CHAPTER 7 ANXIETY AND SLEEP DISORDERS

46. A client experiencing sleepwalking is newly admitted to an in-patient psychiatric unit. Which nursing intervention would take priority? 1. Equip the bed with an alarm that is activated when the bed is exited. 2. Discourage strenuous exercise within 1 hour of bedtime. 3. Limit caffeine-containing substances within 4 hours of bedtime. 4. Encourage activities that prepare one for sleep, such as soft music.

. Sleepwalking is considered a parasomnia. Sleepwalking is characterized by the performance of motor activity during sleep in which the indi- vidual may leave the bed and walk about, dress, go to the bathroom, talk, scream, or even drive. ✅1. Equipping the bed with an alarm that activates when the bed is exited is a priority nursing intervention. During a sleepwalk- ing episode, the client is at increased risk for injury, and interventions must address safety. 2. Discouraging strenuous exercise before bed- time is an appropriate intervention to pro- mote sleep; however, this intervention does not take priority over safety. 3. Limiting caffeine-containing substances within 4 hours of bedtime is an appropriate inter- vention to promote sleep; however, this inter- vention does not take priority over safety. 4. Encouraging activities that prepare one for sleep, such as soft music, is an appropriate intervention to promote sleep; however, this intervention does not take priority over safety. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must understand that a client experiencing sleepwalking is at increased risk for injury. An intervention that addresses safety concerns must be prioritized.

20. When treating individuals with posttraumatic stress disorder, which variables are included in the recovery environment? 1. Degree of ego strength. 2. Availability of social supports. 3. Severity and duration of the stressor. 4. Amount of control over reoccurrence.

.1. The degree of ego strength is a part of indi- vidual variables, not part of the recovery envi- ronment. Other variables of the individual include effectiveness of coping resources, presence of preexisting psychopathology, out- comes of previous experiences with stress and trauma, behavioral tendencies (e.g., tempera- ment), current psychosocial developmental stage, and demographic factors (socioeco- nomic status and education). ✅2. Availability of social supports is part of environmental variables. Others include cohesiveness and protectiveness of family and friends, attitudes of society regarding the experience, and cultural and subcul- tural influences. 3. Severity and duration of the stressor is a vari- able of the traumatic experience, not part of the recovery environment. Other variables of the traumatic experience include amount of control over the recurrence, extent of antici- patory preparation, exposure to death, the number affected by the life-threatening situa- tion, and location where the traumatic event was experienced. 4. Amount of control over the recurrence is a variable of the traumatic experience, not part of the recovery environment. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand the following three significant elements in the development of posttraumatic stress disorder: traumatic experience, individual variables, and environmental variables.

43. A client was admitted to an in-patient psychiatric unit 4 days ago for the treatment of obsessive-compulsive disorder. Which outcome takes priority for this client at this time? 1. The client will use a thought-stopping technique to eliminate obsessive/compulsive behaviors. 2. The client will stop obsessive and/or compulsive behaviors. 3. The client will seek assistance from the staff to decrease obsessive or compulsive behaviors. 4. The client will use one relaxation technique to decrease obsessive or compulsive behaviors.

1 It is unrealistic to expect the client to use a thought-stopping technique totally to elimi- nate obsessive or compulsive behaviors by day 4 of treatment. 2. It is unrealistic for clients diagnosed with obsessive-compulsive disorder to abruptly stop obsessive or compulsive behaviors. 3. It is desirable for the client to seek assistance from the staff to decrease the amount of obsessive or compulsive behaviors. However, this outcome should be prioritized earlier than day 4 of treatment. ✅4. By day 4, it would be realistic to expect the client to use one relaxation technique to decrease obsessive or compulsive behaviors. This would be the current priority outcome. TEST-TAKING HINT: The test taker must recog- nize the importance of time-wise interventions when establishing outcomes. In the case of clients diagnosed with obsessive-compulsive disorder, expectations on admission vary greatly from outcomes developed closer to discharge.

39. Which client would the charge nurse assign to an agency nurse who is new to a psychi- atric setting? 1. A client diagnosed with posttraumatic stress disorder currently experiencing flashbacks. 2. A newly admitted client diagnosed with generalized anxiety disorder beginning ben- zodiazepines for the first time. 3. A client admitted 4 days ago with the diagnosis of algophobia. 4. A newly admitted client with obsessive-compulsive disorder.

1. A client diagnosed with posttraumatic stress disorder experiencing acute flashbacks would need special treatment. An inexperienced agency nurse may find this situation overwhelming. 2. A client diagnosed with generalized anxiety disorder beginning benzodiazepine therapy for the first time may have specific questions about the disease process or prescribed medication. An inexperienced agency nurse may be unfamiliar with client teaching needs. ✅3. A client admitted 4 days ago with a diag- nosis of algophobia, fear of pain, would be an appropriate assignment for the agency nurse. Of the clients presented, this client would pose the least challenge to a nurse unfamiliar with psychiatric clients. 4. A client with obsessive-compulsive disorder would need to be allowed to use his or her ritualistic behaviors to control anxiety to a manageable level. An inexperienced agency nurse may not fully understand client behav- iors that reflect the diagnosis of obsessive- compulsive TEST-TAKING HINT: To answer this question cor- rectly, the test taker needs to recognize the com- plexity of psychiatric diagnoses and understand the ramifications of potentially inappropriate nursing interventions by inexperienced staff members.

42. The nurse has received evening report. Which client would the nurse need to assess first? 1. A newly admitted client with a history of panic attacks. 2. A client who slept 2 to 3 hours last night because of flashbacks. 3. A client pacing the halls and stating that his anxiety is an 8/10. 4. A client diagnosed with generalized anxiety disorder awaiting discharge.

1. A client newly admitted with a panic attack history does not command the immediate attention of the nurse. If the client presents with signs and symptoms of panic, the nurse's priority would then shift to this client. 2. The nurse would assess a client experiencing flashbacks during the night, but this assess- ment would not take priority at this time over the other clients described. ✅3. A client pacing the halls and experienc- ing an increase in anxiety commands immediate assessment. If the nurse does not take action on this assessment, there is a potential for client injury to self or others. 4. A client with generalized anxiety disorder awaiting discharge does not command the immediate attention of the nurse. To meet the criteria for discharge, this client should be in stable mental condition. TEST-TAKING HINT: When the nurse is prioritizing client assessments, it is important to note which client might be a safety risk. When asked to pri- oritize, the test taker must review all the situa- tions presented before deciding which one to address first.

52. During an intake assessment, a client diagnosed with generalized anxiety disorder rates mood at 3/10, rates anxiety at 8/10, and states, "I'm thinking about suicide." Which nursing intervention takes priority? 1. Teach the client relaxation techniques. 2. Ask the client, "Do you have a plan to commit suicide?" 3. Call the physician to obtain a PRN order for an anxiolytic medication. 4. Encourage the client to participate in group activities.

1. Although it is important to teach the client relaxation techniques, this is not the current priority. The client has expressed suicidal ideations, and the priority is to assess the sui- cide plan further. ✅2. It is important for the nurse to ask the client about a potential plan for suicide to intervene in a timely manner. Clients who have developed suicide plans are at higher risk than clients who may have vague sui- cidal thoughts. 3. The nurse may want to call the physician to obtain a PRN order for anxiolytic medica- tions; however, a thorough physical evaluation and further assessment of suicidal ideations need to occur before calling the physician. 2. It is important for the client to participate in group activities. However, the nurse's first priority is assessing suicidal ideations and developing a plan to intervene quickly and appropriately to maintain client safety TEST-TAKING HINT: To answer this question correctly, the test taker must understand the importance of assessing the plan for suicide. Interventions would differ depending on the client's plan. The intervention for a plan to use a gun at home would differ from an intervention for a plan to hang oneself during hospitalization.

26. A client with a history of generalized anxiety disorder enters the emergency depart- ment complaining of restlessness, irritability, and exhaustion. Vital signs are blood pressure 140/90 mm Hg, pulse 96, and respirations 20. Based on this assessed information, which assumption would be correct? 1. The client is exhibiting signs and symptoms of an exacerbation of generalized anxi- ety disorder. 2. The client's signs and symptoms are due to an underlying medical condition. 3. A physical examination is needed to determine the etiology of the client's problem. 4. The client's anxiolytic dosage needs to be increased.

1. Although the client may be exhibiting signs and symptoms of an exacerbation of general- ized anxiety disorder, the nurse cannot assume this to be true before a thorough assessment is done. 2. Although the client may be experiencing an underlying medical condition that is causing the anxiety, the nurse cannot assume this to be true before a thorough assessment is done. ✅3. Physical problems should be ruled out before determining a psychological cause for this client's symptoms. 4. Although the client may need an anxiolytic dosage increase, the nurse cannot assume this to be true before a thorough physical assess- ment is done. TEST-TAKING HINT: The test taker needs to remember that although a client may have a history of a psychiatric illness, a complete, thor- ough evaluation must be done before assuming exhibited symptoms are related to the psychiatric diagnosis. Many medical conditions generate anxiety as a symptom

37. A client has a nursing diagnosis of disturbed sleep patterns R / T increased anxiety AEB inability to fall asleep. Which short-term outcome is appropriate for this client? 1. The client will use one coping skill before bedtime to assist in falling asleep. 2. The client will sleep 6 to 8 hours a night and report a feeling of being rested. 3. The client will ask for prescribed PRN medication to assist with falling asleep by day 2. 4. The client will verbalize his or her level of anxiety as less than a 3/10.

1. Although the nurse may want the client to use one coping skill before bedtime to assist in falling asleep, there is no timeframe on this outcome, and it is not measurable. 2. The outcome of being able to sleep 6 to 8 hours a night and report a feeling of being rested has no timeframe and is not measurable. ✅3 The client's being able to ask for pre- scribed PRN medication to assist with falling asleep by day 2 is a short-term outcome that is specific, has a timeframe, and relates to the stated nursing diagnosis. 4. Although the nurse may want the client to verbalize a decreased level of anxiety, this outcome does not have a timeframe and is not measurable. TEST-TAKING HINT: When given a nursing diagnosis in the question, the test taker should choose the outcome that directly relates to the client's specific problem. If a client had a nursing diagnosis of disturbed sleep patterns R / T frequent naps during the day, the short-term outcome for this client may be "the client will stay in the milieu for all scheduled groups by day 2." Staying in the milieu would assist the client in avoiding napping, which is the cause of this client's problem

30. A client diagnosed with obsessive-compulsive disorder is newly admitted to an in- patient psychiatric unit. Which cognitive symptom would the nurse expect to assess? 1. Compulsive behaviors that occupy more than 4 hours per day. 2. Excessive worrying about germs and illness. 3. Comorbid abuse of alcohol to decrease anxiety. 4. Excessive sweating and an increase in blood pressure and pulse.

1. Compulsive behaviors that occupy many hours per day would be a behavioral, not cognitive, symptom experienced by clients diagnosed with obsessive-compulsive disorder (OCD). ✅2. Excessive worrying about germs and ill- ness is a cognitive symptom experienced by clients diagnosed with OCD. 3. Comorbid abuse of alcohol to decrease anxiety would be a behavioral, not cognitive, symptom experienced by clients diagnosed with OCD. 4. Excessive sweating and increased blood pressure and pulse are physiological, not cognitive, symptoms experienced by clients diagnosed with OCD.

