Anxiety Pass Point
A new nurse asks the charge nurse why the client with body dysmorphic disorder is always looking at their nose in the mirror. Which of the following would be an appropriate response?
"Clients with body dysmorphic disorder are preoccupied with perceived defects in their appearance."
The nurse is admitting a client to the emergency department with symptoms of posttraumatic stress disorder (PTSD) after being in an earthquake. Which questions would the nurse ask to support this diagnosis?
"Do you have difficulty concentrating at work or school?" "Is your sleep disturbed by nightmares about the earthquake?" "Do you ever feel numb or detached from others?"
A client with posttraumatic stress disorder states, "You don't know what I've been through. What can you do?" The nurse should respond:
"I haven't been through what you have, but I'll be better able to understand if you tell me more about it."
A nurse notices that a client with obsessive-compulsive disorder dresses and undresses several times each day. Which comment by the nurse would be most therapeutic?
"I saw you change clothes several times today. Do you find this tiring?"
A client diagnosed with agoraphobia who experiences panic attacks is talking with a nurse about the progress made in treatment. Which client statement indicates a positive response to treatment?
"I went to the mall with my friend last Saturday."
During the interview, the client with schizophrenia is experiencing an anxiety attack. Which of these responses by the nurse would be most appropriate?
"I will stay with you."
The nurse is caring for a client with social anxiety disorder. Which statement by the client is of concern for the nurse?
"I'll have a drink before having lunch with a friend."
A 40-year-old client is admitted for a surgical biopsy of a suspicious lump in the left breast. The client is tearfully writing a letter to the client's two children and 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?"
An adolescent boy who is academically gifted is about to graduate from high school early since he has completed all courses needed to earn a diploma. Within the last 3 months he has begun to experience panic attacks that have forced him to leave classes early and occasionally miss a day of school. He is concerned that these attacks may hinder his ability to pursue a college degree. What would be the best response by the school nurse who has been helping him deal with his panic attacks?
"It sounds like you have a real concern about transitioning to college. I can refer you to a health care provider for assessment and treatment."
A client with a moderate level of anxiety is pacing quickly in the hall and tells the nurse, "Help me. I can't take it anymore." What would be the nurse's best initial response?
"Let's go to a quieter area where we can talk if you want."
A nurse is caring for a veteran with a history of explosive anger, unemployment, and depression since being discharged from the service. The client reports feeling ashamed of being "weak" and of letting past experiences control thoughts and actions in the present. What is the nurse's bestresponse?
"Many people who've been in your situation experience similar emotions and behaviors."
A nurse is interviewing a client with posttraumatic stress disorder (PTSD) when a loud, booming noise from a passing car's radio rattles the windows. The client jumps onto a chair, wide-eyed and frantic. Which statement by the nurse is the most therapeutic response?
"What kinds of feelings are you experiencing?"
The client, who is a veteran and has posttraumatic stress disorder, tells the nurse about the horror and mass destruction of war. He states, "I killed all of those people for nothing." Which response by the nurse is appropriate?
"You did what you had to do at that time."
The client rushes out of the day room where he has been watching television with other clients. He is hyperventilating and flushed and his fists are clenched. He states to the nurse, "That bastard! I almost hit him." What would be the nurse's best response?
"You're angry, and you did well to leave the situation. Let's walk up and down the hall while you tell me about it."
A client diagnosed with anxiety disorder is prescribed buspirone. What priority teaching will the nurse provide?
Buspirone has a delayed therapeutic effect of between 14 to 30 days.
A nurse is providing care for a client vulnerable to panic attacks who is acutely anxious. The client currently has a respiratory rate of 28 breaths/min and a heart rate of 110 beats/min. What action does the nurse perform first?
Coach the client on performing slow, deep breaths.
The nurse observes that a client with a history of panic attacks is hyperventilating. What action should the nurse take?
Have the client breathe into a paper bag.
The nurse is working with a family in crisis. What should the nurse do in order of priority from first to last? All options must be used.
Identify the family member in crisis. Develop strategies to reduce symptoms. Assess the family's resources. Make a plan for managing the crisis.
The nurse is caring for a client with a panic attack. Which nursing intervention is most helpful for this client?
Stay with the client and remaining calm, confident, and reassuring.
Which nursing action would be therapeutic for the client being admitted to the unit with panic disorder? Select all that apply.
Support the client's attempts to discuss feelings. Reassure the client of safety. Respect the client's personal space.
An older adult client hospitalized 4 days ago for treatment of acute respiratory distress has become confused and disoriented. The client has been picking invisible items off blankets and has been yelling at the daughter who is not in the room. The family tells the nurse that the client has been treated for anxiety with alprazolam for years, but alprazolam is not on the current medication list. Which safety measures should be implemented? Select all that apply.
The client will be placed on withdrawal precautions and treatment started immediately. A prescription should be obtained to help with the hallucinations. The client's medical and mental status will be evaluated frequently and treated as needed.
A client periodically has acute panic attacks. These attacks are unpredictable and have no apparent association with a specific object or situation. During an acute panic attack, the client may experience:
a decreased perceptual field.
While a client is taking alprazolam, which food should the nurse instruct the client to avoid?
alcohol
What should the nurse teach a client with generalized anxiety disorder to help the client cope with anxiety?
cognitive and behavioral strategies
A client on the behavioral health unit spends several hours per day organizing and reorganizing the closet. The client repeatedly checks to see if the clothing is arranged in the proper order. What term is commonly used to describe this behavior?
compulsion
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
A client diagnosed as having panic disorder with agoraphobia is admitted to the inpatient psychiatric unit. Until admission, the client had been a virtual prisoner at home for 5 weeks, afraid to go outside even to buy food. When planning care for this client, the nurse's overall priority is to help the client:
function effectively in the environment.
When performing a physical examination on an anxious client, a nurse should expect to find which effect produced by the parasympathetic nervous system?
hyperactive bowel sounds
A client is diagnosed with obsessive-compulsive disorder. Which intervention should the nurse include when developing the care plan for this client?
initially giving the client time to perform rituals and gradually limiting the time
An 18-year-old pregnant college student presented at the prenatal clinic for an initial visit at 14 weeks' gestation. The client's history revealed that she has taken fluoxetine 20 mg orally daily for posttraumatic stress disorder (PTSD) and depression. Her medication was recently increased to 40 mg daily because of reports of increased stress and suicide ideation. Which side effect of fluoxetine would the nurse judge to be the greatest risk for the client and her developing fetus at this stage in her pregnancy?
nausea/anorexia
Which quality is most important for the nurse interacting with obsessive-compulsive clients?
patience
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 client has become increasingly afraid to ride in elevators. While in an elevator one morning, the client experiences shortness of breath, palpitations, dizziness, and trembling. A physician can find no physiological basis for these symptoms and refers the client to a psychiatric clinical nurse specialist for outpatient counseling sessions. Which type of therapy is most likely to reduce the client's anxiety level?
systematic desensitization
A client at an outpatient psychiatric clinic has been experiencing anxiety. The nurse would like to suggest activities for the client to do in their spare time. What would be an appropriate activity for the nurse to suggest to the client? Select all that apply.
taking up a hobby daily walks stretching exercises
A nurse is working with a client with generalized anxiety disorder (GAD) who is reluctant to try a different medication prescribed by the health care provider. Which statement from the nurse is most appropriate?
"Tell me about any concerns you may have about taking the medication."
