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 Sx, which ultimately will not resolve until the client recognizes this. The nurse should not focus on the client's physical Sx or "baby" the client. Telling the client that their Sx are not real is not therapeutic.
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 Sx 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 appointments with his psychologist 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 should the nurse include in the DC plan for a client with anxiety and phobias?
A. Suppress anxious thoughts to alleviate feelings of anxiety
B. Recommend client continue therapy
C. Advise client that adaptive coping strategies will eliminate their symptoms
D. Advise client that since their symptoms have improved, no further treatment is needed and they can keep doing what they're doing
B. Recommend client continue therapy
While improvement has been made, which is why the client is able to get DC'd, we would encourage the client to continue going to therapy so they can keep working through whatever is causing their anxiety and phobias. We would not tell the client that no further Tx is needed. We also would never encourage a client to suppress feelings, nor would we tell them they will be cured through good coping (this is giving false reassurance).
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.
Refusing to treat a client you feel is malingering (making up Sx) would be unethical. Simply having a Dx of factitious disorder doesn't warrant admission to a psych unit. Asking a client why they are "faking their Sx" would not be therapeutic, especially before all testing is done to support the suspicion as the question suggests.
A newly admitted client Dx with delirium is disoriented and having hallucinations. Which of the following should the nurse prioritize in their care?
A. Don't allow visitors, as this will increase agitation
B. Ensure adequate hydration
C. Monitor the client for signs of injury
D. Help with decision making tasks to enhance focus
C. Monitor the client for signs of injury
Safety is always our #1 priority, especially with our confused patients as they may accidentally or purposefully harm themselves. Visitors may be helpful in the alleviation of Sx and would be appropriate. Ensuring hydration is important, but not the priority need at this time. During episodes of disorientation and hallucinations is not the time to try to enhance the client's focus through decision making tasks.
Which of the following is the most important precaution to take when DC'ing a pt with SI home?
A. Ensure family has removed all guns from the home
B. Provide patient with suicide prevention hotline
C. Encourage patient to exercise regularly to help improve their overall mood
D. Ensure family has locked up all medications
A. Ensure family has removed all guns from the home
While the other options are also important, the most critical is the one that poses the most immediate risk to the patient, which would be the firearms and sharp objects.
True or False:
In the treatment of Alzheimer's disease, donepezil is given to slow the rate of cognitive decline and memantine is given improve cognitive function.
True!
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 (AKA Functional Neurological Symptom 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 dementia 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 which have a boxed warning for increased risk of death when given to elderly patients, especially those 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, not for Tx of hallucinations.
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 H/o military service, grief, trauma, abuse, physical illness, untreated mental illness, poor interpersonal relationships, very high or low socioeconomic status, or personal H/o 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 better by then."
C. "If it hasn't helped by now, we'll ask the doctor if you can 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."
Antidepressants can take several weeks to take therapeutic effect. We would encourage the client to continue taking the medication as prescribed. We wouldn't switch or DC the med, nor would we expect it to work within the next two days during week 3.
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, so a low dose SSRI would not likely be prescribed.
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 Sx. Which of the following best explains his Sx?
A. Post-traumatic stress disorder
B. Conversion disorder
C. Factitious disorder
D. Somatic symptom disorder
B. Conversion disorder
Conversion disorder (AKA Functional Neurological Symptom 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, seizures, etc.
PTSD would cause other Sx, 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 the presence of multiple somatic symptoms that cannot be explained medically.
Which of the following is NOT true regarding stages of NCDs? Select all that apply
A. Clients in stage 2 should make lists to avoid forgetting.
B. Misplacing items and forgetfulness are common symptoms seen in stage 1.
C. Confabulation and difficulty communicating with others are often seen in early stages.
D. Clients in stage 4 often have personality changes, behavioral changes and difficulty recognizing loved ones
B. Misplacing items and forgetfulness are common symptoms seen in stage 1.
C. Confabulation and difficulty communicating with others are often seen in early stages.
Stage 1 would show brain changes, but no apparent Sx are present. Confabulation is seen in stage 3. All other answers are true.
Which of the following are common Sx 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 Sx are seen in depression, including social withdrawal, anhedonia (lack of joy or pleasure), and decreased energy levels.
You are assessing a client with MDD using the Hamilton Depression Rating Scale. What is the purpose of this assessment?
A. To measure cognitive function
B. To quantify the severity of depressive Sx
C. To assess for suicide risk
D. To assess level of substance misuse
B. To quantify the severity of depressive Sx
The HDRS is a rating scale for depressive Sx, there are different evaluations for the other options.
Which of the following is true regarding post-traumatic stress disorder (PTSD)? Select all that apply.
A. Symptoms are often 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 often 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 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 misuse. It's important to screen for these behaviors and educate clients/family about avoiding them. 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.
Name two differences between somatic symptom disorder and illness anxiety disorder
Somatic symptom disorder:
- The primary Sx is significant somatic sensations.
- May be being treated by several docs at the same time
Illness anxiety disorder:
- There are few to no somatic Sx but anxiety or fear about having or acquiring an illness is a primary concern.
- Have a H/o "doctor shopping"
Name four interventions you would perform for a client with Lewy Body dementia who is becoming anxious and having hallucinations.
Provide a calm, predictable environment (same caregivers whenever possible, low stimulation [low but adequate lighting, low noise], have their personal effects present and nearby, have set schedule for ADLs)
Help calm the client/alleviate anxiety (reorient them to their surroundings, have a conversation about what is making them anxious [but do not correct their hallucinations, this is not therapeutic for dementia pts], sit with them until they've calmed down)
Educate family on importance of visiting with the client
Administer meds PRN
Encourage client to participate in activities (socialization is important for their health)
Ensure safety of environment (adequate lighting, personal effects nearby, decrease tripping hazards etc.)
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. Remove all potentially harmful objects from his bag and room.
C. Place pt on 1:1 or line of sight monitoring
D. Encourage the client to discuss their feelings about taking the bottle of pills
E. When speaking with family, educate them about signs of suicidal ideations and when to seek help.
All answers are correct!
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/line of sight). The client should be encouraged to talk about his feelings surrounding his admission. Family members should be educated on what to look out for and when to seek help for the client.
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.
All antidepressants carry an FDA boxed warning for increased risk of suicidality in children, adolescents, and young adults. all new Sx should be reported 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.