**Psych Unit 8 CH 18 & 19 *****anxiety obsessive compulsive and related disorders quizlet*****test bank, P, **Chapter 18: Anxiety, Obsessive-Compulsive, and Related Disorders, Ch 9 Groups, Chapter 16: Depressive Disorders - This has 3 or 4 question f...

The physician ordered alprazolam (Xanax), 0.25 mg AM daily, for a client diagnosed with an anxiety disorder. On hand are 0.5-mg tablets. How many tablets will the nurse administer per dose? ___________ tablets.

0.25 mg/X tab = 0.5mg/1 tab 0.5X = 0.25 X = 0.5 tablets

The nurse is assessing a patient who is diagnosed with obsessive-compulsive disorder. Which of the patient's statements would the nurse correctly identify as a compulsion? 1) "I can't stop washing my hands." 2) "I can't stop thinking that I'm going to get deathly ill." 3) "I need drugs to help me with this anxiety." 4) "These symptoms are interfering with my ability to get my work done."

1) "I can't stop washing my hands." A compulsion is a repetitive, ritualistic act, the purpose of which is to reduce anxiety associated with obsessive thoughts. Compulsive handwashing is an example of this behavior.

Gary is admitted to the mental health center for treatment of obsessive-compulsive disorder. He tells the nurse that he has a repetitive fear that he has forgotten to lock the doors to his home. Which symptom of this disorder is Gary describing? 1) An obsession 2) A compulsion 3) Auditory hallucinations 4) Claustrophobia

1) An obsession An obsession is a recurrent, intrusive, stressful thought, and this is what Gary is describing in the scenario. A compulsion is repetitive, ritualistic behavior Hallucinations are false perceptual experiences Claustrophobia is an irrational fear of closed spaces.

Paula, who complains of "always being stressed out" and appears to be easily distracted, is seeking counseling for stress management. Which of the following nurse actions will be essential when intervening with Paula? Select all that apply. 1) Assessing the nurse's own level of anxiety 2) Using a calm, matter-of-fact approach 3) Assessing Paula's level of anxiety before initiating education 4) Observing how Paula interacts with coworkers in stressful situations 5) Administering antianxiety agents (as prescribed) before the session begins

1) Assessing the nurse's own level of anxiety 2) Using a calm, matter-of-fact approach 3) Assessing Paula's level of anxiety before initiating education Feedback 1: Anxiety is "contagious" and may be transferred between the client and nurse, so it is essential to evaluate and manage their own anxiety. Feedback 2: Using a calm, matter-of-fact style of communicating can be an effective approach to reduce escalation of symptoms in the anxious client. Feedback 3: Assessing Paula's level of anxiety before attempting to provide education is essential, if anxiety is high, education will be ineffective.

Forrest is seeking treatment for an anxiety disorder after his wife tells him she wants a divorce. He reports to the nurse "I know it sounds crazy but I feel like everybody hates me." According to cognitive theory this statement would be an example of which of the following? 1) Cognitive distortion 2) Sublimation 3) Delusion of grandeur 4) Delusion of persecution

1) Cognitive distortion Forrest's statement is an example of overgeneralizing, which is a cognitive distortion or irrational thought. Cognitive distortions, according to cognitive theory, are counterproductive thinking patterns that lead to maladaptive behaviors and emotions. Sublimation - channels unacceptable impulses into activities that are more tolerable or constructive. Delusions of grandeur- false beliefs in which the individual has an overexalted belief about his or her own importance. A delusion of persecution is a false belief that one is being persecuted or threatened in some way.

Which of the following is a primary function of nurse generalists in helping clients with anxiety and related disorders? 1) Facilitate the client's development of insight and self-awareness in relation to his or her illness. 2) Decide which antianxiety agent is most appropriate to treat the symptoms. 3) Use behavioral therapies such as systematic desensitization and implosion. 4) Conduct psychological tests to support proper diagnosis of the anxiety disorder.

1) Facilitate the client's development of insight and self-awareness in relation to his or her illness. Self-awareness and insight into an individual's stressors and anxiety responses lay the foundation for effective treatment and intervention. The nurse generalist plays a key role in helping clients develop this awareness and insight.

A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) spends 1 hour packing and unpacking and folding and refolding personal belongings. What is the most likely reason for this behavior? 1) It relieves anxiety. 2) It fosters organizational skills. 3) It delays meeting unfamiliar people in the dayroom. 4) It makes the client feel good.

1) It relieves anxiety. OCD is characterized by recurrent thoughts or ideas (obsessions) that an individual is unable to put out of his or her mind and actions that an individual is unable to refrain from performing (compulsions).

A client is experiencing a panic attack. He states, "I'm losing control. I feel like I'm going crazy." Which nursing intervention takes priority? 1) Stay with the client and offer support. 2) Distract the client by redirecting him to physical activities. 3) Teach about the etiology and management of panic disorders. 4) Encourage the client to express his feelings.

1) Stay with the client and offer support. During a panic attack, the client is experiencing extreme levels of anxiety. The symptoms experienced may mimic life-threatening physiological symptoms, such as chest pain and feelings of suffocation and/or impending doom. Clients need reassurance that these symptoms are psychologically, not physiologically, based. It is a priority to be present for the client and offer this support.

After losing a child in a car accident, a client diagnosed with post-traumatic stress disorder (PTSD) asks the nurse, "Why did I live and my beautiful daughter die?" Which is the client experiencing? 1) Survivor's guilt 2) Anger 3) Denial 4) Suppression

1) Survivor's guilt The statement presented in the question indicates that the client is experiencing survivor's guilt. Survivor's guilt is a common situation that occurs when an individual experiences a traumatic event in which others die and the individual survives.

After undergoing a complete diagnostic work-up, a client is diagnosed with post-traumatic stress disorder (PTSD). What must the nurse understand about the symptoms of PTSD before planning care? 1) Symptoms are psychological coping mechanisms. 2) Symptoms result in feelings of invulnerability. 3) Symptoms are a means to manipulate others. 4) Symptoms develop from a nonspecific psychic event.

1) Symptoms are psychological coping mechanisms. Symptoms of PTSD include psychological numbing, flashbacks, nightmares, and explosive anger. These symptoms are coping mechanisms used to deal with anxiety by blocking memories of traumatic events. Resolution of the post-trauma response is largely dependent on the effectiveness of the coping strategies employed.

What should the nurse plan to teach a client who is taking alprazolam (Xanax) three times a day? 1) That there is a potential for dependence and tolerance 2) The importance of discontinuing Xanax immediately if addiction is suspected 3) The importance of increasing the amount of caffeine consumption 4) That Xanax is not habit forming

1) That there is a potential for dependence and tolerance Xanax is a benzodiazepine and has addictive properties. It is the responsibility of the nurse to teach the client about dependence, tolerance, and other signs and symptoms of addiction.

A 60-year-old woman presents at the emergency department with complaints of anxiety unlike anything she has experienced before. She is unable to identify a precipitating stressor related to her anxiety. In addition to psychosocial assessment, which of the following assessments should the nurse conduct in order to facilitate accurate diagnosis? Select all that apply. 1) Vital signs 2) History of substance use 3) Blood sugar 4) History of thyroid disorders 5) Marital status

1) Vital signs 2) History of substance use 3) Blood sugar 4) History of thyroid disorders

A client diagnosed with an adjustment disorder says to the nurse, "Tell me about medications that will cure this problem." Which of the following are appropriate nursing responses? (Select all that apply.) 1. "Medications can interfere with your ability to find a more permanent solution." 2. "Medications may mask the real problem at the root of this diagnosis." 3. "Adjustment disorders are not commonly treated with medications." 4. "Psychoactive drugs carry the potential for physiological and psychological dependence." 5. "Psychoactive drugs will be prescribed only if your problems persist for more than three months."

1, 2, 3, 4

A nurse is admitting a client who has been diagnosed with PTSD. Which of the following symptoms might the nurse expect to assess? (Select all that apply.) 1. Feelings of guilt that precipitate social isolation 2. Aggressive behavior that affects job performance 3. Relationship problems 4. High levels of anxiety 5. Escalating symptoms lasting less than one month

1, 2, 3, 4

An attractive female client presents with high anxiety levels because of her belief that her facial features are large and grotesque. Body dysmorphic disorder (BDD) is suspected. Which of the following additional symptoms would support this diagnosis? (Select all that apply.) 1.Mirror checking 2.Excessive grooming 3.History of an eating disorder 4.History of delusional thinking 5.Skin picking

1, 2, 5

A nurse recognizes which of the following as the best predictors of PTSD in Vietnam veterans? (Select all that apply.) 1. The severity of the stressor 2. The degree of ego strength 3. The degree of psychosocial isolation in the recovery environment 4. The attitudes of society regarding the experience 5. The presence of preexisting psychopathology

1, 3

By which biological mechanism does EMDR achieve its therapeutic effect? 1. EMDR achieves its therapeutic effect, but the exact biological mechanism is unknown. 2. EMDR achieves its therapeutic effect by causing a decrease in imagery vividness. 3. EMDR achieves its therapeutic effect by causing an increase in memory access. 4. EMDR achieves its therapeutic effect by decreasing trauma associated anxiety.

1. EMDR achieves its therapeutic effect, but the exact biological mechanism is unknown.

Which factors differentiate the diagnosis of PTSD from the diagnosis of adjustment disorder (AD)? 1.PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to "normal" daily events. 2.AD results from exposure to an extreme traumatic event, whereas PTSD results from exposure to "normal" daily events. 3.Depressive symptoms occur in PTSD and not in AD. 4.Depressive symptoms occur in AD and not in PTSD.

1. PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to "normal" daily events.

A nurse recognizes which treatment as most commonly used for AD and its appropriate rationale? 1. Psychotherapy; to examine the stressor and confront unresolved issues 2. Fluoxetine (Prozac); to stabilize mood and resolve symptoms 3. Eye movement desensitization therapy; to reprocess traumatic events 4. Lorazepam (Ativan); a first-line treatment to address symptoms of anxiety

1. Psychotherapy; to examine the stressor and confront unresolved issues

Which symptoms should the nurse recognize that differentiate a client diagnosed with obsessive-compulsive disorder (OCD) from a client diagnosed with obsessive-compulsive personality disorder? 1.Clients diagnosed with OCD experience both obsessions and compulsions, and clients diagnosed with obsessive-compulsive personality disorder do not. 2.Clients diagnosed with obsessive-compulsive personality disorder experience both obsessions and compulsions, and clients diagnosed with OCD do not. 3.Clients diagnosed with obsessive-compulsive personality disorder experience only obsessions, and clients diagnosed with OCD experience only compulsions. 4.Clients diagnosed with OCD experience only obsessions, and clients diagnosed with obsessive-compulsive personality disorder experience only compulsions.

1.Clients diagnosed with OCD experience both obsessions and compulsions, and clients diagnosed with obsessive-compulsive personality disorder do not.

A client diagnosed with AD has been assigned the nursing diagnosis of anxiety R/T divorce. Which correctly written outcome addresses this client's problem? 1. Rates anxiety as 4 out of 10 by discharge 2. States anxiety level has decreased by day one 3. Accomplishes activities of daily living independently 4. Demonstrates ability for adequate social functioning by day three

1.Rates anxiety as 4 out of 10 by discharge

An angry client, throwing objects and scratching eyes, is escorted to the seclusion room by security. Which nursing statement best explains to the client why four-point restraints will be applied? 1) "Restraints are the consequences for what you are doing." 2) "Restraints are a means of providing safety for you and others on the unit." 3) "Restraints are the only way to manage anger." 4) "Restraints are necessary because there is not enough staff on duty to provide other interventions."

2) "Restraints are a means of providing safety for you and others on the unit." It is important to provide safeguards in order to protect clients who are out of control. The nurse is educating the client in a nonjudgmental, objective manner.

A client developed paralysis of the lower extremities after experiencing a severe psychic trauma. Which nursing intervention would be initially implemented? 1) Encourage the client to talk about feelings. 2) Assess the client for organic causes of paralysis. 3) Provide range of motion (ROM) to the lower extremities. 4) Encourage discussion of future goals.

2) Assess the client for organic causes of paralysis. The causative agent of the paralysis must first be identified, prior to any verbalization of feelings. Physical cause must be ruled out prior to assuming psychological involvement.

