Chapter 18 Anxiety, OCD and related disorders

Question 1

Ms. T. has been diagnosed with Agoraphobia. Which behavior would be most characteristic of this disorder?

Answer 1

Ms. T stays in her home for fear of being in a place from which she cannot escape.

Question 2

Which of the following is the most appropriate therapy for a client with agoraphobia?

Answer 2

facing her fear in gradual step progression

Question 3

With implosion therapy, a client with phobic anxiety would be:

Answer 3

Presented with massive exposure to a variety of stimuli associated with the phobic object/situation

Question 4

A client with OCD spends many hours a day washing her hands. The most likely reason she washes her hands so much is because it:

Answer 4

Relieves her anxiety

Question 5

The initial care plan for a client with OCD who washes her hands obsessively would include which of the following nursing interventions?

Answer 5

Structure the clients schedule so that she has plenty of time for washing her hands.

Question 6

A client with OCD says to the nurse, “I’ve been here 4 days now, and I’m feeling better, I feel comfortable on this unit and i’m not ill-at-ease with the staff or other patients’ anymore.” In light of this change, which nursing intervention is most appropriate?

Answer 6

Continue to allow Sandy all the time she wants to carry out the ritualistic behavior.

Question 7

Annie has hair-pulling disorder. She is receiving treatment at the mental health clinic with habit reversal therapy. Which of the following elements would be included in this therapy?

Answer 7

Awareness training
Competing response training
Social support

Question 8

Joanie is a new patient at the mental health clinic. She has been diagnosed with body dysmorphic disorder. Which of the following medications is the psychiatric nurse practitioner most likely to prescribe for Joanie?

Answer 8

Fluoxetine (Prozac)

Question 9

A client who is experiencing a panic attack has just arrived at the emergency department. Which is the priority nursing internention for this client?

Answer 9

Stay with the client and reassure of safety

Question 10

Janet has a diagnosis of Generalized Anxiety Disorder. Her physician has prescribed buspirone 15 mg daily. Janet says to the nurse, “Why do I have to take this everyday? My friend’s doctor ordered Xanax for her, and she only takes it when she is feeling anxious.” Which of the following would be an appropriate response by the nurse?

Answer 10

Buspirone must be taken daily in order to be effective.

Question 11

A client has an irrational fear of height (acrophobia). According to the diagnostic criteria for specific phobias, which of the following symptoms would the nurse expect to assess? Select all that apply.

Answer 11

Exposure to the phobic stimulus provokes an immediate anxiety response.

The client experiences marked and persistent fear that is excessive or unreasonable.

Question 12

A client complains of misshapen legs and a number of other physical defects that are not a part of objective reality. Which nursing diagnoses would initially take priority for this client?

Answer 12

Risk for suicide

Question 13

A nonadherent client has a nursing diagnosis of social isolation R/T anxiety, AEB remaining in room during group activities. Which short-term outcome is appropriate ?

Answer 13

The client will request prn anxiolytic medication prior to attending group.

Question 14

A client is experiencing gamophobia. Which fear would the nurse expect to assess?

Answer 14

Fear of marriage

Question 15

When caring for a client who is experiencing a panic attack, which of the following nursing actions should be implemented? Select all that apply.

1) Leave the client alone to maintain privacy.
2) Reduce stimuli in the immediate environment.
3) Instruct the client regarding unit rules and regulations.
4) Administer antianxiety medication as ordered.
5) Communicate with simple words and brief messages

Answer 15

2, 4, 5

Question 16

A client experiencing numbness of the extremities, trembling, and hyperventilation is admitted to the hospital with a diagnosis of panic disorder. Which nursing intervention takes priority?

Answer 16

Quickly administer an anxiolytic medication.

Question 17

What should the nurse plan to teach a client who is taking alprazolam (Xanax) three times a day?

Answer 17

1) That there is a potential for addiction

Question 18

After losing a child in a car accident, a client diagnosed with Post-Traumatic Stress Disorder (PTSD) asks the nurse, “Why did I live and my beautiful daughter die?” Which is the client experiencing?

