Anxiety, Crisis, Anger, Stress Dynamic Quiz

Crisis, Stress, Anxiety

A nurse in an emergency department is caring for a client who states, "I tripped over the dog again." The nurse notes the client has multiple lacerations and ecchymoses and sees in the client's medical record that she visited 2 months ago for similar injuries. Which of the following actions should the nurse take?

• A.

  Ask the client what she believes she did to deserve being physically abused

• B.

  Avoid documenting subjective verbatim statements from the client regarding injuries

• C.

  Talk to the client about making a safety plan

• D.

  Explain the cycle of violence to the client

C. 

Talk to the client about making a safety plan

If the nurse concludes that physical abuse is occurring, it is important to support the client and take actions such as counseling the client about making a safety plan. The nurse should understand local laws regarding intimate partner violence and should report the incident as required.

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D. The nurse should understand the cycle of violence to increase personal understanding of the pattern of behavior that perpetuates intimate partner abuse. However, when caring for the client, the nurse should use crisis interventions to plan actions that will promote client safety.

A nurse is assessing a client who has been taking an antipsychotic medication for 6 years. The provider has started tapering off the client’s dosage. The nurse should monitor the client for which of the following manifestations of tardive dyskinesia?

• A.

  Muscular weakness

• B.

  Muscle spasms

• C.

  Involuntary tongue protrusion

• D.

  Uncontrolled rolling of the eyes

C. 

Involuntary tongue protrusion

Tardive dyskinesia begins with mouth and facial movements and progresses to involve other muscle groups. All clients receiving antipsychotic therapy for months to years are at risk. This adverse effect is potentially irreversible, and discontinuing the drug rarely relieves these manifestations.

Incorrect Answers:
A. Akinesia manifests as muscular weakness. This adverse effect can be noticeable 1 to 5 days after starting antipsychotic therapy and occurs most often in women, older adults, and clients who are dehydrated.

B. Dystonia involves involuntary muscular movements of the face, arms, legs, and neck. This adverse effect occurs most often in men and clients 25 years of age and younger. The nurse should assess the client for dystonia in the first days of antipsychotic medication therapy.

D. An oculogyric crisis is a condition in which the client has no control of rolling the eyes. This adverse effect might be mistaken for seizure activity and should be treated as an emergency situation. The nurse should assess the client for an oculogyric crisis in the first days of antipsychotic medication therapy.

A nurse is caring for a client whose adolescent child just died in a motor-vehicle crash. The client is crying inconsolably. Which of the following actions should the nurse take?

• A.

  Suggest that the client call the facility's chaplain

• B.

  Provide a quiet place for the client to be alone

• C.

  Stay with the client and allow the client to cry

• D.

  Express sympathy for the client’s loss

C. 

Stay with the client and allow the client to cry

The nurse demonstrates respect for the client’s feelings by staying nearby. The use of silence is a therapeutic communication technique, and allowing the client to cry is therapeutic during times of grieving.

A nurse is assessing a client who takes phenelzine for the treatment of depression. Which of the following findings is the priority for the nurse to report to the provider?

• A.

  Elevated blood pressure

• B.

  Weight gain

• C.

  Muscle twitching

• D.

  2+ peripheral edema

A. 

Elevated blood pressure

The greatest risk to this client is an elevated blood pressure, which increases the risk of a hypertensive crisis that can result from taking an MAOI like phenelzine. The nurse should apply the safety and risk reduction priority-setting framework when assessing this client, which assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the risk posing the greatest threat is the highest priority. The nurse should use Maslow’s hierarchy of needs, the ABC priority-setting framework, and/or nursing knowledge to identify which risk poses the greatest threat to the client.

Incorrect Answers:
B. Weight gain is a common adverse effect of an MAOI like phenelzine. The nurse should report the adverse effect to the provider; however, there is another finding that is a greater risk to the client than weight gain.

C. Muscle twitching is a common adverse effect of an MAOI like phenelzine. The nurse should report the adverse effect to the provider; however, there is another finding that is a greater risk to the client than muscle twitching.

D. Peripheral edema is a common adverse effect of an MAOI like phenelzine. The nurse should report the adverse effect to the provider; however, there is another finding that is a greater risk to the client than peripheral edema.

A nurse is caring for 4 clients in a community mental health facility. For which of the following clients should the nurse provide a tertiary care intervention?

• A.

  A client who has generalized anxiety disorder and reports increased anxiety and insomnia

• B.

  A client who is expressing hopelessness during a crisis

• C.

  A client who is recovering from a crisis and asks for help in completing the recovery process

• D.

  A client who is having difficulty coping with stress and wants to learn relaxation techniques

C. 

A client who is recovering from a crisis and asks for help in completing the recovery process

This client should receive tertiary care interventions such as a referral to community groups or facilities to complete recovery from a crisis. Tertiary care is designed to provide support for mental and physical healing after a crisis occurs.

Incorrect Answers:
A. This client should receive primary care interventions to promote wellness and prevent the occurrence of a crisis. The nurse can determine causes of increased anxiety by having the client complete a Recent Life Events questionnaire as well as by using therapeutic communication techniques to understand the emotions the client is currently experiencing.

B. This client should receive secondary care interventions to decrease prolonged anxiety during an acute crisis. The nurse should provide a protected environment while determining the client's potential for self-harm.

D. This client should receive primary care interventions to promote wellness and prevent the occurrence of a crisis. The nurse can teach the client to use a variety of techniques to decrease anxiety, including muscle relaxation and deep-breathing exercises.

