Question 1

How would a nurse differentiate a client diagnosed with a social phobia from a client diagnosed with a schizoid personality disorder (SPD)?

Accepted Answer

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.

Question 2

A nursing instructor is teaching about specific phobias.Which student statement should indicate that learning has occurred?

Accepted Answer

The nursing instructor should evaluate that learning has occurred when the student knows that clients experiencing phobias have a panic level of fear that is overwhelming and unreasonable.Phobia is fear cued by a specific object or situation in which exposure to the stimulus produces an immediate anxiety response.

Question 3

A nurse is providing discharge teaching to a client taking a benzodiazepine.Which client statement would indicate a need for further follow-up instructions?

Accepted Answer

The client indicates a need for additional information about taking benzodiazepines when stating the need for blood work to monitor for toxic levels.No blood work is needed when taking a short-acting benzodiazepine.The client should understand that taking extra doses of a benzodiazepine may result in addiction and that the drug should not be taken in conjunction with alcohol.

Question 4

Which treatment should a nurse identify as most appropriate for clients diagnosed with generalized anxiety disorder (GAD)?

Accepted Answer

The nurse should identify that an appropriate treatment for clients diagnosed with GAD is long-term treatment with buspirone.Buspirone is an anxiolytic medication that is effective in 60% to 80% of clients with GAD.It takes 10 to 14 days for alleviation of symptoms but does not have the dependency concerns of other anxiolytics.

Question 5

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

Accepted Answer

The nurse can meet this client's immediate need by staying with the client and offering reassurance of safety and security.The client may fear for his or her life,and the presence of a trusted individual provides assurance of personal safety.

Question 6

A client refuses to go on a cruise to the Bahamas with his spouse because of fearing that the cruise ship will sink and all will drown.Using a cognitive theory perspective,the nurse should use which of these statements to explain to the spouse the etiology of this fear?

Accepted Answer

The nurse should explain that from a cognitive perspective the client is experiencing a distorted and unrealistic appraisal of the situation.From a cognitive perspective,fear is described as the result of faulty cognitions.

Question 7

A nursing instructor is teaching about the medications used to treat panic disorder.Which student statement indicates that learning has occurred?

Accepted Answer

The student indicates learning has occurred when he or she states that clonazepam is a particularly effective treatment for panic disorder.Clonazepam is a type of benzodiazepine that can be abused and lead to physical dependence and tolerance.It can be used on an as-needed basis to reduce anxiety and its related symptoms.

Question 8

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

Accepted Answer

The nurse should explain to the client that systematic desensitization exposes the client to a series of increasingly anxiety-provoking steps that will gradually increase anxiety tolerance.Systematic desensitization was introduced by Joseph Wolpe in 1958 and is based on behavioral conditioning principles.

Question 9

A family member is seeking advice about an elderly parent who seems to worry unnecessarily about everything.The family member states,"Should I seek psychiatric help for my mother?" Which is an appropriate nursing reply?

Accepted Answer

The most appropriate reply by the nurse is to explain to the family member that anxiety is considered abnormal when it is out of proportion and impairs functioning.Anxiety is a normal reaction to a realistic danger or threat to biological integrity or self-concept.

Question 10

A cab driver stuck in traffic is suddenly lightheaded,tremulous,and diaphoretic and experiences tachycardia and dyspnea.An extensive workup in an emergency department reveals no pathology.Which medical diagnosis is suspected,and what nursing diagnosis takes priority?

Accepted Answer

The nurse should suspect that the client has exhibited signs/symptoms of a panic disorder.The priority nursing diagnosis should be panic anxiety.Panic disorder is characterized by recurrent,sudden-onset panic attacks in which the person feels intense fear,apprehension,or terror.

Question 11

A client diagnosed with panic disorder states,"When an attack happens,I feel like I am going to die." Which is the most appropriate nursing reply?

