Which of the following medications is most commonly associated with the development of agranulocytosis?

The client presents with acute physical symptoms such as tachycardia, nausea, palpitations, clammy hands, and restlessness, which are consistent with severe panic level anxiety. The diagnostic score of 34 on the generalized anxiety disorder scale indicates significant impairment. The client’s statements reflect overwhelming fear and inability to accept negative test results, showing distorted perception typical of panic. The history of anxiety disorder supports recurrence of severe anxiety episodes. Therefore, severe panic level anxiety is the most accurate condition.

Rationale for the two correct actions

Provide reassurance and remain with the client:This action reduces feelings of isolation and fear, helping the client regain a sense of safety during panic.

Encourage use of relaxation and coping techniques:Teaching breathing exercises or guided imagery helps reduce sympathetic nervous system activation and promotes long-term management of anxiety.

Rationale for parameters to monitor

Reality orientation:Monitoring ensures the client maintains awareness of person, place, and time, which can be impaired during severe panic episodes.

Self-injurious behavior:Although the client denies harm, anxiety can escalate, so monitoring ensures safety and early intervention if risk develops.

Rationale for incorrect conditions

Borderline personality disorder:No evidence of unstable relationships, impulsivity, or identity disturbance.

Bipolar disorder:No history of manic or depressive episodes.

Major depressive disorder:Client is restless and anxious, not withdrawn or showing persistent sadness with vegetative symptoms.

Post-traumatic stress disorder:No trauma history or flashbacks reported.

Rationale for incorrect actions to take

Settle the client in a quiet environment:While helpful, it does not directly address panic symptoms or build coping skills.

Secure a written safety contract:Not appropriate since the client denies suicidal ideation and the issue is acute panic, not self-harm risk.

Establish therapeutic trust:Important but not the immediate priority during a panic episode compared to reassurance and coping strategies.

Rationale for incorrect parameters to monitor

Loss or increase in appetite:More relevant to depressive disorders, not acute panic.

Increased sleeping:Associated with depression or fatigue, not panic.

Neglect of self-care activities:Seen in depressive or psychotic conditions, not in acute anxiety where hyperarousal dominates.

Choice A reason:

Eating uncontrollably for several months is a core feature of binge eating disorder. It reflects recurrent episodes of overeating with loss of control, which is central to the DSM-5 definition. This behavior disrupts basic nutritional needs and contributes to obesity and related health issues.

Choice B reason:

Saying “I feel so fat” shows distorted body image and dissatisfaction with weight. Negative self-perception is common in eating disorders and often drives unhealthy eating patterns. It undermines self-esteem and reinforces the cycle of binge eating.

Choice C reason:

Reporting lifelong struggles with weight highlights chronic preoccupation with body size. Early concerns about weight often predispose individuals to eating disorders later in life. This long-standing issue suggests deep-rooted psychological distress tied to body image.

Choice D reason:

Feeling depressed is strongly linked to binge eating disorder. Mood disturbances often follow binge episodes and worsen the disorder’s impact. Depression reduces motivation for treatment and interferes with daily functioning, making recovery more difficult.

Incorrect findings rationale:

Statements such as being married, having children, and attending social gatherings weekly are not manifestations of an eating disorder. These are contextual social factors but do not meet DSM-5 diagnostic criteria. Similarly, vital signs, lab values, and comorbid conditions (e.g., diabetes, gallstones) are medical findings but not direct indicators of BED. While obesity and elevated blood glucose are associated with BED, they are consequences rather than diagnostic manifestations. DailyMed emphasizes that pharmacologic interventions like glipizide address comorbid diabetes, not the eating disorder itself. Thus, these findings are clinically relevant but not diagnostic markers of BED.