MH:Exam3-anxiety,OCD,R/d

A client diagnosed with anxiety disorder is prescribed cognitive therapy. However, after an interactive session with the client, the therapist postpones the cognitive therapy. Which client statement might have led to the therapist postponing the cognitive therapy? "I feel like I am keyed up on most days." "I start becoming restless ahead of my meetings." "I don't have any problem. I am just a little stressed." "I don't want to meet people. I feel like hiding from them."

"I feel like I am keyed up on most days." Rationale: The client should be aware of his or her condition for the cognitive therapy to be effective. "I start becoming restless ahead of my meetings." Rationale: The client should be aware of the signs and symptoms of anxiety for the cognitive therapy to be effective. Answer : "I don't have any problem. I am just a little stressed." Rationale: Cognitive therapy is an effective therapy for anxiety. However, it may be ineffective if a client is not willing to speak openly about his or her fears and feelings related to the anxiety. "I don't want to meet people. I feel like hiding from them." Rationale: The client should be encouraged to openly talk about his or her fears so that appropriate unlearning and relearning can be facilitated.

A client with claustrophobia is undergoing therapy in which the therapist instructs the client to imagine anxiety-provoking situations and then a healthy response to that anxiety. Which response by the client indicates that the therapy is effective? "I prefer to stay in open spaces rather than closed spaces." "I'm not having any discomfort while watching a movie in a theater." "I always ensure that somebody accompanies me while walking in a subway." "I'm not feeling dizzy while walking up a flight of stairs."

"I'm not having any discomfort while watching a movie in a theater." Rationale: A client who has overcome the fear of closed spaces may not feel any discomfort in theaters or any such closed spaces. Therefore, this indicates that the therapy provided to the client is effective.

Which statement by the registered nurse characterizes social anxiety disorder? "The client shows abnormal behavior due to excessive fear." "The client shows excessive and unreasonable fear of closed spaces." "The client shows repetitive behaviors that interfere with social functioning." "The client shows unpredictable onset of anxiety and tremors."

"The client shows abnormal behavior due to excessive fear." Rationale: The client with social anxiety disorder shows severe fear of situations in which a person might do something embarrassing or be evaluated negatively by others. Due to fear, the client shows abnormal behavior.

A client tells the nurse, "I frequently experience very bad chest pain and choking feelings." Which rating would the nurse record in the client's assessment report, according to the Hamilton Anxiety Rating Scale (HAM-A)? 1 2 3 4

4 Rationale: The nurse assigns a score of 4 to the client who shows very severe symptoms. Very bad chest pain and choking feelings are indications of very severe symptoms.

Which phobia does the nurse suspect if a client is afraid of going out due to the fear of strangers? Xenophobia Agoraphobia Astraphobia Belonephobia

Answer : Xenophobia Rationale: Xenophobia refers to the fear of strangers. Agoraphobia Rationale: Agoraphobia refers to the fear of wide or open spaces. Astraphobia Rationale: Astraphobia refers to the fear of lightning. Belonephobia Rationale: Belonephobia refers to the fear of needles.

While assessing a client with anxiety disorder, the nurse finds the client has a mild startle response, severe broken sleep, moderate pains and aches, very severe tingling sensations, and very severe dyspnea. Which total score would the nurse document in the client's assessment report using Hamilton's Anxiety Rating Scale? Record your answer using a whole number.

Rationale: The client has mild startle response and is given a score of 1. For severe broken sleep, the score given is 3. For moderate pains and aches, the score given is 2. In addition to this, the client has a very severe tingling sensation for which the score given is 4, and for very severe dyspnea, the score given is 4. Finally, on adding all the scores, we get (1 + 3 + 2 + 4 + 4 = 14). So, the nurse would document the total score as 14 in the client's assessment report.

The nurse is caring for a client who is experiencing recurrent, unpredictable episodes of anxiety that manifest as sweating, trembling, chest pain, and dizziness. During interactions with this client, the nurse maintains a calm, nonthreatening, and matter-of-fact approach. Which statement describes the rationale behind this nursing intervention? To develop a sense of security in the client To explore the reasons for the client's anxiety To interrupt the progression of anxiety in the client To demonstrate various ways to interrupt anxiety to the client

To develop a sense of security in the client Rationale: The symptoms of the client indicate panic anxiety. While caring for a client with panic anxiety, the nurse should maintain a calm and nonthreatening approach. This intervention helps develop a sense of security in the client.

Which medication increases the synaptic availability of norepinephrine? Clonidine Paroxetine Yohimbine Propranolol

Yohimbine Rationale: Yohimbine is an alpha-adrenergic blocker that increases the synaptic availability of norepinephrine, resulting in anxiety.

Which instructions by the nurse would be beneficial to the client in the management of hair-pulling disorder? Select all that apply. "Go to bed when you feel like pulling your hair." "Listen to soft music when you feel like pulling your hair." "Hold a paperweight in your hands when you feel like pulling your hair." "Read a book when you feel like pulling your hair." "Drink a glass of water when you feel like pulling your hair."

"Listen to soft music when you feel like pulling your hair." Rationale: Hair-pulling may occur in times of increased anxiety. Stress management techniques, such as listening to soft music, help in the management of this condition. "Hold a paperweight in your hands when you feel like pulling your hair." Rationale: Holding objects, such as a paperweight, reduces anxiety in the client and prevents the pulling of hair. "Read a book when you feel like pulling your hair." Rationale: Distracting the client with activities, such as reading a book, may help prevent the client from pulling his or her hair without being aware of what he or she is doing.

