A prescription reads phenytoin 0.2 g orally twice daily. The medication label states that each capsule is 100 mg. The nurse prepares how many capsule(s) to administer 1 dose?

Choice A reason: Panic-level anxiety activates the sympathetic nervous system, increasing catecholamine release, which impairs cognitive function. This leads to poor concentration as the brain prioritizes fight-or-flight responses, diverting resources from prefrontal cortex activity. Clients struggle to focus, process information, or maintain attention due to heightened arousal and overwhelming fear, making this a key finding.

Choice B reason: Sleepiness is not typical in panic-level anxiety, which causes hyperarousal, not sedation. The sympathetic nervous system activation increases heart rate, alertness, and vigilance, counteracting drowsiness. Sleep disturbances may occur post-panic due to exhaustion, but during a panic episode, clients are hyperalert, making this choice incorrect.

Choice C reason: Voice tremors are common in panic-level anxiety due to autonomic nervous system activation, causing muscle tension and vocal cord vibrations. Elevated adrenaline levels lead to physical symptoms like trembling, including the voice, as the body prepares for a perceived threat, making this a correct expected finding.

Choice D reason: Depersonalization, a sense of detachment from oneself, occurs in panic-level anxiety due to intense fear overwhelming the brain’s sensory integration. The amygdala’s hyperactivation disrupts normal self-perception, leading to feelings of unreality. This dissociative symptom is a hallmark of severe anxiety, making this a correct expected finding.

Choice A reason: Assuming fatigue is due to staying up late is not evidence-based for fibromyalgia. Fatigue in fibromyalgia is linked to chronic pain and sleep disturbances, not simply lifestyle choices. This response dismisses the condition’s complexity and does not address the physiological basis of fibromyalgia-related fatigue.

Choice B reason: Suggesting a new mattress or pillow ignores the underlying pathophysiology of fibromyalgia. Fatigue in this condition stems from non-restorative sleep and chronic pain, not solely sleep environment. This response is unhelpful, as it does not address the medical reasons for the client’s fatigue.

Choice C reason: While anxiety can exacerbate fibromyalgia symptoms, asking about worries does not directly address the primary cause of fatigue. Sleep disturbances and chronic pain are more directly linked to fibromyalgia-related fatigue. This response is less precise, as it focuses on a secondary factor rather than the core issue.

Choice D reason: Fatigue in fibromyalgia is strongly linked to sleep disturbances, particularly non-restorative sleep or insomnia, due to chronic pain and central nervous system dysregulation. This disrupts deep sleep stages, leading to persistent tiredness. This response accurately reflects the pathophysiology, making it the most appropriate choice.