A client has an irrational fear of height (acrophobia). According to the diagnostic criteria for specific phobias, which of the following symptoms would the nurse expect to assess? Select all that apply. 1) The client does not recognize that the fear is excessive or unreasonable. 2) Exposure to the phobic stimulus provokes an immediate anxiety response. 3) The client tolerates the presence of a specific feared object or situation. 4) The client exhibits marked and persistent fear that is excessive or unreasonable. 5) The client reports that even anticipation of being exposed to heights provokes an anxiety response.

2) Exposure to the phobic stimulus provokes an immediate anxiety response. 4) The client exhibits marked and persistent fear that is excessive or unreasonable. 5) The client reports that even anticipation of being exposed to heights provokes an anxiety response.

A client is experiencing gamophobia. Which fear would the nurse expect to assess? 1) Fear of strangers 2) Fear of marriage 3) Fear of numbers 4) Fear of insanity

2) Fear of marriage Xenophobia is the fear of strangers. Gamophobia is the fear of marriage. Numerophobia is the fear of numbers. Dementophobia is the fear of insanity.

For the past year, a college student continually and unrealistically worries about academic performance and love-life performance. The student is irritable and suffers from severe insomnia. This behavior is associated with which Axis I diagnosis? 1) Post-traumatic stress disorder (PTSD) 2) Generalized anxiety disorder (GAD) 3) Social phobia disorder 4) Obsessive-compulsive disorder (OCD)

2) Generalized anxiety disorder (GAD) GAD excessive, unrealistic worry and anxiety become chronic and last for at least 6 months. The anxiety is generalized rather than specific & not associated with a specific object, as in phobia, or event, as in PTSD. PTSD is the manifestation of anxiety in relation to a precipitating event (e.g., war, trauma, sexual assault). Social phobia disorder is characterized by anxiety that prevents a client from participating in social situations. OCD is recurrent thoughts or ideas (obsessions) that an individual is unable to put out of his or her mind and by actions that an individual is unable to refrain from performing (compulsions).

When caring for a client who is experiencing a panic attack, which of the following nursing actions should be implemented? Select all that apply. 1) Leave the client alone to maintain privacy. 2) Reduce stimuli in the immediate environment. 3) Instruct the client regarding unit rules and regulations. 4) Administer antianxiety medication as ordered. 5) Communicate with simple words and brief messages.

2) Reduce stimuli in the immediate environment. 4) Administer antianxiety medication as ordered. 5) Communicate with simple words and brief messages.

A client is experiencing a panic attack. What physical symptoms would the nurse expect to assess? 1) Intense fear and helplessness 2) Sweating and palpitations 3) Psychomotor agitation 4) A narrowed perceptual field and a decreased attention span

2) Sweating and palpitations Intense fear and helplessness are cognitive, not physical, symptoms of a panic attack. Physical symptoms of a panic attack include sweating and palpitations.

Which of the following are realistic outcomes that can be used to evaluate care of a client with an anxiety disorder? Select all that apply. 1) The client successfully removes all stressors that precipitate anxiety. 2) The client recognizes symptoms of escalating anxiety. 3) The client can maintain anxiety at a manageable level. 4) The client demonstrates adaptive coping strategies for dealing with anxiety. 5) The client commits to staying on benzodiazepines indefinitely.

2) The client recognizes symptoms of escalating anxiety. 3) The client can maintain anxiety at a manageable level. 4) The client demonstrates adaptive coping strategies for dealing with anxiety.

The nurse, Robert, is conducting a relaxation group for patients at the mental health center who have been identified as struggling with anxiety disorders. He intends to implement a quality improvement initiative by using an anxiety screening tool to evaluate whether patients report less anxiety at the completion of the program. Which of these would be accepted, reliable tools for that purpose? Select all that apply. 1) Cosmopolitan's "How anxious are you?" quiz. 2) Zung's Self-Rated Anxiety Scale 3) Hamilton Anxiety Rating Scale 4) Beck Anxiety Inventory 5) Folstein's Mini-Mental Status Exam

2) Zung's Self-Rated Anxiety Scale 3) Hamilton Anxiety Rating Scale 4) Beck Anxiety Inventory Feedback 2: Zung's Self-rated Anxiety Scale is recognized as a reliable tool for evaluation of anxiety symptoms. Feedback 3: The Hamilton Anxiety Rating Scale (HAM-A) is recognized as a reliable tool for evaluation of anxiety symptoms. Feedback 4: The Beck Anxiety Inventory is recognized as a reliable tool for evaluation of anxiety symptoms.

A family asks the nurse why their son was diagnosed with PTSD and others in the accident were not. Which of the following information should the nurse offer? (Select all that apply.) 1. An individual's religious affiliation can affect response to trauma. 2. Responses are affected by how an individual handled previous trauma. 3. Protectiveness of family and friends can help an individual deal with trauma. 4. Control over the possibility of recurrence can affect the response to trauma. 5. The time in which the trauma occurred can affect the individual's response.

2, 3, 4, 5

A client diagnosed with posttraumatic stress disorder (PTSD) states, "Why did my doctor prescribe an antidepressant rather than an antianxiety drug for me?" Which of the following are the most appropriate nursing responses? (Select all that apply.) 1. "I'm not sure, because antianxiety drugs have been approved by the FDA for PTSD." 2. "Antidepressants are now considered first-line treatment choice for PTSD." 3. "Many people have adverse reactions to antianxiety drugs." 4. "Because of their addictive properties, antianxiety drugs are less desirable." 5. "There have been no controlled studies on the effect of antianxiety drugs on PTSD."

2, 4, 5

A client receiving EMDR therapy says, "After only two sessions of my therapy, I am feeling great. Now I can stop and get on with my life." Which of the following nursing responses is most appropriate? 1. "I am thrilled that you have responded so rapidly to EMDR." 2. "To achieve lasting results, all eight phases of EMDR must be completed." 3. "If I were you, I would complete the EMDR and comply with doctor's orders." 4. "How do you feel about continuing the therapy?"

2. "To achieve lasting results, all eight phases of EMDR must be completed."

After a teaching session about grief, a client says to the nurse, "I seem to be stuck in the anger stage of grieving over the loss of my son." How would the nurse assess this statement, and in what phase of the nursing process would this occur? 1. Assessment phase; nursing actions have been successful in achieving the objectives of care. 2. Evaluation phase; nursing actions have been successful in achieving the objectives of care. 3. Implementation phase; nursing actions have been successful in achieving the objectives of care. 4. Diagnosis phase; nursing actions have been successful in achieving the objectives of care.

2. Evaluation phase; nursing actions have been successful in achieving the objectives of care.

A client has been extremely nervous ever since a person died as a result of the client's drunk driving. When assessing for the diagnosis of AD, within what time frame should the nurse expect the client to exhibit symptoms? 1. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within 1 year of the accident. 2. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within 3 months of the accident. 3. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within 6 months of the accident. 4. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within 9 months of the accident.

2. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within 3 months of the accident.

A nursing instructor is explaining the etiology of trauma-related disorders from a learning theory perspective. Which student statement indicates that teaching has been effective? 1."How clients perceive events and view the world affect their response to trauma." 2."The psychic numbing in PTSD is a result of negative reinforcement." 3."The individual becomes addicted to the trauma owing to an endogenous opioid response." 4."Believing that the world is meaningful and controllable can protect an individual from PTSD."

2."The psychic numbing in PTSD is a result of negative reinforcement."

5. A client has been assigned a nursing diagnosis of complicated grieving related to the death of multiple family members in a motor vehicle accident. Which intervention should the nurse initially employ? 1. Encourage the journaling of feelings. 2. Assess for the stage of grief in which the client is fixed. 3. Provide community resources to address the client's concerns. 4. Encourage attending a grief therapy group.

2.Assess for the stage of grief in which the client is fixed.

A nursing instructor is teaching about the symptoms of agoraphobia. Which student statement indicates that teaching has been effective? 1.Onset of symptoms most commonly occurs in early adolescence and persists until midlife. 2.Onset of symptoms most commonly occurs in the 20s and 30s and persists for many years. 3.Onset of symptoms most commonly occurs in the 40s and 50s and persists until death. 4.Onset of symptoms most commonly occurs after the age of 60 and persists for at least 6 years.

2.Onset of symptoms most commonly occurs in the 20s and 30s and persists for many years.

A client has made an appointment to see a primary care provider because of increased anxiety. Which medication would likely be prescribed for anxiety? 1) Chlorpromazine (Thorazine) 2) Clozapine (Clozaril) 3) Diazepam (Valium) 4) Methylphenidate (Ritalin)

3) Diazepam (Valium) Diazepam is an antianxiety agent. Chlorpromazine is an antipsychotic medication. Clozapine is an antipsychotic medication. Methylphenidate is a central nervous system stimulant used to treat attention deficit-hyperactivity disorder.

Which nursing intervention takes priority for a client experiencing moderate anxiety? 1) Explore the etiology of the anxiety. 2) Investigate decompensation behaviors. 3) Focus on anxiety reduction. 4) Accept the level of anxiety.

3) Focus on anxiety reduction. Reducing anxiety to a tolerable level should be the nurse's first priority. After reassuring the client of his or her safety and security, the nurse should convey an accepting attitude to facilitate trust. Once the anxiety level has decreased, the client can then begin exploring the triggers that induce anxiety.

A nursing student diagnosed with acute test anxiety is prescribed propranolol (Inderal). What is the rationale for this treatment? 1) Inderal is a mood stabilizer that will decrease situational anxiety. 2) Inderal is an antihypertensive medication. Question this order. 3) Inderal has potent effects on the somatic manifestations of anxiety. 4) Inderal is an anxiolytic used specifically for generalized anxiety.

3) Inderal has potent effects on the somatic manifestations of anxiety.

A client experiencing numbness of the extremities, trembling, fear of dying, and dizziness is admitted to the emergency room with a diagnosis of panic disorder. Which nursing intervention takes priority? 1) Discuss functional coping mechanisms. 2) Determine the source of the problem. 3) Quickly administer an anxiolytic medication. 4) Establish a trusting nurse-client relationship.

3) Quickly administer an anxiolytic medication.

A despondent college student, being treated for a panic disorder, tells the nurse, "I've had it! For no reason, my heart pounds and I can't seem to breathe. It's not worth it." Based on this information, which nursing diagnosis takes priority? 1) Ineffective Airway Clearance 2) Ineffective Coping 3) Risk for Suicide 4) Knowledge Deficit

3) Risk for Suicide

Both situational and intrapersonal factors most likely contribute to an individual's stress response. Which factor would a nurse categorize as intrapersonal? 1. Occupational opportunities 2. Economic conditions 3. Degree of flexibility 4. Availability of social supports

3. Degree of flexibility

As the sole survivor of a roadside bombing, a veteran is experiencing extreme guilt. Which nursing diagnosis would address this client's symptom? 1. Anxiety 2. Altered thought processes 3. Complicated grieving 4. Altered sensory perception

3. Complicated grieving

During her aunt's wake, a 4-year-old child runs up to the casket before her mother can stop her. An appointment is made with a nurse practitioner when the child starts twisting and pulling out hair. Which nursing diagnosis should the nurse practitioner assign to this child? 1.Complicated grieving 2.Altered family processes 3.Ineffective coping 4.Body image disturbance

3. Ineffective coping

A nurse has been caring for a client diagnosed with PTSD. Which realistic goal should be included in this client's plan of care? 1. The client will have no flashbacks. 2. The client will be able to feel a full range of emotions by discharge. 3. The client will not require zolpidem (Ambien) to obtain adequate sleep by discharge. 4. The client will refrain from discussing the traumatic event.

3. The client will not require zolpidem (Ambien) to obtain adequate sleep by discharge.

Which client would a nurse recognize as being at highest risk for the development of an adjustment disorder? 1.A young married woman 2.An elderly unmarried man 3.A young unmarried woman 4.A young unmarried man

3.A young unmarried woman

A client is experiencing a severe panic attack. Which nursing intervention would meet this client's physiological need? 1.Teach deep breathing relaxation exercises. 2.Place the client in a Trendelenburg position. 3.Have the client breathe into a paper bag. 4.Administer the ordered prn buspirone (BuSpar).

3.Have the client breathe into a paper bag.

