A nurse is providing teaching to a client who is to start taking valproic acid. Which of the following instructions should the nurse include?

Choice A reason: Derealization, a dissociative symptom in PTSD, involves feeling detached from reality, linked to altered prefrontal cortex and limbic system activity. Panic from a similar ICU case suggests a triggered memory, not detachment. Derealization is less likely, as the nurse’s response aligns with reliving a traumatic event, not perceptual distortion.

Choice B reason: Hyperarousal in PTSD involves heightened alertness and exaggerated startle, driven by amygdala hyperactivity and elevated norepinephrine. While panic suggests arousal, the trigger of a similar ICU case points to reliving a specific traumatic memory, making flashback more precise than general hyperarousal, which lacks the event-specific re-experiencing component.

Choice C reason: A flashback in PTSD involves reliving a traumatic event, triggered by cues like a similar ICU case, due to amygdala-driven memory reactivation and hippocampal dysfunction. The nurse’s panic reflects re-experiencing the parent’s death, a hallmark of PTSD, where sensory cues vividly recall trauma, causing intense emotional distress.

Choice D reason: Emotional numbing in PTSD involves reduced emotional responsiveness, linked to prefrontal cortex suppression. Panic from a similar ICU case indicates an active emotional response, not numbing. The nurse’s reaction aligns with re-experiencing trauma via a flashback, driven by amygdala activation, rather than emotional detachment.

Choice A reason: Understanding the medication regimen is important for long-term bipolar management, stabilizing mood via dopamine and serotonin modulation. In acute mania, however, hyperactivity and reduced intake increase dehydration risk, which exacerbates cerebral dysfunction. Hydration is a more immediate physiological need than cognitive understanding during an acute episode.

Choice B reason: Acute mania in bipolar disorder involves hyperactivity and reduced self-care, driven by dopamine dysregulation, leading to dehydration. This impairs cerebral perfusion and electrolyte balance, risking seizures or organ damage. Maintaining hydration is the priority, as it stabilizes physiological function, supporting neural recovery during the acute manic phase.

Choice C reason: Practicing problem-solving skills aids long-term bipolar management by enhancing prefrontal cortex function. In acute mania, however, impaired insight and hyperactivity from dopamine excess limit cognitive engagement. Dehydration poses a greater immediate risk to cerebral and systemic stability, making this goal secondary during an acute episode.

Choice D reason: Identifying relapse indications supports long-term bipolar management by recognizing dopamine-driven mood shifts. In acute mania, immediate physiological risks like dehydration from hyperactivity take precedence, as they threaten cerebral and systemic stability. This goal is less urgent, as it addresses future prevention rather than current physiological needs.