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A client has been diagnosed with obsessive-compulsive disorder. The nurse would expect to find which clinical manifestation?
A. Avoidance
B. Persistent unwanted thoughts
C. Feeling of suffocation
D. Flashbacks
Answer: B
Rationale: A client with obsessive-compulsive disorder exhibits obsessions (recurring, persistent, unwanted thoughts or images that cause intense anxiety). Avoidance is a manifestation of a phobia. Feelings of suffocation occur in clients having a panic attack. Flashbacks occur in clients diagnosed with post-traumatic stress disorders.
A military veteran is being seen in the outpatient mental health clinic. The client states, “I’ve been having problems sleeping with nightmares. I’m also having flashbacks of my time deployed. It’s really upsetting.” The nurse correlates these findings as being associated with which condition?
A. Generalized anxiety
B. Obsessive-compulsive
C. Post-traumatic stress
D. Anticipatory
Answer: C
Rationale: Post-traumatic stress disorder is characterized by an inability to sleep, nightmares, and flashbacks as a result of experiencing trauma. In generalized anxiety disorder, the person experiences an increased level of anxiety and worry about various situations on most days over a period of at least 6 months. Obsessive-compulsive disorder is characterized by obsessions coupled with compulsions. Anticipatory anxiety occurs well in advance of a particular situation such as a public speech or social event.
A client has been diagnosed with generalized anxiety disorder. To establish a nurse–client relationship, which should be the nurse's initial goal?
A. Identifying the problem
B. Beginning psychotherapy
C. Determining social support
D. Lowering the client's anxiety level
Answer: D
Rationale: The most important step for this client is to lower the anxiety level. Identifying the problem, beginning psychotherapy, and determining the client's social support are important but would not take priority because the achievement of the other goals would be impossible if the client was acutely anxious.
A client diagnosed with obsessive-compulsive disorder is constantly checking the oven to make sure it is turned off. The nurse interprets this information as reflecting which theme associated with obsessive thoughts?
A. Contamination
B. Repeated doubts
C. Orderliness
D. Aggressive impulses
Answer: B
Rationale: The theme of repeated doubts involves questioning thoughts as to whether one did or did not do something. Themes related to contamination involve thinking of being polluted with germs. Thinking that one has to have everything in particular order reflects the theme of orderliness. Aggressive or horrific impulses are recurring thoughts about doing actions that could bring great distress to others.
A nurse is communicating with a client diagnosed with an anxiety disorder. Which type of questioning would be most appropriate for the nurse to use?
A. Open-ended
B. Directive
C. Probative
D. Abstract
Answer: B
Rationale: The nurse should use directive questions to elicit subjective information about how the client is currently feeling and what happened before the onset of symptoms. Abstract messages are unclear and can make it difficult to communicate. When questioning a client, consider that questioning may increase the client's anxiety and interfere with their ability to answer. Open-ended and probative questions may overwhelm the client and shut down any communication.
A nurse is gathering data about a client diagnosed with generalized anxiety disorder. Based on the nurse’s understanding of this disorder, the nurse would be alert for the client to demonstrate which response?
A. Excessive sleepiness
B. Focused concentration
C. Muscle tension
D. Hypoventilation
Answer: C
Rationale: Signs and symptoms of generalized anxiety disorder include muscle tension, difficulty falling or staying asleep (not excessive sleepiness), difficulty concentrating, hyperventilation and gastrointestinal disturbances such as diarrhea.
A client who is experiencing a panic attack states, “I am going to die. I feel like I am suffocating.” Which is the nurse's best response?
A. “I will leave you alone so that you can calm down.”
B. “Why are you having a panic attack?”
C. “Please calm down. You are not dying.”
D. “You are having a panic attack. I will stay with you.”
Answer: D
Rationale: The most appropriate response from the nurse is to offer reassurance that the client will not be left alone while experiencing the panic attack. Asking the client to calm down or asking the client what is causing the panic attack may elevate the anxiety.
A nurse is reviewing the history of a client diagnosed with generalized anxiety disorder. The nurse would expect the client to have experienced symptoms on most days for at least which amount of time?
A. 3 weeks
B. 6 weeks
C. 3 months
D. 6 months
Answer: D
Rationale: In generalized anxiety disorder, the person experiences an increased level of anxiety and worry about various situations on most days over a period of at least 6 months.
A nurse is reviewing the plan of care for a client diagnosed with obsessive-compulsive disorder. Which intervention would the nurse expect to implement early in treatment?
A. Setting strict limits on the time spent performing the ritual
B. Allowing time for the client to perform the ritual
C. Preventing the client from performing all ritualistic behaviors
D. Increasing exposure to stimuli in the environment
Answer: B
Rationale: The client diagnosed with obsessive-compulsive disorder uses the rituals to decrease anxiety. Therefore, the nurse should allow time for the client to perform the ritual. Banning or setting strict limits on ritualistic behavior would serve to increase the client's anxiety. Increasing environmental stimuli would further increase the client's anxiety level.