8. Using psychodynamic theory, which intervention would be appropriate for a client diagnosed with panic disorder? 1. Encourage the client to evaluate the power of distorted thinking. 2. Ask the client to include his or her family in scheduled therapy sessions. 3. Discuss the overuse of ego defense mechanisms and their impact on anxiety. 4. Teach the client about the effect of blood lactate level as it relates to the client's panic attacks.

1. Encouraging the client to evaluate the power of distorted thinking is based on a cognitive, not psychodynamic, perspective. 2. Asking the client to include his or her family in scheduled therapy sessions is based on an interpersonal, not psychodynamic, perspective. ✅3. The nurse discussing the overuse of ego defense mechanisms illustrates a psychodynamic approach to address the client's behaviors related to panic disorder. 4. Teaching the client the effects of blood lac- tate on anxiety is based on the biological, not psychodynamic, perspective. TEST-TAKING HINT: When answering this ques- tion, the test taker must be able to differentiate among various theoretical perspectives and their related interventions.

24. A client experiencing a panic attack would display which physical symptom? 1. Fear of dying. 2. Sweating and palpitations. 3. Depersonalization. 4. Restlessness and pacing.

1. Fear of dying is an affective, not physical, symptom of a panic attack. ✅2. Sweating and palpitations are physical symptoms of a panic attack. 3. Depersonalization is an alteration in the per- ception or experience of the self, so that the feeling of one's own reality is temporarily lost. 4.Depersonalization is a cognitive, not physical, symptom of a panic attack. Restlessness and pacing are behavioral, not physical, symptoms of a panic attack TEST-TAKING HINT: The test taker must note important words in the question, such as "physi- cal symptoms." Although all the answers are actual symptoms a client experiences during a panic attack, only "2" is a physical symptom.

54. The nurse teaches an anxious client diagnosed with posttraumatic stress disorder a breathing technique. Which action by the client would indicate that the teaching was successful? 1. The client eliminates anxiety by using the breathing technique. 2. The client performs activities of daily living independently by discharge. 3. The client recognizes signs and symptoms of escalating anxiety. 4. The client maintains a 3/10 anxiety level without medications.

1. It is impossible for clients to eliminate anxiety from daily life. Mild anxiety is beneficial and necessary to completing tasks of daily living. 2. Optimally, a client should be able to perform activities of daily living independently by dis- charge; however, this client action does not indicate successful teaching about breathing techniques. 3. It is important that a client recognizes signs and symptoms of escalating anxiety, but this client action does not indicate successful teaching about breathing techniques . ✅4. A client's ability to maintain an anxiety level of 3/10 without medications indi- cates that the client is using breathing techniques successfully to reduce anxiety. TEST-TAKING HINT: To answer this question correctly, the test taker should understand that anxiety cannot be eliminated from life. This understanding would eliminate "1" immediately

14. Which is important when assessing an individual for a sleep disturbance? 1. Limit caffeine intake in the evening hours. 2. Teach the importance of a bedtime routine. 3. Keep the client's door locked during the day to avoid napping. 4. Check the chart to note the client's baseline sleeping habits per night.

1. Limiting caffeine intake may be important for clients experiencing a sleep disturbance, but this is an intervention, not an assessment. 2. Teaching the importance of a bedtime routine may be important for clients experiencing a sleep disturbance, but this is an intervention, not an assessment. 3. Keeping the client's door locked during the day to avoid napping may be important for clients experiencing a sleep disturbance, but this is an intervention, not an assessment. ✅4. An important nursing assessment for a client experiencing a sleep disturbance is to note the client's baseline sleep patterns. These data allow the nurse to recognize alterations in normal patterns of sleep and to intervene appropriately. TEST-TAKING HINT: To answer this question correctly, it is important to note the word "assessing." Answers "1," "2," and "3" can be eliminated immediately because they are interventions, not assessments.

7. A client diagnosed with social phobia has an outcome that states, "Client will voluntarily participate in group activities with peers by day 3." Which would be an appropriate intrapersonal intervention by the nurse to assist the client to achieve this outcome? 1. Offer PRN lorazepam (Ativan) 1 hour before group begins. 2. Attend group with client to assist in decreasing anxiety. 3. Encourage discussion about fears related to socialization. 4. Role-play scenarios that may occur in group to decrease anxiety

1. Offering PRN lorazepam (Ativan) before group is an example of a biological, not intrapersonal, intervention. 2. Attending group with the client is an example of an interpersonal, not intrapersonal, inter- vention. ✅3. Encouraging discussion about fears is an intrapersonal intervention. 4. Role-playing a scenario that may occur is a behavioral, not intrapersonal, intervention TEST-TAKING HINT: It is important to understand that interventions are based on theories of causa- tion. In this question, the test taker needs to know that intrapersonal theory relates to feelings or developmental issues. Only "3" deals with client feelings

5. Which of the following statements explains the etiology of obsessive-compulsive disorder (OCD) from a biological theory perspective? 1. Individuals diagnosed with OCD have weak and underdeveloped egos. 2. Obsessive and compulsive behaviors are a conditioned response to a traumatic event. 3. Regression to the pre-Oedipal anal sadistic phase produces the clinical symptoms of OCD. 4. Abnormalities in various regions of the brain have been implicated in the cause of OCD.

1. The belief that individuals diagnosed with obsessive-compulsive disorder (OCD) have weak and underdeveloped egos is an explana- tion of OCD etiology from a psychoanalytic, not biological, theory perspective. 2. The belief that obsessive and compulsive behaviors are a conditioned response to a traumatic event is an explanation of OCD eti- ology from a learning theory, not biological theory, perspective. 3. The belief that regression to the pre-Oedipal anal sadistic phase produces the clinical symptoms of OCD is an explanation of OCD etiology from a psychoanalytic, not biological, theory perspective. ✅4. The belief that abnormalities in various regions of the brain cause OCD is an explanation of OCD etiology from a bio- logical theory perspective TEST-TAKING HINT: To answer this question cor- rectly, the test taker must understand the differ- ent theories of OCD etiology. This question calls for a biological theory perspective, making "4" the only correct choice.

28. Which assessment data would support a physician's diagnosis of an anxiety disorder in a client? 1. A client experiences severe levels of anxiety in one area of functioning. 2. A client experiences an increased level of anxiety in one area of functioning for a 6-month period. 3. A client experiences increased levels of anxiety that affect functioning in more than one area of life over a 6-month period. 4. A client experiences increased levels of anxiety that affect functioning in at least three areas of life.

1.A client cannot be diagnosed with an anxiety disorder if anxiety is experienced in only one area of functioning. 2. Although anxiety does need to be experienced for a period of time before being diagnosed as an anxiety disorder, this answer states "one" area of functioning and so is incorrect. ✅3. For a client to be diagnosed with an anxi- ety disorder, the client must experience symptoms that interfere in a minimum of two areas, such as social, occupational, or other important functioning. These symp- toms must be experienced for durations of 6 months or longer. 4. A client needs to experience high levels of anxiety that affect functioning in a minimum of two areas of life, and these must have dura- tions of 6 months or longer. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that specific symptoms must be exhibited and specific timeframes achieved for clients to be diagnosed with anxiety disorders.

23. In which situation would the nurse suspect a medical diagnosis of social phobia? 1. A client abuses marijuana daily and avoids social situations because of fear of humiliation. 2. An 8-year-old child isolates from adults because of fear of embarrassment, but has good peer relationships in school. 3. A client diagnosed with Parkinson's disease avoids social situations because of embarrassment regarding tremors and drooling. 4. A college student avoids taking classes that include an oral presentation because of fear of being scrutinized by others.

1.A client cannot be diagnosed with social phobia when under the influence of substances such as marijuana. It would be unclear if the client is experiencing the fear because of the mood- altering substance or a true social phobia. 2. Children can be diagnosed with social pho- bias. However, in children, there must be evi- dence of the capacity for age-appropriate social relationships with familiar people, and the anxiety must occur in peer and adult interactions. 3. If a general medical condition or another men- tal disorder is present, the social phobia must be unrelated. If the fear is related to the med- ical condition, the client cannot be diagnosed with a social phobia. ✅4. A student who avoids classes because of the fear of being scrutinized by others meets the criteria for a diagnosis of social phobia TEST-TAKING HINT: The test taker must under- stand the DSM-IV-TR diagnostic criteria for social phobia to answer this question correctly.

22. Which of the following assessment data would support the disorder of acrophobia? 1. A client is fearful of basements because of encountering spiders. 2. A client refuses to go to Europe because of fear of flying. 3. A client is unable to commit to marriage after a 10-year engagement. 4. A client refuses to leave home during stormy weather.

1.A client fearful of spiders is experiencing arachnophobia, not acrophobia. ✅2. Acrophobia is the fear of heights. An individual experiencing acrophobia may be unable to fly because of this fear. 3. A client fearful of marriage is experiencing gamophobia, not acrophobia. 4.A client fearful of lightning is experiencing astraphobia, not acrophobia. TEST-TAKING HINT: To answer this question cor- rectly, the test taker needs to review the defini- tions of specific commonly diagnosed phobias.

34. A client seen in an out-patient clinic for ongoing management of panic attacks states, "I have to make myself come to these appointments. It is hard because I don't know when an attack will occur." Which nursing diagnosis takes priority? 1. Ineffective breathing patterns R / T hyperventilation. 2. Impaired spontaneous ventilation R / T panic levels of anxiety. 3. Social isolation R / T fear of spontaneous panic attacks. 4. Knowledge deficit R / T triggers for panic attacks.

1.Although ineffective breathing patterns would be an appropriate nursing diagnosis during a panic attack, the client in the question is not experiencing a panic attack, and so this nursing diagnosis is inappropriate at this time. 2. Although impaired spontaneous ventilation would be an appropriate nursing diagnosis during a panic attack, the client in the question is not experiencing a panic attack, and so this nursing diagnosis is inappropriate at this time. ✅3. Social isolation is seen frequently with individuals diagnosed with panic attacks. The client in the question expresses antic- ipatory fear of unexpected attacks, which affects the client's ability to interact with others. 4. Nothing in the question indicates that the client has a knowledge deficit related to triggers for panic attacks. The client in the question is expressing fear as it relates to the unpredictability of panic attacks. TEST-TAKING HINT: To answer this question correctly, the test taker must link the behaviors presented in the question with the nursing diagnosis that is reflective of these behaviors. The test taker must remember the importance of time-wise interventions. Nursing interventions differ according to the degree of anxiety the client is experiencing. If the client were currently experiencing a panic attack, other interventions would be appropriate.

32. A newly admitted client diagnosed with posttraumatic stress disorder is exhibiting recurrent flashbacks, nightmares, sleep deprivation, and isolation from others. Which nursing diagnosis takes priority? 1. Posttrauma syndrome R / T a distressing event AEB flashbacks and nightmares. 2. Social isolation R / T anxiety AEB isolating because of fear of flashbacks. 3. Ineffective coping R / T flashbacks AEB alcohol abuse and dependence. 4. Risk for injury R / T exhaustion because of sustained levels of anxiety.

