Anxiety Prep U
Buspirone has been prescribed for a client with anxiety. When providing health education, the nurse should describe what benefit of this medication over other anxiolytics? decreased risk of hepatic injury less central nervous system depression rapid onset and short duration sublingual administration
Buspirone is a newer anxiolytic drug that does not cause sedation or muscle relaxation. It is preferred when the client needs to be alert such as when driving or working. Buspirone does not have a reduced risk of hepatic injury relative to other anxiolytics, nor does it have a faster onset and shorter duration. It is administered orally, not sublingually.
When discussing various types of anxiolytic medications with a client, the nurse recognizes that which medication has the lowest potential for abuse? Alprazolam Diazepam Buspirone Lorazepam
Buspirone is a nonbenzodiazepine medication that does not have abuse potential. Benzodiazepines such as alprazolam, lorazepam, and diazepam have abuse potential and may become addictive.
A nurse is assessing a client suffering from stress and anxiety. The most common physiologic response to stress and anxiety is: sedation. diarrhea. vertigo. urticaria.
Diarrhea is the most common physiologic response to stress and anxiety. Sedation, vertigo, and urticaria could also be related to stress and anxiety but they don't occur as commonly as diarrhea.
After learning that a roommate is HIV-positive, a client asks a nurse about moving to another room on the psychiatric unit because the client no longer feels "safe." What should the nurse do first? Move the client to another room. Ask the client to describe the fears. Move the client's roommate to a private room. Explain that such a move wouldn't be therapeutic for the client or the roommate.
To intervene effectively, the nurse must first understand the client's fears. After exploring the fears, the nurse may move the client or roommate or explain why such a move wouldn't be therapeutic, as needed.
A nurse assesses a client and determines that the client is experiencing mild anxiety based on what? The client is selectively inattentive The client is aware and alert The client has focused attention on a small area The client voices feelings of unreality
A client who is mildly anxious is aware, alert, sees, hears, and grasps more than before. Selective inattention reflects moderate anxiety. Focusing attention on a small area reflects severe anxiety. Feelings of unreality are associated with panic.
The nurse is assessing a client with anxiety. Which behavior might indicate that the client has moderate anxiety? The client is focused in an activity. The client is nervous and agitated. The client has impaired cognitive skills. The client is unable to communicate verbally.
A client who is moderately anxious has a disturbing feeling that something is wrong. This causes nervousness and agitation. Increased concentration and attention is seen in clients having mild anxiety. Cognitive skills are impaired in clients who have severe anxiety. Inability to communicate verbally indicates that the client is panicking.
A client comes to the emergency department because the client thinks the client is having a heart attack. Further assessment determines that the client is not having a heart attack but is having a panic attack. When beginning to interview the client, which question would be most appropriate for the nurse to ask? "Are you feeling much better now that you are lying down?" "What did you experience just before and during the attack?" "Do you think you will be able to drive home?" "What do you think caused you to feel this way?"
After it has been determined that the client does not have other medical problems, the nurse should assess for the characteristic symptoms of panic attack, focusing the questions on what the client was experiencing just before and during the attack. Asking the client if the client feels better provides no information for the nurse, and lying down may or may not be effective. Asking the client if the client thinks the client can drive home is a question that can be asked much later in the interview, after the attack subsides and the client is stable. Asking the client about what caused the attack is inappropriate because numerous stimuli, both external and internal, can provoke an attack. Most clients will not be able to identify a specific cause. The focus of care is on the characteristics of the attack.
Clients taking benzodiazepines need education about what? Avoiding cheeses and smoked meats Interactions with monoamine oxidase inhibitors (MAOIs) Avoiding spending too much time in the sun Concomitant use of alcohol
Benzodiazepines have long been the drugs of choice for treatment of anxiety disorders. They can induce a physical dependence and can induce severe withdrawal symptoms and intense rebound anxiety when discontinued abruptly. They potentiate the effects of alcohol and other sedative hypnotics, are commonly abused, and have several significant side effects. The most common adverse effects are sedation, ataxia, loss of coordination, slurred speech, memory impairment, paradoxical agitation, and dizziness. They also cause psychomotor impairment.
