Anxiety, Post-traumatic Stress Disorder (PTSD), Suicide Nursing Review

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. Hyponosis

c. Facing her fear in gradual step progression

A client who is experiencing a panic attack has just arrived at the hospital's ED. Which is the priority nursing intervention for this client? a. Encourage the client to talk about what triggered the attack. b. Administer a dose of Lorazepam (Ativan) c. Stay with the client and reassure them that they are safe. d. Leave the client alone in a quiet room so that they can calm down.

c. Stay with the client and reassure them that they are safe.

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

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

A client is hospitalized following a suicide attempt after breaking up with their romantic partner. The client says to the nurse, "When I get out of here, I'm going to try this again, and next time I'll choose a no-fail method." Which is the best response by the nurse? a. "You're just lucky your roommate came home when she did." b. "I don't understand. You have so much to live for." c. "What exactly are you planning to do?" d. "You are safe here. We will make sure nothing happens to you."

c. "What exactly are you planning to do?"

A client with renal colic is scheduled for extracorporeal shock-wave lithotripsy. The night before the procedure, the client puts the call light on frequently and has many demands. Which will be an appropriate statement for the nurse to make? a. "I know how you feel; I had this same procedure last year." b. "We'll take good care of you, so you have nothing to worry about." c. "You are facing a new experience tomorrow; tell me what concerns you have." d. "Your behavior tells me that you are scared of what you are facing tomorrow."

c. "You are facing a new experience tomorrow; tell me what concerns you have." This scenario presents normal anxiety r/t a future medical procedure. The response "You are facing a new experience tomorrow" acknowledges the client's situation and allows the client to discuss feelings and fears related to the surgery.

Theresa, age 27, was admitted to the psych unit from the medical intensive care unit where she was treated for taking a deliberate overdose of her antidepressant medication, trazodone (Desyrel). She says to the nurse, "My boyfriend broke up with me. We had been together for 6 years. I love him so much. I know I'll never get over him." Which is the best response by the nurse? a. "You'll get over him in time" b. "Forget him. There are other fish in the seas" c. "You must be feeling very sad about your loss" d. "Why do you think he broke up with you?"

c. "You must be feeling very sad about your loss"

Which drug is used to treat both generalized anxiety disorder and depression? a. Fluoxetine b. Bupropion c. Duloxetine d. Mirtazapine

c. Duloxetine (Cymbalta) SSNRI Duloxetine is an antidepressant drug used to treat both generalized anxiety disorder and depression. Fluoxetine is used to treat depression. Bupropion is used to treat depression and also aid in smoking cessation. Mirtazapine is used in the treatment of depression and also helpful in reducing the adverse sexual side effects in the male client receiving selective serotonin reuptake inhibitors therapy.

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

c. Have the client breathe into a paper bag This increases CO2 to address side effects from lowered CO2 with hyperventilation: (dizziness, ↑HR, syncope, dyspnea, paresthesias)

A client who is an Iraq war veteran has been diagnosed with post-traumatic stress disorder (PTSD). The client has been medically stabilized after overdosing on medication, and has just been admitted to the psychiatric unit. When developing the initial plan of care, which is the priority nursing diagnosis that the nurse selects for this client? a. Complicated grieving b. Post-trauma syndrome c. Risk for suicide d. Disturbed thought processes

c. Risk for suicide

In determining degree of suicidal risk with a suicidal client, the nurse assesses the following behavioral manifestations: severely depressed, withdrawn, statements of worthlessness, difficulty accomplishing activities of daily living, no close support systems. The nurse identifies the client's risk for suicide as which of the following? a. low b. moderate c. high d. unable to be determined

c. high risk for suicide

A nurse concludes that a client is using displacement. Which behavior has the nurse identified? a. Ignoring unpleasant aspects of reality b. Resisting any demands made by others c. Using imaginative activity to escape reality d. Directing pent-up emotions at someone other than the primary source

d. Directing pent-up emotions at someone other than the primary source When acting out against the primary source of anxiety creates even further anxiety or danger, the individual may use displacement to express feelings toward a "safer" person or object.

What is an appropriate way for a nurse to help a client ease anxiety? a. Avoid unpleasant events. b. Prolong exposure to fearful situations. c. Introduce an element of pleasure into fearful situations. d. Help the client acquire skills with which to face stressful events.

d. Help the client acquire skills with which to face stressful events. Learning a variety of coping mechanisms helps reduce anxiety in stressful situations. A person must learn to cope with unpleasant events; they cannot always be avoided.

A client has a diagnosis of Generalized Anxiety Disorder, and has been prescribed buspirone (BuSpar) 15 mg daily. The client says to the nurse, "Why do I have to take this every single day? My friend's doctor ordered Xanax (alprazolam), and she only takes it when she's feeling anxious." Which of the following would be an appropriate response by the nurse? a. "Buspirone needs to be taken daily in order to be effective." b. "Your friend really should be taking the Xanax every day." c. "Xanax is not effective for generalized anxiety disorder." d. "I will ask the provider to change the order to PRN so that you won't have to take it every day."

a. "Buspirone needs to be taken daily in order to be effective."

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 blood work 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." Look for the answer that shows incorrect information - that would indicate the need for clarification or follow-up instructions. Lab levels are not needed with benzos, all other choices are true

A client has been brought to the emergency department for signs and symptoms of chronic obstructive pulmonary disease (COPD). The client has a history of a suicide attempt 1 year ago. Which nursing intervention would take priority in this situation? a. Assessing the client's pulse-oximetry and vital signs b. Developing a plan for safety for the client c. Assessing the client for suicidal ideations d. Establishing a trusting nurse-client relationship

a. Assessing the client's pulse-oximetry and vital signs The client was brought to the ED for s/s of COPD exasperation. Remember the ABCs. Airway and Breathing come first. The client's suicide attempt was 1 year ago, not the reason they came to the ED.

Annie has hair-pulling disorder. She is receiving treatment at the mental health clinic with habit-reversal therapy (HRT). 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

A nurse is caring for a client who has threatened to commit suicide by hanging. The client states, "I'm going to use a knotted shower curtain when no one is around." Which information would determine the nurse's plan of care for this client? a. The more specific the plan is, the more likely the client will attempt suicide. b. Clients who talk about suicide never actually commit it. c. Clients who threaten suicide should be observed every 15 minutes. d. After a brief assessment, the nurse should avoid the topic of suicide.

a. The more specific the plan is, the more likely the client will attempt suicide. * Use 1:1 supervision * Accompany the client off unit and into the bathroom * Remove items in the environment that could be used to cause injury May need to search or remove belonging Monitor during meals and med administration *cheeking Encourage verbalization of feelings and provide positive support Create a behavior contract with the client to refrain from suicide/self harm for a short interval (12 hours, 24 hours)

What should the nurse do when talking with a client with a history of panic disorder who is displaying many of the emotional and physiologic symptoms of a panic attack? a. Use short sentences and an authoritative voice. b. Describe the possible reasons for the client's anxiety. c. Keep asking questions, because the client is probably not going to volunteer much information. d. Suggest that the client refrain from crying, because most of the time crying makes matters worse.

a. Use short sentences and an authoritative voice. During a panic attack the attention span is shortened, making it difficult to follow long sentences. An authoritative voice lets the client know that the nurse is in control of the situation; the client is unable to set controls because of the anxiety level. Describing to the client the possible reasons for the anxiety may increase the client's anxiety level further. Asking questions may increase the client's anxiety level further. Crying is an outlet and should not be discouraged; telling someone not to cry usually worsens the crying and the anxiety.

