ch.18

Question 1

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

Answer 1

2. “These clients have a panic level of fear that is overwhelming and unreasonable.”

Question 2

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

Answer 2

3. “Clients diagnosed with social anxiety disorder avoid interactions only in social settings,
   whereas clients diagnosed with SPD avoid interactions in all areas of life.”

Question 3

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

Answer 3

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

Question 4

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

Answer 4

3. Long-term treatment with buspirone (BuSpar)

Question 5

5. Which symptoms should a nurse recognize that differentiate a client diagnosed with obsessivecompulsive
   disorder (OCD) from a client diagnosed with obsessive-compulsive personality
   disorder?
6. Clients diagnosed with OCD experience both obsessions and compulsions, and clients
   diagnosed with obsessive-compulsive personality disorder do not.
7. Clients diagnosed with obsessive-compulsive personality disorder experience both obsessions
   and compulsions, and clients diagnosed with OCD do not.
8. Clients diagnosed with obsessive-compulsive personality disorder experience only obsessions,
   and clients diagnosed with OCD experience only compulsions.
9. Clients diagnosed with OCD experience only obsessions, and clients diagnosed with
   obsessive-compulsive personality disorder experience only compulsions.

Answer 5

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

Question 6

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

Answer 6

4. Panic disorder and a nursing diagnosis of anxiety

Question 7

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

Answer 7

1. “I know it’s frightening, but try to remind yourself that this will only last a short time.”

Question 8

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

Answer 8

1. “Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder.”

Question 9

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

Answer 9

2. “Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and
   when it impairs functioning.”

Question 10

10. A client is experiencing a severe panic attack. Which nursing intervention would meet this
    client’s physiological need?
11. Teach deep breathing relaxation exercises.
12. Place the client in a Trendelenburg position.
13. Have the client breathe into a paper bag.
14. Administer the ordered prn buspirone (BuSpar).

Answer 10

3. Have the client breathe into a paper bag.

Question 11

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

Answer 11

C. Altered coping R/T anxiety

Question 12

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

Answer 12

3. “Through a series of increasingly anxiety-provoking steps, we will gradually increase your
   tolerance to anxiety.”

Question 13

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

Answer 13

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

Question 14

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

Answer 14

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

Question 15

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

Answer 15

4. Intellectualization

Question 16

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

Answer 16

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

Question 17

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

Answer 17

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

Question 18

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

Answer 18

A. History of alcohol use disorder

Question 19

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

Answer 19

C. Ineffective coping

Question 20

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

Answer 20

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