Accepted Answer

The most appropriate nursing reply to the client's concerns is to empathize with the client and provide encouragement that panic attacks last only a short period.Panic attacks usually last minutes but can,rarely,last hours.Symptoms of depression are also common with this disorder.

Question 12

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

Accepted Answer

An appropriate initial client outcome is for the client to wake early enough to complete rituals prior to breakfast.The nurse should also provide a structured schedule of activities and later in treatment begin to gradually limit the time allowed for rituals.

Question 13

A nursing student questions an instructor regarding the order for fluvoxamine (Luvox),300 mg daily,for a client diagnosed with obsessive-compulsive disorder (OCD).Which instructor reply is most accurate?

Accepted Answer

The most accurate instructor response is that SSRI doses in excess of what is effective for treating depression may be required in the treatment of OCD.SSRIs have been approved by the U.S.Food and Drug Administration for the treatment of OCD.Common side effects include headache,sleep disturbances,and restlessness.

Question 14

A client diagnosed with an obsessive-compulsive disorder spends hours bathing and grooming.During a one-on-one interaction,the client discusses the rituals in detail but avoids any feelings that the rituals generate.Which defense mechanism should the nurse identify?

Accepted Answer

The nurse should identify that the client is using the defense mechanism of intellectualization when discussing the rituals of obsessive-compulsive disorder in detail while avoiding discussion of feelings.Intellectualization is an attempt to avoid expressing emotions associated with a stressful situation by using the intellectual processes of logic,reasoning,and analysis.

Question 15

A client is newly diagnosed with obsessive-compulsive disorder and spends 45 minutes folding clothes and rearranging them in drawers.Which nursing intervention would best address this client's problem?

Accepted Answer

The nurse should discuss with the client the anxiety-provoking triggers that precipitate the ritualistic behavior.If the client is going to be able to avoid the anxiety,he or she must first learn to recognize precipitating factors.Attempting to distract the client,seeking medication increase,and locking the client's room are not appropriate interventions because they do not help the client recognize anxiety triggers.

Question 16

How would a nurse differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)?

Accepted Answer

The nurse should recognize that a client diagnosed with panic disorder experiences depersonalization,whereas a client diagnosed with GAD would not.Depersonalization refers to being detached from oneself when experiencing extreme anxiety.

Question 17

A client has a history of excessive fear of water.What is the term that a nurse should use to describe this specific phobia,and under what subtype is this phobia identified?

Accepted Answer

The nurse should determine that an excessive fear of water is identified as aquaphobia,which is a natural environment type of phobia.Natural environment-type phobias are fears about objects or situations that occur in the natural environment,such as a fear of heights or storms.

Question 18

Arthur,who is diagnosed with obsessive-compulsive disorder,reports to the nurse that he can't stop thinking about all the potentially life threatening germs in the environment.What is the most accurate way for the nurse to document this symptom?

Accepted Answer

Obsessions are unwanted,intrusive,repetitive thoughts.Compulsions are unwanted,repetitive behavior patterns in response to obsessive thoughts that are efforts to reduce anxiety.

Question 19

A client presents in the emergency department with complaints of overwhelming anxiety.Which of the following is a priority for the nurse to assess?

Accepted Answer

Although all of the listed aspects of assessment are important,the priority is to evaluate cardiac status since a person having an MI,CHF,or mitral valve prolapse can present with symptoms of anxiety.

Question 20

A college student is unable to take a final examination because of severe test anxiety.Instead of studying,the student relieves stress by attending a movie.Which priority nursing diagnosis should a campus nurse assign for this client?

Accepted Answer

The priority nursing diagnosis for this client is altered coping R/T anxiety.The nurse should assist in implementing interventions that should improve the client's healthy coping skills and reduce anxiety.

Quiz 27: Anxiety, Obsessive-Compulsive, and Related Disorders

How would a nurse differentiate a client diagnosed with a social phobia from a client diagnosed with a schizoid personality disorder (SPD) ?