Anxiety, Phobias, OCD, & PTSD
A sudden onset of doom and terror lasting several minutes is called what?
A. Anhedonia
B. Crisis
C. Phobia
D. Panic!
D. Panic
Panic attacks come on suddenly and may last minutes to hours (as opposed to a crisis, which may last days, weeks, or months). Anhedonia is a lack of joy or pleasure in daily activities, which is a common depressive symptom. A phobia is a specific, excessive fear.
Which of the following nursing considerations should be prioritized when caring for a client with a somatic symptom disorder?
A. Help the client come to terms with their physical symptoms.
B. Provide as much ADL assistance as the client asks for.
C. Help the client recognize their symptoms as an inability to cope with their underlying anxiety.
D. Tell the client their symptoms are not real and that they need therapy.
C. Help the client recognize their symptoms as an inability to cope with their underlying anxiety.
Somatic symptom disorders include somatic symptom disorder, conversion disorder, factitious disorder, and illness anxiety disorder. Underlying anxiety is a shared factor in all of these disorders. This causes their symptoms, which ultimately will not resolve until the client recognizes this. The nurse should not focus on the client's physical symptoms or "baby" the client. Telling the client that their symptoms are not real is not therapeutic either.
Which of the following is true regarding Alzheimer's disease?
A. It is progressive and deteriorating.
B. It is short-term and comes on suddenly.
C. It can be reversed by identifying and treating the underlying cause.
D. It is the least common type of neurocognitive disorder (NCD).
A. It is progressive and deteriorating.
Alzheimer's is the most common type of primary NCD. It is a chronic, progressive, degenerative disease that develops slowly over time. Treatments may slow the progression, but it is not reversible or curable (as opposed to delirium).
Which of the following is most accurate regarding depressive disorders?
A. Depressive disorders are associated with increased levels of norepinephrine and serotonin.
B. Olanzapine and electroconvulsive therapy (ECT) are first line options.
C. The Hamilton scale can be used to quantify symptoms of depression.
D. Many people have worsened symptoms in the summer months due to a lack of melatonin.
C. The Hamilton scale can be used to quantify symptoms of depression.
Depressive disorders are associated with DECREASED levels of serotonin and norepinephrine. Individual psychotherapy, group therapy, and antidepressant medication are first line treatments for depression. ECT is reserved for ONLY severe, treatment-resistant cases and is not appropriate for most clients. Olanzapine is an antipsychotic, not an antidepressant. Many people have worsened symptoms in the winter months (seasonal affective disorder) due to an increased secretion of melatonin. Light therapy, which blocks secretion of melatonin, is used to treat SAD.
A client with major depressive disorder attends therapy to help him recognize and reframe his dysfunctional thought patterns. What is this therapy called?
A. Electroconvulsive therapy (ECT)
B. Cognitive behavioral therapy (CBT)
C. Reminiscence therapy
D. Group therapy
B. Cognitive behavioral therapy (CBT)
Which of the following clients most likely represents generalized anxiety disorder?
A. A client who calls her children once per week to catch up with them.
B. A client who sleeps 6-8 hours every night and feels well rested.
C. A client who has not left her house much in 6 months because she worries about everything.
D. A client who uses methamphetamine daily and reports hallucinations while intoxicated.
C. A client who has not left her house much in 6 months because she worries about everything.
Clients with generalized anxiety disorder have generalized worrying/anxiety for at least 6 months that interferes with their occupational and social functioning. It is common for these clients to shut themselves in their home and socially withdraw because they worry about everything around them. It's important to ensure a calm, quiet milieu for these clients in the inpatient setting.
Calling children once per week is reasonable. Sleeping 6-8 hours per night indicates adequate sleep, which is usually not the case with an anxiety disorder. A client using alcohol or a substance like methamphetamine likely has a substance use disorder, not an anxiety disorder.
The nurse is caring for a client in the ER with suspected factitious disorder. Which of the following nursing actions is appropriate at this time?
A. Refuse to treat the client because the nurse does not believe her symptoms are real.
B. Treat the client's symptoms as real until it is determined otherwise.
C. Tell the physician to place the client on a psychiatric unit.
D. Ask the client why she is faking her symptoms.
B. Treat the client's symptoms as real until it is determined otherwise.
Which of the following findings would be concerning if noted in a patient with vascular dementia?