1.Although posttrauma syndrome is an appro- priate nursing diagnosis for this client, it is not the priority nursing diagnosis at this time. 2. Although social isolation is an appropriate nursing diagnosis for this client, it is not the priority nursing diagnosis at this time. 3. Although ineffective coping may be an appro- priate nursing diagnosis for clients diagnosed with posttraumatic stress disorder, there is no information in the question to suggest alcohol use. ✅4. Risk for injury is the priority nursing diagnosis for this client. In the question, the client is exhibiting recurrent flash- backs, nightmares, and sleep deprivation that can cause exhaustion and lead to injury. It is important for the nurse to prioritize the nursing diagnosis that addresses safety TEST-TAKING HINT: When the question asks for a priority, it is important for the test taker to understand that all answer choices may be appro- priate statements. Client safety always should be prioritized.

53. A client diagnosed with posttraumatic stress disorder has a nursing diagnosis of dis- turbed sleep patterns R / T nightmares. Which evaluation would indicate that the stat- ed nursing diagnosis was resolved? 1. The client expresses feelings about the nightmares during group. 2. The client asks for PRN trazodone (Desyrel) before bed to fall asleep. 3. The client states that the client feels rested when awakening and denies nightmares. 4. The client avoids napping during the day to help enhance sleep.

1.Although the nurse would like the client to express feelings about the experienced nightmares, this statement does not relate to the nursing diagnosis of disturbed sleep patterns. 2. Although the client requests the prescribed trazodone (Desyrel) to assist with falling asleep, there is no assessment information to indicate that this medication has resolved the sleep pattern problem. ✅3. The client's feeling rested on awakening and denying nightmares are the evaluation data needed to support the fact that the nursing diagnosis of disturbed sleep patterns R/T nightmares has been resolved. 4. When the client avoids daytime napping, the client has employed a strategy to enhance nighttime sleeping. However, this is not eval- uation information that indicates the dis- turbed sleep problem has been resolved. TEST-TAKING HINT: To answer this question cor- rectly, the test taker needs to discern evaluation data that indicate problem resolution. Answers "1," "2," and "4" all are interventions to assist in resolving the stated nursing diagnosis, not evalu- ation data that indicate problem resolution

36. During an assessment, a client diagnosed with generalized anxiety disorder rates anxi- ety as 9/10 and states, "I have thought about suicide because nothing ever seems to work out for me." Based on this information, which nursing diagnosis takes priority? 1. Hopelessness R / T anxiety AEB client's stating, "Nothing ever seems to work out." 2. Ineffective coping R / T rating anxiety as 9/10 AEB thoughts of suicide. 3. Anxiety R / T thoughts about work AEB rates anxiety 9/10. 4. Risk for suicide R / T expressing thoughts of suicide.

1.Because safety is always a priority, and this client is expressing suicidal ideations, hope- lessness, although appropriate for a client diagnosed with generalized anxiety disorder (GAD), would not be the priority nursing diagnosis at this time. 2. Because safety is always a priority, and this client is expressing suicidal ideations, ineffec- tive coping, although appropriate for a client diagnosed with GAD, would not be the prior- ity nursing diagnosis at this time. 3. Because safety is always a priority, and this client is expressing suicidal ideations, anxiety, although appropriate for a client diagnosed with GAD, would not be the priority nursing diagnosis at this time. ✅4. Because the client is expressing suicidal ideations, the nursing diagnosis of risk for suicide takes priority at this time. Client safety is prioritized over all other client problems. TEST-TAKING HINT: When looking for a priority nursing diagnosis, the test taker always must pri- oritize client safety. Even if other problems exist, client safety must be ensured

11. A client diagnosed with posttraumatic stress disorder states to the nurse, "All those won- derful people died, and yet I was allowed to live." Which is the client experiencing? 1. Denial. 2. Social isolation. 3. Anger. 4. Survivor's guilt.

1.Denial is defined as refusing to acknowledge the existence of a situation or the feelings associated with it. No information is presented in the question that indicates the use of denial. 2. Social isolation is defined as aloneness experi- enced by the individual and perceived as imposed by others and as a negative or threatening statement. No information is presented in the question that indicates the client is experiencing social isolation. 3. Anger is broadly applicable to feelings of resentful or revengeful displeasure. No infor- mation is presented in the question that indicates the client is experiencing anger. ✅4. The client in the question is experiencing survivor's guilt. Survivor's guilt is a common situation that occurs when an individual experiences a traumatic event in which others died and the individual survived. TEST-TAKING HINT: To answer this question cor- rectly, the test taker needs to understand com- mon phenomena experienced by individuals diagnosed with posttraumatic stress disorder and relate this understanding to the client statement presented in the question.

48. A client diagnosed with panic attacks is being admitted for the fifth time in 1 year because of hopelessness and helplessness. Which precaution would the nurse plan to implement? 1. Elopement precautions. 2. Suicide precautions. 3. Homicide precautions. 4. Fall precautions.

1.If a client is being admitted for panic attacks because of feeling hopeless and helpless, the client is seeking help; elopement precautions are not yet necessary. If behaviors indicate that the client is a danger to self or others, and the client has intentions of leaving the unit, treatment team discussions of elopement precautions are indicated. ✅2. Any client who is exhibiting hopelessness or helplessness needs to be monitored closely for suicide intentions. 3. There is no information in the question that supports the need for homicide precautions. 4. There is no information in the question that supports the need for fall precautions. TEST-TAKING HINT: To answer this question cor- rectly, the test taker should note the words "hopelessness" and "helplessness," which would be indications of suicidal ideations that warrant suicide precautions.

1. From a cognitive theory perspective, which is a possible cause of panic disorder? 1. Inability of the ego to intervene when conflict occurs. 2. Abnormal elevations of blood lactate and increased lactate sensitivity. 3. Increased involvement of the neurochemical norepinephrine. 4. Distorted thinking patterns that precede maladaptive behaviors.

1.Inability of the ego to intervene when conflict occurs relates to the psychoanalytic, not cognitive, theory of panic disorder development. 2. Abnormal elevations of blood lactate and increased lactate sensitivity relate to the biological, not cognitive, theory of panic disorder development. 3. Increased involvement of the neurochemical norepinephrine relates to the biological, not cognitive, theory of panic disorder development. ✅4. Distorted thinking patterns that precede maladaptive behaviors relate to the cogni- tive theory perspective of panic disorder development. TEST-TAKING HINT: The test taker should note important words in the question, such as "cogni- tive." Although all of the answers are potential causes of panic disorder development, the only answer that is from a cognitive perspective is "4."

17. What is the most common form of breathing-related sleep disorders? 1. Parasomnia. 2. Hypersomnia. 3. Apnea. 4. Cataplexia.

1.Parasomnia refers to the unusual or undesir- able behaviors that occur during sleep (e.g., nightmares, sleep terrors, and sleep walking). Parasomnias are not classified as breathing- related sleep disorders. 2. Hypersomnia refers to excessive sleepiness or seeking excessive amounts of sleep. Hypersomnia is not classified as a breathing- related sleep disorder. ✅3. Apnea refers to the cessation of breathing during sleep. To be so classified, the apnea must last for at least 10 seconds and occur 30 or more times during a 7-hour period of sleep. Apnea is classified as a breathing-related sleep disorder. 4. Cataplexy refers to a sudden, brief loss of muscle control brought on by strong emotion or emotional response, such as a hearty laugh, excitement, surprise, or anger. Cataplexy is not classified as a breathing-related sleep disorder. TEST-TAKING HINT: To answer this question cor- rectly, the test taker first needs to be familiar with the terminology related to sleep disorders and then to note what affects breathing patterns.

21. A newly admitted client is diagnosed with posttraumatic stress disorder. Which behavioral symptom would the nurse expect to assess? 1. Recurrent, distressing flashbacks. 2. Intense fear, helplessness, and horror. 3. Diminished participation in significant activities. 4. Detachment or estrangement from others.

1.Recurrent distressing flashbacks are emotional, not behavioral, symptoms of posttraumatic stress disorder (PTSD). 2. Intense fear, helplessness, and horror are cog- nitive, not behavioral, symptoms of PTSD. ✅3. Diminished participation in significant activities is a behavioral symptom of PTSD. 4. Detachment or estrangement from aches are interpersonal, not behavioral, symptoms of PTSD. TEST-TAKING HINT: To answer this question correctly, the test taker should take note of the keyword "behavioral," which determines the correct answer. All symptoms may be exhibited in PTSD, but only answer choice "3" is a behav- ioral symptom.

12. Clients diagnosed with obsessive-compulsive disorder commonly use which mechanism? 1. Suppression. 2. Repression. 3. Undoing. 4. Denial.

1.Suppression, the voluntary blocking from one's awareness of unpleasant feelings and experi- ences, is not a defense mechanism commonly used by individuals diagnosed with OCD. 2.Repression, the involuntary blocking of unpleasant feelings and experiences from one's awareness, is not a defense mechanism commonly used by individuals diagnosed with OCD. ✅3. Undoing is a defense mechanism com- monly used by individuals diagnosed with OCD. Undoing is used symbolically to negate or cancel out an intolerable previous action or experience. An individ- ual diagnosed with OCD experiencing intolerable anxiety would use the defense mechanism of undoing to undo this anxiety by substituting obsessions or compulsions or both. Other commonly used defense mechanisms are isolation, displacement, and reaction formation. 4. Denial, the refusal to acknowledge the existence of a real situation or the feelings associated with it or both, is not a defense mechanism commonly used by individuals diagnosed with OCD. TEST-TAKING HINT: To answer this question cor- rectly, the test taker needs to understand the underlying reasons for the ritualistic behaviors used by individuals diagnosed with OCD.

59. A client diagnosed with generalized anxiety disorder is prescribed paroxetine (Paxil) 30 mg QHS. Paroxetine is supplied as a 20-mg tablet. The nurse would administer ______tablets.

20x =30 x= 1.5tabs TEST-TAKING HINT: The test taker should set up the ratio and proportion problem based on the number of milligrams contained in 1 tablet and solve this problem by cross multiplication and solving for "X" by division.

20. Which of the following statements about the assessment of persons with anxiety and anxiety disorders is most accurate? A) When an elder person has an onset of anxiety for the first time in his or her life, it is possible that the anxiety is associated with another condition. B) Panic attacks are the most common late-life anxiety disorders. C) An elder person with anxiety may be experiencing ruminative thoughts. D) Agoraphobia that occurs in late life may be related to trauma experienced or anticipated.

Ans: A Feedback: Anxiety that starts for the first time in late life is frequently associated with another condition such as depression, dementia, physical illness, or medication toxicity or withdrawal. Phobias, particularly agoraphobia, and GAD are the most common late-life anxiety disorders. Most people with late-onset agoraphobia attribute the start of the disorder to the abrupt onset of a physical illness or as a response to a traumatic event such as a fall or mugging. Ruminative thoughts are common in late-life depression and can take the form of obsessions such as contamination fears, pathologic doubt, or fear of harming others.

19. A client states, "I will just die if I don't get this job." The nurse then asks the client, "What will be the worst that will happen if you don't get the job?" The nurse is using this response to A) appraise his situation more realistically. B) assist the client to make alternative plans for the future. C) assess if the client has health problems compounded by stress. D) clarify the client's meaning.

Ans: A Feedback: Decatastrophizing involves the therapist's use of questions to more realistically appraise the situation. The therapist may ask, "What is the worst that could happen? Is that likely? Could you survive that? Is that as bad as you imagine?"

16. A client experiences panic attacks when confronted with riding in elevators. The therapist is teaching the client ways to relax while incrementally exposing the client to getting on an elevator. This technique is called A) systematic desensitization. B) flooding. C) cognitive restructuring. D) exposure therapy.

