PassPoint - Anxiety Disorders

The nurse has completed client instruction about lorazepam. Which of the following client statements indicate that the client understands the teaching?

"I can develop a dependency on this medication."

A client with posttraumatic stress disorder has been complaining of headaches. The healthcare provider orders magnetic resonance imaging (MRI) of the brain to rule out organic disorders. The client later tells a nurse, "I'm not going into that tunnel!" Which response by the nurse is most therapeutic?

"I can tell you're really afraid. Can you tell me more about your fear?"

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?"

A new nurse asks the charge nurse why the client with body dysmorphic disorder is always looking at their nose in the mirror. Which of the following would be an appropriate response?

"Clients with body dysmorphic disorder are preoccupied with perceived defects in their appearance."

A client diagnosed with obsessive-compulsive disorder has been taking sertraline but would like to have more energy every day. At their monthly checkup, the client reports that their massage therapist recommended they take St. John's wort to help with depression. What should the nurse tell the client?

"Combining St. John's wort with the sertraline can cause a serious reaction called serotonin syndrome."

Client brought to emergency department (ED) for a new onset of shortness of breath and chest pain after learning that family members were killed in an automobile accident. Select five (5) statements that indicate the client is improved and ready to be discharged.

"I am relieved that I didn't have a heart attack." "I am relieved that I didn't have a heart attack." "The social worker gave me a list of local grief support groups." "The psychologist scheduled an appointment for me next week." "I am supposed to take this medication if I feel really anxious and scared."

During the interview, the client with schizophrenia is experiencing an anxiety attack. Which of these responses by the nurse would be most appropriate?

"I will stay with you."

A client with borderline personality disorder tells a nurse, "You're the only nurse who really understands me. The others are mean. They always ignore me when I ask for my extra antianxiety medication." How should the nurse respond?

"I'll inform the team of your concerns. Let's talk about how you're feeling."

A client with a moderate level of anxiety is pacing quickly in the hall and tells the nurse, "Help me. I can't take it anymore." What would be the nurse's best initial response?

"Let's go to a quieter area where we can talk if you want."

A nurse is caring for a veteran with a history of explosive anger, unemployment, and depression since being discharged from the service. The client reports feeling ashamed of being "weak" and of letting past experiences control thoughts and actions in the present. What is the nurse's best response?

"Many people who've been in your situation experience similar emotions and behaviors."

A nurse teaches a client how to use physical activity to help manage anxiety. Which of the following statements by the client indicates understanding of the teaching?

"Physical activity provides a natural outlet for the release of muscle tension."

A client with acute stress disorder states to the nurse, "I keep having horrible nightmares about the car accident that killed my daughter. I should not have taken my child with me to the store." Which response by the nurse is most therapeutic?

"The accident just happened and couldn't have been predicted."

The nurse has completed teaching a client about alprazolam. Which statement by the client will the nurse document as evidence of successful teaching?

"This medication carries a risk of dependence."

A client reports experiencing symptoms of stress including nausea, sweating, irritability, and some difficulty sleeping since getting married and becoming a step-parent. The client has always believed symptoms will go away on their own. The nurse is educating the client about stress management. Which statement by the nurse is most appropriate?

"Using stress management techniques will help you calm down and relax."

A nurse is interviewing a client with posttraumatic stress disorder (PTSD) when a loud, booming noise from a passing car's radio rattles the windows. The client jumps onto a chair, wide-eyed and frantic. Which statement by the nurse is the most therapeutic response?

"What kinds of feelings are you experiencing?"

A client who is a veteran with posttraumatic stress disorder tells the nurse about the horror and mass destruction of war. The client states, "I killed all of those people for nothing." Which response by the nurse is appropriate?

"You did what you had to do at that time."

The client rushes out of the day room where he has been watching television with other clients. He is hyperventilating and flushed and his fists are clenched. He states to the nurse, "That bastard! I almost hit him." What would be the nurse's best response?

"You're angry, and you did well to leave the situation. Let's walk up and down the hall while you tell me about it."

A client takes diazepam while establishing a therapeutic dose of antidepressants for generalized anxiety disorder. Which instruction(s) should the nurse give to this client? Select all that apply.

-Consult with a health care provider before they stop taking the drug. -Consult with a health care provider before they stop taking the drug. -Stop taking the drug if they experience swelling of the lips and face and difficulty breathing

A registered nurse caring for a client with generalized anxiety disorder identifies a nursing diagnosis of Anxiety. A short-term goal is established as follows: "The client will identify physical, emotional, and behavioral responses to anxiety." Which nursing interventions will help the client achieve this goal? Select all that apply.