After years of dialysis, an 84-year-old states, "I'm exhausted, depressed, and done with these attempts to keep me alive." Which question should the nurse ask the spouse when preparing a discharge plan of care? a. "Have there been any changes in his appetite or sleep?" b. "How often is your spouse left alone?" c. "Has your spouse been following a diet and exercise program consistently?" d. "How would you characterize your relationship with your spouse?"

b. "How often is your spouse left alone?" Assess the safety risk

Still Theresa.... Theresa is hospitalized following a suicide attempt after breaking up with her boyfriend. Theresa says to the nurse, "When I get out of here, I'm going to try this again, and next time I'll choose a no-fail; method." Which is the best response by the nurse? a. "you are safe here. we will make sure nothing happens to you." b. "you're just lucky your roommate came home when she did." c. "what exactly do you plan to do?" d. "I don't understand. You have so much to live for."

c. "what exactly do you plan to do?" active plans for suicide increase the likelihood of an attempt to end life.

Trauma-informed care is a philosophical approach that includes which of the following principles? Select all that apply. a. Trauma-informed care is based on the principle that traumas are not correlated with depression or increased risk for suicide. b. Medications need to be given before any other interventions are considered. c. Nurses need to be aware of the potential for trauma in any client and provide care that minimizes the risk of re-victimization or re-traumatization. d. Nurses should be aware that trauma may also affect them, and this may impact their effectiveness in providing care to their clients. e. Trauma-informed care highlights the importance of providing care that protects the physical, psychological, and emotional safety of the client.

c. Nurses need to be aware of the potential for trauma in any client and provide care that minimizes the risk of re-victimization or re-traumatization. d. Nurses should be aware that trauma may also affect them, and this may impact their effectiveness in providing care to their clients. e. Trauma-informed care highlights the importance of providing care that protects the physical, psychological, and emotional safety of the client.

During a panic attack, a patient states, "I feel like I'm going to die!" The patient is hyperventilating, tachycardic, and reports feeling upper extremity numbness and tingling. Based on this patient's presentation, the healthcare provider would anticipate which additional clinical manifestation of the panic attack? a. Kussmaul respirations b. Respiratory acidosis c. Respiratory alkalosis d. Hypercapnia

c. Respiratory alkalosis An arterial blood gas (ABG) will provide evidence of how the hyperventilation is affecting other body systems. Hyperventilation causes an increase in the volume of air the patient inhales and exhales. The patient is exhaling more carbon dioxide than normal, causing hypocapnia and respiratory alkalosis. The paresthesia reported by the patient is an additional clinical sign of alkalosis.

John, a veteran of the war in Iraq, is diagnosed with PTSD. He experiences a nightmare during his first night in the hospital. He explains to the nurse that he was dreaming about gunfire all around and people being killed. Which of the following is the nurse's most appropriate INITIAL intervention? a. administer alprazolam as ordered PRN for anxiety b. call the physician and report the incident c. stay with John and reassure him of his safety d. have John listen to a tape of relaxation exercises

c. stay with John and reassure him of his safety

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

correct answers: b, d, e b. "Antidepressants are now considered first-line treatment choice for PTSD." d. "Because of their addictive properties, benzodiazepines are less desirable." e. "There have been no controlled studies on the effect of benzodiazepines on PTSD."

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 a public place 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

A cab driver, stuck in traffic, becomes lightheaded, tremulous, diaphoretic, tachycardic, and dyspneic. A work-up in an ED reveals no pathology. Which medical diagnosis should the nurse suspect, AND what nursing diagnosis should be the nurse's first priority? a. Generalized anxiety disorder and a nursing diagnosis of fear b. Mild anxiety disorder and a nursing diagnosis of anxiety c. Pain disorder and a nursing diagnosis of altered role performance d. Panic disorder and a nursing diagnosis of anxiety

d. Panic disorder and a nursing diagnosis of anxiety

Which of the following factors may be influential in the predisposition to PTSD? a. An excess of the neurotransmitter serotonin and an unhappy marriage b. The history of a traumatic brain injury (TBI) and the presence of distorted negative thought patterns c. An unsatisfactory parent-child relationship and a high-school level education d. The severity of the stressor and the degree of isolation during recovery

d. The severity of the stressor and the degree of isolation during recovery

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 or situation

d. presented with massive exposure to a variety of stimuli associated with the phobic object or situation

Some biological factors may be associated with the predisposition to suicide. Which of the following biological factors have been implicated? a. genetics and decreased levels of serotonin b. heredity and increased levels of norepinephrine c. temporal lobe atrophy and decreased levels of acetylcholine d. structural alterations of the brain and increased levels of dopamine

a. genetics and decreased levels of serotonin

The HCP orders sertraline (Zoloft) for a client who is hospitalized with Adjustment Disorder with Depressed Mood. What is this medication intended to do? a. increase energy and elevate mood b. stimulate the CNS c. prevent psychotic symptoms d. produce a calming effect

a. increase energy and elevate mood

When planning nursing care for a client with severe agoraphobia, what should the nurse do first? a. Determine the client's degree of impairment. b. Support the client's self-esteem through verbal interactions. c. Expose the client gradually to anxiety-provoking situations. d. Teach the client biofeedback techniques for reducing anxiety

a. Determine the client's degree of impairment. Assessment is the first step of the nursing process and must be done before care is planned. Assessment is the priority at this time.

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 client's bathroom locked so she cannot wash her hands all the time b. structure the client's schedule so that she has plenty of time for washing her hands c. place the client in isolation until she promises to stop washing her hands so much d. explain the client's behavior to her, since she is probably unaware that it is maladaptive

b. structure the client's schedule so that she has plenty of time for washing her hands

John, a veteran of the war in Iraq, is diagnosed with PTSD. He says to the nurse, "I can't figure out why God took my buddy instead of me." From this statement the nurse assesses which of the following in John? a. repressed anger b. survivor's guilt c. intrusive thoughts d. spiritual distress

b. survivor's guilt

Success of long-term psychotherapy with a client who had attempted suicide after a relationship breakup could be measured by which of the following behaviors? a. the client has a new boyfriend/girlfriend b. the client has an increased sense of self-worth c. the client does not take antidepressants anymore d. the client expresses anger over the breakup to their former boyfriend/girlfriend

b. the client has an increased sense of self-worth

Which of the following defense mechanisms may be observed in a patient diagnosed with obsessive-compulsive disorder (OCD)? a. Undoing b. Projection c. Regression d. Denial

a. Undoing Defense mechanisms are used when there is a threat to the patient's psychological integrity. The patient diagnosed with OCD will use this defense mechanism to deal with intolerable levels of anxiety. The patient attempts to substitute the anxiety with a behavior which is maladaptive. Undoing is a way of symbolically canceling out (negating) an experience that the patient finds intolerable. The compulsive behavior is designed to counteract or undo the patient's obsession.

A nurse concludes that a client's withdrawn behavior may temporarily provide what? a. Defense against anxiety b. Basis for emotional growth c. Time for internal problem-solving d. Delay to organize personal resources

a. Defense against anxiety Withdrawal provides a temporary defense against anxiety, because it limits contact with reality and reduces the client's world. Withdrawal does not provide a basis for emotional growth, time for internal problem-solving, or a delay in which the client can organize personal resources because feelings and anxieties are still present and little attempt is made to work through problems.

