anxiety disorders

A client is admitted to an inpatient psychiatric unit for treatment of obsessive-compulsive disorder (OCD) symptoms. When the client's partner asks what OCD is, what is the appropriate nursing response?

"Clients with OCD experience repetitive thoughts and recurring, irresistible impulses."

The nurse is preparing to administer diazepam to a client. Which teaching about this drug will the nurse provide to the client?

"Do not drive while taking this medication."

A client who has been prescribed lorazepam is being discharged. What teaching will the nurse provide?

"Do not use alcohol when taking this drug."

A client in a psychiatric facility is prescribed a selective serotonin reuptake inhibitor (SSRI) for depression. The client tells the nurse they have had three seizures after taking the drug for 2 weeks. What question would be appropriate to ask at this time?

"Do you take any herbs, such as St. John's wort or evening primrose?"

The nurse is caring for a client with posttraumatic stress disorder (PTSD) and the family informs the nurse that loud noises cause a serious anxiety response. Which explanation by the nurse would help the family understand the client's response?

"Environmental triggers can cause the client to react emotionally."

The nurse is caring for a client who has post-traumatic stress disorder (PTSD) after a sexual assault. Which client statement is consistent with the diagnosis of PTSD?

"I keep having visions of the event happening."

A client has been diagnosed with an anxiety disorder and is refusing any form of prescribed therapy and medication. The client states, "I am going to try to use an internet support group since it is free." What is the best response by the nurse?

"I need to reinforce that any advice obtained from the internet should be used with caution."

The nurse notices that a client with obsessive-compulsive disorder dresses and undresses numerous times each day. Which comment by the nurse would be therapeutic?

"I saw you change clothes several times today. That must be very tiring."

A client is given triazolam for a sleep disorder. The nurse is reinforcing some teaching precautions concerning the medication. Which statements by the client indicate an understanding of the information provided?

"I shouldn't confuse this medication with Haldol."

A nurse is reinforcing education for a client who has been prescribed buspirone for long-term treatment of anxiety. The nurse determines that the education has been effective when which statement is made by the client?

"I will not take the medicine with grapefruit juice."

A client, age 40, is admitted for a surgical biopsy of a suspicious lump in her left breast. When the nurse comes to take her to surgery, she is tearfully finishing a letter to her two children. She tells the nurse, "I want to leave this for my children in case anything goes wrong today." Which response by the nurse would be most therapeutic?

"In case anything goes wrong? What are your thoughts and feelings right now?"

Which statement made by the nurse would be useful when reinforcing education for the client and family about phobias and the need for a strong support system?

"The family plays a role in promoting client independence."

A woman, age 18, is highly dependent on her parents and fears leaving home to go away to college. Shortly before the fall semester starts, she complains that her legs are paralyzed and is rushed to the emergency department. When physical examination rules out a physical cause for her paralysis, the physician admits her to the psychiatric unit where she is diagnosed with functional neurologic symptom disorder. The client asks the nurse, "Why has this happened to me?" What is the most appropriate response?

"Your problem is real but there is no physical basis for it. We'll work on what is going on in your life to find out why it's happened."

The nurse is working with a client with a generalized anxiety disorder who is experiencing a panic attack. What statements should nurse make to the client? Select all that apply.

-"I am here with you." -"You are safe." -"Take some deep breaths."

A client comes to the mental health clinic with suspected obsessive-compulsive disorder (OCD). The client explains that the compulsion to wash hands is interfering with employment. Which interventions are appropriate when caring for a client with OCD? Select all that apply.

-Support the use of appropriate defense mechanisms. -Explore the patterns leading to the compulsive behavior. -Encourage activities, such as listening to music.

An 8-year-old child, diagnosed with obsessive-compulsive disorder, is admitted by the nurse to a psychiatric facility. When gathering data from the client, which behaviors would be characterized as compulsions? Select all that apply.

-checking and rechecking that the television is turned off before going to school -repeatedly washing the hands -routinely climbing up and down a flight of stairs three times before leaving the house

The nurse is assessing a client admitted with depression and post-traumatic stress disorder. The client admits to having no fixed address and to "couch surfing" at various friends' homes. What will the nurse investigate as possible barriers to care based on the client's living situation? Select all that apply.

-knowledge about accessible housing -access to health care-related resources -ability to receive social benefits with no fixed address

A client undergoing treatment for an anxiety disorder is being cared for by a nursing student. The nursing faculty asks the student, "When is such a disorder considered chronic and generalized?" The student responds that the client must exhibit uncontrollable and unreasonable worry for at least how many months?

6 For a diagnosis of generalized anxiety disorder, the client must exhibit an uncontrollable and unreasonable level of worry about multiple life circumstances for 6 months or more.