Answer 18

1) Survivor’s guilt

Question 19

As a part of discharge teaching, a nurse states that the client is vulnerable to trauma-related disorders when his or her fundamental positive beliefs are invalidated by trauma. Which theory of trauma-related disorder etiology is this nurse embracing?

Answer 19

2: An individual is vulnerable to trauma-related disorders when his or her fundamental beliefs are invalidated by a trauma that cannot be comprehended, and a sense of helplessness and hopelessness prevail. The cognitive appraisal of an event falls under cognitive theory which is what the nurse in the question is embracing.

Question 20

A nurse would recognize which client-therapist interactions occurring in the Desensitization Phase of Eye Movement Desensitization and Reprocessing (EMDR) therapy?

Answer 20

The therapist reassesses the client’s level of disturbance after each set of rapid eye movements in the desensitization phase of EMDR.

Question 21

Two months after losing parents in a plane crash, a 20-year-old vandalizes the grandparents’ home, fights with peers, and stops attending school. Which of the following diagnoses should be considered? Select all that apply
.1) Adjustment Disorder with Disturbance of Conduct2) Adjustment Disorder with Depressed Mood3) Antisocial Personality Disorde

Answer 21

Adjustment disorder with disturbance of conduct

& Antisocial Personality disorder

Question 22

A sole survivor of a plane crash is experiencing flashbacks. Which nursing diagnosis would take priority to specifically address this client’s symptom?

Answer 22

Altered sensory perception
4: During a flashback an individual loses touch with objective reality and experiences altered sensations. These sensations can include auditory and visual hallucinations. The nursing diagnosis of altered sensory perception would correctly identify this client problem.

Question 23

A nursing instructor is explaining the etiology of adjustment disorders (ADs) from a Psychoanalytic Theory perspective. Which student statement indicates that learning has occurred?

Answer 23

“AD is a maladaptive response to stress caused by early childhood trauma.”

Proponents of psychoanalytic theory view AD as a maladaptive response to stress that is caused by early childhood trauma, increased dependency, and retarded ego development.

Question 24

A client has experienced high anxiety, nightmares, and guilt for 2 weeks after a severe car accident. The client is diagnosed with acute stress disorder (ASD) rather than post-traumatic stress disorder (PTSD). Which information led to this diagnosis?

Answer 24

In the diagnosis of ASD, the symptoms are time limited, up to 1 month following the trauma. By definition, if the symptoms last longer than 1 month, the diagnosis would be PTSD.

Question 25

A stressor that occurs without warning and may influence an individual’s adaptation is called a __________ __________ stressor.

Answer 25

Sudden-shock

Question 26

According to psychodynamic theory, which primary defense mechanism would the nurse expect to find in a client experiencing amnesia?

Answer 26

4: Repression, which is the involuntary blocking of unpleasant feelings and experiences from one’s awareness, is the defense mechanism most used by clients experiencing amnesia. Freud believed that dissociative behaviors, including amnesia, occurred when individuals repressed distressing mental contents from conscious awareness. He believed that this mechanism protected the client from emotional pain.

Question 27

A client is experiencing pain that has no organic etiology. This pain allows the client to avoid an unpleasant activity. What best describes what this client is experiencing?

Answer 27

Primary gain describes the benefit to the client of avoidance of some unpleasant activity due to experiencing psychologically based pain. This avoidance directly decreases the client’s anxiety. The situation presented in the question describes primary gain.

Question 28

A client has a history of multiple physical complaints involving several organ systems. Diagnostic studies revealed no physiological cause. Which diagnosis would the nurse expect the physician to assign this client?

Answer 28

Somatic symptom disorder is characterized by multiple physical complaints of several years’ duration involving several organ systems with no organic cause. This diagnosis is often accompanied by anxiety and depressed mood.

Question 29

When working with a client diagnosed with a somatic symptom disorder, which is the most appropriate nursing action?
1) Avoid discussing social and personal problems.2) Focus on the physical symptoms.3) Always meet the client’s dependency needs.

Answer 29

4) Gradually minimize time focusing on physical symptoms.

Question 30

Which of the following can be categorized as a somatic symptom disorder? Select all that apply.

Answer 30

1) Illness anxiety disorder

2) Functional neurological symptom disorder