Anxiety Disorders
A patient scores 30 on their Hamilton Anxiety Rating Scale (HAM-A). They are currently pacing, sweating profusely, and near tears. They report that they feel like they are about to lose control. Select the priority nursing actions. Select all that apply.
a. Educate the patient on new coping skills
b. Obtain Lorazepam from the medication room
c. Allow the patient to pace
d. Provide reassurance and a calm presence
e. Encourage deep breathing
f. Encourage the patient to relax by telling them, "Everyone is looking at you. You need to calm down right now."
c. Allow the patient to pace
d. Provide reassurance and a calm presence
e. Encourage deep breathing
The home health nurse visits a 63-year-old client with a diagnosis of emphysema and finds that the client is smoking. What is the nurse's MOST appropriate statement?
a. "I see you're having trouble quitting smoking. What have you tried so far?"
b. "Apparently, you haven't even been to the smoking cessation classes I recommended."
c. "Why do I even bother coming here, if you're not going to stick to our treatment plan?"
d. "I caught you smoking! Now we can really talk about what you're going to do."
a. "I see you're having trouble quitting smoking. What have you tried so far?"
David is preoccupied with numerous bodily complaints even after a careful diagnostic workup reveals no physiologic problems. Which nursing intervention would be therapeutic for him?
a. Listen to the client's complaints carefully, and question him about specific symptoms.
b. Challenge the physical complaints by confronting the client with the normal diagnostic findings.
c. Ignore the client's complaints, but request that the client keeps a list of all symptoms
d. Acknowledge that the complaints are real to the client, and refocus the client on other concerns and problems.
d. Acknowledge that the complaints are real to the client, and refocus the client on other concerns and problems.
A nurse is caring for a client diagnosed with dissociative identity disorder (DID). During a stressful interaction, the client suddenly begins speaking in a childlike voice and appears confused about the current setting. Which nursing intervention is most appropriate?
a. Ask the client to explain which personality is currently in control.
b. Encourage the client to recall the traumatic event that triggered the behavior.
c. Maintain a calm environment and orient the client to the present situation.
d. Tell the client that the behavior is inappropriate and redirect them to adult behavior.
c. Maintain a calm environment and orient the client to the present situation.
A nurse is preparing to administer Fluoxetine to a patient diagnosed with Obsessive-Compulsive Disorder. Which side effect or assessment finding reported by the patient would require immediate notification to the provider?
a. Decreased libido
b. Agitation and restlessness
c. Abdominal discomfort and nausea
d. Insomnia
b. Agitation and restlessness
An emergency department nurse is evaluating a patient who presents with severe agitation, tachycardia, hypertension, muscle rigidity, myoclonus, and hyperreflexia. The patient was recently prescribed sertraline for panic disorder and admits to self-medicating with an over-the-counter cold remedy containing dextromethorphan. Which complication does the nurse suspect?
a. Benzodiazepine withdrawal syndrome
b. Anticholinergic toxicity
c. Neuroleptic malignant syndrome
d. Serotonin syndrome
d. Serotonin syndrome
The client admitted for alcohol detoxification develops increased tremors, irritability, hypertension, and fever. The nurse should be alert for impending:
a. Wernicke's encephalopathy
b. Korsakoff’s syndrome
c. Serotonin syndrome
d. Delirium tremens
d. Delirium tremens
Malingering is different from somatic symptom disorder because malingering:
a. Has evidence of an organic basis.
b. It is a deliberate effort to handle upsetting events.
c. It is a conscious simulation of illness to gain external benefits.
d. Stress is expressed through physical symptoms
c. It is a conscious simulation of illness to gain external benefits.
A patient reports, "Sometimes I feel like I'm watching myself from outside my body. I can see myself talking and moving, but it doesn't feel like I'm the one doing it."
The nurse knows the patient is experiencing what?
Depersonalization is a feeling of being detached from or observing oneself as though from outside the body.