A client on the sixth floor of a psychiatric unit has a morbid fear of elevators. The client is scheduled to attend occupational therapy, which is located on the ground floor of the hospital. However, the client refuses to take the elevator, insisting that the stairs are safer. Which nursing action would be best given the client's refusal to use the elevator?

Allow the client to use the stairs.

A nurse notices that a client who came to the clinic for treatment of anxiety disorder has a strong body odor. What can the nurse do or say to help this client?

Ask the client basic hygiene questions to determine how frequently he bathes.

The nurse is caring for a client who is agitated and is trying to get out of bed. What should the nurse do first to keep the client free of injury?

Ask the unlicensed assistive personnel to sit with the client.

During a panic attack, a client runs to the nurse and reports breathing difficulty, chest pain, and palpitations. The client is pale with his mouth wide open and eyebrows raised. What should the nurse do first?

Assist the client to breathe deeply into a paper bag.

The nurse in a psychiatric inpatient unit is caring for a client with obsessive-compulsive disorder. As part of the client's treatment, the psychiatrist orders lorazepam, 1 mg by mouth three times per day. During lorazepam therapy, the nurse should instruct the client to follow which advice?

Avoid caffeine

A client is diagnosed with functional neurologic symptom disorder with paralysis of the legs. What's the best nursing intervention for the nurse to use?

Avoid focusing on the client's physical limitations.

A physician's order states to administer lorazepam, 20 mg by mouth twice per day, to treat anxiety. How should the nurse proceed?

Clarify the order with the prescribing physician because the amount prescribed exceeds the recommended dose.

A client with a panic disorder is having difficulty falling asleep. Which nursing intervention should be performed first?

Educate the client about progressive relaxation.

The nurse is caring for a client with panic disorder who has difficulty sleeping. Which nursing intervention will best help the client achieve healthy long-term sleeping habits?

Encourage the use of relaxation exercises.

A client admitted to the psychiatric unit for treatment of repeated panic attacks comes to the nurses' station in obvious distress. After observing that the client is short of breath, dizzy, trembling, and nauseated, which action should the nurse first implement?

Escort the client to a quiet area and suggest using a relaxation exercise that he or she has been taught.

A nurse on the psychiatric unit realizes that she typically fails to administer medications according to schedule. What's the best way for the nurse to improve her medication administration practice?

Evaluate her current practice and devise an improvement plan.

After seeking help at an outpatient mental health clinic, a client who was raped while walking her dog is diagnosed with posttraumatic stress disorder (PTSD). Three months later, the client returns to the clinic, complaining of fear, loss of control, and helpless feelings. Which nursing intervention is most appropriate for this client?

Exploring the meaning of the traumatic event with the client

A client with obsessive-compulsive disorder (OCD) is admitted to a mental health facility. The nurse anticipates the health care practitioner to prescribe which medications that have been known to be effective in treating (OCD)?

Fluvoxamine and clomipramine

A client has been diagnosed with a tic disorder. Which information can the nurse provide to help the client reduce the frequency of the tics?

Get plenty of rest and reduce stress.

A mental health nurse in an outpatient clinic is caring for a client who is newly diagnosed with phobic disorder. Which individual counseling approach is best to assist the client in daily activities?

Help the client identify the source of the anxiety.

While shopping at a mall, a woman experiences an episode of extreme terror accompanied by anxiety, tachycardia, trembling, and fear of going crazy. A friend drives her to the emergency department, where a physician rules out physiological causes and refers her to the psychiatric resident on call. The nurse caring for this client would expect the health care practitioner to prescribe which medication to control the client's anxiety?

Lorazepam

A 49-year-old painter who recently fractured his tibia worries about his finances because he can't work. To treat his anxiety, his physician prescribes buspirone, 5 mg by mouth three times per day. During buspirone therapy, the client should avoid which of the following drugs?

Monoamine oxidase (MAO) inhibitors

A client is refusing all medications and is having difficulty breathing, with a respiratory rate of 34 breaths/minute and anxiety. What is the priority nursing action?

Notify the health care provider of the status of this client.

A client reports having a difficult time settling down for sleep in the evening. What nursing intervention would assist the client in achieving a positive outcome?

Reinforce progressive muscle relaxation.

A client arrives on the psychiatric unit exhibiting extreme excitement, disorientation, incoherent speech, agitation, frantic and aimless physical activity, and grandiose delusion. Which nursing diagnosis takes highest priority for the client at this time?

Risk for injury

A client with agoraphobia has been symptom-free for 4 months. The client returns to the health center with which classic signs and symptoms of this phobia?

Severe anxiety and fear

A nurse is caring for a client diagnosed with panic disorder who begins to hyperventilate. What is the priority nursing action at this time?

Stay with the client to maintain safety.

A client presents to the nurses' station with symptoms of a panic attack, including shortness of breath, dizziness, trembling, and nausea. Which is the nurse's first intervention?

Stay with the client, and offer support.