A nurse is reviewing the medical record of a client who has a new prescription for tranylcypromine. The client still has a current prescription for sertraline. The nurse should notify the provider because taking these medications concurrently increases the risk of which of the following adverse effects?

• A.

  Increased intracranial pressure

• B.

  Serotonin syndrome

• C.

  Acute kidney injury

• D.

  Hypertensive crisis

B. 

Serotonin syndrome

Serotonin syndrome is a toxic effect that can occur from taking an MAOI such as tranylcypromine and an SSRI such as sertraline simultaneously. Manifestations include delirium, abdominal pain, muscle spasms, and irritability, and the condition can worsen to cause cardiovascular shock and death. The nurse should notify the provider immediately of this potential interaction.

A nurse in a community mental health facility is caring for 4 clients. Which of the following clients should the nurse identify as experiencing an adventitious crisis?

• A.

  A client who has a new diagnosis of severe bipolar disorder

• B.

  A client who is depressed following a devastating fire in her home

• C.

  A client who is experiencing acute grief following his father's death

• D.

  A client who is experiencing postpartum depression following the birth of her first child

B. 

A client who is depressed following a devastating fire in her home

The nurse should identify that a client who is experiencing depression following a house fire is experiencing an adventitious crisis. An adventitious crisis is unplanned and not a part of everyday life. The crisis can result from a natural disaster, a national disaster, or a crime of violence.

Incorrect Answers:
A. Bipolar disorder is a chronic recurring mental illness. A client who develops a mental illness can experience a situational crisis, which is unanticipated and extraordinary.

C. A client who is experiencing grief following the death of a family member is experiencing a maturational crisis, which occurs during different stages across the lifespan.

D. A client who is experiencing postpartum depression following the birth of a child is experiencing a maturational crisis, which occurs during different stages across the lifespan.

A nurse is speaking with a client whose partner was killed unexpectedly. The client states, "I just don't know what to do now." Which of the following actions should the nurse take?

• A.

  Talk to the client about available community resources

• B.

  Distract the client by discussing events not related to the crisis

• C.

  Reassure the client that he will feel better soon

• D.

  Give the client advice about what to do during the next few days

A. 

Talk to the client about available community resources

Initial steps should be taken to make a client who is experiencing a crisis feel safe and less anxious. The priority for the nurse is to ensure the client is safe, which includes assessing any thoughts of self-harm. After promoting client safety, the nurse should let the client know what personal and community resources are available. The nurse should determine the client’s perception of the crisis, availability of support, and ability to cope with the crisis.

Incorrect Answers:
B. Changing the subject from the crisis invalidates the client's feelings and can make the client feel isolated.

C. The nurse should avoid giving false reassurance, which belittles the client's feelings.

D. Giving advice inhibits clients' ability to problem-solve. Clients have autonomy over their lives and should be allowed to make decisions about situations that affect them. The nurse can use therapeutic communication techniques to help clients determine what actions they should take.

A nurse is teaching a client who has an anxiety disorder about nonpharmacological ways to promote good sleep habits. Which of the following recommendations should the nurse make?

• A.

  "Schedule 20 minutes of aerobic exercise during the hour before bedtime."

• B.

  "Eliminate all caffeinated beverages from your diet."

• C.

  "Sleep for extra time when you can."

• D.

  "Eat a light snack containing carbohydrates before bedtime."

D. 

"Eat a light snack containing carbohydrates before bedtime."

A light snack consisting of a carbohydrate-based food or milk can help promote sleep when ingested before bedtime. Consuming heavy meals just before sleeping can promote insomnia.

Incorrect Answers:
A. The client should exercise 3 hours or more before bedtime to avoid sleep interruption. Moderate aerobic activity for about 20 minutes earlier in the day has been shown to reduce stress and prevent insomnia.

B. Beverages containing caffeine can cause insomnia and tachycardia and increase anxiety. Clients who drink more than 4 caffeinated beverages daily should be instructed to decrease their use slowly to prevent withdrawal manifestations such as headaches and irritability.

C. Sleeping for extra time can cause sleep disruptions and increased fatigue. The client should be instructed to keep a consistent sleep schedule regarding bedtime and waking time.

A nurse is helping a client who has an anxiety disorder select a nonpharmacological stress-reduction therapy for home use. Which of the following therapies engages the insular cortex of the brain to allow the client to focus on a single thought that is important to the client in the present moment?

• A.

  Guided imagery

• B.

  Progressive relaxation

• C.

  Cognitive reframing

• D.

  Mindfulness

D. 

Mindfulness

The practice of mindfulness engages the insular cortex as the person focuses on the sensations and surroundings of the present moment. The client learns to stop the mind from wandering to multiple thoughts and worries and to concentrate on a single thought or situation that is important at that time.

Incorrect Answers:
A. Guided imagery allows the client to focus on pleasant mental images such as peaceful scenes remembered from previous experiences.

B. Progressive relaxation focuses on tightening and then relaxing muscle groups to reduce muscle tension. The client focuses on the relaxation activity rather than on thoughts or events that are important to the client.

C. Cognitive reframing is a technique that reduces anxiety as the individual changes how to interpret thoughts or situations that have already occurred in a more positive way.

A nurse is caring for a client who has social anxiety disorder. Which of the following client statements should the nurse expect?

• A.

  "I am embarrassed to eat in public."

• B.

  "I often feel like I am going to have a heart attack."

• C.

  "I struggle to control my constant worry."

• D.

  "I have to step over the cracks in the sidewalk or else something bad might happen."

A. 

"I am embarrassed to eat in public."