Nurse Kenzo is teaching a client about sertraline (Zoloft), which has been prescribed for Generalized Anxiety Disorder. A significant side effect is an interference with sexual arousal by inhibiting erectile function. How should Nurse Kenzo approach this topic?
a. Nurse Kenzo should avoid mentioning the sexual side effects to prevent the client from having anxiety about potential erectile problems.
b. Nurse Kenzo should advise the client to report any changes in sexual functioning in case medication adjustments are needed.
c. Nurse Kenzo should explain that the client's sexual desire will probably decrease while on this medication.
d. Nurse Kenzo should tell the client that sexual side effects are expected, but that they will decrease when his depression lifts.
b. Nurse Kenzo should advise the client to report any changes in sexual functioning in case medication adjustments are needed.
A nurse is assessing a patient who reports, "I keep getting unwanted thoughts that I might accidentally hurt someone, even though I would never do it." Which interpretation is most appropriate?
a. The patient is experiencing psychosis
b. The patient is experiencing compulsions
c. The patient is experiencing obsessions
d. The patient is experiencing anxiety
c. The patient is experiencing obsessions
A nurse is assessing a patient in the emergency department who has cocaine intoxication. Which of the following should the nurse expect?
a. Pinpoint pupils
b. Drowsiness
c. Nystagmus
d. Hypervigilance
d. Hypervigilance
A client with multiple unexplained gastrointestinal complaints has undergone several diagnostic tests, all of which were normal. The client frequently contacts the clinic, expresses intense concern about the symptoms, and has stopped working because of fear that the symptoms indicate a serious illness. Which nursing response is most therapeutic?
a. "Your tests are normal, so there is no reason to be concerned."
b. "Let's focus on managing how these symptoms are affecting your daily life."
c. "You should request additional diagnostic testing to rule out a serious condition."
d. "Your symptoms are caused by stress, so you should try to relax."
b. "Let's focus on managing how these symptoms are affecting your daily life."
A patient reports, “Sometimes I feel like I'm watching myself from outside my body. I can see myself talking and moving, but it doesn't feel like I'm the one doing it.” The patient states that the experience is frightening but recognizes that the sensation is not literally occurring. Which response by the nurse is most appropriate?
a. "This indicates that you are losing touch with reality."
b. "You should try to suppress these experiences when they occur."
c. "The experience can feel frightening; let's focus on helping you feel connected to the present."
d. "You are experiencing a hallucination, so we need to determine what you are seeing."
c. "The experience can feel frightening; let's focus on helping you feel connected to the present."
A nurse is teaching a patient who has been prescribed buspirone for generalized anxiety disorder. Which statement by the patient indicates a need for further teaching?
a. “I should take this medication consistently as prescribed.”
b. “I may not notice the full effect immediately.”
c. “I can take this medication whenever I suddenly feel a panic attack coming on.”
d. “I should avoid drinking alcohol while taking this medication.”
c. “I can take this medication whenever I suddenly feel a panic attack coming on.”
A nurse is caring for a patient experiencing severe anxiety. Which behavior would the nurse expect?
a. The patient is able to concentrate and solve problems effectively.
b. The patient has a narrowed perceptual field and has difficulty processing information.
c. The patient is able to consider multiple solutions to a problem.
d. The patient is relaxed and able to learn new information.
b. The patient has a narrowed perceptual field and has difficulty processing information.
For alcohol use disorder:
1. Name two safety concerns with acute intoxication
2. Name two safety concerns with withdrawal syndrome
3. Name a medication we use to help with withdrawal syndrome
4. Name two signs of alcohol intoxication
5. Name some long-term effects of alcohol abuse
1. Risk for bleeding, risk for injury, risk for DUIs, aspiration of vomit, severe dehydration
2. Seizures, delirium tremens
3. Benzodiazepines, magnesium sulfate for seizure prevention
4. Nystagmus, impaired judgement, impaired coordination, mood and behavior changes, slurred speech
5. Wernicke's encephalopathy, Korsakoff syndrome, liver impairment, cardiomyopathy, psychosocial effects such as loss of employment and relationships
A client repeatedly visits healthcare providers because of fear of having cancer despite multiple normal diagnostic evaluations. The client has minimal physical symptoms but spends several hours each day checking the body for signs of cancer and researching diseases online. Which finding most clearly differentiates illness anxiety disorder from somatic symptom disorder?
a. The client's symptoms interfere with occupational functioning.
b. The client experiences significant anxiety related to health.
c. The client's primary concern is having a serious disease despite minimal or absent symptoms.
d. The client repeatedly seeks reassurance from healthcare professionals.
c. The client's primary concern is having a serious disease despite minimal or absent symptoms.