When a parent observes the parent's young child heading toward a busy road the parent becomes stressed, feeling the parent's heart pounding, breathing heavily, and hands becoming wet with perspiration. Which physiological system is activated with the parent's "fight or flight" reaction to this danger? Parasympathetic nervous system Sympathetic nervous system Motherly response system Central nervous system
Correct response: Sympathetic nervous system Explanation: The sympathetic nervous system activates the fight or flight response quickly as a survival response that results in an increased heart and respiratory rate, moist hands and feet, and dilated pupils. The parasympathetic system is most active in nonstressful events. The motherly instinct is not a proven physiological system.
A nurse in a psychiatric inpatient unit is caring for a client with generalized anxiety disorder. As part of the client's treatment, the psychiatrist orders lorazepam, 1 mg by mouth three times per day. During lorazepam therapy, the nurse should remind the client to: avoid caffeine. avoid aged cheeses. stay out of the sun. maintain an adequate salt intake.
Correct response: avoid caffeine. Explanation: Ingesting 500 mg or more of caffeine can significantly alter the anxiolytic effects of lorazepam. Other dietary restrictions are unnecessary. Staying out of the sun or using sunscreens is required when taking phenothiazines. An adequate salt intake is necessary for clients receiving lithium.
Relaxation techniques help clients with anxiety disorders because they can promote what? Reduction of autonomic arousal Increase in sympathetic stimulation Release of cortisol Increase in the metabolic rate
Correct response: Reduction of autonomic arousal Explanation: Regularly inducing the relaxation response reduces the general level of autonomic arousal in anxious clients. It lowers blood pressure, heart rate, metabolic rate, and oxygen demands. This physiologic effect may result from effects on the production of cortisol, a hormone the body releases in response to stress. Cortisol is helpful during the fight-or-flight response, but its prolonged presence in chronically anxious or stressed clients can inhibit the immune system and have other deleterious effects on the body.
A client with generalized anxiety disorder states that the client is worried about the client's job. The client never feels like the client has control over the client's responsibilities, even though the client puts in extra hours. The client adds that the client is afraid the client will be fired. Which response by the nurse is most therapeutic? "It sounds to me like you're doing a good job." "Your worries are a feature of your anxiety disorder. Tell yourself that you have nothing to worry about." "Has something changed at work that is causing you to worry?" "Why do you think you'll be fired?"
Correct response: "Has something changed at work that is causing you to worry?" Explanation: The nurse begins an assessment by simply asking the client if he or she is currently feeling anxious or worried or has experienced these feelings recently. The nurse also asks the client about obsessive thinking patterns, worrying, compulsions and repetitive activity, specific phobias, and exposure to traumatic events. Once the nurse has determined that signs and symptoms of anxiety do exist, the nurse assesses the possible underlying causes and inquires about family history, recent life events, current stress level, personal history of anxiety, medical and medication history, history of substance abuse, and other possible causes of the anxiety.
Which question in the assessment of a client with anxiety is mostclinically appropriate? "What can I give you to make you feel less anxious right now?" "Does your anxiety make you feel less valuable and competent as a person?" "Do you think that you're justified in feeling anxious right now?" "How do you feel about everything that is happening in your life right now?"
Correct response: "How do you feel about everything that is happening in your life right now?" Explanation: An open-ended question that prompts the client to describe his or her current feelings is a useful assessment technique. Offering medications or other solutions, asking if the client feels justified in his or her feelings, and questioning the client's self-worth are not normally appropriate, or effective, assessment techniques.
A nurse notices that a client with obsessive-compulsive disorder dresses and undresses several times each day. Which comment by the nurse would be most therapeutic? "I saw you change clothes several times today. Do you find this tiring?" "It might be helpful if you dress only once per day so you will not be so tired." "It must really bother you to change your clothes so often. How can I help?" "I see that you are a perfectionist about the clothes you wear."
