A nurse is assessing a client with bipolar disorder during a manic episode. Which of the following findings should the nurse expect?

Choice A reason: Pointing the syringe toward the top of the ear canal risks directing water at the eardrum, potentially causing trauma or perforation. Irrigation should aim along the canal’s side to gently dislodge debris, ensuring safety and effectiveness without damaging delicate structures.

Choice B reason: Cool water can cause dizziness or discomfort by stimulating the vestibular system in the inner ear. Warm water (body temperature, ~37°C) is used to prevent vertigo and ensure client comfort during irrigation, making cool water an incorrect choice.

Choice C reason: Inserting the syringe 2.5 cm into the ear canal is unsafe, as it risks trauma to the canal or eardrum. The syringe tip should be placed just at the entrance to direct water safely, preventing injury during the irrigation procedure.

Choice D reason: Tilting the head with the affected ear up allows water to flow into the canal and debris to exit via gravity. This position ensures effective irrigation, prevents fluid pooling, and minimizes complications like infection or discomfort, aligning with safe practice standards.

Choice A reason: Fluoxetine, an SSRI, treats PTSD’s depressive and anxiety symptoms by increasing serotonin levels, but it is less effective for nightmares. Nightmares in PTSD are linked to noradrenergic hyperactivity, which fluoxetine does not directly target, making it less specific for this symptom compared to prazosin.

Choice B reason: Prazosin, an alpha-1 adrenergic blocker, reduces nightmares in PTSD by decreasing norepinephrine-mediated hyperarousal in the locus coeruleus. This mitigates trauma-related sleep disturbances, a core symptom, improving sleep quality and reducing distress, making it the expected medication for this specific PTSD manifestation.

Choice C reason: Haloperidol, an antipsychotic, is not indicated for PTSD nightmares. It targets dopamine receptors to manage psychosis, not the noradrenergic-driven sleep disturbances in PTSD. Its use risks extrapyramidal side effects, making it inappropriate for addressing nightmares in this context.

Choice D reason: Diazepam, a benzodiazepine, may reduce anxiety but is not recommended for PTSD nightmares due to dependence risk and lack of specificity for noradrenergic hyperactivity. It sedates without addressing trauma-specific sleep disturbances, making it less effective than prazosin for this symptom.