A client with dissociative symptoms becomes increasingly detached during a therapy session and says, "Everything feels unreal." Which nursing intervention is most appropriate?
a. Encourage the client to explore their trauma by asking questions.
b. Orient the patient by grabbing their shoulders and shaking them a little bit while loudly calling their name.
c. Use grounding techniques to help the client reconnect with the present.
d. Tell the client that the sensation is not real and should be ignored.
c. Use grounding techniques to help the client reconnect with the present.
A patient recently started sertraline for generalized anxiety disorder. Which findings should the nurse recognize as requiring further assessment or intervention? Select all that apply.
A. The patient reports increased restlessness and difficulty sitting still after the dose was increased.
B. The patient takes St. John’s wort daily and recently started sertraline.
C. The patient reports mild nausea during the first week of treatment.
D. The patient reports feeling significantly more energetic but sleeping only 2–3 hours each night.
E. The patient says, “I stopped taking it because I felt better after 5 days.”
F. The patient develops sweating, diarrhea, agitation, and muscle rigidity.
G. The patient reports that their anxiety has not improved after 3 days of treatment.
A, B, D, E, F
A patient is experiencing a panic attack and reports feeling like they are going to die. Explain what nursing interventions are priority, and which nursing interventions to avoid and which to postpone.
Priority: Move to low-stimulus environment, stay with the patient, provide calm reassurance using short and concise statements, encourage them to take slow, controlled breaths
Postpone: Assessing what triggered the panic attack, educating on coping skills
Avoid: Crowd them or have several people in the room, tell them to calm down, tell them it's "all in their head"
A 34-year-old male is brought to the emergency department by his partner due to profound confusion, tremors, and visual hallucinations ("seeing crawling insects") starting approximately 36 hours after his last alcoholic drink. He has a history of severe Alcohol Use Disorder. Vital signs show: Blood Pressure 165/100 mmHg, Heart Rate 118 bpm, Temperature 38.3°C (101°F), and profuse diaphoresis.
What nursing intervention is your priority? What interventions would you postpone? What interventions would you avoid?
Priority: Initiate tapering protocol of benzodiazepines intravenously, monitor vital signs
Postpone: Encourage participation in a 12-step program or other therapy or rehabilitation program, administering naltrexone to decrease cravings
Avoid: Administering disulfiram at this point, applying wrist restraints
A patient has chronic abdominal pain despite multiple negative diagnostic tests. They remain extremely worried about having a serious illness, frequently seek additional tests, and their symptoms interfere with daily life. Explain why this patient may have Somatic Symptom Disorder and how the nurse should respond
Somatic Symptom Disorder involves distressing physical symptoms accompanied by excessive anxiety, thoughts, or behaviors related to those symptoms. The symptoms do not have to be medically unexplained. The nurse should validate the patient's symptoms and distress without reinforcing excessive health concerns, avoid saying the symptoms are "all in their head," and encourage appropriate follow-up and coping strategies.
Explain the difference between depersonalization, derealization, psychosis, and dissociative amnesia
Depersonalization: Feeling disconnected from self/body, for example, a patient says: "I feel like I'm watching myself from outside my body."
Derealization: Feeling disconnected from world/environment, for example, a patient says: "Everything around me feels fake, dreamlike, or distant"
Dissociative amnesia: Gaps in memory, usually of a traumatic event. "I can't remember important information about what happened."
Psychosis: Breaks from reality, seeing or hearing things that are not there, or firmly believing things that are not true.
Match the medication to its description/purpose.
Antidote for opioid overdose: Naloxone
Used as a deterrent in the use of alcohol: Disulfiram
An opioid antagonist that blocks the effects of opioids and eliminates the rewarding sensation of use: Naltrexone
An antidepressant, reduce cravings and block pleasure from smoking: Bupropion
Restores brain chemical balance to ease post-withdrawal distress in alcohol use disorder: Acamprosate
Reduce cravings and withdrawal by binding to opioid receptors: Methadone