Ans: A Feedback: One behavioral therapy often used to treat phobias is systematic (serial) desensitization, in which the therapist progressively exposes the client to the threatening object in a safe setting until the client's anxiety decreases. Flooding is a form of rapid desensitization in which a behavioral therapist confronts the client with the phobic object (either a picture or the actual object) until it no longer produces anxiety. Cognitive restructuring involves challenging the client's irrational beliefs. Exposure therapy is similar to flooding.

12. Which of the following theories about anxiety is based upon intrapsychic theories? A) A person's innate anxiety is the stimulus for behavior. B) Anxiety is generated from problems in interpersonal relationships. C) A nurse can help the client to achieve health by attending to interpersonal and physiologic needs. D) Anxiety is learned through experiences.

Ans: A Feedback: Theories of anxiety can be classified as intrapsychic/psychoanalytic theories, interpersonal theories, and behavioral theories. Freud's intrapsychic theory views a person's innate anxiety as the stimulus for behavior. Interpersonal theories include Sullivan's theory that anxiety is generated from problems in interpersonal relationships and Peplau's belief that humans exist in interpersonal and physiologic realms. Behavioral theorists view anxiety as being learned through experiences.

31. When teaching a client with generalized anxiety disorder, which is the highest priority for the nurse to teach the client to avoid? A) Caffeine B) High-fat foods C) Refined sugars D) Sodium

Ans: A Feedback: The effects of caffeine are similar to some anxiety symptoms, and, therefore, caffeine ingestion will worsen anxiety. The other types of foods are also potentially harmful to physical as well as psychological health, but the worst offender is caffeine.

11. Which of the following best explains the etiology of anxiety disorders from an interpersonal perspective? A) Anxiety is learned in childhood through interactions with caregivers. B) Anxiety is learned throughout life as a response to life experiences. C) Anxiety stems from an unconscious attempt to control awareness. D) Anxiety results from conforming to the norms of a cultural group.

Ans: A Feedback: Interpersonal theory proposes that caregivers can communicate anxiety to infants or children through inadequate nurturing, agitation when holding or handling the child, and distorted messages. In adults, anxiety arises from the person's need to conform to the norms and values of his or her cultural group. Psychoanalytic theories describe reducing anxiety through the use of defense mechanisms. Defense mechanisms are cognitive distortions that a person uses unconsciously to maintain a sense of being in control of a situation, to lessen discomfort, and to deal with stress.

22. Which of the following are cognitiveñbehavioral therapy techniques that may be used effectively with anxious clients? Select all that apply. A) Positive reframing B) Decatastrophizing C) Assertiveness training D) Humor E) Unlearning

Ans: A, B, C, E Feedback: Positive reframing means turning negative messages into positive messages. Decatastrophizing involves the therapist's use of questions to more realistically appraise the situation. Assertiveness training helps the person take more control over life situations. Positive reframing, decatastrophizing, and assertiveness training are cognitiveñbehavioral therapy techniques. Humor is not a cognitiveñbehavioral therapy technique. Unlearning is the theory underlying behavioral therapy.

1. The nurse knows that which of the following are stages in Selye's general adaptation syndrome? Select all that apply. A) Alarm reaction stage B) Resistance stage C) Coping stage D) Exhaustion stage E) Panic stage

Ans: A, B, D Feedback: The stages in Selye's general adaptation syndrome include the alarm reaction stage, the resistance stage, and the exhaustion stage. Selye did not identify either a coping stage or a panic stage.

34. Which of the following are reasons that the nurse must understand why and how anxiety behaviors work? Select all that apply. A) To provide better care for the client B) To help understand the role anxiety plays in performing nursing responsibilities C) To help the nurse to mask his or her own feelings of anxiety D) So the nurse can identify that his or her own needs are more important than the clients E) To help nurses to function at a high level

Ans: A, B, E Feedback: Nurses must understand why and how anxiety behaviors work, not just for client care but to help understand the role anxiety plays in performing nursing responsibilities. Nurses are expected to function at a high level and to avoid allowing their own feelings and needs to hinder the care of their clients, but as emotional beings, nurses are just as vulnerable to stress and anxiety as others, and they have needs of their own.

17. Which techniques would be most effective for a client who has situational phobias? Select all that apply. A) Flooding B) Reminding the person to calm down C) Systematic desensitization D) Assertiveness training E) Decatastrophizing

Ans: A, C Feedback: Systematic desensitization is when the therapist progressively exposes the client to a threatening object in a safe setting until the client's anxiety decreases. Flooding is a form of rapid desensitization in which the behavior therapist confronts the client with the phobic object until it no longer produces anxiety. Systematic desensitization and flooding are behavioral therapies used in the treatment of phobias. Assertiveness training would help the person to take more control over life situations. Decatastrophizing helps the client to realistically appraise the situation. These are both used for general anxiety. When a person is exposed to a phobic object, the person is not likely in control. Reminding a person to calm down is not at all an effective way to manage anxiety.

9. Which of the following statements about the use of defense mechanisms in persons with anxiety disorders are accurate? Select all that apply. A) Defense mechanisms are a human's attempt to reduce anxiety. B) Persons are usually aware when they are using defense mechanisms. C) Defense mechanisms can be harmful when overused. D) Defense mechanisms are cognitive distortions. E) The use of defense mechanisms should be avoided. F) Defense mechanisms can control the awareness of anxiety.

Ans: A, C, D, F Feedback: Freud described defense mechanisms as the human's attempt to control awareness of and to reduce anxiety. Defense mechanisms are cognitive distortions that a person uses unconsciously to maintain a sense of being in control of a situation, to lessen discomfort, and to deal with stress. Because defense mechanisms arise from the unconscious, the person is unaware of using them. Some people overuse defense mechanisms, which stops them from learning a variety of appropriate methods to resolve anxiety-producing situations. The dependence on one or two defense mechanisms also can inhibit emotional growth, lead to poor problem-solving skills, and create difficulty with relationships.

25. When a client is experiencing a panic attack while in the recreation room, what interventions are the nurse's first priorities? Select all that apply. A) Provide a safe environment. B) Request a prescription for an antianxiety agent. C) Offer the client therapy to calm down D) Ensure the client's privacy. E) Engage the client in recreational activities.

Ans: A, D Feedback: During a panic attack, the nurse's first concern is to provide a safe environment and to ensure the client's privacy. If the environment is overstimulating, the client should move to a less stimulating place. Decreasing external stimuli will help lower the client's anxiety level. The client's safety is priority. Anxious behavior can be escalated by external stimuli. In a large area, the client can feel lost and panicked, but a smaller room can enhance a sense of security. An antianxiety agent may be helpful, but it is not the priority. It would likely be stimulating to engage the client in recreational activities.

30. The nurse is educating a client and family about managing panic attacks after discharge from treatment. The nurse includes which of the following in the discharge teaching? Select all that apply. A) Continued development of positive coping skills B) Weaning off of medications as necessary C) Lessening the amount of daily responsibilities D) Continued practice of relaxation techniques E) Development of a regular exercise program

Ans: A, D, E Feedback: Client/family education for panic disorder includes reviewing breathing control and relaxation techniques, discussing positive coping strategies, encouraging regular exercise, emphasizing the importance of maintaining prescribed medication regimen and regular follow-up, describing time management techniques such as creating ìto doî lists with realistic estimated deadlines for each activity, crossing off completed items for a sense of accomplishment, saying ìno,î and stressing the importance of maintaining contact with community and participating in supportive organizations. Medication should be adhered to as prescribed. Daily responsibilities cannot be avoided, rather should be successfully accomplished.

24. The nursing student understands correctly when identifying which objective is appropriate for all clients with anxiety disorders? A) The client will experience reduced anxiety and accept the fact that underlying conflicts cannot be treated. B) The client will experience reduced anxiety and develop alternative responses to anxiety-provoking situations. C) The client will experience reduced anxiety and learn to control primitive impulses. D) The client will experience reduced anxiety and strive for insight through psychoanalysis

Ans: B Feedback: A primary client outcome is improved adaptive coping skills.

3. The nursing student answers the test item correctly when identifying which one of the following statements is true? A) Anxiety and fear are the same. B) Anxiety is unavoidable. C) Anxiety is always harmful. D) Fear is feeling threatened by an unknown entity.

Ans: B Feedback: Anxiety is distinguished from fear, which is feeling afraid or threatened by a clearly identifiable external stimulus that represents danger to the person. Anxiety is unavoidable in life and can serve many positive functions such as motivating the person to take action to solve a problem or to resolve a crisis.

15. A nurse is working with a client to develop assertive communication skills. The nurse documents achievement of treatment outcomes when the client makes a statement such as, A) "I'm sorry. I'm not picking this up very quickly." B) "I feel upset when you interrupt me." C) "You are pushing me too hard." D) "I'm not going to let people push me around anymore."

Ans: B Feedback: Assertiveness training helps the person take more control over life situations. Techniques help the person negotiate interpersonal situations and foster self- assurance. They involve using ìIî statements to identify feelings and to communicate concerns or needs to others.

8. A client who suffers from frequent panic attacks describes the attack as feeling disconnected from himself. The nurse notes in the client's chart that the client reports experiencing A) hallucinations. B) depersonalization. C) derealization. D) denial.

Ans: B Feedback: During a panic attack, the client may describe feelings of being disconnected from himself or herself (depersonalization) or sensing that things are not real (derealization). Denial is not admitting reality. Hallucinations involve sensing something that is not there.

4. The student nurse correctly identifies that which one of the following statements applies to the parasympathetic nervous system? A) It is activated during the alarm reaction stage. B) It is activated during the resistance stage. C) It is activated during the exhaustion stage. D) It is commonly referred to as the fight, flight, or freeze response.

Ans: B Feedback: In the alarm reaction stage, stress stimulates the body to send messages to the hypothalamus to the glands, which stimulates the sympathetic nervous system. Sympathetic nerve fibers ìcharge upî the vital signs at any hint of danger to prepare the body's defensesófight, flight, or freeze. The adrenal glands release adrenaline (epinephrine), which causes the body to take in more oxygen, dilate the pupils, and increase arterial pressure and heart rate while constricting the peripheral vessels and shunting blood from the gastrointestinal and reproductive systems and increasing glycogenolysis to release free glucose for the heart, muscles, and central nervous system. When the danger has passed, parasympathetic nerve fibers reverse this process and return the body to normal operating conditions until the next sign of threat reactivates the sympathetic nervous system. During the resistance stage of the generalized anxiety syndrome, if the threat has ended, the parasympathetic nervous system is stimulated and the body responses relax. If the threat persists, the body will eventually enter the exhaustion stage when the body stores are depleted as a result of the continual arousal of the physiologic responses and little reserve capacity.

33. Which of the following would be key points for the nurse to remember when working with persons who are suffering from anxiety disorders? A) It is important for the nurse to ìfixî the client's problems. B) Remember to practice techniques to manage stress and anxiety in your own life. C) If you have any uncomfortable feelings, do not tell anyone about them. D) Remember that only people who suffer from anxiety disorders have stress that can interfere with daily life and work.