Correct response: "I saw you change clothes several times today. Do you find this tiring?" Explanation: Mentioning to the client that changing clothes so often may be tiring focuses on the client's feelings rather than making an assumption. This helps reduce the intensity of the client's ritualistic behavior, thereby promoting trust and rapport. Suggesting to the client to dress only once per day and implying that the client's behavior is bothersome or foolish would convey disapproval, impede trust and rapport, promote dysfunctional behavior, and worsen anxiety. Saying to the client that "you are a perfectionist about the clothes you wear" is sarcastic and does not promote trust and rapport. The client has been dressing and undressing repetitively in response to anxiety not perfectionism. The client already knows the need for repetitive dressing and undressing is frustrating and wants to be understood instead of misunderstood. Perfectionism is more reflective of obsessive-compulsive personality disorder instead of obsessive-compulsive disorder.
A 40-year-old client is admitted for a surgical biopsy of a suspicious lump in the left breast. The client is tearfully writing a letter to the client's two children and tells the nurse, "I want to leave this for my children in case anything goes wrong today." Which response by the nurse would be most therapeutic? "In case anything goes wrong? What are your thoughts and feelings right now?" "I can understand that you're nervous, but this really is a minor procedure. You'll be back in your room before you know it." "Try to take a few deep breaths and relax. I have some medication that will help." "I'm sure your children know how much you love them. You'll be able to talk to them on the phone in a few hours."
Correct response: "In case anything goes wrong? What are your thoughts and feelings right now?" Explanation: By acknowledging how the client feels, this response encourages discussion about what the client is thinking and feeling. Minimizing the client's feelings or offering empty reassurances isn't therapeutic or helpful. Deep breathing and preoperative medication would be appropriate only after the client has expressed the fears and dealt with them.
The nurse in the emergency department (ED) is caring for a client who suffers recurrent panic attacks. The client states, "I want to know what causes these panic attacks so I can do something to keep it from happening again." Which responses by the nurse is correct? Select all that apply. "Panic attacks are not your fault. They are thought to be caused by high levels of epinephrine." "No one really knows what causes panic attacks." "There are no treatments for panic attacks outside of behavioral modification therapy." "Psychological factors and social triggers can contribute to panic attacks." "Some people believe that panic attacks are caused by an abnormal pathway in the brain."
Correct response: "Panic attacks are not your fault. They are thought to be caused by high levels of epinephrine." "Psychological factors and social triggers can contribute to panic attacks." Explanation: An excess of epinephrine (NE) is thought to be a causative factor. There are specific neurotransmitters and areas of the brain that are responsible for the perceptions and symptoms of a panic attack. Medications act on these specific areas of the brain to lessen the occurrence of panic attacks. Psychological factors and social conditions may contribute but are not causative of panic attacks. The answer, "Some people believe that panic attacks are caused by an abnormal pathway in the brain" is incorrect. Neurological deficits may be present in other anxiety disorders, such as obsessive compulsive disorder, but are not associated with panic attacks.
Which statement by the nurse demonstrates an understanding of the role automatisms have in a panic attack? "The client taps her fingers very rapidly when she is feeling anxious." "I discourage her finger tapping since it serves to increase her anxiety level." "She knows that if she taps her fingers she will be able to lessen her anxiety." "I can tell that the more she taps, the less anxiety she is actually feeling."
Correct response: "The client taps her fingers very rapidly when she is feeling anxious." Explanation: Automatisms are automatic, unconscious mannerisms associated with anxiety. Examples include tapping fingers, jingling keys, or twisting hair. Automatisms are geared toward anxiety relief and increase in frequency and intensity with the client's anxiety level. None of the remaining options accurately state the fact that the tapping identifies the level of anxiety a client is experiencing but does not manage or less the emotion.
A client approaches the nurse on an inpatient psychiatric hospital unit crying, trembling, and feeling nauseous. The client states, "I've tried everything, I still feel so anxious." Which action by the nurse would be most appropriate? Direct the client to continue deep breathing. Take the client on a walk around the unit. Take the client to the dayroom as a distraction. Administer the prescribed PRN anxiolytic medication.
Correct response: Administer the prescribed PRN anxiolytic medication. Explanation: The client is experiencing severe anxiety. The client tells the nurse the client has tried other strategies but they have not been effective. Given the client's report of symptoms, it would be appropriate to administer a dose of the prescribed PRN anxiolytic medication. Once the client is experiencing a decrease in the uncomfortable physiologic symptoms associated with the severe anxiety, it will be easier to engage the client in nonpharmacological interventions, such as deep breathing, to manage any residual signs and symptoms of the anxiety.
