A nurse is assessing a client with suspected post-traumatic stress disorder (PTSD). Which of the following findings shouldn't the nurse expect?

Correct Answer: D

Rationale: Post-traumatic stress disorder (PTSD) is a psychiatric condition that develops after exposure to a traumatic event, characterized by specific symptom clusters including re-experiencing the trauma, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. These symptoms must persist for at least one month and cause significant distress or impairment. When assessing a client with suspected PTSD, the nurse should expect findings aligned with these diagnostic criteria from the DSM-5, but not symptoms from unrelated disorders. Let's examine each option step by step to understand why certain findings are expected in PTSD and why manic episodes are not. First, consider option A: Flashbacks. Flashbacks are a hallmark symptom of PTSD, falling under the re-experiencing cluster. They involve vivid, intrusive recollections where the individual feels as if the traumatic event is recurring in the present moment, often triggered by sensory cues. For example, a combat veteran might suddenly relive a battlefield explosion, experiencing intense fear and disorientation. This is not mere reminiscing but a dissociative-like state that disrupts daily functioning. Nurses should anticipate this in PTSD assessments, as it differentiates PTSD from simple grief or adjustment disorders. Thus, flashbacks are an expected finding. Next, option B: Avoidance of reminders of the trauma. This is a core feature of PTSD, categorized under the avoidance cluster. Individuals actively steer clear of people, places, conversations, or activities that remind them of the trauma to prevent emotional distress. For instance, a survivor of a car accident might refuse to drive or avoid highways, leading to social isolation or occupational interference. This avoidance is persistent and maladaptive, distinguishing it from normal coping after trauma. In nursing assessments, recognizing this helps identify the need for exposure-based therapies like cognitive processing therapy. Therefore, this is a finding the nurse should expect. Now, option C: Increased arousal and hypervigilance. This belongs to the arousal and reactivity cluster in PTSD, manifesting as exaggerated startle responses, irritability, difficulty concentrating, sleep disturbances, and constant scanning for threats (hypervigilance). A client might jump at loud noises or remain perpetually on guard, as if anticipating danger. This physiological hyperarousal stems from dysregulated autonomic nervous system activity post-trauma, often linked to elevated cortisol and adrenaline levels. It's a key diagnostic criterion and can lead to comorbidities like substance abuse if unaddressed. During assessment, nurses observe these signs through behavioral cues or self-reports, making them expected in suspected PTSD. Finally, option D: Manic episodes. Manic episodes are not associated with PTSD; they are defining features of bipolar I disorder. Mania involves a distinct period of abnormally elevated, expansive, or irritable mood lasting at least one week, accompanied by increased energy, grandiosity, decreased need for sleep, racing thoughts, distractibility, and risky behaviors like excessive spending or hypersexuality. These episodes can severely impair judgment and require interventions like mood stabilizers. While trauma can trigger bipolar episodes in predisposed individuals (comorbidity exists), manic symptoms are not inherent to PTSD's diagnostic profile. In PTSD, mood alterations are typically depressive or numbed, not euphoric or manic. Expecting manic episodes in a PTSD assessment would indicate a misdiagnosis or co-occurring condition, so the nurse shouldn't anticipate this as a primary finding. Instead, screening for bipolar disorder separately is advisable if mania is observed. In summary, options A, B, and C directly align with PTSD's symptom clusters, aiding in accurate diagnosis and care planning, such as trauma-focused psychotherapy or medications like SSRIs. Option D, however, points to a different psychopathology, underscoring the importance of differential diagnosis in mental health nursing to avoid conflating disorders and ensure targeted treatment.

Correct Answer: C

Rationale: Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants that work by increasing serotonin levels in the brain, commonly prescribed for depression, anxiety, and other mood disorders. While effective, they are associated with a range of side effects, primarily gastrointestinal, neurological, and sexual in nature. To determine which option is not a common side effect, we evaluate each choice based on established pharmacological profiles and clinical data from sources like the FDA and medical literature. Starting with option A: Nausea. This is a very common side effect of SSRIs, occurring in up to 20-30% of patients, especially during the initial weeks of treatment. It results from serotonin's influence on the gastrointestinal tract, stimulating 5-HT3 receptors in the gut, which can trigger vomiting centers in the brain. Nausea often diminishes over time as the body adjusts, but it's one of the most frequently reported complaints, leading many patients to take medications with food or use antiemetics. Option B: Insomnia. Sleep disturbances, including insomnia, are also common with SSRIs, affecting about 10-20% of users. This stems from increased serotonin activity, which can heighten arousal and disrupt the sleep-wake cycle, particularly with stimulating SSRIs like fluoxetine or sertraline. Conversely, some SSRIs may cause somnolence, but insomnia is a well-documented issue, often managed by timing doses earlier in the day or switching medications. Option C: Weight loss. This is not a common side effect of SSRIs; in fact, the opposite is typically observed. Most SSRIs, such as paroxetine and citalopram, are linked to weight gain in 10-25% of long-term users, due to appetite stimulation, metabolic changes, or improved mood leading to increased caloric intake. Weight loss is rare and usually transient if it occurs at all, often only in the early stages from nausea or reduced appetite. Clinical trials and meta-analyses, like those in the Journal of Clinical Psychiatry, consistently show net weight gain as the predominant effect, making weight loss an uncommon or atypical outcome not representative of standard SSRI use. Option D: Sexual dysfunction. This is among the most prevalent side effects, impacting 40-70% of patients on SSRIs. It manifests as decreased libido, erectile dysfunction, delayed orgasm, or anorgasmia, primarily because excess serotonin inhibits dopamine pathways involved in sexual arousal and reward. This is a leading cause of treatment discontinuation, and management may involve dose adjustments, adjunctive therapies like bupropion, or switching to non-SSRI antidepressants. In summary, while nausea, insomnia, and sexual dysfunction align with the serotonergic mechanism of SSRIs and are frequently encountered in clinical practice, weight loss does not—it contradicts the typical profile of metabolic side effects. Understanding these distinctions helps patients and providers weigh benefits against risks, often through monitoring and personalized adjustments.

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: B

Rationale: In caring for a client with generalized anxiety disorder (GAD), it is important to encourage the client to express their feelings, promote regular physical activity, and discourage the use of caffeine. Addressing weight and caloric intake monitoring may exacerbate anxiety related to body image, and focusing on these aspects can be distressing for the client. Therefore, monitoring daily caloric intake and weight should be avoided in this scenario.

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.