Deck 18: Anxiety, Obsessive-Compulsive, and Related Disorders

Question 1

The client living in a riverfront community is seeking help with an extreme fear of bridges, which is interfering with daily functioning. The psychiatric nurse practitioner decides to try systematic desensitization. Which best explanation of this treatment should the nurse provide?

A) "Using your imagination, we will attempt to achieve a state of relaxation."
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 while in a relaxed state."
D) "In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate."

Answer 1

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

Question 2

A cab driver, stuck in traffic, becomes lightheaded, tremulous, diaphoretic, tachycardic, and dyspneic. A work-up in an emergency department reveals no pathology. Which nursing diagnosis should be the nurse's first priority?

A) Fear
B) Powerlessness
C) Altered role performance
D) Anxiety

Answer 2

Anxiety

Question 3

Which medication treatment should the nurse administer to clients diagnosed with generalized anxiety disorder (GAD)?

A) Long-term treatment with diazepam (Valium)
B) Acute symptom control with propranolol (Inderal)
C) Long-term treatment with buspirone (BuSpar)
D) Acute symptom control with ziprasidone (Geodon)

Answer 3

Long-term treatment with buspirone (BuSpar)

Question 4

The client diagnosed with obsessive-compulsive disorder has an elaborate routine for toileting activities. Which would be an appropriate initial client outcome during the first week of hospitalization?

A) The client will refrain from ritualistic behaviors during daylight hours.
B) The client will wake early enough to complete rituals prior to breakfast.
C) The client will participate in three unit activities by day three.
D) The client will substitute a productive activity for rituals by day one.

Question 5

The nurse is providing discharge teaching to a client about benzodiazepines. Which client statement would indicate a need for further follow-up instructions?

A) "I will need scheduled blood work in order to monitor for toxic levels of this drug."
B) "I won't stop taking this medication abruptly because there could be serious complications."
C) "I will not drink alcohol while taking this medication."
D) "I won't take extra doses of this drug because I can become addicted."

Question 6

During her uncle's wake, a 5-year-old girl runs up to the casket before her mother can stop her. An appointment is made with a nurse practitioner when the child starts twisting and pulling out her hair, resulting in hair loss. Which nursing diagnosis should the nurse assign to this child?

A) Fear
B) Altered family processes
C) Ineffective impulse control
D) Disturbed body image

Question 7

The nursing instructor is teaching about medications used to treat clients diagnosed with panic disorder. Which student statement indicates teaching has been effective?

A) "Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder."
B) "Clonidine (Catapres) is used off-label in long-term treatment of panic disorder."
C) "Atenolol (Tenormin) can be used in low doses to relieve symptoms of panic attacks."
D) "Buspirone (BuSpar) is used for its immediate effect to lower anxiety during panic attacks."

Question 8

The nurse is teaching the staff about specific phobias. Which statement from a staff member indicates teaching has been effective?

A) "These clients recognize their fear as excessive and frequently seek treatment."
B) "These clients have a panic level of fear that is overwhelming and unreasonable."
C) "These clients experience symptoms that mirror a cerebrovascular accident."
D) "These clients exhibit symptoms of tachycardia, dysphagia, and diaphoresis."

Question 9

A son is seeking advice about his mother who seems to worry unnecessarily about everything. The son states, "Should I seek psychiatric help for my mother?" Which is an appropriate nursing response?

A) "My mother also worries unnecessarily. I think it is part of the aging process."
B) "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning."
C) "From what you have told me, you should get her to a psychiatrist as soon as possible."
D) "Worry and anxiety are complex phenomena and are effectively treated only with psychotropic medications."

Question 10

The college student has severe test anxiety. Instead of studying for finals, the student relieves stress by attending a movie. Which priority nursing diagnosis should the campus nurse assign for this student?

A) Non-adherence R/T test taking
B) Ineffective role performance R/T helplessness
C) Ineffective coping R/T anxiety
D) Powerlessness R/T fear

Question 11

The client is experiencing a severe panic attack. Which nursing intervention would meet this client's physiological need?

A) Teach deep breathing relaxation exercises.
B) Place the client in a brightly lit room.
C) Have the client breathe into a paper bag.
D) Administer the ordered prn buspirone (BuSpar).

Question 12

The client with panic disorder says, "When an attack happens, I feel like I am going to die." Which response should the nurse make?

A) "I know it's frightening, but try to remind yourself that this will only last a short time."
B) "Death from a panic attack happens so infrequently that there is no need to worry."
C) "Most people who experience panic attacks have feelings of impending doom."
D) "Tell me why you think you are going to die every time you have a panic attack."