Jennifer is a 25-year-old woman of average height and weight who reports to the mental health clinic with complaints that she has been unable to go to work for the last 2 weeks because she can't get her "appearance right." She reports that she repetitively checks the mirror and has to redo her make-up every 5 or 10 minutes. Jennifer is most likely experiencing which of these disorders? 1) Social anxiety disorder 2) Panic disorder 3) Eating disorder 4) Body dysmorphic disorder

4) Body dysmorphic disorder Repetitive mirror-checking and excessive grooming R/T perception of flawed appearance that interferes with social, occupational, or other areas of functioning are symptoms of body dysmorphic disorder.

A noncompliant client has a nursing diagnosis of "Social Isolation related to anxiety evidenced by remaining in room during group activities." Which short-term outcome is appropriate for this client? 1) The client will attend three group sessions. 2) The client will understand and accept social withdrawal as a personality trait. 3) The client will remain safe throughout the hospital stay. 4) The client will request as needed (prn) anxiety medication prior to attending group sessions.

4) The client will request as needed (prn) anxiety medication prior to attending group sessions. Acknowledging the need for prn medications prior to attending group sessions indicates a positive outcome for the client problem of social isolation.

Which clinical presentation is associated with the most commonly diagnosed adjustment disorder (AD)? 1. Anxiety, feelings of hopelessness, and worry 2. Truancy, vandalism, and fighting 3. Nervousness, worry, and jitteriness 4. Depressed mood, tearfulness, and hopelessness

4. Depressed mood, tearfulness, and hopelessness

Eye movement desensitization and reprocessing (EMDR) has been empirically validated for which disorder? 1. Adjustment disorder 2. Generalized anxiety disorder 3. Panic disorder 4. Posttraumatic stress disorder

4. Posttraumatic stress disorder

A 20-year-old client and a 60-year-old client have had drunk driving accidents and are both experiencing extreme anxiety. From a psychosocial theory perspective, which of these clients would be predisposed to the diagnosis of adjustment disorder? 1. The 60-year-old, because of memory deficits 2. The 60-year-old, because of decreased cognitive processing ability 3. The 20-year-old, because of limited cognitive experiences 4. The 20-year-old, because of lack of developmental maturity

4. The 20-year-old, because of lack of developmental maturity

A client, who recently delivered a stillborn baby, has a diagnosis of adjustment disorder unspecified. The nurse case manager should expect which client presentation that is characteristic of this diagnosis? 1. The client worries continually and appears nervous and jittery. 2. The client complains of a depressed mood, is tearful, and feels hopeless. 3. The client is belligerent, violates others' rights, and defaults on legal responsibilities. 4. The client complains of many physical ailments, refuses to socialize, and quits her job.

4. The client complains of many physical ailments, refuses to socialize, and quits her job.

The nurse is providing education to a client diagnosed with anxiety. Which statement by the client indicates that teaching has been effective? 1."There is nothing that I can do to that will reduce anxiety." 2."Medication is available, but only for those who have had anxiety for a year or more." 3."If I ignore the symptoms of anxiety, it will go away." 4."Practicing yoga or meditation may help reduce my anxiety."

4."Practicing yoga or meditation may help reduce my anxiety."

1. Traume & Stressor Related disorders A nursing instructor is teaching about trauma and stressor-related disorders. Which statement by one of the students indicates that further instruction is needed? 1."The trauma that women experience is more likely to be sexual assault and child sexual abuse." 2."The trauma that men experience is more likely to be accidents, physical assaults, combat, or viewing death or injury." 3."After exposure to a traumatic event, only 10 percent of victims develop posttraumatic stress disorder (PTSD)." 4."Research shows that PTSD is more common in men than in women."

4."Research shows that PTSD is more common in men than in women."

Order the eight-phase process of eye movement desensitization and reprocessing (EMDR). ________ Instillation ________ Body scan ________ Closure ________ Reevaluation ________ Preparation ________ History and treatment planning ________ Desensitization ________ Assessment

5, 6, 7, 8, 2, 1, 4, 3

10. A nursing instructor is teaching about the medications used to treat panic disorder. Which student statement indicates that learning has occurred? A. "Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder." B. "Clozapine (Clozaril) is used off-label in long-term treatment of panic disorder." C. "Doxepin (Sinequan) can be used in low doses to relieve symptoms of panic attacks." D. "Buspirone (BuSpar) is used for its immediate effect to lower anxiety during panic attacks."

A. "Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder."

9. A client diagnosed with panic disorder states, "When an attack happens, I feel like I am going to die." Which is the most appropriate nursing reply? A. "I know it's frightening, but try to remind yourself that this will only last a short time." B. "Death from a panic attack happens so infrequently that there is no need to worry." C. "Most people who experience panic attacks have feelings of impending doom." D. "Tell me why you think you are going to die every time you have a panic attack."

A. "I know it's frightening, but try to remind yourself that this will only last a short time."

16. A nurse is providing discharge teaching to a client taking a benzodiazepine. Which client statement would indicate a need for further follow-up instructions? A. "I will need scheduled bloodwork in order to monitor for toxic levels of this drug." B. "I won't stop taking this medication abruptly, because there could be serious complications." C. "I will not drink alcohol while taking this medication." D. "I won't take extra doses of this drug because I can become addicted."

A. "I will need scheduled blood work in order to monitor for toxic levels of this drug."

2. A client has a history of excessive fear of water. What is the term that a nurse should use to describe this specific phobia, and under what subtype is this phobia identified? A. Aquaphobia, a natural environment type of phobia B. Aquaphobia, a situational type of phobia C. Acrophobia, a natural environment type of phobia D. Acrophobia, a situational type of phobia

A. Aquaphobia, a natural environment type of phobia

Annie has trichotillomania. She is receiving treatment at the mental health clinic with habit-reversal therapy. Which of the following elements would be included in this therapy? (Select all that apply) A. Awareness training B. Competing response training C. Social Support D. Hypnotherapy E. Aversive therapy

A. Awareness training, B. Competing response training, C. Social support

The nurse can anticipate a prescription for what medication for the client who was just diagnosed with obsessive compulsive disorder? A. Clomipramine B. Clonidine C. Clonazepam D. Propranolol

A. Clomipramine, a tricyclic antidepressant, as well as SSRIs such as fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and fluvoxamine (Luvox) have been approved for treatment of OCD.

21. A client is prescribed alprazolam (Xanax) for acute anxiety. What client history should cause a nurse to question this order? A. History of alcohol dependence B. History of personality disorder C. History of schizophrenia D. History of hypertension

A. History of alcohol dependence

7. Arthur, who is diagnosed with obsessive-compulsive disorder, reports to the nurse that he can't stop thinking about all the potentially life threatening germs in the environment. What is the most accurate way for the nurse to document this symptom? A. Patient is expressing an obsession with germs. B. Patient is manifesting compulsive thinking. C. Patient is expressing delusional thinking about germs. D. Patient is manifesting arachnophobia of germs.

A. Patient is expressing an obsession with germs.

A client with OCD spends many hours each day washing her hands. The most likely reason she washes her hands so much is that it: A. Relieves her anxiety B. Reduced her probability of infection C. Gives her a feeling of control over her life D. Increases her self-concept

A. Relieves her anxiety

A client who is experiencing a panic attack just arrived at the ER. Which is the priority nursing intervention for this client? A. Stay with the client and reassure safety B. Administer a dose of diazepam C. Leave the client alone in a quiet room so that she can calm down. D. Encourage the client to talk about what triggered the attack.

A. Stay with the client and reassure safety

The mental health nurse practitioner would include what initial intervention in the care of the client with hoarding disorder: A. Psychoeducation about their disorder B. Ordering neuroimaging to determine activity in the cingulate cortex. C. Psychopharmacology including an SSRI D. Cognitive-behavioral therapy

A. psychoeducation about their disorder. This is the most likely INITIAL intervention. Treatment for hoarding disorder is most commonly a combination of cognitive-behavioral therapy and SSRIs. Decreased activity in the cingulate cortex IS associated with hoarding disorder (pg 540) but neuroimaging of the client's brain is unlikely to be ordered to diagnose/treat this disorder.

Which symptoms should a nurse recognize that differentiate a client diagnosed with obsessive-compulsive disorder (OCD) from a client diagnosed with obsessive-compulsive personality disorder? 1. Clients diagnosed with OCD experience both obsessions and compulsions, and clients diagnosed with obsessive-compulsive personality disorder do not. 2. Clients diagnosed with obsessive-compulsive personality disorder experience both obsessions and compulsions, and clients diagnosed with OCD do not. 3. Clients diagnosed with obsessive-compulsive personality disorder experience only obsessions, and clients diagnosed with OCD experience only compulsions. 4. Clients diagnosed with OCD experience only obsessions, and clients diagnosed with obsessive-compulsive personality disorder experience only compulsions.

ANS: 1 Rationale: A client diagnosed with OCD experiences both obsessions and compulsions. Clients with obsessive-compulsive personality disorder exhibit a pervasive pattern of preoccupation with orderliness, perfectionism, mental and interpersonal control, but do not experience obsessions and compulsions

9. A nurse reviews the laboratory data of a client suspected of having the diagnosis of major depressive episode. Which lab value would potentially rule out this diagnosis? 1. Thyroid-stimulating hormone (TSH) level of 25 U/mL 2. Potassium (K+) level of 4.2 mEq/L 3. Sodium (Na+) level of 140 mEq/L 4. Calcium (Ca2+) level of 9.5 mg/dL

ANS: 1 Rationale: A diagnosis of major depressive episode may be ruled out if the client's lab results reveal a TSH level of 25 U/mL. Normal levels of TSH range from 2 to 10 U/mL. High levels of TSH indicate low thyroid function. The client's high TSH value may indicate hypothyroidism, which can lead to depressive symptoms. The DSM-5 criteria for the diagnosis of major depressive episode states that this diagnosis must not be attributable to the direct physiological effects of another medical condition. Cognitive Level: Analysis Integrated Process: Evaluation

20. A client, who is taking transdermal selegiline (Emsam) for depressive symptoms, states, "My physician told me there was no need to worry about dietary restrictions." Which would be the most appropriate nursing response? 1. "Because your dose of Emsam is 6 mg in 24 hours, dietary restrictions are not recommended." 2. "You must have misunderstood. An MAOI like Emsam always has dietary restrictions." 3. "Only oral MAOIs require dietary restrictions." 4. "All transdermal MAOIs do not require dietary modifications."

ANS: 1 Rationale: Selegiline is a Monoamine Oxidase Inhibitor (MAOI). Hypertensive crisis, caused by the ingestion of foods high in tyramine, has not shown to be a problem with selegiline transdermal system at the 6 mg/24 hr dosage, and dietary restrictions at this dose are not recommended. Dietary modifications are recommended, however, at the 9 mg/24 hr and 12 mg/24 hr dosages. Cognitive Level: Application Integrated Process: Implementation

A nurse is providing discharge teaching to a client taking a benzodiazepine. Which client statement would indicate a need for further follow-up instructions? 1. "I will need scheduled blood work in order to monitor for toxic levels of this drug." 2. "I won't stop taking this medication abruptly because there could be serious complications." 3. "I will not drink alcohol while taking this medication." 4. "I won't take extra doses of this drug because I can become addicted."

ANS: 1 Rationale: The client indicates a need for additional information about taking benzodiazepines when stating the need for blood work to monitor for toxic levels. This intervention is used when taking lithium (Eskalith) for the treatment of bipolar disorder. The client should understand that taking extra doses of a benzodiazepine may result in addiction and that the drug should not be taken in conjunction with alcohol.

A client diagnosed with panic disorder states, "When an attack happens, I feel like I am going to die." Which is the most appropriate nursing response? 1. "I know it's frightening, but try to remind yourself that this will only last a short time." 2. "Death from a panic attack happens so infrequently that there is no need to worry." 3. "Most people who experience panic attacks have feelings of impending doom." 4. "Tell me why you think you are going to die every time you have a panic attack."

