Three years ago, the nurse's parent died in an intensive care unit (ICU). The nurse is caring for a client in the ICU with the same diagnosis and similar features to the nurse's parent. Which manifestation of posttraumatic stress disorder (PTSD) did the nurse likely experience when feeling a sense of panic confronting the client?

Choice A reason: Echinacea is used for immune support and has no significant interaction with paroxetine, an SSRI that increases serotonin by inhibiting reuptake. Echinacea’s effects on cytokine production do not alter serotonin metabolism or CYP450 enzymes, which paroxetine relies on for clearance, making it a safe supplement in this context.

Choice B reason: Ginkgo enhances cerebral blood flow but has minimal interaction with paroxetine. It may affect platelet aggregation, but paroxetine’s serotonin reuptake inhibition is primarily metabolized via CYP2D6, unaffected by ginkgo’s mechanisms. No significant pharmacodynamic or pharmacokinetic interactions occur, making this supplement safe for concurrent use with paroxetine.

Choice C reason: St. John’s Wort induces CYP3A4 and P-glycoprotein, accelerating paroxetine metabolism, an SSRI reliant on CYP2D6. This reduces paroxetine’s efficacy, lowering serotonin levels and risking treatment failure for depression. It also increases serotonin syndrome risk due to additive serotonergic effects, making it a critical interaction to avoid.

Choice D reason: Saw palmetto, used for prostate health, has no significant interaction with paroxetine. It primarily affects androgen pathways, not serotonin metabolism or CYP2D6, which paroxetine uses for clearance. No pharmacodynamic or pharmacokinetic conflicts arise, making saw palmetto a safe supplement for clients taking paroxetine for depression.

Choice A reason: In severe PTSD exacerbation, flashbacks and hypervigilance indicate amygdala hyperactivity and impaired prefrontal cortex regulation, increasing risk of impulsive or self-harming behaviors. Ensuring safety addresses immediate dangers, as heightened arousal can lead to disorientation or panic, necessitating a secure environment to stabilize the client’s neurobiological stress response.

Choice B reason: Promoting self-esteem is valuable in PTSD but secondary to safety. Low self-esteem may stem from trauma-related guilt, linked to serotonin dysregulation, but does not pose immediate risk. Flashbacks and hypervigilance, driven by amygdala overactivity, require urgent safety measures to prevent harm during acute episodes.

Choice C reason: Helping cope with stress and emotions is important in PTSD management, addressing cortisol dysregulation and amygdala hyperactivity. However, during severe exacerbation with flashbacks, safety is the priority, as acute episodes can lead to disorientation or self-harm. Coping strategies are secondary to stabilizing the immediate neurobiological crisis.

Choice D reason: Establishing a community support system aids long-term PTSD recovery by enhancing oxytocin-mediated emotional regulation. However, during acute exacerbation with flashbacks, immediate safety is critical due to heightened amygdala-driven arousal. Community support is a secondary intervention, as it does not address the urgent risk of harm in acute episodes.