Question 1

A client has a history of excessive fear of water. What is the term that a nurse should use to describe this specific phobia, and under what subtype is this phobia identified?

Accepted Answer

Aquaphobia is the specific phobia of water or being in or near bodies of water. It is classified as a natural environment type of phobia, as it is related to a fear of natural phenomena or situations, such as heights or storms.

Question 2

A college student is unable to take a final examination due to severe test anxiety. Instead of studying, the student relieves stress by attending a movie. Which priority nursing diagnosis should a campus nurse assign for this client?

Accepted Answer

The nursing diagnosis of Altered Coping related to anxiety would be the best choice for this client. This diagnosis reflects the client's ineffective coping mechanism of avoiding the source of anxiety (studying for the test) by engaging in a more passive activity (attending a movie). It addresses the client's current state and suggests the need for alternative coping strategies to manage the anxiety, which could be explored with the client during a nursing assessment. The other options may be relevant in a different context, but they are not as applicable to this specific scenario.

Question 3

A client diagnosed with obsessive-compulsive disorder is admitted to a psychiatric unit. The client has an elaborate routine for toileting activities. Which would be an appropriate initial client outcome during the first week of hospitalization?

Accepted Answer

An appropriate initial client outcome is for the client to wake early enough to complete rituals prior to breakfast.The nurse should also provide a structured schedule of activities and later in treatment begin to gradually limit the time allowed for rituals.

Question 4

A nurse has been caring for a client diagnosed with post-traumatic stress disorder. What short-term, realistic, correctly written outcome should be included in this client's plan of care?

Accepted Answer

This short-term outcome is realistic and achievable within a reasonable timeframe. It addresses a specific symptom commonly seen in clients with PTSD, which is difficulty with sleep. It also sets an achievable goal for the client to work towards, which can help improve their sense of control and agency in their healing process. The other options are either unrealistic (A), potentially harmful (D), or not specific enough (B).

Question 5

A client is experiencing a severe panic attack. Which nursing intervention would meet this client's immediate need?

Accepted Answer

The most immediate need for a client experiencing a severe panic attack is to have a nurse stay with them and offer reassurance of safety. This can help the client feel less alone, less afraid, and more grounded. Teaching relaxation exercises, administering medications like buspirone, or positioning the client in a Trendelenburg position may be appropriate interventions for panic disorder but are not the best choices for meeting the client's immediate needs during a severe panic attack.

Question 6

A client diagnosed with an obsessive-compulsive disorder spends hours bathing and grooming. During a one-on-one interaction, the client discusses the rituals in detail but avoids any feelings that the rituals generate. Which defense mechanism should the nurse identify?

Accepted Answer

The client is discussing the rituals in detail but avoiding any feelings that the rituals generate, which is an example of intellectualization, a defense mechanism where the individual uses excessive analysis and logic to avoid experiencing uncomfortable emotions.

Question 7

How would a nurse differentiate a client diagnosed with a social phobia from a client diagnosed with a schizoid personality disorder (SPD)?

Accepted Answer

Clients diagnosed with social phobia avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life. SPD is a pervasive pattern of detachment from social relationships and a restricted range of emotional expression, whereas social phobia is an excessive and persistent fear of social situations in which the person is exposed to unfamiliar people or to possible scrutiny by others leading to avoidance of social situations. Clients with social phobia may benefit from certain medications and therapy, whereas clients with SPD may require a more intensive treatment plan.

Question 8

A cab driver, stuck in traffic, suddenly is lightheaded, tremulous, diaphoretic, and experiences tachycardia and dyspnea. An extensive workup in an emergency department reveals no pathology. Which medical diagnosis is suspected, and what nursing diagnosis takes priority?

Accepted Answer

The symptoms described are typical of a panic attack, which may be part of panic disorder. Therefore, this diagnosis is suspected. The nursing diagnosis of anxiety takes priority because the patient is experiencing acute physical and psychological symptoms related to anxiety.

Question 9

A nursing instructor is teaching about specific phobias. Which student statement should indicate that learning has occurred?

Accepted Answer

This statement accurately describes the defining feature of specific phobias, which is an intense, unreasonable fear or anxiety in response to a specific object or situation. Clients may experience panic symptoms, but their fear is not necessarily at a panic level. The other statements are not accurate descriptions of specific phobias.

Question 10

A client refuses to go on a cruise to the Bahamas with his spouse due to fearing that the cruise ship will sink and all will drown. Using a cognitive theory perspective, how should a nurse explain to the spouse the etiology of this fear?

Accepted Answer

From a cognitive theory perspective, this fear may be due to the individual's distorted and unrealistic appraisal of the situation, leading to excessive anxiety. It is important to explore the individual's thoughts and beliefs about the risk of the cruise ship sinking and work on challenging and restructuring these thoughts to reduce their fear.

