A client diagnosed with generalized anxiety disorder (GAD) is receiving education from a healthcare provider. Which of the following statements by the client indicates a need for further teaching? Select all that apply.

Correct Answer: B

Rationale: The correct answer is B. The statement 'I can stop taking my medication once I feel better' indicates a need for further teaching. It is crucial for individuals with generalized anxiety disorder to continue taking their medication as prescribed even when they start feeling better. Discontinuing medication abruptly can lead to a recurrence of symptoms. It is essential to emphasize the importance of following the prescribed treatment plan and regularly consulting with a healthcare provider to assess the need for medication adjustments.

Correct Answer: B

Rationale: Schizophrenia is a complex psychiatric disorder characterized by a range of symptoms that can be broadly categorized into positive symptoms (additions to normal behavior, like hallucinations and delusions), negative symptoms (reductions in normal functioning, such as emotional flatness), cognitive impairments, and sometimes motor disturbances. To determine which option is an uncommon symptom, we need to evaluate each choice against the established diagnostic criteria from sources like the DSM-5, which outlines core features of the disorder. Starting with option A: Delusions. Delusions are a hallmark positive symptom of schizophrenia, involving fixed false beliefs that are not amenable to reason, such as persecutory delusions (believing one is being targeted) or grandiose delusions (believing one has exceptional abilities). They occur in approximately 50-80% of individuals with schizophrenia and are often among the first symptoms to prompt clinical attention. This makes delusions a common and defining feature, not uncommon. Next, option B: Fatigue. While fatigue can be experienced by many people with schizophrenia, it is not considered a primary or core symptom of the disorder itself. Instead, fatigue often arises secondarily from factors like poor sleep due to hallucinations, side effects of antipsychotic medications (e.g., sedation from drugs like olanzapine), depression that co-occurs with schizophrenia, or the overall stress of managing symptoms. The DSM-5 does not list fatigue as a diagnostic criterion for schizophrenia; it's more commonly associated with general medical conditions, mood disorders, or lifestyle factors. In clinical studies, fatigue is reported in some patients but at rates no higher than in the general population when controlling for comorbidities, making it an uncommon direct symptom of schizophrenia proper. Now, option C: Disorganized speech. This is a classic positive symptom, often manifesting as loose associations, tangentiality, or word salad, where thoughts jump erratically or become incoherent. It reflects underlying disorganized thinking and is present in a majority of schizophrenia cases, particularly during acute episodes. It's explicitly included in diagnostic criteria and differentiates schizophrenia from other psychoses, so it's far from uncommon—it's a frequent indicator used in assessments like the Positive and Negative Syndrome Scale (PANSS). Finally, option D: Catatonia. Catatonia involves motor abnormalities such as stupor, mutism, posturing, or purposeless agitation, and while it's less prevalent in modern schizophrenia diagnoses (affecting about 10-15% of cases), it is still recognized as a potential feature, especially in the catatonic subtype. The DSM-5 includes catatonic symptoms as specifiers for schizophrenia, and they can respond to treatments like benzodiazepines or ECT. Historical and current literature, including studies from the World Health Organization, confirm catatonia as a valid, if rarer, manifestation tied to the disorder's neurobiological underpinnings, like dopamine dysregulation in motor pathways. Thus, it's not uncommon in the sense of being outside the spectrum of schizophrenia symptoms. In summary, the uncommon symptom here is fatigue because it lacks a direct pathophysiological link to schizophrenia's core mechanisms (e.g., aberrant dopamine signaling or glutamate dysfunction), unlike the others, which align with the disorder's established symptomatology. Recognizing this distinction helps students differentiate primary psychiatric symptoms from secondary or nonspecific complaints, aiding accurate diagnosis and avoiding misattribution in clinical scenarios. For instance, if a patient reports fatigue without other psychotic features, clinicians might explore anemia, thyroid issues, or sleep apnea first rather than assuming schizophrenia. This nuanced understanding is crucial for multidisciplinary care in mental health.

Correct Answer: D

Rationale: In major depressive disorder, common findings include anhedonia (loss of interest or pleasure), hypersomnia (excessive sleepiness), fatigue, and feelings of worthlessness. Flight of ideas, characterized by racing thoughts and rapid speech, is typically associated with bipolar disorder during manic episodes, not major depressive disorder.

Correct Answer: A

Rationale: During a panic attack, a well-lit environment might exacerbate the client's symptoms due to sensory overload. Therefore, it is inappropriate to provide a well-lit environment during a panic attack. Encouraging deep breathing, moving the client to a quiet environment, and administering prescribed antianxiety medication are appropriate interventions for managing a panic attack. These actions help create a calming atmosphere and address the physiological symptoms associated with panic attacks.

Correct Answer: D

Rationale: In caring for a client with bipolar disorder in a depressive episode, the nurse should implement interventions that promote mental well-being. Encouraging participation in activities, promoting adequate nutrition and hydration, and monitoring for suicidal ideation are all essential components of care. Discouraging verbalization of feelings is counterproductive as it hinders the therapeutic process and communication, which are crucial for the client's emotional expression and recovery.