A patient being treated for major depressive disorder has taken 300 mg amitriptyline daily for a year. The patient calls the case manager at the clinic and says, 'I stopped taking my antidepressant 2 days ago. Now I am having cold sweats, nausea, a rapid heartbeat, and nightmares.' How should the nurse advise the patient?

Correct Answer: A

Rationale: The correct answer is A) Go to the nearest emergency department immediately. This patient is experiencing symptoms of antidepressant withdrawal, known as discontinuation syndrome. Amitriptyline, as a tricyclic antidepressant, can cause withdrawal symptoms if stopped abruptly after long-term use. The patient's symptoms of cold sweats, nausea, rapid heartbeat, and nightmares are indicative of withdrawal and require immediate medical attention to manage potential complications. Option B is incorrect as it trivializes the situation and does not address the severity of the symptoms. Taking aspirin and fluids will not alleviate withdrawal symptoms. Option C is incorrect because restarting the antidepressant without medical guidance can be dangerous and may not address the immediate symptoms effectively. The patient needs urgent evaluation by a healthcare provider. Option D is incorrect as it advises the patient to resume and then discontinue the medication again without medical supervision. This approach can worsen withdrawal symptoms and is not a recommended practice in managing antidepressant withdrawal. In an educational context, this question highlights the importance of understanding and managing antidepressant withdrawal symptoms. Nurses need to be vigilant in recognizing such symptoms and providing appropriate guidance to patients to ensure their safety and well-being. Immediate medical attention is crucial in such situations to prevent complications and provide necessary support to the patient.

Correct Answer: D

Rationale: In working with a patient diagnosed with PTSD, the most appropriate intervention is option D: helping the patient identify triggers and develop coping strategies. This approach is grounded in evidence-based practice for PTSD management. By identifying triggers, the patient gains awareness of what may lead to distress or flashbacks, empowering them to implement coping strategies to manage these triggers effectively. Option A, encouraging avoidance of talking about the trauma, is not recommended as it may perpetuate avoidance behaviors, worsen symptoms, and hinder the patient's ability to process and heal from the traumatic experience. Option B, exposure therapy, although effective for some individuals with PTSD, may not be appropriate for all patients, especially if they are not ready or willing to confront the trauma directly. Option C, offering sedating medications during flashbacks, only addresses the symptoms temporarily without addressing the underlying triggers or providing the patient with long-term coping skills. In an educational context, it is crucial for nurses to understand the principles of trauma-informed care and evidence-based interventions for PTSD. By choosing option D, nurses can actively engage in supporting patients to develop resilience and regain control over their lives in a safe and empowering manner.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Elevated mood, increased energy, and impulsive behavior. During the manic phase of bipolar disorder, individuals often exhibit symptoms such as heightened mood, increased energy levels, impulsivity, racing thoughts, and decreased need for sleep. These symptoms can lead to risky behaviors and poor decision-making. Option A) Lethargy and lack of interest in activities is incorrect because these are characteristics of the depressive phase of bipolar disorder, not the manic phase. Option C) Frequent crying episodes and withdrawal from others are more indicative of symptoms seen in the depressive phase of bipolar disorder, not the manic phase. Option D) Hypersomnia (excessive sleeping) and difficulty concentrating are also more commonly associated with the depressive phase of bipolar disorder, rather than the manic phase. Educationally, understanding the symptoms of bipolar disorder in its different phases is crucial for nurses to provide appropriate care and interventions for patients. Recognizing the distinct behaviors seen in the manic phase helps nurses ensure patient safety, manage symptoms effectively, and provide support during episodes of mania. This knowledge also aids in developing individualized care plans and promoting a therapeutic nurse-patient relationship.

Correct Answer: B

Rationale: In the context of Alzheimer's disease, the correct answer is B) Age. This is because advancing age is the single greatest risk factor for developing Alzheimer's disease. As individuals grow older, the risk of developing this condition increases significantly. This is attributed to the natural aging process, which can lead to changes in the brain that make individuals more susceptible to developing Alzheimer's. Genetics (option A) also play a role in Alzheimer's disease, but it is not as significant as age. While having a family history of the disease can increase one's risk, age remains the primary factor. History of Down syndrome (option C) is a risk factor for early-onset Alzheimer's disease, but it is not as common as age-related Alzheimer's. Androgen deprivation therapy (option D) is not a recognized risk factor for Alzheimer's disease. In an educational context, it is important for the community health nurse to emphasize the impact of age as the primary risk factor for Alzheimer's disease. Understanding this can help individuals take proactive steps to maintain brain health as they age, such as engaging in cognitive activities, staying socially connected, and adopting a healthy lifestyle. By raising awareness about the significance of age in Alzheimer's risk, the nurse can empower individuals to make informed decisions about their brain health as they grow older.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Increased suicidal thoughts or behaviors. When a patient with major depressive disorder is prescribed an antidepressant, there is a risk of increased suicidal ideation, especially in the initial stages of treatment. This phenomenon, known as activation syndrome, can occur as the antidepressant starts to take effect before mood improvement is observed. Therefore, close monitoring for any signs of increased suicidal thoughts or behaviors is crucial to ensure the safety of the patient. Option A) Increased energy and insomnia may actually be expected side effects of some antidepressants as they can have activating properties. However, this is not the most critical side effect to monitor in a patient with major depressive disorder. Option B) Decreased appetite and weight loss are common side effects of some antidepressants, but they are not as immediately concerning as increased suicidal thoughts or behaviors in a patient with major depressive disorder. Option C) Dizziness and confusion are potential side effects of medications, but they are not the primary side effects to monitor for in this specific case. In an educational context, understanding the potential side effects of medications used in behavioral nursing is essential for providing safe and effective care to patients. Nurses need to be vigilant in monitoring for both common and serious side effects, especially in patients with mental health conditions. Recognizing and addressing adverse effects promptly can help prevent complications and ensure optimal outcomes for patients undergoing treatment for major depressive disorder.