Which immediate intervention would the nurse implement to minimize the immobilizing effects of anxiety in a client? Teach relaxation techniques Recognize precipitating factors Maintain a stimulating environment Administer tranquilizing medication as prescribed

Administer tranquilizing medication as prescribed Rationale: The nurse should immediately administer tranquilizing or antianxiety medications to the client to provide relief from the immobilizing effects of anxiety.

Which immediate intervention would the nurse implement to minimize the immobilizing effects of anxiety in a client? Teach relaxation techniques Recognize precipitating factors Maintain a stimulating environment Administer tranquilizing medication as prescribed

Administer tranquilizing medication as prescribed Rationale: The nurse should immediately administer tranquilizing or antianxiety medications to the client to provide relief from the immobilizing effects of anxiety.

The nurse observes severe fear when a client with an anxiety disorder sees lizards. Which area of the brain is particularly affected in the client when the client experiences this specific fear? Brain stem Amygdala Thalamus Hypothalamus

Amygdala Rationale: The client who shows fear toward lizards has herpetophobia. The amygdala is the area of the brain that mediates fear, particularly in phobic disorders.

Which statement supports the nurse's suspicion that the client has obsessive-compulsive disorder (OCD)? "I wash my hands every 15 minutes." "I have 12 puppies and love caring for them." "My nose has a deformity even after rhinoplasty." "I bite my nails and scratch myself in extreme tension."

Answer : "I wash my hands every 15 minutes." Rationale: The client with OCD will show repetitive behaviors, including excessive hand washing. "I have 12 puppies and love caring for them." Rationale: Hoarding food and animals is a symptom associated with hoarding disorder, not OCD. "My nose has a deformity even after rhinoplasty." Rationale: Generally, rhinoplasty removes a deformity present on the nose. However, the client believes that the deformity remained even after surgery, though it does not exist. This may be a symptom of body dysmorphic disorder. "I bite my nails and scratch myself in extreme tension." Rationale: Nail biting and scratching are symptoms associated with excoriation disorder and trichotillomania, or hair-pulling disorder.

After interacting with the parent of an adolescent client, the nurse suspects a diagnosis of obsessive-compulsive disorder (OCD). Which statement made by the client's parent would support this suspicion? "My child often pulls out his facial hair." "My child refuses to throw away her old possessions." "My child spends more than 1 hour per day in total washing his hands." "My child is deeply preoccupied with her appearance."

Answer : "My child spends more than 1 hour per day in total washing his hands." Rationale: This statement supports the nurse's suspicion of OCD. In OCD, the obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment. "My child is deeply preoccupied with her appearance." Rationale: This statement may be indicative of body dysmorphic disorder. Additional information is needed to suggest OCD. "My child often pulls out his facial hair." Rationale: This statement may be indicative of trichotillomania (hair-pulling disorder). Additional information is needed to suggest OCD. "My child refuses to throw away her old possessions." Rationale: This statement may be indicative of hoarding disorder. Additional information is needed to suggest OCD.

While caring for a client with psychiatric illness, the nurse finds that the client frequently pulls out hair from the scalp and eyebrows. Which other behaviors does the nurse expect in the client accompanying this behavior? Select all that apply. Biting Scratching Skin picking Head banging Mirror checking

Answer : Biting Rationale: A client with trichotillomania may perform self-mutilating behaviors such as biting. Answer : Scratching Rationale: A client with trichotillomania may perform self-mutilating behaviors such as scratching. Skin picking Rationale: Skin picking is not necessarily a self-mutilating behavior. A client with excoriation disorder will repetitively perform this behavior. Answer : Head banging Rationale: A client with trichotillomania may perform self-mutilating behaviors such as head banging. Mirror checking Rationale: Mirror checking is not a self-mutilating behavior. A client with body dysmorphic disorder repetitively performs mirror checking to examine his or her own appearance.

A client is depressed due to a facial scar as a result of an accident. The client frequently looks at the scar in a mirror and gradually developed a fixation on attempting to alter the facial scarring. The medical data of the client report excessive visits to plastic surgeons. Which disorder would the nurse suspect in the client? Trichotillomania Hoarding disorder Body dysmorphic disorder Obsessive-compulsive disorder

Answer : Body dysmorphic disorder Rationale: Body dysmorphic disorder is the exaggerated belief that the body is deformed or defective. The client first developed this disorder after he or she was left with a facial scar. Trichotillomania Rationale: Trichotillomania is the recurrent pulling out of one's hair, resulting in hair loss. Hoarding disorder Rationale: Hoarding disorder is defined as persistent difficulties discarding or parting with possessions, regardless of their actual value. Obsessive-compulsive disorder Rationale: Obsessive-compulsive disorder is an obsession, compulsion, or both that compels the person to continue an act. In this situation, frequent mirror checking is the result of the client believing that his or her face is deformed, not the result of an obsession, compulsion, or both.

A client on medication for generalized anxiety disorder developed physical dependence and tolerance. Which medication would the primary health-care provider replace? Clonidine Diazepam Duloxetine Buspirone

Answer : Diazepam Rationale: Diazepam is a benzodiazepine for which a client may develop tolerance and physical dependence. So, the primary health-care provider would replace diazepam. Clonidine Rationale: Clonidine is useful in the treatment of acute anxiety. It has limited use in generalized anxiety, so the client is not likely to have been prescribed clonidine. Duloxetine Rationale: Duloxetine is a serotonin and norepinephrine reuptake inhibitor (SNRI), which is the first-line medication for generalized anxiety and surpasses benzodiazepines in the treatment of anxiety. Buspirone Rationale: Buspirone is 60 to 80 percent effective in the treatment of generalized anxiety due to lack of physical dependence and tolerance.

