The nurse is conducting discharge teaching with a client who has been newly diagnosed with type 1 diabetes mellitus. Which statement from the client indicates the need for additional teaching?

Choice A reason: Encouraging the client to talk about the trauma may be therapeutic but is not the priority. Trauma-informed care prioritizes safety to stabilize the client, as discussing trauma without ensuring safety can exacerbate distress, particularly if the client feels vulnerable or unsupported.

Choice B reason: Assessing social and family support is important for long-term recovery but secondary to immediate safety. Trauma-informed care emphasizes creating a secure environment first, as lack of safety can hinder effective support assessment and exacerbate psychological distress from trauma.

Choice C reason: Contacting a social worker to report abuse is necessary if abuse is confirmed, but it is not the initial priority. Ensuring the client’s immediate physical and emotional safety takes precedence, as reporting without safety measures may escalate risk or distress.

Choice D reason: Ensuring the client’s safety is the priority in trauma-informed care, addressing immediate physical and emotional threats. Safety stabilizes the client, reducing stress hormone release (e.g., cortisol) and creating a foundation for trust, enabling further therapeutic interventions like support assessment or trauma discussion.

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.