study questions Flashcards
Ms. T has been diagnosed with agoraphobia. Which behavior would be most characteristic of this disorder?
A. Ms. T. experiences panic anxiety when she encounters snakes.
B. Ms. T refuses to fly in an airplane.
C. Ms. T. Will not eat in public places.
D. Ms. T. stays in her home for fear of being in a place from which she cannot escape.
D. Ms. T. stays in her home for fear of being in a place from which she cannot escape.
Which of the following is the most appropriate therapy for a client with agoraphobia?
A. 10 mg Valium qid
B. Group therapy with other agoraphobics
C. Facing her fear in gradual step progression
D. Hypnosis
C. Facing her fear in gradual step progression
With implosion therapy, a client with phobic anxiety would be:
A. Taught relaxation exercises.
B. Subjected to graded intensities of the fear
C. Instructed to stop the therapeutic session as soon as anxiety is experienced.
D. Presented with massive exposure to a variety of stimuli associated with the phobic object/situation.
D. Presented with massive exposure to a variety of stimuli associated with the phobic object/situation.
A client with OCD spends many hours each day washing her hands. The most likely reason she washes her hands so much is that it:
A. Relieves her anxiety
B. Reduced her probability of infection
C. Gives her a feeling of control over her life
D. Increases her self-concept
A. Relieves her anxiety
The initial care plan for a client with OCD who washes her hands obsessively would include which of the following nursing interventions?
A. Keep the ct’s bathroom locked so she can’t wash her hands all the time.
B. Structure the ct’s schedule so that she has plenty of time for washing her hands.
C. Place the ct in isolation until she promises to stop washing her hands so much.
D. Explain the ct’s behavior to her, since she’s probably unaware that it’s maladaptive.
B. Structure the ct’s schedule so that she has plenty of time for washing her hands.
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 at ill-at-ease with the staff or other pts anymore.” In light of this change, which nursing intervention is most appropriate?
A. Give attention the to ritualistic behaviors each time they occur and point out their inappropriateness.
B. Ignore the ritualistic behaviors, and they will be eliminated for lack of reinforcement.
C. Set limits on the amount of time Sandy may engage in the ritualistic behavior.
D. Continue to allow Sandy all the time she wants to carry out the ritualistic behavior.
C. Set limits on the amount of time Sandy may engage in the ritualistic behavior
Annie has trichotillomania. She is receiving treatment at the mental health clinic with habit-reversal therapy. Which of the following elements would be included in this therapy? (Select all that apply) A. Awareness training B. Competing response training C. Social Support D. Hypnotherapy E. Aversive therapy
A. Awareness training, B. Competing response training, C. Social support
Joanie is a new pt at the mental health clinic. She has been diagnosed with body dysmorphic disorder. Which of the following medication is the psychiatric nurse practitioner most likely to prescribe for Joanie? A. Alprazolam (Xanax) B. Diazepam (Valium) C. Fluoxetine (Prozac) D. Olanzapine (Zyprexa)
C. Fluoxetine (Prozac)
A client who is experiencing a panic attack just arrived at the ER. Which is the priority nursing intervention for this client?
A. Stay with the client and reassure safety
B. Administer a dose of diazepam
C. Leave the client alone in a quiet room so that she can calm down.
D. Encourage the client to talk about what triggered the attack.
A. Stay with the client and reassure safety
Janet has a diagnosis of generalized anxiety disorder. Her physician has prescribed buspirone 15 mg daily. Janet says to her nurse, “Why do I have to take this every day? My friend’s doctor ordered Xanax for her, and she only takes it when she’s feeling anxious.” Which of the following would be an appropriate response by the nurse?
A. “Xanax is not effective for generalized anxiety disorder.”
B. “Buspirone must be taken daily to be effective.”
C. “I will ask the doctor if he will change your dose of buspirone to prn so that you don’t have to take it every day.”
D. “Your friend really should be taking the Xanax every day.”
B. “Buspirone must be taken daily to be effective.
What is the difference between fear and anxiety?