Question 11

A nursing student questions an instructor regarding the order for fluvoxamine (Luvox) 300 mg daily for a client diagnosed with obsessive-compulsive disorder (OCD). Which instructor reply is most accurate?

Accepted Answer

This response accurately reflects the current understanding that higher doses of SSRIs may be needed to achieve therapeutic effects in treating OCD, compared to doses effective for depression. Tricyclic medications are typically not used as first-line treatment for OCD due to their less favorable side effect profile, compared to SSRIs. The dose of Luvox may be appropriately prescribed at 300 mg daily for OCD. The potential side effects of daytime drowsiness and nighttime insomnia are common with many SSRIs, and may not necessarily indicate an incorrect dosage.

Question 12

A client diagnosed with panic disorder states, "When an attack happens, I feel like I am going to die." Which is the most appropriate nursing reply?

Accepted Answer

The nurse acknowledges the client's fear but offers reassurance that the panic attack will only last a short time, which can provide some comfort and a sense of control over the situation. Option B is not appropriate because minimizing the client's fear may invalidate their experience. Option C may be true, but it does not provide any immediate comfort or support to the client. Option D may feel confrontational to the client and may not be helpful in managing the panic attack.

Question 13

A nursing instructor is teaching about the medications used to treat panic disorder. Which student statement indicates that learning has occurred?

Accepted Answer

This statement correctly identifies that clonazepam (Klonopin) is effective in the treatment of panic disorder, indicating that learning has occurred. The other options either contain incorrect information or do not specifically relate to the treatment of panic disorder.

Question 14

A family member is seeking advice about an elderly parent who seems to worry unnecessarily about everything. The family member states, "Should I seek psychiatric help for my mother?" Which is an appropriate nursing reply?

Accepted Answer

The nursing reply should provide accurate information and guidance to the family member. Option B is the most appropriate response as it explains that excessive worrying can be considered abnormal and could impair functioning. However, seeking psychiatric help should be based on a thorough assessment by a healthcare professional, and not solely based on the family member's opinion.

Question 15

A client living on the beachfront seeks help with an extreme fear of crossing bridges which interferes with daily life. A psychiatric nurse practitioner decides to try systematic desensitization. Which explanation of this therapy should the nurse convey to the client?

Accepted Answer

The answer of A client living on the beachfront seeks...

Question 16

A nurse is providing discharge teaching to a client taking a benzodiazepine. Which client statement would indicate a need for further follow-up instructions?

Accepted Answer

The statement "I will need scheduled blood work in order to monitor for toxic levels of this drug" is not accurate, as monitoring for therapeutic levels of the drug is important, but monitoring for toxic levels is not typically necessary unless the client experiences adverse effects or has a history of liver or kidney disease. The other statements are all correct and indicate an understanding of proper benzodiazepine use.

Question 17

How would a nurse differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)?

Accepted Answer

The nurse should recognize that a client diagnosed with panic disorder experiences depersonalization,whereas a client diagnosed with GAD would not.Depersonalization refers to being detached from oneself when experiencing extreme anxiety.

Question 18

Which treatment should a nurse identify as most appropriate for clients diagnosed with generalized anxiety disorder (GAD)?

Accepted Answer

Long-term treatment with buspirone (BuSpar) is the most appropriate treatment for clients with generalized anxiety disorder (GAD). This medication is a non-addictive anxiolytic medication that is effective in treating GAD. Diazepam (Valium) and ziprasidone (Geodon) are not recommended for the long-term treatment of GAD due to their high potential for addiction and side effects. Citalopram (Celexa) is more effective for treating depression than anxiety and may take weeks to show significant improvement in anxiety symptoms.

Question 19

A client is newly diagnosed with obsessive-compulsive disorder and spends 45 minutes folding clothes and rearranging them in drawers. Which nursing intervention would best address this client's problem?

Accepted Answer

This intervention is best because it addresses the underlying cause of the client's ritualistic behavior. By discussing the anxiety-provoking triggers, the nurse can help the client identify and manage these triggers, potentially reducing the need for ritualistic behaviors. A and C do not address the underlying cause of the behavior, and B may not be necessary or appropriate at this time.

Question 20

How would a nurse differentiate a client diagnosed with obsessive-compulsive disorder (OCD) from a client diagnosed with obsessive-compulsive personality disorder?

Accepted Answer

Clients diagnosed with OCD experience both obsessions (persistent and recurring thoughts, impulses, or images) and compulsions (repetitive behaviors or mental acts), while clients diagnosed with obsessive-compulsive personality disorder may exhibit perfectionism, rigidity, and preoccupation with orderliness, but do not typically experience the same level of intrusive thoughts and ritualistic behaviors as those with OCD.

Quiz 29: Anxiety Disorders