ANS: 1 Rationale: The most appropriate nursing response to the client's concerns is to empathize with the client and provide encouragement that panic attacks only last a short period. Panic attacks usually last minutes but can, rarely, last hours. When the nurse states that "Most people who experience panic attacks..." the nurse depersonalizes and belittles the client's feeling

4. Immediately after electroconvulsive therapy (ECT), in which position should a nurse place the client? 1. On his or her side, to prevent aspiration 2. In high Fowler's position, to prevent increased intracranial pressure 3. In Trendelenburg's position, to promote blood flow to vital organs 4. In prone position, to prevent airway blockage

ANS: 1 Rationale: The nurse should place a client who has received ECT on his or her side, to prevent aspiration. Cognitive Level: Application Integrated Process: Implementation

A nursing instructor is teaching about the medications used to treat panic disorder. Which student statement indicates that learning has occurred? 1. "Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder." 2. "Clozapine (Clozaril) is used off-label in long-term treatment of panic disorder." 3. "Doxepin (Sinequan) can be used in low doses to relieve symptoms of panic attacks." 4. "Buspirone (BuSpar) is used for its immediate effect to lower anxiety during panic attacks."

ANS: 1 Rationale: The student indicates learning has occurred when he or she states that clonazepam is a particularly effective treatment for panic disorder. Clonazepam is a type of benzodiazepine in which the major risk is physical dependence and tolerance, which may encourage abuse. It can be used on an as-needed basis to reduce anxiety and the related symptoms.

25. A nursing instructor is teaching about the new DSM-5 diagnostic category of disruptive mood dysregulation disorder (DMDD). Which of the following information should the instructor include? (Select all that apply.) 1. Symptoms include verbal rages or physical aggression toward people or property. 2. Temper outbursts must be present in at least two settings (at home, at school, or with peers). 3. DMDD is characterized by severe recurrent temper outbursts. 4. The temper outbursts are manifested only behaviorally. 5. Symptoms of DMDD must be present for 18 or more months to meet diagnostic criteria.

ANS: 1, 2, 3 Rationale: The APA has included a new diagnostic category in the Depressive Disorders chapter of the DSM-5. This childhood disorder is called disruptive mood dysregulation disorder. Criteria for the diagnosis include, but are not limited to, the following. Verbal rages or physical aggression toward people or property; temper outbursts must be present in at least two settings (at home, at school, or with peers). DMDD is characterized by severe recurrent temper outbursts. The temper outbursts are manifested both behaviorally and/or verbally. Symptoms of DMDD must be present for 12, not 18 or more months to meet diagnostic criteria.

24. A client is prescribed phenelzine (Nardil). Which of the following statements by the client should indicate to a nurse that discharge teaching about this medication has been successful? (Select all that apply.) 1. "I'll have to let my surgeon know about this medication before I have my cholecystectomy." 2. "I guess I will have to give up my glass of red wine with dinner." 3. "I'll have to be very careful about reading food and medication labels." 4. "I'm going to miss my caffeinated coffee in the morning." 5. "I'll be sure not to stop this medication abruptly."

ANS: 1, 2, 3, 5 Rationale: The nurse should evaluate that teaching has been successful when the client states that phenelzine should not be taken in conjunction with the use of alcohol or foods high in tyramine and should not be stopped abruptly. Phenelzine is an MAOI that can have negative interaction with other medications. The client needs to tell other physicians about taking MAOIs, because of the risk of drug interactions. Cognitive Level: Application Integrated Process: Implementation

An attractive female client presents with high anxiety levels because of her belief that her facial features are large and grotesque. Body dysmorphic disorder (BDD) is suspected. Which of the following additional symptoms would support this diagnosis? (Select all that apply.) 1. Mirror checking 2. Excessive grooming 3. History of an eating disorder 4. History of delusional thinking 5. Skin picking

ANS: 1, 2, 5 Rationale: The DSM-5 lists preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others as a diagnostic criteria for the diagnosis of BDD. Also listed is that at some point during the course of the disorder, the person has performed repetitive behaviors, such as mirror checking, excessive grooming, skin picking, or reassurance seeking.

A nurse has been caring for a client diagnosed with generalized anxiety disorder (GAD). Which of the following nursing interventions would address this client's symptoms? (Select all that apply.) 1. Encourage the client to recognize the signs of escalating anxiety. 2. Encourage the client to avoid any situation that causes stress. 3. Encourage the client to employ newly learned relaxation techniques. 4. Encourage the client to cognitively reframe thoughts about situations that generate anxiety. 5. Encourage the client to avoid caffeinated products.

ANS: 1, 3, 4, 5 Rationale: Nursing interventions that address GAD symptoms should include encouraging the client to recognize signs of escalating anxiety, to employ relaxation techniques, to cognitively reframe thoughts about anxiety-provoking situations, and to avoid caffeinated products. Avoiding situations that cause stress is not an appropriate intervention, because avoidance does not help the client overcome anxiety and because not all situations are easily avoidable

22. A nursing home resident has a diagnosis of dysthymic disorder. When planning care for this client, which of the following symptoms should a nurse expect the client to exhibit? (Select all that apply.) 1. Sad mood on most days 2. Mood rating of 2 out of 10 for the past 6 months 3. Labile mood 4. Sad mood for the past 3 years after spouse's death 5. Pressured speech when communicating

ANS: 1, 4 Rationale: The nurse should anticipate that a client with a diagnosis of dysthymic disorder would experience a sad mood on most days for more than two years. The essential feature of dysthymia is a chronically depressed mood, which can have an early or late onset. Cognitive Level: Application Integrated Process: Planning

A college student has been diagnosed with generalized anxiety disorder (GAD). Which of the following symptoms should a campus nurse expect this client to exhibit? (Select all that apply.) 1. Fatigue 2. Anorexia 3. Hyperventilation 4. Insomnia 5. Irritability

ANS: 1, 4, 5 Rationale: The nurse should expect that a client diagnosed with GAD would experience fatigue, insomnia, and irritability. GAD is characterized by chronic, unrealistic, and excessive anxiety and worry.

17. A number of assessment rating scales are available for measuring severity of depressive symptoms. Which scale would a nurse practitioner use to assess a depressed client? 1. Zung Depression Scale 2. Hamilton Depression Rating Scale 3. Beck Depression Inventory 4. AIMS Depression Rating Scale

ANS: 2 Rationale: A number of assessment rating scales are available for measuring severity of depressive symptoms. Some are meant to be clinician administered, whereas others may be self-administered. Examples of self-rating scales include the Zung Self-Rating Depression Scale and the Beck Depression Inventory. One of the most widely used clinician-administered scales is the Hamilton Depression Rating Scale. The Abnormal Involuntary Movement Scale (AIMS) is a rating scale that measures involuntary movements associated with tardive dyskinesia. Cognitive Level: Application Integrated Process: Assessment

5. A client is diagnosed with major depressive episode. Which nursing diagnosis should a nurse assign to this client, to address a behavioral symptom of this disorder? 1. Altered communication R/T feelings of worthlessness AEB anhedonia 2. Social isolation R/T poor self-esteem AEB secluding self in room 3. Altered thought processes R/T hopelessness AEB persecutory delusions 4. Altered nutrition: less than body requirements R/T high anxiety AEB anorexia

ANS: 2 Rationale: A nursing diagnosis of social isolation R/T poor self-esteem AEB secluding self in room addresses a behavioral symptom of major depressive episode. Other behavioral symptoms include psychomotor retardation, virtually nonexistent communication, curled-up position, and no attention to personal hygiene and grooming. Cognitive Level: Analysis Integrated Process: Diagnosis

A client diagnosed with obsessive-compulsive disorder is admitted to a psychiatric unit. The client has an elaborate routine for toileting activities. Which would be an appropriate initial client outcome during the first week of hospitalization? 1. The client will refrain from ritualistic behaviors during daylight hours. 2. The client will wake early enough to complete rituals prior to breakfast. 3. The client will participate in three unit activities by day three. 4. The client will substitute a productive activity for rituals by day one.

ANS: 2 Rationale: An appropriate initial client outcome is for the client to wake early enough to complete rituals prior to breakfast. The nurse should also provide a structured schedule of activities and begin to gradually limit the time allowed for rituals

21. After 6 months of taking imipramine (Tofranil) for depressive symptoms, a client complains that the medication doesn't seem as effective as before. Which question should the nurse ask to determine the cause of this problem? 1. "Are you consuming foods high in tyramine?" 2. "How many packs of cigarettes do you smoke daily?" 3. "Do you drink any alcohol?" 4. "Are you taking St. John's wort?"

ANS: 2 Rationale: Imipramine is a tricyclic antidepressant. Smoking should be avoided while receiving tricyclic therapy. Smoking increases the metabolism of tricyclics, requiring an adjustment in dosage to achieve the therapeutic effect. Alcohol potentiates the effects of antidepressants. Tyramine is only an issue when MAOI medications are prescribed. Concomitant use of St. John's wort and SSRIs, not tricyclics, increases, not decreases the effects of the drug. Cognitive Level: Application Integrated Process: Implementation

14. A nurse recently admitted a client to an inpatient unit after a suicide attempt. A health-care provider orders amitriptyline (Elavil) for the client. Which intervention, related to this medication, should be initiated to maintain this client's safety upon discharge? 1. Provide a 6-month supply of Elavil to ensure long-term compliance. 2. Provide a 1-week supply of Elavil, with refills contingent on follow-up appointments. 3. Provide pill dispenser as a memory aid. 4. Provide education regarding the avoidance of foods containing tyramine.

ANS: 2 Rationale: The health-care provider should provide no more than a 1-week supply of amitriptyline, with refills contingent on follow-up appointments, as an appropriate intervention to maintain the client's safety. Antidepressants, which are central nervous system depressants, can be used to commit suicide. Also these medications can precipitate suicidal thoughts during the initial use period. Limiting the amount of medication and monitoring the client weekly would be appropriate interventions to address the client's risk for suicide. Cognitive Level: Application Integrated Process: Implementation

A nursing student questions an instructor regarding the order for fluvoxamine (Luvox) 300 mg daily for a client diagnosed with obsessive-compulsive disorder (OCD). Which instructor response is most accurate? 1. High doses of tricyclic medications will be required for effective treatment of OCD. 2. Selective serotonin reuptake inhibitor (SSRI) doses, in excess of what is effective for treating depression, may be required for OCD. 3. The dose of Luvox is low because of the side effect of daytime drowsiness. 4. The dose of this selective serotonin reuptake inhibitor (SSRI) is outside the therapeutic range and needs to be questioned.

ANS: 2 Rationale: The most accurate instructor response is that SSRI doses in excess of what is effective for treating depression may be required in the treatment of OCD. SSRIs have been approved by the Food and Drug Administration for the treatment of OCD. Common side effects include headache, sleep disturbances, and restlessness

A family member is seeking advice about an older parent who seems to worry unnecessarily about everything. The family member states, "Should I seek psychiatric help for my mother?" Which is an appropriate nursing response? 1. "My mother also worries unnecessarily. I think it is part of the aging process." 2. "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning." 3. "From what you have told me, you should get her to a psychiatrist as soon as possible." 4. "Anxiety is a complex phenomenon and is effectively treated only with psychotropic medications."

ANS: 2 Rationale: The most appropriate response by the nurse is to explain to the family member that anxiety is considered abnormal when it is out of proportion and impairs functioning. Anxiety is a normal reaction to a realistic danger or threat to biological integrity or self-concept.

11. What is the rationale for a nurse to perform a full physical health assessment on a client admitted with a diagnosis of major depressive episode? 1. The attention during the assessment is beneficial in decreasing social isolation. 2. Depression can generate somatic symptoms that can mask actual physical disorders. 3. Physical health complications are likely to arise from antidepressant therapy. 4. Depressed clients avoid addressing physical health and ignore medical problems.

ANS: 2 Rationale: The nurse should determine that a client with a diagnosis of major depressive episode needs a full physical health assessment, because depression can generate somatic symptoms that can mask actual physical disorders. Cognitive Level: Application Integrated Process: Implementation

16. A client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, "I heard about something called a monoamine oxidase inhibitor (MAOI). Can't my doctor add that to my medications?" Which is an appropriate nursing response? 1. "This combination of drugs can lead to delirium tremens." 2. "A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis." 3. "That's a good idea. There have been good results with the combination of these two drugs." 4. "The only disadvantage would be the exorbitant cost of the MAOI." ]

ANS: 2 Rationale: The nurse should explain to the client that combining an MAOI and fluvoxamine, an SSRI, can lead to a life-threatening hypertensive crisis. Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches, with occasional photophobia, sensations of choking, palpitations, and a feeling of "dread." Cognitive Level: Application Integrated Process: Implementation

A nursing instructor is teaching about specific phobias. Which student statement indicates to the instructor that learning has occurred? 1. "These clients recognize their fear as excessive and frequently seek treatment." 2. "These clients have a panic level of fear that is overwhelming and unreasonable." 3. "These clients experience symptoms that mirror a cerebrovascular accident (CVA)." 4. "These clients experience the symptoms of tachycardia, dysphagia, and diaphoresis."

