Anxiety Disorders & Medications

A client diagnosed with generalized anxiety disorder is prescribed paroxetine (Paxil) 30 mg QHS. Paroxetine is supplied as a 20-mg tablet. The nurse would administer ______tablets.

1.5 tablets

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

2. It is important for the nurse to ask the client about a potential plan for suicide to intervene in a timely manner. Clients who have developed suicide plans are at higher risk than clients who may have vague suicidal thoughts. TEST-TAKING HINT: To answer this question correctly, the test taker must understand the importance of assessing the plan for suicide. Interventions would differ depending on the client's plan. The intervention for a plan to use a gun at home would differ from an intervention for a plan to hang oneself during hospitalization.

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

An overuse or ineffective use of ego defense mechanisms, which results in a maladaptiveresponse to anxiety, is an example of thepsychodynamic theory of generalized anxiety disorder development. TEST-TAKING HINT: To answer this question correctly, the test taker should review the various theories related to the development of generalized anxiety disorder.

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

4. A student who avoids classes because of the fear of being scrutinized by others meets the criteria for a diagnosis of social phobia. TEST-TAKING HINT: The test taker must understand the DSM-IV-TR diagnostic criteria for social phobia to answer this question correctly.

A client diagnosed with generalized anxiety disorder complains of feeling out of control and states, "I just can't do this anymore." Which nursing action takes priority at this time? 1. Ask the client, "Are you thinking about harming yourself?" 2. Remove all potentially harmful objects from the milieu. 3. Place the client on a one-to-one observation status. 4. Encourage the client to verbalize feelings during the next group.

1. The nurse should recognize the statement, "I can't do this anymore," as evidence of hopelessness and assess further the potential for suicidal ideations. TEST-TAKING HINT: To answer this question correctly, the test taker should apply the nursing process. Assessment is the first step of this process. The nurse initially must assess a situation before determining appropriate nursing interventions.

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

3. Clonazepam would be used for shortterm treatment while waiting for the buspirone to take full effect, which can take 4 to 6 weeks. TEST-TAKING HINT: To answer this question correctly, the test taker must note appropriate teaching needs for clients prescribed different classifications of antianxiety medications.

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

Diazepam (Valium) is a benzodiazepine. Benzodiazepines are physiologically and psychologically addictive. If a benzodiazepine is stopped abruptly, a rebound stimulation of the central nervous system occurs, and the client may experience insomnia, increased anxiety, abdominal and muscle cramps, tremors, vomiting, sweating, convulsions, and delirium. 1. Insomnia is correct. 2. Tremor is correct. 3. Delirium is correct. 4. Dry mouth is a side effect of taking benzodiazepines and is not related to stopping the medication abruptly. 5. Lethargy is a side effect of taking benzodiazepines and is not related to stopping the medication abruptly. TEST-TAKING HINT: The test taker must distinguish between benzodiazepine side effectsand symptoms of withdrawal to answer this question correctly.

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

The client can receive 4 PRN doses. Medications are given four times in a 24-hour period when the order reads q6h: 1.5 mg x 4 = 6 mg. The test taker must factor in 2 mg bid = 4 mg. These two dosages together add up to 10 mg, the maximum daily dose of alprazolam (Xanax), and so the client can receive all 4 PRN doses. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize that the timing of standing medication may affect the decision- making process related to administration of PRN medications. In this case, the client would be able to receive all possible doses of PRN medication because the standing and PRN ordered medications together do not exceed the maximum daily dose.

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

1. A client diagnosed with generalized anxiety disorder (GAD) would experience excessive worry about items difficult to control. 2. A client diagnosed with GAD would experience muscle tension. 5. A client diagnosed with GAD would experience an increased startle reflex and tension, causing feelings of being "keyed up" or being "on edge." TEST-TAKING HINT: To answer this question correctly, the test taker would need to recognize the signs and symptoms of GAD.

Which of the following would the nurse expect to assess in a client diagnosed with posttraumatic stress disorder? Select all that apply. 1. Dissociative events. 2. Intense fear and helplessness. 3. Excessive attachment and dependence toward others. 4. Full range of affect. 5. Avoidance of activities that are associated with the trauma.