-Observe the client for overt signs of anxiety. -Help the client connect anxiety with uncomfortable physical, emotional, or behavioral responses. -Introduce the client to new strategies for coping with anxiety, such as relaxation techniques and exercise.

Client brought to emergency department (ED) for a new onset of shortness of breath and chest pain after learning that family members were killed in an automobile accident. Which healthcare provider order(s) would the nurse anticipate for the client at this time?

-Psychology consultation -Social services consultation

Which nursing action(s) would be therapeutic for the client being admitted to the unit with panic disorder? Select all that apply.

-Support the client's attempts to discuss feelings. -Reassure the client of safety. -Respect the client's personal space.

A client has been diagnosed with avoidant personality disorder. The client reports loneliness, but has fears about making friends. The client also reports anxiety about being rejected by others. In a long-term treatment plan, in what order, from first to last, should the nurse list interventions for the client? All options must be used.

-Talk with the client about self-esteem and fears. -Teach the client anxiety management and social skills. -Help the client make a list of small group activities at the center that the client would find interesting. -Ask the client to join in a chosen activity with the nurse and two other clients.

An older adult client hospitalized 4 days ago for treatment of acute respiratory distress has become confused and disoriented. The client has been picking invisible items off blankets and has been yelling at the client's child who is not in the room. The family tells the nurse that the client has been treated for anxiety with alprazolam for years, but alprazolam is not on the current medication list. Which safety measure(s) should be implemented? Select all that apply.

-The client should be placed on withdrawal precautions and treatment started immediately. -A prescription should be obtained to help with the hallucinations. -The client's medical and mental status should be evaluated frequently and treated as needed.

Client brought to emergency department (ED) for a new onset of shortness of breath and chest pain after learning that family members were killed in an automobile accident. Complete the following sentence(s) by choosing from the lists of options.

-a panic disorder -physical symptoms after the shock of parents' deaths

A nurse is caring for a client experiencing sudden onset of palpitations, sweating, intense fear of dying, feelings of choking, dizziness and shortness of breath. Which nursing intervention(s) is appropriate? Select all that apply.

-decreasing stimuli in the environment -staying with the client and speaking in a calm voice

Client brought to emergency department (ED) for a new onset of shortness of breath and chest pain after learning that family members were killed in an automobile accident. Highlight the findings that require immediate follow-up by the nurse.

-identify their parents who were killed in automobile accident -chest pain -shortness of breath -pulse 112; respirations 24 breaths per minute -blood pressure 144/90 mm Hg -desire to throw up

After being examined by a forensic nurse in the emergency department, a rape victim is prepared for discharge. The nurse determines that the client is at risk for posttraumatic stress disorder (PTSD) and teaches the client to recognize symptoms of PTSD. Which symptoms does the nurse include? Select all that apply.

-recurrent, intrusive recollections -sleep disturbances -difficulty concentrating

Client brought to emergency department (ED) for a new onset of shortness of breath and chest pain after learning that family members were killed in an automobile accident. Complete the following sentence(s) by choosing from the lists of options. To support the client at this time, the nurse would

-stay with the client -of recovering from a panic attack

The nurse is assessing a client with somatic symptom disorder who reports a fall. The nurse finds the client rubbing the left knee. How should the nurse best intervene?

Assess the client's injury, notify the healthcare provider, and document the incident.

A client diagnosed with anxiety disorder is prescribed buspirone. What priority teaching will the nurse provide?

Buspirone has a delayed therapeutic effect of between 14 to 30 days.

Client brought to emergency department (ED) for a new onset of shortness of breath and chest pain after learning that family members were killed in an automobile accident. For each client finding, click to specify if the finding is associated with an acute myocardial infarction or an acute stress response. Each finding may support more than 1 condition.

Chest pain - Both Shortness of breath - Both Dilated pupils - Stress Elevated BP - Both Rapid pulse - Both Rapid respirations - Both Nausea - Both Stressful event - Stress

A nurse is providing care for a client vulnerable to panic attacks who is acutely anxious. The client currently has a respiratory rate of 28 breaths/min and a heart rate of 110 beats/min. What action does the nurse perform first?

Coach the client on performing slow, deep breaths.