The nurse should recognize that this statement describes social anxiety disorder. Clients who have this disorder experience severe anxiety or fear of behaving in a manner that can be negatively viewed by others. These clients attempt to avoid activities such as eating or speaking in public. If they are unable to avoid activities that trigger the anxiety, clients experience severe anxiety and emotional distress.

Incorrect Answers:
B. The nurse should recognize that this statement describes a panic disorder, which manifests as a feeling of impending doom. Panic attacks are unpredictable and intense, and they cause a variety of stress-related physical manifestations. The attacks usually last a few minutes and then subside.

C. The nurse should recognize that this statement describes generalized anxiety disorder, which manifests as excessive worry. This disorder causes impaired concentration that can lead to fatigue, irritability, and sleep disturbances.

D. The nurse should recognize that this statement describes obsessive-compulsive disorder (OCD), which manifests in the performance of repetitive behaviors. Clients who have OCD adhere to stringent rules and routines that can occupy much of their time.

A nurse is caring for a child who has Tourette's disorder. Which of the following behaviors should the nurse expect?

• A.

  Multiple motor and vocal tics

• B.

  Areas of baldness on the scalp

• C.

  Insatiable hunger

• D.

  Exaggerated startle response

A. 

Multiple motor and vocal tics

The nurse should expect a child who has Tourette's disorder to display multiple motor and vocal tics. A tic is a sudden physical movement or vocalization of sounds or words that are unrelated to the topic of conversation. Tics can change in frequency, severity, and location. Tourette's disorder is an inherited condition that causes clients to have multiple physical tics and one or more vocal tics.

Incorrect Answers:
B. A child who has trichotillomania pulls out hair on the scalp, eyebrows, and eyelashes in response to anxiety or to obtain a sense of self-gratification.

C. Insatiable hunger is a manifestation of Prader-Willi syndrome, which is a genetic abnormality that results initially in a failure to thrive. Later in childhood, a child who has this syndrome develops insatiable hunger and morbid obesity. Other manifestations include cognitive dysfunction and behavior disorders.

D. A child who has posttraumatic stress disorder can experience several manifestations that include flashbacks, social withdrawal, sleep disturbances, and an exaggerated startle response.

A nurse enters a client’s room and observes that the client is agitated and pacing rapidly. The client looks at the nurse and says, "Back off. Leave me alone." Which of the following statements should the nurse make?

• A.

  "I demand that you calm down now. Your behavior is unacceptable."

• B.

  "I will close the door to provide privacy, and you can tell me what is bothering you."

• C.

  "I will give you space if you calm down. Tell me what is causing you to feel so tense."

• D.

  "I will leave you alone for a few minutes while you try to control yourself."

C. 

"I will give you space if you calm down. Tell me what is causing you to feel so tense."

The nurse should stay at a safe distance and remain calm while stressing the importance of maintaining control. The nurse should use verbal de-escalation techniques while determining the client’s needs and respecting the client’s personal space.

Incorrect Answers:
A. The nurse should avoid confrontational communication that will likely increase the client’s level of agitation.

B. The nurse should consider staff safety when attempting to calm the client. By closing the door, the nurse does not have an escape route if the client becomes violent.

D. The nurse should avoid leaving the client alone while in an agitated state and a potential danger to self. If other de-escalation techniques are ineffective, then the nurse may implement seclusion in a safe and monitored environment.

A nurse is caring for a client who has post-traumatic stress disorder (PTSD) and who is undergoing eye movement desensitization and reprocessing (EMDR) therapy. The nurse should identify that EMDR includes which of the following strategies?

• A.

  Exposes the client to circumstances that trigger the PTSD

• B.

  Assists the client with behavioral modification

• C.

  Encourages the client to visualize a relaxing scene when traumatic memories occur

• D.

  Uses stimuli to change how the client processes the trauma

D. 

Uses stimuli to change how the client processes the trauma

EMDR uses stimuli such as tapping, eye movements, or audio sounds combined with verbalization of the traumatic event by the client. While the client recalls the traumatic event, these stimuli create neurological and physiological changes in how the client integrates the memories. EMDR is a type of psychotherapy carried out during several sessions by a therapist who is trained in the method.

Incorrect Answers:
A. Cognitive behavioral therapy includes exposing therapy. However, this action is not a strategy of EMDR.

B. Behavioral modification is within the scope of cognitive behavioral therapy. However, this action is not a strategy of EMDR.

C. Imagining a pleasant or relaxing scene can give the client some relief from stress and trauma. However, this action is not a strategy of EMDR.

A nurse is assessing a client who is experiencing stress following a near fall out of bed. Which of the following physiological responses should the nurse expect due to the fight-or-flight response?

• A.

  Decreased respiratory rate

• B.

  Pinpoint pupils

• C.

  Increased blood pressure

• D.

  Bronchiolar construction

C. 

Increased blood pressure

The nurse should expect a client who is experiencing the fight-or-flight response to manifest an increase in arterial blood pressure, heart rate, and cardiac output due to arousal of the central nervous system.

Incorrect Answers:
A. The nurse should expect an increased respiratory rate in a client who is experiencing the fight-or-flight response.

B. The nurse should expect dilated pupils in a client who is experiencing the fight-or-flight response.

D. The nurse should expect bronchiolar dilation in a client who is experiencing the fight-or-flight response.

A nurse is caring for a client who has post-traumatic stress disorder (PTSD). Which of the following actions by the client indicates the current treatment plan is effective?

• A.

  The client reports techniques she uses to promote sleep.

• B.

  The client shows limited emotion when witnessing a traumatic event.

• C.

  The client asks the nurse’s opinion about the clothes she is wearing.

• D.

  The client avoids situations that might trigger memories of past trauma.

A. 

