Anxiety Disorders PrepU

A nurse is admitting a client who is experiencing a panic attack. Physiologic causes have been ruled out. The assessment reveals the client has difficulty breathing, chest pain, and palpitations. The client is pale, with the mouth wide open and eyebrows raised. What should the nurse do first?

Stay with the client, reminding client the panic attack will only last a brief period

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."

A nurse teaches a client how to use physical activity to help manage anxiety. Which of the following statements by the client indicates understanding of the teaching?

"Physical activity provides a natural outlet for the release of muscle tension."

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 my child with me to the store." Which response by the nurse is most therapeutic?

"The accident just happened and couldn't have been predicted."

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 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 calm down and relax."

A client describes anxiety attacks that usually occur shortly after work when they are preparing an evening meal. Which question would be most appropriate for the nurse to ask the client first in an effort to learn how they can be helped?

"What are you thinking about before you start to prepare supper?"

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?"

Which nursing action(s) 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. -Respect the client's personal space. -Reassure the client of safety.

Lorazepam is commonly given along with a neuroleptic agent. What is the purpose of administering the drugs together?

to reduce anxiety and potentiate the neuroleptic's sedative action

An adolescent client diagnosed with posttraumatic stress disorder (PTSD) is admitted to the unit after slicing both arms with a razor blade. The client says, "Maybe my parent will listen to me now. They tell me I'm just crazy when I say I'm screwed up because my stepparent had sex with me for years." What should the nurse ask first?

to state what they will do if they feel the urge to hurt themself

A soldier on their second tour of duty was notified of the date that they will be redeployed. As this date approaches, the client is showing signs of excessive anxiety, irritability, and an inability to sleep at night because of nightmares of explosive device tragedies, all leading to poor work performance. The client's commanding officer refers them to the base hospital for an evaluation. What should the nurse do in order of priority from first to last? All options must be used.

---Remove any weapons and dangerous items they have in their possession. ---Remind the client that any feelings and problems that they are having are typical in this current situation. ---Acknowledge any injustices or unfairness related to their experiences, and offer empathy and support. ---Ask them to talk about their upsetting experiences.

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 client's child 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 measure(s) should be implemented? Select all that apply.

-The client should 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 should be evaluated frequently and treated as needed.

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 they have taken fluoxetine 20 mg orally daily for posttraumatic stress disorder (PTSD) and depression. Their 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 their developing fetus at this stage in the pregnancy?

nausea/anorexia

The nurse is caring for clients on an inpatient psychiatric unit. Which client with obsessive-compulsive disorder is ready to be considered for discharge?

the client who showers 3 times instead of their initial 10 times per day

A client reports that before they leave home to go anywhere, they count the money in their wallet as many as 12 times. The nurse judges this behavior to indicate which client need?

the need to channel emotions unacceptable to them with an acceptable activity

After being discharged from the hospital with acute stress disorder, a client is referred to the outpatient clinic for follow-up. What is most important for the client to use for continued alleviation of anxiety?

using adaptive and palliative methods to reduce anxiety

A client commonly jumps when spoken to and reports feeling uneasy. The client says, "It's as though something bad is going to happen." In which order, from first to last, should the nursing actions be done? All options must be used.

--Reduce environmental stimuli. --Ask the client to deep breathe for 2 minutes. --Discuss the client's feelings in more depth. --Teach problem-solving strategies.

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

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

A young school-age girl whose maternal parent and aunt have been diagnosed as having bipolar disorder and whose paternal parent is diagnosed with depression is brought to the clinic because of problems with behavior and attention in school and inability to sleep at night. The child says, "My brain does not turn off at night." The child is diagnosed with attention deficit hyperactivity disorder (ADHD) with a possibility of bipolar disorder as well. What should the nurse say to the parental parent to explain what the health care provider said? Select all that apply.

-"Your child was diagnosed as having ADHD because of their attention and behavior problems at school." -"ADHD involves difficulty with attention, impulse control, and hyperactivity at school, home, or in both settings." -"Your provider is considering a bipolar diagnosis because of your child's family history of bipolar disorder and their sleep issues."

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?

"I'll inform the team of your concerns. Let's talk about how you're feeling."

