Question 1

Selective serotonin reuptake inhibitors are known to be effective for which disorders? (Select all that apply.)&#10;A) Generalized anxiety disorder (GAD)&#10;B) Obsessive-compulsive disorder&#10;C) Panic disorder&#10;D) Post-traumatic stress disorder&#10;E) Social anxiety disorder

Accepted Answer

SSRIs have been shown to be effective in treating GAD, OCD, panic disorder, and social anxiety disorder. They are used to treat PTSD but have not demonstrated effectiveness in clinical research.

Question 2

An agitated, extremely anxious patient is brought to the emergency department. The prescriber orders a benzodiazepine. The nurse understands that benzodiazepines are used in this clinical situation based on which principle?

A) Benzodiazepines have a very short half-life.
B) Physical dependence is not a risk when taking benzodiazepines.
C) Benzodiazepines are known to cure generalized anxiety.
D) Benzodiazepines have a rapid onset of action.

Accepted Answer

The patient is clearly in a state of extreme, uncontrolled anxiety. Benzodiazepines are the drug of choice for acute episodes of anxiety because of their rapid onset of action. Benzodiazepines do not have a very short half-life. Benzodiazepines are associated with physical dependence. Benzodiazepines do not cure generalized anxiety, nor do any other drugs.

Question 3

During an admission history, a patient reports a frequent need to return to a room multiple times to make sure an iron or other appliance is unplugged. What does the nurse understand about this patient's behavior?

A) It helps the patient reduce anxiety about causing a fire.
B) It usually is treated with clomipramine (Anafranil).
C) It seems perfectly normal to the patient.
D) It will best respond to deep brain stimulation.

Accepted Answer

Patients with OCD have compulsive behaviors, such as repeatedly checking to make sure appliances have been unplugged. The compulsion is a ritualized behavior resulting from obsessive anxiety or fear that something bad will happen, such as starting a fire with an overheated appliance. Clomipramine is not a first-line drug for treating OCD. Patients usually understand that compulsive behaviors are excessive and senseless but are unable to stop. Deep brain stimulation is indicated for patients in whom other treatments have failed; its effectiveness at reducing symptoms has been shown to be about 40%.

Question 4

A patient describes feelings of anxiety and fear when speaking in front of an audience and is having difficulty at work because of an inability to present information at meetings three or four times each year. The patient is reluctant to take long-term medications. The nurse will expect the provider to order which treatment?

A) Alprazolam (Xanax) as needed
B) Cognitive behavioral therapy
C) Paroxetine (Paxil)
D) Psychotherapy

Accepted Answer

This patient is describing social anxiety disorder; the symptoms are related to performance only and are not generalized to all social situations. Because this patient must speak in front of an audience only three or four times per year, a PRN medication can be used. Cognitive behavioral therapy is used for OCD. Paroxetine must be used continuously for at least 1 year. Psychotherapy can be used but is more effective when used in combination with drugs.

Question 5

A nurse is admitting a patient to a hospital unit and is taking a history. The patient reports taking alprazolam (Xanax) for "nerves." The nurse knows that this patient is most likely being treated for which condition?

A) Generalized anxiety disorder
B) Obsessive-compulsive disorder (OCD)
C) Panic disorder
D) Post-traumatic stress disorder (PTSD)

Accepted Answer

Benzodiazepines are first-choice drugs for anxiety, and alprazolam and lorazepam are prescribed most often. Selective serotonin reuptake inhibitors (SSRIs) are the first-line drugs for the treatment of OCD. Panic disorder is treated with any of the three classes of antidepressants: SSRIs, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). Research has not shown any drug to be effective in the treatment of PTSD, although two SSRIs have been approved for use for this disorder.

Question 6

A patient reports having occasional periods of tremors, palpitations, nausea, and a sense of fear. To treat this condition, the nurse anticipates the provider will prescribe a drug in which drug class?

A) Benzodiazepines
B) Monoamine oxidase inhibitors
C) Selective serotonin reuptake inhibitors
D) Tricyclic antidepressants

Accepted Answer

This patient is showing characteristics of panic disorder. All three major classes of antidepressants are effective, but selective serotonin reuptake inhibitors are first-line drugs. Benzodiazepines are second-line drugs and are rarely used because of their abuse potential. MAOIs are effective but are difficult to use because of side effects and drug and food interactions. Tricyclic antidepressants are second-line drugs, and their use is recommended only after a trial of at least one SSRI has failed.

Question 7

A nurse is preparing a patient to change from taking lorazepam (Ativan) for anxiety to buspirone (Buspar). Which statement by the patient indicates a need for further teaching?&#10;A) &#34;I can drink alcohol when taking Buspar, but not grapefruit juice.&#34;&#10;B) &#34;I may need to use a sedative medication if I experience insomnia.&#34;&#10;C) &#34;I may not feel the effects of Buspar for a few weeks.&#34;&#10;D) &#34;I should stop taking the Ativan when I start taking the Buspar.&#34;

Accepted Answer

Ativan should not be withdrawn quickly; it needs to be tapered to prevent withdrawal symptoms. Moreover, Buspar does not have immediate effects. Because no cross-dependence occurs with these two medications, they may be taken together while the benzodiazepine is tapered. Because Buspar does not have sedative effects, patients can consume alcohol without increasing sedation. Levels of Buspar can be increased by grapefruit juice, leading to drowsiness and a feeling of dysphoria. Buspar can cause nervousness and excitement and does not have sedative effects, so patients with insomnia must use a sedative. Buspar does not have immediate effects.

Deck 35: Management of Anxiety Disorders