Ans: B Feedback: It is critical for the nurse to remember to practice techniques to manage stress and anxiety in his or her own life. Remember that everyone occasionally suffers from stress and anxiety that can interfere with daily life and work. It is important for the nurse to avoid falling into the pitfall of trying to ìfixî the client's problems. It is important that the nurse should discuss any uncomfortable feelings with a more experienced nurse for suggestions on how to deal with his or her feelings toward these clients.

7. A student is preparing to give a class presentation. A few minutes before the presentation is to begin, the student seems nervous and distracted. The student is looking at and listening to the peer speaker and occasionally looking at note cards. When the peer speaker asks a question of the group, the student is able to answer correctly. The professor understands that the student is likely experiencing which level of stress? A) Mild B) Moderate C) Severe D) Panic

Ans: B Feedback: Moderate anxiety is the disturbing feeling that something is definitely wrong; the person becomes nervous or agitated. In moderate anxiety, the person can still process information, solve problems, and learn new things with assistance from others. He or she has difficulty concentrating independently but can be redirected to the topic. Mild anxiety is a sensation that something is different and warrants special attention. Sensory stimulation increases and helps the person focus attention to learn, solve problems, think, act, feel, and protect himself or herself. As the person progresses to severe anxiety and panic, more primitive survival skills take over, defensive responses ensue, and cognitive skills decrease significantly. A person with severe anxiety has trouble thinking and reasoning.

13. Which of the following are interpersonal theories regarding the etiologies of major anxiety disorders? Select all that apply. A) Sigmund Freud's theory B) Henry Stack Sullivan's theory C) Hildegard Peplau's theory D) Pavlov's theory

Ans: B, C Feedback: Theories of anxiety can be classified as intrapsychic/psychoanalytic theories, interpersonal theories, and behavioral theories. Freud's intrapsychic theory views a person's innate anxiety as the stimulus for behavior. Interpersonal theories include Sullivan's theory that anxiety is generated from problems in interpersonal relationships and Peplau's belief that humans exist in interpersonal and physiologic realms. Behavioral theorists view anxiety as being learned through experiences.

28. A client asks how his prescribed alprazolam (Xanax) helps his anxiety disorder. The nurse explains that antianxiety medications such as alprazolam affect the function of which neurotransmitter that is believed to be dysfunctional in anxiety disorders? A) Serotonin B) Norepinephrine C) GABA D) Dopamine

Ans: C Feedback: Gamma-aminobutyric acid (GABA) is the amino acid neurotransmitter believed to be dysfunctional in anxiety disorders. GABA reduces anxiety, and norepinephrine increases it; researchers believe that a problem with the regulation of these neurotransmitters occurs in anxiety disorders. Serotonin is usually implicated in psychosis and mood disorders. Dopamine is indicated in psychosis.

14. The student nurse correctly identifies that according to Selye (1956, 1974), which stage of reaction to stress stimulates the body to send messages from the hypothalamus to the glands and organs to prepare for potential defense needs? A) Resistance B) Exhaustion C) Alarm reaction D) Autonomic

Ans: C Feedback: In the alarm reaction stage, stress stimulates the body to send messages from the hypothalamus to the glands and organs to prepare for potential defense needs. In the resistance stage, the digestive system reduces function to shunt blood to areas needed for defense. The exhaustion stage occurs when the person has responded negatively to anxiety and stress. There is no autonomic stage.

6. A client says to the nurse, "I just can't talk in front of the group. I feel like I'm going to pass out." The nurse assesses the client's anxiety to be at which level? A) Mild B) Moderate C) Severe D) Panic

Ans: C Feedback: Physiologic responses to severe anxiety include headache, nausea, vomiting, diarrhea, trembling, rigid stance, vertigo, pale, tachycardia, and chest pain.

23. The nurse is teaching about postoperative wound care. As the wound is uncovered, the client begins mumbling, breathing rapidly, and trying to get out of bed, and the client does not respond when the nurse calls his name. Which of the following should be the nurse's first action? A) Ask the client to describe his feelings. B) Proceed with wound care quickly. C) Replace the dressing on the wound. D) Get the assistance of another nurse.

Ans: C Feedback: The client has severe anxiety; the priority is to lower the client's anxiety level. The first action should be to replace the dressing on the wound to decrease the client's level of anxiety and to prevent contamination of the wound before a new dressing can be applied. The other choices could be done after replacing the dressing on the wound.

29. The nurse is teaching a client with an anxiety disorder ways to manage anxiety. The nurse suggests which of the following schedules for practicing stress management techniques? A) Practice the techniques each morning and night as part of a daily routine. B) Use the techniques as needed when experiencing severe anxiety. C) Practice the techniques when relatively calm. D) Expect to practice the techniques when meeting with a therapist.

Ans: C Feedback: The nurse can teach the client relaxation techniques to use when he or she is experiencing stress or anxiety, including deep breathing, guided imagery and progressive relaxation, and cognitive restructuring techniques. For any of these techniques, it is important for the client to learn and to practice them when he or she is relatively calm.

18. A client is currently experiencing a panic attack. Which of the following is the most appropriate response by the nurse? A) "Just try to relax." B) "There is nothing here to harm you." C) "You are safe. Take a deep breath." D) "What are you feeling right now?"

Ans: C Feedback: Nursing interventions for panic disorder include providing a safe environment and ensuring the client's privacy during a panic attack, remaining with the client during a panic attack, helping the client to focus on deep breathing, talking to the client in a calm, reassuring voice, teaching the client to use relaxation techniques, helping the client to use cognitive restructuring techniques, and the engaging client to explore how to decrease stressors and anxiety-provoking situations.

32. An anxiolytic agent, lorazepam (Ativan), has been prescribed for the client. Which of the following statements by the client would indicate to the nurse that client education about this medication has been effective? A) "My anxiety will be eliminated if I take this medication as prescribed." B) "This medication presents no risk of addiction or dependence." C) "I will probably always need to take this medication for my anxiety" D) "This medication will relax me, so I can focus on problem solving."

Ans: D Feedback: Anxiolytics are designed for short-term use to relieve anxiety. These drugs are designed to relieve anxiety so that the person can deal more effectively with whatever crisis or situation is causing stress. Benzodiazepines have a tendency to cause dependence. Clients need to know that antianxiety agents are aimed at relieving symptoms such as anxiety but do not treat the underlying problems that cause the anxiety.

10. Which one of the following can be a positive outcome of using defense mechanisms? A) Defense mechanisms can inhibit emotional growth. B) Defense mechanisms can lead to poor problem-solving skills. C) Defense mechanisms can create difficulty with relationships. D) Defense mechanisms can help a person to reduce anxiety.

Ans: D Feedback: Defense mechanisms can help a person to reduce anxiety. This is the only positive outcome of using defense mechanisms. The dependence on defense mechanisms can inhibit emotional growth, lead to poor problem-solving skills, and create difficulty with relationships. These are all negative outcomes of using defense mechanisms.

2. The nurse knows that which one of the following statements is true about stress and anxiety? A) All people handle stress in the same way. B) Stress is a person's reaction to anxiety. C) Anxiety occurs when a person has trouble dealing with life situations, problems, and goals. D) Stress is the wear and tear that life causes on the body.

Ans: D Feedback: Stress is the wear and tear that life causes on the body. It occurs when a person has difficulty dealing with life situations, problems, and goals. Each person handles stress differently. Anxiety is a vague feeling of dread or apprehension; it is a response to external or internal stimuli that can have behavioral, emotional, cognitive, and physical symptoms. Anxiety is a response to stress.

27. A client asks the nurse, "Why do I have to go to counseling? Why can't I just take medications?" The best response by the nurse would be, A) "Both therapies are effective. You can eventually choose one or the other." B) "You cannot get the full effect of your medications without cognitive therapy as well." C) "As soon as your medications reach therapeutic level, you can omit the therapy." D) "Medications combined with therapy help you change how well you function."

Ans: D Feedback: Treatment for anxiety disorders usually involves medication and therapy. This combination produces better results than either one alone.

58. Which teaching need is important when a client is newly prescribed buspirone (BuSpar) 5 mg tid? 1. Encourage the client to avoid drinking alcohol while taking this medication because of the additive central nervous system depressant effects. 2. Encourage the client to take the medication continually as prescribed because onset of action is delayed 2 to 3 weeks. 3. Encourage the client to monitor for signs and symptoms of anxiety to determine need for additional buspirone (BuSpar) PRN. 4. Encourage the client to be compliant with monthly lab tests to monitor for medication toxicity.

Buspirone (BuSpar) is an antianxiety medication that does not depress the central nervous system the way benzodiazepines do. Although its action is unknown, the drug is believed to produce the desired effects through interactions with serotonin, dopamine, and other neurotransmitter receptors. 1. Alcohol consumption is contraindicated while taking any psychotropic medication; however, buspirone (BuSpar) does not depress the cen- tral nervous system, and so there is no addi- tive effect. ✅2. It is important to teach the client that the onset of action for buspirone (BuSpar) is 2 to 3 weeks. Often the nurse may see a benzodiazepine, such as clonazepam, prescribed because of its quick onset of effect, until the buspirone begins working. 3. Buspirone (BuSpar) is not effective in PRN dosing because of the length of time it takes to begin working. Benzodiazepines have a quick onset of effect and are used PRN. 4. No current lab tests monitor buspirone (BuSpar) toxicity. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must understand that bus- pirone (BuSpar) has a delayed onset of action, which can affect medication compliance. If the effects of the medication are delayed, the client is likely to stop taking the medication. Teaching about delayed onset is an important nursing intervention.

31. A client diagnosed with hypersomnia states, "I can't even function anymore; I feel worthless." Which nursing diagnosis would take priority? 1. Risk for suicide R / T expressions of hopelessness. 2. Social isolation R / T sleepiness AEB, "I can't function." 3. Self-care deficit R / T increased need for sleep AEB being unable to take a bath with- out assistance. 4. Chronic low self-esteem R / T inability to function AEB the statement, "I feel worth- less."

Hypersomnia, or somnolence, can be defined as excessive sleepiness or seeking excessive amounts of sleep. Excessive sleepiness interferes with attention, concentration, memory, and produc- tivity. It also can lead to disruption in social and family relationships. Depression is a common side effect of hypersomnia, as are substance- related disorders. ✅1. Verbalizations of worthlessness may indicate that this client is experiencing suicidal ideations. After assessing suicide risk further, the risk for suicide should be prioritized. 2. Social isolation R / T sleepiness would be an appropriate nursing diagnosis for a client diagnosed with hypersomnia because of limited contact with others as a result of increased sleep. Compared with the other nursing diagnoses presented, however, this diagnosis would not take priority. 3. Self-care deficit R / T increased need for sleep AEB being unable to bathe without assistance would be an appropriate nursing diagnosis for a client diagnosed with hypersomnia because of the limited energy for bathing related to increased sleepiness. Compared with the other nursing diagnoses presented, however, this diagnosis would not take priority. 4. Chronic low self-esteem R / T inability to function AEB the statement, "I feel worthless," is an appropriate nursing diagnosis for a client diagnosed with hypersomnia. Compared with the other nursing diagnoses presented, however, this diagnosis would not take priority. TEST-TAKING HINT: All the nursing diagnoses presented document problems associated with hypersomnia. Because the nurse always priori- tizes safety, the nursing diagnosis of risk for suicide takes precedence.

18. Which would the nurse expect to assess in a client suspected to have sleep terror disorder? 1. The client, on awakening, is able to explain the nightmare in vivid detail. 2. The client is easily awakened after the night terror. 3. The client experiences an abrupt arousal from sleep with a piercing scream or cry. 4. The client, when awakening during the night terror, is alert and oriented.

