Anxiety Disorders Prep-U
A nurse is caring for a client with obsessive-compulsive disorder (OCD) with rituals of washing hands, folding and unfolding towels, and switching the bathroom light on and off multiple times prior to meals. What action should the nurse take? Assist the client in completing the rituals. Allow ample time for the client to complete the rituals. Gradually limit the time allowed for the client to complete the rituals. Interrupt the client's ability to complete the rituals.
Correct response: Gradually limit the time allowed for the client to complete the rituals. Explanation: When caring for a client with OCD, the long-term goal is to systematically decrease the undesirable behavior. This is done by helping the client gradually decrease the anxiety that drives the behaviors and, in concert, gradually limiting the time available to perform the rituals. Interrupting the client's rituals will create more anxiety. Getting involved in the client's rituals will make it worse because it reinforces the importance of the ritual. Allowing unlimited time for the client to perform the rituals is appropriate in the early stages of treatment while medications are first begun, but it will not help extinguish the behavior.
A client with borderline personality disorder tells a nurse, "You're the only nurse who really understands me. The others are mean. They always ignore me when I ask for my extra antianxiety medication." How should the nurse respond? "You will have to talk with your healthcare provider about how the medication order is written." "I'll inform the team of your concerns. Let's talk about how you're feeling." "I know the other nurses follow the rules for giving medications." "You know you can't have extra antianxiety medication according to your plan of care."
Correct response: "I'll inform the team of your concerns. Let's talk about how you're feeling." Explanation: Telling the client that it is important for them to talk about how they are feeling is an appropriate response, as it focuses on the emotional content of the client's message and helps the client identify their feelings. Focusing on the request for extra medication would allow the client to ignore the underlying emotional issues. Clients with borderline personality disorder commonly split the staff into "good guys" and "bad guys" to meet their needs; staff members must maintain consistency and a united front at all times. The nurse should not take the client's statements personally, as doing so would interfere with the nurse's ability to maintain a therapeutic relationship.
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." "I find that it is difficult for me to do my everyday tasks." "I'm doing crafts and cooking while at home." "I'm taking my medication to prevent the panic attacks."
Correct response: "I went to the mall with my friend last Saturday." Explanation: Clients with agoraphobia tend to be socially withdrawn. Going to the mall is a sign of working on avoidance behaviors and is a positive response to treatment. Doing activities at home is not a positive change from the avoidance behavior. Inability to do everyday tasks is not showing improvement of the withdrawn behavior. It is good that the client is taking medications, but this is not a positive behavioral change to the avoidance behavior.
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." "Maybe you didn't kill as many people as you think." "How many people did you kill?" "War is a terrible thing."
Correct response: "You did what you had to do at that time." Explanation: The nurse states, "You did what you had to do at that time," to help the client evaluate past behavior in the context of the trauma. Clients commonly feel guilty about past behaviors when viewing them in the context of current values. The other statements are inappropriate because they do not help the client to evaluate past behavior in the context of the trauma.
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 generalized anxiety schizoaffective disorder depression
Correct response: agoraphobia Explanation: Agoraphobia is a phobia, or fear, and avoidance of open spaces accompanied by the concern that escape to safety would be difficult or embarrassing. Agoraphobia is commonly accompanied by physical symptoms, such as palpitations, trembling, nausea, and shortness of breath. It is also commonly accompanied or preceded by panic attacks. Thanatophobia is the fear of death; aerophobia, the fear of air; and hodophobia is the fear of traveling.
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. Perform a focused respiratory assessment. Request STAT cardiac monitoring. Administer antianxiety medications as prescribed.
Correct response: Coach the client on performing slow, deep breaths. Explanation: Although antianxiety drugs provide symptomatic relief during a panic attack, the nurse should first attempt to coach the client to reduce the feelings of anxiety and panic, if possible. The scenario does not present any complaints of chest pain, so cardiac monitoring is not indicated at this time. Although the nurse could conduct a focused respiratory assessment, slowing the respiratory rate would be attempted first. The slower respiratory rate will help reduce the risk for respiratory alkalosis developing and enable better auscultation of breath sounds.
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 brushing teeth three times per day wanting to play the same video game each night repeatedly washing the hands routinely climbing up and down a flight of stairs three times before leaving the house spending the night at only one friend's house
Correct response: 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 Explanation: Compulsions involve symbolic rituals that relieve anxiety when they are performed. The disorder is caused by anxiety from obsessive thoughts, and acts are seen as irrational. Examples include repeatedly checking the television set, washing hands, or climbing stairs. An activity such as playing the same video game each night or spending the night at a friend's friend, maybe a best friend's house, may be indicative of normal development for a school-age child. Frequent brushing of the teeth is not abnormal.
The nurse is assessing a client who has just experienced a crisis. The nurse should first assess this client for which behavior? increased level of anxiety capability of effective problem solving shortened attention span seeks help from others
Correct response: increased level of anxiety Explanation: During the first phase of crisis, the client exhibits elevated anxiety. A client who can use problem-solving capabilities is not in crisis. A shortened attention span is characteristic of the fourth phase of crisis. Reaching out to others for help is indicative of the third phase of crisis.
