Deck 27: Anxiety,obsessive-Compulsive,and Related Disorders

Question 1

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?

A)"Using your imagination,we will attempt to achieve a state of relaxation that you can replicate when faced with crossing a bridge."
B)"Because anxiety and relaxation are mutually exclusive states,we can attempt to substitute a relaxation response for the anxiety response."
C)"Through a series of increasingly anxiety-provoking steps,we will gradually increase your tolerance to anxiety."
D)"In one intense session,you will be exposed to a maximum level of anxiety that you will learn to tolerate."

Answer 1

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

Question 2

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

A)Aquaphobia,a natural environment type of phobia
B)Aquaphobia,a situational type of phobia
C)Acrophobia,a natural environment type of phobia
D)Acrophobia,a situational type of phobia

Answer 2

Aquaphobia,a natural environment type of phobia

Question 3

The nurse is providing discharge teaching to a client taking a benzodiazepine.Which client statement indicates a need for further instructions?

A)"I will need scheduled bloodwork 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."

Answer 3

"I will need scheduled bloodwork to monitor for toxic levels of this drug."

Question 4

Which treatment should the nurse identify as most appropriate for clients diagnosed with GAD?

A)Long-term treatment with diazepam (Valium)
B)Acute symptom control with citalopram (Celexa)
C)Long-term treatment with buspirone (BuSpar)
D)Acute symptom control with ziprasidone (Geodon)

Question 5

A client diagnosed with OCD is admitted to a psychiatric unit.The client has an elaborate routine for toileting activities.Which should be the initial client outcome during the first week of hospitalization?

A)The client will refrain from ritualistic behaviors during daylight hours.
B)The client will wake early enough to complete rituals prior to breakfast.
C)The client will participate in three unit activities by day 3.
D)The client will substitute a productive activity for rituals by day 1.

Question 6

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

A)Teach deep-breathing relaxation exercises.
B)Place the client in a Trendelenburg position.
C)Stay with the client and offer reassurance of safety.
D)Administer the ordered prn buspirone (BuSpar).

Question 7

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

A)Generalized anxiety disorder and a nursing diagnosis of fear
B)Altered sensory perception and a nursing diagnosis of panic disorder
C)Pain disorder and a nursing diagnosis of altered role performance
D)Panic disorder and a nursing diagnosis of panic anxiety

Question 8

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

A)"Clonazepam (Klonopin)is particularly effective in the treatment of panic disorder."
B)"Clozapine (Clozaril)is used off-label in long-term treatment of panic disorder."
C)"Doxepin (Sinequan)can be used in low doses to relieve symptoms of panic attacks."
D)"Buspirone (BuSpar)is used for its immediate effect to lower anxiety during panic attacks."

Question 9

A family member is seeking advice about an elderly parent who seems to worry unnecessarily about everything.The family member asks,"Should I seek psychiatric help for my mother?" Which is the nurse's most appropriate reply?

A)"My mother also worries unnecessarily.I think it is part of the aging process."
B)"Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning."
C)"From what you have told me,you should get her to a psychiatrist as soon as possible."
D)"Anxiety is a complex phenomenon and is effectively treated only with psychotropic medications."

Question 10

A nursing student questions an instructor regarding the order for fluvoxamine (Luvox),300 mg daily,for a client diagnosed with OCD.Which instructor reply is most accurate?

A)"High doses of tricyclic medications will be required for effective treatment of OCD."
B)"SSRI doses,more than what is effective for treating depression,may be required for OCD."
C)"The dose of fluvoxamine (Luvox)is low due to the side effect of daytime drowsiness and nighttime insomnia."
D)"The dosage of fluvoxamine (Luvox)is outside the therapeutic range and needs to be questioned."

Question 11

Arthur,who is diagnosed with Obsessive-Compulsive Disorder (OCD),reports to the nurse that he can't stop thinking about all the potentially life-threatening germs in the environment.Which is the most accurate way for the nurse to document this symptom?

A)Patient is expressing an obsession with germs.
B)Patient is manifesting compulsive thinking.
C)Patient is expressing delusional thinking about germs.
D)Patient is manifesting arachnophobia of germs.

Question 12

A client diagnosed with Panic Disorder states,"When an attack happens,I feel like I am going to die." Which is the nurse's most appropriate reply?

A)"I know it's frightening,but try to remind yourself that this will only last a short time."
B)"Death from a panic attack happens so infrequently that there is no need to worry."
C)"Most people who experience panic attacks have feelings of impending doom."
D)"Tell me why you think you are going to die every time you have a panic attack."

Question 13

A client diagnosed with OCD 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?

