Anxiety, Obsessive-Compulsive, and Related Disorders, Issues Related to Sexuality

Which of the following symptom assessments would validate the diagnosis of generalized anxiety disorder? Select all that apply. 1. Excessive worry about items difficult to control. 2. Muscle tension. 3. Hypersomnia. 4. Excessive amounts of energy. 5. Feeling "keyed up" or "on edge."

1. A client diagnosed with generalized anxiety disorder (GAD) would experience excessive worry about items difficult to control. 2. A client diagnosed with GAD would experience muscle tension. 5. A client diagnosed with GAD would experience an increased startle reflex and tension, causing feelings of being "keyed up" or being "on edge."

A client leaving home for the first time in a year arrives on the psychiatric in-patient unit wearing a surgical mask and white gloves. The client states, "The germs in here are going to kill me." Which correctly written nursing diagnosis addresses this client's problem? 1. Social isolation R/T fear of germs AEB continually refusing to leave the home. 2. Fear of germs R/T obsessive-compulsive disorder. 3. Ineffective coping AEB dysfunctional isolation R/T unrealistic fear of germs. 4. Anxiety R/T the inability to leave home, resulting in dysfunctional fear of germs.

1. According to the North American Nursing Diagnosis Association (NANDA), the nursing diagnosis format must contain three essential components: (1) identification of the health problem, (2) presentation of the etiology (or cause) of the problem, and (3) description of a cluster of signs and symptoms known as "defining characteristics." The correct answer, 1, contains all three components in the correct order: health problem/ NANDA stem (social isolation); etiology/ cause, or R/T (fear of germs); and signs and symptoms, or AEB (refusing to leave home for the past year). Because this client has been unable to leave home for a year as a result of fear of germs, the client's behaviors meet the defining characteristics of social isolation.

A client diagnosed with exhibitionistic disorder is newly admitted to an in-patient psychiatric unit. Which would be an example of a behavioral nursing intervention for this client? 1. Encourage the client to pair noxious stimuli with sexually deviant impulses. 2. Help the client to identify unresolved conflicts and traumas from childhood. 3. Administer prescribed medications that block or decrease circulating androgens. 4. Administer prescribed progestin derivatives to decrease the client's libido.

1. Aversion therapy is a behavioral nursing intervention that encourages the pairing of noxious stimuli, such as bad odors, with deviant sexual impulses in an attempt to assist the client in avoiding inappropriate behavior. This behavioral approach is used in the treatment of clients diagnosed with paraphilic disorder such as exhibitionistic disorder.

Anxiety is a symptom that can result from which of the following physiological conditions? Select all that apply. 1. Chronic obstructive pulmonary disease. 2. Hyperthyroidism. 3. Hypertension. 4. Diverticulosis. 5. Hypoglycemia.

1. Chronic obstructive pulmonary disease causes shortness of breath. Air deprivation causes anxiety, sometimes to the point of panic. 2. Hyperthyroidism (Graves' disease) involves excess stimulation of the sympathetic nervous system and excessive levels of thyroxine. Anxiety is one of several symptoms brought on by these increases. 5. Marked irritability and anxiety are some of the many symptoms associated with hypoglycemia.

Risperidone (Risperdal) is to hallucinations as clonazepam (Klonopin) is to: 1. Anxiety. 2. Depression. 3. Mania. 4. Catatonia.

1. Clonazepam (Klonopin) is a benzodiazepine that works quickly to relieve anxiety.

Which of the following medications can be used to treat clients with anxiety disorders? Select all that apply. 1. Clonidine hydrochloride (Catapres). 2. Fluvoxamine maleate (Luvox). 3. Buspirone (BuSpar). 4. Alprazolam (Xanax). 5. Haloperidol (Haldol).

1. Clonidine hydrochloride (Catapres), an antihypertensive, is used in the treatment of panic disorders and generalized anxiety disorder. 2. Fluvoxamine maleate (Luvox), an antidepressant, is used in the treatment of obsessive-compulsive disorder. 3. Buspirone (BuSpar), an anxiolytic, is used in the treatment of panic disorders and generalized anxiety disorders. 4. Alprazolam (Xanax), a benzodiazepine, is used for the short-term treatment of anxiety disorders.

A newly admitted client diagnosed with social anxiety disorder has a nursing diagnosis of social isolation R/T fear of ridicule. Which correctly written outcome is appropriate for this client? 1. The client will participate in two daily group activities by day 4. 2. The client will use relaxation techniques to decrease anxiety. 3. The client will verbalize one positive attribute about self by discharge. 4. The client will request buspirone (BuSpar) prn to attend group by day 2.

1. Expecting the client to participate in a set number of group activities by day 4 directly relates to the stated nursing diagnosis of social isolation and is a measurable outcome that includes a time frame.