A client has sought treatment because of the overwhelming anxiety the client experiences regarding the safety of the client's young children. The client admits that the client will not normally let the client's children leave the client's sight for fear that they will be abducted, abused, or injured. The client is unable to function at work as a result of this anxiety. The nurse would recognize that this client experiences which condition? Signal anxiety Fear Derealization Anticipatory anxiety
Correct response: Anticipatory anxiety Explanation: Anticipatory anxiety exists in the context of phobia. People with phobias develop anticipatory anxiety even when thinking about possibly encountering the dreaded phobic situation (i.e., danger to the client's children). The anticipatory anxiety in this case is so severe that the client is unable to function in certain situations leading to hardship. Signal anxiety refers to the natural anxiety mechanism that communicates danger or motivation for needed change. Fear refers to feeling afraid or threatened by a clearly identifiable external stimulus that presents a danger to a person. Derealization refers to a stage in the experience of anxiety when a person senses that things are not real.
The nurse is teaching a client prescribed the antianxiety agent chlordiazepoxide. The nurse should incorporate which instruction into the teaching plan? Avoid taking antianxiety drugs with alcohol. Take the medication at the same time each day, avoiding taking at bedtime. Take antianxiety drugs in the morning with breakfast or a snack. Avoid consuming items with tyramine when taking antianxiety agents.
Correct response: Avoid taking antianxiety drugs with alcohol. Explanation: The client should be instructed to avoid alcohol while taking chlordiazepoxide because alcohol potentiates the drug's CNS depressant effect. Taken at bedtime, this drug will induce sleep and can potentiate the effects of other drugs. Chlordiazepoxide comes in capsule form and can usually be taken with water any time of day. Tyramine is restricted with monoamine oxidase inhibitors, not antianxiety agents.
The nurse is teaching a client diagnosed with a generalized anxiety disorder how to effectively cope with severe distress. Which interventions would the nurse use to promote effective coping with anxiety? Select all that apply. Discuss previous methods that were effective in handling stress. Encourage the client to limit to a mutually decided amount of time spent on worrying. Help the client to establish a goal and develop a plan to meet the goal. Teach the client how to label feelings and how to express them. Discuss ways to examine the reality of fears. Assist the client to acknowledge the major consequences of blaming others.
Correct response: Discuss previous methods that were effective in handling stress. Encourage the client to limit to a mutually decided amount of time spent on worrying. Help the client to establish a goal and develop a plan to meet the goal. Teach the client how to label feelings and how to express them. Explanation: To promote effective skills, the nurse would focus on having the client identify successful coping skills used in the past and on building on the client's knowledge of the disorder. Setting a mutually agreed upon limit on the amount of time spent worrying gives the client boundaries and acknowledges the concerns. Establishing a goal and planning to meet the goal allows the client to engage in solving the problem and exercise control over the stressful situation. Labeling and expressing feelings is a healthy way to acknowledge feelings. Clients with schizophrenia, not generalized anxiety disorder, require help with focusing on reality-based behaviors. Clients who demonstrate oppositional behavior tend to blame others instead of taking responsibility for their inappropriate behavior.
Which assessment question is most likely to allow the nurse to differentiate between anxiety disorder due to a general medical condition and psychological factors affecting a medical condition? Reviewing the client's previous medication administration record and the client's current list of medications Questioning the client about the clinician who first diagnosed the medical problem Asking the client to provide a detailed explanation of his or her medical problem to determine if the presentation is typical of the problem Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first
Correct response: Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first Explanation: Considering the relationship of anxiety with the onset, exacerbation, or remission of the general medical condition can help determine whether a medical condition contributes to anxiety or vice versa. The client's medication list, the identity of the clinician who diagnosed the disease, and the client's symptoms are all aspects of the assessment process, but these are less likely to establish the primary cause.
When a client is experiencing panic, which is the priorityintervention? Give the client medication immediately. Move the client to a quiet environment. Offer the client therapy to calm down. Physically restrain the client.
