Question 1

How would the nurse differentiate a client diagnosed with a social phobia from a client diagnosed with a schizoid personality disorder (SPD)?&#10;A) Clients diagnosed with social phobia can manage anxiety without medications, whereas clients diagnosed with SPD can manage anxiety only with medications.&#10;B) Clients diagnosed with SPD are distressed by the symptoms experienced in social settings, whereas clients diagnosed with social phobia are not.&#10;C) Clients diagnosed with social phobia avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life.&#10;D) Clients diagnosed with SPD avoid interactions only in social settings, whereas clients diagnosed with social phobias tend to avoid interactions in all areas of life.&#10;

Accepted Answer

1.This is incorrect. Clients diagnosed with social phobia avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life. Social phobia is an excessive fear of situations in which a person might do something embarrassing or be evaluated negatively by others. Benzodiazepines may be used to treat social phobia.
2.This is incorrect. Clients diagnosed with social phobia are distressed by the symptoms experienced in social settings. Clients diagnosed with SPD avoid interactions in all areas of life. Social phobia is an excessive fear of situations in which a person might do something embarrassing or be evaluated negatively by others.
3.This is correct. Clients diagnosed with social phobia avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life. Social phobia is an excessive fear of situations in which a person might do something embarrassing or be evaluated negatively by others.
4.This is incorrect. Clients diagnosed with social phobia avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life.

Question 2

A client living on the beachfront seeks help with an extreme fear of crossing bridges, which interferes with daily life. A psychiatric-mental health nurse practitioner decides to try systematic desensitization. Which explanation of this therapy should the nurse convey to the client?

A) "Using your imagination, we will attempt to achieve a state of relaxation that you can replicate when faced with crossing a bridge."
B) "Because anxiety and relaxation are mutually exclusive states, we can attempt to substitute a relaxation response for the anxiety response."
C) "Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety."
D) "In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate."

"Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety."

Accepted Answer

1.This is incorrect. Using imagination does not increase the exposure to the anxiety-provoking stimulus.
2.This is incorrect. Substituting relaxation is not a part of the therapy for the fear.
3.This is correct. The nurse should explain that systematic desensitization is used to gradually increase anxiety tolerance by exposure to a series of increasingly anxiety-provoking steps. Systematic desensitization was introduced by Joseph Wolpe in 1958 and is based on behavioral conditioning principles.
4.This is incorrect. Exposing the client to anxiety-provoking stimulus in one session is not part of the therapy.

Question 3

A client who has been diagnosed with a phobic disorder asks the nurse if there are any medications that would be beneficial in treating phobic disorders. Which of the following responses by the nurse are accurate? Select all that apply.

A) "Some antianxiety agents have been successful in treating social phobias."
B) "Some antidepressant agents have been successful in diminishing symptoms of agoraphobia and social anxiety disorder (social phobia)."
C) "Specific phobias are generally not treated with medication unless accompanied by panic attacks."
D) "Beta blockers have been used successfully to treat phobic responses to public performance."
E) "Medications are not the preferred treatment for phobic disorders. One would exhaust all non-medication treatments first."

"Some antianxiety agents have been successful in treating social phobias."
"Some antidepressant agents have been successful in diminishing symptoms of agoraphobia and social anxiety disorder (social phobia)."
"Specific phobias are generally not treated with medication unless accompanied by panic attacks."
"Beta blockers have been used successfully to treat phobic responses to public performance."

Accepted Answer

1.This is correct. The benzodiazepines have been successful in the treatment of social anxiety disorder (social phobia). 2.This is correct. The tricyclic imipramine and the monoamine oxidase inhibitor phenelzine have been effective in diminishing symptoms of agoraphobia and social anxiety disorder. 3.This is correct. Specific phobias are generally not treated with medication unless panic attacks accompany the phobia. 4.This is correct. Several studies have called attention to the effectiveness of beta blockers (e.g., propranolol) and alpha₂-receptor agonists (e.g., clonidine) in the amelioration of anxiety symptoms (Bhatt, 2016). Propranolol has potent effects on the somatic manifestations of anxiety (e.g., palpitations, tremors), with less dramatic effects on the psychic component of anxiety. 5. This is incorrect. There are non-medication approaches to treating phobic disorders, however, not all other approaches are exhausted before using medication.