Which symptom would be a manifestation of hoarding disorder? Disruptive sexual urges or fantasies Ritualized eating behavior Recurrent pulling of one's hair Difficulty in parting with possessions

Answer : Difficulty in parting with possessions Rationale: A client with hoarding disorder will have extreme difficulty in discarding or parting with his or her possessions. Disruptive sexual urges or fantasies Rationale: Disruptive sexual urges or fantasies are symptoms associated with paraphilic disorder. Ritualized eating behavior Rationale: Ritualized eating behavior is not a symptom of hoarding disorder. It is a manifestation of an eating disorder. Recurrent pulling of one's hair Rationale: Recurrent pulling of one's own hair resulting in hair loss is a symptom of trichotillomania.

A client who is being treated for anxiety develops sexual dysfunction. Which medication in the prescription would need to be replaced? Diazepam Fluoxetine Propranolol Pentobarbital

Answer : Fluoxetine Rationale: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) that may lead to sexual dysfunction as a side effect. Diazepam Rationale: Diazepam is a benzodiazepine that increases the affinity of the GABAA receptor for gamma-Aminobutyric acid (GABA), causing dizziness, weakness, and physical dependence. Propranolol Rationale: Propranolol blocks the adrenergic receptors and does not interfere with sexual function. Pentobarbital Rationale: Pentobarbital is a barbiturate that causes central nervous system (CNS) depression. It may not cause sexual dysfunction.

While teaching about obsessive-compulsive disorder (OCD), the registered nurse says to the student nurses, "Active avoidance explains the behavioral patterns of a client with OCD." The nurse's statement is most consistent with which theory? Learning theory Cognitive theory Psychoanalytic theory Psychodynamic theory

Answer : Learning theory Rationale: Some clients may indulge in behaviors that provide comfort from the anxiety associated with a traumatic event. This is known as active avoidance, which explains the behavioral patterns of the clients with OCD according to the learning theory. Cognitive theory Rationale: Cognitive theory states that faulty, distorted, and counterproductive thinking patterns may result in anxiety. Psychoanalytic theory Rationale: Psychoanalytic theory states that OCD is a result of a weak and underdeveloped ego. Psychodynamic theory Rationale: Psychodynamic theory states that anxiety results from the inability of an individual's ego to intervene when there is a conflict between id and superego.

A client is diagnosed with obsessive-compulsive disorder (OCD). Which other comorbid conditions should be evaluated in the client? Select all that apply. Mood disorder Anxiety disorders Schizoid disorder Endocrine disorder Personality disorders

Answer : Mood disorder Rationale: Mood disorder is a psychiatric disorder associated with OCD. Answer :Anxiety disorders Rationale: Anxiety disorders may be associated with OCD. Schizoid disorder Rationale: Schizoid disorder is associated with body dysmorphic disorder. Endocrine disorder Rationale: Endocrine disorder induces anxiety, but it is not associated with OCD. Personality disorders Rationale: Hoarding may be a comorbid condition in people with personality disorders.

A client is taken to the hospital by his roommates after being totally confined at home for 3 months without any apparent reason. Which condition would the nurse suspect in the client? Social phobia Agoraphobia Murophobia Anthropophobia

Answer: Agoraphobia Rationale: In agoraphobia, the client is afraid to go into open or public places. As such, the client may confine himself or herself to the home. Social phobia Rationale: Social phobia is the excessive fear of situations such as speaking or eating in public. Murophobia Rationale: The fear of mice is called murophobia and is not a likely condition of the client. Anthropophobia Rationale: Anthropophobia is the fear of people. The client has continued to live with roommates, which indicates that anthropophobia is not a likely condition.

During assessment, the client says, "I need to visit my daughter." The client repeats this sentence many times even without any context. Which condition would the nurse suspect in the client? Panic disorder Hoarding disorder Generalized anxiety disorder Obsessive-compulsive disorder

Answer : Obsessive-compulsive disorder Rationale: A client with obsessive-compulsive disorder may have repeated thoughts or act in the same manner repeatedly. These thoughts or acts may interfere with the normal functioning of the client. Panic disorder Rationale: Panic disorder is a sudden attack characterized by intense fear or terror. Panic disorder does not involve the symptom of repeating words. Hoarding disorder Rationale: Hoarding disorder is associated with the inability to discard or part with possessions. It does not involve repeating words. Generalized anxiety disorder Rationale: Generalized anxiety disorder is characterized by muscle tension, restlessness, and feeling uneasy or apprehensive.

A client who as a child was once sexually abused in a car developed ochophobia. Which theory explains the client's behavior? Learning theory Cognitive theory Psychoanalytic theory Psychodynamic theory

Answer : Psychoanalytic theory Rationale: Psychoanalytic theory suggests that phobias develop when a child who experienced sexual abuse represses the fear of the adult and displaces it. Learning theory Rationale: Learning theory suggests that when a stressful stimulus is repeatedly paired with an object, eventually the object itself produces fear. The client was abused only once and not repeatedly; thus, this theory does not explain the phobia. Cognitive theory Rationale: Cognitive theory suggests that anxiety is the product of faulty cognitions or anxiety-inducing self-instructions. Psychodynamic theory Rationale: Psychodynamic theory acts as a predisposing factor to panic and generalized anxiety disorder. Because the client has a phobia of cars, it cannot be a generalized anxiety.