The parasomnia of sleep terrors is closely associ- ated with sleepwalking, and often a night terror episode progresses into a sleepwalking episode. Approximately 1% to 6% of children experience sleep terrors, and the incidence seems to be more common in boys than in girls. Resolution usually occurs spontaneously during adoles- cence. If the disorder begins in adulthood, it usually runs a chronic course. 1. The client, on awakening, is unable to explain the nightmare. On awakening in the morning, the client experiences amnesia about the entire episode. 2. The client is not easily awakened after the night terror. The client is often difficult to awaken or comfort. ✅3. During a sleep terror, the client does experience an abrupt arousal from sleep with a piercing scream or cry. 4. The client, on awakening during a night terror, is usually disoriented, not alert and oriented. The client expresses a sense of intense fear, but cannot recall the dream episode. TEST-TAKING HINT: To answer this question correctly, the test taker must understand the characteristics associated with sleep terrors.

29. Which of the following symptom assessments would validate the diagnosis of general- ized anxiety disorder? Select all that apply. 1. Excessive worry about items difficult to control. 2. Muscle tension. 3. Hypersomnia. 4. Excessive amounts of energy. 5. Feeling "keyed up" or "on edge."

✅ 1. A client diagnosed with generalized anxiety disorder (GAD) would experience excessive worry about items difficult to control. ✅2. A client diagnosed with GAD would experience muscle tension. 3. A client diagnosed with GAD would experi- ence insomnia, not hypersomnia. Sleep dis- turbances would include difficulty falling asleep, difficulty staying asleep, and restless sleep. 4. A client diagnosed with GAD would be easily fatigued and not experience excessive amounts of energy. ✅5. A client diagnosed with GAD would experience an increased startle reflex and tension, causing feelings of being "keyed up" or being "on edge." TEST-TAKING HINT: To answer this question cor- rectly, the test taker would need to recognize the signs and symptoms of GAD.

19. Which of the following would the nurse expect to assess in a client diagnosed with posttraumatic stress disorder? Select all that apply. 1. Dissociative events. 2. Intense fear and helplessness. 3. Excessive attachment and dependence toward others. 4. Full range of affect. 5. Avoidance of activities that are associated with the trauma.

✅ 1. A client diagnosed with posttraumatic stress disorder (PTSD) may have dissociative events in which the client feels detached from the situation or feelings ✅2. A client diagnosed with PTSD may have intense fear and feelings of helplessness. 3. A client diagnosed with PTSD has feelings of detachment or estrangement toward others, not excessive attachment and dependence. 4. A client diagnosed with PTSD has restricted, not full, range of affect. ✅5. A client diagnosed with PTSD avoids activ- ities associated with the traumatic event. TEST-TAKING HINT: To answer this question correctly, the test taker must be aware of the different symptoms associated with the diagnosis of PTSD

33. A client leaving home for the first time in a year arrives on the psychiatric in-patient unit wearing a surgical mask and white gloves and crying, "The germs in here are going to kill me." Which nursing diagnosis addresses this client's problem? 1. Social isolation R / T fear of germs AEB continually refusing to leave the home. 2.Fear of germs R/T obsessive-compulsive disorder, resulting in dysfunctional isolation. 3. Ineffective coping AEB dysfunctional isolation R / T unrealistic fear of germs. 4. Anxiety R / T the inability to leave home, resulting in dysfunctional fear of germs.

✅ 1. According to the North American Nursing Diagnosis Association (NANDA), the nursing diagnosis format must contain three essential components: (1) identification of the health problem, (2) presentation of the etiology (or cause) of the problem, and (3) description of a cluster of signs and symptoms known as "defining characteristics." The correct answer, "1," contains all three components in the correct order: health problem/NANDA stem (social isolation); etiology/cause, or R / T (fear of germs); and signs and symptoms, or AEB (refusing to leave home for the past year). Because this client has been unable to leave home for a year as a result of fear of germs, the client's behaviors meet the defining char- acteristics of social isolation. 2. Obsessive-compulsive disorder is a medical diagnosis and cannot be used in any compo- nent of the nursing diagnosis format. Nursing diagnoses are functional client problems that fall within the scope of nursing practice. Also missing from this nursing diagnosis are the signs and symptoms, or AEB, component of the problem. 3. The etiology (R / T) and signs and symptoms (AEB) are out of order in this nursing diagnostic statement. 4. The inability to leave home is a sign or symp- tom, which is the third component of the nursing diagnosis format (AEB) not the cause of the problem (R / T statement). TEST-TAKING HINT: To answer this question correctly, the test taker needs to know the components of a correctly stated nursing diagnosis and the order in which these components are written

35. A client newly admitted to an in-patient psychiatric unit is diagnosed with obsessive- compulsive disorder. Which correctly stated nursing diagnosis takes priority? 1. Anxiety R / T obsessive thoughts AEB ritualistic behaviors. 2. Powerlessness R / T ritualistic behaviors AEB statements of lack of control. 3. Fear R / T a traumatic event AEB stimulus avoidance. 4. Social isolation R / T increased levels of anxiety AEB not attending groups.

✅1 Anxiety is the underlying cause of the diagnosis of obsessive compulsive disorder (OCD), therefore, anxiety R/T obsessive thoughts is the priority nursing diagnosis for the client newly admitted for the treatment of this disorder. 2. Powerlessness R / T ritualistic behaviors is an appropriate nursing diagnosis for a client diagnosed with OCD; however, for the client to begin working on feelings of powerlessness, the level of anxiety must be decreased first. 3. Fear R / T a traumatic event AEB stimulus avoidance would be an appropriate nursing diagnosis for a client diagnosed with post- traumatic stress disorder, not for a client diagnosed with OCD. 4. Social isolation R / T increased levels of anxi- ety is an appropriate diagnosis for a client diagnosed with OCD; however, anxiety must be decreased before the client can work on socializing. TEST-TAKING HINT: When the question is asking for a priority, the test taker should consider which client problem would need to be addressed before any other problem can be explored. When anxiety is decreased, social isola- tion should improve, and feelings about power- lessness can be expressed.

56. Which of the following medications can be used to treat clients with anxiety disorders? Select all that apply. 1. Clonidine hydrochloride (Catapres). 2. Fluvoxamine maleate (Luvox). 3. Buspirone (BuSpar). 4. Alprazolam (Xanax). 5. Haloperidol (Haldol).

✅1. Clonidine hydrochloride (Catapres) is used in the treatment of panic disorders and generalized anxiety disorder. ✅ 2. Fluvoxamine maleate (Luvox) is used in the treatment of obsessive-compulsive disorder. ✅3. Buspirone (BuSpar) is used in the treat- ment of panic disorders and generalized anxiety disorders. ✅4. Alprazolam (Xanax), a benzodiazepine, is used for the short-term treatment of anxi- ety disorders. 5. Haloperidol (Haldol) is an antipsychotic used to treat thought disorders, not anxiety disorders. TEST-TAKING HINT: To answer this question cor- rectly, the test taker needs to understand that many medications are used off-label to treat anx- iety disorders.

40. A newly admitted client diagnosed with social phobia has a nursing diagnosis of social isolation R/T fear of ridicule. Which outcome is appropriate for this client? 1. The client will participate in two group activities by day 4. 2. The client will use relaxation techniques to decrease anxiety. 3. The client will verbalize one positive attribute about self by discharge. 4. The client will request buspirone (BuSpar) PRN to attend group by day 2.

✅1. Expecting the client to participate in a set number of group activities by day 4 directly relates to the stated nursing diagnosis of social isolation and is a measurable outcome that includes a timeframe. 2. Although the nurse may want the client to use relaxation techniques to decrease anxiety, this outcome does not have a timeframe and is not measurable. 3. Having the client verbalize one positive attribute about self by discharge relates to the nursing diagnosis of low self-esteem, not social isolation. 4.Buspirone (BuSpar) is not used on a PRN basis, and so this is an inappropriate outcome for this client. TEST-TAKING HINT: To express an appropriate outcome, the statement must be related to the stated problem, be measurable and attainable, and have a timeframe. The test taker can elimi- nate "2" immediately because there is no time- frame, and then "3" because it does not relate to the stated problem.

45. A 10-year-old client diagnosed with nightmare disorder is admitted to an in-patient psychiatric unit. Which of the following interventions would be appropriate for this client's problem? Select all that apply. 1. Involving the family in therapy to decrease stress within the family. 2. Using phototherapy to assist the client to adapt to changes in sleep. 3. Administering medications such as tricyclic antidepressants or low-dose benzodiazepines or both. 4. Giving central nervous system stimulants, such as amphetamines. 5. Using relaxation therapy, such as meditation and deep breathing techniques, to assist the client in falling asleep.

✅1. Family stress can occur as the result of repeated client nightmares. This stress within the family may exacerbate the client's problem and hamper any effective treatment. Involving the family in therapy to relieve obvious stress would be an appropriate intervention to assist in the treatment of clients diagnosed with a nightmare disorder. 2. Phototherapy to assist clients to adapt to changes in sleep would be an appropriate intervention for clients diagnosed with circa- dian rhythm sleep disorders, not nightmare disorder. Phototherapy, or "bright light" therapy, has been shown to be effective in treating the circadian rhythm sleep disorders of delayed sleep phase disorder and jet lag. ✅3. Administering medications such as tricyclic antidepressants or low-dose benzodiazepines or both is an appropriate intervention for clients diagnosed with a parasomnia disorder, such as a nightmare disorder. 4. Giving central nervous system stimulants, such as amphetamines, would be an appropri- ate intervention for clients diagnosed with hypersomnia, not a nightmare disorder. ✅5. Relaxation therapy, such as meditation and deep breathing techniques, would be appropriate for clients diagnosed with a nightmare disorder to assist in falling back to sleep after the nightmare occurs. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must be able first to under- stand the manifestation of a nightmare disorder and then to choose the interventions that would address these manifestations effectively.

9. Which nursing diagnosis reflects the intrapersonal theory of the etiology of obsessive- compulsive disorder? 1. Ineffective coping R / T punitive superego. 2. Ineffective coping R / T active avoidance. 3. Ineffective coping R / T alteration in serotonin. 4. Ineffective coping R / T classic conditioning.

✅1. Ineffective coping R/T punitive superego reflects an intrapersonal theory of the etiology of obsessive-compulsive disorder (OCD). The punitive superego is a concept contained in Freud's psychosocial theory of personality development. 2. Ineffective coping R / T active avoidance reflects a behavioral, not intrapersonal, theory of the etiology of OCD. 3. Ineffective coping R / T alteration in sero- tonin reflects a biological, not intrapersonal, theory of the etiology of OCD. 4. Ineffective coping R / T classic conditioning reflects a behavioral, not intrapersonal, theo- ry of the etiology of OCD. TEST-TAKING HINT: To answer this question cor- rectly, the test taker needs to understand the different theories of the etiology of OCD. The keyword "intrapersonal" should make the test taker look for a concept inherent in this theory, such as "punitive superego."

38. A hospitalized client diagnosed with posttraumatic stress disorder has a nursing diag- nosis of ineffective coping R/T history of rape AEB abusing alcohol. Which is the expected short-term outcome for this client problem? 1. The client will recognize triggers that precipitate alcohol abuse by day 2. 2. The client will attend follow-up weekly therapy sessions after discharge. 3. The client will refrain from self-blame regarding the rape by day 2. 4. The client will be free from injury to self throughout the shift.