ANS: 2 Rationale: The nursing instructor should evaluate that learning has occurred when the student knows that clients with phobias have a panic level of fear that is overwhelming and unreasonable. Phobia is fear cued by a specific object or situation in which exposure to the stimuli produces an immediate anxiety response. Even though the disorder is relatively common among the general population, people seldom seek treatment unless the phobia interferes with ability to function.

A nursing instructor is teaching about the symptoms of agoraphobia. Which student statement indicates that learning has occurred? 1. Onset of symptoms most commonly occurs in early adolescence and persists until midlife. 2. Onset of symptoms most commonly occurs in the 20s and 30s and persists for many years. 3. Onset of symptoms most commonly occurs in the 40s and 50s and persists until death. 4. Onset of symptoms most commonly occurs after the age of 60 and persists for at least 6 years.

ANS: 2 Rationale: The onset of the symptoms of agoraphobia most commonly occurs in the 20s and 30s and persists for many years

18. The severity of depressive symptoms in the postpartum period varies from a feeling of the "blues," to moderate depression, to psychotic depression or melancholia. Which disorder is correctly matched with its presenting symptoms? 1. Maternity blues (lack of concentration, agitation, guilt, and an abnormal attitude toward bodily functions) 2. Postpartum depression (irritability, loss of libido, sleep disturbances, expresses concern about inability to care for baby) 3. Postpartum melancholia (overprotection of infant, expresses concern about inability to care for baby, mysophobia) 4. Postpartum depressive psychosis (transient depressed mood, agitation, abnormal fear of child abduction, suicidal ideations)

ANS: 2 Rationale: The symptoms of the maternity blues include tearfulness, despondency, anxiety, and subjectively impaired concentration appearing in the early puerperium. Symptoms of postpartum depression are associated with fatigue, irritability, loss of appetite, sleep disturbances, loss of libido, and expressions of great concern about her inability to care for her baby. Both postpartum melancholia and postpartum depressive psychosis are characterized by a lack of interest in, or rejection of, the baby, or a morbid fear that the baby may be harmed. Other symptoms include depressed mood, agitation, indecision, lack of concentration, guilt, and an abnormal attitude toward bodily functions. Cognitive Level: Application Integrated Process: Assessment

A nurse is discussing treatment options with a client whose life has been negatively impacted by claustrophobia. Which of the following commonly used behavioral therapies for phobias should the nurse explain to the client? (Select all that apply.) 1. Benzodiazepine therapy 2. Systematic desensitization 3. Imploding (flooding) 4. Assertiveness training 5. Aversion therapy

ANS: 2, 3 Rationale: The nurse should explain to the client that systematic desensitization and imploding are the most common behavioral therapies used for treating phobias. Systematic desensitization involves the gradual exposure of the client to anxiety-provoking stimuli. Imploding is the intervention used in which the client is exposed to extremely frightening stimuli for prolonged periods of time

23. An individual experiences sadness and melancholia in September continuing through November. Which of the following factors should a nurse identify as most likely to contribute to the etiology of these symptoms? (Select all that apply.) 1. Gender differences in social opportunities that occur with age 2. Drastic temperature and barometric pressure changes 3. A seasonal increase in social interactions 4. Variations in serotonergic functioning 5. Inaccessibility of resources for dealing with life stressors

ANS: 2, 3, 4 Rationale: The nurse should identify drastic temperature and barometric pressure changes, a seasonal increase in social interactions, and/or variations in serotonergic functioning as contributing to the etiology of the client's symptoms. A number of studies have examined seasonal patterns associated with mood disorders and have revealed two prevalent periods of seasonal involvement: spring (March, April, May) and fall (September, October, November). Cognitive Level: Application Integrated Process: Evaluation

13. A nurse admits an older client with memory loss, confused thinking, and apathy. A psychiatrist suspects a depressive disorder. What is the rationale for performing a mini-mental status exam? 1. To rule out bipolar disorder 2. To rule out schizophrenia 3. To rule out neurocognitive disorder 4. To rule out personality disorder

ANS: 3 Rationale: A mini-mental status exam should be performed to rule out neurocognitive disorder. The client may be experiencing reversible dementia, which can occur as a result of depression. Cognitive Level: Application Integrated Process: Evaluation

Which nursing statement to a client about social anxiety disorder versus schizoid personality disorder (SPD) is most accurate? 1. "Clients diagnosed with social anxiety disorder can manage anxiety without medications, whereas clients diagnosed with SPD can only manage anxiety with medications." 2. "Clients diagnosed with SPD are distressed by the symptoms experienced in social settings, whereas clients diagnosed with social anxiety disorder are not." 3. "Clients diagnosed with social anxiety disorder avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life." 4. "Clients diagnosed with SPD avoid interactions only in social settings, whereas clients diagnosed with social anxiety disorder tend to avoid interactions in all areas of life."

ANS: 3 Rationale: Clients diagnosed with social anxiety disorder avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life. Social anxiety disorder is an excessive fear of situations in which a person might do something embarrassing or be evaluated negatively by others.

3. A nurse administers 100% oxygen to a client during and after electroconvulsive therapy treatment (ECT). What is the rationale for this procedure? 1. To prevent increased intracranial pressure resulting from anoxia. 2. To prevent decreased blood pressure, pulse, and respiration owing to electrical stimulation. 3. To prevent anoxia resulting from medication-induced paralysis of respiratory muscles. 4. To prevent blocked airway, resulting from seizure activity.

ANS: 3 Rationale: The nurse administers 100% oxygen during and after ECT to prevent anoxia resulting from medication-induced paralysis of respiratory muscles. Cognitive Level: Application Integrated Process: Implementation

A client is experiencing a severe panic attack. Which nursing intervention would meet this client's physiological need? 1. Teach deep breathing relaxation exercises. 2. Place the client in a Trendelenburg position. 3. Have the client breathe into a paper bag. 4. Administer the ordered prn buspirone (BuSpar).

ANS: 3 Rationale: The nurse can meet this client's physiological need by having the client breathe into a paper bag. Hyperventilation may occur during periods of extreme anxiety. Hyperventilation causes the amount of carbon dioxide (CO2) in the blood to decrease, possibly resulting in lightheadedness, rapid heart rate, shortness of breath, numbness or tingling in the hands or feet, and syncope. If hyperventilation occurs, assist the client to breathe into a small paper bag held over the mouth and nose. Six to twelve natural breaths should be taken, alternating with short periods of diaphragmatic breathing.

10. A depressed client reports to a nurse a history of divorce, job loss, family estrangement, and cocaine abuse. Which theoretical principle best explains the etiology of this client's depressive symptoms? 1. According to psychoanalytic theory, depression is a result of negative perceptions. 2. According to object-loss theory, depression is a result of overprotection. 3. According to learning theory, depression is a result of repeated failures. 4. According to cognitive theory, depression is a result of anger turned inward.

ANS: 3 Rationale: The nurse should assess that, according to learning theory, this client's depressive symptoms may have resulted from repeated failures. The learning theory is a model of "learned helplessness" in which multiple life failures cause the client to abandon future attempts to succeed. Cognitive Level: Application Integrated Process: Assessment

8. A client with a history of suicide attempts has been taking fluoxetine (Prozac) for one month. The client suddenly presents with a bright affect, rates mood at 9 out of 10, and is much more communicative. Which action should be the nurse's priority at this time? 1. Give the client off-unit privileges as positive reinforcement. 2. Encourage the client to share mood improvement in group. 3. Increase the level of this client's suicide precautions. 4. Request that the psychiatrist reevaluate the current medication protocol.

ANS: 3 Rationale: The nurse should be aware that a sudden increase in mood rating and change in affect could indicate that the client is at risk for suicide. Suicide risk may occur early during treatment with antidepressants. The return of energy may bring about an increased ability to act out self-destructive behavior. Cognitive Level: Analysis Integrated Process: Implementation

A client living in a beachfront community is seeking help with an extreme fear of bridges, which is interfering with daily functioning. A psychiatric nurse practitioner decides to try systematic desensitization. Which explanation of this treatment should the nurse provide? 1. "Using your imagination, we will attempt to achieve a state of relaxation." 2. "Because anxiety and relaxation are mutually exclusive states, we can attempt to substitute a relaxation response for the anxiety response." 3. "Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety." 4. "In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate."

ANS: 3 Rationale: The nurse should explain to the client that when participating in systematic desensitization he or she will go through a series of increasingly anxiety-provoking steps that will gradually increase tolerance. Systematic desensitization was introduced by Joseph Wolpe in 1958 and is based on behavioral conditioning principles.

Which treatment should a nurse identify as most appropriate for clients diagnosed with generalized anxiety disorder (GAD)? 1. Long-term treatment with diazepam (Valium) 2. Acute symptom control with citalopram (Celexa) 3. Long-term treatment with buspirone (BuSpar) 4. Acute symptom control with ziprasidone (Geodon)

ANS: 3 Rationale: The nurse should identify that an appropriate treatment for clients diagnosed with GAD is long-term treatment with buspirone. Buspirone is an anxiolytic medication that is effective in 60% to 80% of clients diagnosed with GAD. Buspirone takes 10 to 14 days for alleviation of symptoms but does not have the dependency concerns of other anxiolytics.

6. A client diagnosed with major depressive episode hears voices commanding self-harm. Which should be the nurse's priority intervention at this time? 1. Obtaining an order for locked seclusion until client is no longer suicidal. 2. Conducting 15-minute checks to ensure safety. 3. Placing the client on one-to-one observation while continuing to monitor suicidal ideations. 4. Encouraging client to express feelings related to suicide.

ANS: 3 Rationale: The nurse's priority intervention when a depressed client hears voices commanding self-harm is to place the client on one-to-one observation while continuing to monitor suicidal ideations. By providing one-to-one observation, the nurse will be able to interrupt any attempts at suicide. Cognitive Level: Analysis Integrated Process: Implementation

1. A nurse discovers a client's suicide note that details the time, place, and means to commit suicide. What should be the priority nursing action, and why? 1. Administer lorazepam (Ativan) prn, because the client is angry about plan exposure. 2. Establish room restrictions, because the client's threat is an attempt to manipulate the staff. 3. Place client on one-to-one suicide precautions, because specific plans likely lead to attempts. 4. Call an emergency treatment team meeting, because the client's threat must be addressed.

ANS: 3 Rationale: The priority nursing action should be to place this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide. Cognitive Level: Analysis Integrated Process: Implementation

19. A staff nurse is counseling a depressed client. The nurse determines that the client is using the cognitive distortion of "automatic thoughts." Which client statement is evidence of the "automatic thought" of discounting positives? 1. "It's all my fault for trusting him." 2. "I don't play games. I never win." 3. "She never visits because she thinks I don't care." 4. "I don't have a green thumb. Any old fool can grow a rose."

ANS: 4 Rationale: Examples of automatic thoughts in depression include: Personalizing: "I'm the only one who failed." All or nothing: "I'm a complete failure." Mind reading: "He thinks I'm foolish." Discounting positives: "The other questions were so easy. Any dummy could have gotten them right." Cognitive Level: Application Integrated Process: Assessment

12. A nurse is planning care for a 13 -year-old who is experiencing depression. Which medication is approved by the Food and Drug Administration (FDA) for the treatment of depression in adolescents? 1. Paroxetine (Paxil) 2. Sertraline (Zoloft) 3. Citalopram (Celexa) 4.Fluoxetine (Prozac

ANS: 4 Rationale: Fluoxetine (Prozac) has been approved by the FDA to treat depression in children and adolescents, and escitalopram was approved in 2009 for treatment of depression in adolescents aged 12 to 17 years. All antidepressants carry an FDA warning for increased risk of suicide in children and adolescents. Cognitive Level: Application Integrated Process: Planning

7. A nurse assesses a client suspected of having the diagnosis of major depressive episode. Which client symptom would rule out this diagnosis? 1. The client is disheveled and malodorous. 2. The client refuses to interact with others and isolates self in room. 3. The client is unable to feel any pleasure. 4. The client has maxed-out charge cards and exhibits promiscuous behaviors.