Which conditions can be effectively treated with the use of antianxiety agents? Select all that apply. Status epilepticus Psychotic disorders Postoperative sedation Skeletal muscle spasms Acute alcohol withdrawal

Answer : Status epilepticus Rationale: Antianxiety agents are used for the treatment of status epilepticus. Psychotic disorders Rationale: Antipsychotic or antidepressant agents are effective for the treatment of psychotic disorders. Postoperative sedation Rationale: Antianxiety agents are given preoperatively to reduce fear and anxiety in the client. Answer : Skeletal muscle spasms Rationale: Antianxiety agents are used in the treatment of skeletal muscle spasms by increasing the contractility of skeletal muscles. Answer : Acute alcohol withdrawal Rationale: Antianxiety agents act by depressing the central nervous system. Therefore, they are used in the treatment of acute alcohol withdrawal.

A client expresses having attacks of extreme nervousness, usually once a week. The nurse finds that these attacks are not precipitated by any trigger factors. Which other symptoms in the client may indicate panic disorder? Select all that apply. Sweating Trembling Decreased rate of respiration Accelerated heart rate Repeating words quietly

Answer : Sweating Rationale: Sweating is a symptom of a panic attack caused by hyperarousal of the nervous system. Answer : Trembling Rationale: Trembling or shaking is also found in panic attacks. Decreased rate of respiration Rationale: During panic attacks, the client has restlessness and an increased rate of respiration. Answer : Accelerated heart rate Rationale: Panic disorder is characterized by accelerated heart rate caused by hyperarousal of the nervous system. Repeating words quietly Rationale: Repeating words quietly is a symptom of obsessive-compulsive disorder.

Which characteristic symptoms does a client who has social phobia exhibit? Select all that apply. The client has a fear of using public restrooms. The client is afraid of snakes. The client does not cook food because of the fear of fire. The client is afraid to present a speech in an auditorium. The client gets embarrassed during stage performances.

Answer : The client has a fear of using public restrooms. Rationale: A client with social phobia has a fear of using public restrooms. Using public restrooms may cause the client to have intense sweating and tachycardia. Answer: The client is afraid to present a speech in an auditorium. Rationale: The client with social phobia has a fear of speaking in public areas. Answer : The client gets embarrassed during stage performances. Rationale: The client who has social phobia gets embarrassed during stage performances due to fear. The client is afraid of snakes. Rationale: A client who has ophidiophobia is afraid of snakes. The client does not cook food because of the fear of fire. Rationale: A client who does not cook food due to fear of fire has pyrophobia.

Which phobias are included under specific phobias? Select all that apply. Acrophobia Ophidiophobia Social phobia Agoraphobia Trichophobia

Answer :Acrophobia Rationale: Specific phobias involve fear of specific objects or situations that could conceivably cause harm. Acrophobia, the fear of heights, is a specific phobia. Answer :Ophidiophobia Rationale: Specific phobias involve fear of specific objects or situations that could conceivably cause harm. Ophidiophobia, the fear of snakes, is a specific phobia. Answer :Trichophobia Rationale: Specific phobias involve fear of specific objects or situations that could conceivably cause harm. Trichophobia, the fear of hair loss, is a specific phobia.

Which medication would the nurse anticipate to be prescribed by the primary health-care provider for a client who works as a cab driver and has symptoms of depression and anxiety? Buspirone Alprazolam Hydroxyzine Meprobamate

Answer :Buspirone Rationale: Buspirone does not depress the central nervous system and is among the first-line medications for anxiety. Alprazolam Rationale: Alprazolam, being a benzodiazepine, depresses the subcortical levels of the central nervous system, so it would not be an ideal choice for an already depressed client. Hydroxyzine Rationale: Hydroxyzine is an antihistaminic medication that causes drowsiness and should be avoided in clients whose work demands constant attention, such as cab driving. Meprobamate Rationale: Meprobamate is a carbamate derivative that aggravates the symptoms of depression, making it not the medication of choice in an already depressed client.

Which medication does the nurse expect the primary health-care provider to prescribe for treatment of generalized anxiety disorder? Buspirone Propranolol Amitriptyline Clomipramine

Answer Buspirone Rationale: The primary health-care provider prescribes buspirone to the client with generalized anxiety disorder. Propranolol Rationale: The primary health-care provider may prescribe propranolol to the client with a phobic disorder. Amitriptyline Rationale: Amitriptyline is a psychopharmacological agent that is noted as a potential medication for the treatment of trichotillomania, although no medications have demonstrated consistent benefits for clients with trichotillomania. Clomipramine Rationale: The primary health-care provider may prescribe clomipramine to the client who has body dysmorphic disorder or obsessive-compulsive disorder.

A client has neurodegeneration in the regions of the locus ceruleus and frontal cortex. Which physiological processes does the nurse expect to be altered in the client? Select all that apply. Arousal Heart rate Motor coordination Respiratory activation Cognitive interpretations

Arousal Rationale: The locus ceruleus controls the function of the arousal and sleep cycles. Therefore, the client with neurodegeneration in the locus ceruleus may experience a disturbance in arousal and in the sleep-wake cycle. Cognitive interpretations Rationale: Cognitive interpretations of an individual are governed by the neurons that originate from the frontal cortex of the brain. Therefore, neurodegeneration in the frontal cortex may result in altered cognitive interpretations.

The nurse is caring for a client who has a condition associated with intense anxiety. The nurse finds that the client is performing ritualistic actions repetitively as part of this condition. Which drug will the primary health-care provider advise the nurse to administer to the client as a part of long-term therapy? Diazepam Lorazepam Alprazolam Clomipramine

Clomipramine Rationale: The client with obsessive-compulsive disorder has intense anxiety. Antidepressant agents, such as clomipramine, are administered to the client to reduce these symptoms.