Question 4

____________________ is the subjective emotional response to a stressor or fear.&#10;A) Stress&#10;B) Anxiety&#10;C) Fear&#10;D) Panic&#10;

Accepted Answer

1.This is correct. Stress, or a stressor, is an external pressure that is brought to bear on the individual.
2.This is incorrect. Anxiety is the subjective emotional response to a stressor or fear.
3.This is incorrect. Fear involves the intellectual appraisal of a threatening stimulus.
4.This is incorrect. Panic describes a sudden overwhelming feeling of terror or impending doom.

Question 5

Which condition appears to have a connection to bipolar disorder in youth?&#10;A) Attention deficit-hyperactivity disorder (ADHD)&#10;B) Disruptive mood dysregulation disorder&#10;C) Nonepisodic irritability&#10;D) Schizophrenia&#10;

Accepted Answer

1.This is correct. There appears to be a connection between ADHD and bipolar disorder in youth.
2.This is incorrect. Disruptive mood dysregulation disorder is a new diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, to describe the profile of atypical symptoms found in youth.
3.This is incorrect. Nonepisodic irritability in youth is not a risk factor for developing bipolar disorder.
4.This is incorrect. Schizophrenia is not connected with bipolar disorder in youth.

Question 6

The nurse suspects the client of having MDD due to the client having psychomotor retardation. Which of the following would be an example of psychomotor retardation?&#10;A) The client is disheveled and malodorous.&#10;B) The client exhibits promiscuous behaviors.&#10;C) The client ambulates independently.&#10;D) The client has maxed-out charge cards.&#10;

Accepted Answer

1.This is correct. Psychomotor retardation can manifest as being disheveled and malodorous.
2.This is incorrect. Hypersexuality is a symptom of mania, not depression.
3.This is incorrect. This is not an example of psychomotor retardation.
4.This is incorrect. Excessive spending is a symptom of mania. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria indicate a diagnosis of MDD is appropriate when there is no history of manic behavior.

Question 7

Which of the following best defines secondary depression?&#10;A) Depressive symptoms that occur as a consequence of an adverse side effect of certain medications.&#10;B) Depressive symptoms as a result of MDD exacerbation and elevated serotonin levels.&#10;C) Depressive symptoms that occur as a result of psychomotor retardation.&#10;D) Depressive symptoms that occur with abrupt discontinuation of antidepressants.&#10;

Accepted Answer

1.This is correct. The DSM-5 stipulates that medical conditions should be identified before a psychiatric diagnosis is made, as symptoms of a medical condition may mimic those of psychiatric disorders. Depressive symptoms that occur as a consequence of a non-mood disorder or as an adverse effect of certain medications are known as secondary depression. Secondary depression may be related to medication side effects, neurological disorders, electrolyte or hormonal disturbances, nutritional deficiencies, and other physiological or psychological conditions.
2.This is incorrect. It has been theorized that since selective serotonin reuptake inhibitors (SSRIs) are drugs that elevate serotonin levels, low serotonin levels in the brain must be responsible for depression. However, SSRIs also seem to be beneficial in the treatment of anxiety, leading to the hypothesis that low serotonin levels are responsible for anxiety. Further, too much serotonin has also been implicated in anxiety states and schizophrenia.
3.This is incorrect. Psychomotor retardation is a symptom of MDD, not secondary depression.
4.This is incorrect. Abrupt discontinuation of an antidepressant will exacerbate the primary depressive state, not cause secondary depression.

Question 8

Which of the following is considered a predisposing factor for depression?&#10;A) Decreased serum cortisol levels&#10;B) Decreased thyroid function&#10;C) Decreased sodium levels&#10;D) Genetic factors&#10;

Accepted Answer

1.This is incorrect. The normal system of hormonal inhibition fails in clients who are depressed, resulting in hypersecretion of cortisol. Elevated serum cortisol is the basis for the dexamethasone suppression test that is sometimes used to determine if an individual has somatically treatable depression.
2.This is incorrect. Hypothyroidism may mimic symptoms of depression; laboratory testing to evaluate TSH (thyroid-stimulating hormone) levels is relevant to distinguish between depressive disorders and thyroid disorders. The client would be treated with thyroid hormones instead of antidepressants.
3.This is incorrect. Hyponatremia (low serum sodium levels) may contribute to symptoms of confusion and may be a side effect of many medications but is not a predisposing factor in depression.
4.This is correct. Twin studies suggest a strong genetic factor in the etiology of affective illness, including depressive disorders and bipolar disorders.

Deck 11: Anxiety, Obsessive-Compulsive, and Related Disorders