The client reports techniques she uses to promote sleep.

Clients who have PTSD often experience disrupted sleep; therefore, reporting the use of techniques that promote sleep indicates the current treatment plan is effective.

Incorrect Answers:
B. Clients who have PTSD often repress emotion and appear detached from situations; therefore, showing limited emotion when witnessing a traumatic event indicates the current treatment plan is not effective.

C. Clients who have PTSD often exhibit indecisiveness; therefore, asking the nurse’s opinion about clothes indicates the current treatment plan is not effective.

D. Clients who have PTSD often avoid situations that might trigger memories of past trauma; therefore, avoiding these situations indicates the current treatment plan is not effective.

A nurse is speaking with parents who are at a clinic for a 2-week follow-up visit after the birth of their second child. They report that their 5-year-old daughter has started to wet the bed at night after being toilet trained for 2 years. The nurse should tell the parents that this is expected behavior and illustrates which of the following defense mechanisms?

• A.

  Compensation

• B.

  Repression

• C.

  Regression

• D.

  Suppression

C. 

Regression

Regression is reverting to a previous, more child-like behavior.

Incorrect Answers:
A. Compensation is an attempt to counterbalance a deficiency with a strength.

B. Repression is an unconscious act of avoiding unpleasant experiences, emotions, or ideas.

D. Suppression is the conscious act of avoiding stressful situations or feelings.

A nurse is providing teaching to a client who has obsessive-compulsive disorder and performs hand hygiene to decrease anxiety. Which of the following actions by the nurse implements modeling as a behavioral intervention strategy?

• A.

  Setting a time limit between episodes of hand hygiene

• B.

  Demonstrating performance of hand hygiene at scheduled times

• C.

  Telling the client to shout “stop” each time an urge to perform hand hygiene arises

• D.

  Instructing the client to practice muscle relaxation when experiencing the urge to perform hand hygiene

B. 

Demonstrating performance of hand hygiene at scheduled times

This action is an example of modeling, which is a behavioral intervention strategy that allows the client to see the expected behaviors performed by the nurse.

Incorrect Answers:
A. This action is an example of response prevention, which instructs the client to set time limits between each episode of the compulsive ritual.

C. This action is an example of thought stopping, which is a strategy the client uses to interrupt obtrusive thoughts or actions.

D. This action is an example of relaxation training, which is a behavioral intervention the client can use to counteract stress and anxiety.

A nurse in a mental health clinic is caring for a client who states, "I think I might have a problem with alcohol." Which of the following actions should the nurse take first?

• A.

  Provide the client with information about a 12-step recovery program

• B.

  Encourage the client to accept responsibility for his alcohol use

• C.

  Teach the client alternate coping mechanisms to use in place of alcohol

• D.

  Ask the client to complete the CAGE questionnaire

D. 

Ask the client to complete the CAGE questionnaire

The nurse should apply the nursing process priority-setting framework to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with an assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify the provider of a change in the client's status, the nurse must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with the knowledge to make an appropriate decision. Therefore, the first action the nurse should take is to assess the client’s alcohol use. Completing a CAGE questionnaire can help determine the impact of alcohol use on the client’s life.

Incorrect Answers:
A. The nurse should provide the client with information about a 12-step recovery program, such as Alcoholics Anonymous; however, there is another action that the nurse should take first.

B. The nurse should encourage the client to accept responsibility for his alcohol use, which encourages acceptance of the alcohol use problem and promotes recovery; however, there is another action that the nurse should take first.

C. The nurse should teach the client coping mechanisms to use in response to stress besides alcohol; however, there is another action that the nurse should take first.

A nurse in a substance use disorder program is interacting with a client. Which of the following statements indicates the client is using intellectualization as a means of coping with the anxiety of admission?

• A.

  "I was just using the medication to help me during a rough time in my life. I can stop whenever I want."

• B.

  "This all happened because my spouse is unemployed. That puts an enormous amount of stress on me."

• C.

  "I’ve read that problems with substances can have a variety of predisposing factors."

• D.

  "I just don’t want to talk. Anyway, there is nothing you can do to help."

C. 

"I’ve read that problems with substances can have a variety of predisposing factors."

The nurse should identify this response as a use of intellectualization, which is an attempt to use intellectual processes to avoid expressing the emotions that stem from stressful situations.

Incorrect Answers:
A. This response illustrates the defense mechanism of denial, as the client is refusing to acknowledge the existence of a substance use disorder.

B. This response illustrates the defense mechanism of rationalization, as the client is attempting to make excuses to justify socially or professionally unacceptable behavior.

D. This response illustrates the defense mechanism of suppression, as the client is consciously avoiding a discussion of the substance use disorder.

A nurse is providing teaching about stress management to a client who is experiencing anxiety. Which of the following techniques should the nurse recommend to assist the client in identifying his stressors?

• A.

  Biofeedback

• B.

  Intellectualization

• C.

  Journaling

• D.

  Cognitive reframing

: C. 

Journaling

Journaling is a technique that can be used to identify stressors. By recording feelings and responses to events, the client can find the source of everyday stressors and begin the process of stress reduction.

Incorrect Answers:
A. Biofeedback is a mind-body relaxation technique that uses instrumentation to monitor physiological responses such as heart rate, blood pressure, and skin temperature.

B. Intellectualization is a defense mechanism that uses facts to examine events rather than responding with emotion. The technique can be adaptive or maladaptive.

D. Cognitive reframing is a relaxation technique that replaces negative self-talk with positive responses. Also known as cognitive restructuring, this technique is designed to reduce stress by giving the client a sense of better control over situations.