A 10 year-old client diagnosed with nightmare disorder is admitted to an in-patient psychiatric unit. Which of the following interventions would be appropriate for this client's problem? Select all that apply. 1. Involving the family in therapy to decrease stress within the family. 2. Using phototherapy to assist the client in adapting to changes in sleep. 3. Administering medications such as tricyclic antidepressants or low-dose benzodiazepines or both. 4. Giving central nervous system stimulants, such as amphetamines. 5. Using relaxation therapy, such as meditation and deep breathing techniques, to assist the client in falling asleep.

1. Family stress can occur as the result of repeated client nightmares. This stress within the family may exacerbate the client's problem and hamper any effective treatment. Involving the family in therapy to relieve obvious stress would be an appropriate intervention to assist in the treatment of clients diagnosed with a nightmare disorder. 3. Administering medications such as tricyclic antidepressants or low-dose benzodiazepines or both is an appropriate intervention for clients diagnosed with a parasomnia disorder, such as a nightmare disorder. 5. Relaxation therapy, such as meditation and deep breathing techniques, would be appropriate for clients diagnosed with a nightmare disorder to help them fall back to sleep after the nightmare occurs.

When a client experiences a panic attack, which correctly written outcome takes priority? 1. The client will remain safe throughout the duration of the panic attack. 2. The client will verbalize an anxiety level of less than 2/10. 3. The client will use learned coping mechanisms to decrease anxiety. 4. The client will verbalize the positive effects of exercise by day 2.

1. Remaining safe throughout the duration of the panic attack is the priority outcome for the client.

The nursing student is learning about paraphilic disorder. Which student statement indicates that learning has occurred? 1. "The term 'paraphilia' is used to identify repetitive or preferred sexual fantasies or behaviors." 2. "Individuals diagnosed with a paraphilic disorder experience extreme personal distress and frequently seek treatment." 3. "Oral-genital, anal, homosexual, and sexual contact with animals are currently viewed as paraphilic disorders." 4. "Most individuals with a paraphilic disorder are women, and more than 50% of these individuals have onset of their paraphilic arousal after age 18."

1. The term "paraphilia" is used to identify repetitive or preferred sexual fantasies or behaviors that involve any of the following: the preference for use of nonhuman objects, repetitive sexual activity with humans that involves real or simulated suffering or humiliation, or repetitive sexual activity with non-consenting partners.

The nurse is using a cognitive intervention to decrease anxiety during a client's panic attack. Which client statement would indicate that the intervention has been successful? 1. "I reminded myself that the panic attack would end soon, and it helped." 2. "I paced the halls until I felt my anxiety was under control." 3. "I felt my anxiety increase, so I took lorazepam (Ativan) to decrease it." 4. "Thank you for staying with me. It helped to know staff was there."

1. This statement is an indication that the cognitive intervention was successful. By remembering that panic attacks are selflimiting, the client is applying the information gained from the nurse's cognitive intervention.

A client complains of poor sleep and loss of appetite. When prescribed trazodone (Desyrel) 50 mg qhs, the client states, "Why am I taking an antidepressant? I'm not depressed." Which nursing response is most appropriate? 1. "Sedation is a side effect of this low dose of trazodone. It will help you sleep." 2. "Trazodone is an appetite stimulant used to prevent weight loss." 3. "Trazodone is an antianxiety medication that decreases restlessness at bedtime." 4. "Trazodone is an antipsychotic medication used off label to treat insomnia."

1. Trazodone is an antidepressant and when prescribed at a low dose can be used to improve sleep.

The nurse on the in-patient psychiatric unit should include which of the following interventions when working with a newly admitted client diagnosed with obsessive-compulsive disorder? Select all that apply. 1. Assess previously used coping mechanisms and their effects on anxiety. 2. Allow time for the client to complete compulsions. 3. With the client's input, set limits on ritualistic behaviors. 4. Present the reality of the impact that the compulsions have on the client's life. 5. Discuss client feelings surrounding the obsessions and compulsions.

1. When a client is newly admitted, it is important for the nurse to assess past coping mechanisms and their effects on anxiety. Assessment is the first step in the nursing process, and this information needs to be gathered to intervene effectively. 2. Allowing time for the client to complete compulsions is important for a client who is newly admitted. If compulsions are limited, anxiety levels increase. If the client had been hospitalized for a while, then, with the client's input, limits would be set on the compulsive behaviors. 5. It is important for the nurse to allow the client to express his or her feelings about the obsessions and compulsions. This assessment of feelings should begin at admission.

A client is prescribed estazolam (ProSom) 1 mg qhs. In which situation would the nurse clarify this order with the physician? 1. A client with a blood urea nitrogen (BUN) of 16 mg/dL and creatinine level of 1.0 mg/dL. 2. A client with an aspartate aminotransferase (AST) of 60 mcg/L and an alanine aminotransferase (ALT) of 70 U/L. 3. A client sleeping 2 to 3 hours per night. 4. A client rating anxiety level at night to be a 5 out of 10.