ANS: 4 Rationale: The nurse should assess that a client who has maxed-out credit cards and exhibits promiscuous behavior is exhibiting signs of mania. The DSM-5 criteria state that there must never have been a manic episode or a hypomanic episode to meet the criteria for the diagnosis of major depressive episode. Cognitive Level: Application Integrated Process: Assessment

A client is newly diagnosed with obsessive-compulsive disorder and spends 45 minutes folding clothes and rearranging them in drawers. Which nursing intervention would best address this client's problem? 1. Distract the client with other activities whenever ritual behaviors begin. 2. Report the behavior to the psychiatrist to obtain an order for medication dosage increase. 3. Lock the room to discourage ritualistic behavior. 4. Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors.

ANS: 4 Rationale: The nurse should discuss with the client the anxiety-provoking triggers that precipitate the ritualistic behavior. If the client is going to be able to control interrupting anxiety, he or she must first learn to recognize precipitating factors. Attempting to distract the client, seeking medication increase, and locking the client's room are not appropriate interventions, because they do not help the client gain insight.

A client diagnosed with an obsessive-compulsive disorder spends hours bathing and grooming. During a one-on-one interaction, the client discusses the rituals in detail but avoids any feelings that the rituals generate. Which defense mechanism should the nurse identify? 1. Sublimation 2. Dissociation 3. Rationalization 4. Intellectualization

ANS: 4 Rationale: The nurse should identify that the client is using the defense mechanism of intellectualization when discussing the rituals of obsessive-compulsive disorder in detail while avoiding discussion of feelings. Intellectualization is an attempt to avoid expressing emotions associated with a stressful situation by using the intellectual process of logic, reasoning, and analysis.

What symptoms should a nurse recognize that differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)? 1. GAD is acute in nature, and panic disorder is chronic. 2. Chest pain is a common GAD symptom, whereas this symptom is absent in panic disorders. 3. Hyperventilation is a common symptom in GAD and rare in panic disorder. 4. Depersonalization is commonly seen in panic disorder and absent in GAD.

ANS: 4 Rationale: The nurse should recognize that a client diagnosed with panic disorder experiences depersonalization, whereas a client diagnosed with GAD would not. Depersonalization refers to being detached from oneself when experiencing extreme anxiety.

A cab driver, stuck in traffic, becomes lightheaded, tremulous, diaphoretic, tachycardic and dyspneic. A workup in an emergency department reveals no pathology. Which medical diagnosis should a nurse suspect, and what nursing diagnosis should be the nurse's first priority? 1. Generalized anxiety disorder and a nursing diagnosis of fear 2. Altered sensory perception and a nursing diagnosis of panic disorder 3. Pain disorder and a nursing diagnosis of altered role performance 4. Panic disorder and a nursing diagnosis of anxiety

ANS: 4 Rationale: The nurse should suspect that the client has exhibited signs and symptoms of a panic disorder. The priority nursing diagnosis should be anxiety. Panic disorder is characterized by recurrent, sudden-onset panic attacks in which the person feels intense fear, apprehension, or terror

15. An older client has recently been prescribed sertraline (Zoloft). The client's spouse is taking paroxetine (Paxil). A nurse assesses that the client is experiencing restlessness, tachycardia, diaphoresis, and tremors. Which complication should a nurse suspect, and why? 1. Neuroleptic malignant syndrome; caused by ingestion of two different seratonin reuptake inhibitors (SSRIs) 2. Neuroleptic malignant syndrome; caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI) 3. Serotonin syndrome; possibly caused by ingestion of an SSRI and an MAOI 4. Serotonin syndrome; possibly caused by ingestion of two different SSRIs

ANS: 4 Rationale: The nurse should suspect that the client is suffering from serotonin syndrome; possibly caused by ingesting two different SSRI's (sertraline and paroxetine). Symptoms of serotonin syndrome include confusion, agitation, tachycardia, hypertension, nausea, abdominal pain, myoclonus, muscle rigidity, fever, sweating, and tremor. Cognitive Level: Application Integrated Process: Assessment

2. In planning care for a suicidal client, which correctly written outcome should be a nurse's first priority? 1. The client will not physically harm self. 2. The client will express hope for the future by day three. 3. The client will establish a trusting relationship with the nurse. 4. The client will remain safe during hospital stay.

ANS: 4 Rationale: The nurse's first priority should be that the client will remain safe during the hospital stay. Client safety should always be the nurse's first priority. Outcomes should be client-centered, specific, realistic, measureable, and must also include a time frame. Cognitive Level: Analysis Integrated Process: Planning

A client is prescribed alprazolam (Xanax) for acute anxiety. What client history should cause a nurse to question this order? A. History of alcohol use disorder B. History of personality disorder C. History of schizophrenia D. History of hypertension

ANS: A Rationale: The nurse should question a prescription of alprazolam for acute anxiety if the client has a history of alcohol use disorder. Alprazolam is a benzodiazepine used in the treatment of anxiety and has an increased risk for physiological dependence and tolerance. A client with a history of substance use disorder may be more likely to abuse other addictive substances.

18. A 10-week, prenuptial counseling group composed of five couples is terminating. At the last group meeting, a nurse notices that the two most faithful and participative couples are absent. When considering concepts of group development, what might explain this behavior? A. They are experiencing problems with termination, leading to feelings of abandonment. B. They did not think any new material would be covered at the last session. C. They were angry with the leader for not extending the length of the group. D. They were bored with the material covered in the group.

ANS: A The nurse should determine that the clients' absence from the final group meeting may indicate that they are experiencing problems with termination. The termination phase of group development may elicit feelings of abandonment and anger. Successful termination may help members develop skills to cope with future unrelated losses. PTS: 1 REF: 193 KEY: Cognitive Level: Application | Integrated Process: Assessment

10. During an inpatient educational group, a client shouts out, "This information is worthless. Nothing you have said can help me." These statements indicate to the nurse leader that the client is assuming which group role? A. The group role of aggressor B. The group role of initiator C. The group role of gatekeeper D. The group role of blocker

ANS: A The nurse should identify that the client is assuming the group role of the aggressor. The aggressor expresses negativism and hostility toward others in the group or to the group leader and may use sarcasm in an effort to degrade the status of others. PTS: 1 REF: 195 KEY: Cognitive Level: Application | Integrated Process: Evaluation

4. During a community meeting, a nurse encourages clients to present unit problems and discuss possible solutions. Which type of leadership style is the nurse demonstrating? A. Democratic B. Autocratic C. Laissez-faire D. Bureaucratic

ANS: A The nurse who encourages clients to present problems and discuss solutions is demonstrating a democratic leadership style. Democratic leaders share information with group members and promote decision making by the members of the group. The leader provides guidance and expertise as needed. PTS: 1 REF: 194 KEY: Cognitive Level: Application | Integrated Process: Implementation

2. During a therapeutic group, two clients engage in an angry verbal exchange. The nurse leader interrupts the exchange and excuses both of the clients from the group. The nurse has demonstrated which leadership style? A. Autocratic B. Democratic C. Laissez-faire D. Bureaucratic

ANS: A The nurse who excuses clients from the group has demonstrated an autocratic leadership style. An autocratic leadership style may be useful in certain situations that require structure and limit setting. Democratic leaders focus on the members of the group and group-selected goals. Laissez-faire leaders provide no direction to group members. PTS: 1 REF: 193-194 KEY: Cognitive Level: Application | Integrated Process: Implementation

8. During a group discussion, members freely interact with each other. Which member statement is an example of Yalom's curative group factor of imparting information? A. "I found a Web site explaining the different types of brain tumors and their treatment." B. "My brother also had a brain tumor and now is completely cured." C. "I understand your fear and will be by your side during this time." D. "My mother was also diagnosed with cancer of the brain."

ANS: A Yalom's curative group factor of imparting information involves sharing knowledge gained through formal instruction as well as by the sharing of advice and suggestions by other group members. PTS: 1 REF: 192 KEY: Cognitive Level: Application | Integrated Process: Evaluation

30 A client who has been diagnosed with a phobic disorder asks the nurse if there are any medications that would be beneficial in treating phobic disorders. Which of the following would be accurate responses by the nurse? Select all that apply. A. Some antianxiety agents have been successful in treating social phobias. B. Some antidepressant agents have been successful in diminishing symptoms of agoraphobia and social anxiety disorder (social phobia). C. Specific phobias are generally not treated with medication unless accompanied by panic attacks. D. Beta-blockers have been used successfully to treat phobic responses to public performance.

ANS: A, B, C, D

21. Which of the following observed client behaviors would lead a nurse to evaluate a member as assuming a maintenance group role? (Select all that apply.) A. A client decreases conflict within the group by encouraging compromise. B. A client offers recognition and acceptance of others. C. A client outlines the task at hand and proposes solutions. D. A client listens attentively to group interaction. E. A client uses the group to gain sympathy from others.

ANS: A, B, D The nurse should identify clients who decrease conflict within the group, offer recognition and acceptance of others, and listen attentively to group interaction as assuming a maintenance group role. There are member roles within each group. Maintenance roles include the compromiser, the encourager, the follower, the gatekeeper, and the harmonizer. PTS: 1 REF: 195 KEY: Cognitive Level: Application | Integrated Process: Assessment

29. A nurse has been caring for a client diagnosed with generalized anxiety disorder (GAD). Which of the following nursing interventions would address this client's symptoms? Select all that apply. A. Encourage the client to recognize the signs of escalating anxiety. B. Encourage the client to avoid any situation that causes stress. C. Encourage the client to employ newly learned relaxation techniques. D. Encourage the client to cognitively reframe thoughts about situations that generate anxiety. E. Encourage the client to avoid caffeinated products

ANS: A, C, D, E

27. A college student has been diagnosed with generalized anxiety disorder (GAD). Which of the following symptoms should a campus nurse expect this client to exhibit? Select all that apply. A. Fatigue B. Anorexia C. Hyperventilation D. Insomnia E. Irritability

ANS: A, D, E

12. During a group session, which client statement demonstrates that the group has progressed to the middle, or working, phase of group development? A. "It's hard for me to tell my story when I'm not sure about the reactions of others." B. "I think Joe's Antabuse suggestion is a good one and might work for me." C. "My situation is very complex, and I need professional, not peer, advice." D. "I am really upset that you expect me to solve my own problems."

ANS: B The nurse should determine that group members have progressed to the working phase of group development when members begin to look to each other instead of to the leader for guidance. Group members in the working phase begin to accept criticism from each other and then use it constructively to foster change. PTS: 1 REF: 193 KEY: Cognitive Level: Application | Integrated Process: Evaluation

1. During a therapeutic group, a client talks about personal accomplishments in an effort to gain attention. Which group role, assumed by this client, should the nurse identify? A. The task role of gatekeeper B. The individual role of recognition seeker C. The maintenance role of dominator D. The task role of elaborator

ANS: B The nurse should evaluate that the client is assuming the individual role of the recognition seeker. Other individual roles include the aggressor, the blocker, the dominator, the help seeker, the monopolizer, and the seducer. PTS: 1 REF: 195 KEY: Cognitive Level: Application | Integrated Process: Evaluation

5. Which situation should a nurse identify as an example of an autocratic leadership style? A. The president of Sigma Theta Tau assigns members to committees to research problems. B. Without faculty input, the dean mandates that all course content be delivered via the Internet. C. During a community meeting, a nurse listens as clients generate solutions. D. The student nurses' association advertises for candidates for president.