Correct response: Move the client to a quiet environment. Explanation: Decreasing external stimuli will help lower the client's anxiety level. The client's safety is priority. Anxious behavior can be escalated by external stimuli. In a large area, the client can feel lost and panicked, but a smaller room can enhance a sense of security. Medicating the client would be inappropriate. Restraint should only be used as a last resort. Therapy can be appropriate once the client's anxiety level decreases.
A client who experiences panic anxiety around dogs is sitting in a room with a dog and the client's nurse therapist. The nurse therapist is using which behavioral intervention for this type of anxiety? Systematic desensitization Implosion therapy Relaxation exercise Biofeedback
Correct response: Systematic desensitization Explanation: Systematic desensitization refers to the exposure of a person to a fear-producing situation in a systematized manner to decrease a phobic disorder. Implosion therapy, while similar, is not the technique described in this option. This scenario lacks the physical control techniques implemented by relaxation exercise, and it lacks the auditory and/or visual techniques implemented by biofeedback.
A client is worried and states, "I just know I won't be able to sleep before my surgery." What sleeping pattern would the nurse anticipate? The client will likely not be able to sleep. The worry will make the client fall asleep quickly. The client will probably not be able to stay asleep. The client will likely sleep all night.
Correct response: The client will likely not be able to sleep. The expectation that the onset of sleep will be difficult increases the person's anxiety. The anxiety floods the brain with stimulating chemicals that interfere with relaxation, which is a prerequisite for natural sleep. Given the client's anxiety about the surgery, as well as the expectation that they will not sleep, it is likely that the client will not be able to sleep. Worry may cause exhaustion, but it will not cause the client to fall asleep quickly. Since the client will likely not sleep, the nurse does not anticipate patterns of wakening for the client.
A client periodically has acute panic attacks. These attacks are unpredictable and have no apparent association with a specific object or situation. During an acute panic attack, the client may experience: a decreased perceptual field. a decreased heart rate. a decreased respiratory rate. heightened concentration.
Correct response: a decreased perceptual field. Explanation: Panic is the most severe level of anxiety. During a panic attack, a client's perceptual field, narrows. The client becomes more self-focused, less aware of surroundings, and unable to process information from the environment. The client's decreased perceptual field impairs attention and ability to concentrate. During an acute panic attack, the client may experience an increase, not a decrease, in heart and respiratory rates, resulting from stimulation of the sympathetic nervous system.
Which nursing intervention is focused on the primary goal of anxiety management and treatment? assessing the client's ability to implement stress management techniques effectively helping the client identify ways to eliminate all sources of stress in his or her daily life educating the client concerning the use of medications to manage anxiety disorders assessing the client for possible symptoms of panic disorder
Correct response: assessing the client's ability to implement stress management techniques effectively Explanation: For people with anxiety disorders, it is important to emphasize that the goal is effective management of stress and anxiety, not the total elimination of anxiety. Learning anxiety management techniques and effective methods for coping with life and its stresses is essential for overall improvement in life quality. Although medication is important to relieve excessive anxiety, it does not solve or eliminate the problem entirely. While assessment is appropriate, it is not directly associated with the management and treatment of the original disorder.
A nurse notices that a client with obsessive-compulsive disorder washes the hands for long periods each day. How should the nurse respond to this compulsive behavior? by setting aside times during which the client can focus on the behavior by urging the client to reduce the frequency of the behavior as rapidly as possible by calling attention to or trying to prevent the behavior by discouraging the client from verbalizing his anxieties
Correct response: by setting aside times during which the client can focus on the behavior Explanation: The nurse should set aside times during which the client is free to focus on the compulsive behavior or obsessive thoughts. The nurse should urge the client to reduce the frequency of the compulsive behavior gradually, not rapidly. The nurse shouldn't call attention to the behavior or try to prevent it. Trying to prevent the behavior may frighten and hurt the client. The nurse should encourage the client to verbalize anxieties to help distract attention from the compulsive behavior.