A nurse is working with a client being evaluated for social anxiety disorder. Which assessment question by the nurse would be most appropriate?

Do you feel others are judging you?

A nurse is caring for a client with obsessive-compulsive disorder (OCD) with rituals of washing hands, folding and unfolding towels, and switching the bathroom light on and off multiple times prior to meals. What action should the nurse take?

Gradually limit the time allowed for the client to complete the rituals.

The nurse observes that a client with a history of panic attacks is hyperventilating. What action should the nurse take?

Have the client breathe into a paper bag.

The client is shaking and is reporting a high degree of stress about hospitalization. Which nursing intervention is most appropriate?

Instruct the client to inhale and exhale slowly.

A week ago, a tornado destroyed a client's home and seriously injured their spouse. The client has been walking around the hospital in a daze without any outward display of emotions. The client tells the nurse that they feel like they are going crazy. Which intervention should the nurse use first?

Reassure the client that their feelings are typical reactions to serious trauma.

A client commonly jumps when spoken to and reports feeling uneasy. The client says, "It's as though something bad is going to happen." In which order, from first to last, should the nursing actions be done? All options must be used.

Reduce environmental stimuli. Ask the client to deep breathe for 2 minutes. Discuss the client's feelings in more depth. Teach problem-solving strategies.

A nurse is admitting a client who is experiencing a panic attack. Physiologic causes have been ruled out. The assessment reveals the client has difficulty breathing, chest pain, and palpitations. The client is pale, with the mouth wide open and eyebrows raised. What should the nurse do first?

Stay with the client, reminding client the panic attack will only last a brief period

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 client on the behavioral health unit reports palpitations, trembling, and nausea while traveling alone, outside the home. These symptoms have severely limited the client's ability to function and have caused the client to avoid leaving home whenever possible. The nurse recognizes that this client has symptoms of what disorder?

agoraphobia

A client has been prescribed alprazolam. Which food should the nurse instruct the client to avoid?

alcohol

A nurse refers a client with severe anxiety to a psychiatrist for medication evaluation. The physician is most likely to order which psychotropic drug regimen on a short-term basis?

alprazolam, 0.25 mg orally every 8 hours

During alprazolam therapy, the nurse should be alert for which dose-related adverse reaction?

ataxia

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.

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

A nurse is assessing a client suffering from stress and anxiety. The most common physiologic response to stress and anxiety is:

diarrhea

A client enters the crisis unit complaining of increased stress from studies as a medical student. The client reports increasing anxiety for the past month. The physician orders alprazolam, 0.25 mg by mouth three times per day, along with professional counseling. Before administering alprazolam, the nurse reviews the client's medication history. Which drug can produce additive effects when taken concomitantly with alprazolam?

diphenhydramine

Which group therapy intervention is of primary importance to a client with panic disorder?

discussing new ways of thinking and feeling about panic attacks

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

The nurse is performing medication reconciliation for a client being treated for several chronic conditions, including obsessive-compulsive disorder (OCD). Which medications will the nurse verify as being prescribed for the treatment of OCD?

fluvoxamine and clomipramine

A client is admitted to the psychiatric unit with a diagnosis of functional neurologic symptom disorder. Since witnessing a beating at gunpoint, the client is paralyzed. Which action should the nurse initially focus on when planning this client's care?

helping the client identify and verbalize their feelings about the incident

A client is diagnosed with obsessive-compulsive disorder. Which intervention should the nurse include when developing the care plan for this client?

initially giving the client time to perform rituals and gradually limiting the time

A client is brought to the emergency department experiencing a spontaneous episode of extreme terror, palpitations, tachycardia, tremor, and shortness of breath. The client describes a fear of dying or going crazy. The healthcare provider rules out physiologic causes. The nurse advocates for the client to receive which medication?

lorazepam

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?

monoamine oxidase (MAO) inhibitors

While in the facility, a client with obsessive-compulsive disorder (OCD) saves all used medicine cups and paper cups and arranges them in elaborate sculptures in the room. At home, the client saves mail and magazines and makes elaborate paper sculptures from them. Which action by the client indicates progression toward the treatment goals?

refraining from keeping some obsessive items

A client is scheduled for cardiac catheterization the next morning. The physician ordered temazepam, 30 mg by mouth at bedtime, for sedation. Before administering the drug, the nurse should know that:

sedatives reduce excitement; hypnotics induce sleep.

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?

systematic desensitization

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