1. A client diagnosed with posttraumatic stress disorder (PTSD) may have dissociative events in which the client feels detached from the situation or feelings. 2. A client diagnosed with PTSD may have intense fear and feelings of helplessness. 5. A client diagnosed with PTSD avoids activities associated with the traumatic event. TEST-TAKING HINT: To answer this question correctly, the test taker must be aware of the different symptoms associated with the diagnosis of PTSD.

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

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

A client newly admitted to an in-patient psychiatric unit is diagnosed with obsessivecompulsive disorder. Which correctly stated nursing diagnosis takes priority? 1. Anxiety R /T obsessive thoughts AEB ritualistic behaviors. 2. Powerlessness R /T ritualistic behaviors AEB statements of lack of control. 3. Fear R /T a traumatic event AEB stimulus avoidance. 4. Social isolation R /T increased levels of anxiety AEB not attending groups.

1. Anxiety is the underlying cause of the diagnosis of obsessive compulsive disorder (OCD), therefore, anxiety R/T obsessive thoughts is the priority nursing diagnosis for the client newly admitted for the treatment of this disorder. TEST-TAKING HINT: When the question is asking for a priority, the test taker should consider which client problem would need to be addressed before any other problem can be explored. When anxiety is decreased, social isolation should improve, and feelings about powerlessness can be expressed.

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

1. Chronic obstructive pulmonary disease causes shortness of breath. Air deprivation causes anxiety, sometimes to the point of panic. 2. Hyperthyroidism (Graves's disease) involves excess stimulation of the sympathetic nervous system and excessive levels of thyroxine. Anxiety is one of several symptoms brought on by these increases. 5. Marked irritability and anxiety are some of the many symptoms associated with hypoglycemia. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand that anxiety is manifested by physiological responses.

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

1. Clonidine hydrochloride (Catapres) is used in the treatment of panic disorders and generalized anxiety disorder. 2. Fluvoxamine maleate (Luvox) is used in the treatment of obsessive-compulsive disorder. 3. Buspirone (BuSpar) is used in the treatment of panic disorders and generalized anxiety disorders. 4. Alprazolam (Xanax), a benzodiazepine, is used for the short-term treatment of anxiety disorders. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand that many medications are used off-label to treat anxiety disorders.

A client on an in-patient psychiatric unit is experiencing a flashback. Which intervention takes priority? 1. Maintain and reassure the client of his or her safety and security. 2. Encourage the client to express feelings. 3. Decrease extraneous external stimuli. 4. Use a nonjudgmental and matter-of-fact approach.

1. During a flashback, the client is experiencing severe-to-panic levels of anxiety; the priority nursing intervention is to maintain and reassure the client of his or her safety and security. The client's anxiety needs to decrease before other interventions are attempted. TEST-TAKING HINT: It is important to understand time-wise interventions when dealing with individuals experiencing anxiety. When the client experiences severe-to-panic levels of anxiety during flashbacks, the nurse needs to maintain safety and security until the client's level of anxiety has decreased.

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

1. Expecting the client to participate in a set number of group activities by day 4 directly relates to the stated nursing diagnosis of social isolation and is a measurable outcome that includes a timeframe. TEST-TAKING HINT: To express an appropriate outcome, the statement must be related to the stated problem, be measurable and attainable, and have a timeframe. The test taker can eliminate "2" immediately because there is no timeframe, and then "3" because it does not relate to the stated problem.

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

1. Family stress can occur as the result of repeated client nightmares. This stress within the family may exacerbate the client's problem and hamper any effective treatment. Involving the family in therapy to relieve obvious stress would be an appropriate intervention to assist in the treatment of clients diagnosed with a nightmare disorder. 3. Administering medications such as tricyclic antidepressants or low-dose benzodiazepines or both is an appropriate intervention for clients diagnosed with a parasomnia disorder, such as a nightmare disorder. 5. Relaxation therapy, such as meditation and deep breathing techniques, would be appropriate for clients diagnosed with a nightmare disorder to assist in falling back to sleep after the nightmare occurs. TEST-TAKING HINT: To answer this question correctly, the test taker must be able first to understand the manifestation of a nightmare disorder and then to choose the interventions that would address these manifestations effectively.