A nurse asks an older adult client, "Did you have any visitors yesterday?" The client responds, "Yes, several members of my church choir came to see me." The nurse knows that only the client’s daughter visited on the day in question. Which of the following cognitive impairments is the client demonstrating?

• A.

  Perseveration

• B.

  Confabulation

• C.

  Apraxia

• D.

  Agnosia

B. 

Confabulation

Confabulation involves filling in gaps in memory by fabrication. The client unconsciously makes up responses that are inaccurate to avoid the embarrassment of memory loss.

Incorrect Answers:
A. Perseveration is the repetition of phrases or behavior and is most often exhibited by clients under stress.

C. Apraxia is the loss of purposeful movement in the absence of motor or sensory impairment. This is often exhibited by clients who are unable to perform once-familiar tasks.

D. Agnosia is the loss of the sensory ability to recognize objects. This is often exhibited by clients who have lost the ability to recognize familiar sounds or people.

A nurse is caring for a client who has excoriation disorder. Which of the following statements by the client should the nurse expect?

• A.

  "I pick my face when I am nervous."

• B.

  "I have bald patches from pulling out my hair."

• C.

  "I inspect my body in the mirror several times a day."

• D.

  "I am unable to part with any of my belongings."

A. 

"I pick my face when I am nervous."

The nurse should recognize that this statement is an indication of excoriation disorder. Clients who have excoriation disorder typically pick their faces when experiencing stress or anxiety.

Incorrect Answers:
B. The nurse should recognize that this statement is an indication of trichotillomania (hair pulling disorder). Hair is typically pulled from the head, although other parts of the body with hair can be affected. For some clients, the pain experienced from pulling their hair reduces stress and anxiety.

C. The nurse should recognize that this statement is an indication of body dysmorphic disorder. Clients who have body dysmorphic disorder obsessively believe their body is defective in some manner. The preoccupation with these false beliefs can lead to depression and self-shame. Suicide risk is high for clients who have this disorder.

D. The nurse should recognize that this statement is an indication of hoarding disorder, which manifests as being unable to discard any belongings. Possessions can collect to the point of completely filling the client's place of residence, which can lead to an unsafe or unsanitary environment. This disorder can stem from a stressful event and, eventually, can become so pervasive that it impairs normal living.

A nurse is assessing a client who has adjustment disorder. Which of the following statements by the client should the nurse recognize as a manifestation of this disorder?

• A.

  "I am unable to remember my address."

• B.

  "I feel like I am living in a fog."

• C.

  "I sometimes cannot remember large blocks of time."

• D.

  "I could have done something to prevent my cousin's death."

: D. 

"I could have done something to prevent my cousin's death."

The nurse should recognize that this statement indicates adjustment disorder, which occurs as a response to a stressful event. Manifestations can include guilt, depression, anxiety, and anger. These feelings might accompany physical manifestations, social withdrawal, or work or academic changes. The disorder can be treated with antidepressant medications.

Incorrect Answers:
A. The nurse should recognize that this statement indicates dissociative amnesia, a disorder in which there is an inability to recall important personal information. The disorder is generally a response to a traumatic or stressful event.

B. The nurse should recognize that this statement indicates derealization disorder, which manifests as a client feeling that his or her surroundings are unreal or distant. The disorder is a response to acute stress. Manifestations can come and go or become constant.

C. The nurse should recognize that this statement indicates dissociative identity disorder, which manifests as other distinct personalities controlling a client's behavior. The primary personality is unaware of the alter personalities and can, therefore, lose time and memory of events.

A nurse is planning care for a client who reports abdominal pain. An assessment by the nurse reveals the client has a temperature of 39.2°C (102.6°F), a heart rate of 105/min, a soft nontender abdomen, and menses overdue by 2 days. Which of the following findings should be the nurse's priority?

• A.

  Heart rate of 105/min

• B.

  Soft nontender abdomen

• C.

  Temperature

• D.

  Overdue menses

C. 

Temperature

Elevated temperature is an emergent physiological need that requires priority intervention by the nurse. The nurse should consider Maslow’s Hierarchy of Needs, which includes five levels of priority. The levels are as follows: physiological needs, safety, and security needs, love and belonging needs, personal achievement and self-esteem needs, and achievement of full potential and the ability to problem-solve and cope with life situations.

When applying Maslow’s Hierarchy of Needs, the nurse should review physiological needs first before following the remaining four levels. However, it is important for the nurse to consider all contributing client factors, as higher levels of the pyramid can compete with those at the lower levels, depending on the situation.

Incorrect Answers:

A. This is an important assessment finding because the client's heart rate is elevated. However, a fever and pain can contribute to tachycardia. This is not the priority finding.

B. This is an important assessment finding because of the client’s report of pain. However, a soft non-tender abdomen is an expected finding and should not cause concern.

D. This is an important assessment finding because of the client’s report of pain. However, an irregularity in the menstrual cycle is a common finding when a client is stressed. This is not the priority finding.

A nurse is leading a support group for clients who are about to be discharged from an acute care mental health facility. During a group session, a client states, "I'm scared of being discharged." Which of the following responses should the nurse offer?

• A.

  "Maybe you are not ready to be discharged yet."

• B.

  "Do others in the group have similar feelings they would like to share?"

• C.

  "You ought to be happy that you're being discharged."

• D.

  "How many in the group feel this member is not yet ready to be discharged?"

B. 

"Do others in the group have similar feelings they would like to share?"

The nurse should identify that some of the goals of a support group include providing improved interpersonal relationships, mutual support, and methods to decrease stress. By asking if others in the group have similar feelings, the nurse is allowing the client to hear that feelings regarding discharge are not unique. The client might receive support from group members who express similar feelings.

