Which of the following interventions should not be included in the care plan for a client with major depressive disorder?

Correct Answer: C

Rationale: Interventions for a client with major depressive disorder should focus on promoting activities, adequate nutrition, hydration, and monitoring for suicidal ideation. Verbalizing feelings is a crucial part of therapy for clients with depression as it helps in processing emotions and seeking support. Therefore, discouraging verbalization of feelings is not appropriate and goes against therapeutic principles.

Correct Answer: B

Rationale: The nurse should exclude the instruction to 'Avoid all social interactions' when providing discharge teaching to a client with schizophrenia. It's important for individuals with schizophrenia to continue taking medications as prescribed, report any medication side effects to the healthcare provider, and develop a daily routine to promote stability. Social interactions, albeit with appropriate boundaries, can be beneficial for the client's well-being and integration into the community.

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: D

Rationale: During a manic episode in bipolar disorder, interventions should focus on providing a structured environment, encouraging rest periods, and setting limits on inappropriate behaviors. Allowing the client to engage in stimulating activities may exacerbate the symptoms of mania, such as increased energy, impulsivity, and risk-taking behaviors. Therefore, it is important to avoid encouraging such activities to prevent worsening of manic symptoms.

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.