An older adult is prescribed a benzodiazepine as part of the treatment plan for an anxiety disorder. When administering this medication, which information would be most important for the nurse to keep in mind?
A. Benzodiazepines are safer and less addicting than the barbiturate-based antianxiety medications.
B. Sensitivity to benzodiazepines appears to increase with age.
C. Benzodiazepines produce the calming effects without toxic and addictive qualities of alcohol.
D. Older adults have an increased tendency toward developing addictions.
Answer: B
Rationale: Sensitivity to benzodiazepines is increased in older adults. Smaller doses may be effective as well as safer. There is no research to support that older adults are more likely to develop addictions. The remaining options are true but are not specifically related to the older population.
The nurse observes a client in a group therapy session beginning to demonstrate signs of anxiety when preparing to speak in front of other group members. The nurse interprets this as suggesting which type of anxiety?
A. Separation
B. Anticipatory
C. Free-floating
D. Uncued
Answer: B
Rationale: Anticipatory anxiety occurs well in advance of a particular situation such as a public speaking or social event. This leads to thoughts of dread leading up to the event. Free-floating anxiety occurs when the person is unable to connect the anxiety to a stimulus. This factor, in itself, can create additional anxiety. Uncued anxiety refers to the inability of the client to connect any particular stimulus with the panic attack. Separation anxiety occurs when there is excessive anxiety due to separation, for example, from home or parents to whom the client is attached.
A client diagnosed with agoraphobia associated with panic disorder has been unable to leave the home for the last 6 months. In reviewing the client’s plan of care, which goal would the nurse expect to find?
A. Control of symptoms
B. Effective functioning within the environment
C. Participation in psychotherapy
D. Performance of self-care activities
Answer: B
Rationale: The overall goal for this client would be to function effectively within the environment, thereby enabling the client to control the symptoms. Normally, there should not be any impairment in self-care. Participation in psychotherapy may help the client but is not the overall goal.
A client is suspected of having a generalized anxiety disorder. The client reports significant levels of apprehension and worry. Which assessment data would support the diagnosis? Select all that apply.
A. Exhibits mild tremors as noted in both hands.
B. States, “My neck and shoulder muscles are always tense and really hurt.”
C. Reports symptoms beginning to significantly affect client's quality of life 4 months ago.
D. States, “I usually sleep a lot when my anxiety level is really high.”
E. Reports gastrointestinal discomfort as, “always having to deal with a nervous stomach.”
Answer: A, B, E
Rationale: In generalized anxiety disorder, the person experiences an increased level of anxiety and worry about various situations on most days over a period of at least 6 months. In addition to the excessive worry and anxiety over several different activities or events, the person also experiences at least three other symptoms that include restlessness, irritability, muscle tension, difficulty falling or staying asleep, and fatigue. Other somatic concerns may also be reported such as chest pain, hyperventilation, headaches, tremors, increased urinary frequency, or gastrointestinal disturbances.
A nurse is providing care to a client recently diagnosed with an anxiety disorder. When assisting with developing the client's plan of care, which treatment approach(s) would the nurse anticipate as being used most likely? Select all that apply.
A. Antianxiety medications
B. Antipsychotic agents
C. Psychotherapy
D. Guided imagery
E. Support groups
Answer: A, C, E
Rationale: The two main approaches to the treatment of the anxiety disorders include medications and psychotherapy, either singly or in combination. The medications used are antianxiety drugs (anxiolytics) along with some antidepressant agents. The largest percentage of success is experienced when antianxiety drug agents are used in combination with psychotherapy sessions. For the psychotherapy component of treatment, research demonstrates that cognitive-behavioral therapy is the most effective in helping the individual to replace negative thoughts and behaviors with more positive and productive ones. The basis for the outcome is that individuals have the ability to control and change their thinking and consequently, their actions. Anxiety support groups can also provide sharing of experiences and offer suggestions for coping. Guided imagery is not used as a treatment approach for anxiety disorders.
A client is experiencing panic anxiety. Which finding would the nurse correlate with the body's sympathetic nervous system response to panic anxiety? Select all that apply.
A. Decreased blood pressure
B. Increased heart rate
C. Dry skin
D. Pale extremities
E. Tingling of the hands
Answer: B, E
Rationale: Sympathetic nervous system responses to panic anxiety include increased heart rate, increased blood pressure, increased perspiration, tingling or numbness of the hands, and flushing of the skin.
A client has been compliant with long-term treatment prescribed for obsessive-compulsive disorder (OCD). Which assessment data support the conclusion that the client is experiencing a decline in the generally observed characteristics of this disorder? Select all that apply.