2. A nurse would be concerned if a client's aspartate aminotransferase (AST) is 60 mcg/L (normal range 16 to 40 mcg/L) and alanine aminotransferase (ALT) is 70 U/L (normal range 8 to 54 U/L). A client needs to have normal liver function to metabolize estazolam properly, and the nurse would need to check with the physician to clarify the safety of this order. HINT: To answer this question correctly, the test taker first has to understand that sedative/hypnotics are metabolized through the liver and then recognize that aspartate aminotransferase and alanine aminotransferase are liver function studies; the values presented are outside the normal range.

Which assessment data would support the disorder of acrophobia? 1. A client is fearful of basements because of encountering spiders. 2. A client refuses to go to Europe because of a fear of flying. 3. A client is unable to commit to marriage after a 10-year engagement. 4. A client refuses to leave home during stormy weather.

2. Acrophobia is the fear of heights. An individual experiencing acrophobia may be unable to travel by air because of this fear.

A client diagnosed with panic attacks is being admitted for the fifth time in 1 year because of hopelessness and helplessness. Which precaution would the nurse plan to implement? 1. Elopement precautions. 2. Suicide precautions. 3. Homicide precautions. 4. Fall precautions.

2. Any client who is exhibiting hopelessness or helplessness needs to be monitored closely for suicide intentions.

In which situation would benzodiazepines be prescribed appropriately? 1. Long-term treatment of posttraumatic stress disorder, convulsive disorder, and alcohol induced withdrawal. 2. Short-term treatment of generalized anxiety disorder, alcohol induced withdrawal, and preoperative sedation. 3. Short-term treatment of obsessive-compulsive disorder, skeletal muscle spasms, and essential hypertension. 4. Long-term treatment of panic disorder, alcohol use disorder, and bipolar affective disorder: manic episode.q

2. Benzodiazepines are prescribed for short-term treatment of generalized anxiety disorder and alcohol induced withdrawal and can be prescribed during preoperative sedation.

Which of the following would you expect to assess in a client diagnosed with hoarding disorder? Select all that apply. 1. The client experienced a brain injury, which initiated the hoarding behaviors. 2. The client reports the thought of parting with possessions causes symptoms of panic. 3. The client has been collecting items for the past year, keeping them neatly in a closet. 4. The landlord has evicted the client because his or her possessions have become a fire hazard. 5. The family has to discard possessions because the client is psychologically unable to discard them.

2. Clients diagnosed with hoarding disorder will report panic levels of anxiety when asked to part with possessions. 4. A client being evicted because his or her possessions have become a safety hazard would meet the criteria for the diagnosis of a hoarding disorder. 5. A client needing family to remove possessions because the client is psychologically unable to remove them would meet the criteria for the diagnosis of a hoarding disorder.

A client is diagnosed with delayed ejaculation disorder. Which of the following assessment data support this diagnosis? Select all that apply. 1. Inability to maintain an erection. 2. A delay in ejaculation following normal sexual excitement. 3. Premature ejaculation. 4. Dyspareunia. 5. The absence of ejaculation.

2. Delayed ejaculation disorder is characterized by persistent or recurrent delay in achieving orgasm following a normal sexual excitement phase during sexual activity, which the clinician, taking into account the person's age, judges to be adequate in focus, intensity, and duration. 5. Delayed ejaculation disorder is characterized by marked infrequency or absence of ejaculation following a normal sexual excitement phase during sexual activity, which the clinician, taking into account the person's age, judges to be adequate in focus, intensity, and duration.

A client diagnosed with obsessive-compulsive disorder is newly admitted to an in-patient psychiatric unit. Which cognitive symptom would the nurse expect to assess? 1. Compulsive behaviors that occupy more than 4 hours per day. 2. Excessive worrying about germs and illness. 3. Comorbid abuse of alcohol to decrease anxiety. 4. Excessive sweating and an increase in blood pressure and pulse.

2. Excessive worrying about germs and illness is a cognitive symptom experienced by clients diagnosed with OCD.

Which would the nurse expect to assess in a client diagnosed with fetishistic disorder? 1. History of exposing genitalia to strangers. 2. History of sexually arousing fantasies involving nonliving objects. 3. History of urges to touch and rub against non-consenting individuals. 4. History of fantasies involving the act of being humiliated, beaten, or bound.

2. Fetishistic disorder involves recurrent, intense sexual urges or behaviors, of at least 6 months in duration, involving the use of nonliving objects. The sexual focus is commonly on objects intimately associated with the human body (e.g., shoes, gloves, or stockings).

41. A client diagnosed with obsessive-compulsive disorder has been hospitalized for the past 4 days. Which intervention would be a priority at this time? 1. Notify the client of the expected limitations on compulsive behaviors. 2. Reinforce the use of learned relaxation techniques. 3. Allow the client the time needed to complete the compulsive behaviors. 4. Say "stop" to the client as a thought-stopping technique.