A client admitted to the unit is visibly anxious. The nurse documents what assessment finding as an expected finding in a client experiencing mild to moderate anxiety? dyspnea chest pain increased heart rate drop in blood pressure
Correct response: increased heart rate Explanation: During anxiety, the sympathetic nervous system is activated. This can result in increased heart rate and cardiac contractility, leading to an increase in cardiac output and blood pressure (BP = CO x HR). The client's respiratory rate may increase, but unless the client is experiencing a panic attack, neither dyspnea nor chest pain should be present. If these present with mild anxiety, the nurse would not document these as an expected finding.
A client who is a painter recently fractured a tibia and can't work. The client worries about finances. To treat the client's anxiety, the physician orders buspirone, 5 mg by mouth three times per day. Which drugs interact with buspirone? beta-adrenergic blockers antineoplastic drugs antiparkinsonian drugs monoamine oxidase (MAO) inhibitors
Correct response: monoamine oxidase (MAO) inhibitors Explanation: Buspirone interacts only with MAO inhibitors, producing a hypertensive reaction. Administration of beta-adrenergic blockers, antineoplastic drugs, or antiparkinsonian drugs wouldn't cause an interaction, so they can be administered simultaneously with buspirone.
A client arrives on the psychiatric unit exhibiting extreme excitement, disorientation, incoherent speech, agitation, frantic and aimless physical activity, and grandiose delusion. Which nursing diagnosis takes highest priority for this client at this time? ineffective coping hopelessness risk for injury disturbed personal identity
Correct response: risk for injury Explanation: This client is at increased risk for injury because of severe hyperactivity, disorientation, and agitation. Although ineffective coping, hopelessness, and disturbed personal identity also are appropriate diagnoses, the client's safety takes highest priority. The nurse should take immediate action to protect the client from injury.
A patient with anxiety disorder has excessive anxiety and worries about multiple life circumstances. For how long would this patient experience these feelings before the anxiety disorder would be considered chronic and generalized? 6 months 2 months 12 months 4 months
For generalized anxiety disorder, the diagnostic criteria listed include unrealistic or excessive anxiety and worry about two or more life circumstances for 6 months or more, during which time these concerns exist for a majority of days.
The nurse is providing care for a psychiatric-mental health client who has a diagnosis of anxiety. Which statement by the nurse is likely the most therapeutic intervention? "Anxiety is a feeling that is experienced by everyone at some point and it can never be completely removed from one's life." "With the development of more life skills and a demonstration of continued success in life, your anxiety will shrink and eventually disappear." "Every time you feel anxious, try to focus on how much easier your life would be if you didn't experience anxiety so often." "If you address the causes of your anxiety head-on, you will find that you can recover from it without medications or therapy."
It is therapeutic to foster in clients the understanding that the experience of anxiety is natural and inevitable. It would be inaccurate to promise recovery with increased success in life and self-discipline. Clients with anxiety are likely to be well aware of how much easier their lives would be without recurring anxiety.
Lorazepam is commonly given along with a neuroleptic agent. What is the purpose of administering the drugs together? to reduce anxiety and potentiate the neuroleptic's sedative action to counteract the neuroleptic's extrapyramidal effects to manage depressed clients to increase a client's level of awareness and concentration
Lorazepam, when taken with a neuroleptic such as haloperidol, potentiates the neuroleptic's sedating effect and is used to treat severely agitated clients. Lorazepam wouldn't be given to counteract extrapyramidal effects. Both drugs can cause depression, so they aren't used to treat depression. The drugs' depressant effect would decrease concentration, not increase it.
Lorazepam is commonly given along with a neuroleptic agent. What is the purpose of administering the drugs together? to reduce anxiety and potentiate the neuroleptic's sedative action to counteract the neuroleptic's extrapyramidal effects to manage depressed clients to increase a client's level of awareness and concentration
Lorazepam, when taken with a neuroleptic such as haloperidol, potentiates the neuroleptic's sedating effect and is used to treat severely agitated clients. Lorazepam wouldn't be given to counteract extrapyramidal effects. Both drugs can cause depression, so they aren't used to treat depression. The drugs' depressant effect would decrease concentration, not increase it.
