Question 1

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

Accepted Answer

The symptoms described suggest a panic attack, which is a hallmark symptom of panic disorder. The nurse's first priority should be to assess the patient's anxiety level and provide interventions to decrease anxiety and promote relaxation.

Question 2

What symptoms should the nurse recognize that differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)?

Accepted Answer

Depersonalization is commonly seen in panic disorder, where the client may feel detached or estranged from their own self or reality, whereas it is absent in GAD. Other common symptoms of panic disorder include palpitations, sweating, shaking, shortness of breath, and fear of losing control or dying. In comparison, GAD is characterized by excessive worry and anxiety about a variety of everyday events and activities, along with physical symptoms such as muscle tension, restlessness, fatigue, and irritability. Hyperventilation and chest pain may be present in both disorders. However, panic disorder is not chronic, but rather episodic in nature.

Question 3

A client living in a beachfront 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 explanation of this treatment should the nurse provide?

Accepted Answer

C

Question 4

During her aunt's wake, a 4-year-old child 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 hair. Which nursing diagnosis should the nurse practitioner assign to this child?

Accepted Answer

The child's behavior of twisting and pulling out hair suggests that they are struggling with coping with their grief. Therefore, the nursing diagnosis of "ineffective coping" is the most appropriate option.

Question 5

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

Accepted Answer

Having the client breathe into a paper bag helps to increase the carbon dioxide level in the body, which can help relieve the symptoms of hyperventilation that often occur during a panic attack. This intervention is specifically geared towards meeting the physiological need of the client in the midst of a panic attack.

Question 6

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

The answer of A client diagnosed with obsessive-compulsive disorder is...

Question 7

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

While it is important for clients taking benzodiazepines to have regular blood work, there is no need to monitor for toxic levels of the drug unless specifically indicated by the healthcare provider. This statement indicates a potential misunderstanding and a need for further clarification from the nurse.

Question 8

A client is prescribed alprazolam (Xanax) for acute anxiety. What client history should cause a nurse to question this order?

Accepted Answer

Alprazolam is a benzodiazepine which has a high risk of abuse and dependence, so the history of alcohol use disorder may increase the risk of addiction and overdose. Benzodiazepines and alcohol increase each other's effects and can cause respiratory depression, sedation, and death. Therefore, it is important to assess the patient's history of substance use disorder and caution in monitoring the patient's medication adherence and potential drug interactions.

Question 9

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

Accepted Answer

Research has shown that higher doses of SSRI medications, such as fluvoxamine, are necessary for effectively treating OCD compared to doses for depression. This is because the neurotransmitter serotonin plays a key role in OCD symptoms, and higher doses of SSRIs can increase serotonin levels in the brain. Tricyclic medications are not typically used for OCD treatment. The dose of 300 mg daily for fluvoxamine is within the therapeutic range and has been studied in clinical trials for OCD treatment. The side effect of daytime drowsiness can occur with fluvoxamine, but it is not the reason for the lower dose.

Question 10

A nursing instructor is teaching about specific phobias. Which student statement indicates to the instructor that teaching has been effective?

Accepted Answer

Specific phobias involve an overwhelming and unreasonable fear of an object or situation that poses little real danger but provokes anxiety and avoidance.

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 response?

Accepted Answer

This response acknowledges the client's feelings and provides a reassuring message that the panic attack will not last forever. It also encourages the client to focus on coping strategies. Option B may cause the client to feel invalidated, option C may normalize the client's fear but does not offer any coping strategies, and option D may prompt the client to become defensive or shut down.

Question 12

The nurse is providing education to a client diagnosed with anxiety. Which statement by the client indicates that teaching has been effective?

Accepted Answer

Option D correctly states that practicing yoga or meditation may help reduce anxiety. Options A, B, and C are incorrect as they all suggest ineffective methods of managing anxiety.

Question 13

Which treatment should the nurse identify as most appropriate for clients diagnosed with generalized anxiety disorder?

Accepted Answer

Long-term treatment with buspirone (BuSpar) is most appropriate for clients diagnosed with generalized anxiety disorder as it is a long-acting anti-anxiety medication that does not cause sedation or tolerance. Benzodiazepines like diazepam (Valium) can cause sedation, dependence, and withdrawal symptoms. Antidepressants like citalopram (Celexa) may be useful for acute symptom control but are not the primary treatment for generalized anxiety disorder. Antipsychotics like ziprasidone (Geodon) are not an appropriate treatment for generalized anxiety disorder.

Question 14

A family member is seeking advice about an older 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 response?

Accepted Answer

The nursing response should provide an accurate assessment of the situation. Option B provides this by indicating when anxiety is considered abnormal and when it becomes a concern. Option A is incorrect because it normalizes the behavior with aging, which is not necessarily true. Option C is incorrect because it jumps to a conclusion without gathering more information. Option D is incorrect because it suggests that medication is the only effective treatment for anxiety, which is not accurate.

Question 15

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

Accepted Answer

The nursing diagnosis that best fits this scenario is Altered coping R/T anxiety. The student is struggling to effectively cope with their test anxiety and is turning to a maladaptive coping mechanism (watching a movie) instead of studying or seeking support from resources available on campus.

Question 16

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

Accepted Answer

Clonazepam (Klonopin) is a benzodiazepine that is effective in treating panic disorder due to its anxiolytic properties.

Question 17

A nursing instructor is teaching about the symptoms of agoraphobia. Which student statement indicates that teaching has been effective?

Accepted Answer

According to the DSM-5, the onset of symptoms for agoraphobia most commonly occurs in the 20s and 30s and persists for many years. Option A is incorrect because early adolescence is too early for onset. Option C is incorrect because onset is typically earlier in life than the 40s and 50s. Option D is incorrect because onset can occur before the age of 60, and there is no set time frame for how long symptoms persist.

Question 18

Which symptoms should the nurse recognize that differentiate a client diagnosed with obsessive-compulsive disorder (OCD) from a client diagnosed with obsessive-compulsive personality disorder?

Accepted Answer

Clients diagnosed with OCD experience both obsessions (recurring and persistent thoughts, impulses, or images) and compulsions (repetitive behaviors or mental acts that someone feels driven to perform as a response to an obsession or according to strict rules). Clients diagnosed with obsessive-compulsive personality disorder, on the other hand, do not experience either obsessions or compulsions, but instead exhibit a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.

Question 19

Which nursing statement to a client about social anxiety disorder versus schizoid personality disorder (SPD) is most accurate?

Accepted Answer

Clients diagnosed with social anxiety disorder avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life. This is the most accurate statement as it correctly distinguishes between the two disorders based on the extent of avoidant behavior. The other options either make false statements or do not provide a clear distinction between the two disorders.

Question 20

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

Discussing the anxiety-provoking triggers helps the client understand and manage the underlying causes of their compulsive behaviors, which is a therapeutic approach in treating OCD.

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