A 14-year-old client reports to the school nurse, "My mind goes blank and I get shaky and sweaty while taking tests." Which medication would be beneficial for the client in this situation? Clonidine Duloxetine Propranolol Alprazolam

Clonidine Rationale: Clonidine is used in the amelioration of anxiety symptoms. Duloxetine Rationale: Duloxetine is used in the treatment of generalized anxiety disorder. Answer : Propranolol Rationale: Propranolol is an antianxiety agent used in the treatment of acute situational anxiety, such as performance anxiety or test anxiety. Alprazolam Rationale: Alprazolam is particularly effective in the treatment of panic disorder.

A primary health-care provider observes that a client exhibits obsessive hand washing. Which first-line medication would the nurse expect the primary health-care provider to prescribe? Clonidine Clomipramine Clonazepam Chlorpromazine

Clonidine Rationale: Clonidine is used to treat acute anxiety disorders. Answer : Clomipramine Rationale: Obsessive washing of hands is a symptom of obsessive-compulsive disorder. The first-line drug for this disorder is clomipramine. Clonazepam Rationale: Clonazepam is the medication of choice for phobic disorders. Chlorpromazine Rationale: Chlorpromazine is a medication used to treat hair-pulling disorder.

While communicating with a client, the nurse finds that she folds and arranges clothes five times a day. Which nursing intervention would be beneficial to the client in this situation? Distract the client with other activities Report to the primary health-care provider Determine the situations provoking this behavior Administer antianxiety medication to the client

Determine the situations provoking this behavior Rationale: The client should first learn to recognize the precipitating factors to avoid the anxiety. Therefore, the nurse should discuss with the client the anxiety-provoking triggers that precipitate the ritualistic behavior.

Which symptoms does the nurse expect in a client experiencing anticipatory performance anxiety? Select all that apply. Dry mouth Sweaty palms Trembling hands Tremors Rapid breathing

Dry mouth Rationale: A phobic response such as dry mouth is expected in a client experiencing anticipatory performance anxiety. Sweaty palms Rationale: A phobic response such as sweaty palms is expected in a client experiencing anticipatory performance anxiety. Trembling hands Rationale: A phobic response such as trembling hands is expected in a client experiencing anticipatory performance anxiety.

Which symptoms does the nurse expect in a client experiencing anticipatory performance anxiety? Select all that apply. Dry mouth Sweaty palms Trembling hands Tremors Rapid breathing

Dry mouth Rationale: A phobic response such as dry mouth is expected in a client experiencing anticipatory performance anxiety. Sweaty palms Rationale: A phobic response such as sweaty palms is expected in a client experiencing anticipatory performance anxiety. Trembling hands Rationale: A phobic response such as trembling hands is expected in a client experiencing anticipatory performance anxiety.

A client tells the nurse, "I experience palpitations and sweating before starting exams, so I avoid taking them." Which symptoms does the nurse record about the condition of the client in the client's assessment report? Select all that apply. Fear Anxiety Powerlessness Ineffective coping Ineffective impulse control

Fear Rationale: The client avoids taking exams due to fear. Therefore, the nurse identifies the condition of fear in the assessment report. Anxiety Rationale: Palpitations and sweating are symptoms of anxiety. Therefore, the nurse records this condition as anxiety in the assessment report. Ineffective coping Rationale: The client is not trying to overcome or manage anxiety. Instead, the client is avoiding taking exams. Therefore, the nurse records ineffective coping in the assessment sheet.

The nurse is caring for a client who has taphophobia. What does the nurse expect in the client as a result of this phobia? Fear of fire Fear of death Fear of insanity Fear of being buried alive

Fear of fire Rationale: Pyrophobia refers to the fear of fire. Fear of death Rationale: Thanatophobia refers to the fear of death. Fear of insanity Rationale: Dementophobia refers to the fear of insanity. Answer : Fear of being buried alive Rationale: Taphophobia refers to the fear of being buried alive. The nurse expects the client to have this fear.

The nurse is caring for a client with anxiety disorder who is on buspirone therapy. Which conditions would the nurse monitor for in the client and report to the primary health-care provider? Select all that apply. Fever Bruising Dry mouth Sore throat Orthostatic hypotension

Fever Rationale: A client with anxiety disorder who is on buspirone therapy may develop fever as a side effect. Therefore, the nurse should monitor the body temperature in the client and report to the primary health-care provider. Bruising Rationale: A client with anxiety disorder who is on buspirone therapy may develop bruising as a side effect. The nurse should monitor the client for the appearance of bruises on the skin and report to the primary health-care provider. Sore throat Rationale: A client with anxiety disorder who is on buspirone therapy may develop a sore throat as a side effect; this is a characteristic sign of blood dyscrasias. The nurse should monitor the client for the occurrence of sore throat and report to the primary health-care provider.

The nurse finds that a client keeps pulling his hair compulsively. Which strategies should be included in the treatment plan for relieving this symptom in the client? Select all that apply. Flooding Social support Awareness training Concept care mapping Competing response training

Flooding Rationale: Flooding, or implosion therapy, is used for specific phobias. In it, the client is allowed to imagine the situations in real life of which he is extremely afraid. Answer : Social support Rationale: In social support therapy, family members are encouraged to participate in the therapy process and offer positive feedback for the client's attempts at habit reversal. Answer : Awareness training Rationale: Awareness training is a part of habit-reversal therapy (HRT) in which the client is helped to become aware of times when the hair-pulling often occurs. Concept care mapping Rationale: Concept care mapping is a diagrammatic teaching and learning strategy that allows the visualization of interrelationships between medical diagnoses, nursing diagnoses, assessment data, and treatments. Answer : Competing response training Rationale: In competing response training, the client learns to substitute another response for the urge to pull his hair.