A nurse is giving a presentation on mental health promotion to college students. One student asks the nurse to explain the difference between normal anxiety and an anxiety disorder. Which response is best? "People with anxiety disorders experience a fight-or-flight response when threatened." "People with anxiety disorders generally find that the anxiety interferes with daily activities." "Normal anxiety does not result in feelings of dread or restlessness." "Normal anxiety occurs in response to everyday stressors."
Pathologic anxiety is suspected if a person feels anxious when no real threat exists, when a threat has passed long ago but continues to impair the person's functioning, or when a person substitutes adaptive coping mechanisms with maladaptive ones.
A client has become increasingly afraid to ride in elevators. While in an elevator one morning, the client experiences shortness of breath, palpitations, dizziness, and trembling. A physician can find no physiological basis for these symptoms and refers the client to a psychiatric clinical nurse specialist for outpatient counseling sessions. Which type of therapy is most likely to reduce the client's anxiety level? psychoanalytically oriented psychotherapy group psychotherapy systematic desensitization referral for evaluation for electroconvulsive therapy
Phobias are commonly viewed as learned responses to anxiety that can be unlearned through certain techniques such as behavior modification. Systematic desensitization, a form of behavior modification, attempts to reduce anxiety, and thereby eradicate the phobia, through gradual exposure to anxiety-producing stimuli. Psychoanalytically oriented therapy also may be effective in this situation, but years of treatment are required to achieve results. Group psychotherapy could be used as an adjunct treatment to increase the client's self-esteem and reduce generalized anxiety. Electroconvulsive therapy is reserved primarily for clients with severe depression or psychosis who respond poorly to other treatments; it's rarely indicated for phobic disorders.
Which medication classification has been used to treat social phobia? Selective serotonin reuptake inhibitors (SSRIs) Monoamine oxidase inhibitors (MAOIs) Tricyclic antidepressants (TCAs) Nonbenzodiazepines
SSRIs are used to treat clients with social phobia because they significantly reduce social anxiety and phobic avoidance. Benzodiazepines are also used to reduce anxiety caused by phobias.
Which medication classifications used in the treatment of panic disorder can cause physical dependence? Benzodiazepines Selective serotonin reuptake inhibitors (SSRIs) Tricyclic antidepressants (TCAs) Serotonin-norepinephrine reuptake inhibitors (SNRIs)
SSRIs, SNRIs, TCAs, monoamine oxidase inhibitors (MAOIs), and antianxiety medication (benzodiazepines) have been shown to be effective in panic disorders. Benzodiazepines are well tolerated but physical dependence is a potential side effect, and they carry the risk of withdrawal symptoms upon discontinuation of use.
In speaking with a client with moderate anxiety, the client becomes tangential discussing unrelated topics. To help the client's attention from wandering, which is an effective intervention? The nurse should speak in short and simple sentences. The nurse should remain with the client until the anxiety is reduced. The nurse should speak in a soft and calm voice. The nurse should take the client to a nonstimulating environment.
Speaking in short, simple, and easy-to-understand sentences has been shown to be effective with clients with moderate anxiety whose attention wanders. Not leaving the client alone unless the anxiety is reduced and speaking in a soft voice are interventions used with a client with severe anxiety. If the client has panic-level anxiety, the nurse should give primary attention to the safety of the client and move the client to a nonstimulating environment.
A client presents to the nurses' station with symptoms of a panic attack, including shortness of breath, dizziness, trembling, and nausea. Which is the nurse's first intervention? Teach the client relaxation techniques. Administer PRN antianxiety medication. Stay with the client, and offer support. Help the client identify triggers for anxiety.
Staying with the client and offering support will provide a sense of security. Never leave a client alone during a panic attack. Teaching relaxation techniques and helping the client identify triggers are not appropriate during an acute panic attack, but they are important interventions when the client is calmer and able to receive information. Administering anxiety medication isn't the best initial action, because they don't take effect immediately.
A client at an outpatient psychiatric clinic has been experiencing anxiety. The nurse would like to suggest activities for the client to do in their spare time. What would be an appropriate activity for the nurse to suggest to the client? Select all that apply. taking up a hobby board games daily walks bingo stretching exercises
Taking daily walks and stretching exercises allow the client to expend energy and establish a trusting, neutral relationship with the nurse. Taking up a hobby will help the client change their attention and focus from negative anxiety to more positive and relaxed thoughts. The other suggestions are higher stimulation activities that insert competition and added anxiety to the situation.
