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Townsend Chapter 27 Anxiety, Obsessive-Compulsive Disorders
Terms in this set (30)
1. A nursing instructor is teaching about specific phobias. Which student statement should indicate 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.
The nursing instructor should evaluate that learning has occurred when the student knows that clients experiencing phobias have a panic level of fear that is overwhelming and unreasonable. Phobia is fear cued by a specific object or situation in which exposure to the stimulus produces an immediate anxiety response.
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?
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
The nurse should determine that an excessive fear of water is identified as aquaphobia, which is a natural environment type of phobia. Natural environmenttype phobias are fears about objects or situations that occur in the natural environment, such as a fear of heights or storms.
3. How would a 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.
Clients diagnosed with social phobia avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life. Social phobia is an excessive fear of situations in which a person might do something embarrassing or be evaluated negatively by others.
4. How would a 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.
The nurse should recognize that a client diagnosed with panic disorder experiences depersonalization, whereas a client diagnosed with GAD would not. Depersonalization refers to being detached from oneself when experiencing extreme anxiety.
5. Which treatment should a nurse identify as most appropriate for clients diagnosed with generalized anxiety disorder (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)
The nurse should identify that an appropriate treatment for clients diagnosed with GAD is long-term treatment with buspirone. Buspirone is an anxiolytic medication that is effective in 60% to 80% of clients with GAD. It takes 10 to 14 days for alleviation of symptoms but does not have the dependency concerns of other anxiolytics.
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?
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.
The nurse should explain that from a cognitive perspective the client is experiencing a distorted and unrealistic appraisal of the situation. From a cognitive perspective, fear is described as the result of faulty cognitions.
7. Arthur, who is diagnosed with obsessive-compulsive disorder, reports to the nurse that he cant 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?
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.
Obsessions are unwanted, intrusive, repetitive thoughts. Compulsions are unwanted, repetitive behavior patterns in response to obsessive thoughts that are efforts to reduce anxiety.
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?
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
The nurse should suspect that the client has exhibited signs/symptoms of a panic disorder. The priority nursing diagnosis should be panic anxiety. Panic disorder is characterized by recurrent, sudden-onset panic attacks in which the person feels intense fear, apprehension, or terror.
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?
A. I know its 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.
The most appropriate nursing reply to the clients concerns is to empathize with the client and provide encouragement that panic attacks last only a short period. Panic attacks usually last minutes but can, rarely, last hours. Symptoms of depression are also common with this disorder.
10. 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.
The student indicates learning has occurred when he or she states that clonazepam is a particularly effective treatment for panic disorder. Clonazepam is a type of benzodiazepine that can be abused and lead to physical dependence and tolerance. It can be used on an as-needed basis to reduce anxiety and its related symptoms.
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?
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.
The most appropriate reply by the nurse is to explain to the family member that anxiety is considered abnormal when it is out of proportion and impairs functioning. Anxiety is a normal reaction to a realistic danger or threat to biological integrity or self-concept.
12. A client is experiencing a severe panic attack. Which nursing intervention would meet this clients 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)
The nurse can meet this clients immediate need by staying with the client and offering reassurance of safety and security. The client may fear for his or her life, and the presence of a trusted individual provides assurance of personal safety.
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?
A. Noncompliance R/T test taking
B. Ineffective role performance R/T helplessness
C. Altered coping R/T anxiety
D. Powerlessness R/T fear
The priority nursing diagnosis for this client is altered coping R/T anxiety. The nurse should assist in implementing interventions that should improve the clients healthy coping skills and reduce anxiety.
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?
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.
The nurse should explain to the client that systematic desensitization exposes the client to a series of increasingly anxiety-provoking steps that will gradually increase anxiety tolerance. Systematic desensitization was introduced by Joseph Wolpe in 1958 and is based on behavioral conditioning principles.
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?
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.
An appropriate initial client outcome is for the client to wake early enough to complete rituals prior to breakfast. The nurse should also provide a structured schedule of activities and later in treatment begin to gradually limit the time allowed for rituals.
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?
A. I will need scheduled bloodwork in order to monitor for toxic levels of this drug.
B. I wont stop taking this medication abruptly, because there could be serious complications.
C. I will not drink alcohol while taking this medication.
D. I wont take extra doses of this drug because I can become addicted.
The client indicates a need for additional information about taking benzodiazepines when stating the need for blood work to monitor for toxic levels. No blood work is needed when taking a short-acting benzodiazepine. The client should understand that taking extra doses of a benzodiazepine may result in addiction and that the drug should not be taken in conjunction with alcohol.
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?
