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Chapter 27

Psychology

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Chapter 27. Anxiety, Obsessive-Compulsive, and Related Disorders

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

A. These clients do not recognize that their fear is excessive, and they rarely seek treatment.

B. These clients have overwhelming symptoms of panic when exposed to the phobic stimulus.

C. These clients experience symptoms that mirror a cerebrovascular accident (CVA).

D. These clients experience the symptoms of tachycardia, dysphagia, and diaphoresis.

2. 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?

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

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

A. Clients diagnosed with social phobia can manage anxiety without medications, whereas clients diagnosed with SPD can manage anxiety only with medications.

B. Clients diagnosed with SPD are distressed by the symptoms experienced in social settings, whereas clients diagnosed with social phobia are not.

C. Clients diagnosed with social phobia avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life.

D. Clients diagnosed with SPD avoid interactions only in social settings, whereas clients diagnosed with social phobias tend to avoid interactions in all areas of life.

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

A. GAD is acute in nature, and panic disorder is chronic.

B. Chest pain is a common GAD symptom, whereas this symptom is absent in panic disorders.

C. Hyperventilation is a common symptom in GAD and rare in panic disorder.

D. Depersonalization is commonly seen in panic disorder and absent in GAD.

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

A. Long-term treatment with diazepam (Valium)

B. Acute symptom control with citalopram (Celexa)

C. Long-term treatment with buspirone (BuSpar)

D. Acute symptom control with ziprasidone (Geodon)

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

A. Your spouse may be unable to resolve internal conflicts, which result in projected anxiety.

B. Your spouse may be experiencing a distorted and unrealistic appraisal of the situation.

C. Your spouse may have a genetic predisposition to overreacting to potential danger.

D. Your spouse may have high levels of brain chemicals that may distort thinking.

7. Arthur, who is diagnosed with obsessive-compulsive disorder, reports to the nurse that he cant stop thinking about all the potentially life threatening germs in the environment. What is the most accurate way for the nurse to document this symptom?

A. Patient is expressing an obsession with germs.

B. Patient is manifesting compulsive thinking.

C. Patient is expressing delusional thinking about germs.

D. Patient is manifesting arachnophobia of germs.

8. A cab driver stuck in traffic is suddenly lightheaded, tremulous, and 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?

A. Generalized anxiety disorder and a nursing diagnosis of fear

B. Altered sensory perception and a nursing diagnosis of panic disorder

C. Pain disorder and a nursing diagnosis of altered role performance

D. Panic disorder and a nursing diagnosis of panic anxiety

9. 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?

A. I know its frightening, but try to remind yourself that this will only last a short time.

B. Death from a panic attack happens so infrequently that there is no need to worry.

C. Most people who experience panic attacks have feelings of impending doom.

D. Tell me why you think you are going to die every time you have a panic attack.

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

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.

11. 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?

A. My mother also worries unnecessarily. I think it is part of the aging process.

B. Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning.

C. From what you have told me, you should get her to a psychiatrist as soon as possible.

D. Anxiety is a complex phenomenon and is effectively treated only with psychotropic medications.

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

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)

13. A college student is unable to take a final examination because of 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?

A. Noncompliance R/T test taking

B. Ineffective role performance R/T helplessness

C. Altered coping R/T anxiety

D. Powerlessness R/T fear

14. 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?

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.

15. 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?

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.

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?

A. I will need scheduled bloodwork in order to monitor for toxic levels of this drug.

B. I wont stop taking this medication abruptly, because there could be serious complications.

C. I will not drink alcohol while taking this medication.

D. I wont take extra doses of this drug because I can become addicted.

17. 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?

A. Sublimation

B. Dissociation

C. Rationalization

D. Intellectualization

18. 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 clients problem?

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.

19. 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?

A. High doses of tricyclic medications will be required for effective treatment of OCD.

B. Selective serotonin reuptake inhibitor (SSRI) doses, in excess of what is effective for treating depression, may be required for OCD.

C. The dose of Luvox is low due to the side effect of daytime drowsiness and nighttime insomnia.

D. The dosage of Luvox is outside the therapeutic range and needs to be questioned.

20. A client presents in the emergency department with complaints of overwhelming anxiety. Which of the following is a priority for the nurse to assess?

A. Risk for suicide

B. Cardiac status

C. Current stressors

D. Substance use history

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

A. History of alcohol dependence

B. History of personality disorder

C. History of schizophrenia

D. History of hypertension

22. Warrens college roommate actively resists going out with friends whenever they invite him. He says he cant stand to be around other people and confides to Warren They wouldnt like me anyway. Which disorder is Warrens roommate likely suffering from?

A. Agoraphobia

B. Mysophobia

C. Social anxiety disorder (social phobia)

D. Panic disorder

23. A client has the following symptoms: preoccupation with imagined defect, verbalizations that are out of proportion to actual physical abnormalities, and numerous visits to plastic surgeons to seek relief. Which nursing diagnosis would best describe the problems evidenced by these symptoms?

A. Ineffective coping

B. Disturbed body image

C. Complicated grieving

D. Panic anxiety

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

A. Clients overuse medical care because of 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.

25. 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?

A. The client is developing insight.

B. The clients coping skills are improving.

C. The client has a distorted perception of problem resolution.

D. The client is meeting outcomes and moving toward discharge.

26. 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?

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

27. 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? 

A. Fatigue

B. Anorexia

C. Hyperventilation

D. Insomnia

E. Irritability

28. 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? 

A. Benzodiazepine therapy

B. Systematic desensitization

C. Imploding (flooding)

D. Assertiveness training

E. Aversion therapy

29. A nurse has been caring for a client diagnosed with generalized anxiety disorder (GAD). Which of the following nursing interventions would address this clients symptoms? 

A. Encourage the client to recognize the signs of escalating anxiety.

B. Encourage the client to avoid any situation that causes stress.

C. Encourage the client to employ newly learned relaxation techniques.

D. Encourage the client to cognitively reframe thoughts about situations that generate anxiety.

E. Encourage the client to avoid caffeinated products.