ANS: B The nurse should identify that mandating decisions without consulting the group is considered an autocratic leadership style. Autocratic leadership increases productivity but often reduces morale and motivation due to lack of member input and creativity. PTS: 1 REF: 193-194 KEY: Cognitive Level: Application | Integrated Process: Assessment

15. The nurse should utilize which group function to help an extremely withdrawn, paranoid client increase feelings of security? A. Socialization B. Support C. Empowerment D. Governance

ANS: B The nurse should identify that the group function of support would help an extremely withdrawn, paranoid client increase feelings of security. Support assists group members in gaining a feeling of security from group involvement. PTS: 1 REF: 190 KEY: Cognitive Level: Application | Integrated Process: Implementation

7. A man diagnosed with alcohol dependence experiences his first relapse. During his AA meeting, another group member states, "I relapsed three times, but now have been sober for 15 years." Which of Yalom's curative group factors does this illustrate? A. Imparting of information B. Instillation of hope C. Catharsis D. Universality

ANS: B This scenario is an example of the curative group factor of instillation of hope. This occurs when members observe the progress of others in the group with similar problems and begin to believe that personal problems can also be resolved. PTS: 1 REF: 192 KEY: Cognitive Level: Application | Integrated Process: Assessment

28. A nurse is discussing treatment options with a client whose life has been negatively impacted by claustrophobia. The nurse would expect which of the following behavioral therapies to be most commonly used in the treatment of phobias? Select all that apply. A. Benzodiazepine therapy B. Systematic desensitization C. Imploding (flooding) D. Assertiveness training E. Aversion therapy

ANS: B, C

22. Which of the following behavioral skills should a nurse implement when leading a group that is functioning in the orientation phase of group development? (Select all that apply.) A. Encouraging members to provide feedback to each other about individual progress B. Ensuring that group rules do not interfere with goal fulfillment C. Working with group members to establish rules that will govern the group D. Emphasizing the need for and importance of confidentiality within the group E. Helping the members to resolve conflicts and foster cohesiveness within the group

ANS: B, C, D During the orientation phase of group development, the nurse leader should work together with members to establish rules that will effectively govern the group. The leader should ensure that group rules do not interfere with goal fulfillment and establish the need for and importance of confidentiality within the group. Members need to establish trust and cohesion to move into the working phase of group development. PTS: 1 REF: 193 KEY: Cognitive Level: Application | Integrated Process: Implementation

19. An experienced psychiatric registered nurse has taken a new position leading groups in a day treatment program. Without further education, which group is this nurse most qualified to lead? A. A psychodrama group B. A psychotherapy group C. A parenting group D. A family therapy group

ANS: C A psychiatric registered nurse is qualified to lead a parenting group. A parenting group can be classified as either a teaching group or therapeutic group. Psychodrama, psychotherapy, and family therapy are forms of group therapy that must be facilitated by qualified leaders who generally have advanced degrees in psychology, social work, nursing, or medicine. PTS: 1 REF: 190 KEY: Cognitive Level: Application | Integrated Process: Implementation

During her aunt's wake, a four-year-old child runs up to the casket before a mother can stop her. An appointment is made with a nurse practitioner when the child starts twisting and pulling out hair. Which nursing diagnosis should the nurse practitioner assign to this child? A. Complicated grieving B. Altered family processes C. Ineffective coping D. Body image disturbance

ANS: C Rationale: Ineffective coping is defined as an inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources. This child is coping with the anxiety generated by viewing her deceased aunt by pulling out hair. If this behavior continues, a diagnosis of hair-pulling disorder, or trichotillomania, may be assigned

A college student is unable to take a final exam owing to severe test anxiety. Instead of studying, the student relieves stress by attending a movie. Which priority nursing diagnosis should a campus nurse assign for this client? A. Non-adherence R/T test taking B. Ineffective role performance R/T helplessness C. Altered coping R/T anxiety D. Powerlessness R/T fear

ANS: C Rationale: The priority nursing diagnosis for this client is altered coping R/T anxiety. The nurse should assist in implementing interventions that will improve the client's healthy coping skills and reduce anxiety.

3. During a therapeutic group, which nursing action demonstrates a laissez-faire leadership style? A. The nurse mandates that all group members reveal an embarrassing personal situation. B. The nurse asks for a show of hands to determine group topic preference. C. The nurse sits silently as the group members stray from the assigned topic. D. The nurse shuffles through papers to determine the facility policy on length of group.

ANS: C The nurse leader who sits silently and allows group members to stray from the assigned topic is demonstrating a laissez-faire leadership style. This style allows group members to do as they please with no direction from the leader. Group members often become frustrated and confused in reaction to a laissez-faire leadership style. PTS: 1 REF: 194-195 KEY: Cognitive Level: Application | Integrated Process: Implementation

11. A nurse believes that the members of a parenting group are in the initial, or orientation, phase of group development. Which group behaviors would support this assumption? A. The group members manage conflict within the group. B. The group members use denial as part of the grief response. C. The group members compliment the leader and compete for the role of recorder. D. The group members initially trust one another and the leader.

ANS: C The nurse should anticipate that members in the initial, or orientation, phase of group development often compliment the leader and compete for the role of recorder. Members in this phase have not yet established trust and have a fear of not being accepted. Power struggles may occur as members compete for their position in the group. PTS: 1 REF: 193 KEY: Cognitive Level: Application | Integrated Process: Evaluation

20. A nursing instructor is teaching about psychodrama, a specialized type of therapeutic group. Which student statement indicates that further teaching is necessary? A. "Psychodrama provides a safe setting in which to discuss painful issues." B. "In psychodrama, the client is the protagonist." C. "In psychodrama, the client observes actor interactions from the audience." D. "Psychodrama facilitates resolution of interpersonal conflicts."

ANS: C The nurse should educate the student that in psychodrama the client plays the role of himself or herself in a life-situation scenario and is called the protagonist. During psychodrama, the client does not observe interactions from the audience. Other group members perform the role of the audience and discuss the situation they have observed, offer feedback, and express their feelings. Leaders of psychodrama must have specialized training to become a psychodramatist. PTS: 1 REF: 194-195 KEY: Cognitive Level: Application | Integrated Process: Evaluation

16. When planning group therapy, a nurse should identify which configuration as most optimal for a therapeutic group? A. Open-ended membership; circle of chairs; group size of 5 to 10 members B. Open-ended membership; chairs around a table; group size of 10 to 15 members C. Closed membership; circle of chairs; group size of 5 to 10 members D. Closed membership; chairs around a table; group size of 10 to 15 members

ANS: C The nurse should identify that the most optimal conditions for a therapeutic group are when the membership is closed and the group size is between 5 and 10 members who are arranged in a circle of chairs. The focus of therapeutic groups is on relationships within the group and the interactions among group members. PTS: 1 REF: 191-192 KEY: Cognitive Level: Application | Integrated Process: Planning

9. Prayer group members at a local Baptist church are meeting with a poor, homeless family they are supporting. Which member statement is an example of Yalom's curative group factor of altruism? A. "I'll give you the name of a friend that rents inexpensive rooms." B. "The last time we helped a family, they got back on their feet and prospered." C. "I can give you all of my baby clothes for your little one." D. "I can appreciate your situation. I had to declare bankruptcy last year."

ANS: C Yalom's curative group factor of altruism occurs when group members provide assistance and support to each other creating a positive self-image and promoting self-growth. Individuals increase self-esteem through mutual caring and concern. PTS: 1 REF: 192 KEY: Cognitive Level: Application | Integrated Process: Evaluation

13. Which group leader activity should a nurse identify as being most effective in the final, or termination, phase of group development? A. The group leader establishes the rules that will govern the group after discharge. B. The group leader encourages members to rely on each other for problem solving. C. The group leader presents and discusses the concept of group termination. D. The group leader helps the members to process feelings of loss.

ANS: D The most effective intervention in the final, or termination, phase of group development would be for the group leader to help the members to process feelings of loss. The leader should encourage the members to review the goals and discuss outcomes, reminisce about what has occurred, and encourage members to provide feedback to each other about progress. PTS: 1 REF: 193 KEY: Cognitive Level: Application | Integrated Process: Implementation

17. During the sixth week of a 10-week parenting skills group, a nurse observes as several members get into a heated dispute about spanking. As a group, they decide to create a pros-and-cons poster on the use of physical discipline. At this time, what is the role of the group leader? A. To referee the debate B. To adamantly oppose physical discipline measures C. To redirect the group to a less controversial topic D. To encourage the group to solve the problem collectively

ANS: D The role of the group leader is to encourage the group to solve the problem collectively. A democratic leadership style supports members in their participation and problem solving. Members are encouraged to cooperatively solve issues that relate to the group. PTS: 1 REF: 194 KEY: Cognitive Level: Application | Integrated Process: Implementation

6. A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate. A mother of three admits to having felt that way herself. Which of Yalom's curative group factors does this illustrate? A. Imparting of information B. Instillation of hope C. Altruism D. Universality

ANS: D The scenario is an example of the curative group factor of universality. Universality occurs when individuals realize that they are not alone in the problems, thoughts, and feelings they are experiencing. This realization reduces anxiety by the support and understanding of others. PTS: 1 REF: 192 KEY: Cognitive Level: Application | Integrated Process: Assessment

14. A nursing instructor is teaching students about self-help groups like Alcoholics Anonymous (AA). Which student statement indicates that learning has occurred? A. "There is little research to support AA's effectiveness." B. "Self-help groups used to be the treatment of choice, but their popularity is waning." C. "These groups have no external regulation, so clients need to be cautious." D. "Members themselves run the group, with leadership usually rotating among the members."

ANS: D The student indicates an understanding of self-help groups when stating, "Members themselves run the group, with leadership usually rotating among the members." Nurses may or may not be involved in self-help groups. These groups allow members to talk about feelings and reduce feelings of isolation while receiving support from others undergoing similar experiences. PTS: 1 REF: 191 KEY: Cognitive Level: Application | Integrated Process: Evaluation

Antianxiety drugs are also called ______________________ and minor tranquilizers.

ANS: anxiolytics Rationale: Antianxiety drugs are also called anxiolytics and minor tranquilizers. Antianxiety agents are used in the treatment of anxiety disorders, anxiety symptoms, acute alcohol withdrawal, skeletal muscle spasms, convulsive disorders, status epilepticus, and preoperative sedation.

Traits associated with schizoid, obsessive-compulsive, and _____________________ personality disorders are commonly seen in clients with the diagnosis of body dysmorphic disorder.

ANS: narcissistic Rationale: Traits associated with schizoid, obsessive-compulsive, and narcissistic personality disorders are not uncommon in clients with the diagnosis of BDD

Caroline reports to the nurse that she has an intense fear of riding the bus and being in crowds. The type of phobia she is describing is____________.

Agoraphobia fear or anxiety must occur in at least two of five situations to diagnose agoraphobia; fear of public transportation and being in crowds are two of those criteria.

Antianxiety drugs are also called ______________________ and minor tranquilizer

Anxiolytics

11. A family member is seeking advice about an elderly parent who seems to worry unnecessarily about everything. The family member states, "Should I seek psychiatric help for my mother?" Which is an appropriate nursing reply? A. "My mother also worries unnecessarily. I think it is part of the aging process." B. "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning." C. "From what you have told me, you should get her to a psychiatrist as soon as possible." D. "Anxiety is a complex phenomenon and is effectively treated only with psychotropic medications."

B. "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning."

Janet has a diagnosis of generalized anxiety disorder. Her physician has prescribed buspirone 15 mg daily. Janet says to her nurse, "Why do I have to take this every day? My friend's doctor ordered Xanax for her, and she only takes it when she's feeling anxious." Which of the following would be an appropriate response by the nurse? A. "Xanax is not effective for generalized anxiety disorder." B. "Buspirone must be taken daily to be effective." C. "I will ask the doctor if he will change your dose of buspirone to prn so that you don't have to take it every day." D. "Your friend really should be taking the Xanax every day."

B. "Buspirone must be taken daily to be effective."

The mental health nurse recognizes the new nurse requires more teaching when she makes this statement about panic disorder: A. " The panic attacks are manifested by intense apprehension, fear or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort." B. "Episodes of panic attacks associated with panic disorder are predictable and often occur on exposure to an anxiety producing situation." C. "Some common symptoms of panic disorder are: palpitations, pounding heart, sweating and sensations of shortness of breath." D. "The average onset of panic disorder is in the late 20s."