✅1. It is a realistic expectation for a client who copes with previous trauma by abusing alcohol to recognize the triggers that precipitate this behavior. This outcome should be developed mutually early in treatment. 2. Attending follow-up weekly therapy sessions after discharge is a long-term, not short-term, outcome. 3. Expecting the client to refrain from self- blame regarding the rape by day 2 would be an unrealistic outcome. Clients who experi- ence traumatic events need extensive out- patient therapy. 4. Being free from injury does not relate to the nursing diagnosis of ineffective coping. TEST-TAKING HINT: It is important to relate out- comes to the stated nursing diagnosis. In this question, the test taker should choose an answer that relates to the nursing diagnosis of ineffective coping. Answer "4" can be eliminated immedi- ately because it does not assist the client in cop- ing more effectively. Also, the test taker must note important words, such as "short-term." Answer "2" can be eliminated immediately because it is a long-term outcome.

41. When a client experiences a panic attack, which outcome takes priority? 1. The client will remain safe throughout the duration of the panic attack. 2. The client will verbalize an anxiety level less than 2/10. 3. The client will use learned coping mechanisms to decrease anxiety. 4. The client will verbalize the positive effects of exercise by day 2.

✅1. Remaining safe throughout the duration of the panic attack is the priority outcome for the client 2. Although a decreased anxiety level is a desired outcome for a client experiencing panic, this outcome is not measurable because it con- tains no timeframe. 3. Although the use of coping mechanisms to decrease anxiety is a desired outcome, this outcome is not measurable because it con- tains no timeframe. 4. The verbalization of the positive effects of exercise is a desired outcome, and it contains a timeframe that is measurable. This would be an unrealistic outcome, however, for a client experiencing a panic attack. TEST-TAKING HINT: All outcomes must be appro- priate for the situation described in the question. In the question, the client is experiencing a panic attack; having the client verbalize the positive effects of exercise would be inappropriate. All out- comes must be client-centered, specific, realistic, positive, and measurable, and contain a timeframe

51. A client diagnosed with generalized anxiety disorder complains of feeling out of con- trol and states, "I just can't do this anymore." Which nursing action takes priority at this time? 1. Ask the client, "Are you thinking about harming yourself?" 2. Remove all potentially harmful objects from the milieu. 3. Place the client on a one-to-one observation status. 4. Encourage the client to verbalize feelings during the next group.

✅1. The nurse should recognize the statement, "I can't do this anymore," as evidence of hopelessness and assess further the potential for suicidal ideations. 2.Removing all potentially harmful objects from the milieu can be an appropriate inter- vention, but only after the severity of client risk is determined. This assessment is critical for the nurse to intervene appropriately and in a timely manner. 3. Placing the client on a one-to-one observa- tion status can be an appropriate intervention, but only after the severity of client risk is determined. This assessment is critical for the nurse to intervene appropriately and in a timely manner. 4. Although it is important for the client to verbalize feelings, this does not take priority at this time. Suicidal risk needs to be determined to ensure client safety by implementation of appropriate and timely nursing interventions TEST-TAKING HINT: To answer this question cor- rectly, the test taker should apply the nursing process. Assessment is the first step of this process. The nurse initially must assess a situation before determining appropriate nursing interventions.

50. The nurse on the in-patient psychiatric unit should include which of the following interventions when working with a newly admitted client diagnosed with obsessive- compulsive disorder? Select all that apply. 1. Assess previously used coping mechanisms and their effects on anxiety. 2. Allow time for the client to complete compulsions. 3. With the client's input, set limits on ritualistic behaviors. 4. Present the reality of the impact the compulsions have on the client's life. 5. Discuss client feelings surrounding the obsessions and compulsions.

✅1. When a client is newly admitted, it is important for the nurse to assess past coping mechanisms and their effects on anxiety. Assessment is the first step in the nursing process, and this information needs to be gathered to intervene effectively. ✅2.Allowing time for the client to complete compulsions is important for a client who is newly admitted. If compulsions are lim- ited, anxiety levels increase. If the client had been hospitalized for a while, then, with the client's input, limits would be set on the compulsive behaviors. ✅3. The nurse would set limits on ritualistic behaviors, with the client's input, later in the treatment process, not when a client is newly admitted. 4. A newly admitted client who is exhibiting compulsions is experiencing a high level of anxiety. To present the impact of these compulsions on daily living would be inappropriate at this time and may lead to further increases in anxiety. Clients diagnosed with obsessive-compulsive disorder are aware that their compulsions are "different." ✅5. It is important for the nurse to allow the client to express his or her feelings about the obsessions and compulsions. This assessment of feelings should begin at admission. TEST-TAKING HINT: It is important for the test taker to note the words "newly admitted" in the question. The nursing interventions implement- ed vary and are based on length of stay on the unit, along with client's insight into his or her disorder. For clients with obsessive-compulsive disorder, it is important to understand that the compulsions are used to decrease anxiety. If the compulsions are limited, anxiety increases. Also, the test taker must remember that during treat- ment it is imperative that the treatment team includes the client in decisions related to any limitation of compulsive behaviors.

13. Which charting entry documents a subjective assessment of sleep patterns? 1. "Reports satisfaction with the quality of sleep since admission." 2. "Slept 8 hours during night shift." 3. "Rates quality of sleep as 3/10." 4. "Woke up three times during the night."

✅1. When the client reports satisfaction with the quality of sleep, the client is providing subjective assessment data. Good sleepers self-define themselves as getting enough sleep and feeling rested. These individuals feel refreshed in the morning, have energy for daily activities, fall asleep quickly, and rarely awaken during the night. 2. The number of hours a client has slept during the night is an objective assessment of sleep. Sleep can be observed objectively by noting closed eyes, snoring sounds, and regular breathing patterns. 3. The use of a sleep scale objectifies the subjec- tive symptom of sleep quality. 4. The number of midnight awakenings is an objective assessment of sleep. Even though the client reports this assessment, the number of midnight awakenings is objective data. TEST-TAKING HINT: The test taker must look for an answer choice that meets the criteria of a subjective assessment. Subjective symptoms are symptoms of internal origin, evident only to the client.

27. Anxiety is a symptom that can result from which of the following physiological condi- tions? Select all that apply. 1. Chronic obstructive pulmonary disease. 2. Hyperthyroidism. 3. Hypertension. 4. Diverticulosis. 5. Hypoglycemia.

✅1.Chronic obstructive pulmonary disease causes shortness of breath. Air deprivation causes anxiety, sometimes to the point of panic. ✅2. Hyperthyroidism (Graves's disease) involves excess stimulation of the sympa- thetic nervous system and excessive levels of thyroxine. Anxiety is one of several symptoms brought on by these increases. 3. Hypertension is an often asymptomatic disor- der characterized by persistently elevated blood pressure. Hypertension may be caused by anxiety, in contrast to anxiety being the result of hypertension. 4. Diverticulosis results from the outpocketing of the colon. Unless these pockets become inflamed, diverticulosis is generally asympto- matic. ✅5. Marked irritability and anxiety are some of the many symptoms associated with hypoglycemia. TEST-TAKING HINT: To answer this question cor- rectly, the test taker needs to understand that anxiety is manifested by physiological responses.

47. A client on an in-patient psychiatric unit is experiencing a flashback. Which interven- tion takes priority? 1. Maintain and reassure the client of his or her safety and security. 2. Encourage the client to express feelings. 3. Decrease extraneous external stimuli. 4. Use a nonjudgmental and matter-of-fact approach.

✅1.During a flashback, the client is experiencing severe-to-panic levels of anxiety; the priority nursing intervention is to maintain and reassure the client of his or her safety and security. The client's anxiety needs to decrease before other interventions are attempted. 2. Encouraging the client to express feelings during a flashback would only increase the client's level of anxiety. The client's anxiety level needs to decrease to a mild or moderate level before the nurse encourages the client to express feelings. 3. Although the nurse may want to decrease external stimuli in an attempt to reduce the client's anxiety, ensuring safety and security takes priority. 4. It is important for the nurse to be nonjudg- mental and use a matter-of-fact approach when dealing with a client experiencing a flashback. However, because this client is experiencing a severe-to-panic level of anxi- ety, safety is the priority. TEST-TAKING HINT: It is important to understand time-wise interventions when dealing with indi- viduals experiencing anxiety. When the client experiences severe-to-panic levels of anxiety dur- ing flashbacks, the nurse needs to maintain safety and security until the client's level of anxiety has decreased.

44. A client diagnosed with generalized anxiety disorder has a nursing diagnosis of panic anxiety R/T altered perceptions. Which of the following short-term outcomes is most appropriate for this client? 1. The client will be able to intervene before reaching panic levels of anxiety by discharge. 2. The client will verbalize decreased levels of anxiety by day 2. 3. The client will take control of life situations by using problem-solving methods effectively. 4. The client will voluntarily participate in group therapy activities by discharge.

✅1.The client's being able to intervene before reaching panic levels of anxiety by dis- charge is measurable, relates to the stated nursing diagnosis, has a timeframe, and is an appropriate short-term outcome for this client. 2. The "verbalization of decreased levels of anxiety" in this outcome is neither specific nor measurable. Instead of a general "decrease" in anxiety, the use of an anxiety scale would make this outcome measurable. 3. The client's taking control of life situations by effectively using problem-solving methods relates to the stated nursing diagnosis; how- ever, it does not have a timeframe and so is not measurable. 4. The client's being able to participate vol- untarily in group therapy activities is a short- term outcome; however, this outcome does not relate to the stated nursing diagnosis. TEST-TAKING HINT: When evaluating outcomes, the test taker must make sure that the outcome is specific to the client's need, is realistic, is measurable, and contains a reasonable time- frame. If any of these components is missing, the outcome is incorrectly written and can be eliminated.

55. The nurse is using a cognitive intervention to decrease anxiety during a client's panic attack. Which statement by the client would indicate that the intervention has been successful? 1. "I reminded myself that the panic attack would end soon, and it helped." 2. "I paced the halls until I felt my anxiety was under control." 3. "I felt my anxiety increase, so I took lorazepam (Ativan) to decrease it." 4. "Thank you for staying with me. It helped to know staff was there."

✅1.This statement is an indication that the cognitive intervention was successful. By remembering that panic attacks are self-limiting, the client is applying the information gained from the nurse's cognitive intervention. 2. This statement is an indication that a behav- ioral, not cognitive, intervention was imple- mented by the nurse. From a behavioral perspective, the nurse has taught this client that exercise can decrease anxiety. 3. This statement is an indication that the nurse implemented a biological, not cognitive, intervention. From a biological perspective, the nurse has taught this client that anxiolytic medication can decrease anxiety. 4. This statement is an indication that the nurse implemented an interpersonal, not cognitive, intervention. From an interpersonal perspective, the nurse has taught this client that a social support system can decrease anxiety. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand which interventions support which theories of causation. When looking for a "cognitive" inter- vention, the test taker must remember that the theory involves thought processes.

25. A client newly admitted to an in-patient psychiatric unit is diagnosed with obsessive- compulsive disorder. Which behavioral symptom would the nurse expect to assess? 1. The client uses excessive hand washing to relieve anxiety. 2. The client rates anxiety at 8/10. 3. The client uses breathing techniques to decrease anxiety. 4. The client exhibits diaphoresis and tachycardia.