While reviewing the diagnostic reports of a client, the primary health-care provider finds that there is abnormal neural activity in the cingulate cortex region of the brain. Which psychiatric complication can be expected in the client based on this finding? Hoarding disorder Hair-pulling disorder Body dysmorphic disorder Obsessive-compulsive disorder

Hoarding disorder Rationale: The client with hoarding disorder exhibits indecisiveness. This is associated with low neural activity in the cingulate cortex region of the brain, the area of the brain that connects the emotional part of the brain with the parts that control higher-level thinking.

Which conditions are associated with the development of anxiety symptoms? Select all that apply. Hyperglycemia Hypoventilation Hyperthyroidism Pheochromocytoma Patent ductus arteriosus

Hyperthyroidism Rationale: Increased thyroxine levels are associated with the development of anxiety symptoms. Pheochromocytoma Rationale: Pheochromocytoma, or increased secretion of adrenaline, is associated with the development of anxiety symptoms.

Which medications may cause substance-induced anxiety disorder? Select all that apply. Hypnotics Anxiolytics Analgesics Amphetamines Antihistamines

Hypnotics Rationale: Hypnotics are medications that help induce sleep. However, these medications may cause substance-induced anxiety after long-term therapy. Anxiolytics Rationale: Anxiolytics help alleviate the effects of anxiety in clients. However, sudden withdrawal of anxiolytics may cause substance-induced anxiety. Amphetamines Rationale: Amphetamines are central nervous system stimulants that may cause substance-induced anxiety at higher doses.

Which therapies help in the management of a fear of enclosed spaces exhibited by a client? Select all that apply. Implosion therapy. Benzodiazepine therapy Systematic desensitization Lithium carbonate therapy Selective serotonin reuptake inhibitor therapy

Implosion therapy Rationale: Claustrophobia is the fear of enclosed spaces. Implosion therapy is effective in the management of specific phobias. The therapist floods the client with information concerning situations that trigger anxiety in the client. Systematic desensitization Rationale: Systematic desensitization is commonly used to treat clients with specific phobias. In systematic desensitization, the client is gradually exposed to the phobic stimulus in a real or imagined situation.

Which side effects does the nurse expect in a client who is receiving buspirone therapy? Select all that apply. Diarrhea Insomnia Headaches Constipation Sexual dysfunction

Insomnia Rationale: Buspirone is a partial agonist of the 5-HT1A receptor. It causes insomnia as a side effect. Headaches Rationale: Buspirone is a partial agonist of the 5-HT1A receptor. It causes headaches as a side effect.

A client with anthophobia is admitted to a psychiatric ward. How would the nurse seek to prevent the aggravation of the client's condition? Instruct the family members not to bring flowers when visiting. Instruct the caregiver to maintain sufficient light in the client's room. Avoid placing syringes at the client's bedside. Ensure that the client's room is not on the higher floors of the hospital.

Instruct the family members not to bring flowers when visiting. Rationale: The phobic stimulus for the client with anthophobia is flowers. Therefore, the nurse should instruct the client's family members not to bring flowers even though it is meant to be a soothing gesture.

The nurse is caring for a client with anxiety disorder who is taking antianxiety medication therapy. The nurse instructs the client to rise slowly from a lying or sitting position. Which side effect is the nurse trying to reduce in the client by using this intervention? Lethargy Nausea Drowsiness Orthostatic hypotension

Lethargy Rationale: Anxiety frequently causes lethargy. The nurse would instruct the client to perform exercises to reduce fatigue and lethargy. Nausea Rationale: The nurse would instruct the client to take medication with food or milk to prevent nausea and vomiting. Drowsiness Rationale: The nurse would instruct the client to take medications during the nighttime because they cause drowsiness. Answer : Orthostatic hypotension Rationale: A client with orthostatic hypotension should be instructed to rise slowly from a sitting or lying position.

Which symptoms in a client diagnosed with panic disorder indicate that the client is experiencing hyperventilation? Select all that apply. Cyanosis Slow heart rate Lightheadedness Shortness of breath Tingling sensation in feet

Lightheadedness Rationale: Hyperventilation may occur in a client diagnosed with panic disorder. The symptoms associated with hyperventilation include lightheadedness due to a decreased oxygen supply to the brain. Shortness of breath Rationale: Hyperventilation causes decreased carbon dioxide levels in the blood. Shortness of breath is a symptom associated with hyperventilation. Tingling sensation in feet Rationale: A tingling sensation in the feet is associated with hyperventilation due to its effect on nerve endings.

Which instruction does the primary health-care provider give the nurse to help decrease the frequency of anxiety episodes in the client with panic disorder? Maintain a calm environment Include more nursing staff on the client's care team Talk to the client less frequently Involve the client in physical activities like jogging

Maintain a calm environment Rationale: Anxiety is contagious and can be transferred from nurse to client or vice versa. Maintaining a calm environment, instead of a stimulating environment, around the client ensures a feeling of security in the client. Therefore, the primary health-care provider instructs the nurse to maintain a calm environment.

Which nursing intervention is appropriate for a client who is on buspirone therapy and has paradoxical excitement? Provide food or milk to the client Notify the primary health-care provider immediately Raise the client slowly from a sitting position Observe for the symptoms of sore throat and fever

Notify the primary health-care provider immediately Rationale: When the nurse notices paradoxical excitement, which includes increased anxiety symptoms in the client, the nurse should immediately notify the primary health-care provider.

Which medication is effective in blocking acute anxiety effects in a client going through opioid or nicotine withdrawal? Pimozide Clonidine Olanzapine Amitriptyline

Pimozide Rationale: Pimozide is used in the treatment of trichotillomania. Answer : Clonidine Rationale: Clonidine is effective in blocking acute anxiety effects in a client going through opioid or nicotine withdrawal. Olanzapine Rationale: Olanzapine is a potential medication for the treatment of trichotillomania. Amitriptyline Rationale: Amitriptyline is used in the treatment of trichotillomania.

