PassPoint Anxiety Disorders
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."
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"
An 8-year-old child, diagnosed with obsessive-compulsive disorder, is admitted by the nurse to a psychiatric facility. During the admission assessment, 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 with a panic attack in the emergency department. The nurse documents which assessment findings as consistent with panic attacks? Select all that apply.
- chest pain and palpitations - sweating and tremors - hot flashes and abdominal distress - vertigo and nausea - shortness of breath and choking sensations
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.
1.) The client will be placed on withdrawal precautions and treatment started immediately. 2.) A prescription should be obtained to help with the hallucinations 3.) The client's medical and mental status will be evaluated frequently and treated as needed.
The client is shaking and is reporting a high degree of stress about hospitalization. Which nursing intervention is most appropriate?
Instruct the client to inhale and exhale slowly
A client with an anxiety disorder is admitted to the psychiatric unit because of panic attacks. What statement by the nurse is the most appropriate?
I am going to ask you some questions to help me understand the anxiety that you are experiencing
Which client statement indicates the need for additional teaching about benzodiazepines?
I can stop taking the diazepam anytime I want
A client who is a painter recently fractured a tibia and can't work. The client worries about finances. To treat the client's anxiety, the physician orders buspirone, 5 mg by mouth three times per day. Which drugs interact with buspirone?
MAOI
The nurse has completed teaching a client about alprazolam. Which statement by the client will the nurse document as evidence of successful teaching?
This medication carries a risk of dependence
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
A client on the behavioral health unit reports palpitations, trembling, and nausea while traveling alone, outside the home. These symptoms have severely limited the client's ability to function and have caused the client to avoid leaving home whenever possible. The nurse recognizes that this client has symptoms of what disorder?
agoraphobia
A client who recently developed paralysis of the arms is diagnosed with functional neurologic symptom disorder after tests fail to uncover a physical cause for the paralysis. Which intervention should the nurse include in the care plan for this client?
exercising the client's arms regularly
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 client states he washes his feet endlessly because they "are so dirty that I can't put on my socks and shoes." The nurse recognizes the client is using ritualistic behavior primarily to relieve discomfort associated with which feeling?
Intolerable anxiety
A nurse is formulating a short-term goal for a client suffering from a severe obsessive-compulsive disorder (OCD). The nurse documents what short-term goal as appropriate for a 1-week time frame?
The client will participate in a daily exercise group.
A client with posttraumatic stress disorder needs to find new housing and wants to wait for a month before setting another appointment to see the nurse. How should the nurse interpret this action?
a necessary break in treatment
A nurse refers a client with severe anxiety to a psychiatrist for medication evaluation. The physician is most likely to order which psychotropic drug regimen on a short-term basis?
alprazolam, 0.25 mg orally every 8 hours
The client with obsessive-compulsive disorder eats slowly and is always the last to finish lunch, which makes it difficult for the group to start at 1300. Which approach would be the best plan of action for this problem?
arrange for the client to start eating earlier than the others
A nurse in a psychiatric inpatient unit is caring for a client with generalized anxiety 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 remind the client to:
avoid caffeine
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
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 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."
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"
A nurse recognizes improvement in a client with the nursing diagnosis of Ineffective role performance related to the need to perform rituals. Which behaviors indicate improvement? Select all that apply.
- the client refrains from performing rituals during stress - the client verbalizes that he uses "thought stopping" when obsessive thoughts occur - the client verbalizes the relationship between stress and ritualistic behaviors
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 client is admitted to the emergency department with diaphoresis, chest pain, vertigo, and palpitations. On initial assessment, it appears there is no physiologic basis for the client's symptoms. The client is seen by the psychiatric emergency department nurse who, on recognition that the client has had four similar episodes in the past month, suspects the client has a panic disorder. Which intervention should the nurse perform?
maintain a calm approach that is not threatening
Which quality is most important for the nurse interacting with obsessive-compulsive clients?
patience
A week ago, a tornado destroyed the client's home and seriously injured her husband. The client has been walking around the hospital in a daze without any outward display of emotions. She tells the nurse that she feels like she is going crazy. Which intervention should the nurse use first?
reassure the client that her feelings are typical reactions to serious trauma
A client with obsessive-compulsive disorder reveals that he was late for his appointment "because of my dumb habit. I have to take off my socks and put them back on 41 times! I can't stop until I do it just right." The nurse interprets the client's behavior as most likely representing which factor?
relief from anxiety
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?
After months of coaxing by the spouse, a client is brought by spouse to the mental health clinic and reports that the client suffers from an overwhelming fear of leaving the house, which has caused the client to lose their job and is taking a toll on their marriage. The physician diagnoses the client with agoraphobia. Which treatment options would the nurse be aware of as effective in treating this disorder? Select all that apply.
- desensitization - alprazolam therapy - paroxetine therapy
A 6-year-old male client is having an examination in the community clinic. Click to highlight the findings that will require the nurse to follow up. Client is a 6-year-old male brought to the clinic by a parent to be evaluated for behavior changes. The parent reports the child constantly taps their feet and runs throughout the house . The client's teachers at school are concerned because the client constantly talks and interrupts others. The client also keeps losing their coats and sweaters . School activities are not completed and client loses interest when performing small tasks around the house. The client is a picky eater but has appropriate height and weight for age. Parent reports the client gets easily angered and will run to their room and slam the door.
Highlight: - taps their feet - runs throughout the house - constantly talks - interrupts others - losing their coats and sweaters - school activities are not completed - loses interest - easily angered
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 say you change clothes several times today. Do you find this tiring?
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 acute stress disorder states to the nurse, "I keep having horrible nightmares about the car accident that killed my daughter. I should not have taken her with me to the store." Which response by the nurse is most therapeutic?
The accident just happened and couldn't have been predicted
A nurse at a community mental health clinic is caring for a client diagnosed with a specific phobia of being in enclosed spaces. The client wants assistance to stop these troubling symptoms. The nurse determines which goal is the most appropriate?
The client will be able to meet social and occupational functioning in the presence of the phobic situation.
During the admission assessment, a client with a panic disorder begins to hyperventilate and says, "I'm going to die if I don't get out of here right now!" What is the nurse's best response?
You're having a panic attack. I'll stay here with you
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
A client is admitted to the psychiatric unit with a diagnosis of functional neurologic symptom disorder. Since witnessing a beating at gunpoint, the client is paralyzed. Which action should the nurse initially focus on when planning this client's care?
helping the client identify and verbalize their feelings about the incident
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
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 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
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 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 best response?
many people who've been in your situation experience similar emotions and behaviors