2. It is important for the client to learn techniques to reduce overall levels of anxiety to decrease the need for compulsive behaviors. The teaching of these techniques should begin by day 4.

During an intake assessment, a client diagnosed with generalized anxiety disorder rates mood at 3/10, rates anxiety at 8/10, and states, "I'm thinking about suicide." Which nursing intervention takes priority? 1. Teach the client relaxation techniques. 2. Ask the client, "Do you have a plan to commit suicide?" 3. Call the physician to obtain a prn order for an anxiolytic medication. 4. Encourage the client to participate in group activities.

2. It is important for the nurse to ask the client about a potential plan for suicide in order to evaluate the client's intentions and safety risk. This knowledge would direct appropriate and timely nursing interventions. Clients who have developed suicide plans are at higher risk than clients who may have vague suicidal thoughts.

55. A client recently diagnosed with generalized anxiety disorder is prescribed clonazepam (Klonopin), buspirone (BuSpar), and citalopram (Celexa). Which assessment related to the concurrent use of these medications is most important? 1. Monitor for signs and symptoms of worsening depression and suicidal ideation. 2. Monitor for changes in mental status, diaphoresis, tachycardia, tremor, and diarrhea. 3. Monitor for hyperpyresis, dystonia, and muscle rigidity. 4. Monitor for spasms of face, legs, and neck and for bizarre facial movements.

2. It is important for the nurse to monitor for serotonin syndrome, which occurs when a client takes multiple medications that affect serotonin levels. Symptoms include change in mental status, restlessness, myoclonus, hyperreflexia, tachycardia, labile blood pressure, diaphoresis, shivering, tremor, and diarrhea.

Which teaching need is important when a client is newly prescribed buspirone (BuSpar) 5 mg tid? 1. Encourage the client to avoid drinking alcohol while taking this medication because of the additive central nervous system depressant effects. 2. Encourage the client to take the medication continuously as prescribed because onset of action is delayed 2 to 3 weeks. 3. Encourage the client to monitor for signs and symptoms of anxiety to determine the need for additional buspirone (BuSpar) prn. 4. Encourage the client to be compliant with monthly lab tests to monitor for medication toxicity.

2. It is important to teach the client that the onset of action for buspirone (BuSpar) is 2 to 3 weeks. Often the nurse may see a benzodiazepine, such as clonazepam (Klonopin), prescribed because of its quick onset of effect, until the buspirone begins working.

A 65 year-old woman with a history of prostitution is seen in the emergency department experiencing a recent onset of auditory hallucinations and bizarre behaviors. Which diagnosis would the nurse expect to document? 1. Schizophrenia. 2. Tertiary syphilis. 3. Gonorrhea. 4. Schizotypal personality disorder.

2. One of the symptoms of the tertiary stage of syphilis is psychosis and bizarre behaviors. The client's symptoms of auditory hallucinations and bizarre behaviors would be reflective of this diagnosis. Although there can be other reasons for these symptoms, the client's history of prostitution and recent onset of symptoms would warrant investigation into the possible diagnosis of tertiary syphilis.

A client newly admitted to an in-patient psychiatric unit has a diagnosis of pedophilic disorder. When working with this client, which should be the nurse's initial action? 1. Assess the part of the sexual response cycle in which the disturbance occurs. 2. Evaluate the nurse's feelings regarding working with the client. 3. Establish a therapeutic nurse-client relationship. 4. Explore the developmental alterations associated with pedophilia.

2. When working with clients diagnosed with pedophilic disorder, the nurse's initial action should be to evaluate personal feelings. Personal feelings, attitudes, and values should not interfere with acceptance of the client. The nurse must remain nonjudgmental.

The nurse has received the evening report. Which client would the nurse need to assess first? 1. A newly admitted client with a history of panic attacks. 2. A client who slept 2 to 3 hours last night because of flashbacks. 3. A client pacing the halls and stating that his anxiety is an 8/10. 4. A client diagnosed with generalized anxiety disorder awaiting discharge.

3. A client pacing the halls and experiencing an increase in anxiety commands immediate assessment. If the nurse does not take action on this assessment, there is a potential for client injury to self or others.

A client diagnosed with generalized anxiety disorder is placed on clonazepam (Klonopin) and buspirone (BuSpar). Which client statement indicates teaching has been effective? 1. The client verbalizes that the clonazepam is to be used for long-term therapy in conjunction with buspirone. 2. The client verbalizes that buspirone can cause sedation and should be taken at night. 3. The client verbalizes that clonazepam is to be used short term until the buspirone takes full effect. 4. The client verbalizes that tolerance could result with the long-term use of buspirone.

3. Clonazepam would be used for short-term treatment while waiting for the buspirone to take effect, which can take 2 to 3 weeks.