The client states they wash their 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 client is brought to the emergency department experiencing a spontaneous episode of extreme terror, palpitations, tachycardia, tremor, and shortness of breath. The client describes a fear of dying or going crazy. The healthcare provider rules out physiologic causes. The nurse advocates for the client to receive which medication?

lorazepam

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?

monoamine oxidase (MAO) inhibitors

A client taking lithium is ordered citalopram for panic disorder. Five days after starting the citalopram, the client reports sweating and feelings of anxiety, restlessness, and confusion. The nurse suspects the client is experiencing:

serotonin syndrome.

A client with a diagnosis of posttraumatic stress disorder tells the nurse they wish they had been on the airplane that crashed and killed their spouse and children a month ago. The nurse assesses the client's statement to be an example of which symptom?

survivor guilt

A client with functional neurologic symptom disorder reports sudden onset blindness. The nurse examines the client's health record for evidence of what most likely causative factor for the client's symptoms?

exposure to a traumatic event

The nurse is caring for a client who has been admitted for inpatient psychiatric treatment after being diagnosed with somatic symptom disorder. When planning the client's care, it will be important for the nurse to consider which aspect of treatment?

providing instruction and assessment for stress management techniques

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 you are experiencing."

The nurse has completed client instruction about lorazepam. Which of the following client statements indicate that the client understands the teaching?

"I can develop a dependency on this medication."

The nurse evaluates a client's understanding of benzodiazepines. Which client statement indicates the need for additional teaching about benzodiazepines?

"I can stop taking the diazepam anytime I want."

A client with posttraumatic stress disorder has been complaining of headaches. The healthcare provider orders magnetic resonance imaging (MRI) of the brain to rule out organic disorders. The client later tells a nurse, "I'm not going into that tunnel!" Which response by the nurse is most therapeutic?

"I can tell you're really afraid. Can you tell me more about your fear?"

A nurse admits a client with a preliminary diagnosis of acute stress disorder to the mental health unit. Which statement by the client requires the nurse's immediate action?

"I don't have a desire to live anymore."

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 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?"

In a mental health interview, a client who has returned from military service 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."

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

When assessing a client with post-traumatic stress disorder secondary to being adopted as a child, the nurse would expect which findings? Select all that apply.

-sleep pattern disturbances -difficulty communicating feelings -lack of impulse control

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 diagnosed with posttraumatic stress disorder is readmitted for suicidal thoughts and continued trouble sleeping. She states that when she closes her eyes, she has vivid memories about being awakened at night. "My dad would be on top of me trying to have sex with me. I couldn't breathe." Which suggestions would be appropriate for the nurse to make to treat the insomnia? Select all that apply.

-trying relaxation techniques to help decrease anxiety before bedtime -taking the quetiapine 25 mg as needed as prescribed by the health care provider -listening to calming music when trying to fall asleep -leaving their door slightly open to decrease noise during the nightly checks

During a panic attack, a client hyperventilates, becomes unable to speak, and reports symptoms that mimic those of a heart attack. Which nursing intervention is appropriate?

Accompanying the client to his/her room; remaining there and providing instructions in short, simple statements

What should the nurse do when a hospitalized client is observed to have a ritualistic pattern of behavior?

Allow the client to continue so that they will not become more anxious.

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.

A 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.

The nurse is assessing a client with somatic symptom disorder who reports a fall. The nurse finds the client rubbing the left knee. How should the nurse best intervene?

Assess the client's injury, notify the healthcare provider, and document the incident.

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.

A nurse is working with a client being evaluated for social anxiety disorder. Which assessment question by the nurse would be most appropriate?

Do you feel others are judging you?

A client with obsessive-compulsive disorder who was admitted early yesterday morning must make their bed 22 times before they can have breakfast. Because of this behavior, the client missed having breakfast yesterday with the other clients. Which action should the nurse institute to help the client be on time for breakfast?

Wake the client an hour earlier to perform their ritual.

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 has been prescribed alprazolam. Which food should the nurse instruct the client to avoid?

alcohol

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

During alprazolam therapy, the nurse should be alert for which dose-related adverse reaction?

ataxia

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 client is diagnosed with agoraphobia without panic disorder. Which type of therapy would the nurse most expect to see included in the plan of care?

behavioral therapy

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

The nurse is caring for a newly admitted client suspected of having a somatic symptom disorder. The client reports feeling pain in multiple areas. The nurse will conduct what priority assessment?

current assessment findings including a focused assessment on the client's current pain

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 nurse is admitting a client diagnosed with psychogenic amnesia. The client is in apparent good health. The nurse would expect the client to exhibit which of the following behaviors?