A client who is to undergo a mastectomy for breast cancer tells the nurse that she is worried about what she will look like after the surgery. What is the most appropriate initial response by the nurse? a. "I understand that you'd be concerned." b. "Try not to think about the surgery now." c. "Everyone having this surgery feels the same way." d. "Perhaps you should discuss this with your husband."

a. "I understand that you'd be concerned." Women facing breast surgery often have feelings relating to their sexuality and change in body image; the nurse plays a vital role in helping the client verbalize feelings, and this response keeps channels of communication open. This is an anxiety-inducing event. The client's concerns are real, and a statement such as "Try not to think about the surgery now" will only block further communication.

On the morning of a scheduled visit the parents of a client hospitalized for incapacitating obsessive behavior call to say that they cannot come because of problems with the accountant for their small business. The client appears upset and goes into elaborate detail about the parents' business and the monthly visit of the accountant. What is the best response by the nurse? a. "It's disappointing to have plans change at the last minute." b. "Would you like to talk about what you'd planned to do today?" c. "Would you like to make new plans now that they're not coming?" d. "It's good that you can recognize that your parents are sometimes busy."

a. "It's disappointing to have plans change at the last minute." Expressing understanding of the client's disappointment recognizes and supports these justified feelings and provides an opportunity for the client to ventilate further. Asking whether the client would like to talk about the now-scuttled plans or would like to make new plans ignores the client's feelings and directs communication away from the emotionally charged area.

A client is scheduled for a closed magnetic resonance imaging test (MRI) for a knee problem. The client states, "I'm a little scared of small places." Which is the nurse's most appropriate response? a. "Mild sedation is available if you are anxious about lying in a confined area." b. "Maybe it is best that you not have this test. Let me talk with your primary healthcare provider." c. "We will make sure that all metal objects are removed from the immediate area to avoid injury." d. "You will be able to communicate with us by an intercom system, so you have nothing to worry about.

a. "Mild sedation is available if you are anxious about lying in a confined area," acknowledges the client's concern and offers a potential intervention that may reduce the client's anxiety. If necessary, an open MRI may be performed; however, a closed, high-magnet scanner may produce more significant results than will be produced by an open, low-magnet scanner.

The nurse is interviewing a client admitted for uncontrolled diabetes after binging on alcohol for the past 2 weeks. The client states, "I am worried about how I am going to pay my bills for my family while I am hospitalized." Which statement by the nurse would best elicit information from the client? a. "You are worried about paying your bills?" b. "Don't worry; your bills will get paid eventually." c. "When was the last time you were admitted for hyperglycemia?" d. "You really shouldn't be drinking alcohol because of your diagnosis of diabetes."

a. "You are worried about paying your bills?" Reflection can help the client to elaborate.

A nurse is creating a therapy group for low-functioning clients. Which client is the most appropriate member? a. A 77-year-old man with anxiety and mild dementia b. A 52-year-old woman with alcoholism and an antisocial personality c. A 38-year-old woman whose depression is responding to medication d. A 28-year-old man with bipolar disorder who is in a hypermanic state

a. A 77-year-old man with anxiety and mild dementia An older person with mild dementia and anxiety can participate in a low-functioning group in which there is greater structure and staff direction. A depressed client who is responding to medication should be able to participate in a higher-functioning group. An alcoholic, antisocial client or one in a hypermanic state might be disruptive in a low-functioning therapy group.

A nurse is administering oxygen to a client with chest pain who is restless. What method of oxygen administration will most likely prevent a further increase in the client's anxiety level? a. Cannula b. Catheter c. Venturi mask d. Rebreather mask

a. Cannula --- Use the nasal cannula. Oxygen via nasal cannula [1] [2] is the most comfortable and least intrusive, because the cannula extends minimally into the nose. Use of the catheter is intrusive and may increase anxiety. A Venturi mask and a rebreather mask are oppressive, and clients complain of feeling "suffocated" when they are used.

When a client is expressing severe anxiety by sobbing in the fetal position on the bed, what is the nurse's priority? a. Ensuring a safe therapeutic environment b. Monitoring and documenting vital signs c. Eliminating the cause of the client's anxiety d. Ensuring that the client's physical needs are met

a. Ensuring a safe therapeutic environment Client safety is the nurse's first priority, and because the client has not experienced any physical injuries and is not at risk, attention should be directed toward psychiatric risk, in this case crisis control. The severely stressed individual is likely to experience increased vital signs and will continue to have physiologic needs such as food and water; however, these issues do not take priority over a psychiatric crisis. The client will not be able to concentrate on therapy related to identifying the source of the anxiety until the crisis has been managed.

A client with a borderline personality disorder becomes hostile and calls the nurse names. When the nurse denies privileges, the client states that the nurse is uncaring. How can the nurse be most therapeutic in this situation? a. Helping the client identify feelings b. Increasing the client's limits on privileges c. Avoiding the client until the hostility is resolved d. Advising the client how to approach people differently

a. Helping the client identify feelings To be most therapeutic the nurse needs to help the client identify feelings, thereby aiding self-understanding. Increasing the limits on the client's privileges is a hostile response by the nurse. Avoiding the client will increase the client's hostility. The nurse should never give advice to clients; the nurse's role is to facilitate the client's problem-solving abilities.

A client in the mental health clinic has a phobia about closed spaces. Which desensitization method should the nurse expect to be used successfully with this client? a. Imagery b. Contracting c. Role playing d. Assertiveness training

a. Imagery Imagery is a therapeutic approach that is used to facilitate positive self-talk; mental pictures under the control of and initiated by the client may correct faulty cognitions. Contracting, role play, and assertiveness training are all useful general behavioral approaches, but none is a desensitization technique.

A client comes to the mental health clinic with the complaint of a progressing inability to be in enclosed spaces. The primary healthcare provider makes the diagnosis of claustrophobia and prescribes desensitization therapy. The nurse recalls that desensitization therapy is used successfully with clients experiencing phobias because it is focused on what? a. Imagery b. Modeling c. Role-playing d. Assertiveness training

a. Imagery Imagery is a therapeutic approach used to facilitate positive self-talk; mental pictures under the control of and initiated by the client may correct faulty cognitions. Modeling, role play, and assertiveness training are useful general behavioral approaches but are not specific desensitization techniques.

Which medication does the nurse anticipate will be prescribed to relieve anxiety and apprehension in a client with pulmonary edema? a. Morphine b. Phenobarbital c. Hydroxyzine d. Chloral hydrate

a. Morphine Morphine binds with the same receptors as natural opioids. However, it has a rapid onset, lowers the blood pressure, decreases pulmonary reflexes, and produces sedation. Phenobarbital has a slower onset than morphine and does not affect respirations and blood pressure to the same extent as morphine. Hydroxyzine generally is used to control anxiety associated with less acute situations. Chloral hydrate is a hypnotic that is not appropriate for the acute situation described.

When caring for a patient during an acute panic attack, which of the following actions by the healthcare provider is MOST appropriate? a. Offer the patient reassurance of safety and security b. Explore common phobias associated with panic attacks c. Ask open-ended questions to encourage communication d. Use distraction techniques to change the patient's focus

a. Offer the patient reassurance of safety and security The patient is experiencing intense apprehension and fear. Physical symptoms such as chest pain, palpitations, and trembling are often present. During the panic attack, the patient's focus is on the distressing physical symptoms caused by the anxiety. Distraction techniques, open-ended questioning, or exploration of phobias will not be helpful during an acute attack. Because the patient may experience a feeling of impending doom and fears for his or her life, reassurance of safety and security is the best initial intervention for this patient.