✅1.Using excessive hand washing to relieve anxiety is a behavioral symptom exhibited by clients diagnosed with obsessive- compulsive disorder (OCD). 2 The verbalization of anxiety is not classified as a behavioral symptom of OCD. 3. Using breathing techniques to decrease anxiety is a behavioral intervention, not a behavioral symptom. 4. Excessive sweating and increased pulse are biological, not behavioral, symptoms of OCD TEST-TAKING HINT: To answer this question cor- rectly, the test taker must be able to differentiate various classes of symptoms exhibited by clients diagnosed with OCD. The keyword "behavioral" determines the correct answer to this question.

3. A client diagnosed with posttraumatic stress disorder is close to discharge. Which client statement would indicate that teaching about the psychosocial cause of posttraumatic stress disorder was effective? 1. "I understand that the event I experienced, how I deal with it, and my support system all affect my disease process." 2. "I have learned to avoid stressful situations as a way to decrease emotional pain." 3. "So, natural opioid release during the trauma caused my body to become 'addicted.'" 4. "Because of the trauma, I have a negative perception of the world and feel hopeless."

✅1.When the client verbalizes understanding of how the experienced event, individual traits, and available support systems affect his or her diagnosis, the client demon- strates a good understanding of the psy- chosocial cause of posttraumatic stress disorder (PTSD). 2. Avoiding situations as a way to decrease emo- tional pain is an example of a learned, not psychosocial, cause of PTSD. 3. The release of natural opioids during a trau- matic event is an example of a biological, not psychosocial, cause of PTSD. 4 Having a negative perception of the world because of a traumatic event is an example of a cognitive, not psychosocial, cause of PTSD TEST-TAKING HINT: To answer this question cor- rectly, the test taker should review the different theories as they relate to the causes of different anxiety disorders, including PTSD. Only "1" describes a psychosocial etiology of PTSD.

57. A client is prescribed alprazolam (Xanax) 2 mg bid and 1.5 mg q6h PRN for agita- tion. The maximum daily dose of alprazolam is 10 mg/d. The client can receive _____ PRN doses of alprazolam within a 24-hour period.

✅4 The client can receive 4 PRN doses. Medications are given four times in a 24-hour period when the order reads q6h: 1.5 mg X 4 = 6 mg. The test taker must factor in 2 mg bid = 4 mg. These two dosages together add up to 10 mg, the maximum daily dose of alprazolam (Xanax), and so the client can receive all 4 PRN doses. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must recognize that the tim- ing of standing medication may affect the deci- sion-making process related to administration of PRN medications. In this case, the client would be able to receive all possible doses of PRN med- ication because the standing and PRN ordered medications together do not exceed the maxi- mum daily dose.

15. Which of the following situations is a common reason for the elderly to experience sleep disturbances? Select all that apply. 1. Discomfort or pain or both. 2. Dementia. 3. Inactivity. 4. Anxiety. 5. Medications.

✅All are correct Sleep disturbances include hypersomnia and insomnia. 1. Chronic conditions, such as arthritis and joint and muscle discomfort and pain, rep- resent some of the many reasons why elderly clients are at an increased risk for sleep disturbances. 2. Confusion and wandering as a result of dementia can be a reason why elderly clients are at an increased risk for sleep disturbances. 3. Inactivity and other psychosocial concerns, such as loneliness or boredom, can be a reason why elderly clients are at an increased risk for sleep disturbances. 4. Increased anxiety is a reason why elderly clients can be at an increased risk for sleep disturbances. 5. Medications have many side effects, including insomnia, and medications are metabolized differently in elderly clients. Many elderly clients, because of chronic conditions, experience polypharmacy, and so they are at higher risk for sleep disturbances. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must understand the differ- ent biological and psychosocial factors that may influence the sleep patterns of elderly clients.

4. Counselors have been sent to a location that has experienced a natural disaster to assist the population to deal with the devastation. This is an example of __________________ prevention.

✅Primary Sending counselors to a natural disaster site to assist individuals to deal with the devastation is an example of primary prevention. Primary prevention reduces the incidence of mental disorders, such as posttraumatic stress disorder, within the population by helping individuals to cope more effectively with stress early in the grieving process. Primary prevention is extremely important for individuals who experience any traumatic event, such as a rape, war, hurricane, tornado, or school shooting. TEST-TAKING HINT: To answer this question cor- rectly, it is necessary to understand the differences between primary, secondary, and tertiary prevention.

6. After being diagnosed with pyrophobia, the client states, "I believe this started at the age of 7 when I was trapped in a house fire." When examining theories of phobia etiology, this situation would be reflective of ____________ theory.

✅learning thoery When examining theories of phobia etiology, this situation would be reflective of learning theory. Some learning theorists believe that fears are conditioned responses, and they are learned by imposing rewards for certain behaviors. In the instance of phobias, when the individual avoids the phobic object, he or she escapes fear, which is a powerful reward. This client has learned that avoiding the stimulus of fire eliminates fear. TEST-TAKING HINT: To answer this question correctly, the test taker needs to review the different theories of the causation of specific phobias.

26. A client is learning to cope with anxiety and stress. The expected outcome is that the client will A) change reactions to stressors. B) ignore situations that cause stress. C) limit major stressors in his or her life. D) avoid anxiety at all costs.

Ans: A Feedback: Stress and anxiety in life are unavoidable; managing the effects of stress is a reasonable goal for treatment. It is not possible or desirable to avoid anxiety at all costs as anxiety is a warning that the client is not dealing with stress effectively. Learning to heed this warning and to make needed changes is a healthy way to deal with the stress of daily events.

10. The nurse is using an intrapersonal approach to assist a client in dealing with survivor's guilt. Which intervention would be appropriate? 1. Encourage the client to attend a survivor's group. 2. Encourage expression of feelings during one-to-one interactions with the nurse. 3. Ask the client to challenge the irrational beliefs associated with the event. 4. Administer regularly scheduled paroxetine (Paxil) to deal with depressive symptoms.

1. Encouraging a client to attend group is an interpersonal, not intrapersonal, approach to treating survivor's guilt associated with PTSD. ✅2. Encouraging expressions of feelings during one-to-one interactions with the nurse is an intrapersonal approach to interventions that treat survivor's guilt associated with PTSD. 3. Asking the client to challenge the irrational beliefs associated with the event is a cogni- tive, not intrapersonal, intervention to treat survivor's guilt associated with PTSD. 4. Administering regularly scheduled paroxetine (Paxil) is a biological, not intrapersonal, intervention to treat survivor's guilt associated with PTSD. TEST-TAKING HINT: To answer this question correctly, the test taker needs to differentiate various theoretical approaches and which inter- ventions reflect these theories.

49. A client diagnosed with obsessive-compulsive disorder has been hospitalized for the last 4 days. Which intervention would be a priority at this time? 1. Notify the client of the expected limitations on compulsive behaviors. 2. Reinforce the use of learned relaxation techniques. 3. Allow the client the time needed to complete the compulsive behaviors. 4. Say "stop" to the client as a thought-stopping technique.

1.The nurse would include, not notify, the client when making decisions to limit compulsive behaviors. To be successful, the client and the treatment team must be involved with the development of the plan of care. ✅2. It is important for the client to learn tech- niques to reduce overall levels of anxiety to decrease the need for compulsive behaviors. The teaching of these tech- niques should begin by day 4. 3. By day 4, the nurse, with the client's input, should begin setting limits on the compulsive behaviors. 4. The client, not the nurse, should say the word "stop" as a technique to limit obsessive thoughts and behaviors.

5. The nurse plans to teach a client about dietary modifications to manage diabetes. Teaching would be most effective if the client displayed which one of the following characteristics? A) Focusing only on immediate task B) Faster rate of speech C) Narrowed perceptual field D) Heightened focus

Ans: D Feedback: Mild anxiety is associated with increased learning ability. It involves a sensation that something is different and warrants special attention. Sensory stimulation increases and helps the person focus attention to learn, solve problems, think, act, feel, and protect himself or herself. Mild anxiety often motivates people to make changes or to engage in goal-directed activity. Focusing only on immediate task, a faster rate of speech, and a narrowed perceptual field are associated with moderate levels of anxiety.

21. The nurse enters the client's room and finds the client anxiously pacing the floor. The client begins shouting at the nurse, "Get out of my room!" The best intervention by the nurse would be to A) approach the client and ask, "What's wrong?" B) call for help and say, "Calm down." C) turn and walk away from the room without saying anything. D) stand at the doorway and say, "You seem upset."

Ans: D Feedback: Staying with the client while allowing personal space is an important and safe intervention; this therapeutic communication technique is designed to get the client to communicate feelings. It may not be safe for the nurse to approach the client. Help is not needed at this time, and saying, ìCalm down,î is not effective. Turning and walking away from the client may seem like rejection and may worsen the client's anxiety as well as damage the nurseñclient relationship

16. A client has been diagnosed with insomnia. Which of the following data would the nurse expect to assess? Select all that apply. 1. Daytime irritability. 2. Problems with attention and concentration. 3. Inappropriate use of substances. 4. Nightmares. 5. Sleepwalking.

Primary insomnia may manifest by a combination of difficulty falling asleep and intermittent wakefulness during sleep. ✅1. Lack of sleep results in daytime irritability. ✅2. Lack of sleep results in problems with attention and concentration. ✅3. Individuals diagnosed with insomnia may inappropriately use substances, including hypnotics for sleep and stimulants to counteract fatigue. 4. Nightmares are frightening dreams that occur during sleep. Because clients diagnosed with insomnia have trouble sleeping, nightmares are not a characteristic of this disorder. 5. Sleepwalking is characterized by the performance of motor activity during sleep, not wakefulness, in which the individ- ual may leave the bed and walk about, dress, go to the bathroom, talk, scream, and even drive TEST-TAKING HINT: The test taker must recognize the symptoms of insomnia to answer this ques- tion correctly.

60. A client is prescribed lorazepam (Ativan) 0.5 mg qid and 1 mg PRN q8h. The maxi- mum daily dose of lorazepam should not exceed 4 mg QD. This client would be able to receive ______ PRN doses as the maximum number of PRN lorazepam doses.

✅2 This client should receive 2 PRN doses. The test taker must recognize that medications are given three times in a 24-hour period when the order reads q8h: 1 mg X 3 = 3 mg. The test taker must factor in the 0.5 mg qid = 2 mg. These two dosages together add up to 5 mg, 1 mg above the maximum daily dose of lorazepam (Ativan). The client would be able to receive only two of the three PRN doses of lorazepam. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize that the timing of standing medication may affect the decision-making process related to administra- tion of PRN medications. In this case, although the PRN medication is ordered q8h, and could be given three times, the standing medication dosage limits the PRN to two doses, each at least 8 hours apart.

2. An overuse or ineffective use of ego defense mechanisms, which results in a maladaptive response to anxiety, is an example of the ___________________ theory of generalized anxiety disorder development.

✅psychodynamic An overuse or ineffective use of ego defense mechanisms, which results in a maladaptive response to anxiety, is an example of the PSYCHODYNAMIC theory of generalized anxiety disorder development. TEST-TAKING HINT: To answer this question correctly, the test taker should review the various theories related to the development of generalized anxiety disorder.