Which nursing diagnosis reflects the intrapersonal theory of the etiology of obsessivecompulsive disorder? 1. Ineffective coping R /T punitive superego. 2. Ineffective coping R /T active avoidance. 3. Ineffective coping R /T alteration in serotonin. 4. Ineffective coping R /T classic conditioning.

1. Ineffective coping R /T punitive superego reflects an intrapersonal theory of the etiology of obsessive-compulsive disorder (OCD). The punitive superego is a concept contained in Freud's psychosocial theory of personality development. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand the different theories of the etiology of OCD. The keyword "intrapersonal" should make the test taker look for a concept inherent in this theory, such as "punitive superego."

A hospitalized client diagnosed with posttraumatic stress disorder has a nursing diagnosis of ineffective coping R /T history of rape AEB abusing alcohol. Which is the expected short-term outcome for this client problem? 1. The client will recognize triggers that precipitate alcohol abuse by day 2. 2. The client will attend follow-up weekly therapy sessions after discharge. 3. The client will refrain from self-blame regarding the rape by day 2. 4. The client will be free from injury to self throughout the shift.

1. It is a realistic expectation for a client who copes with previous trauma by abusing alcohol to recognize the triggers that precipitate this behavior. This outcome should be developed mutually early in treatment. TEST-TAKING HINT: It is important to relate outcomes to the stated nursing diagnosis. In this question, the test taker should choose an answer that relates to the nursing diagnosis of ineffective coping. Answer "4" can be eliminated immediately because it does not assist the client in coping more effectively. Also, the test taker must note important words, such as "short-term." Answer "2" can be eliminated immediately because it is a long-term outcome.

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

1. Remaining safe throughout the duration of the panic attack is the priority outcome for the client. TEST-TAKING HINT: All outcomes must be appropriate for the situation described in the question. In the question, the client is experiencing a panic attack; having the client verbalize the positive effects of exercise would be inappropriate. All outcomes must be client-centered, specific, realistic, positive, and measurable, and contain a timeframe.

A client diagnosed with generalized anxiety disorder has a nursing diagnosis of panic anxiety R/T altered perceptions. Which of the following short-term outcomes is most appropriate for this client? 1. The client will be able to intervene before reaching panic levels of anxiety by discharge. 2. The client will verbalize decreased levels of anxiety by day 2. 3. The client will take control of life situations by using problem-solving methods effectively. 4. The client will voluntarily participate in group therapy activities by discharge.

1. The client's being able to intervene before reaching panic levels of anxiety by discharge is measurable, relates to the stated nursing diagnosis, has a timeframe, and is an appropriate short-term outcome for this client. TEST-TAKING HINT: When evaluating outcomes, the test taker must make sure that the outcome is specific to the client's need, is realistic, is measurable, and contains a reasonable timeframe. If any of these components is missing, the outcome is incorrectly written and can be eliminated.

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

1. This statement is an indication that the cognitive intervention was successful. By remembering that panic attacks are self-limiting, the client is applying the information gained from the nurse's cognitive intervention. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand which interventions support which theories of causation. When looking for a "cognitive" intervention, the test taker must remember that the theory involves thought processes.

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

1. Using excessive hand washing to relieve anxiety is a behavioral symptom exhibited by clients diagnosed with obsessivecompulsive disorder (OCD). TEST-TAKING HINT: To answer this question correctly, the test taker must be able to differentiate various classes of symptoms exhibited by clients diagnosed with OCD. The keyword "behavioral" determines the correct answer to this question.

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

1. When a client is newly admitted, it is important for the nurse to assess past coping mechanisms and their effects on anxiety. Assessment is the first step in the nursing process, and this information needs to be gathered to intervene effectively. 2. Allowing time for the client to complete compulsions is important for a client who is newly admitted. If compulsions are limited, anxiety levels increase. If the client had been hospitalized for a while, then, with the client's input, limits would be set on the compulsive behaviors. 5. It is important for the nurse to allow the client to express his or her feelings about the obsessions and compulsions. This assessment of feelings should begin at admission. TEST-TAKING HINT: It is important for the test taker to note the words "newly admitted" in the question. The nursing interventions implemented vary and are based on length of stay on the unit, along with client's insight into his or her disorder. For clients with obsessive-compulsive disorder, it is important to understand that the compulsions are used to decrease anxiety. If the compulsions are limited, anxiety increases. Also, the test taker must remember that during treatment it is imperative that the treatment team includes the client in decisions related to any limitation of compulsive behaviors.

