anxiety disorders and their specific symptoms is crucial for healthcare professionals, especially nurses, who may encounter clients with such conditions in clinical practice. Recognizing the specific characteristics of each disorder is essential for accurate assessment and effective intervention to support clients in managing their anxiety.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Electroconvulsive therapy (ECT). ECT is the treatment of choice for severe depression unresponsive to conventional treatments like antidepressant medications and psychotherapy. ECT is particularly effective for individuals who have not benefited from other forms of treatment or are in need of rapid relief due to the severity of their symptoms. Option A) Lithium is primarily used in the treatment of bipolar disorder, not as a first-line treatment for depression. Option C) Light therapy is typically used for seasonal affective disorder, a subtype of depression with a seasonal pattern, and may not be effective for severe, treatment-resistant depression like in Helen's case. Option D) Neurolinguistic programming is a psychological approach that focuses on changing patterns of behavior, but it is not a recommended treatment for severe, treatment-resistant depression. Educationally, understanding the hierarchy of treatment options for depression is crucial for healthcare professionals working with individuals with mental health conditions. Knowing when to escalate treatment to ECT, a highly effective intervention in severe cases of depression, can significantly impact patient outcomes and quality of life. This knowledge ensures that patients like Helen receive the most appropriate and effective care tailored to their individual needs.