Chapter 27

Question 1

A nursing instructor is teaching about specific phobias. Which student statement should indicate that learning has occurred?

Answer 1

“These clients have overwhelming symptoms of panic when exposed to the phobic stimulus.”

Question 2

A client has a history of excessive fear of water. What is the term that a nurse should use to describe this specific phobia, and under what subtype is this phobia identified?

Answer 2

Aquaphobia, a natural environment type of phobia

Question 3

How would a nurse differentiate a client diagnosed with a social phobia from a client diagnosed with a schizoid personality disorder (SPD)?

Answer 3

Clients diagnosed with social phobia avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life.

Question 4

How would a nurse differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)?

Answer 4

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

Question 5

Which treatment should a nurse identify as most appropriate for clients diagnosed with generalized anxiety disorder (GAD)?

Answer 5

Long-term treatment with buspirone (BuSpar)

Question 6

A client refuses to go on a cruise to the Bahamas with his spouse because of fearing that the cruise ship will sink and all will drown. Using a cognitive theory perspective, the nurse should use which of these statements to explain to the spouse the etiology of this fear?

Answer 6

“Your spouse may be experiencing a distorted and unrealistic appraisal of the situation.”

Question 7

Arthur, who is diagnosed with obsessive-compulsive disorder, reports to the nurse that he can’t stop thinking about all the potentially life threatening germs in the environment. What is the most accurate way for the nurse to document this symptom?

Answer 7

Patient is expressing an obsession with germs.

Question 8

A cab driver stuck in traffic is suddenly lightheaded, tremulous, and diaphoretic and experiences tachycardia and dyspnea. An extensive workup in an emergency department reveals no pathology. Which medical diagnosis is suspected, and what nursing diagnosis takes priority?

Answer 8

Panic disorder and a nursing diagnosis of panic anxiety

Question 9

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 reply?

Answer 9

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

Question 10

A nursing instructor is teaching about the medications used to treat panic disorder. Which student statement indicates that learning has occurred?

Answer 10

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

Question 11

A family member is seeking advice about an elderly 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 reply?

Answer 11

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

Question 12

A client is experiencing a severe panic attack. Which nursing intervention would meet this client’s immediate need?

Answer 12

Stay with the client and offer reassurance of safety

Question 13

A college student is unable to take a final examination because of 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?

Answer 13

Altered coping R/T anxiety

Question 14

A client living on the beachfront seeks help with an extreme fear of crossing bridges, which interferes with daily life. A psychiatric nurse practitioner decides to try systematic desensitization. Which explanation of this therapy should the nurse convey to the client?

Answer 14

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

Question 15

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?

Answer 15

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

Question 16

A nurse is providing discharge teaching to a client taking a benzodiazepine. Which client statement would indicate a need for further follow-up instructions?

Answer 16

“I will need scheduled bloodwork in order to monitor for toxic levels of this drug.”

Question 17

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?

Answer 17

Intellectualization

Question 18

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?

Answer 18

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

Question 19

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 reply is most accurate?

Answer 19

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

Question 20

A client presents in the emergency department with complaints of overwhelming anxiety. Which of the following is a priority for the nurse to assess?

Answer 20

Cardiac status

Question 21

A client is prescribed alprazolam (Xanax) for acute anxiety. What client history should cause a nurse to question this order?

Answer 21

History of alcohol dependence

Question 22

Warren’s college roommate actively resists going out with friends whenever they invite him. He says he can’t stand to be around other people and confides to Warren “They wouldn’t like me anyway.” Which disorder is Warren’s roommate likely suffering from?

Answer 22

Social anxiety disorder (social phobia)

Question 23

A client has the following symptoms: preoccupation with imagined defect, verbalizations that are out of proportion to actual physical abnormalities, and numerous visits to plastic surgeons to seek relief. Which nursing diagnosis would best describe the problems evidenced by these symptoms?

Answer 23

Disturbed body image

Question 24

How should a nurse best describe the major maladaptive client response to panic disorder?

Answer 24

Clients perceive having no control over life situations.

Question 25

A client diagnosed with generalized anxiety states, “I know the best thing for me to do now is to just forget my worries.” How should the nurse evaluate this statement?

Answer 25

The client has a distorted perception of problem resolution.

Question 26

A client is taking chlordiazepoxide (Librium) for generalized anxiety disorder symptoms. In which situation should a nurse recognize that this client is at greatest risk for drug overdose?

Answer 26

When the client combines the drug with alcohol

Question 27

A college student has been diagnosed with generalized anxiety disorder (GAD). Which of the following symptoms should a campus nurse expect this client to exhibit? Select all that apply.

A. Fatigue
B. Anorexia
C. Hyperventilation
D. Insomnia
E. Irritability

Answer 27

A, D, E

Question 28

A nurse is discussing treatment options with a client whose life has been negatively impacted by claustrophobia. The nurse would expect which of the following behavioral therapies to be most commonly used in the treatment of phobias? Select all that apply.

A. Benzodiazepine therapy
B. Systematic desensitization
C. Imploding (flooding)
D. Assertiveness training
E. Aversion therapy

Answer 28

B, C

Question 29

A nurse has been caring for a client diagnosed with generalized anxiety disorder (GAD). Which of the following nursing interventions would address this client’s symptoms? Select all that apply.

A. Encourage the client to recognize the signs of escalating anxiety.
B. Encourage the client to avoid any situation that causes stress.
C. Encourage the client to employ newly learned relaxation techniques.
D. Encourage the client to cognitively reframe thoughts about situations that generate anxiety.
E. Encourage the client to avoid caffeinated products.

Answer 29

A, C, D, E

Question 30

A client who has been diagnosed with a phobic disorder asks the nurse if there are any medications that would be beneficial in treating phobic disorders. Which of the following would be accurate responses by the nurse? Select all that apply.

A. Some antianxiety agents have been successful in treating social phobias.
B. Some antidepressant agents have been successful in diminishing symptoms of agoraphobia and social anxiety disorder (social phobia).
C. Specific phobias are generally not treated with medication unless accompanied by panic attacks.
D. Beta-blockers have been used successfully to treat phobic responses to public performance.

Answer 30

A, B, C, D