B. "Episodes of panic attacks associated with panic disorder are predictable and often occur on exposure to an anxiety producing situation." Panic disorder is characterized by recurrent panic attacks, the onset of which is UNPREDICTABLE. The symptoms come on unexpectedly, not before or on exposure to a situation that usually causes anxiety. pg. 532

19. A nursing student questions an instructor regarding the order for fluvoxamine (Luvox), 300 mg daily, for a client diagnosed with obsessive-compulsive disorder (OCD). Which instructor reply is most accurate? A. "High doses of tricyclic medications will be required for effective treatment of OCD." B. "Selective serotonin reuptake inhibitor (SSRI) doses, in excess of what is effective for treating depression, may be required for OCD." C. "The dose of Luvox is low due to the side effect of daytime drowsiness and nighttime insomnia." D. "The dosage of Luvox is outside the therapeutic range and needs to be questioned."

B. "Selective serotonin reuptake inhibitor (SSRI) doses, in excess of what is effective for treating depression, may be required for OCD."

1. A nursing instructor is teaching about specific phobias. Which student statement should indicate that learning has occurred? A. "These clients do not recognize that their fear is excessive, and they rarely seek treatment." B. "These clients have overwhelming symptoms of panic when exposed to the phobic stimulus." C. "These clients experience symptoms that mirror a cerebrovascular accident (CVA)." D. "These clients experience the symptoms of tachycardia, dysphagia, and diaphoresis."

B. "These clients have overwhelming symptoms of panic when exposed to the phobic stimulus."

6. A client refuses to go on a cruise to the Bahamas with his spouse because of fearing that the cruise ship will sink and all will drown. Using a cognitive theory perspective, the nurse should use which of these statements to explain to the spouse the etiology of this fear? A. "Your spouse may be unable to resolve internal conflicts, which result in projected anxiety." B. "Your spouse may be experiencing a distorted and unrealistic appraisal of the situation." C. "Your spouse may have a genetic predisposition to overreacting to potential danger." D. "Your spouse may have high levels of brain chemicals that may distort thinking."

B. "Your spouse may be experiencing a distorted and unrealistic appraisal of the situation."

20. A client presents in the emergency department with complaints of overwhelming anxiety. Which of the following is a priority for the nurse to assess? A. Risk for suicide B. Cardiac status C. Current stressors D. Substance use history

B. Cardiac status

23. A client has the following symptoms: preoccupation with imagined defect, verbalizations that are out of proportion to actual physical abnormalities, and numerous visits to plastic surgeons to seek relief. Which nursing diagnosis would best describe the problems evidenced by these symptoms? A. Ineffective coping B. Disturbed body image C. Complicated grieving D. Panic anxiety

B. Disturbed body image

The initial care plan for a client with OCD who washes her hands obsessively would include which of the following nursing interventions? A. Keep the ct's bathroom locked so she can't wash her hands all the time. B. Structure the ct's schedule so that she has plenty of time for washing her hands. C. Place the ct in isolation until she promises to stop washing her hands so much. D. Explain the ct's behavior to her, since she's probably unaware that it's maladaptive.

B. Structure the ct's schedule so that she has plenty of time for washing her hands.

15. A client diagnosed with obsessive-compulsive disorder is admitted to a psychiatric unit. The client has an elaborate routine for toileting activities. Which would be an appropriate initial client outcome during the first week of hospitalization? A. The client will refrain from ritualistic behaviors during daylight hours. B. The client will wake early enough to complete rituals prior to breakfast. C. The client will participate in three unit activities by day 3. D. The client will substitute a productive activity for rituals by day 1.

B. The client will wake early enough to complete rituals prior to breakfast.

26. A client is taking chlordiazepoxide (Librium) for generalized anxiety disorder symptoms. In which situation should a nurse recognize that this client is at greatest risk for drug overdose? A. When the client has a knowledge deficit related to the effects of the drug B. When the client combines the drug with alcohol C. When the client takes the drug on an empty stomach D. When the client fails to follow dietary restrictions

B. When the client combines the drug with alcohol

What is a biochemical abnormality associated with panic disorder?

Blood elevations of lactate. Pg 533

14. A client living on the beachfront seeks help with an extreme fear of crossing bridges, which interferes with daily life. A psychiatric nurse practitioner decides to try systematic desensitization. Which explanation of this therapy should the nurse convey to the client? A. "Using your imagination, we will attempt to achieve a state of relaxation that you can replicate when faced with crossing a bridge." B. "Because anxiety and relaxation are mutually exclusive states, we can attempt to substitute a relaxation response for the anxiety response." C. "Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety." D. "In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate."

C. "Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety."

13. A college student is unable to take a final examination because of severe test anxiety. Instead of studying, the student relieves stress by attending a movie. Which priority nursing diagnosis should a campus nurse assign for this client? A. Noncompliance R/T test taking B. Ineffective role performance R/T helplessness C. Altered coping R/T anxiety D. Powerlessness R/T fear

C. Altered coping R/T anxiety

3. How would a nurse differentiate a client diagnosed with a social phobia from a client diagnosed with a schizoid personality disorder (SPD)? A. Clients diagnosed with social phobia can manage anxiety without medications, whereas clients diagnosed with SPD can manage anxiety only with medications. B. Clients diagnosed with SPD are distressed by the symptoms experienced in social settings, whereas clients diagnosed with social phobia are not. C. Clients diagnosed with social phobia avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life. D. Clients diagnosed with SPD avoid interactions only in social settings, whereas clients diagnosed with social phobias tend to avoid interactions in all areas of life.

C. Clients diagnosed with social phobia avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life.

24. How should a nurse best describe the major maladaptive client response to panic disorder? A. Clients overuse medical care because of physical symptoms. B. Clients use illegal drugs to ease symptoms. C. Clients perceive having no control over life situations. D. Clients develop compulsions to deal with anxiety.

C. Clients perceive having no control over life situations.

Which of the following is the most appropriate therapy for a client with agoraphobia? A. 10 mg Valium qid B. Group therapy with other agoraphobics C. Facing her fear in gradual step progression D. Hypnosis

C. Facing her fear in gradual step progression

Joanie is a new pt at the mental health clinic. She has been diagnosed with body dysmorphic disorder. Which of the following medication is the psychiatric nurse practitioner most likely to prescribe for Joanie? A. Alprazolam (Xanax) B. Diazepam (Valium) C. Fluoxetine (Prozac) D. Olanzapine (Zyprexa)

C. Fluoxetine (Prozac)

5. Which treatment should a nurse identify as most appropriate for clients diagnosed with generalized anxiety disorder (GAD)? A. Long-term treatment with diazepam (Valium) B. Acute symptom control with citalopram (Celexa) C. Long-term treatment with buspirone (BuSpar) D. Acute symptom control with ziprasidone (Geodon)

C. Long-term treatment with buspirone (BuSpar)

A client with OCD says to the nurse, "I've been here 4 days now, and I'm feeling better. I feel comfortable on this unit, and I'm not at ill-at-ease with the staff or other pts anymore." In light of this change, which nursing intervention is most appropriate? A. Give attention the to ritualistic behaviors each time they occur and point out their inappropriateness. B. Ignore the ritualistic behaviors, and they will be eliminated for lack of reinforcement. C. Set limits on the amount of time Sandy may engage in the ritualistic behavior. D. Continue to allow Sandy all the time she wants to carry out the ritualistic behavior.

C. Set limits on the amount of time Sandy may engage in the ritualistic behavior.

22. Warren's college roommate actively resists going out with friends whenever they invite him. He says he can't stand to be around other people and confides to Warren "They wouldn't like me anyway." Which disorder is Warren's roommate likely suffering from? A. Agoraphobia B. Mysophobia C. Social anxiety disorder (social phobia) D. Panic disorder

C. Social anxiety disorder (social phobia)

12. A client is experiencing a severe panic attack. Which nursing intervention would meet this client's immediate need? A. Teach deep breathing relaxation exercises B. Place the client in a Trendelenburg position C. Stay with the client and offer reassurance of safety D. Administer the ordered prn buspirone (BuSpar)

C. Stay with the client and offer reassurance of safety

25. A client diagnosed with generalized anxiety states, "I know the best thing for me to do now is to just forget my worries." How should the nurse evaluate this statement? A. The client is developing insight. B. The client's coping skills are improving. C. The client has a distorted perception of problem resolution. D. The client is meeting outcomes and moving toward discharge.

C. The client has a distorted perception of problem resolution.

Neurotransmitters have been implicated in the pathophysiology of anxiety disorders. Select the disturbances that are associated with anxiety disorders: A. Increased seratonin, decreased norepinephrine, and decreased GABA. B. Increased seratonin, decreased norepinephrine, and increased GABA. C. Decreased seratonin, decreased norepinephrine, and decreased GABA. D. Decreased seratonin, increased norepinephrine, and decreased GABA.

D. Decreased seratonin, increased norepinephrine, and decreased GABA. pg. 530

4. How would a nurse differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)? A. GAD is acute in nature, and panic disorder is chronic. B. Chest pain is a common GAD symptom, whereas this symptom is absent in panic disorders. C. Hyperventilation is a common symptom in GAD and rare in panic disorder. D. Depersonalization is commonly seen in panic disorder and absent in GAD.

D. Depersonalization is commonly seen in panic disorder and absent in GAD.

18. A client is newly diagnosed with obsessive-compulsive disorder and spends 45 minutes folding clothes and rearranging them in drawers. Which nursing intervention would best address this client's problem? A. Distract the client with other activities whenever ritual behaviors begin. B. Report the behavior to the psychiatrist to obtain an order for medication dosage increase. C. Lock the room to discourage ritualistic behavior. D. Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors.

D. Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors.

17. A client diagnosed with an obsessive-compulsive disorder spends hours bathing and grooming. During a one-on-one interaction, the client discusses the rituals in detail but avoids any feelings that the rituals generate. Which defense mechanism should the nurse identify? A. Sublimation B. Dissociation C. Rationalization D. Intellectualization

D. Intellectualization

Ms. T has been diagnosed with agoraphobia. Which behavior would be most characteristic of this disorder? A. Ms. T. experiences panic anxiety when she encounters snakes. B. Ms. T refuses to fly in an airplane. C. Ms. T. Will not eat in public places. D. Ms. T. stays in her home for fear of being in a place from which she cannot escape.

D. Ms. T. stays in her home for fear of being in a place from which she cannot escape.

Which of the following is not a common traits/symptom of hoarding disorder? A. Perfectionism B. Indecisiveness C. Distractibility D. narcissistic personality disorder

D. Narcissistic personality disorder is associated body dysmorphic disorder. Associated symptoms of hoarding disorder include: perfectionism, indecisiveness, anxiety, depression, distractibility, and difficulty planning and organizing.

8. A cab driver stuck in traffic is suddenly lightheaded, tremulous, and diaphoretic and experiences tachycardia and dyspnea. An extensive workup in an emergency department reveals no pathology. Which medical diagnosis is suspected, and what nursing diagnosis takes priority? A. Generalized anxiety disorder and a nursing diagnosis of fear B. Altered sensory perception and a nursing diagnosis of panic disorder C. Pain disorder and a nursing diagnosis of altered role performance D. Panic disorder and a nursing diagnosis of panic anxiety

D. Panic disorder and a nursing diagnosis of panic anxiety

With implosion therapy, a client with phobic anxiety would be: A. Taught relaxation exercises. B. Subjected to graded intensities of the fear C. Instructed to stop the therapeutic session as soon as anxiety is experienced. D. Presented with massive exposure to a variety of stimuli associated with the phobic object/situation.

D. Presented with massive exposure to a variety of stimuli associated with the phobic object/situation.

What is the difference between fear and anxiety?

Fear involves cognition-the intellectual appraisal of a threatening stimulus while anxiety is the emotional response to that stimulus.

A type of therapy in which a client is directed to imagine or actually participate in real-life situations that he or she finds intensely frightening, and to do this for prolonged periods of time, is called____________.

Implosion therapy, or flooding In implosion therapy the therapist "floods" the client with information concerning situations that trigger anxiety, with the belief that prolonged exposure will result in the client experiencing a reduction in anxiety.

The neurotransmitter most strongly associated with panic disorder is:

Increased levels of Norepinephrine. It's known to mediate arousal, and it causes hyperarousal and anxiety. Seratonin and GABA are believed to be decreased in panic disorder as well.

Traits associated with schizoid, obsessive-compulsive, and _____________________ personality disorders are commonly seen in clients with the diagnosis of BDD.

Narcissistic

An extremely distressing experience that causes severe emotional shock and may have long-lasting psychological effects is called _________________.

Trauma