Which assessment data would support a physician's diagnosis of an anxiety disorder in a client? 1. A client experiences severe levels of anxiety in one area of functioning. 2. A client experiences an increased level of anxiety in one area of functioning for a 6-month period. 3. A client experiences increased levels of anxiety that affect functioning in more than one area of life over a 6-month period. 4. A client experiences increased levels of anxiety affecting at least three areas of functioning.

3. For a client to be diagnosed with an anxiety disorder, the client must experience symptoms that interfere in a minimum of two areas, such as social, occupational, or other important functioning. These symptoms must be experienced for durations of 6 months or longer.

A client has a nursing diagnosis of disturbed sleep patterns R/T increased anxiety AEB inability to fall asleep. Which correctly written short-term outcome is appropriate for this client? 1. The client will use one coping skill before bedtime to assist in falling asleep. 2. The client will sleep 6 to 8 hours a night and report a feeling of being rested. 3. The client will ask for prescribed prn medication to assist with sleep by day 2. 4. The client will verbalize his or her level of anxiety as less than a 3/10.

3. The client's being able to ask for prescribed prn medication to assist with falling asleep by day 2 is a short-term outcome that is specific, has a time frame, and relates to the stated nursing diagnosis.

Which of the following are important when assessing an individual for a sleep disturbance? Select all that apply. 1. limit caffeine intake in the evening hours 2. Teach the importance of a bedtime routine. 3. Keep the client's door locked during the day to avoid napping 4. Check the chart to note the client's baseline sleeping habits per night 5. Monitor the client every 15 minutes throughout the night and document sleep pattern

4. An important nursing assessment for a client experiencing a sleep disturbance is to note the client's baseline sleep patterns. These data allow the nurse to recognize alterations in normal patterns of sleep and to intervene appropriately. 5. It would be important to monitor the client regularly during the night to determine sleep pattern. Frequently clients will report less sleep than what is actually experienced.

During an assessment, a client diagnosed with generalized anxiety disorder rates anxiety as 9/10 and states, "I have thought about suicide because nothing ever seems to work out for me." Based on this information, which nursing diagnosis takes priority? 1. Hopelessness R/T anxiety AEB statement: "Nothing ever seems to work out." 2. Ineffective coping R/T rating anxiety as 9/10 AEB thoughts of suicide. 3. Anxiety R/T thoughts about work AEB rates anxiety 9/10. 4. Risk for suicide R/T expressing thoughts of suicide.

4. Because the client is expressing suicidal ideations, the nursing diagnosis of risk for suicide takes priority at this time. Client safety is prioritized over all other client problems.

A client was admitted to an in-patient psychiatric unit 4 days ago for the treatment of obsessive-compulsive disorder. Which outcome takes priority for this client at this time? 1. The client will use a thought-stopping technique to eliminate obsessive and/or compulsive behaviors. 2. The client will stop obsessive and/or compulsive behaviors in order to focus on activities of daily living. 3. The client will seek assistance from the staff to decrease obsessive and/or compulsive behaviors. 4. The client will use one relaxation technique to decrease obsessive and/or compulsive behaviors.

4. By day 4, it would be realistic to expect the client to use one relaxation technique to decrease obsessive or compulsive behaviors. This would be the current priority outcome.

A client diagnosed with body dysmorphic disorder has a nursing diagnosis of disturbed body image R/T reddened face. Which is a correctly written long-term outcome for this client? 1. The client will recognize the exaggeration of a reddened face by day 2. 2. The client will acknowledge the link between anxiety and exaggerated perceptions. 3. The client will use behavioral modification techniques to begin accepting a reddened face. 4. The client will verbalize acceptance of a reddened face by 3-month follow-up visit. Curtis, Cathy Melfi. Psychiatric Mental Health Nursing Success A Q&A Review Applying Critical Thinking to Test Taking (Davis's Q&a Success) (p. 128). F.A. Davis Company. Kindle Edition.

4. The long-term outcome of the verbalization of acceptance of a reddened face by the scheduled 3-month follow-up appointment is an outcome that is client specific, measurable, and attainable and has a stated time frame.

Which client would the charge nurse assign to an agency nurse who is new to a psychiatric setting? 1. A client diagnosed with posttraumatic stress disorder currently experiencing flashbacks. 2. A newly admitted client diagnosed with generalized anxiety disorder beginning benzodiazepines for the first time. 3. A client admitted 4 days ago with the diagnosis of algophobia. 4. A newly admitted client diagnosed with obsessive-compulsive disorder.

A client admitted 4 days ago with a diagnosis of algophobia, fear of pain, would be an appropriate assignment for the agency nurse. Of the clients presented, this client would pose the least challenge to a nurse unfamiliar with psychiatric clients.