Fear involves cognition-the intellectual appraisal of a threatening stimulus while anxiety is the emotional response to that stimulus.
Neurotransmitters have been implicated in the pathophysiology of anxiety disorders. Select the disturbances that are associated with anxiety disorders:
A. Increased seratonin, decreased norepinephrine, and decreased GABA.
B. Increased seratonin, decreased norepinephrine, and increased GABA.
C. Decreased seratonin, decreased norepinephrine, and decreased GABA.
D. Decreased seratonin, increased norepinephrine, and decreased GABA.
D. Decreased seratonin, increased norepinephrine, and decreased GABA. pg. 530
The mental health nurse recognizes the new nurse requires more teaching when she makes this statement about panic disorder:
A. “ The panic attacks are manifested by intense apprehension, fear or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort.”
B. “Episodes of panic attacks associated with panic disorder are predictable and often occur on exposure to an anxiety producing situation.”
C. “Some common symptoms of panic disorder are: palpitations, pounding heart, sweating and sensations of shortness of breath.”
D. “The average onset of panic disorder is in the late 20s.”
B. “Episodes of panic attacks associated with panic disorder are predictable and often occur on exposure to an anxiety producing situation.”
Panic disorder is characterized by recurrent panic attacks, the onset of which is UNPREDICTABLE. The symptoms come on unexpectedly, not before or on exposure to a situation that usually causes anxiety. pg. 532
What is a biochemical abnormality associated with panic disorder?
Blood elevations of lactate. Pg 533
The neurotransmitter most strongly associated with panic disorder is:
Increased levels of Norepinephrine. It’s known to mediate arousal, and it causes hyperarousal and anxiety. Seratonin and GABA are believed to be decreased in panic disorder as well.
Which of the following is not a common traits/symptom of hoarding disorder? A. Perfectionism B. Indecisiveness C. Distractibility D. narcissistic personality disorder
D. Narcissistic personality disorder is associated body dysmorphic disorder. Associated symptoms of hoarding disorder include: perfectionism, indecisiveness, anxiety, depression, distractibility, and difficulty planning and organizing.
The mental health nurse practitioner would include what initial intervention in the care of the client with hoarding disorder:
A. Psychoeducation about their disorder
B. Ordering neuroimaging to determine activity in the cingulate cortex.
C. Psychopharmacology including an SSRI
D. Cognitive-behavioral therapy
A. psychoeducation about their disorder. This is the most likely INITIAL intervention. Treatment for hoarding disorder is most commonly a combination of cognitive-behavioral therapy and SSRIs. Decreased activity in the cingulate cortex IS associated with hoarding disorder (pg 540) but neuroimaging of the client’s brain is unlikely to be ordered to diagnose/treat this disorder.
The nurse can anticipate a prescription for what medication for the client who was just diagnosed with obsessive compulsive disorder? A. Clomipramine B. Clonidine C. Clonazepam D. Propranolol
A. Clomipramine, a tricyclic antidepressant, as well as SSRIs such as fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and fluvoxamine (Luvox) have been approved for treatment of OCD.
Clonidine and propranolol, are anthypertensives that have been used used successful to treat anxiety disorders. Clonazepam and other benzodiazepines are used to treat social anxiety disorder.
A nursing instructor is teaching about specific phobias. Which student statement indicates to the instructor that learning has occurred?
- “These clients recognize their fear as excessive and frequently seek treatment.”
- “These clients have a panic level of fear that is overwhelming and unreasonable.”
- “These clients experience symptoms that mirror a cerebrovascular accident (CVA).”
- “These clients experience the symptoms of tachycardia, dysphagia, and diaphoresis.”
