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A nurse is assessing four clients with anxiety symptoms. Which client’s description is most consistent with agoraphobia?
A. A client who avoids grocery stores and public transportation because they fear being unable to escape if they panic.
B. A client who becomes extremely anxious when meeting new people and worries about being judged negatively.
C. A client who reports excessive worry about multiple life areas, such as finances, work, and health, occurring most days for at least 6 months.
D. A client who experiences sudden episodes of intense fear accompanied by palpitations and sweating.
Ans: A
Agoraphobia involves fear of places or situations where escape might be difficult or help unavailable during panic‑like symptoms. Avoiding public transportation, stores, or crowds fits this diagnosis (Option A).
Social Anxiety Disorder involves fear of social situations due to worry about embarrassment or judgment (Option B).
Generalized Anxiety Disorder (GAD) involves chronic, excessive worry about multiple aspects of life for at least 6 months (Option C).
Option D describes panic attacks, which can occur with panic disorder or other anxiety disorders but does not define agoraphobia
A client diagnosed with obsessive–compulsive disorder (OCD) tells the nurse, “I’m terrified to stop checking the locks. If I don’t check them at least 20 times, something bad will happen.” The client has just begun exposure and response prevention (ERP) therapy. Which nursing statement best supports the goals of ERP?
A. “Let’s try distracting you with another activity when you feel the urge to check the locks.”
B. “You will gradually face the fear of not checking the locks while learning to tolerate the anxiety without performing the ritual.”
C. “We will work on eliminating your obsessive thoughts before addressing the compulsive behaviors.”
D. “It’s important to avoid situations that trigger your urge to check the locks until your anxiety decreases.”
Answer: B
ERP is the gold‑standard behavioral treatment for OCD.
It involves gradual exposure to the feared situation (e.g., not checking the locks) while preventing the compulsive response, allowing anxiety to decrease naturally over time.
Option B accurately describes this process: facing the fear and resisting the ritual.
Why the others are incorrect:
A: Distraction does not address the compulsive cycle and is not the core of ERP.
C: ERP targets compulsions first, not the elimination of intrusive thoughts.
D: Avoidance reinforces OCD and worsens symptoms.
he nurse approaches a patient with PTSD in the inpatient unit. Which action is most appropriate?
A. Approach quietly from behind to avoid disturbing the patient.
B. Make your presence known before approaching the patient.
C. Ask rapid‑fire questions to obtain information quickly.
D. Touch the patient gently to get their attention.
B is correct: PTSD patients are often hypervigilant and in “survival mode.” The nurse must announce presence to avoid startling them.
A is unsafe and may trigger a startle response.
C increases anxiety.
D touching without warning can trigger flashbacks or panic.
Which medication is appropriate for short‑term management of acute anxiety?
A. Buspirone
B. Benzodiazepines
C. SSRIs
D. Antipsychotics
B is correct: Benzodiazepines are used short‑term for acute anxiety or panic.
A takes weeks to work.
C are long‑term treatments.
D are not first‑line for anxiety.
A nurse is teaching a group of parents about common anxiety presentations in children and adults. Which statement by a parent indicates a correct understanding of the different types of anxiety disorders?
A. “When my 3‑year‑old cries and clings to me at daycare drop‑off, that’s separation anxiety, which is normal for young children.”
B. “Feeling terrified to speak in front of my class is an example of generalized anxiety disorder.”
C. “Adults who refuse to leave their partner because they fear something bad will happen are showing normal separation anxiety.”
D. “Generalized anxiety disorder is rare and not a common reason people visit their doctor.”
A is correct
Separation anxiety is normal in young children (and even pets).
It becomes a disorder only when it occurs in adults or is developmentally inappropriate.
Crying at daycare drop‑off is a classic, age‑appropriate example.
B. “Terrified to speak in front of class = GAD”
This describes social anxiety disorder, not GAD.
Social anxiety is triggered by performance or social situations.
C. “Adult separation anxiety is normal”
Incorrect.
Separation anxiety in adults is not developmentally normal and may indicate a disorder.
D. “GAD is rare”
Incorrect.
Generalized anxiety disorder is the most common psychiatric reason people visit their primary care provider.
True or False?
The myelinated vagus sends signals quickly and supports calm, socially engaged states, while the unmyelinated vagus sends signals slowly and is responsible for shutdown responses during extreme threat.
Ans: TRUE
Polyvagal Theory explains how the autonomic nervous system uses 3 hierarchical states—social engagement, fight/flight, and shutdown—based on how the vagus nerve detects safety or threat.