A. The client follows a low cholesterol diet with regular exercise.
B. The client demonstrates occasional disorientation and confusion.
C. The client lives with his wife and has a supportive family network.
D. The client drinks alcohol and smokes a pack of cigarettes daily.
D. The client smokes a pack of cigarettes daily.
Vascular dementia shares the same risk factors as cardiovascular disease. These clients should be eating a heart healthy diet, exercising regularly, and should not smoke cigarettes as this can exacerbate their condition. Occasional confusion and disorientation are expected symptoms of this condition. Having a supportive family network and a wife who takes care of him at home are ideal.
You are taking care of a client who has had difficulty sleeping, poor appetite, and depressed mood for about three years, which causes her to socially isolate. Her symptoms occur 7 days per week every week. She has no suicidal ideations or recurrent thoughts of death. Which of the following is the most likely diagnosis?
A. Persistent depressive disorder
B. Premenstrual dysphoric disorder
C. Major depressive disorder
D. Seasonal affective disorder
A. Persistent depressive disorder
Symptoms of persistent depressive disorder (dysthymia) are more mild than those of major depressive disorder and must be present nearly every day for at least two years. Clients would not have suicidal ideations, recurrent thoughts of death, or psychotic symptoms (if they did, they would meet criteria for major depressive disorder).
PMDD involves severe mood swings, anxiety, and depressive symptoms that interfere with daily functioning, but these symptoms directly correlate with the menstrual cycle and improve after the period starts.
Seasonal affective disorder has a seasonal pattern, so symptoms typically arise in the winter months and then improve during the spring months.
Which of the following clients would be appropriate for group therapy?
A. A client who is withdrawing from cocaine
B. A client who was newly diagnosed with a social phobia
C. A client who was diagnosed with a depressive disorder 8 months ago
D. A client with a stage 4 NCD
C. A client who was diagnosed with a depressive disorder 8 months ago
For clients to be appropriate for group therapy, they must be stable with no new diagnoses or recent changes. Clients with delirium, substance withdrawal, or NCDs are also not appropriate for group therapy.
The nurse is caring for a client with a specific phobia who was just admitted to an inpatient unit. Which of the following is appropriate for the nurse to do?
A. Discourage the client from verbalizing underlying feelings of anxiety.
B. Assess the onset and impact on daily life of the phobia, as well as the client's coping mechanisms.
C. Leave the client alone so she can relax in peace.
D. Engage the client by encouraging her to join a song and dance session this afternoon.
B. Assess the onset and impact on daily life of the phobia, as well as the client's coping mechanisms.
The nurse should assess the phobia and the client's coping mechanisms, as well as encourage the client to verbalize underlying feelings of anxiety. Do NOT leave a client alone if they are experiencing anxiety or a crisis. A song and dance session would not be appropriate for this client, as the nurse should promote a calm, quiet milieu for clients with anxiety disorders and phobias.
The nurse is taking care of a client who is constantly worried about an undiagnosed illness. Which of the following diagnoses is most likely?
A. Conversion disorder
B. Factitious disorder
C. Illness anxiety disorder
D. Generalized anxiety disorder
C. Illness anxiety disorder
Illness anxiety disorder (hypochondriasis) is an excessive worry about illness in general. Conversion disorder is the sudden bizarre loss of neurological function (hearing, sight, etc.) after a stressful event. Factitious disorder is intentionally causing, faking, or exacerbating an illness in order to gain emotional support through medical attention. Generalized anxiety disorder includes worry about many different things, not just illness.
Olanzapine is prescribed to an 89-year-old client with a neurocognitive disorder who is experiencing agitation and hallucinations. Which of the following is an important nursing consideration regarding this medication?
A. The client should be monitored for suicidal ideations.
B. This medication has a black box warning for increased risk of death in clients like this one.
C. This medication would not control hallucinations as well as donepezil.
D. The client should be monitored for serotonin syndrome.
B. This medication has a black box warning for increased risk of death in clients like this one.
Olanzapine is a 2nd generation (atypical) antipsychotic. These medications have a boxed warning for increased risk of death when given to elderly patients with dementia.
Antidepressants (SSRIs, SNRIS, etc.) may cause suicidal ideations and/or serotonin syndrome. Donepezil is given to help treat cognitive impairment in early stages of NCDs by inhibiting the breakdown of acetylcholine, thereby slowing the progression of diseases such as Alzheimer's.
Which of the following is NOT a risk factor for suicide?
A. Poor interpersonal relationships
B. Highest or lowest socioeconomic groups
C. Personal history of suicide attempt
D. Father with PTSD after serving in the military
D. Father with PTSD after serving in the military
A personal history of military service, grief, trauma, abuse, physical illness, untreated mental illness, poor interpersonal relationships, very high or low socioeconomic status, or personal history of suicide attempts are major risk factors for suicide. A family member who has committed suicide is also a major risk factor.