In which situation would the nurse suspect a diagnosis of social anxiety disorder? 1. A client abuses marijuana daily and avoids social situations because of fear of humiliation. 2. An 8 year-old child isolates from adults because of fear of embarrassment but has good peer relationships in school. 3. A client diagnosed with Parkinson's disease avoids social situations because of embarrassment regarding tremors and drooling. 4. A college student avoids taking classes that include an oral presentation because of fear of being scrutinized by others.

A student who avoids classes because of the fear of being scrutinized by others meets the criteria for a diagnosis of social anxiety disorder.

What is the most common form of breathing-related sleep disorders? 1. Parasomnia. 2. Hypersomnia. 3. Apnea. 4. Cataplexia.

Apnea refers to the cessation of breathing during sleep. To be so classified, the apnea must last for at least 10 seconds and occur 30 or more times during a 7-hour period of sleep. Apnea is classified as a breathingrelated sleep disorder.

In which situation would the nurse expect an additive central nervous system depressant effect? 1. When the client is prescribed chloral hydrate (Noctec) and thioridazine (Mellaril). 2. When the client is prescribed temazepam (Restoril) and methylphenidate (Concerta). 3. When the client is prescribed zolpidem (Ambien) and buspirone (BuSpar). 4. When the client is prescribed zaleplon (Sonata) and verapamil (Calan).

Chloral hydrate (Noctec), temazepam (Restoril), zolpidem (Ambien), and zaleplon (Sonata) all are sedative/hypnotic medications. Additive central nervous system (CNS) depression can occur when sedative/hypnotic medications are taken concomitantly with alcohol, antihistamines, antidepressants, phenothiazines, or any other CNS depressant. 1. Chloral hydrate is a sedative/hypnotic, and thioridazine is a phenothiazine. When they are given together, the nurse needs to watch for an additive CNS depressant effect.

Which of the following symptoms are seen when a client abruptly stops taking diazepam (Valium)? Select all that apply. 1. Insomnia. 2. Tremor. 3. Delirium. 4. Dry mouth. 5. Lethargy.

Diazepam (Valium) is a benzodiazepine. Benzodiazepines are physiologically and psychologically addictive. If a benzodiazepine is stopped abruptly, a rebound stimulation of the central nervous system occurs, and the client may experience insomnia, increased anxiety, abdominal and muscle cramps, tremors, vomiting, sweating, convulsions, and delirium. 1. Insomnia may be experienced if diazepam is abruptly stopped. 2. Tremor may be experienced if diazepam is abruptly stopped. 3. Delirium may be experienced if diazepam is abruptly stopped.

From a Cognitive theory perspective, which is a possible cause of panic disorder? 1. Inability of the ego to intervene when conflict occurs 2. Abnormal elevations oof blood lactate and increased lactate sensitivity 3. Increased involvement of the neurochemical norepinephrine 4. Distorted thinking patterns that precede maladaptive behaviors

Distorted thinking patterns that precede maladaptive behaviors relate to the cognitive theory perspective of panic disorder development

A client diagnosed with social anxiety disorder has an outcome that states, "client will voluntarily participate in group activities by day 3." Which would be an appropriate interpersonal nursing intervention to assist the client in achieving this outcome? 1. Offer prn lorazepam (Ativan) 1 hour before group begins 2. Attend group with client to assist in decreasing anxiety 3. Encourage discussion about fears related to socialization 4. Role-play scenarios that may occur in group to decrease anxiety

Encouraging discussion about fears is an interpersonal nursing intervention

A client diagnosed with hypersomnia states, "I can't even function anymore; I feel worthless." Which nursing diagnosis would take priority? 1. Risk for suicide R/T expressions of hopelessness. 2. Social isolation R/T sleepiness AEB, "I can't function." 3. Self-care deficit R/T increased need for sleep AEB being unable to bathe without help. 4. Chronic low self-esteem R/T inability to function AEB the statement, "I feel worthless."

Hypersomnia, or somnolence, can be defined as excessive sleepiness or seeking excessive amounts of sleep. Excessive sleepiness interferes with attention, concentration, memory, and productivity. It also can lead to disruption in social and family relationships. Depression is a common side effect of hypersomnia, as are substance-related disorders. 1. Verbalizations of worthlessness may indicate that this client is experiencing suicidal ideations. After assessing suicide risk further, the risk for suicide should be prioritized.

Which nursing diagnosis reflects the intrapersonal theory of the etiology of obsessive-compulsive disorder? 1. Ineffective coping r/t punitive superego 2. Ineffective coping r/t active avoidance 3. Ineffective coping r/t alteration in serotonin 4. Ineffective coping r/t classic conditioning

Ineffective coping r/t punitive superego reflects an intrapersonal theory of the etiology of OCD. The punitive superego is a concept contained in Freud's psychosocial theory of personality development

A client is diagnosed with male hypoactive sexual desire disorder. A nursing diagnosis of sexual dysfunction is documented for this client. Which behavior indicates successful resolution of this client's problem? 1. Client resumes sexual activities at a level satisfactory to self and partner. 2. Client expresses satisfaction with his or her own sexual patterns. 3. The client's deviant sexual behaviors have decreased. 4. The client accepts the experienced change in sexual functioning.