demonstrating disinterest toward the impact of the memory loss

A nurse is assessing a client suffering from stress and anxiety. The most common physiologic response to stress and anxiety is:

diarrhea

A client enters the crisis unit complaining of increased stress from studies as a medical student. The client reports increasing anxiety for the past month. The physician orders alprazolam, 0.25 mg by mouth three times per day, along with professional counseling. Before administering alprazolam, the nurse reviews the client's medication history. Which drug can produce additive effects when taken concomitantly with alprazolam?

diphenhydramine

Which group therapy intervention is of primary importance to a client with panic disorder?

discussing new ways of thinking and feeling about panic attacks

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

A client is a military soldier who returned home from a 1-month tour of relief duty following a natural disaster. The client is exhibiting symptoms of insomnia, irritability, and anxiety. The client tells the nurse, "I just can't get the sight of those dead bodies out of my head. When I was at the disaster, I tried not to think about what I was doing; now I think about it all the time." Which assessment question would be most relevant for this client?

"What more can you tell me about what is happening now?"

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."

An adolescent client who is academically gifted is about to graduate from high school early since they have completed all courses needed to earn a diploma. Within the last 3 months, the client has begun to experience panic attacks that have forced them to leave classes early and occasionally miss a day of school. The client is concerned that these attacks may hinder their ability to pursue a college degree. What would be the best response by the school nurse who has been helping this student deal with 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 who is a veteran with posttraumatic stress disorder tells the nurse about the horror and mass destruction of war. The client 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."

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?

"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."

A client is newly diagnosed with posttraumatic stress disorder (PTSD). The client and family are concerned about the care the client will receive. What is the nurse's most appropriate response(s)? Select all that apply.

-"We will help you find meaningful goals for the future." -"We will discuss your old ways of coping and help you learn new ones." -"We will assist you in reassuming your usual roles."

A physician prescribes clomipramine for a client with obsessive-compulsive disorder (OCD). What instructions should the nurse include when teaching the client about this medication? Select all that apply.

-Avoid hazardous activities that require alertness or good coordination until adverse central nervous system effects are known. -Avoid alcohol and other depressants. -Use saliva substitutes or sugarless candy or gum to relieve dry mouth.

A registered nurse caring for a client with generalized anxiety disorder identifies a nursing diagnosis of Anxiety. A short-term goal is established as follows: "The client will identify physical, emotional, and behavioral responses to anxiety." Which nursing interventions will help the client achieve this goal? Select all that apply.

-Observe the client for overt signs of anxiety. -Help the client connect anxiety with uncomfortable physical, emotional, or behavioral responses. -Introduce the client to new strategies for coping with anxiety, such as relaxation techniques and exercise.

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 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.

A week ago, a tornado destroyed a client's home and seriously injured their spouse. The client has been walking around the hospital in a daze without any outward display of emotions. The client tells the nurse that they feel like they are going crazy. Which intervention should the nurse use first?

Reassure the client that their feelings are typical reactions to serious trauma.

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.

A nurse is caring for a client diagnosed with panic disorder. The client begins to hyperventilate. How should the nurse respond initially?

Stay with the client during the anxiety attack.

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 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 nurse discovers that a client with obsessive-compulsive disorder (OCD) is attempting to resist the compulsion. Based on this finding, the nurse should assess the client for:

increased anxiety.

The nurse is assessing a client who has just experienced a crisis. The nurse should first assess the client for which behavior?

increased level of anxiety

A week ago, a tornado destroyed a client's home and seriously injured their spouse. The client has been walking around the hospital in a daze without any outward display of emotions. The client is being admitted to the stress unit with the diagnosis of acute stress disorder. The client tells the nurse in a matter-of-fact manner that their spouse is paraplegic, "but that is better than total paralysis." Which protective mechanism is the client exhibiting?

intellectualization

While in the facility, a client with obsessive-compulsive disorder (OCD) saves all used medicine cups and paper cups and arranges them in elaborate sculptures in the room. At home, the client saves mail and magazines and makes elaborate paper sculptures from them. Which action by the client indicates progression toward the treatment goals?

refraining from keeping some obsessive items

A client with obsessive-compulsive disorder reveals that they were late for their 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 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 is scheduled for cardiac catheterization the next morning. The physician ordered temazepam, 30 mg by mouth at bedtime, for sedation. Before administering the drug, the nurse should know that:

sedatives reduce excitement; hypnotics induce sleep.