A client who began taking sertraline two and a half weeks ago for major depressive disorder calls the clinic to report he has not experienced an improvement in symptoms. Which response is most appropriate?
A. "I will ask the doctor to switch you to a different medication."
B. "Give it another 24-48 hours and you should feel completely better by then."
C. "If it hasn't helped by now, go ahead and stop taking it."
D. "It takes about 4-6 weeks for this medication to work well, so keep taking it as prescribed until then."
D. "It takes about 4-6 weeks for this medication to work well, so keep taking it as prescribed until then."
Which of the following nursing interventions is appropriate for a client with obsessive-compulsive disorder?
A. Help the client recognize their compulsions stem from an underlying need to be perfect.
B. Enforce a boundary with the client to stop them from engaging in ritualistic behaviors.
C. Discuss anxiety triggers that lead to compulsions & help the client recognize their underlying anxiety.
D. Administer a low-dose selective serotonin reuptake inhibitor (SSRI).
C. Discuss anxiety triggers that lead to compulsions & help the client recognize their underlying anxiety.
OCD includes obsessions (intrusive thoughts), compulsions (ritualistic behaviors), or both. Obsessions typically lead to compulsions, with underlying anxiety as the driving force behind these symptoms (not the need for perfection). Compulsions are an attempt to REDUCE underlying anxiety, which only provides temporary relief. The nurse should NOT try to interrupt compulsions unless they are dangerous. OCD is treated with SSRIs at higher doses than those given for depression or anxiety disorders.
You are taking care of a client who experienced sudden blindness shortly after finding his friend murdered at his home. He was evaluated in the ER but there was no cause identified for his symptoms. Which of the following best explains his symptoms?
A. Post-traumatic stress disorder
B. Conversion disorder
C. Factitious disorder
D. Somatic symptom disorder
B. Conversion disorder
Conversion disorder is the sudden bizarre loss of neurological function after a stressful event. This can be the loss of sight, hearing, smell, or taste, or paralysis, dysphagia, seizures, etc.
PTSD would cause other symptoms, but not a loss of neurological function. Factitious disorder is intentionally causing, faking, or exacerbating an illness in order to gain emotional support through medical attention. Somatic symptom disorder is an excessive, disproportionate anxiety about specific medical symptoms one is experiencing.
Which of the following is NOT true regarding stages of NCDs?
A. Clients in stage 2 should make lists to avoid forgetting.
B. Misplacing items and forgetfulness are common symptoms seen in the mild stage.
C. Confabulation and difficulty communicating with others are often seen in early stages.
D. Clients in stage 3 often have trouble remembering directions and end up getting lost driving.
C. Confabulation and difficulty communicating with others are often seen in early stages.
Confabulation is seen in stage 4 and aphasia is seen in stage 7. All other answers are true.
Which of the following may be symptoms of depression? Select all that apply.
A. Pressured speech
B. Difficulty concentrating
C. Sleep and/or appetite changes
D. Elevated mood and joyfulness
E. Feelings of guilt, hopelessness, or worthlessness
B. Difficulty concentrating
C. Sleep and/or appetite changes
E. Feelings of guilt, hopelessness, or worthlessness
Pressured speech, elevated mood, and euphoria are symptoms of mania (bipolar disorder) but would not be seen in unipolar depression. All other symptoms, especially depressed mood, anhedonia (lack of joy or pleasure), and/or apathy are seen in depression.
A client who has been taking sertraline for years recently developed fever, diaphoresis, tachycardia, mental status changes, and tremors after paroxetine was also added to her regimen. The provider is now concerned about serotonin syndrome. Which of the following is the most likely cause of this?
A. A drug-drug interaction between an SSRI and an MAOI
B. A drug-drug interaction between an SSRI and SNRI
C. A drug-drug interaction between an SSRI and an antipsychotic
D. A drug-drug interaction between two SSRIs
D. A drug-drug interaction between two SSRIs
Paroxetine and sertraline (as well as fluoxetine, escitalopram, and citalopram) are SSRIs. If a client reports symptoms of serotonin syndrome, this should be reported to the provider ASAP.
Which of the following is true or appropriate regarding post-traumatic stress disorder (PTSD)? Select all that apply.