The nurse understands that a primary gain is distinguished from a secondary gain. What is the main function of a primary gain? a. Reduce anxiety b. Gain benefits from others c. Fulfill unconscious desires d. Control unacceptable impulses

a. Reduce anxiety A primary gain is always the reduction of anxiety. Gaining benefits from others is related to a secondary gain. Fulfillment of unconscious desires is unrelated to primary gains. Control of unacceptable impulses is unrelated to primary gains.

Clients who experience anxiety may use defense mechanisms to cope. The nurse knows that a common defense mechanism is denial. What is denial? a. Refusing to acknowledge reality or associated feelings b. Transferring feelings from one object or person to another c. Attempting to pattern or resemble the personality of an admired person d. Attributing one's own unacceptable feelings and thoughts to others

a. Refusing to acknowledge reality or associated feelings

Ten minutes before lunch, a client with obsessive-compulsive behavior begins the ritual of changing clothes for the fourth time. How should the nurse respond to this behavior? a. Tell the client to finish changing clothes and say that lunch can be eaten afterward. b. Help the client change clothes quickly so lunch can be eaten at the scheduled time. c. Lead the client to the dining room and explain that the clothes can be changed after lunchtime. d. Inform the client that everyone is required to be in the dining room at a specific time, so there is no time to change clothes.

a. Tell the client to finish changing clothes and say that lunch can be eaten afterward. Telling the client to finish changing clothes and explaining that lunch can be eaten afterward sets some limits on the compulsive act; it permits the ritual without reinforcing it but does not increase anxiety by removing the defense. Rushing the completion of the ritual will increase anxiety, because the ritual is being used as a defense. Leading the client to the dining room and explaining that the clothes can be changed after lunch will increase the client's anxiety and reinforce the need for the behavior. Preventing the ritual will increase anxiety, because the ritual is being used as a defense.

A client was brought into the emergency department and was the victim of a robbery. Upon assessment, his heart rate is 112 bpm, respirations 34 and deep, and he is complaining of nausea and lower abdominal pain. Which stage of general adaptive syndrome (GAS) is this client in? a. Alarm b. Resistance c. Adaptation d. Recovery

a. alarm

Trauma-informed care is a philosophical approach that includes which of the following principles? Select all that apply: a. nurses need to be aware of the potential for trauma in any client and provide care that minimizes the risk of revictimization or retraumatization b. medications need to be given before any other interventions are considered c. trauma-informed care highlights the importance of providing care that protects the physical, psychological, and emotional safety of the client d. trauma-informed care is cased on the principle that traumas are not correlated with depression or increased risk for suicide

a. nurses need to be aware of the potential for trauma in any client and provide care that minimizes the risk of revictimization or retraumatization c. trauma-informed care highlights the importance of providing care that protects the physical, psychological, and emotional safety of the client

John, a veteran of the war in Iraq, is diagnosed with PTSD. Which of the following therapy regimens would most appropriately be ordered for John? a. paroxetine and group therapy b. diazepam and implosion therapy c. alprazolam and behavior therapy d. carbamazepine and cognitive therapy

a. paroxetine and group therapy

A client who is experiencing a panic attack has just arrived at the emergency department. Which is the priority nursing intervention for this client? a. stay with the client and reassure the client of her 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 the client of her safety

The nurse identifies the primary nursing diagnosis for Theresa as Risk for Suicide r/t feelings of hopelessness from loss of relationship. Which is the outcome criterion that would most accurately measure achievement of this diagnosis? a. the client has experienced no physical harm to herself b. the client sets realistic goals for herself c. the client expresses some optimism and hope for the future d. the client has reached a stage of acceptance in the loss of the relationship.

a. the client has experienced no physical harm to herself

A client with OCD spends many hours each day washing his hands. What is the most likely reason she washes her hands so much? a. to relieve her anxiety b. to reduce the probability of infection c. to gain a feeling of control over her life d. to increase her self-concept

a. to relieve her anxiety

An individual who is diagnosed with Adjustment Disorder with Disturbance of Conduct most likely: a. violates the rights of others to feel better b. expresses symptoms that reveal a high level of anxiety c. exhibits severe social isolation and withdrawal d. is experiencing a complicated grieving process

a. violates the rights of others to feel better

Janet has a diagnosis of generalized anxiety disorder (GAD). Her physician has prescribed buspirone 15 mg daily. Janet says to the 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 is 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 in order 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 in order to be effective."

Nina, who is depressed following the breakup of a very stormy marriage, says to the nurse, "I feel so bad. I thought I would feel better once I left, but I feel worse!" Which is the best response by the nurse? a. "Cheer up, Nina. You have a lot to be happy about." b. "You are grieving the loss of your marriage. It's natural for you to feel badly." c. "Try not to dwell on how you feel. If you don't think about it, you'll feel better." d. "You did the right thing, Nina. Knowing that should make you feel better."

b. "You are grieving the loss of your marriage. It's natural for you to feel badly."

Which of the following individuals is at highest risk for suicide? a. 33 F, Asian American, Catholic, middle socioeconomic group, alcoholic b. 72 M, white, Methodist, low socioeconomic group, dx of metastatic cancer of the pancreas c. 15 F, African American, Baptist, high socioeconomic group, no physical or mental health problems d. 55 M, Jewish, middle socioeconomic group, suffered myocardial infarction a year ago

b. 72 M, white, Methodist, low socioeconomic group, dx of metastatic cancer of the pancreas

A nurse admits a client with the long-standing obsessive-compulsive behavior of washing the hands and body to the psychiatric unit. What should the initial treatment plan include? a. Determining the purpose of the ritual b. Allowing enough time for the ritualistic behavior c. Distracting the client from the ritualistic behavior with unit activities d. Suggesting a variety of symptom substitutions to refocus the ritualistic behavior

b. Allowing enough time for the ritualistic behavior Until trust has been developed and the client is less anxious, the ritual should be allowed. However, limits should be set if the handwashing leads to skin problems. Although identification of the purpose of the ritual is one of the objectives to be fulfilled, this should be done during the working phase of the nurse-client relationship, not in the initial phase.

A patient diagnosed with agoraphobia is scheduled for a functional magnetic resonance imaging (fMRI) study of the brain. The healthcare provider anticipates that the scan will show increased activity in which of the following areas of this patient's brain? a. Parietal lobe b. Amygdala c. Medulla d. Cerebellum

b. Amygdala Nerve fibers link this portion of the brain to the limbic system and frontal cortex. This part of the brain is a component of the patient's "fear circuitry." Patients diagnosed with anxiety disorders often demonstrate hyperactivity of the amygdala, insula, and limbic system.

How can the nurse best assist a client with an obsessive-compulsive disorder to decrease the use of ritualistic behavior? a. By providing repetitive activities that require little thought b. By attempting to limit situations that will worsen the anxiety c. By getting the client involved in activities that will provide distraction d. By suggesting that the client perform menial tasks to hide feelings of guilt

b. By attempting to limit situations that will worsen the anxiety People with high anxiety develop various behaviors to relieve the anxiety; when anxiety is reduced, the need for these obsessive-compulsive actions is reduced.

A client with phobias about elevators and large crowds comes to the clinic for help because of feelings of depression related to these fears. What is an appropriate short-term goal for this client? a. Riding an elevator without anxiety when accompanied by the nurse b. Describing the thoughts and feelings experienced in terrifying situations c. Experiencing an elevation of mood and relief from feelings of depression d. Identifying the early childhood conflicts that resulted in the development of these fears

b. Describing the thoughts and feelings experienced in terrifying situations This is a realistic essential first step. The problem and related feelings must be thoroughly explored before solutions can be developed. Riding an elevator without anxiety when accompanied by the nurse is a long-term goal. Experiencing an elevation of mood and relief from feelings of depression is a long-term goal. Identifying the early childhood conflicts leading to the development of the fears is an inappropriate goal; a direct connection to life events is often difficult to find.