A nurse is assessing a client who is experiencing post-traumatic stress disorder (PTSD) following a traumatic event. Which of the following medications should the nurse expect the provider to prescribe?

• A.

  Bupropion

• B.

  Phenelzine

• C.

  Mirtazapine

• D.

  Paroxetine

D. 

Paroxetine

The nurse should expect the provider to prescribe paroxetine, an SSRI that is considered the first-line treatment for PTSD.

Incorrect Answers:
A. Bupropion is an aminoketone antidepressant that is prescribed for smoking cessation, depression, and treatment of ADHD. It is not prescribed for the treatment of PTSD.

B. Phenelzine is an MAOI antidepressant that can be prescribed for PTSD. However, SSRIs such as paroxetine are the first choice for PTSD.

C. Mirtazapine is a tricyclic antidepressant that can be prescribed for PTSD. However, SSRIs such as paroxetine are the first choice for PTSD.

A nurse is assessing a newly admitted client who has generalized anxiety disorder and states, “I drink alcohol to forget the pain.” The client is exhibiting a maladaptive response to which of the following defense mechanisms?

• A.

  Compensation

• B.

  Conversion

• C.

  Projection

• D.

  Suppression

A. 

Compensation

Compensation is a defense mechanism by which a person covers a real or perceived problem or weakness. This client is temporarily attempting to block the constant worry of generalized anxiety disorder by drinking alcohol, which is a maladaptive method of increasing self-esteem. An example of an adaptive use of compensation would be if a person who had an anxiety disorder worked hard to excel in some way to avoid being defined by the anxiety disorder.

Incorrect Answers:
B. Conversion is the unconscious transformation of anxiety into physical manifestations with no organic cause.

C. Projection is the unknowing rejection of emotionally unacceptable feelings by attributing those feelings to others.

D. Suppression is the conscious blocking of disturbing feelings by suppressing conscious thoughts to avoid worrying about a stressor.

A nurse is providing teaching to the partner of a client who has conversion disorder. Which of the following statements by the partner shows an understanding of the teaching?

• A.

  "My partner is pretending to be ill to get attention."

• B.

  "My partner is purposefully making our child sick."

• C.

  "The stress of losing our child caused my partner to go blind."

• D.

  "My partner is worried that he has cancer, even though his tests are normal."

C. 

"The stress of losing our child caused my partner to go blind."

The nurse should explain to the partner that conversion disorder manifests as deficits in motor or sensory functions. Emotional conflict or stress is reflected in physical manifestations that can include paralysis, blindness, movement disorder, numbness, paresthesia, loss of hearing, or episodes resembling epilepsy.

Incorrect Answers:
A. The nurse should explain to the partner that clients who have factitious disorder pretend to be sick by creating manifestations to have their emotional needs met.

B. The nurse should explain to the partner that factitious disorder imposed on another, also known as Munchausen syndrome by proxy, is when a caregiver deliberately falsifies illness in a dependent. The motive of the perpetrator is to gain attention by having a sick dependent. The dependent is often exposed to unnecessary tests and treatments.

D. The nurse should explain to the partner that illness anxiety disorder is characterized by obsessive worry and fear of having a disease. The obsession leads to frequent attention to the body to identify signs of illness. Some clients seek medical care, while others who have the disorder avoid medical care.

A nurse is preparing to care for a client who was brought to a community health facility by her caregiver, who states that the client refuses to eat. The nurse notes the client has lost weight, avoids making eye contact, and defers questions to the caregiver. Which of the following actions should the nurse take?

• A.

  Make sure the caregiver is present when interviewing the client

• B.

  Document how the caregiver responds when told that the client looks neglected

• C.

  Ask the client why she refuses to eat the caregiver's food

• D.

  Identify sources of stress for the caregiver

D. 

Identify sources of stress for the caregiver

In addition to collecting information from the client, the nurse should interview the caregiver and should ask about sources of stress. It is important to gain an understanding of the social environment of the home to identify needed changes that may improve care for the client.

Incorrect Answers:
A. The nurse should interview the client in private and should work to establish a trusting nurse-client relationship to put the client at ease during care.

B. The nurse should avoid trying to prove maltreatment by making accusations, placing blame, or judging because these actions decrease trust. If maltreatment is suspected by the nurse following an assessment, the nurse has the duty to report the situation to adult protective services.

C. This question could cause the client to feel at fault or in trouble and should be avoided. The nurse should use open-ended statements and questions to obtain information from the client.

A nurse is teaching a client who has a new prescription for disulfiram to treat alcohol use disorder. Which of the following statements by the client indicates an understanding of the teaching?

• A.

  "If I have a strong urge to drink alcohol, I should skip my dose for that day."

• B.

  "Even when I'm not drinking alcohol, adverse effects can include seizures."

• C.

  "Medication therapy can begin as soon as I enter the detoxification program."

• D.

  "I should check the labels of my skin-care products, medications, and food for alcohol."

D. 

"I should check the labels of my skin-care products, medications, and food for alcohol."

The client should check all products for the presence of alcohol when taking disulfiram. The nurse should inform the client that 7 mL of alcohol is needed to precipitate adverse effects of the medication. Alcohol can be found in cough syrups, vinegar, and sauces. It might also be applied to the skin in aftershave and cologne.

Incorrect Answers:
A. The nurse should inform the client that the effects of disulfiram will continue for up to 2 weeks following the last dose. The nurse should stress the importance of avoiding alcohol during this time period as well.

