A patient started Alendronate (Fosamax) once a week for the treatment of osteoporosis. The nurse determines that further instruction about the drug is needed when what is said by the patient?

Choice A reason: Expressing sadness about the partner’s death reflects grief, not avoidance. Avoidance involves actively suppressing thoughts or discussions about the trauma. This statement indicates emotional processing, not avoidance, making it incorrect for identifying avoidance symptoms in this context.

Choice B reason: Inability to recall the accident may suggest dissociative amnesia, a potential trauma response, but it is not a clear avoidance symptom. Avoidance involves conscious efforts to avoid trauma-related stimuli, not memory loss, making this choice less precise than active refusal to discuss.

Choice C reason: Refusing to think or talk about the accident is a hallmark of avoidance symptoms in post-traumatic stress disorder (PTSD). This behavior reflects deliberate efforts to suppress trauma-related thoughts or conversations to reduce distress, aligning with the scenario, making this the correct choice.

Choice D reason: Blaming oneself for the accident reflects guilt or negative self-perception, common in PTSD, but is not an avoidance symptom. Avoidance involves dodging trauma-related stimuli, not internalizing blame, making this choice incorrect for identifying avoidance behaviors.

Choice A reason: Separation anxiety disorder involves excessive fear of being separated from attachment figures, primarily in children but sometimes persisting into adulthood. It manifests as distress about separation, not generalized worry across multiple situations, as described. The client’s broad, uncontrollable anxiety does not align with this specific fear-based disorder.

Choice B reason: Agoraphobia involves fear of situations where escape or help may be unavailable, like crowded places or public transport, leading to avoidance behaviors. The client’s symptoms of excessive, uncontrollable worry across various circumstances do not specifically indicate fear of such situations, making agoraphobia an incorrect diagnosis.

Choice C reason: Panic disorder is characterized by recurrent, unexpected panic attacks with intense physical symptoms like heart palpitations and shortness of breath, followed by persistent fear of future attacks. The client’s ongoing, diffuse worry without mention of discrete panic episodes does not fit this diagnosis, which is more acute and episodic.

Choice D reason: Generalized anxiety disorder involves excessive, uncontrollable worry about multiple aspects of life, such as work, health, or daily events, lasting at least six months. The client’s symptoms of pervasive anxiety and inability to control worry align directly with this disorder, reflecting its chronic, diffuse nature affecting daily functioning.