Which drug worsens uncontrolled angle-closure glaucoma when used for the treatment of generalized anxiety disorder? a. Buspirone b. Duloxetine c. Chlorpromazine d. Lithium carbonate

b. Duloxetine Duloxetine is an antidepressant drug used in the treatment of generalized anxiety disorder. A contraindication is that it can worsen uncontrolled angle-closure glaucoma. Lithium carbonate is used to treat manic episodes but is contraindicated in clients with renal disease. Buspirone is an antidepressant drug contraindicated in clients with known allergic reactions to this drug. Chlorpromazine is an antipsychotic drug contraindicated in clients with blood dyscrasias.

A client has just been admitted with the diagnosis of borderline personality disorder. There is a history of suicidal behavior and self-mutilation. What does the nurse remember is the main reason that clients use self-mutilation? a. Control others b. Express anger or frustration c. Convey feelings of autonomy d. Manipulate family and friends

b. Express anger or frustration Typically, recurrent self-mutilation is an expression of intense anger, helplessness, or guilt or is a form of self-punishment. Self-mutilation is used not to control others but for self-validation; also, it is a means of blocking psychological pain by inducing physical pain. Self-destructive behaviors are not an expression of autonomy but rather an expression of negative feelings of anger, rage, and abandonment. Self-destructive behaviors represent not an attempt to manipulate others but rather a way to blunt emotional pain.

What should a nurse do when caring for a client whose behavior is characterized by pathologic suspicion? a. Protect the client from environmental stress. b. Help the client feel accepted by the staff on the unit. c. Ask the client to explain the reasons for the feelings. d. Help the client realize that the suspicions are unrealistic.

b. Help the client feel accepted by the staff on the unit. Delusions are protective and can be abandoned only when the individual feels secure and adequate. Helping the client feel accepted by the staff is the only response directed at building the client's security and reducing anxiety. Protecting the client from environmental stress is almost impossible. A client cannot be argued out of a delusion. The client is unable to explain the reason for the feelings.

A client appears anxious, exhibiting 40 shallow respirations per minute. The client complains of feeling dizzy and lightheaded and of having tingling sensations of the fingertips and around the lips. What does the nurse conclude that the client's complaints probably are related to? a. Eupnea b. Hyperventilation c. Kussmaul respirations d. Carbon dioxide intoxication

b. Hyperventilation The client is hyperventilating and blowing off excessive carbon dioxide, which leads to these adaptations; if uninterrupted this can result in respiratory alkalosis.

An 11-year-old client reports having the habit of bedwetting (enuresis). Which drug may be prescribed to this client? a. Alprazolam b. Imipramine c. Lithium salts d. Clomipramine

b. Imipramine Certain conditions of pediatric clients necessitate the usage of tricyclic antidepressant drugs as an adjuvant. Childhood enuresis is one such condition that necessitates the administration of imipramine.

An extremely agitated client hospitalized in a mental health unit begins to pace around the dayroom. What should the nurse do? a. Lock the client in the client's room to limit external stimuli. b. Let the client pace in the hall away from other clients. c. Get the client involved in a card game to distract the client's thoughts. d. Encourage the client to work with another client on a unit task.

b. Let the client pace in the hall away from other clients. Letting the client pace in the hall away from other clients allows the client to work off energy without upsetting other clients.

A delusional client verbalizes the belief that others are out to cause the client harm. A nurse notes the client's worsening pacing and agitation. What is the best nursing intervention? a. Advising the client to use a punching bag b. Moving the client to a safe, quiet place on the unit c. Encouraging the client to sit down for a while d. Allowing the client to continue pacing with supervision

b. Moving the client to a safe, quiet place on the unit A client losing control feels frightened and threatened; this client needs external controls and a reduction in external stimuli. Advising the client to use a punching bag is helpful if the client is holding back aggressive behavior but is not useful in easing agitation associated with delusions. The client is unable, at this time, to sit in one place; the agitation is building. The client may get completely out of control if the pacing is allowed to continue.

A nurse is caring for a client with bipolar I disorder. What should the plan of care for this client include? Select all that apply. a. Touching the client to provide reassurance b. Providing a structured environment for the client c. Ensuring that the client's nutritional needs are met d. Engaging the client in conversation about current affairs e. Designing activities that require the client to maintain contact with reality

b. Providing a structured environment for the client c. Ensuring that the client's nutritional needs are met Structure tends to decrease agitation and anxiety and to increase the client's feelings of security. Whether the individual is experiencing mania or depression, nutritional needs must be met. The hyperactivity associated with mania interferes with the ability to sit still long enough to eat; hyperactivity requires an increase in the intake of calories for the energy expended. Touching can be threatening for many clients and should not be used indiscriminately. Conversations should be kept simple. The client with a bipolar disorder, either depressed or manic phase, may have difficulty following involved conversations about current affairs. Clients with bipolar disorders are in contact with reality, so designing activities that require the client to maintain such contact will serve little purpose.

The nurse enters the room of a client just diagnosed with cancer. The client is tearful and tells the nurse, "I feel like I have no control over anything. I am scared." What is the best intervention the nurse can perform next? a. Informing the client that the feelings are normal and expected b. Providing the client information about what will happen with treatment c. Allowing the client time to express feelings by sitting and listening d. Telling the health-care provider that the client may need an antidepressant

b. Providing the client information about what will happen with treatment Although the client's feelings are normal and expected, saying so to the client will not help give the client a sense of control. Providing the client information about what to expect with treatment helps empower the client with knowledge and helps diminish the fear of the unknown. It is important to allow the client to express his or her feelings, but this can be done after giving the client more information.

Many clients who call a crisis hotline are extremely anxious. The nurse answering the hotline phone remembers what characteristic as distinguishing posttraumatic stress disorders from other anxiety disorders? a. Lack of interest in family and others b. Reexperiencing the trauma in dreams and flashbacks c. Avoidance of situations and activities that resemble the stress d. Depression and a blunted affect when discussing the traumatic situation

b. Reexperiencing the trauma in dreams and flashbacks Experiencing the actual trauma in dreams or flashbacks is the major symptom that distinguishes posttraumatic stress disorders from other anxiety disorders.

A nurse is counseling the family of a child with school phobia. What should the parents be taught to do? a. Accompany the child to the classroom. b. Return the child to school immediately. c. Explain to the child why school attendance is necessary. d. Allow the child to enter the classroom before other children

b. Return the child to school immediately. The longer children with school phobia stay out of the classroom, the more difficult it is to get them to return to school, because more fantasies and fears develop. Accompanying the child to the classroom will feed into the child's fear that the phobia is realistic. Explaining to the child why school attendance is necessary is not effective. Allowing the child to enter the classroom before other children will intensify, not ease, the child's fear.

The INITIAL care plan for a client with OCD who washes their hands obsessively should include which of the following nursing interventions? a. Keep the client's bathroom locked so they cannot wash their hands all the time. b. Structure the client's schedule so that they have plenty of time for washing their hands. c. Place the client in isolation until they agree to stop washing their hands so much. d. Explain the client's behavior to them, since they are probably unaware that it is maladaptive.

b. Structure the client's schedule so that they have plenty of time for washing their hands.