Ventral Vagal (Myelinated Vagus) — Safety & Social Engagement
Fast conduction due to myelin
Supports calm, connection, communication
Regulates heart rate, facial expression, voice tone
Activated when the body perceives safety
Sympathetic Nervous System — Fight or Flight
Mobilization, energy, hyperarousal
Activated when the body perceives danger
Dorsal Vagal (Unmyelinated Vagus) — Shutdown / Freeze
Slow conduction due to lack of myelin
Evolutionarily older
Causes immobilization, collapse, dissociation
Activated when the body perceives life threat
Following a hurricane that leveled a woman’s home, the woman goes to the Emergency shelter and exhibits severe anxiety when interviewed by the RN who is part of the emergency response team. The most appropriate intervention is?
A. Provide anti-anxiety medication to reduce the women’s symptoms
B. Provide reassurance and discussion of the stages of grief
C. Ask family or friends to stay with the woman
D. Tell the woman that she is safe and everything will be all right
B. Provide reassurance and discussion of the stages of grief
In a mass‑casualty disaster, survivors often experience acute grief, loss, and disorientation in addition to anxiety. If the woman has lost her home, she is experiencing a real, tangible loss, and early grief reactions are expected.
In this framework, the RN’s role includes:
Normalizing the emotional response
Providing reassurance that her reactions are understandable
Helping her understand the grief process
Supporting her as she begins to process the loss
Which medication is commonly prescribed to reduce nightmares and flashbacks in patients with PTSD?
A. Prazosin
B. Alprazolam
C. Haloperidol
D. Pimozide
A is correct: Prazosin is used to treat nightmares, flashbacks, and hypervigilance in PTSD.
*It is also an antihypertensive, so vitals must be monitored.
A nurse is caring for a patient with end‑stage heart failure who states, “I don’t want any more aggressive treatments, but I still want help with my pain and anxiety.” The provider recommends hospice care. Which statement by the nurse best explains the difference between hospice and palliative care?
A. “Hospice is for patients who want to continue curative treatments, while palliative care is only for end‑of‑life.”
B. “Hospice is for patients with a life expectancy of six months or less, while palliative care can be provided at any stage of illness.”
C. “Palliative care focuses only on emotional comfort, while hospice focuses on physical comfort.”
D. “Palliative care is only available in the hospital, while hospice is only available at home.”
B is correct
Hospice is appropriate when:
The patient has 6 months or less to live
Death is expected
The focus shifts from curative treatment to comfort, dignity, and symptom management
No new curative treatments are started (though the patient may revoke hospice if they choose)
Palliative care:
Focuses on comfort and symptom relief
Can be provided at any stage of illness, not just end‑of‑life
Often overlaps with hospice but does not require a terminal prognosis
A patient in the emergency department says to the nurse, “During the episode, everything around me looked strange and unreal, like I was in a movie. Later, I couldn’t remember parts of what happened.” Which combination of dissociative symptoms is the patient most likely experiencing?
A. Depersonalization and localized amnesia
B. Derealization and dissociative amnesia
C. Depersonalization and generalized amnesia
D. Derealization and illusion
B is correct Derealization = the environment feels unreal, dreamlike, foggy, distorted.
The patient says: “Everything around me looked strange and unreal.”
Dissociative amnesia = inability to recall important events, often related to stress or panic.
The patient says: “I couldn’t remember parts of what happened.”
Which of the following medications is most likely to trigger a psychotic or manic response?
A. Antipsychotics
B. Anticonvulsants
C. Anxiolytics
D. Antidepressants
D. Antidepressants
-can cause activation syndrome especially in bipolar 2 depressed pts
A nursing student is discussing end‑of‑life options with the instructor. Which statement indicates the student correctly understands the difference between euthanasia and physician‑assisted suicide?
A. “Euthanasia is legal in the United States when a patient is suffering.”
B. “In physician‑assisted suicide, the physician administers the lethal medication directly.”
C. “Euthanasia is performed on humans, while physician‑assisted suicide is only for animals.”
D. “Physician‑assisted suicide involves the doctor prescribing medication, but the patient takes it independently.”
D is correct-Physician‑assisted suicide involves a doctor prescribing a lethal medication, but the patient self‑administers it.
It is legal in some states, but not all.
Why the other options are incorrect
A. “Euthanasia is legal in the United States…”.
Euthanasia is not legal for humans in the U.S.
It is used for animals to relieve suffering.
B. “The physician administers the medication…”
This describes euthanasia, not physician‑assisted suicide.
In physician‑assisted suicide, the patient administers the medication.
C. “Euthanasia is performed on humans…”
Euthanasia is not legal for humans in the U.S.
A client with obsessive–compulsive disorder reports spending several hours each day performing hand‑washing rituals. The provider plans to start medication therapy to help reduce the client’s obsessive thoughts and compulsive behaviors. Which medication should the nurse expect to be prescribed?