A client diagnosed with anxiety disorder is prescribed buspirone. What priority teaching will the nurse provide? Buspirone can cause immediate bradycardia. Buspirone blood levels need to be checked 1 week after initiating the drug. Buspirone can cause neuroleptic malignant syndrome. Buspirone has a delayed therapeutic effect of between 14 to 30 days.
The client should be informed that the drug's therapeutic effect might not be achieved for 14 to 30 days. The client must be instructed to continue taking the drug as directed. Tachycardia, not bradycardia, is a reported effect of buspirone. Blood level checks are not necessary. Neuroleptic malignant syndrome has not been reported with this drug.
The most important factor in the person's stress response is what? Strength of the immune system Supportive friends Relaxation techniques Adaptive coping strategies
The most important factor in a person's stress response is the ability of engage in adaptive coping behaviors. This ability can assist a person in developing resilience, or the ability to "bounce back" when faced with stress and stressful situations. The immune system, having a supportive network of friends, and understanding of relaxation techniques are also influencing factors when considering how an individual responds to stress; however, the correct option relates to an internal, sustainable strength that comes from adaptive coping.
The nurse recognizes that who is the client most likely experiencing generalized anxiety disorder (GAD)? 40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months 22-year-old soldier who served in the Middle East who "cannot sleep" and is facing criminal charges for hurting someone in a barroom brawl 70-year-old whose spouse died 1 year ago who has "no desire to leave my house" and reports severe fatigue 30-year-old business executive who reports being anxious about attending the meetings and social events that are the executive's job responsibilities
The nurse recognizes that the client most likely experiencing GAD is a 40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months. The other options provided do not describe conditions of GAD.
A client is admitted to the acute psychiatric care unit after 2 weeks of increasingly erratic behavior. The client is unkempt, has lost approximately 9 lb (4 kg), has been sleeping poorly, and exhibits hyperactivity. The client loudly denies the need for hospitalization. What priority intervention will the nurse apply? providing adequate hygiene asking the client to go eat a meal in the day room decreasing environmental stimulation orientating the client to the unit activities
This client is at increased risk for injuring self or others. Decreasing environmental stimulation, a measure the nurse may take independently, may reduce the client's hyperactivity. Providing adequate hygiene is an appropriate nursing intervention but isn't the highest priority. Because the overall goal is to reduce the client's hyperactivity, orientating him to unit activities is contraindicated. Asking the client to go eat a meal in the day room is contraindicated because there is risk for harm to self or others and it is likely there will be more stimulation in the day room.
A client who recently developed paralysis of the arms is diagnosed with functional neurologic symptom disorder after tests fail to uncover a physical cause for the paralysis. Which intervention should the nurse include in the care plan for this client? exercising the client's arms regularly insisting that the client eat without assistance working with the client rather than with the family teaching the client how to use nonpharmacologic pain-control methods
To maintain the integrity of the affected areas and prevent muscle wasting and contractures, the nurse should help the client perform regular passive range-of-motion exercises with the arms. The nurse shouldn't insist that the client use the arms to perform such functions as eating without assistance, because the client can't consciously control the symptoms and move the arms; such insistence may anger the client and endanger the therapeutic relationship. The nurse should include family members in the client's care because they may be contributing to the client's stress or conflict and are essential to helping the client regain function of the arms. The client isn't experiencing pain and, therefore, doesn't need education regarding pain management.
All of the following pharmacological agents are useful in treating anxiety disorders except which ones? Tricyclic antidepressants Selective serotonin reuptake inhibitors (SSRIs) Benzodiazepines Calcium channel blockers
Tricyclic antidepressants and SSRIs are known to be useful in reducing anxiety and are sometimes useful in treating the anxiety disorders. Benzodiazepines are an excellent choice for the treatment of symptoms of anxiety; however, they are extremely addictive and should only be given in the case of true anxiety disorders. Calcium channel blockers are not used in treating anxiety disorders.