Question 1

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

A)  "Using your imagination, we will attempt to achieve a state of relaxation that you can replicate when faced with crossing a bridge."
B)  "Because anxiety and relaxation are mutually exclusive states, we can attempt to substitute a relaxation response for the anxiety response."
C)  "Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety."
D)  "In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate." C

Question 2

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

A)  Sublimation
B)  Dissociation
C)  Rationalization
D)  Intellectualization D

Question 3

A client diagnosed with post-traumatic stress disorder is receiving paliperidone (Invega). Which symptoms should a nurse identify that warrant the need for this medication?

Accepted Answer

A)  Flat affect and anhedonia
B)  Persistent anorexia and 10 lb weight loss in 3 weeks
C)  Flashbacks of killing the enemy
D)  Distant and guarded relationships C

Question 4

A client diagnosed with generalized anxiety states, "I know the best thing for me to do now is to just forget my worries." How should the nurse evaluate this statement?

Accepted Answer

A)  The client is developing insight.
B)  The client's coping skills are improving.
C)  The client has a distorted perception of problem resolution.
D)  The client is meeting outcomes and moving toward discharge.

Question 5

A client is taking chlordiazepoxide (Librium) for generalized anxiety disorder symptoms. In which situation should a nurse recognize that this client is at greatest risk for drug overdose?

Accepted Answer

A)  When the client has a knowledge deficit related to the effects of the drug
B)  When the client combines the drug with alcohol
C)  When the client takes the drug on an empty stomach
D)  When the client fails to follow dietary restrictions

Question 6

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

A)  Aquaphobia, a natural environment type of phobia
B)  Aquaphobia, a situational type of phobia
C)  Acrophobia, a natural environment type of phobia
D)  Acrophobia, a situational type of phobia

Question 7

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

Accepted Answer

A)  Teach deep breathing relaxation exercises
B)  Place the client in a Trendelenburg position
C)  Stay with the client and offer reassurance of safety
D)  Administer the ordered prn buspirone (BuSpar)

Question 8

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

A)  The client will have no flashbacks.
B)  The client will be able to feel a full range of emotions by discharge.
C)  The client will not require zolpidem (Ambien)  to obtain adequate sleep by discharge.
D)  The client will refrain from discussing the traumatic event.

Question 9

How should a nurse best describe the major maladaptive client response to panic disorder?

Accepted Answer

A)  Clients overuse medical care due to physical symptoms.
B)  Clients use illegal drugs to ease symptoms.
C)  Clients perceive having no control over life situations.
D)  Clients develop compulsions to deal with anxiety.

Question 10

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

A)  Noncompliance R/T test taking
B)  Ineffective role performance R/T helplessness
C)  Altered coping R/T anxiety
D)  Powerlessness R/T fear

Question 11

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

Accepted Answer

A)  Clients diagnosed with OCD experience both obsessions and compulsions, and clients diagnosed with obsessive-compulsive personality disorder do not.
B)  Clients diagnosed with obsessive-compulsive personality disorder experience both obsessions and compulsions, and clients diagnosed with OCD do not.
C)  Clients diagnosed with obsessive-compulsive personality disorder experience only obsessions, and clients diagnosed with OCD experience only compulsions.
D)  Clients diagnosed with OCD experience only obsessions, and clients diagnosed with obsessive-compulsive personality disorder experience only compulsions.

Question 12

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

A)  Distract the client with other activities whenever ritual behaviors begin.
B)  Report the behavior to the psychiatrist to obtain an order for medication dosage increase.
C)  Lock the room to discourage ritualistic behavior.
D)  Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors.

Question 13

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

Accepted Answer

A)  "These clients do not recognize that their fear is excessive and rarely seek treatment."
B)  "These clients have a panic level of fear that is overwhelming and unreasonable."
C)  "These clients experience symptoms that mirror a cerebrovascular accident (CV
A)  ."
D)  "These clients experience the symptoms of tachycardia, dysphagia, and diaphoresis."

Question 14

A nurse is discussing treatment options with a client whose life has been negatively impacted by claustrophobia. The nurse would expect which of the following behavioral therapies to be most commonly used in the treatment of phobias? (Select all that apply.)

Accepted Answer

A)  Benzodiazepine therapy
B)  Systematic desensitization
C)  Imploding (flooding) 
D)  Assertiveness training
E)  Aversion therapy

Question 15

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

A)  "I will need scheduled blood work in order to monitor for toxic levels of this drug."
B)  "I won't stop taking this medication abruptly because there could be serious complications."
C)  "I will not drink alcohol while taking this medication."
D)  "I won't take extra doses of this drug because I can become addicted."

Question 16

A client who is a veteran of the Gulf War is being assessed by a nurse for post-traumatic stress disorder (PTSD). Which of the following client symptoms would support this diagnosis? (Select all that apply.)

Accepted Answer

A)  The client has experienced symptoms of the disorder for 2 weeks.
B)  The client fears a physical integrity threat to self.
C)  The client feels detached and estranged from others.
D)  The client experiences fear and helplessness.
E)  The client is lethargic and somnolent.

Question 17

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

A)  The client will refrain from ritualistic behaviors during daylight hours.
B)  The client will wake early enough to complete rituals prior to breakfast.
C)  The client will participate in three unit activities by day 3.
D)  The client will substitute a productive activity for rituals by day 1.

Question 18

A client is prescribed alprazolam (Xanax) for acute anxiety. What client history should cause a nurse to question this order?

Accepted Answer

A)  History of alcohol dependence
B)  History of personality disorder
C)  History of schizophrenia
D)  History of hypertension

Question 19

A college student has been diagnosed with generalized anxiety disorder (GAD). Which of the following symptoms should a campus nurse expect this client to exhibit? (Select all that apply.)

Accepted Answer

A)  Fatigue
B)  Anorexia
C)  Hyperventilation
D)  Insomnia
E)  Irritability

Question 20

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

Accepted Answer

A)  "Clonazepam (Klonopin)  is particularly effective in the treatment of panic disorder."
B)  "Clozapine (Clozaril)  is used off-label in long-term treatment of panic disorder."
C)  "Doxepin (Sinequan)  can be used in low doses to relieve symptoms of panic attacks."
D)  "Buspirone (BuSpar)  is used for its immediate effect to lower anxiety during panic attacks."

Exam 29: Anxiety Disorders