A. Agoraphobia is marked by the fear of being in situations where escape may be difficult or help unavailable in case of panic-like symptoms. It is not characterized by generalized worry.

B. Generalized anxiety disorder (GAD) is characterized by excessive anxiety and worry that is difficult to control and is associated with a variety of circumstances. Individuals with GAD often experience chronic worry about multiple life domains, without a specific focus.

C. Separation anxiety disorder involves excessive fear of being separated from loved ones or familiar environments, which is different from generalized worry about multiple life events.

D. Panic disorder involves recurrent panic attacks that are not necessarily related to generalized anxiety or worry about various life situations.

A. Potassium intake is not specifically important for the management of lithium therapy, though potassium levels should be monitored in some situations for general health.

B. Lithium is a mood stabilizer used to treat bipolar disorder, and it is important to maintain a consistent sodium intake. Lithium levels can be affected by changes in sodium levels, as low sodium levels can increase lithium toxicity.

C. Vitamin C is not directly related to lithium therapy and is not necessary for managing its effects.

D. Vitamin K does not have a significant role in lithium therapy and does not impact its effectiveness or toxicity.

A. Persistent low-grade depression without hypomania is not typical of bipolar II disorder, as hypomanic episodes are a key feature of the disorder.

B. Psychosis is more common during full manic episodes, typically seen in bipolar I disorder, not bipolar II.

C. Bipolar II disorder is characterized by hypomanic episodes that alternate with major depressive episodes. Hypomania is a less severe form of mania, and individuals with bipolar II do not experience full manic episodes as in bipolar I.

D. Severe manic episodes are characteristic of bipolar I disorder, not bipolar II, which involves hypomanic episodes instead.

A. While support groups may be helpful, the immediate intervention for a client experiencing heightened anxiety and hypervigilance is to provide structure and safety.

B. Mindfulness meditation may be beneficial in the long term, but it is not the first intervention in an acute phase where anxiety and hypervigilance are prominent.

C. A structured environment with predictable routines and consistent staff can help clients with PTSD feel more secure and reduce feelings of anxiety, hypervigilance, and paranoia. Predictability and structure are key interventions for clients with PTSD.

D. Administering a PRN sedative medication should be a secondary intervention after providing a supportive and safe environment. Medications may be used as part of treatment, but they do not address the underlying anxiety and hypervigilance as effectively as a structured environment.

A. A mother with a healthy pregnancy and delivery has a lower risk, though postpartum depression can still occur, it is not as likely as in cases with more risk factors.

B. A first-time mother with a supportive partner has protective factors such as a strong support system, reducing the risk of postpartum depression.

C. A history of depression and minimal social support are significant risk factors for postpartum depression. Previous mental health issues increase the likelihood of postpartum mood disorders, and lack of support makes coping more difficult.

D. A lack of a family history of mental illness does not eliminate the risk of postpartum depression, especially if other risk factors, such as previous depression or limited support, are present.

A. While gastrointestinal side effects are common with fluoxetine, they are not the priority concern in the context of bipolar disorder.

B. Fluoxetine (Prozac) is an SSRI used to treat depression, but in patients with bipolar disorder, it can trigger a manic episode. Therefore, the nurse's priority is to monitor for signs of mania, such as increased energy, euphoria, or impulsivity.

C. Administering the medication as ordered is essential, but the nurse must be vigilant for signs of mania, especially with SSRIs in bipolar patients.

D. Educating about weight gain is important but does not address the immediate risk of precipitating mania with fluoxetine in a bipolar patient.

A. Documenting the size and location is important for medical records, but it is secondary to providing immediate care for the wounds.

B. The first action is to inspect the cuts for any debris to ensure proper wound care. Cleaning the wounds and assessing their severity is necessary to prevent infection.

C. Administering a tetanus antitoxin is not the first step unless the cuts show signs of contamination or the patient is at risk of tetanus.

D. Implementing a behavioral modification plan is important for addressing self-harm behaviors, but the immediate priority is to assess and treat the cuts to prevent infection.

A. Attention-seeking conduct is more typical of personality disorders, such as borderline personality disorder, rather than anxiety.

B. Mild fidgeting is common in anxiety, but severe anxiety tends to manifest more intensely, with behaviors like threatening or aggressive actions.

C. Severe anxiety can lead to heightened agitation, which may include threatening behaviors as the client struggles to cope with overwhelming feelings of fear or distress.

D. While anxiety may impair problem-solving abilities, severe anxiety is more likely to lead to emotional dysregulation, not just mild difficulty in problem solving.

A. Isolating the client is not helpful and may increase anxiety, potentially worsening the compulsive behaviors.

B. Setting strict limits can lead to resistance and increased anxiety, making compulsive behaviors more difficult to manage.

C. Confronting the client about the senseless nature of their compulsions is not effective and may increase anxiety, making the behaviors more intense. Instead, it is important to provide support and understanding while working with the client to reduce the impact of OCD on daily functioning.

D. Clients with OCD often perform compulsive rituals to reduce anxiety. Planning time for rituals allows the nurse to balance the need to manage the behavior with the need to provide structure and care.

A. A lithium level of 1.0 mEq/L is within the therapeutic range (0.6 to 1.2 mEq/L). The nurse should administer the morning dose of lithium as prescribed.

B. While it is important to monitor for medication adherence, there is no indication from the current lithium level that this client is refusing the medication.

C. Gastric lavage is unnecessary, as the lithium level is not elevated enough to warrant this extreme intervention.

D. Early signs of lithium toxicity typically occur with levels above 1.5 mEq/L. Since the level is 1.0 mEq/L, the nurse should proceed with administering the medication.