A client diagnosed with posttraumatic stress disorder is close to discharge. Which client statement would indicate that teaching about the psychosocial cause of posttraumatic stress disorder was effective? 1. "I understand that the event I experienced, how I deal with it, and my support system all affect my disease process." 2. "I have learned to avoid stressful situations as a way to decrease emotional pain." 3. "So, natural opioid release during the trauma caused my body to become 'addicted.'" 4. "Because of the trauma, I have a negative perception of the world and feel hopeless."

1. When the client verbalizes understanding of how the experienced event, individual traits, and available support systems affect his or her diagnosis, the client demonstrates a good understanding of the psychosocial cause of posttraumatic stress disorder (PTSD). To answer this question correctly, the test taker should review the different theories as they relate to the causes of different anxiety disorders, including PTSD. Only "1" describes a psychosocial etiology of PTSD.

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

2. Sweating and palpitations are physical symptoms of a panic attack. TEST-TAKING HINT: The test taker must note important words in the question, such as "physical symptoms." Although all the answers are actual symptoms a client experiences during a panic attack, only "2" is a physical symptom.

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

2. Acrophobia is the fear of heights. An individual experiencing acrophobia may be unable to fly because of this fear. TEST-TAKING HINT: To answer this question correctly, the test taker needs to review the definitions of specific commonly diagnosed phobias.

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

2. Any client who is exhibiting hopelessness or helplessness needs to be monitored closely for suicide intentions. TEST-TAKING HINT: To answer this question correctly, the test taker should note the words "hopelessness" and "helplessness," which would be indications of suicidal ideations that warrant suicide precautions.

When treating individuals with posttraumatic stress disorder, which variables are included in the recovery environment? 1. Degree of ego strength. 2. Availability of social supports. 3. Severity and duration of the stressor. 4. Amount of control over reoccurrence.

2. Availability of social supports is part of environmental variables. Others include cohesiveness and protectiveness of family and friends, attitudes of society regarding the experience, and cultural and subcultural influences. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand the following three significant elements in the development of posttraumatic stress disorder: traumatic experience, individual variables, and environmental variables.

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

2. Benzodiazepines are prescribed for shortterm treatment of generalized anxiety disorder and alcohol withdrawal, and can be prescribed during preoperative sedation. TEST-TAKING HINT: The test taker needs to note the words "long-term" and "short-term" in the answers. Benzodiazepines are prescribed in the short-term because of their addictive properties. The test taker must understand that when taking a test, if one part of the answer is incorrect, the whole answer is incorrect, as in answer choice "3."

The nurse is using an intrapersonal approach to assist a client in dealing with survivor's guilt. Which intervention would be appropriate? 1. Encourage the client to attend a survivor's group. 2. Encourage expression of feelings during one-to-one interactions with the nurse. 3. Ask the client to challenge the irrational beliefs associated with the event. 4. Administer regularly scheduled paroxetine (Paxil) to deal with depressive symptoms.

2. Encouraging expressions of feelings during one-to-one interactions with the nurse is an intrapersonal approach to interventions that treat survivor's guilt associated with PTSD. TEST-TAKING HINT: To answer this question correctly, the test taker needs to differentiate various theoretical approaches and which interventions reflect these theories.

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

2. Excessive worrying about germs and illness is a cognitive symptom experienced by clients diagnosed with OCD. TEST-TAKING HINT: To answer this question correctly, the test taker must note the keyword "cognitive." Only "2" is a cognitive symptom.

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

2. It is important for the client to learn techniques to reduce overall levels of anxiety to decrease the need for compulsive behaviors. The teaching of these techniques should begin by day 4. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that nursing interventions should be based on timeframes appropriate to the expressed symptoms and severity of the client's disorder. The length of hospitalization also must be considered in planning these interventions. The average stay on an in-patient psychiatric unit is 5 to 7 days.