The nurse should identify that the client is using the defense mechanism of intellectualization when discussing the rituals of obsessive-compulsive disorder in detail while avoiding discussion of feelings. Intellectualization is an attempt to avoid expressing emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, and analysis.
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 clients 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.
The nurse should discuss with the client the anxiety-provoking triggers that precipitate the ritualistic behavior. If the client is going to be able to avoid the anxiety, he or she must first learn to recognize precipitating factors. Attempting to distract the client, seeking medication increase, and locking the clients room are not appropriate interventions because they do not help the client recognize anxiety triggers.
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?
A. High doses of tricyclic medications will be required for effective treatment of OCD.
B. Selective serotonin reuptake inhibitor (SSRI) doses, in excess of what is effective for treating depression, may be required for OCD.
C. The dose of Luvox is low due to the side effect of daytime drowsiness and nighttime insomnia.
D. The dosage of Luvox is outside the therapeutic range and needs to be questioned.
The most accurate instructor response is that SSRI doses in excess of what is effective for treating depression may be required in the treatment of OCD. SSRIs have been approved by the U.S. Food and Drug Administration for the treatment of OCD. Common side effects include headache, sleep disturbances, and restlessness.
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?
A. Risk for suicide
B. Cardiac status
C. Current stressors
D. Substance use history
Although all of the listed aspects of assessment are important, the priority is to evaluate cardiac status since a person having an MI, CHF, or mitral valve prolapse can present with symptoms of anxiety.
21. A client is prescribed alprazolam (Xanax) for acute anxiety. What client history should cause a nurse to question this order?
A. History of alcohol dependence
B. History of personality disorder
C. History of schizophrenia
D. History of hypertension
The nurse should question a prescription of alprazolam (Xanax) for acute anxiety if the client has a history of alcohol dependence. Alprazolam is a benzodiazepine used in the treatment of anxiety and has an increased risk for physiological dependence and tolerance. A client with a history of substance abuse may be more likely to abuse other addictive substances and/or combine this drug with alcohol.
22. Warrens college roommate actively resists going out with friends whenever they invite him. He says he cant stand to be around other people and confides to Warren They wouldnt like me anyway. Which disorder is Warrens roommate likely suffering from?
C. Social anxiety disorder (social phobia)
D. Panic disorder
Social anxiety disorder is an excessive fear of social situations R/T fear that one might do something embarrassing or be evaluated negatively by others.
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?
A. Ineffective coping
B. Disturbed body image
C. Complicated grieving
D. Panic anxiety
The symptoms presented describe the DSM-5 diagnosis of body dysmorphic disorder, and the related nursing diagnosis is disturbed body image.
24. How should a 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.
The major maladaptive client response to panic disorder is the perception of having no control over life situations, which leads to nonparticipation in decision making and doubts regarding role performance.
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?
A. The client is developing insight.
B. The clients coping skills are improving.
C. The client has a distorted perception of problem resolution.
D. The client is meeting outcomes and moving toward discharge.
This client has a distorted perception of how to deal with the problem of anxiety. Clients should be encouraged to openly deal with anxiety and recognize the triggers that precipitate anxiety responses.
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?
A. When the client has a knowledge deficit related to the effects of the drug
B. When the client combines the drug with alcohol
C. When the client takes the drug on an empty stomach
D. When the client fails to follow dietary restrictions
Both Librium and alcohol are central nervous system depressants. In combination, these drugs have an additive effect and can suppress the respiratory system, leading to respiratory arrest and death.
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.
ANS: A, D, E
The nurse should expect that a client diagnosed with GAD would experience fatigue, insomnia, and irritability. GAD is characterized by chronic, unrealistic, and excessive anxiety and worry.
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
ANS: B, C
The nurse should explain to the client that systematic desensitization and imploding are the most commonly used behavioral therapies in the treatment of phobias. Systematic desensitization involves the gradual exposure of the client to anxiety-provoking stimuli. Imploding is the intervention used in which the client is exposed to extremely frightening stimuli for prolonged periods of time.
29. A nurse has been caring for a client diagnosed with generalized anxiety disorder (GAD). Which of the following nursing interventions would address this clients 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.
ANS: A, C, D, E
Nursing interventions that address GAD symptoms should include encouraging the client to recognize signs of escalating anxiety, to employ relaxation techniques, to cognitively reframe thoughts about anxiety-provoking situations, and to avoid caffeinated products. Avoiding situations that cause stress is not an appropriate intervention, because avoidance does not help the client overcome anxiety. Stress is a component of life and is not easily evaded.
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.
ANS: A, B, C, D
All of the listed pharmacological treatments are evidence-based treatments for phobic disorders.
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