ANS: 2
Rationale: The nursing instructor should evaluate that learning has occurred when the student knows that clients with phobias have a panic level of fear that is overwhelming and unreasonable. Phobia is fear cued by a specific object or situation in which exposure to the stimuli produces an immediate anxiety response. Even though the disorder is relatively common among the general population, people seldom seek treatment unless the phobia interferes with ability to function.
Which nursing statement to a client about social anxiety disorder versus schizoid personality disorder (SPD) is most accurate?
- “Clients diagnosed with social anxiety disorder can manage anxiety without medications, whereas clients diagnosed with SPD can only manage anxiety with medications.”
- “Clients diagnosed with SPD are distressed by the symptoms experienced in social settings, whereas clients diagnosed with social anxiety disorder are not.”
- “Clients diagnosed with social anxiety disorder avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life.”
- “Clients diagnosed with SPD avoid interactions only in social settings, whereas clients diagnosed with social anxiety disorder tend to avoid interactions in all areas of life.”
ANS: 3
Rationale: Clients diagnosed with social anxiety disorder avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life. Social anxiety disorder is an excessive fear of situations in which a person might do something embarrassing or be evaluated negatively by others.
What symptoms should a nurse recognize that differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)?
- GAD is acute in nature, and panic disorder is chronic.
- Chest pain is a common GAD symptom, whereas this symptom is absent in panic disorders.
- Hyperventilation is a common symptom in GAD and rare in panic disorder.
- Depersonalization is commonly seen in panic disorder and absent in GAD.
ANS: 4
Rationale: 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.
Which treatment should a nurse identify as most appropriate for clients diagnosed with generalized anxiety disorder (GAD)?
- Long-term treatment with diazepam (Valium)
- Acute symptom control with citalopram (Celexa)
- Long-term treatment with buspirone (BuSpar)
- Acute symptom control with ziprasidone (Geodon)
ANS: 3
Rationale: The nurse should identify that an appropriate treatment for clients diagnosed with GAD is long-term treatment with buspirone. Buspirone is an anxiolytic medication that is effective in 60% to 80% of clients diagnosed with GAD. Buspirone takes 10 to 14 days for alleviation of symptoms but does not have the dependency concerns of other anxiolytics.
Which symptoms should a nurse recognize that differentiate a client diagnosed with obsessive-compulsive disorder (OCD) from a client diagnosed with obsessive-compulsive personality disorder?
- Clients diagnosed with OCD experience both obsessions and compulsions, and clients diagnosed with obsessive-compulsive personality disorder do not.
- Clients diagnosed with obsessive-compulsive personality disorder experience both obsessions and compulsions, and clients diagnosed with OCD do not.
- Clients diagnosed with obsessive-compulsive personality disorder experience only obsessions, and clients diagnosed with OCD experience only compulsions.
- Clients diagnosed with OCD experience only obsessions, and clients diagnosed with obsessive-compulsive personality disorder experience only compulsions.
ANS: 1
Rationale: A client diagnosed with OCD experiences both obsessions and compulsions. Clients with obsessive-compulsive personality disorder exhibit a pervasive pattern of preoccupation with orderliness, perfectionism, mental and interpersonal control, but do not experience obsessions and compulsions.
- A cab driver, stuck in traffic, becomes lightheaded, tremulous, diaphoretic, tachycardic and dyspneic. A workup in an emergency department reveals no pathology. Which medical diagnosis should a nurse suspect, and what nursing diagnosis should be the nurse’s first priority?
- Generalized anxiety disorder and a nursing diagnosis of fear
- Altered sensory perception and a nursing diagnosis of panic disorder
- Pain disorder and a nursing diagnosis of altered role performance
- Panic disorder and a nursing diagnosis of anxiety
ANS: 4
Rationale: The nurse should suspect that the client has exhibited signs and symptoms of a panic disorder. The priority nursing diagnosis should be anxiety. Panic disorder is characterized by recurrent, sudden-onset panic attacks in which the person feels intense fear, apprehension, or terror.