B. The nurse should inform the client about adverse effects of the medication such as drowsiness and skin eruptions. Respiratory depression and convulsions are manifestations of acetaldehyde syndrome, which is a potentially dangerous event that can occur when alcohol is consumed while taking this medication.

C. The nurse should inform the client that disulfiram should not be administered until at least 12 hours after alcohol was last ingested.

A client who has hypertension tells the nurse in a provider's office that she feels the considerable amount of stress at work is affecting her blood-pressure control. The nurse should instruct the client to do which of the following when the stress is unavoidable?

• A.

  Consider changing jobs to something less stressful

• B.

  Identify the stressors at work and then try to reduce them

• C.

  Plan for periods away from work throughout the day

• D.

  Improve her ability to cope with identified stressors

D. 

Improve her ability to cope with identified stressors

The nurse should help the client learn stress-management techniques to deal with stress without internalizing it.

Incorrect Answers:
A. Changing jobs is not a long-term solution and is among the top 10 life stressors. Even if the new job seems less stressful at first, some stressors will likely emerge over time.

B. If the client had control over work stressors, it is unlikely that she would report somatic effects of job stress.

C. The client likely cannot take periods of time away from work that are frequent or long enough to relieve work-related stress.

A nurse in a mental health facility is caring for a client who has generalized anxiety disorder. Which of the following statements should the nurse offer?

• A.

  "We’ll assist you with making decisions."

• B.

  "Someone will work with you when you have flashbacks."

• C.

  "You’ll be going through aversion therapy to help you cope."

• D.

  "The therapy will help you control your impulses."

A. 

"We’ll assist you with making decisions."

Clients who have generalized anxiety disorder are often indecisive and dread making decisions. Therefore, the nurse should reassure the client that help will be provided with making decisions.

Incorrect Answers:
B. Clients who have post-traumatic stress disorder experience flashbacks; this would not be necessary for a client who has generalized anxiety disorder.

C. Clients who have behaviors that might not be successfully treated by other methods, such as alcohol use disorder or aggression, can benefit from aversion therapy. Aversion therapy is not a treatment method for clients who have generalized anxiety disorder.

D. Clients who have obsessive-compulsive disorder often have difficulty controlling impulses; this would not be necessary for a client who has generalized anxiety disorder.

A nurse is caring for a client who has been unable to leave the house for the past 10 years without accompaniment. When attempting to go out alone, the client becomes anxious and must quickly return inside. The nurse should identify that the client is exhibiting which of the following disorders?

• A.

  Agoraphobia

• B.

  Post-traumatic stress disorder

• C.

  Panic disorder

• D.

  Obsessive-compulsive disorder

A. 

Agoraphobia

Agoraphobia is the fear and subsequent avoidance of places or situations from which escape might be difficult. The most common manifestations of this disorder are a fear of leaving home and avoiding open public places, such as shopping malls.

Incorrect Answers:
B. Post-traumatic stress disorder (PTSD) is a trauma-related disorder in which the client experiences flashbacks, distressing memories, and dreams of a traumatic event. The client tries to avoid distressing memories but does not become anxious from leaving the residence.

C. Panic disorder is an anxiety disorder in which recurrent panic attacks that are not associated with any specific stimulus or situation seem to occur spontaneously.

D. Obsessive-compulsive disorders are characterized by recurrent obsessional thoughts or ritual behaviors.

A nurse is admitting a client who has derealization disorder. Which of the following manifestations should the nurse expect?

• A.

  The inability to recall important personal information

• B.

  The feeling that the surroundings are unreal

• C.

  The inability to recall identity

• D.

  The presence of at least 2 distinct personalities

B.

The feeling that the surroundings are unreal

The feeling that the surroundings are unreal or distant is a manifestation of derealization disorder. Clients who have this disorder might feel mechanical, dreamy, or detached from their body. Often, the manifestations are distressing and come and go. The disorder occurs as a response to acute stress.

Incorrect Answers:
A. The inability to recall important personal information is a manifestation of dissociative amnesia, which generally occurs after a traumatic or stressful event. The memory loss can be localized or selective.

C. The inability to recall identity or all or some information from the past is a subtype of dissociative amnesia known as dissociative fugue. In rare cases, a client who has this disorder will assume a new identity. The client's former identity might return in a few weeks or months.

D. The presence of 2 or more distinct personality states that recurrently take over behavior is the essential feature of dissociative identity disorder.

A nurse is caring for a client who has anxiety disorder. The client states that she forgot her partner's birthday after they had an argument. The nurse recognizes this action as which of the following defense mechanisms?

• A.

  Repression

• B.

  Splitting

• C.

  Conversion

• D.

  Projection

A. 

Repression

The nurse should identify that the client forgetting her partner's birthday following an argument is an example of repression. Repression is an unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness.

Incorrect Answers:
B. Splitting is a pathological defense mechanism in which clients have an inability to accept positive and negative qualities of themselves or others in a cohesive image.

C. Conversion is a pathological defense mechanism in which clients unconsciously transform anxiety or stress into a physical manifestation with no organic cause.

D. Projection is an immature defense mechanism in which clients unconsciously reject emotionally unacceptable features in themselves and attribute them to others.

A nurse is teaching a parent who has admitted to verbally abusing his children about stress management techniques. Which of the following strategies is the nurse providing?

• A.

  Tertiary prevention

• B.

  Individual psychotherapy

• C.

  Family psychotherapy

• D.

  Primary prevention

A. 

Tertiary prevention

The nurse is providing tertiary prevention methods by offering stress management techniques to the abuser after the abuse has occurred. Tertiary prevention methods facilitate the rehabilitative process for both victims of violence and those who perpetuate it.

