A nurse at a mental health clinic is caring for a client.

The client reports they have been overeating since they were 14 years old. The nurse is reviewing the client's medical record.

Based on the information, which of the following actions should the nurse take? For each potential action, specify if the potential action is anticipated or contraindicated for the client.

Choice A rationale:

Obsession over a fictitious defect in physical appearance is characteristic of body dysmorphic disorder, not generalized anxiety disorder (GAD).

Individuals with body dysmorphic disorder become preoccupied with an imagined or slight defect in their appearance, often to the point of significant distress and impairment in functioning.

They may engage in excessive grooming behaviors, repeatedly check their appearance in mirrors, or avoid social situations due to their appearance concerns.

While individuals with GAD may also experience concerns about their physical appearance, these concerns are typically not as severe or pervasive as those seen in body dysmorphic disorder.

Choice B rationale:

Constant worry about the undiagnosed presence of an illness is a hallmark feature of GAD.

Individuals with GAD often experience excessive worry about a variety of things, including health, finances, relationships, and work.

This worry is often accompanied by physical symptoms such as restlessness, fatigue, difficulty concentrating, and muscle tension.

The worry is typically difficult to control and can significantly interfere with daily life.

Choice C rationale:

Sudden unexplained loss of vision without a physical medical explanation is not a common symptom of GAD. It may be indicative of a more serious medical condition, such as a stroke or a neurological disorder.

It is important to rule out any potential medical causes before attributing a symptom like this to GAD.

Choice D rationale:

Prior physical health followed by the need for two surgeries within the last three months may be a stressful life event that could contribute to the development of GAD.

However, it is not a specific symptom of GAD.

Many people experience stressful life events without developing GAD.

The presence of other symptoms, such as excessive worry and physical symptoms, is necessary for a diagnosis of GAD.

Rationale:

Choice A is incorrect. Alprazolam does not have any known dietary interactions with aged cheeses. This information is specific to monoamine oxidase inhibitors (MAOIs), not benzodiazepines like alprazolam.

Choice B is incorrect. While some benzodiazepines can have side effects like drowsiness or dizziness that might indirectly affect blood pressure, alprazolam itself is not known to directly cause an increase in blood pressure.

Choice D is incorrect. Doubling the next dose of medication if a dose is missed is dangerous and can lead to overdose and increased risk of serious side effects. The client should be instructed to contact their doctor if they miss a dose.

Choice C is correct. Alprazolam is a pregnancy category D medication, meaning it has positive evidence of fetal risk. Studies have shown an increased risk of birth defects, including cleft lip and palate, in babies exposed to alprazolam during pregnancy. Therefore, it is crucial for women of childbearing age to use a reliable form of contraception while taking alprazolam to prevent unintended pregnancy and potential harm to the fetus.

Additional teaching points for the nurse:

The nurse should inform the client about the specific risks associated with alprazolam during pregnancy and the importance of discussing alternative treatment options if pregnancy is desired.

The nurse should emphasize the importance of using a reliable form of contraception that is effective both during and after treatment with alprazolam, as the medication can remain in the system for some time after the last dose.

The nurse should provide the client with resources on contraception and reproductive health, and encourage her to talk to her doctor about any s or concerns she may have.