A. Symptoms are usually triggered by a near-death experience or one in which death was witnessed.
B. Clients should be screened for alcohol & substance use and educated against the use of these.
C. Therapeutic touch is appropriate for clients who have PTSD after suffering a violent attack.
D. Clients with PTSD should be assigned a different nurse and/or tech each day on the unit.
E. Clients should be encouraged to talk about their trauma when they're ready.
A. Symptoms are usually triggered by a near-death experience or one in which death was witnessed.
B. Clients should be screened for alcohol & substance use and educated against the use of these.
E. Clients should be encouraged to talk about their trauma when they're ready.
Symptoms of PTSD (nightmares, flashbacks, hypervigilance, depressive symptoms, avoidance, etc.) are triggered by a traumatic event. This most commonly involves a near-death experience or after witnessing someone die. These clients are at high risk of suicide, self-harm, and substance and/or alcohol use. It's important to screen for these behaviors and educate clients/family about avoiding substances that can cloud their judgment. When caring for these clients, it's best to avoid touch as it can be triggering for clients who have suffered a violent attack. Nursing staff assignments should be kept consistent as much as possible for these clients. These clients should be encouraged to talk about their trauma at their own pace, and the nurse should focus on validating their feelings when they are ready to talk.
Which of the following are expected findings of a client with somatic symptom disorder? Select all that apply.
A. A client has disproportionate, excessive anxiety about the seriousness of his symptoms.
B. A client is worried about illness in general.
C. A client has seen 6 providers in the past 6 months for the same symptoms with no clear medical cause.
D. A client expresses relief that he is not actually having a heart attack despite his symptoms.
E. A client who is diagnosed with Crohn's disease is concerned about abdominal pain and diarrhea.
A. A client has disproportionate, excessive anxiety about the seriousness of his symptoms.
C. A client has seen 6 providers in the past 6 months for the same symptoms with no clear medical cause.
Somatic symptom disorder is characterized by disproportionate, excessive anxiety about the seriousness of one's symptoms, despite no identifiable medical cause. These clients have a hard time accepting that there is no medical cause and tend to "doctor shop", going to several providers to work up the same symptoms. Ruling out illnesses does not help relieve their anxiety. These clients do NOT have actual medical diagnoses (excessive anxiety about diagnosed illness would be a different disorder).
Which of the following are appropriate interventions for clients with NCDs? Select all that apply.
A. Ensure safety and monitor the client closely for safety.
B. Switch up their daily routines every so often to prevent boredom.
C. Encourage these clients to finish their tasks in a timely manner like every other client.
D. Distract the client with exercise or by focusing on real people and real events.
E. Ensure the client's items are within reach and keep a dim light on at all times.
A. Ensure safety and monitor the client closely for safety.
D. Distract the client with exercise or by focusing on real people and real events.
E. Ensure the client's items are within reach and keep a dim light on at all times.
Clients with NCDs or delirium are at an increased risk for accidental injury, so fall precautions should be initiated and the client should be monitored closely for safety. Consistent routines should be maintained for these clients and extra time should be allotted for them to complete tasks. Distracting the client with exercise or by focusing on real people or events would also be appropriate.
You are caring for an adolescent client with major depressive disorder who was just admitted to the hospital after taking a bottle of pills. Which of the following are appropriate nursing considerations for this client? Select all that apply.
A. Assess for suicidal ideations, including indirect statements such as "I wish I wasn't here".
B. Observe the client closely and remove all potentially harmful objects from his bag and room.
C. If the client is having suicidal ideations, assess for a plan.
D. Use only closed-ended questions when speaking with the client.
E. When speaking with family, educate them about signs of suicidal ideations and when to seek help.
A. Assess for suicidal ideations, including indirect statements such as "I wish I wasn't here".
B. Observe the client closely and remove all potentially harmful objects from his bag and room.
C. If the client is having suicidal ideations, assess for a plan.
E. When speaking with family, educate them about signs of suicidal ideations and when to seek help.
The nurse must assess his suicide risk thoroughly, including a plan, access, intent, etc.
Belongings should be searched upon admission and if the client leaves the unit for any reason. The client should be placed on suicide precautions with close supervision (1:1). The family members should be educated on what to look out for and when to seek help for the client.
Open-ended questions are most therapeutic.
Which of the following education is appropriate to provide to a client about antidepressant medication such as escitalopram? Select all that apply.
A. This medication may increase the risk of suicide.
B. It's okay to drink alcohol in moderation.
C. This should only be taken in the morning.
D. Report any sudden agitation or fast heart rate to the provider ASAP.
E. You will need to avoid tyramine-rich foods while taking this medication.
A. This medication may increase the risk of suicide.
D. Report any sudden agitation or fast heart rate to the provider ASAP.
Alcohol should be avoided while on antidepressants. If the medication causes drowsiness, it should be taken at night. Tyramine-rich foods interact with MAOIs, not SSRIs.