A)Sublimation
B)Dissociation
C)Rationalization
D)Intellectualization

Question 14

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

A)"These clients do not recognize that their fear is excessive,and they rarely seek treatment."
B)"These clients have overwhelming symptoms of panic when exposed to the phobic stimulus."
C)"These clients experience symptoms that mirror a cerebrovascular accident (CVA)."
D)"These clients experience the symptoms of tachycardia,dysphagia,and diaphoresis."

Question 15

A client presents in the emergency department with complaints of overwhelming anxiety.Which of the following is the priority nursing assessment?

A)Suicide risk
B)Cardiac status
C)Current stressors
D)Substance use history

Question 16

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 the etiology of this fear?

A)"Your spouse may be unable to resolve internal conflicts,which result in projected anxiety."
B)"Your spouse may be experiencing a distorted and unrealistic appraisal of the situation."
C)"Your spouse may have a genetic predisposition to overreacting to potential danger."
D)"Your spouse may have high levels of brain chemicals that may distort thinking."

Question 17

A client is newly diagnosed with OCD and spends 45 minutes folding clothes and rearranging them in drawers.Which nursing intervention would best address this client's problem?

A)Distract the client with other activities whenever ritual behaviors begin.
B)Report the behavior to the psychiatrist to obtain an order for medication dosage increase.
C)Lock the room to discourage ritualistic behavior.
D)Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors.

Question 18

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 is the priority nursing diagnosis that the campus nurse should assign for this client?

A)Noncompliance R/T test taking
B)Ineffective role performance R/T helplessness
C)Altered coping R/T anxiety
D)Powerlessness R/T fear

Question 19

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

A)Clients diagnosed with social phobia can manage anxiety without medications,whereas clients diagnosed with SPD can manage anxiety only with medications.
B)Clients diagnosed with SPD are distressed by the symptoms experienced in social settings,whereas clients diagnosed with social phobia are not.
C)Clients diagnosed with social phobia avoid interactions only in social settings,whereas clients diagnosed with SPD avoid interactions in all areas of life.
D)Clients diagnosed with SPD avoid interactions only in social settings,whereas clients diagnosed with social phobias tend to avoid interactions in all areas of life.

Question 20

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

A)GAD is acute in nature,and panic disorder is chronic.
B)Chest pain is a common GAD symptom,whereas this symptom is absent in panic disorders.
C)Hyperventilation is a common symptom in GAD and rare in panic disorder.
D)Depersonalization is commonly seen in panic disorder and absent in GAD.

Question 21

In which way can anxiety be distinguished from fear?

A)Anxiety involves the intellectual appraisal of a threatening stimulus.
B)Anxiety is an emotional process while fear is a cognitive one.
C)Fear involves the emotional response to the appraisal of anxiety.
D)Anxiety results from a specific or known threat.

Question 22

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 best describes the problems evidenced by these symptoms?

A)Ineffective coping
B)Disturbed body image
C)Complicated grieving
D)Panic anxiety

Question 23

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

A)Clients overuse medical care because of physical symptoms.
B)Clients use illegal drugs to ease symptoms.
C)Clients perceive having no control over life situations.
D)Clients develop compulsions to deal with anxiety.

Question 24

The 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

Question 25

____________ is an external pressure that is brought to bear on the individual.

Question 26

Neuroimaging studies of individuals with a hoarding disorder have indicated less activity in the:

A)Frontal cortex.
B)Amygdala-hippocampal formation.
C)Cingulate cortex.
D)Putamen.

Question 27

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?

A)The client is developing insight.
B)The client's coping skills are improving.
C)The client has a distorted perception of problem resolution.
D)The client is meeting outcomes and moving toward discharge.

Question 28

Prior to anxiety being clearly defined as a separate entity,which of the following diagnostic terms were used to identify symptoms? Select all that apply.

A)Cardiac necrosis
B)Vasomotor neurosis
C)Vasoregulatory asthenia
D)Soldier's tachycardia

Question 29

The nurse has been caring for a client diagnosed with GAD.Which of the following nursing interventions 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 reframe cognitively thoughts about situations that generate anxiety.
E)Encourage the client to avoid caffeinated products.

Question 30

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?

A)Agoraphobia
B)Mysophobia
C)Social anxiety disorder (social phobia)
D)Panic disorder

Question 31

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

A)History of alcohol dependence
B)History of personality disorder
C)History of schizophrenia
D)History of hypertension

Question 32

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

A)The client has a knowledge deficit related to the effects of the drug.
B)The client combines the drug with alcohol.
C)The client takes the drug on an empty stomach.
D)The client fails to follow dietary restrictions.

Question 33

A college student has been diagnosed with 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

Question 34

Nursing care of a client with a diagnosis of substance-induced anxiety disorder must take into consideration the nature of the substance and if the symptoms are in the context of: Select all that apply.

A)Intoxication.
B)Psychosocial needs.
C)Previous exposure.
D)Withdrawal.

Question 35

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 responses by the nurse are accurate? 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."
E)"None of above"