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

2. It is important for the nurse to monitor for serotonin syndrome, which occurs when a client takes multiple medications that affect serotonin levels. Symptoms include change in mental status, restlessness, myoclonus, hyperreflexia, tachycardia, labile blood pressure, diaphoresis, shivering, and tremor. TEST-TAKING HINT: To answer this question correctly, the test taker must be familiar with the signs and symptoms of serotonin syndrome and which psychotropic medications affect serotonin, potentially leading to this syndrome.

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

2. It is important to teach the client that the onset of action for buspirone (BuSpar) is 2 to 3 weeks. Often the nurse may see a benzodiazepine, such as clonazepam, prescribed because of its quick onset of effect, until the buspirone begins working. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that buspirone (BuSpar) has a delayed onset of action, which can affect medication compliance. If the effects of the medication are delayed, the client is likely to stop taking the medication. Teaching about delayed onset is an important nursing intervention.

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

3. A client admitted 4 days ago with a diagnosis of algophobia, fear of pain, would be an appropriate assignment for the agency nurse. Of the clients presented, this client would pose the least challenge to a nurse unfamiliar with psychiatric clients. TEST-TAKING HINT: To answer this question correctly, the test taker needs to recognize the complexity of psychiatric diagnoses and understand the ramifications of potentially inappropriate nursing interventions by inexperienced staff members.

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

3. A client pacing the halls and experiencing an increase in anxiety commands immediate assessment. If the nurse does not take action on this assessment, there is a potential for client injury to self or others. TEST-TAKING HINT: When the nurse is prioritizing client assessments, it is important to note which client might be a safety risk. When asked to prioritize, the test taker must review all the situations presented before deciding which one to address first.

A newly admitted client is diagnosed with posttraumatic stress disorder. Which behavioral symptom would the nurse expect to assess? 1. Recurrent, distressing flashbacks. 2. Intense fear, helplessness, and horror. 3. Diminished participation in significant activities. 4. Detachment or estrangement from others.

3. Diminished participation in significant activities is a behavioral symptom of PTSD. TEST-TAKING HINT: To answer this question correctly, the test taker should take note of the keyword "behavioral," which determines the correct answer. All symptoms may be exhibited in PTSD, but only answer choice "3" is a behavioral symptom.

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

3. Encouraging discussion about fears is an intrapersonal intervention. TEST-TAKING HINT: It is important to understand that interventions are based on theories of causation. In this question, the test taker needs to know that intrapersonal theory relates to feelings or developmental issues. Only "3" deals with client feelings.

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

3. For a client to be diagnosed with an anxiety disorder, the client must experience symptoms that interfere in a minimum of two areas, such as social, occupational, or other important functioning. These symptoms must be experienced for durations of 6 months or longer. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that specific symptoms must be exhibited and specific timeframes achieved for clients to be diagnosed with anxiety disorders.

A client with a history of generalized anxiety disorder enters the emergency department complaining of restlessness, irritability, and exhaustion. Vital signs are blood pressure 140/90 mm Hg, pulse 96, and respirations 20. Based on this assessed information, which assumption would be correct? 1. The client is exhibiting signs and symptoms of an exacerbation of generalized anxiety disorder. 2. The client's signs and symptoms are due to an underlying medical condition. 3. A physical examination is needed to determine the etiology of the client's problem. 4. The client's anxiolytic dosage needs to be increased.

3. Physical problems should be ruled out before determining a psychological cause for this client's symptoms. TEST-TAKING HINT: The test taker needs to remember that although a client may have a history of a psychiatric illness, a complete, thorough evaluation must be done before assuming exhibited symptoms are related to the psychiatric diagnosis. Many medical conditions generate anxiety as a symptom.

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

3. Social isolation is seen frequently with individuals diagnosed with panic attacks. The client in the question expresses anticipatory fear of unexpected attacks, which affects the client's ability to interact with others. TEST-TAKING HINT: To answer this question correctly, the test taker must link the behaviors presented in the question with the nursing diagnosis that is reflective of these behaviors. The test taker must remember the importance of time-wise interventions. Nursing interventions differ according to the degree of anxiety the client is experiencing. If the client were currently experiencing a panic attack, other interventions would be appropriate.