A nurse is interviewing a client with a phobia. Which treatment should the nurse inform the client has the highest success rate? a. Insight therapy to determine the origin of the fear b. Systematic desensitization involving relaxation techniques c. Psychotherapy aimed at rearranging psychotic thought processes d. Psychoanalytic exploration of repressed conflicts of an earlier developmental phase

b. Systematic desensitization involving relaxation techniques The most successful therapy for clients with phobias involves behavior modification techniques involving desensitization.

A client on a psychiatric unit misses breakfast because of an elaborate handwashing ritual. What is the most important therapeutic intervention during the early period of the client's hospitalization? a. Having the client wait until after breakfast to start the ritual b. Waking the client early so the ritual can be completed before breakfast c. Encouraging the client to interrupt the ritual for meals at the scheduled times d. Allowing the client to choose between eating breakfast and completing the ritual

b. Waking the client early so the ritual can be completed before breakfast In the early part of treatment, before new defenses are developed, time must be allowed for the client to complete the ritual to keep anxiety under control. The ritual is a defense that cannot be interrupted or delayed; it is used until new defenses are developed.

A female client is hospitalized following a suicide attempt and is placed on suicide precautions on the psychiatric unit. She admits that she is still feeling suicidal. Which of the following interventions is more appropriate in this instance? a. obtain an order from the physician to place the client in restraints to prevent any attempts to harm herself. b. check on the client every 15 minutes, or assign a staff person to stay with her on a one-to-one basis c. obtain an order from the phsycian to give the client a sedative to calm her and reduce suicide ideas d. do not allow the client to participate in any unit activities while she is on suicide precautions

b. check on the client every 15 minutes, or assign a staff person to stay with her on a one-to-one basis

Nina recently left her husband of 10 years. She was very dependent on her husband and is having difficulty adjusting to an independent lifestyle. She has been hospitalized with a diagnosis of Adjustment Disorder with Depressed Mood. Which of the following is the PRIORITY nursing diagnosis for this client? a. risk-prone health behavior related to loss of dependency b. complicated grieving related to breakup of marriage c. ineffective coping related to problems with dependency d. social isolation related to depressed mood

b. complicated grieving related to breakup of marriage

A patient diagnosed with an anxiety disorder is prescribed a benzodiazepine. When teaching the patient about the medication, which of the following information would the healthcare provider include? a. "It's important that you discontinue this medication if you begin to feel drowsy." b. "You should avoid taking aspirin while you are taking this medication." c. "Call our office right away if you experience increased restlessness or agitation." d. "Decreasing your daily caffeine intake is not necessary when taking this medication.

c. "Call our office right away if you experience increased restlessness or agitation." Benzodiazepines increase the effects of GABA. GABA (gamma-aminobutyric acid) is the major inhibitory neurotransmitter in the central nervous system. Decreased anxiety and a feeling of drowsiness are expected effects of benzodiazepines. Patients should be advised of a possible paradoxical reaction of restlessness or agitation.

What is the priority discharge criterion for a client who is using ritualistic behaviors? a. Verbalizes positive aspects about self b. Follows the rules of the therapeutic milieu c. Able to intervene when increasing levels of anxiety occur d. Recognizes that hallucinations occur at times of extreme anxiety

c. Able to intervene when increasing levels of anxiety occur Knowing when and how to intervene to hold increasing anxiety at a manageable level will result from teaching the client to recognize situations that provoke ritualistic behavior and how to interrupt the pattern.

When working with a client who has a phobia of black cats, what problem does the nurse anticipates for this client? a. Denying that the phobia exists b. Anger toward the feared object c. Anxiety when discussing the phobia d. Distortion of reality when completing daily routines

c. Anxiety when discussing the phobia Discussion of the feared object triggers an emotional response to the object. People with phobias generally acknowledge their existence. Extreme fear is more of a problem than anger. Distortion of reality related to the daily routine usually is not a problem for a person with a phobia.

Which statement provides the best rationale for closely monitoring a severely depressed client during antidepressant medication therapy? a. Suicide is an impulsive act, and the use of antidepressant medication does not alter impulsive behavior. b. Clients who previously had suicidal thoughts need to discuss their feelings. c. As depression improves, a client may have more physical energy available to carry out plans for suicide. d. For most clients, taking antidepressant medication results in increased suicidal thoughts

c. As depression improves, a client may have more physical energy available to carry out plans for suicide.

Which class of drugs is frequently prescribed for a client with bipolar disorder to induce sedation? a. Antipsychotics b. Antidepressants c. Benzodiazepines d. Mood stabilizers

c. Benzodiazepines Benzodiazepines are frequently used to sedate clients with bipolar disorder (BPD). BPD is treated with three major classes of drugs which include mood stabilizers, antipsychotics, and antidepressants.

Joanie is a new patient at the mental health clinic. She has been diagnosed with body dysmorphic disorder. Which of the following medications 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)

A 13-year-old student visits the school nurse numerous times over the course of several weeks. The student has reported, "I worry about my parents because I don't want them to get a divorce. They tell me that they're happy, but I can't stop worrying. I'm having trouble sleeping, I'm always tired, and my grades have dropped." Which condition does the nurse consider that this student may be experiencing? a. Panic disorder b. Separation anxiety c. Generalized anxiety d. Acute stress disorder

c. Generalized anxiety he data presented reflect generalized anxiety disorder (GAD), which includes three or more of these adaptations: uncontrollable worry, restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances. The criteria for panic disorder include a panic attack followed by persistent concern and worry about another attack, with significant changes in behavior. With acute stress disorder, three or more dissociative symptoms, including detachment, feeling of being in a daze, numbing, reduced awareness of surroundings, derealization, or dissociative amnesia, appear within 4 weeks of a traumatic event.

Nina has been hospitalized with Adjustment Disorder with Depressed Mood following the breakup of her marriage. Which of the following is true regarding the diagnosis of adjustment disorder? a. Nina will require long-term psychotherapy to achieve relief. b. Nina likely inherited a genetic tendency for the disorder. c. Nina's symptoms will likely remit once she has accepted the change in her life. d. Nina probably would not have experienced adjustment disorder if she had a higher level of intelligence.

c. Nina's symptoms will likely remit once she has accepted the change in her life.

A patient diagnosed with obsessive-compulsive disorder (OCD) continually carries a toothbrush, and will brush and floss up to fifty times each day. The healthcare provider understands that the patient's behavior is an attempt to accomplish which of the following? a. Avoid interacting with others b. Promote oral health c. Relieve anxiety d. Experience pleasure

c. Relieve anxiety The patient diagnosed with OCD often recognizes the repeated actions are excessive and interfere with the patient's normal routine. The continual brushing and flossing are a result of persistent thoughts that compel the patient to perform the ritual. The ritualistic behavior (brushing and flossing the teeth) are compulsions which are performed in an attempt to provide relief from anxiety-provoking obsessions.

Sandy, a client with OCD says to the nurse, "I've been here four days now, and I'm feeling better. I feel comfortable on this unit, and I'm not ill-at-ease with the staff or other patients anymore." In light of this change, which nursing intervention is most appropriate? a. Give attention to the 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

A patient diagnosed with general anxiety disorder (GAD) reports ongoing nausea and abdominal bloating. A physical examination fails to confirm a medical illness to explain these symptoms. The healthcare provider suspects these findings are a result of which of the following? a. Dysthymia b. Dissociation c. Somatization d. Derealization

c. Somatization The physical symptoms the patient is experiencing are caused by anxiety. Although the physical symptoms may not be explained by a known medical condition, the symptoms are real to the patient. Somatization is a means of coping with psychosocial distress by developing physical symptoms (soma = body). Dysthymia is a persistent depressive disorder that may occur together with anxiety and somatization. Derealization is a sense of detachment from reality. Dissociation is impaired awareness of one's body, self, or environment, and may include derealization.

