Question 1

Which assessment questions are most appropriate to ask a patient with possible obsessive-compulsive disorder? Select all that apply.

Accepted Answer

The correct questions refer to obsessive thinking and compulsive behaviors.The incorrect responses are more pertinent to a patient with suspected posttraumatic stress disorder or with suspected social phobia.

Question 2

A patient performs ritualistic hand washing.What should the nurse do to help the patient develop more effective coping strategies?

Accepted Answer

Because patients with obsessive-compulsive disorder become overly involved in rituals,promoting involvement with other people and activities is necessary to improve the patient's coping strategies.Daily activities prevent the constant focus on anxiety and its symptoms.The other interventions focus on the compulsive symptom.

Question 3

Which comment by a person who is experiencing severe anxiety indicates the possibility of obsessive-compulsive disorder?

Accepted Answer

Recurring doubt (obsessive thinking)and the need to check (compulsive behavior)suggest obsessive-compulsive disorder.The repetitive behavior is designed to decrease anxiety but fails and must be repeated.The statement,"My legs feel weak most of the time," is more in keeping with a somatoform disorder.Being embarrassed to go out in public is associated with an avoidant personality disorder.Reliving a traumatic event is associated with posttraumatic stress disorder.

Question 4

A nurse plans health teaching for a patient with generalized anxiety disorder who takes lorazepam (Ativan).What information should be included? Select all that apply.

Accepted Answer

Caffeine is a central nervous system stimulant that acts as an antagonist to the benzodiazepine lorazepam.Daily caffeine intake should be reduced to the amount contained in one cup of coffee.Benzodiazepines are sedatives,thus the importance of exercising caution when driving or using machinery and the importance of not using other central nervous system depressants such as alcohol or sedatives to avoid potentiation.Benzodiazepines do not require a special diet.Food will reduce gastric irritation from the medication.

Question 5

Which finding indicates that a patient with moderate-to-severe anxiety has successfully lowered the anxiety level to mild? The patient:

Accepted Answer

The ability to concentrate and attend to reality is increased slightly in mild anxiety and decreased in moderate-,severe-,and panic-level anxiety.Patients with high levels of anxiety often ask,"What's the matter with me?" Staying in a room alone and pacing suggest moderate anxiety.Expressing a lack of hunger is not necessarily a criterion for evaluating anxiety.

Question 6

For a patient experiencing panic,which nursing intervention should be first?

Accepted Answer

Calm,brief,directive verbal interaction can help the patient gain control of the overwhelming feelings and impulses related to anxiety.Patients experiencing panic-level anxiety are unable to focus on reality;thus learning relaxation techniques is virtually impossible.Administering an anxiolytic medication should be considered if providing calm,brief,directive communication is ineffective.Although the patient is disorganized,violence may not be imminent,ruling out the intervention of preparing for physical control until other less-restrictive measures are proven ineffective.

Question 7

A student says,"Before taking a test,I feel a heightened sense of awareness and restlessness." The nurse can correctly assess the student's experience as:

Accepted Answer

Mild anxiety is rarely obstructive to the task at hand.It may be helpful to the patient because it promotes study and increases awareness of the nuances of questions.The incorrect responses have different symptoms.

Question 8

Which statement is mostly likely to be made by a patient with agoraphobia?

Accepted Answer

Individuals who are agoraphobic generally acknowledge that the behavior is not constructive and that they do not really like it.Patients state they are unable to change the behavior.Patients with agoraphobia are not optimistic about change.Most families are dissatisfied when family members refuse to leave the house.

Question 9

If a cruel and abusive person rationalizes this behavior,which comment is most characteristic of this person?

Accepted Answer

Rationalization consists of justifying one's unacceptable behavior by developing explanations that satisfy the teller and attempt to satisfy the listener.The abuser is suggesting that the abuse is not his or her fault;it would not have occurred except for the provocation by the other person.

Question 10

A patient has a fear of public speaking.The nurse should be aware that social phobias are often treated with which type of medication?

Accepted Answer

Beta-blockers,such as propranolol,are often effective in preventing symptoms of anxiety associated with social phobias.Neuroleptic medications are major tranquilizers and not useful in treating social phobias.Tricyclic antidepressants are rarely used because of their side effect profile.MAOIs are administered for depression and only by individuals who can observe the special diet required.

