A client with major depressive disorder is prescribed an antidepressant. Which of the following instructions should the nurse exclude from the teaching?

Correct Answer: C

Rationale: The nurse should not include the instruction to discourage the client from washing her hands in the teaching for a client prescribed an antidepressant. This instruction is not relevant to the medication regimen. Instead, the nurse should educate the client that it may take several weeks for the medication to take effect, to avoid alcohol, not to discontinue the medication abruptly, and that there may be an increase in energy before mood improves. Regular blood tests are not typically required for most antidepressants.

Correct Answer: A

Rationale: Panic attacks, as defined by the DSM-5, involve a sudden surge of intense fear or discomfort that peaks within minutes and is accompanied by at least four of 13 possible symptoms, many of which are physical and can mimic serious medical conditions like heart attacks. These symptoms arise from the body's fight-or-flight response, involving the sympathetic nervous system, leading to hyperventilation, increased heart rate, and other physiological changes. To determine which option is not a symptom, we must evaluate each against established criteria from psychology and medicine, such as those from the American Psychiatric Association and clinical studies. Start with option A: Chest pain. Contrary to some misconceptions, chest pain or discomfort is indeed a core symptom of panic attacks, listed explicitly in the DSM-5 as one of the 13 criteria. It often feels like tightness, pressure, or sharp pain in the chest due to rapid heartbeat (palpitations) or muscle tension from anxiety. This symptom affects up to 50% of people during attacks, per research in the Journal of Anxiety Disorders, and frequently leads to emergency room visits because it resembles cardiac issues. Importantly, while chest pain can occur, it is not caused by actual heart damage in panic disorders—it's a benign but distressing autonomic response. If the question posits chest pain as "not a symptom," this would be inaccurate based on evidence; however, in rare educational contexts or outdated materials, it might be downplayed to differentiate from physical illnesses, though modern guidelines confirm its inclusion. Now, option B: Shortness of breath. This is unequivocally a symptom, often described as a sensation of smothering or difficulty breathing. It stems from hyperventilation, where rapid breathing expels too much carbon dioxide, causing respiratory alkalosis and the feeling of air hunger. Studies, including those from the National Institute of Mental Health, report it in 60-70% of panic episodes. It's incorrect to dismiss this as non-symptomatic because it directly contributes to the escalating fear cycle in attacks, distinguishing panic from calmer anxiety states. Option C: Dizziness. Dizziness, lightheadedness, or feeling faint is another standard symptom, affecting about 50% of individuals per epidemiological data from the Anxiety and Depression Association of America. It results from hyperventilation reducing blood flow to the brain or from vasovagal responses, leading to unsteadiness or vertigo-like sensations. This is not just incidental; it's part of the diagnostic cluster and often heightens the sense of impending doom. Ruling it out as a symptom would ignore its role in how panic attacks impair daily functioning, such as causing falls or avoidance behaviors. Option D: Hot flashes. Hot flashes, or sensations of intense heat flushing through the body, are recognized symptoms, akin to the DSM-5's "chills or hot flushes." They occur due to surges in adrenaline causing vasodilation and sweating, with prevalence around 30-40% in clinical reports from sources like Mayo Clinic. While the term "hot flashes" is more commonly linked to menopause (due to hormonal shifts), in panic attacks, it's a transient autonomic reaction, not estrogen-related. It's incorrect to exclude this because it fits the pattern of temperature dysregulation seen alongside chills, and ignoring it overlooks how such symptoms validate the panic diagnosis over other conditions like thyroid issues. In summary, all four options—A, B, C, and D—are actual symptoms of panic attacks, supported by decades of research showing their overlap with the fight-or-flight mechanism. If the intent was to identify a non-symptom, none qualify perfectly; perhaps the question draws from a specific framework where chest pain is emphasized as "atypical" to encourage medical evaluation, but this doesn't negate its status. Students should consult reliable sources like the DSM-5 or a mental health professional to differentiate panic from physical ailments—chest pain during anxiety warrants ruling out cardiac causes first. Understanding this helps in early recognition and treatment, such as through cognitive-behavioral therapy, which targets symptom misinterpretation to break the fear cycle. This comprehensive view ensures accurate learning, preventing unnecessary alarm while promoting mental health awareness.

Correct Answer: D

Rationale: In a client experiencing a depressive episode in bipolar disorder, common findings include low energy, feelings of hopelessness, insomnia or hypersomnia, and decreased appetite. Difficulty concentrating is more indicative of attention deficit disorders or cognitive impairment rather than a typical presentation of a depressive episode in bipolar disorder.

Correct Answer: C

Rationale: The correct answer is monitoring for suicidal ideation. When caring for a client with OCD, interventions should include allowing the client to perform rituals initially, setting limits on the time allowed for rituals, encouraging the client to verbalize feelings, and providing a structured schedule of activities. Monitoring for suicidal ideation is crucial in assessing the client's safety and mental health status, but it is not a direct intervention specific to managing OCD symptoms.

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.