Before eating a meal, a client with obsessive-compulsive disorder (OCD) must wash his or her hands for 18 minutes, comb his or her hair 444 strokes, and switch the bathroom light on and off 44 times. When creating the plan of care, what is the most appropriate goal for this client?

Systematically decrease the number of repetitions of rituals and the amount of time spent performing them.

A client is diagnosed with illness anxiety disorder. When assisting with the plan of care, which intervention should be included?

Teach the client adaptive coping strategies.

The nurse is gathering data from a client during an intake for a mental-health admission. The client states to the nurse, "I have gotten fired from my job because I am no longer able to get there on time. I have to check my lock and touch my door 15 times in sets of three." How will the nurse document this behavior?

The client is experiencing compulsions.

While in the facility, a client with obsessive-compulsive disorder saves all used medicine cups and paper cups and arranges them in elaborate sculptures in the room. At home, the client saves mail and magazines and makes elaborate paper sculptures from them. Which outcome would indicate successful treatment for this client?

The client throws away all disposable cups.

A client diagnosed as having panic disorder is admitted to the inpatient psychiatric unit. Until admission, he or she had been a virtual prisoner in the house for 5 weeks because of agoraphobia, afraid to go outside even to buy food. The nurse, when planning care for this client, determines which action as this client's overall goal?

To help the client function effectively in his or her environment

Lorazepam is often given along with a neuroleptic agent, such as haloperidol. What is the purpose of administering the drugs together?

To reduce anxiety and potentiate the sedative action of the neuroleptic

The nurse is caring for a client with a panic disorder. Which panic attack does the nurse document as uncued?

Upon awaking from a peaceful nap, the client reports shortness of breath.

Which factor should the nurse be most concerned about when caring for a client taking an antianxiety medication?

abrupt withdrawal

The nurse is gathering information on a client who appears to be anxious. Which is important for the nurse to remember when questioning the anxious client?

be specific and direct

A client is admitted to the acute psychiatric care unit after 2 weeks of increasingly erratic behavior. The client is unkempt, has lost approximately 9 lb (4 kg), has been sleeping poorly, and exhibits hyperactivity. The client loudly denies the need for hospitalization. What priority intervention will the nurse apply?

decreasing environmental stimulation

Initial interventions for the client with acute anxiety include:

encouraging the client to verbalize feelings and concerns.

A client sees a spider while raking leaves. Immediately, the client's heart begins beating rapidly and the client breaks into a sweat. To which condition is the client's response related?

fear triggered by a known, specific object or event

A client is admitted for abrupt onset of paralysis in the left arm. Although no physiologic cause has been found, the symptoms are exacerbated when the client speaks about losing custody of children in a recent divorce. The nurse determines these findings are characteristic of what disorder?

functional neurologic symptom disorder

While administering medications to a group of clients admitted with anxiety, a nurse hears someone call for help. The nurse should respond by:

locking the medication cart and responding to the call for help.

A student nurse is preparing to administer an injection to a client. The instructor asked the student questions related to the administration of the injection. The student did not hear the questions, her muscles became tense, and her hands sweaty. The student nurse may be experiencing which level of anxiety?

moderate

The nurse is caring for a client with a diagnosis of conversion disorder. Which clinical symptoms does the client demonstrate that correlate with this diagnosis?

neurologic symptoms associated with psychological conflict or need

The nurse is caring for a client who complains of a choking sensation, racing heart, dizziness and fearfulness. Which term would the nurse use to document these symptoms?

panic disorder

Which therapeutic strategy is used to reduce anxiety in a client diagnosed with illness anxiety disorder?

relaxation exercises

A client arrives on the psychiatric unit exhibiting extreme excitement, disorientation, incoherent speech, agitation, frantic and aimless physical activity, and grandiose delusion. Which nursing diagnosis takes highest priority for this client at this time?

risk for injury

A 59-year-old client is scheduled for cardiac catheterization the next morning. His physician prescribed secobarbital sodium, 100 mg by mouth at bedtime, for sedation. Before administering the drug, the nurse should know that:

sedatives reduce excitement; hypnotics induce sleep.

The nurse is caring for a client with posttraumatic stress disorder (PTSD) experiencing a frightening flashback. The nurse can best offer reassurance of safety and security through which nursing action?

staying with the client

A client with a diagnosis of generalized anxiety disorder (GAD) wants to stop taking lorazepam. Which important fact should the nurse discuss with the client about discontinuing the medication?

stopping the drug can cause withdrawal symptoms

The nurse is providing group therapy for a group of adolescents who witnessed the violent death of a peer. Which outcome would best meet the needs of the students?

to discuss the effect of the trauma on their lives

While reviewing a client record, the nurse sees that the client has a documented history of microphobia. What behavior does the nurse anticipate the client exhibiting?

washing the hands repetitively