In what situation should a nurse anticipate that a client will experience a phobic reaction? a. When seeking attention from others b. When thinking about the feared object c. When coming into contact with the feared object d. When being exposed to an unfamiliar environment

c. When coming into contact with the feared object With phobias, the individual transfers anxiety to a safer inanimate object or situation. Therefore the anxiety and resulting feelings will be precipitated only when the client is in direct contact with the object or situation.

which of the following interventions are appropriate for a client on suicide precautions? Select all that apply: a. remove all sharp objects, belts, and other potentially dangerous articles from the client's environment b. accompany the client to off-unit activities c. obtain a promise from the client that she will not do anything to harm herself for the next 12 hours d. put all of the client's possessions in storage and explain to her that she may have them back when she is off suicide precautions

correct answers: a. remove all sharp objects, belts, and other potentially dangerous articles from the client's environment b. accompany the client to off-unit activities c. obtain a promise from the client that she will not do anything to harm herself for the next 12 hours

Which of these clinical manifestations would the healthcare provider anticipate observing in a patient experiencing an acute panic attack? Select all that apply: a. Dilated pupils b. Hypoglycemia c. Elevated blood pressure d. Decreased thyroid e. Bronchoconstriction

correct answers: a & c An acute panic attack involves both psychological and physical responses, and is characterized by an abrupt surge of intense fear and a sense of impending doom. The sympathetic nervous system is responsible for some aspects of the patient's clinical presentation. SNS activation results in fight-or-flight responses such as increased blood sugar (through increased glucocorticoid release from adrenal glands), bronchodilation, increased blood pressure, pupillary dilation, and increased thyroid hormone release.

The nurse is discussing coping strategies with a client who has generalized anxiety disorder. Which behaviors reported by the client indicate the use of positive coping strategies? Select All That Apply. a. Jogging b. Knitting c. Smoking d. Counseling e. Eating binges

correct answers: a, b, d

A registered nurse teaches a nursing student about the care to be taken in clients receiving lithium. Which statements made by the nursing student indicates a need for correction? Select all that apply. a. "I will advise a client to strictly adhere to the dosage regimen." b. "I will advise a pregnant client to use the drug with caution during first trimester." c. "I will verify the plasma levels of T3, T4, and TSH levels before initiating therapy." d. "I will verify the plasma lithium levels every two to three days during lithium therapy." e. "I will instruct the client to restrict sodium intake while co-administering lithium and diuretics.

correct answers: b & e Lithium should be avoided during the first trimester of pregnancy, and it should be used with caution during the remainder of the pregnancy. Sodium deficiency can cause lithium to accumulate. Diuretics promote sodium excretion, so the client should make necessary dietary changes to maintain the required sodium intake, but he or she should not restrict the intake. Rigid adherence to the prescribed regimen is important because any deviations in dosage size and timing can cause toxicity. Plasma levels of T3, T4, and TSH should be measured before treatment and yearly thereafter. Plasma levels should be measured every two to three days during initial therapy and every three to six months during maintenance to avoid toxicity.

The healthcare provider is using implosion therapy for a patient diagnosed with a social phobia. Which of the following interventions would the healthcare provider include in this type of cognitive-behavioral therapy? select all that apply: a. Introducing a more adaptive behavior to substitute for the anxiety b. Abruptly placing the patient in a social situation that causes anxiety c. Gradual exposure to social situations the patient finds intolerable d. Listening to vivid descriptions of anxiety-provoking social situations e. Progressive relaxation techniques used to extinguish the anxiety

correct answers: b and d During implosion therapy the patient will experience intense anxiety. The goal of implosion therapy is to desensitize the patient to the phobia. Implosion therapy (also called "flooding") is a technique whereby the patient is exposed to the situation that produces anxiety. The exposure is not gradual. The patient may be exposed to an imaginary situation or an actual (in-vivo) situation.

Which of the following interventions are appropriate for a client on suicide precautions? Select all that apply. a. Remove all of the client's possessions until they are no longer on suicide precautions. b. Accompany the client to off-unit activities. c. Remove all sharp objects, belts, and other potentially dangerous articles from the client's environment. d. Obtain a promise from the client that they will not engage in self-harm for the next 24 hours. e. Allow the client to have some solitary time to consider their goals for therapy.

correct answers: b, c, d

During a group discussion it is learned that a group member hid suicidal urges and committed suicide several days ago. What should the nurse leading the group be prepared to manage? a. Guilt of the co-leaders for failing to anticipate and prevent the suicide b. Guilt of group members because they could not prevent another's suicide c. Lack of concern over the suicide expressed by several of the members in the group d. Fear by some members that their own suicidal urges may go unnoticed and that they may go unprotected

d. Fear by some members that their own suicidal urges may go unnoticed and that they may go unprotected Ambivalence about life and death, plus the introspection commonly found in clients with emotional problems, can lead to increased anxiety and fear among the group members. These feelings must be handled within the support and supervisory systems for the staff; the group members are the primary concern.

The healthcare provider is planning care for a patient diagnosed with a social phobia. Which of the following should the healthcare provider include in the plan of care for this patient? select all that apply: a. ignore the development of fight-or-flight symptoms b. Examine the validity of thought processes c. Avoid social situations that cause excessive anxiety d. Rehearse relaxation techniques for use in social situations e. Recognize self-defeating thoughts

correct answers: b, d, e Social phobia is characterized by anxiety and excessive fear of scrutiny or embarrassment in social situations. The patient will not engage in social situations in order to avoid experiencing distressing feelings of anxiety. The patient should learn how to recognize (not ignore) physiological responses and thought processes that undermine their ability to function socially. Patients should learn to use techniques that will assist them in social situations, such as relaxation and "thought-stopping" which is a technique that helps the patient control intrusive and self-defeating thoughts.

A patient is involved in a motor vehicle accident in which a friend was killed. The patient reports difficulty concentrating and admits to being irritable and angry most of the time. Which of the following additional findings support a diagnosis of post-traumatic stress disorder (PTSD)? select all that apply: a. Excessive attachment to friends or loved ones b. Flashbacks or nightmares c. Tendency to sleep 12 - 14 hours each day d. Reluctance to drive a motor vehicle e. Signs of sympathetic hyperactivity f. Self-medication with drugs or alcohol

correct answers: b, d, e, f PTSD is caused by psychological trauma which affects the patient's cognitive, physiological, emotional, and behavioral functions. The traumatic event is repeatedly re-experienced by the patient, which causes extreme anxiety and a physiological reaction. The patient will avoid situations that remind them of the traumatic event. DREAMS is a handy mnemonic to help you remember some of the common clinical manifestations of PTSD: Detachment - refers to feeling detached from others or unresponsive emotionally; Re-experiencing the event - the patient often experiences intrusive recollections, flashbacks, or nightmares about the event; Emotional effects - the event causes the patient to experience significant emotional distress; Avoidance - the patient will tend to avoid situations or even close friends that remind them of the event; Medication - the patient may self-medicate with alcohol or other drugs in an attempt to deal with the psychological trauma; Sympathetic hyperactivity - refers to a hypervigilant or hyper-aroused state, irritability, and difficulty falling or staying asleep

The healthcare provider is teaching a class on obsessive-compulsive disorder (OCD). Which of the following will be included in the teaching? select all that apply: a. Repeating words silently is an example of an obsession b. The patient often hears voices that direct the behavior c. The obsessions are intrusive and unwanted d. Obsessions and compulsions are time-consuming e. Hair pulling or skin picking are common features f. The behavior is sometimes related to substance abuse

correct answers: c & d OCD is characterized by intrusive thoughts or urges and by repetitive mental or behavioral acts. If the patient's behaviors are related to substance abuse, the patient is not diagnosed with OCD. Patients diagnosed with OCD do not experience hallucinations. Hair pulling and skin picking are different disorders and not characteristic of OCD. OCD is characterized by intrusive thoughts or urges (obsessions) that compel the patient to perform repetitive mental or behavioral acts (compulsions). The obsessions and compulsions are typically time-consuming and often impair social, occupational, or other important areas of functioning.