A 14-year-old client reports to the school nurse, "My mind goes blank and I get shaky and sweaty while taking tests." Which medication would be beneficial for the client in this situation? Clonidine Duloxetine Propranolol Alprazolam

Propranolol Rationale: Propranolol is an antianxiety agent used in the treatment of acute situational anxiety, such as performance anxiety or test anxiety.

A client who has a fear of the dark is made to sit a dark room for a long time during therapy, until anxiety is reduced. Which therapy is the client undergoing? Psychotherapy Cognitive behavior therapy Implosion therapy Habit-reversal therapy

Psychotherapy Rationale: Psychotherapy focuses on helping clients understand the situations that create anxiety. Cognitive behavior therapy Rationale: Cognitive behavior therapy relates how individuals respond to stressful situations to their subjective cognitive appraisal of the event. Answer : Implosion therapy Rationale: In implosion therapy (flooding), the individual is "flooded" with stimuli related to the phobic situation or object (rather than in gradual steps) until anxiety associated with the object or situation is no longer experienced. Habit-reversal therapy Rationale: Habit-reversal therapy is used to treat disorders like hair-pulling disorder by modifying the habits that manifest from them.

A child's mother tells the nurse, "My child refuses to go to school and complains of headache, nausea, and vomiting." Which condition does the nurse expect in the child based on these findings? Conduct disorder Major depressive disorder Autism spectrum disorder Separation anxiety disorder

Separation anxiety disorder Rationale: Separation anxiety disorder is the psychological condition in which the child experiences anxiety about separation from home. Therefore, the child refuses to go to school and often complains about physical symptoms such as headache, nausea, and vomiting.

Which inhibitory neurotransmitter levels are elevated by benzodiazepines to produce a calming effect? Serotonin Epinephrine Acetylcholine Gamma-Aminobutyric acid (GABA)

Serotonin Rationale: Serotonin is an inhibitory neurotransmitter, which is elevated by selective serotonin reuptake inhibitors but not by benzodiazepines. Epinephrine Rationale: Epinephrine levels are increased in clients with anxiety disorders. It does not suppress the functioning of the central nervous system. Acetylcholine Rationale: Acetylcholine is an excitatory neurotransmitter, and it does not suppress the functioning of the central nervous system. Answer : Gamma-Aminobutyric acid (GABA) Rationale: GABA is an inhibitory neurotransmitter that suppresses the central nervous system, resulting in a calming effect.

Which conditions can be effectively treated with the use of antianxiety agents? Select all that apply. Status epilepticus Psychotic disorders Postoperative sedation Skeletal muscle spasms Acute alcohol withdrawals

Status epilepticus Rationale: Antianxiety agents are used for the treatment of status epilepticus. Skeletal muscle spasms Rationale: Antianxiety agents are used in the treatment of skeletal muscle spasms by increasing the contractility of skeletal muscles. Acute alcohol withdrawal Rationale: Antianxiety agents act by depressing the central nervous system. Therefore, they are used in the treatment of acute alcohol withdrawal.

.Which instruction would the nurse provide a client with depression in order to minimize nausea and vomiting associated with lorazepam therapy? Limit the intake of alcohol Drink small sips of water frequently Take the medication with food or milk Rise slowly to standing when moving from a sitting position

Take the medication with food or milk Rationale: Taking the medication along with food or milk helps prevent nausea and vomiting.

A client diagnosed with claustrophobia is undergoing implosion therapy (flooding), in which the client is locked in closed spaces for prolonged times and the response is monitored. Which would cause the therapy to be discontinued? The client masters relaxation therapy. The client develops a renal disorder. The client experiences less anxiety. The client starts taking antianxiety drugs.

The client experiences less anxiety. Rationale: The goal of implosion therapy is to reduce specific phobia-related anxiety. Therefore, if the client experiences less anxiety in the same situation, the client goal is met, and the therapy is discontinued.

Which fear supports the nurse's suspicion that the client has algophobia? The client has fear of people. The client has fear of needles. The client has a persistent fear of lightning. The client has a persistent fear of pain.

The client has a persistent fear of pain. Rationale: Algophobia is a persistent fear of pain. Therefore, this client's fear supports the nurse's suspicion.

Which statement indicates that the client is experiencing fear? The client has a vague, uneasy feeling of discomfort from an unknown threat. The client has an alerting signal that warns of impending danger. The client has a feeling of apprehension caused by the anticipation of danger. The client has a vague, uneasy feeling of discomfort from a specific danger.

The client has a vague, uneasy feeling of discomfort from a specific danger. Rationale: The client experiences an uneasy feeling due to the existence of a specific danger. Thus, the danger is real, and the client's symptoms indicate fear.

The nurse is caring for a client with intense physical discomfort. After interaction with the client and observing the client's behaviors, the nurse suspects that the client has panic disorder. Based on which observations would the nurse draw this conclusion? Select all that apply. The client has ataxia. The client has feelings of choking. The client has feelings of derealization. The client has feelings of being detached from the self. The client has poor memory and difficulty in concentrating.

The client has feelings of choking. Rationale: The client with panic disorder has intense apprehension, fear, and terror associated with intense physical discomfort. The client with this disorder has a feeling of choking. The client has feelings of derealization. Rationale: The client with panic disorder has a feeling of derealization, which is described as feelings of unreality. The client has feelings of being detached from the self. Rationale: The client with panic disorder has a feeling of depersonalization, which is described as a feeling of being detached.