Question 11

A student says,"Before taking a test,I feel a heightened sense of awareness and restlessness." The nursing intervention most suitable for assisting the student is to:

Accepted Answer

Teaching about the symptoms of anxiety,their relation to precipitating stressors,and,in this case,the positive effects of anxiety serves to reassure the patient.Advising the patient to discuss the experience with a health care provider implies that the patient has a serious problem.Listening without comment will do no harm but deprives the patient of health teaching.Antioxidant vitamin supplements are not useful in this scenario.

Question 12

A patient has the nursing diagnosis: Anxiety,related to __________,as evidenced by an inability to control compulsive cleaning.Which phrase correctly completes the etiologic portion of the diagnosis?

Accepted Answer

Many compulsive rituals accompany obsessive thoughts.The patient uses these rituals to relief anxiety.Unfortunately,the anxiety relief is short lived,and the patient must frequently repeat the ritual.The other options are unrelated to the dynamics of compulsive behavior.

Question 13

A person who has been unable to leave home for more than a week because of severe anxiety says,"I know it does not make sense,but I just can't bring myself to leave my apartment alone." Which nursing intervention is appropriate?

Accepted Answer

This intervention,a form of cognitive restructuring,replaces negative thoughts such as "I can't leave my apartment" with positive thoughts such as "I can control my anxiety." This technique helps the patient gain mastery over the symptoms.The other options reinforce the sick role.

Question 14

A child is placed in a foster home after being removed from parental contact because of abuse.The child is apprehensive and overreacts to environmental stimuli.The foster parents ask the nurse how to help the child.What should the nurse recommend? Select all that apply.

Accepted Answer

The child can be hypothesized to have moderate-to-severe trait (chronic)anxiety.A calm manner calms the child.A simple,structured,predictable environment is less anxiety provoking and reduces overreaction to stimuli.Calm,simple explanations that reinforce reality validate the environment.Repetition is often needed when the child is unable to concentrate because of elevated levels of anxiety.Opportunities for play and exercise should be provided as avenues to reduce anxiety.Physical movement helps channel and lower anxiety.Play also helps by allowing the child to act out concerns.

Question 15

A patient checks and rechecks electrical cords related to an obsessive thought that the house may burn down.The nurse and patient explore the likelihood of an actual fire.The patient states that a house fire is not likely.This counseling demonstrates the principles of:

Accepted Answer

Cognitive restructuring involves the patient in testing automatic thoughts and drawing new conclusions.Desensitization involves a graduated exposure to a feared object.Relaxation training teaches the patient to produce the opposite of the stress response.Flooding exposes the patient to a large amount of undesirable stimuli in an effort to extinguish the anxiety response.

Question 16

When alprazolam (Xanax)is prescribed for acute anxiety,health teaching should include instructions to:

Accepted Answer

Drinking alcohol or taking other anxiolytic medications along with the prescribed benzodiazepine should be avoided because depressant effects of both drugs will be potentiated.Tyramine-free diets are necessary only with monoamine oxidase inhibitors (MAOIs).Drowsiness is an expected effect and needs to be reported only if it is excessive.Patients should be taught not to deviate from the prescribed dose and schedule for administration.

Question 17

A patient with severe anxiety suddenly begins running and shouting,"I'm going to explode!" The nurse should:

Accepted Answer

The safety needs of the patient and other patients are a priority.The patient is less likely to cause self-harm or hurt others when several staff members take responsibility for providing limits.The explanation given to the patient should be simple and neutral.Simply being told that others can help provide the control that has been lost may be sufficient to help the patient regain control.Running after the patient will increase the patient's anxiety.More than one staff member is needed to provide physical limits if they become necessary.Asking the patient to give an example is futile;a patient in panic processes information poorly.

Question 18

A patient tells the nurse,"I wanted my health care provider to prescribe diazepam (Valium)for my anxiety disorder,but buspirone (BuSpar)was prescribed instead.Why?" The nurse's reply should be based on the knowledge that buspirone:

Accepted Answer

Buspirone is considered effective in the long-term management of anxiety because it is not habituating.Because it is long acting,buspirone is not valuable as an as-needed or as a fast-acting medication.The fact that buspirone does not produce blood dyscrasias is less relevant in the decision to prescribe buspirone.

Question 19

A patient tells the nurse,"I don't go to restaurants because people might laugh at the way I eat or I could spill food and be laughed at." The nurse assesses this behavior as consistent with:

Accepted Answer

The fear of a potentially embarrassing situation represents a social phobia.Acrophobia is the fear of heights.Agoraphobia is the fear of a place in the environment.Posttraumatic stress disorder is associated with a major traumatic event.

Quiz 11: Anxiety, anxiety Disorders, and Obsessive-Compulsive Disorders