Question 13

Which guideline should the nurse use to help differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)?

A) GAD is acute in nature, and panic disorder is chronic.
B) Chest pain is a common GAD symptom, whereas this symptom is absent in panic disorders.
C) Depression is a common symptom in GAD and rare in panic disorder.
D) Depersonalization is absent in GAD but is commonly seen in panic disorder.

Question 14

A nurse questions the charge nurse about an order for fluvoxamine (Luvox) 300 mg daily in two divided doses for a client diagnosed with obsessive-compulsive disorder (OCD). Which charge nurse response is most accurate?

A) "High doses of tricyclic medications will be required for effective treatment of OCD."
B) "High doses of selective serotonin reuptake inhibitor (SSRI), above what is effective for depression, may be required for OCD."
C) "The dose of Luvox is low because of the side effect of daytime drowsiness."
D) "The dose of this SSRI is outside the therapeutic range and needs to be brought to the psychiatrist's attention."

Question 15

The client is prescribed alprazolam (Xanax) for acute anxiety. Which client finding should cause a nurse to question this order?

A) History of alcohol use disorder
B) History of personality disorder
C) History of schizophrenia
D) History of hypertension

Question 16

Which information would a nurse include in client teaching about social anxiety disorder?

A) Obsessions are the underlying reason for clients to avoid social situations.
B) These people avoid social interactions because of a perceived physical flaw.
C) Individuals with social anxiety disorder avoid performing in front of others.
D) People with this disorder avoid social gatherings because of fear of separation.

Question 17

The nurse is preparing a presentation about the onset of symptoms for agoraphobia. Which information should the nurse include in the teaching session?

A) Occurs in early adolescence and persists until midlife
B) Occurs in the 20s and 30s and persists for many years
C) Occurs in the 40s and 50s and persists until death
D) Occurs after the age of 60 and persists for at least 6 years

Question 18

The nurse is teaching a client diagnosed with anxiety about treatment options. Which statement by the client indicates effective teaching?

A) "There is nothing that I can do to that will reduce anxiety."
B) "Medication is available, but only for those who have had anxiety for a year or more."
C) "If I ignore the symptoms of anxiety, it will go away."
D) "Practicing yoga or meditation may help reduce my anxiety."

Question 19

The nurse is assessing a client diagnosed with hoarding disorder. Which statement would the nurse expect to hear from the client?

A) "I am a perfectionist."
B) "I get obsessive about cleaning my counter tops."
C) "I donate my clothing to charities."
D) "I prefer to have wide walkways in my home."

Question 20

The client is newly diagnosed with obsessive-compulsive disorder and spends 50 minutes folding clothes and rearranging them in drawers. Which nursing action would best address this client's problem?

A) Distract the client with other activities whenever ritual behaviors begin.
B) Report the behavior to the psychiatrist to obtain an order for medication dosage increase.
C) Lock the room to discourage ritualistic behavior.
D) Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors.

Question 21

The nurse is caring for a client diagnosed with generalized anxiety disorder. Which activities would the nurse encourage for this client? (Select all that apply.)

A) Recognize the signs of escalating anxiety.
B) Avoid any situation that causes stress.
C) Employ newly learned relaxation techniques.
D) Cognitively reframe thoughts about situations that generate anxiety.
E) Avoid caffeinated products.

Question 22

An attractive female client with a diagnosis of body dysmorphic disorder (BDD) presents with high anxiety levels because of her belief that her facial features are large and grotesque. Which additional symptoms would support this diagnosis? (Select all that apply.)

A) Mirror checking
B) Excessive grooming
C) Stereotypic movement
D) History of delusional thinking
E) Skin picking

Question 23

____________________ are intrusive thoughts that are recurrent and stressful, and even though these thoughts are recognized by the individual as irrational, they continue to be repetitive and cannot be ignored.

Question 24

The nurse is discussing treatment options with a client who has arachnophobia. Which commonly used behavioral therapies for phobias should the nurse explain to the client? (Select all that apply.)

A) Benzodiazepine therapy
B) Systematic desensitization
C) Imploding (flooding)
D) Competing response training
E) Habit reversal training

Question 25

The client has been diagnosed with generalized anxiety disorder (GAD). Which symptoms would the nurse observe upon assessment? (Select all that apply.)

A) Muscle tension
B) Paresthesia
C) Hyperventilation
D) Restlessness
E) Procrastination

Question 26

Antianxiety drugs are also called ____________________ and minor tranquilizers.