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: Aphasia, a language impairment, is not a hallmark of delirium but is associated with neurological conditions like stroke affecting Broca’s or Wernicke’s areas. Delirium involves acute cognitive dysfunction due to underlying causes like infection or hypoxia, primarily affecting attention and awareness, not specific language processing, making this choice scientifically inaccurate for delirium.

Choice B reason: Confusion is a core feature of delirium, characterized by disorientation and impaired attention due to acute brain dysfunction. It results from disruptions in cerebral metabolism, often triggered by systemic issues like electrolyte imbalances or sepsis. This symptom distinguishes delirium from dementia, as it reflects rapid, reversible cognitive changes, requiring immediate assessment.

Choice C reason: Impaired level of consciousness, such as fluctuating alertness or stupor, is a defining feature of delirium. It stems from diffuse brain dysfunction, often due to toxic, metabolic, or infectious causes affecting neurotransmitter balance or cerebral perfusion. This distinguishes delirium from dementia, which typically preserves consciousness, making this a critical diagnostic criterion.

Choice D reason: Long-term memory impairment is characteristic of dementia, not delirium. Delirium involves acute, reversible cognitive deficits, primarily affecting attention and short-term memory due to transient brain dysfunction. Long-term memory remains relatively intact in delirium, as the underlying pathology does not typically involve chronic neuronal loss, unlike Alzheimer’s or other dementias.

Choice E reason: Mood fluctuations occur in delirium due to acute brain dysfunction affecting emotional regulation, often linked to neurotransmitter imbalances or systemic stressors like infection. However, they are not a primary diagnostic criterion compared to confusion, impaired consciousness, and rapid onset, as they may also occur in other psychiatric conditions, reducing specificity.

Choice F reason: Rapid onset of symptoms is a hallmark of delirium, distinguishing it from dementia’s gradual progression. Symptoms develop over hours to days due to acute insults like hypoxia, infection, or medication toxicity, disrupting cerebral function. This rapid timeline is critical for diagnosis, as it indicates a reversible condition requiring urgent intervention.