A healthcare provider is assessing a client with generalized anxiety disorder (GAD). Which of the following findings shouldn't the healthcare provider expect?

Correct Answer: D

Rationale: In clients with generalized anxiety disorder (GAD), common symptoms include restlessness, fatigue, excessive worry, and irritability. Mania is not typically associated with GAD; instead, it is a key feature of bipolar disorder. Therefore, the healthcare provider should not expect to find mania in a client with GAD.

Correct Answer: D

Rationale: In bipolar disorder, common findings include periods of elevated mood, decreased need for sleep, and flight of ideas. Anhedonia, the inability to feel pleasure, is more indicative of conditions like major depressive disorder. Therefore, the nurse should not expect to find anhedonia in a client with suspected bipolar disorder.

Correct Answer: C

Rationale: Interventions for a client with anorexia nervosa should focus on monitoring daily caloric intake and weight, establishing a structured eating plan, providing liquid supplements as prescribed, and offering rewards for weight gain. Encouraging exercise is not recommended as it can worsen the condition by increasing energy expenditure and potentially reinforcing unhealthy behaviors associated with anorexia nervosa.

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: Electroconvulsive therapy (ECT) is a medical procedure primarily used to treat severe mental health conditions like major depressive disorder, bipolar disorder, and schizophrenia when other treatments fail. It involves passing a controlled electrical current through the brain under anesthesia to induce a brief seizure, which can lead to therapeutic changes in brain chemistry and function. However, like any medical intervention, ECT carries potential side effects, mostly related to the brain's temporary disruption during the procedure. To determine which option is not a potential side effect, we need to evaluate each choice based on established medical knowledge from sources like the American Psychiatric Association guidelines and clinical studies. Starting with option A: Short-term memory loss. This is a well-documented and common side effect of ECT. The electrical stimulation can temporarily impair the hippocampus and other memory-related brain regions, leading to anterograde amnesia (difficulty forming new memories) or retrograde amnesia (forgetting recent events) that typically resolves within days to weeks after treatment. Studies, such as those in the Journal of ECT, show that up to 70-80% of patients experience some degree of memory disruption, making this a valid potential side effect. Option B: Headache. Headaches are another frequent acute side effect of ECT, occurring in about 50-75% of sessions. They result from the muscle contractions during the induced seizure, increased intracranial pressure, or the effects of anesthesia. These headaches are usually mild to moderate, manageable with over-the-counter pain relievers like acetaminophen, and subside within hours to a day. Clinical protocols often include preventive measures, such as anti-inflammatory medications, confirming this as a recognized risk. Option C: Confusion. Post-ictal confusion is a standard immediate side effect following ECT, affecting nearly all patients to some extent. It stems from the brain's recovery phase after the seizure, similar to confusion after a grand mal seizure in epilepsy. This disorientation can last from minutes to hours, sometimes extending to a day, and is more pronounced in bilateral ECT compared to unilateral. Research from the National Institute of Mental Health highlights this as a transient but expected cognitive effect, often resolving without long-term impact. Now, option D: Tardive dyskinesia. This is not a potential side effect of ECT. Tardive dyskinesia (TD) is a neurological disorder characterized by involuntary, repetitive movements of the face, tongue, or limbs, such as lip smacking or grimacing. It is primarily caused by prolonged use of dopamine-blocking antipsychotic medications (e.g., haloperidol or risperidone), which disrupt the basal ganglia's balance over months to years. ECT, by contrast, does not involve dopaminergic blockade or long-term neurochemical alterations that lead to TD; in fact, ECT is sometimes used to treat conditions alongside antipsychotics without inducing this movement disorder. No major psychiatric literature, including meta-analyses in The Lancet Psychiatry, links ECT to TD, distinguishing it clearly from the other options. Patients receiving ECT might coincidentally have TD from prior medications, but the therapy itself does not cause or exacerbate it. In summary, while A, B, and C represent genuine, evidence-based risks of ECT—stemming directly from its mechanism of action—D arises from a unrelated pharmacological pathway, making it the incorrect choice as a side effect. Understanding these distinctions helps patients and clinicians weigh ECT's benefits against its manageable risks, often leading to significant symptom relief in treatment-resistant cases.