Male hypoactive sexual desire disorder is characterized by a persistent or recurrent extreme aversion to, and avoidance of, all genital sexual contact with a sexual partner. 1. A client's resuming sexual activities at a level satisfactory to self and partner indicates successful resolution of the client's sexual dysfunction problem. Sexual dysfunction is defined as the state in which an individual experiences a change in sexual function that is viewed as unsatisfying, unrewarding, or inadequate.

Nail biting, scratching, and hair pulling for extended periods of time in a private setting are symptoms associated with the diagnosis of _________________________.

Nail biting, scratching, and hair pulling for extended periods of time in a private setting are symptoms associated with the diagnosis of trichotillomania (hair-pulling disorder).

A client has been diagnosed with insomnia. Which of the following data would the nurse expect to assess? Select all that apply. 1. Daytime irritability. 2. Problems with attention and concentration. 3. Inappropriate use of substances. 4. Nightmares. 5. Sleepwalking.

Primary insomnia may manifest by a combination of difficulty falling asleep and intermittent wakefulness during sleep. 1. Lack of sleep results in daytime irritability. 2. Lack of sleep results in problems with attention and concentration. 3. Individuals diagnosed with insomnia may inappropriately use substances, including hypnotics for sleep and stimulants to counteract fatigue.

A client experiencing sleepwalking is newly admitted to an in-patient psychiatric unit. Which nursing intervention would take priority? 1. Equip the bed with an alarm that is activated when the bed is exited. 2. Discourage strenuous exercise within 1 hour of bedtime. 3. Limit caffeine-containing substances within 4 hours of bedtime. 4. Encourage activities that prepare one for sleep, such as soft music.

Sleepwalking is considered a parasomnia. Sleepwalking is characterized by the performance of motor activity during sleep in which the individual may leave the bed and walk about, dress, go to the bathroom, talk, scream, or even drive. 1. Equipping the bed with an alarm that activates when the bed is exited is a priority nursing intervention. During a sleepwalking episode, the client is at increased risk for injury, and interventions must address safety.

A client seen in an out-patient clinic for ongoing management of panic attacks states, "I have to make myself come to these appointments. It is hard because I don't know when an attack will occur." Which nursing diagnosis takes priority? 1. Ineffective breathing patterns R/T hyperventilation. 2. Impaired spontaneous ventilation R/T panic levels of anxiety. 3. Social isolation R/T fear of spontaneous panic attacks. 4. Knowledge deficit R/T triggers for panic attacks

Social isolation is seen frequently with individuals diagnosed with panic attacks. The client in the question expresses anticipatory fear of unexpected attacks, which affects the client's ability to interact with others.

A client experiencing a panic attack would display which physical symptom? 1. Fear of dying. 2. Sweating and palpitations. 3. Depersonalization. 4. Restlessness and pacing.

Sweating and palpitations are physical symptoms of a panic attack.

Which statement explains the etiology of obsessive-compulsive disorder (OCD) from a biological theory perspective? 1. individuals diagnosed with OCD have weak and underdeveloped egos 2. Obsessive and compulsive behaviors are a conditioned response to a traumatic event 3. Regression to the pre-Oedipal anal sadistic phase produces the symptoms of OCD 4. Abnormalities in various regions of the brain have been implicated in the cause of OCD

The belief that abnormalities in various regions of the brain cause OCD is an explanation of OCD etiology from a biological theory perspective.

A client is prescribed alprazolam (Xanax) 2 mg bid and 1.5 mg q6h prn for agitation. The maximum daily dose of alprazolam is 10 mg/d. The client can receive _____ prn doses of alprazolam within a 24-hour period.

The client can receive 4 prn doses. Medications are given four times in a 24-hour period when the order reads q6h: 1.5 mg × 4 = 6 mg. The test taker must factor in 2 mg bid = 4 mg. These two dosages together add up to 10 mg, the maximum daily dose of alprazolam (Xanax), so the client can receive all 4 prn doses.

Using psychodynamic theory, which intervention would be appropriate for a client diagnosed with panic disorder? 1. Encourage the client to evaluate the power of distorted thinking. 2. Ask the client to include his or her family in scheduled therapy sessions. 3. Discuss the overuse of ego defense mechanisms and their impact on anxiety. 4. Teach the client regarding blood lactate level as it relates to the client's panic attacks.

The nurse discussing the overuse of ego defense mechanisms illustrates a psychodynamic approach to address the client's behaviors related to panic disorder

Which would the nurse expect to assess in a client suspected of having nightmare disorder? 1. The client, on awakening, is able to explain the nightmare in vivid detail. 2. The client is easily awakened after the nightmare. 3. The client experiences an abrupt arousal from sleep with a piercing scream or cry. 4. The client, when awakening during the nightmare, is alert and oriented.