A client with a history of obsessive-compulsive behaviors has a marked decrease in symptoms and expresses a wish to obtain a part-time job. On the day of a job interview the client arrives at the mental health center with signs of anxiety. What is the most therapeutic response to the client's behavior by the nurse? a. "I know you're anxious, but by forcing yourself to go to the interview you may conquer your fear." b. "If going to an interview makes you this anxious, you're probably not ready to go back to work." c. "It must be that you really don't want that job after all. I think you should reconsider going to the interview." d. "Going for your interview triggered some feelings in you. Perhaps you could call a friend to drive you there."

d. "Going for your interview triggered some feelings in you. Perhaps you could call a friend to drive you there." The symptoms are a defense against anxiety resulting from decision-making, which triggers old fears; the client needs support. Forcing the client to go to the interview ultimately denies the client's overwhelming anxiety and lacks realistic support.

A patient is receiving care after being diagnosed with generalized anxiety disorder (GAD). Which of these statements made by the patient indicate to the healthcare provider that the patient is beginning to show signs of improvement? a. "Situations that cause anxiety can always be avoided." b. "Now I know that my anxiety is caused by a lack of sleep." c. "As long as I take my medication, I can deal with anxiety." d. "I can tell when I'm beginning to experience anxiety."

d. "I can tell when I'm beginning to experience anxiety." GAD is characterized by excessive worrying that may result in problems such as a hyperarousal, muscle tension, difficulty relaxing, and impaired sleep patterns. Patients diagnosed with GAD often engage in avoidance behaviors. Recognizing when symptoms of anxiety occur is an initial goal for the patient. Once anxiety is recognized, the patient can employ coping skills to manage the anxiety. Mediations can be helpful in managing GAD, but should be used in conjunction with cognitive-behavioral therapies.

What should a nurse include in the initial plan of care for a client with the long-standing obsessive-compulsive behavior of handwashing? a. Determining the purpose of the ritualistic behavior b. Limiting the time allowed for the ritualistic behavior c. Suggesting a symptom-substitution technique to refocus the ritualistic behavior d. Developing a routine schedule of activities to reduce the need for the ritualistic behavior

d. Developing a routine schedule of activities to reduce the need for the ritualistic behavior Accommodate time in the schedule for the patient to complete their rituals without stressing about completing too quickly or not being able to complete the ritual, this will cause increased anxiety. Knowledge of a schedule allows the client to prepare for transitions; hurrying may increase anxiety and spur the need to perform the ritual. Routines will also ease anxiety and reduce the need for the ritual. Determining the purpose of the ritualistic behavior is one of the objectives to be accomplished later during the client's hospitalization, not in the initial phase. Some clients will never be able to identify the purpose of their rituals beyond the fact that they help ease anxiety.

A patient is diagnosed with agoraphobia. Which of the following would the healthcare identify as a characteristic of this disorder? a. Avoids being in the presence of clowns b. Avoids interacting with strangers c. Refuses to use a public restroom d. Fears the use of public transportation

d. Fears the use of public transportation Agoraphobia is a type of anxiety disorder where the patient fears situations that make the patient feel trapped, helpless, or embarrassed. The patient fears an actual or even an anticipated situation. Examples of agoraphobic situations include being outside of the home alone or being in a crowd. Other agoraphobic situations include being in a train or a bus, or other forms of public transportation. Refusing to use a public restroom is a sign of a social phobia. Xenophobia is a fear of strangers, and coulrophobia is a fear of clowns.

After being robbed and beaten by an unknown assailant, a patient is diagnosed with post-traumatic stress disorder (PTSD). When developing a plan of care for the patient, which of these interventions will the healthcare provider plan to implement FIRST? a. Ensure the patient is taking medications as prescribed b. Assist the patient in recalling the details of the event c. Teach the patient coping skills to deal with anxiety d. Promote the establishment of a trusting relationship

d. Promote the establishment of a trusting relationship PTSD is characterized by intrusive thoughts, nightmares, and flashbacks of past traumatic events, causing severe anxiety. Typically, the patient will avoid reminders of the trauma, so the patient should be encouraged to talk about the trauma at his or her own pace. Medication therapy and teaching effective coping skills will be part of the patient's plan of care, but these will have limited effectiveness until the patient feels safe and has a trusting relationship with the healthcare provider.

While preparing a client for her first routine Papanicolaou (Pap) smear, a nurse determines that she appears anxious. What should the nurse include as part of the teaching plan? a. Past statistics on the incidence of cervical cancer b. Description of the early symptoms of cervical cancer c. Explanation of why there is a small risk for cervical cancer d. Verbal instructions that a Papanicolaou smear is effective in detecting precancerous and cancerous cells within the cervix

d. Verbal instructions that a Papanicolaou smear is effective in detecting precancerous and cancerous cells within the cervix Pap smears and vaginal exams can cause anxiety for many clients. Providing verbal information about what a Papanicolaou smear is used for decreases fear and fosters further communication. Cervical cancer is asymptomatic in the early stages. Explanation of why there is a small risk for cervical cancer offers false reassurance. Current, not past statistics on the incidence of cervical cancer should be used.

Carol, age 16, has recently been diagnosed with diabetes mellitus. She must watch her diet and take an oral hypoglycemia medication daily. She has become very depressed, and her mother reports that Carol refuses to change her diet and often skips her medication. Carol has been hospitalized for stabilization of her blood sugar. The psychiatric nurse practitioner has been called in as a consult. Which of the following nursing diagnoses by the psych nurse would be a priority for Carol at this time? a. anxiety r/t hospitalization AEB noncompliance b. low self-esteem r/t feeling different from her peers AEB social isolation c. risk for self-harm/suicide r/t new diagnosis of diabetes mellitus d. risk-prone health behavior r/t denial of seriousness of her illness AEB refusal to follow diet and take medication

d. risk-prone health behavior r/t denial of seriousness of her illness AEB refusal to follow diet and take medication

Which of the following may be influential in the predisposition to PTSD? a. unsatisfactory parent-child relationship b. excess of the neurotransmitter serotonin c. distorted, negative cognition d. severity of the stressor and availability of support systems

d. severity of the stressor and availability of support systems

Theresa is hospitalized following a suicide attempt after breaking up with her boyfriend. Freudian psychoanalytic theory would explain Theresa's suicide attempt in which of the following ways? a. she feels hopeless about her future without her boyfriend b. without her boyfriend, she feels like an outsider with her peers c. she is feeling intense guilt because her boyfriend broke up with her d. she is angry at her boyfriend for breaking up with her and has turned the anger inward on herself.

d. she is angry at her boyfriend for breaking up with her and has turned the anger inward on herself.