A client diagnosed with posttraumatic stress disorder has a nursing diagnosis of disturbed sleep patterns R /T nightmares. Which evaluation would indicate that the stated nursing diagnosis was resolved? 1. The client expresses feelings about the nightmares during group. 2. The client asks for PRN trazodone (Desyrel) before bed to fall asleep. 3. The client states that the client feels rested when awakening and denies nightmares. 4. The client avoids napping during the day to help enhance sleep.

3. The client's feeling rested on awakening and denying nightmares are the evaluation data needed to support the fact that the nursing diagnosis of disturbed sleep patterns R/T nightmares has been resolved. TEST-TAKING HINT: To answer this question correctly, the test taker needs to discern evaluation data that indicate problem resolution. Answers "1," "2," and "4" all are interventions to assist in resolving the stated nursing diagnosis, not evaluation data that indicate problem resolution.

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

3. The nurse discussing the overuse of ego defense mechanisms illustrates a psychodynamic approach to address the client's behaviors related to panic disorder. TEST-TAKING HINT: When answering this question, the test taker must be able to differentiate among various theoretical perspectives and their related interventions.

Clients diagnosed with obsessive-compulsive disorder commonly use which mechanism? 1. Suppression. 2. Repression. 3. Undoing. 4. Denial.

3. Undoing is a defense mechanism commonly used by individuals diagnosed with OCD. Undoing is used symbolically to negate or cancel out an intolerable previous action or experience. An individual diagnosed with OCD experiencing intolerable anxiety would use the defense mechanism of undoing to undo this anxiety by substituting obsessions or compulsions or both. Other commonly used defense mechanisms are isolation, displacement, and reaction formation. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand the underlying reasons for the ritualistic behaviors used by individuals diagnosed with OCD.

The nurse teaches an anxious client diagnosed with posttraumatic stress disorder a breathing technique. Which action by the client would indicate that the teaching was successful? 1. The client eliminates anxiety by using the breathing technique. 2. The client performs activities of daily living independently by discharge. 3. The client recognizes signs and symptoms of escalating anxiety. 4. The client maintains a 3/10 anxiety level without medications.

4. A client's ability to maintain an anxiety level of 3/10 without medications indicates that the client is using breathing techniques successfully to reduce anxiety. TEST-TAKING HINT: To answer this question correctly, the test taker should understand that anxiety cannot be eliminated from life. This understanding would eliminate "1" immediately.

During an assessment, a client diagnosed with generalized anxiety disorder rates anxiety as 9/10 and states, "I have thought about suicide because nothing ever seems to work out for me." Based on this information, which nursing diagnosis takes priority? 1. Hopelessness R /T anxiety AEB client's stating, "Nothing ever seems to work out." 2. Ineffective coping R /T rating anxiety as 9/10 AEB thoughts of suicide. 3. Anxiety R /T thoughts about work AEB rates anxiety 9/10. 4. Risk for suicide R /T expressing thoughts of suicide.

4. Because the client is expressing suicidal ideations, the nursing diagnosis of risk for suicide takes priority at this time. Client safety is prioritized over all other client problems. TEST-TAKING HINT: When looking for a priority nursing diagnosis, the test taker always must prioritize client safety. Even if other problems exist, client safety must be ensured.

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

4. By day 4, it would be realistic to expect the client to use one relaxation technique to decrease obsessive or compulsive behaviors. This would be the current priority outcome. TEST-TAKING HINT: The test taker must recognize the importance of time-wise interventions when establishing outcomes. In the case of clients diagnosed with obsessive-compulsive disorder, expectations on admission vary greatly from outcomes developed closer to discharge.

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

4. Distorted thinking patterns that precede maladaptive behaviors relate to the cognitive theory perspective of panic disorder development. TEST-TAKING HINT: The test taker should note important words in the question, such as "cognitive." Although all of the answers are potential causes of panic disorder development, the only answer that is from a cognitive perspective is "4."

