During a home visit, the client with fibromyalgia is concerned about being constantly tired. Which response should the nurse make to this client?

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: Hand tremors at rest are a hallmark symptom of Parkinson disease, resulting from the degeneration of dopaminergic neurons in the substantia nigra, which disrupts basal ganglia function. This leads to rhythmic, involuntary movements, typically unilateral at onset, occurring when the limb is relaxed. These tremors are a primary motor symptom, distinguishing PD from other neurological conditions.

Choice B reason: Slurred speech, or dysarthria, in Parkinson disease arises from impaired motor control of speech muscles due to dopamine depletion in the basal ganglia. This affects articulation, causing soft, monotone, or slurred speech. It is a common motor symptom in PD, reflecting the disease's impact on coordinated muscle movements required for clear speech production.

Choice C reason: A lack of facial expression, known as masked facies, is a classic Parkinson disease symptom caused by bradykinesia and rigidity from dopamine deficiency. The basal ganglia's impaired signaling reduces spontaneous facial movements, resulting in a flat, emotionless appearance. This motor symptom significantly affects social interaction and is a key diagnostic feature of PD.

Choice D reason: Memory impairment, such as forgetting what was eaten for breakfast, is not a primary feature of Parkinson disease. While cognitive decline may occur in advanced stages or in related conditions like dementia with Lewy bodies, it is not a core diagnostic criterion. PD primarily affects motor functions due to dopaminergic neuron loss, not memory.

Choice E reason: Increased blood pressure upon standing, or orthostatic hypertension, is not associated with Parkinson disease. Orthostatic hypotension is more common in PD due to autonomic dysfunction from dopamine depletion, causing blood pressure to drop upon standing. Increased blood pressure suggests other conditions, not PD's typical autonomic or motor symptoms.