The nurse is providing care to a client in the clinic who is newly diagnosed with generalized anxiety disorder. Which of the following is the first-choice medication for a client with anxiety?

Choice A reason: Obstructive sleep apnea causes interrupted breathing during sleep, leading to fatigue, irritability, and potential cognitive impairment. While chronic sleep disruption may contribute to mood changes, it is not typically associated with aggressive or self-injurious behaviors. These behaviors are more characteristic of neurodevelopmental or psychiatric disorders, making sleep apnea an unlikely primary cause in this scenario, as it primarily affects sleep quality and daytime alertness.

Choice B reason: Insomnia involves difficulty falling or staying asleep, which can lead to irritability, fatigue, and emotional dysregulation. However, it is not directly linked to aggressive or self-injurious behaviors, which are more commonly associated with neurodevelopmental conditions like autism or psychiatric disorders. Insomnia may exacerbate underlying issues but is not a primary cause of such behaviors in this context.

Choice C reason: Autism spectrum disorder is characterized by challenges with social communication, sensory sensitivities, and emotional regulation, which can manifest as aggression or self-injurious behaviors, particularly under stress or sensory overload. These behaviors may occur due to difficulties processing emotions or environmental stimuli, making autism a likely diagnosis for the client’s presentation, requiring targeted behavioral and therapeutic interventions.

Choice D reason: Narcolepsy involves excessive daytime sleepiness and sudden sleep attacks due to dysregulation of sleep-wake cycles. It does not typically cause aggressive or self-injurious behaviors, as its primary symptoms are related to sleep disturbances. These behaviors are more aligned with neurodevelopmental or psychiatric conditions, ruling out narcolepsy as a likely cause of the client’s aggressive and self-injurious actions.

Choice A reason: Akinesia, dystonia, and pseudoparkinsonism are extrapyramidal symptoms caused by dopamine receptor blockade in the nigrostriatal pathway from typical antipsychotics. These motor-related side effects differ from anticholinergic effects, which involve muscarinic receptor blockade affecting the parasympathetic system. The client’s symptoms do not align with these movement disorders.

Choice B reason: Hyperglycemia and diabetes are metabolic side effects associated with atypical antipsychotics, not typical ones, due to effects on insulin regulation. Anticholinergic side effects from typical antipsychotics involve muscarinic receptor blockade, not metabolic pathways, making this an incorrect choice for the expected symptoms in this scenario.

Choice C reason: Typical antipsychotics, like haloperidol, block muscarinic receptors, causing anticholinergic side effects such as dry mouth (reduced salivation), constipation (decreased gastrointestinal motility), and urinary retention (impaired bladder contraction). These symptoms result from parasympathetic inhibition, precisely matching the expected side effect profile for long-term use of these medications.

Choice D reason: Muscle rigidity, hyperpyrexia, and tachycardia are symptoms of neuroleptic malignant syndrome, a rare, life-threatening reaction to antipsychotics, not routine anticholinergic side effects. This syndrome involves dopamine dysregulation and autonomic instability, distinct from the muscarinic receptor blockade causing anticholinergic effects, making it an incorrect choice.