A client with generalized anxiety disorder (GAD) is being discharged. Which of the following instructions should the nurse not include in the discharge teaching?

Correct Answer: D

Rationale: Discharge instructions for a client with GAD should include practicing relaxation techniques daily, avoiding caffeine and alcohol, engaging in regular physical activity, and seeking support from friends and family. Benzodiazepines are not recommended as the first-line treatment due to their potential for dependence and should not be included in the discharge teaching.

Correct Answer: D

Rationale: Borderline personality disorder is characterized by an intense fear of abandonment, unstable relationships, impulsivity, and chronic feelings of emptiness. Grandiosity, which involves an inflated sense of self-importance, is typically associated with narcissistic personality disorder rather than borderline personality disorder.

Correct Answer: B

Rationale: Rapid heart rate is a characteristic symptom of severe anxiety due to the body's fight-or-flight response being activated. This physiological response leads to an increased heart rate to prepare the body to deal with perceived threats. Healthcare professionals should be vigilant in monitoring and managing this symptom in clients experiencing severe anxiety.

Correct Answer: B

Rationale: Fluoxetine, commonly known as Prozac, is a selective serotonin reuptake inhibitor (SSRI) used to treat depression, anxiety, and other mental health conditions. When providing discharge instructions, nurses must prioritize patient safety and education on key interactions and risks. The most critical instruction here is to avoid drinking alcohol while taking this medication, as alcohol can significantly exacerbate the drug's side effects and reduce its therapeutic efficacy. Step 1: Understanding why avoiding alcohol is essential. Alcohol is a central nervous system depressant that can interact dangerously with fluoxetine. This combination increases the risk of severe drowsiness, dizziness, impaired coordination, and judgment, potentially leading to accidents or falls. More concerningly, alcohol can worsen depressive symptoms, counteract the antidepressant effects of fluoxetine, and heighten the risk of serotonin syndrome—a potentially life-threatening condition characterized by confusion, rapid heart rate, fever, and muscle rigidity. It can also amplify gastrointestinal issues like nausea or vomiting. Clinical guidelines from sources like the FDA and American Psychiatric Association explicitly warn against alcohol use with SSRIs, making this a non-negotiable teaching point for safe discharge. By emphasizing this, the nurse empowers the client to prevent adverse outcomes and promotes adherence to therapy. Step 2: Why choice A is incorrect. Taking fluoxetine with food to avoid stomach upset is not a primary or required instruction. While fluoxetine may occasionally cause mild gastrointestinal discomfort such as nausea in about 20-30% of users initially, it is generally well-tolerated and can be taken with or without food. The manufacturer's prescribing information does not mandate food intake; instead, it recommends consistency in dosing time. Advising this could unnecessarily complicate the regimen for clients without symptoms, potentially leading to non-adherence. This is more relevant for medications like NSAIDs or certain antibiotics, not SSRIs like fluoxetine. Step 3: Why choice C is incorrect. Reporting unusual side effects to the healthcare provider is sound general advice applicable to virtually all medications, not specific to fluoxetine. While clients should indeed monitor for issues like sexual dysfunction, weight changes, insomnia, or rare severe reactions (e.g., allergic responses or suicidal ideation in young adults), this is a universal safety net rather than a targeted discharge instruction for this drug. Nursing education focuses on proactive, drug-specific guidance over broad statements, as the latter might dilute the importance of unique risks like alcohol interaction. Step 4: Why choice D is incorrect. Informing the client that it may take several weeks for the medication to take effect is accurate—fluoxetine typically requires 4-6 weeks for full therapeutic benefits due to its long half-life and gradual serotonin modulation—but this is anticipatory guidance about efficacy, not an immediate safety concern for discharge. While helpful for managing expectations and preventing premature discontinuation, it does not address acute risks like interactions that could harm the client right away. Discharge teaching prioritizes harm prevention over timeline education, especially when alcohol avoidance directly impacts safety from day one. In summary, selecting B ensures the nurse addresses the most actionable and hazardous interaction, fostering client safety and informed self-management. This targeted approach aligns with evidence-based nursing practice, reducing readmission risks from preventable complications. Clients educated on alcohol avoidance are better equipped to integrate fluoxetine into their lifestyle without compromising health.

Correct Answer: B

Rationale: Lithium is a mood stabilizer commonly prescribed for bipolar disorder, and its therapeutic levels must be carefully maintained to avoid toxicity or reduced efficacy. The client's statement in option B, "I need to maintain a consistent sodium intake," demonstrates an accurate understanding because lithium is primarily excreted by the kidneys, and fluctuations in dietary sodium directly impact its renal clearance. A low-sodium diet can decrease lithium excretion, leading to elevated blood levels and potential toxicity symptoms like nausea, tremors, or confusion. Conversely, a high-sodium intake can increase excretion, potentially dropping levels below therapeutic range and risking manic episodes. By recognizing the need for consistency, the client shows awareness of this critical interaction, which is a cornerstone of lithium education emphasized by healthcare providers to ensure safe long-term use. Now, examining why the other options are incorrect: Option A, "I should avoid eating aged cheeses and processed meats," reflects a misunderstanding, as this dietary restriction applies to monoamine oxidase inhibitors (MAOIs) used for depression, not lithium. Those foods are high in tyramine, which can cause hypertensive crises with MAOIs, but lithium has no such interaction. Advising this would confuse the client and indicate poor grasp of lithium-specific guidelines. Option C, "I should drink plenty of fluids to stay hydrated," is partially true but not the most precise indicator of understanding lithium therapy. While adequate hydration (about 2-3 liters daily) supports kidney function and helps prevent lithium toxicity, especially in hot weather or with diuretics, it's a general health recommendation rather than the unique, evidence-based lithium precaution. Overemphasizing fluids without mentioning sodium consistency could overlook the primary risk factor, so this statement alone doesn't fully capture the medication's nuances. Option D, "I can take over-the-counter medications without consulting my doctor," is outright incorrect and dangerous. Lithium has significant interactions with many OTC drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs like ibuprofen), which can reduce lithium excretion and cause toxicity, or decongestants that might exacerbate side effects. Clients must always consult providers before using any OTC products, including herbal supplements, to avoid adverse outcomes. This statement signals a lack of awareness about lithium's narrow therapeutic index and the need for vigilant monitoring. In summary, effective lithium education focuses on lifestyle factors like stable sodium intake to maintain steady-state levels, typically monitored via regular blood tests (target 0.6-1.2 mEq/L). Clients who understand this reduce their risk of complications, underscoring why B is the optimal choice.