The parasomnia of nightmare disorder is closely associated with sleepwalking, and often a night terror episode progresses into a sleepwalking episode. Approximately 1% to 6% of children experience nightmare disorder, and the incidence seems to be more common in boys than in girls. Resolution usually occurs spontaneously during adolescence. If the disorder begins in adulthood, it usually runs a chronic course. 3. During a nightmare, the client does experience an abrupt arousal from sleep with a piercing scream or cry.

A client is prescribed lorazepam (Ativan) 0.5 mg qid and 1 mg prn q8h. The maximum daily dose of lorazepam should not exceed 4 mg qd. This client would be able to receive ______ prn doses as the maximum number of prn lorazepam doses.

This client should receive 2 prn doses. The test taker must recognize that medications are given three times in a 24-hour period when the order reads q8h: 1 mg × 3 = 3 mg. The test taker must factor in the 0.5 mg qid = 2 mg. These two dosages together add up to 5 mg, 1 mg above the maximum daily dose of lorazepam (Ativan). The client would be able to receive only two of the three prn doses of lorazepam.

Which of the following clients would have to be monitored closely when prescribed triazolam (Halcion) 0.125 mg qhs? Select all that apply. 1. An 80 year-old man diagnosed with a depressive disorder. 2. A 45 year-old woman diagnosed with alcohol use disorder. 3. A 25 year-old woman admitted to the hospital after a suicide attempt. 4. A 60 year-old man admitted after a panic attack. 5. A 50 year-old man who has a diagnosis of Parkinson's disease.

Triazolam (Halcion) is a benzodiazepine used in the treatment of anxiety or sleep disturbances. 1. An 80 year-old is at risk for injury, and giving this client a central nervous system (CNS) depressant can increase the risk for falls. This client needs to be monitored closely. 2. Benzodiazepines such as triazolam can be addictive. Individuals diagnosed with alcohol use disorder may have increased risk of abusing a benzodiazepine and would need to be monitored closely. Alcohol is a central nervous system (CNS) depressant and if taken with a benzodiazepine, the client could experience an additive CNS depressant effect. 3. CNS depressants such as triazolam increase depressive symptoms. It would be important that the nurse monitor this client closely for suicidal ideations. 4. There are no risk factors in this situation that would warrant close observation 5. A client who is diagnosed with Parkinson's disease is at increased risk for injury because of altered gait and poor balance, and giving this client a CNS depressant can increase the risk for falls. This client needs to be monitored closely.

Client diagnosed with obsessive-compulsive disorder commonly use which defense mechanisms? 1. Suppression 2. Repression 3. Undoing 4. Denial

Undoing is a defense mechanism commonly used by individuals diagnosed with OCD. Undoing is used symbolically to negate or cancel out an intolerable previous action or experience. An individual diagnosed with OCD experiencing intolerable anxiety would use the defense mechanism of undoing to undo this anxiety by substituting obsessions or compulsions or both. Other commonly used defense mechanisms are isolation, displacement, and reaction formation.

A client newly admitted to an in-patient psychiatric unit is diagnosed with obsessive-compulsive disorder. Which behavioral symptom would the nurse expect to assess? 1. The client uses excessive hand washing to relieve anxiety. 2. The client rates anxiety at 8/10. 3. The client uses breathing techniques to decrease anxiety. 4. The client exhibits diaphoresis and tachycardia.

Using excessive hand washing to relieve anxiety is a behavioral symptom exhibited by clients diagnosed with OCD.

After being diagnosed with pyrophobia, the client states, "I believe this started at the age of 7 when I was trapped in a house fire." When examining theories of phobia etiology, this situation would be reflective of ____________ theory.

When examining theories of phobia etiology, this situation would be reflective of learning theory. Some learning theorists believe that fears are conditioned responses, and they are learned by imposing rewards for certain behaviors. In the instance of phobias, when the individual avoids the phobic object, he or she escapes fear, which is a powerful reward. This client has learned that avoiding the stimulus of fire eliminates fear.

Which charting entry documents a subjective assessment of sleep patterns? 1. "Reports satisfaction with the quality of sleep since admission" 2. "Slept 8 hours during night shift" 3. "Rates quality of sleep as 3/10" 4. "Woke up three times during the night"

When the client reports satisfaction with the quality of sleep, the client is providing subjective assessment data. Good sleepers self-define themselves as getting enough sleep and feeling rested. These individuals feel refreshed in the morning, have energy for daily activities, fall asleep quickly, and rarely awaken during the night.

An overuse of ineffective use of ego defense mechanisms, which results in a maladaptive response to anxiety, is an example of the _________________ theory of generalized anxiety disorder development

psychodynamic theory of generalized anxiety disorder development