A. Client states, “I know the thoughts about germs are created in my own head.”
B. Handwashing is confined to before meals and when hands are visibly soiled.
C. Client recently completed an online college level English literature course.
D. Client reports improved sleeping patterns without the presence of nightmares.
E. Work attendance has improved with only one absence in the last 5 months.
Answer: B, E
Rationale: Symptomatology associated with OCD includes repetitive acts, impulses, or rituals such as washing hair or hands; to confine these rituals to appropriate times would show symptom management. The general characteristics of OCD make it difficult to perform well at a job and often result in absenteeism. Reducing work-related absences to one in 5 months is another indication the symptoms are decreasing as a result of the client's compliance with treatment. It is characteristic that a client diagnosed with OCD is aware that the thoughts regarding the rituals are produced in their own mind and so this does not demonstrate improvement. Taking an online course is unrelated to the client’s condition and would not aid in determining improvement in the client’s condition. Nightmares are not a typical characteristic of OCD, but rather post-traumatic stress disorder (PTSD).
A client is experiencing a panic attack. Which intervention(s) would the nurse most likely implement? Select all that apply.
A. Communicating in a nonthreatening manner
B. Maintaining a calm environment
C. Ensuring the environment is safe
D. Touching the client gently
E. Encouraging the client to relax
Answer: A, B, C
Rationale: Communicating in a nonthreatening manner, maintaining a calm environment, and providing a safe place for the client are all appropriate interventions. It is important to use caution when touching or approaching the person having a panic attack. Doing so may pose an additional threat to the client or be an invasion of their personal space. In the panic stage, the client is incapable of relaxing and to ask them to do so is an unrealistic expectation.
A nurse is reviewing information about alprazolam (Xanax) that has been newly prescribed for the client. When teaching the client about this medication, which information would the nurse likely include? Select all that apply.
A. “Be particularly careful going up and down stairs since you will be more prone to falling.”
B. “This medication poses little risk of either psychological or physiologic dependency.”
C. “We'll take your blood pressure regularly since hypertension commonly occurs.”
D. “Some people experience insomnia; let me know if you have any difficulty falling asleep.”
E. “If you experience sight problems like blurred vision, we need to know that immediately.”
Answer: A, E
Rationale: Benzodiazepines such as alprazolam may be prescribed for the management of anxiety. This classification of medications can cause dizziness, ataxia, hypotension, and blurred vision. These side effects increase the risk for falls and need to be addressed by the health care provider. Benzodiazepines do pose a significant rise for both physical and psychological dependence. The nonbenzodiazepine buspirone (BuSpar) is known to cause insomnia.
The nurse is updating the assessment of a client diagnosed with obsessive-compulsive disorder (OCD). The nurse asks the client questions to assess for other related comorbid mental health disorders. Which question(s) should the nurse ask? Select all that apply.
A. “Do you get anxious when you are asked to give away something of yours?”
B. “Have you ever resorted to pulling out your own hair when you are anxious?”
C. “Do you hear voices that others don't seem to hear?”
D. “Do you have any particular fears about people wanting to hurt you?”
E. “Is there anything about your appearance that bothers you?”
Answer: A, B, E
Rationale: Disorders related to OCD include hoarding disorder, or a persistent difficulty discarding possessions regardless of their actual value; disorders involving body-focused repetitive behaviors such as body dysmorphic disorder in which the person has a preoccupation with an imagined defect in appearance or an overconcern with an existing slight physical defect and experiences distress over the imagined or existing defect, trichotillomania (hair-pulling disorder), and excoriation (skin-picking) disorder. Hallucinations and paranoia are not generally considered comorbid conditions associated with OCD.
A client is prescribed antianxiety medication. After teaching the client about the prescribed medication, the nurse determines that the teaching was successful based on which client statement(s)? Select all that apply.
A. “I’ll be alert for common side effects, such as confusion and incoordination.”
B. “I won’t mix this medication with over-the-counter (OTC) pain medications.”
C. “I’ll make sure not to smoke so the medication’s sedative effects don’t increase.”
D. “I’ll call my provider immediately if I bruise easily or have any bleeding.”
E. “I might be very restless in the beginning, but this should disappear in a few days.”
Answer: A, B, D
Rationale: The most common side effects of antianxiety medication are drowsiness, fatigue, confusion, and loss of coordination. These medications should not be combined with alcohol or other medications such as anesthetics, muscle relaxants, CNS depressants, and other prescribed pain medications. The client should report any symptoms of fever, sore throat, malaise, easy bruising, bleeding, or increased motor restlessness to the health care provider. Smoking decreases the sedative and antianxiety effects of the benzodiazepine drugs.