Which client statement indicates the need for additional teaching about benzodiazepines? "Diazepam can make me drowsy, so I shouldn't drive for a while." "I can stop taking the diazepam anytime I want." "Diazepam will help my tight muscles feel better." "I can't drink alcohol while taking diazepam."
Correct response: "I can stop taking the diazepam anytime I want." Explanation: Diazepam, like any benzodiazepine, cannot be stopped abruptly. The client must be slowly tapered off of the medication to decrease withdrawal symptoms, which would be similar to withdrawal from alcohol. Alcohol in combination with a benzodiazepine produces an increased central nervous system depressant effect and therefore should be avoided. Diazepam can cause drowsiness, and the client should be warned about driving until tolerance develops. Diazepam has muscle relaxant properties and will help tight, tense muscles feel better.
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'd like to help you if you'll let me." "I haven't been through what you have, but I'll be better able to understand if you tell me more about it." "Perhaps you'll feel better if you can become interested in a hobby once again." "I need to refer you to a survivors' group where you'll feel more comfortable."
Correct response: "I haven't been through what you have, but I'll be better able to understand if you tell me more about it." Explanation: Saying that the nurse has not been through what the client has is nonjudgmental, supportive, and conveys honesty and empathy to the client. Telling the client he will feel more comfortable in a survivors' group dismisses the client. However, a survivors' group may be needed later. Stating that the client should become interested in a hobby dismisses his feelings and is not helpful. Saying that the nurse would like to help if the client would allow it implies that the client is not being cooperative; it may alienate him.
A client reports experiencing symptoms of stress including nausea, sweating, irritability, and some difficulty sleeping since getting married and becoming a step-parent. The client has always believed symptoms will go away on their own. The nurse is educating the client about stress management. Which statement by the nurse is most appropriate? "Using stress management techniques will help you challenge the validity of your physical symptoms." "Using stress management techniques will help you calm down and relax." "Using stress management techniques will help you focus on what is causing your anxiety." "Using stress management techniques will reduce your anxiety until you feel your legs go numb."
Correct response: "Using stress management techniques will help you calm down and relax." Explanation: Stress management techniques are meant to reduce anxiety and promote calmness. The goal of using stress management techniques is not to challenge the validity of physical symptoms; this would promote more rumination on the source of the anxiety. Using stress management techniques should not help the client focus on what is causing the anxiety, but rather to distract the client. The client should not strain muscles to the point of numbness.
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." "I can see you're angry. Let me get you some lorazepam to help you calm down. Then we'll talk about what happened." "I'm glad you left the situation. Go to your room and calm down. I'll come in soon to talk." "Even if you're angry, you can't use that language here."
Correct 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." Explanation: The nurse acknowledges and labels the client's emotion and acknowledges his appropriate behavior. Recognizing the client's physiologic arousal, the nurse suggests an activity to decrease anxiety and stays with him. Setting limits on the client's language does not acknowledge his control and does not help the client manage his anxiety. The client needs to engage in physical activity to decrease muscle tension and anxiety. Offering the client medication suggests that he cannot control his behavior. Medication would be used only if other interventions failed to reduce the anxiety level.
An 18-year-old highly dependent on the parents fears leaving home to attend college. Shortly before the fall semester starts, the client reports paralyzed legs and is rushed to the emergency department. When physical examination rules out a physical cause for the paralysis, the physician admits the client to the psychiatric unit. The client is diagnosed with functional neurologic symptom disorder and asks the nurse, "Why has this happened to me?" What is the nurse's best response? "It must be awful not to be able to move your legs. You may feel better if you realize the problem is psychological, not physical." "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." "You've developed this paralysis so you will have a reason to stay with your parents. You must deal with this conflict if you want to walk again." "It's common for someone with your personality to develop a conversion disorder during times of stress."
Correct 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." Explanation: The nurse must be honest by telling the client that the paralysis has no physiologic cause while also conveying empathy and acknowledging that the symptoms are real. The client will benefit from psychiatric treatment, to help understand the underlying cause of the symptoms. After the psychological conflict is resolved, the symptoms will disappear. Telling the client that being unable to move the legs must be awful wouldn't answer the client's question; knowing that the cause is psychological rather than physical wouldn't necessarily make the client feel better. Saying that the client developed paralysis to avoid leaving the parents or that the client's personality caused the disorder wouldn't help the client understand and resolve the underlying conflict.
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? Ask the client to detail the current symptoms. Instruct the client how to monitor respirations and pulse rate. Educate the client about the support groups available. Maintain a calm approach that is not threatening.
Correct response: Maintain a calm approach that is not threatening. Explanation: Clients with a panic disorder need the staff to remain calm. Anxiety, like calmness, can be transferred between the client and nurse. Asking for detail about the symptoms is likely to cause more anxiety in the client. Having the client pay more attention to vital signs is not appropriate at this time. The nurse should give only the information the client needs on an elemental level. Providing information about a support group is not appropriate in the acute situation. Once the client's anxiety level has been reduced, assessments for other underlying psychiatric issues could be explored, but the client should not be assailed with questions at this time.