A client's score on the Hamilton Anxiety Rating Scale (HAM-A) is 23. Which statement can the nurse infer from this finding? The client has mild anxiety. The client has severe anxiety. The client's condition is normal. The client has moderate anxiety.

The client has mild anxiety. Rationale: According to the HAM-A rating scale, the score of the client does not indicate mild anxiety. The client has severe anxiety. Rationale: An assessment score of 25 to 30 is considered to indicate a severe form of anxiety. The client's condition is normal. Rationale: The assessment score of the client does not indicate that the client is normal and healthy. Answer : The client has moderate anxiety. Rationale: An assessment score of 23 indicates that the client has moderate anxiety.

The nurse is caring for a client who presents with palpitations, chest pain, shortness of breath, and fear of dying. Which outcome indicates that the nursing care plan is effective? The client is able to make independent decisions about his or her life. The client is able to express feelings that reflect a positive body image. The client is able to manage anxiety without resorting to the use of ritualistic behavior. The client is able to create a plan for responding in the presence of a phobic situation.

The client is able to make independent decisions about his or her life. Rationale: Symptoms such as palpitations, chest pain, shortness of breath, and fear of dying indicate panic disorder. Interventions are aimed at making the client independent in decision making. Therefore, the nursing care plan is considered effective if the client is able to make independent decisions about his or her life.

While communicating with a client, the nurse suspects that the client has agoraphobia. Which client behaviors support the nurse's suspicion? Select all that apply. The client is repeating words quietly. The client is afraid to venture out alone. The client is afraid to be in parking lots. The client has a fear of taking the bus for transportation. The client is scratching his or her own body to relieve tension.

The client is afraid to venture out alone. Rationale: The fear of being out of the house alone is the diagnostic criteria for agoraphobia. The client is afraid to be in parking lots. Rationale: Fear of being in open spaces such as parking lots, marketplaces, or bridges is one of the diagnostic criteria for agoraphobia. The client has a fear of taking the bus for transportation. Rationale: Fear of using public transportation is one of the diagnostic criteria of agoraphobia.

A client with a severe illness tells the nurse, "Please give me pills. I don't want injections." Which statement would the nurse infer from the client's statement? The client is experiencing xenophobia. The client is experiencing ochophobia. The client is experiencing belonephobia. The client is experiencing ophidiophobia.

The client is experiencing belonephobia. Rationale: Belonephobia is a condition in which the client has a fear of needles. Therefore, the nurse infers that the client is experiencing belonephobia.

While caring for a client who has severe blood loss following an accident, the nurse finds that the client is having aggravated symptoms of panic anxiety. The nurse finds anxiety neurosis in the health history of the client. Which statement describes the potential cause of this condition in the client? The client has elevated levels of serotonin. The client has less activity in the cingulate cortex of brain. The client has hypovolemic shock due to severe blood loss. The client received a sodium lactate infusion.

The client received a sodium lactate infusion. Rationale: Sodium lactate infusion helps replenish electrolytes in the blood. However, sodium lactate may precipitate the symptoms of panic anxiety in clients with anxiety neuroses due to elevated levels of lactic acid in blood.

A client is receiving treatment for generalized anxiety disorder. Which client outcomes indicate that the nursing interventions are effective? Select all that apply. The client recognizes the signs of escalating anxiety. The client manages anxiety while taking a challenging exam. The client manages anxiety without using repetitive behaviors. The client expresses positive feelings about his or her body. The client is able to make independent decisions about future life goals.

The client recognizes the signs of escalating anxiety. Rationale: After the client undergoes appropriate treatment for generalized anxiety disorder, he or she is able to identify the signs of anxiety. This indicates that the treatment has been effective. The client manages anxiety while taking a challenging exam. Rationale: Severe anxiety may lead to struggling while taking a challenging exam. If a client is able to manage anxiety while taking a challenging exam, it indicates that the interventions provided to the client are effective. The client is able to make independent decisions about future life goals. Rationale: The client making independent decisions about a life situation shows an effective outcome because the client with generalized anxiety disorder is unable to make decisions.

While caring for a client with anxiety, the nurse suspects that the client has ineffective impulse control. Which client behavior supports the nurse's suspicion? The client is afraid to venture out alone. The client repeatedly pulls out his or her own hair. The client is unable to meet the basic needs of life. The client has had multiple elective plastic surgeries.

The client repeatedly pulls out his or her own hair. Rationale: Repetitive and impulsive pulling of one's own hair indicates that the client has ineffective impulse control.

Which short-term goal would be appropriate for a client diagnosed with ineffective impulse control? The client will discuss his or her phobic situation with the health-care provider. The client will decrease participation in ritualistic behavior by half within a week. The client will verbalize adaptive ways to cope with stress other than pulling out his or her hair. The client will understand that the perceptions of changes in the body structure are exaggerated.

The client will verbalize adaptive ways to cope with stress other than pulling out his or her hair. Rationale: Ineffective impulse control is associated with hair-pulling disorder. The short-term goal of the nurse is to help the client in identifying coping methods to reduce stress.

A client with anxiety disorder is prescribed buspirone. The nurse explains to the client about safe drug administration. Which information, if not included in the medication instruction, may result in the therapy being perceived to be ineffective? The drug shows its action in 10 to 14 days. The drug may cause nausea and vomiting. The drug can be taken with milk and food. The drug may cause orthostatic hypotension.

The drug shows its action in 10 to 14 days. Rationale: Buspirone takes 10 to 14 days to show its therapeutic effect. Therefore, the client should be instructed to have patience during this period to see the beneficial effects of the drug.