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: Valproic acid does not typically require thyroid function tests, as it primarily affects liver metabolism via glucuronidation and mitochondrial pathways. Thyroid dysfunction is not a common side effect, unlike with lithium, which impacts thyroid hormone synthesis. This instruction is irrelevant, as valproic acid’s toxicity risks are hepatic, not thyroid-related.

Choice B reason: Expecting a gradual decrease in valproic acid dosage is incorrect, as it is titrated to therapeutic levels for conditions like seizures or bipolar disorder, based on serum levels (50–100 mcg/mL). Dosage adjustments depend on efficacy, not routine reduction, as stable neural excitability is needed, making this scientifically inaccurate.

Choice C reason: Taking aspirin for pain with valproic acid is risky, as both inhibit platelet function, increasing bleeding risk via synergistic effects on prostaglandin synthesis. Valproic acid’s hepatic metabolism also raises hepatotoxicity concerns, making aspirin inappropriate. Alternative analgesics like acetaminophen are safer, rendering this instruction incorrect.

Choice D reason: Valproic acid requires regular liver function monitoring, as it is hepatically metabolized and can cause hepatotoxicity, particularly in the first 6 months, due to mitochondrial dysfunction and oxidative stress. Elevated liver enzymes or rare fulminant hepatitis necessitate early detection to prevent liver failure, making this a critical instruction.

Choice A reason: Seasonal Affective Disorder (SAD) is a subtype of major depressive disorder with a seasonal pattern, requiring at least two major depressive episodes in a seasonal pattern over two years, not necessarily five key features for two weeks. The diagnostic criteria involve symptoms like low mood, anhedonia, and fatigue, but the two-week duration with five symptoms applies to major depression generally, not specifically SAD, which emphasizes seasonal recurrence.

Choice B reason: The statement is false because Seasonal Affective Disorder is defined by recurrent depressive episodes tied to specific seasons, typically winter, rather than a strict requirement of five key features for two weeks. SAD involves symptoms like hypersomnia and carbohydrate craving, but the diagnostic focus is on the seasonal pattern, not the exact symptom count or duration stated.