A.Fluoxetine
B. Fluvoxamine
C. Haloperidol
D. Buspirone
Ans: B Fluvoxamine or Luvox
Fluvoxamine is an SSRI specifically FDA‑approved for OCD and is considered a first‑line medication for reducing obsessions and compulsions.
Fluoxetine (Prozac) can be used for OCD, but it is not the most specific or first‑choice SSRI when compared to fluvoxamine.
Haloperidol is an antipsychotic and not indicated for OCD.
Buspirone treats generalized anxiety disorder, not OCD symptoms.
A patient experiencing a panic attack tells the nurse, “I suddenly felt like I was floating outside my body watching myself. Then afterward, I couldn’t remember parts of what happened.” Which combination of symptoms is the patient describing?
A. Derealization and selective amnesia
B. Depersonalization and dissociative amnesia
C. Derealization and generalized amnesia
D. Depersonalization and illusion
Correct Answer: B. Depersonalization and dissociative amnesia
Depersonalization = feeling detached from oneself, like watching yourself from outside your body.
Dissociative amnesia = inability to recall important personal information, often related to stress or panic.
Why the other options are incorrect
A. Derealization and selective amnesia
Derealization = the environment feels unreal (foggy, dreamlike).
The patient describes detachment from self, not surroundings.
C. Derealization and generalized amnesia
Again, derealization is incorrect.
Generalized amnesia is total memory loss of one’s identity—far more severe than described.
D. Depersonalization and illusion
Illusion = misinterpreting a real external stimulus (e.g., mistaking a coat for a person).
No misinterpretation of stimuli is described.
A patient who witnessed a violent accident is now curled up on the stretcher, barely speaking, with slowed breathing and a blank stare. The nurse recognizes this as a dorsal vagal response. Which nursing intervention is most appropriate?
A. Encourage the patient to process the traumatic event in detail
B. Use grounding techniques and a calm voice to help the patient return to a regulated state
C. Increase environmental stimulation to keep the patient alert
D. Ask the patient to stand and walk to prevent further dissociation
B is correct: In dorsal vagal shutdown, the patient is in a freeze/collapse state.
Best interventions include:
Grounding
Slow, calm communication
Helping the patient re‑orient
Reducing overwhelm
This supports safe re‑regulation.
A is incorrect: Trauma processing is never done during shutdown; it worsens dissociation.
C is incorrect: Increasing stimulation can overwhelm the nervous system further.
D is unsafe: The patient may be hypotensive, dissociated, or unstable.
The anxiety level at which a pt is typically alert, energized and effective at problem solving because of the ability to focus narrowly is?
A. Mild
B. Moderate
C. Severe
D. Panic
A. Mild-Everyday problem-solving leverage, Grasps more information effectively
Moderate anxiety narrows the perceptual field and makes problem‑solving less effective, not more.
Severe anxiety greatly reduces the perceptual field and impairs problem‑solving.
Panic eliminates problem‑solving ability entirely.
A nurse is teaching a patient about advance care planning. Which statement by the patient indicates a correct understanding of the difference between a power of attorney, an advance directive, and a living will?
A. “My power of attorney describes how I want to die if I become terminally ill.”
B. “My advance directive names the person who will make medical decisions for me and outlines my wishes if I can’t speak for myself.”
C. “My living will allows my family to make financial decisions for me if I’m incapacitated.”
D. “A power of attorney and a living will are the same document.”
B is correct
An advance directive is the umbrella document that includes:
A durable power of attorney for healthcare (who makes decisions if the patient cannot)
A living will (how the patient wants medical care handled at the end of life)
POA is A person assigned to make $ and health decisions for the patient if the patient is unable to do so for themselves.
A living will outlines how and where the patient wishes to die or receive end‑of‑life care.
A patient with generalized anxiety disorder is being started on medication. Which medication is appropriate?
A. Duloxetine
B. Clozapine
C. Phenelzine
D. Carbamazepine
A is correct: Duloxetine, an SNRI, is effective for anxiety.
B is an antipsychotic
C is an MAOI, not first‑line for anxiety.
D is an anticonvulsant used for bipolar disorder.
A patient diagnosed with dissociative identity disorder (DID) has begun switching between two distinct personality states during therapy sessions. The nurse explains to a student that this switching most often occurs for which reason?
A. The patient is attempting to manipulate the therapist for attention.
B. The alternate personalities emerge to protect the patient from overwhelming traumatic memories.
C. Switching occurs because the patient is unable to distinguish reality from hallucinations.
D. The personalities compete for dominance, causing frequent shifts in behavior.
B is correct
DID develops as a response to severe, early, often prolonged trauma.
The mind creates distinct alters to protect the individual from overwhelming or intolerable memories.
One alter is typically functional, while others may hold repressed or traumatic memories.
Switching is a defense mechanism, not manipulation or psychosis.