A newly admitted client diagnosed with posttraumatic stress disorder is exhibiting recurrent flashbacks, nightmares, sleep deprivation, and isolation from others. Which nursing diagnosis takes priority? 1. Posttrauma syndrome R /T a distressing event AEB flashbacks and nightmares. 2. Social isolation R /T anxiety AEB isolating because of fear of flashbacks. 3. Ineffective coping R /T flashbacks AEB alcohol abuse and dependence. 4. Risk for injury R /T exhaustion because of sustained levels of anxiety.

4. Risk for injury is the priority nursing diagnosis for this client. In the question, the client is exhibiting recurrent flashbacks, nightmares, and sleep deprivation that can cause exhaustion and lead to injury. It is important for the nurse to prioritize the nursing diagnosis that addresses safety. TEST-TAKING HINT: When the question asks for a priority, it is important for the test taker to understand that all answer choices may be appropriate statements. Client safety always should be prioritized.

Counselors have been sent to a location that has experienced a natural disaster to assist the population to deal with the devastation. This is an example of __________________ prevention.

4. Sending counselors to a natural disaster site to assist individuals to deal with the devastation is an example of primary prevention. Primary prevention reduces the incidence of mental disorders, such as posttraumatic stress disorder, within the population by helping individuals to cope more effectively with stress early in the grieving process. Primary prevention is extremely important for individuals who experience any traumatic event, such as a rape, war, hurricane, tornado, or school shooting. TEST-TAKING HINT: To answer this question correctly, it is necessary to understand the differences between primary, secondary, and tertiary prevention.

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

4. The belief that abnormalities in various regions of the brain cause OCD is an explanation of OCD etiology from a biological theory perspective. TEST-TAKING HINT: To answer this question correctly, the test taker must understand the different theories of OCD etiology. This question calls for a biological theory perspective, making "4" the only correct choice.

A client diagnosed with posttraumatic stress disorder states to the nurse, "All those wonderful people died, and yet I was allowed to live." Which is the client experiencing? 1. Denial. 2. Social isolation. 3. Anger. 4. Survivor's guilt.

4. The client in the question is experiencing survivor's guilt. Survivor's guilt is a common situation that occurs when an individual experiences a traumatic event in which others died and the individual survived. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand common phenomena experienced by individuals diagnosed with posttraumatic stress disorder and relate this understanding to the client statement presented in the question.

A client rates anxiety at 8 out of 10 on a scale of 1 to 10, is restless, and has narrowed perceptions. Which of the following medications would appropriately be prescribed to address these symptoms? Select all that apply. 1. Chlordiazepoxide (Librium). 2. Clonazepam (Klonopin). 3. Lithium carbonate (lithium). 4. Clozapine (Clozaril). 5. Oxazepam (Serax).

An anxiety rating of 8 out of 10, restlessness, and narrowed perceptions all are symptoms of increased levels of anxiety. 1. Chlordiazepoxide (Librium) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. 2. Clonazepam (Klonopin) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. 5. Oxazepam (Serax) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. TEST-TAKING HINT: The test taker first must recognize the signs and symptoms presented in the question as an indication of increased levels of anxiety. Next, the test taker must recognize the medications that address these symptoms. Also, it is common to confuse lithium carbonate (lithium) and Librium and clozapine and clonazepam. To answer this question correctly, the test taker needs to distinguish between medications that are similar in spelling.

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

This client should receive 2 PRN doses. The test taker must recognize that medications are given three times in a 24-hour period when the order reads q8h: 1 mg x 3 = 3 mg. The test taker must factor in the 0.5 mg qid = 2 mg. These two dosages together add up to 5 mg, 1 mg above the maximum daily dose of lorazepam (Ativan). The client would be able to receive only two of the three PRN doses of lorazepam. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize that the timing of standing medication may affect the decision-making process related to administration of PRN medications. In this case, although the PRN medication is ordered q8h, and could be given three times, the standing medication dosage limits the PRN to two doses, each at least 8 hours apart.

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

When examining theories of phobia etiology, this situation would be reflective of learning theory. Some learning theorists believe that fears are conditioned responses, and they are learned by imposing rewards for certain behaviors. In the instance of phobias, when the individual avoids the phobic object, he or she escapes fear, which is a powerful reward. This client has learned that avoiding the stimulus of fire eliminates fear. TEST-TAKING HINT: To answer this question correctly, the test taker needs to review the different theories of the causation of specific phobias.