A patient with a history of traumatic brain injury becomes increasingly irritable, pacing and muttering. He then begins yelling, slamming his fists into the wall, and charging toward staff. The provider orders emergency medication. Which combination of medications is most appropriate for acute violent behavior?
A. Haloperidol, lorazepam, and diphenhydramine
B. Fluoxetine and propranolol
C. Buspirone and hydroxyzine
D. Risperidone oral tablet only
A is correct: The classic B‑52 (haloperidol + lorazepam + diphenhydramine) is used for acute agitation and violent behavior.
Haloperidol: antipsychotic for agitation
Lorazepam: benzodiazepine for calming
Diphenhydramine: prevents EPS
B is incorrect: These are not emergency medications.
C is incorrect: These are non‑emergent anxiolytics.
D is too slow‑acting for acute violence.
When using a trauma informed care approach with a pt who was admitted to a traumatic experience, the RN should?
A. Stress the need to share info with others
B. Ask probing ques to elicit more info
C. Make a judgmental statement
D. Provide emotional support
D. Provide emotional support
Trauma‑informed care is built on safety, trust, choice, collaboration, and empowerment. The RN’s priority is to:
A nurse is assessing several patients in a bereavement support group. Which statement indicates disenfranchised grief?
A. “My ex‑husband died last month, and I feel devastated, but no one understands why I’m still grieving.”
B. “Ever since my mother entered hospice, I’ve been preparing myself for what life will be like without her.”
C. “It’s been over a year since my brother died, and I still can’t sleep or eat. I think about his death constantly.”
D. “I can’t stop watching the news about the school shooting. The coverage makes the pain feel even worse.”
A is correct- Disenfranchised grief occurs when the loss is not socially recognized or supported, such as grieving:an ex‑spouse, a lover, a pet, a patient (for healthcare workers) The person feels invalidated, unsupported, or unable to openly mourn.
B. Anticipatory grief- This describes mourning in advance of an expected loss.
C. Persistent complex bereavement disorder: This involves intense, disabling grief lasting longer than 12 months, inability to eat or sleep, pervasive preoccupation with the death, impaired daily functioning, possible suicidal ideation.
D. Grief caused Public tragedies (e.g., mass shootings, disasters) can cause grief that is intensified by nonstop media coverage, which worsens distress.
A patient with a terminal illness is calm and accepting of her prognosis. Her daughter, however, is angry and repeatedly demands more aggressive treatment. Which action by the nurse best reflects an understanding of the Kubler‑Ross model?
A. Encourage the daughter to match her mother’s stage of grief.
B. Explain that family members may experience different stages at different times.
C. Tell the daughter that anger is inappropriate at this point.
D. Redirect the daughter by focusing only on the patient’s acceptance.
B is correct: Family members often move through grief at different paces and may be in different stages simultaneously. This is expected and should be normalized.
A is incorrect because grief cannot be forced or synchronized.
C is non‑therapeutic and dismissive.
D ignores the daughter’s emotional needs and does not support family‑centered care.
A patient on an inpatient psychiatric unit begins pacing, clenching their fists, and shouting that staff are “trying to control” them. The nurse notes escalating anger that is progressing toward aggression. When the patient suddenly throws a chair across the room, the team prepares for possible violence. Which nursing action is most appropriate at this time?
A. Immediately place the patient in restraints because they are angry and verbally threatening.
B. Administer a PRN B‑52 (haloperidol, lorazepam, diphenhydramine) without attempting verbal de‑escalation.
C. Attempt verbal de‑escalation and reduce environmental stimuli; use restraint or seclusion only if the patient poses imminent danger to self or others.
D. Allow the patient to leave the unit to “cool off” since anger is a normal emotion.
C is correct
The nurse must first use least restrictive interventions, including: Verbal de‑escalation, Maintaining safe distance, Reducing stimuli, Offering PRN medication voluntarily
A client recently experienced the sudden loss of a job. The nurse observes that the client is increasingly anxious, states “nothing I usually do is helping,” and is beginning to feel overwhelmed and unable to problem‑solve. According to Caplan’s (1964) phases of crisis, which phase is the client most likely experiencing?
A. Phase 1 – Increased tension relieved by usual coping mechanisms
B. Phase 2 – Escalating tension as usual coping mechanisms fail
C. Phase 3 – Attempts at new coping strategies and possible panic
D. Phase 4 – Severe breakdown with disorganization and immobilization
Ans: B, Phase 2, the individual’s usual coping strategies no longer work, leading to increased tension, feelings of helplessness, and growing disorganization—exactly what the client is demonstrating.
Phase 1 involves rising tension but coping skills still function.
Phase 3 involves trying new coping methods and possible panic.
Phase 4 involves severe dysfunction, immobilization, or collapse.