Incorrect Answers:
B. Individual psychotherapy is available for both victims of violence and those who perpetrate violence on others. This form of therapy aims to help the client develop healthier coping skills, identify causes of maladaptive behaviors, and deal with stress or depression associated with the violence.

C. Family psychotherapy aims to assist all members of the family in coping with past violence and developing better means of communicating with each other.

D. The nurse should employ primary prevention before abuse actually occurs. Primary prevention methods include identifying clients at risk of committing child violence and providing support services to prevent the occurrence of abuse.

A nurse is caring for a client who has panic disorder and is experiencing anxiety at the panic level. Which of the following actions should the nurse take first?

• A. 

  Identify the cause of the anxiety.

• B. 

  Instruct the client to take slow, deep breaths.

• C. 

  Teach the client how to use positive self-talk.

• D. 

  Explain the physical manifestations of anxiety to the client.

B. 

Instruct the client to take slow, deep breaths.

The nurse should apply the safety and risk-reduction priority-setting framework, which assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow’s Hierarchy of Needs, the ABC priority-setting framework, and/or nursing knowledge to identify which risk poses the greatest threat to the client. The nurse cannot perform other actions while the client is having a panic attack and experiencing hyperventilation, shortness of breath, dizziness, and other associated manifestations. Therefore, instructing the client to take slow, deep breaths is the priority.

A nurse is providing teaching to a client who has generalized anxiety disorder and a new prescription for buspirone. Which of the following manifestations is a common adverse effect of this medication?

• A. 

  Confusion

• B. 

  Bradycardia

• C. 

  Dizziness

• D. 

  Insomnia

 C. 

Dizziness

The nurse should inform the client that dizziness is a common adverse effect of buspirone. The nurse should instruct the client to avoid driving and operating heavy machinery until the presence of adverse effects has been determined.

Incorrect Answers:

A. Confusion is not an adverse effect of buspirone, although the client might experience decreased concentration and headaches.

B. Tachycardia and palpitations are possible adverse effects of buspirone.

D. Drowsiness, not insomnia, is an adverse effect of buspirone.

A nurse is assessing a client who is experiencing moderate-level anxiety. Which of the following findings should the nurse expect?

• A. 

  The client has a heightened perceptual field.

• B. 

  The client has difficulty concentrating.

• C. 

  The client reports shortness of breath.

• D. 

  The client reports a sense of impending doom.

B. 

The client has difficulty concentrating.

The nurse should expect a client who has moderate-level anxiety to have difficulty concentrating and focusing. This lack of concentration increases as the anxiety level escalates.

Incorrect Answers:

A. The nurse should expect a client who is experiencing mild anxiety to have a heightened perceptual field; however, the perceptual field becomes narrowed as the anxiety increases to a moderate level.

C. The nurse should expect severe somatic complaints, such as shortness of breath, from a client who is experiencing a panic level of anxiety.

D. The nurse should expect a sense of impending doom from a client experiencing a severe level of anxiety.

A nurse is caring for a client who is having an acute panic attack. Which of the following actions should the nurse take?

• A. 

  Speak to the client in a raised voice

• B. 

  Walk the client to the dayroom

• C. 

  Use repetition when speaking with the client

• D. 

  Secure the client in his room alone

C. 

Use repetition when speaking with the client

A client who is having a panic attack might have a hard time understanding what the nurse is saying. Using simple phrases and repetition are effective methods of communication.

Incorrect Answers:A. The nurse should speak in a calm, low voice. A raised or high-pitched voice can indicate anxiety on the nurse's part and might make the client's level of anxiety worse.

B. The client should be moved to a quieter setting with decreased stimulation such as the client's room. The nurse should accompany and remain with the client.

D. A client who is experiencing a panic attack should not be left alone because this might further increase the client's level of anxiety.

A nurse is assessing a client who has an anxiety disorder and is taking a benzodiazepine. For which of the following adverse effects should the nurse monitor the client?

• A. 

  Seizures

• B. 

  Dizziness

• C. 

  Polyuria

• D. 

  Insomnia

B. 

Dizziness

Dizziness is a common adverse effect of benzodiazepines. Other common adverse effects are drowsiness and sedation.

Incorrect Answers:

A. Benzodiazepines are often prescribed for the treatment of seizure disorder. However, the sudden withdrawal of benzodiazepines can be associated with the development of seizures.

C. Polyuria is an adverse effect of lithium, not benzodiazepines.

D. Drowsiness is a common adverse effect of benzodiazepines.

A nurse is updating the plan of care for a client who has major depression and a new prescription for amitriptyline. The nurse should plan to monitor the client for which of the following adverse effects?

• A. 

  Hypertension

• B. 

  Drowsiness

• C. 

  Panic attacks

• D. 

  Diarrhea

B. 

Drowsiness

Drowsiness is an expected side effect of amitriptyline and other tricyclic antidepressants. Sedation is most likely to be present during the first weeks of treatment with amitriptyline and can increase the risk of falls.

Incorrect Answers:

A. The nurse should monitor a client who takes amitriptyline for hypotension and EKG changes, such as dysrhythmias. Orthostatic hypotension is a common adverse effect among clients taking amitriptyline, and the nurse should instruct the client to change positions slowly when rising from a reclining position.

C. The nurse should monitor a client who takes amitriptyline for suicidal thoughts, especially during the first weeks of treatment. Increased anxiety or panic attacks are not adverse effects of amitriptyline.

D. The nurse should monitor a client who takes amitriptyline for constipation, dry mouth, blurred vision, and other anticholinergic side effects.

An emergency room nurse is assessing a client who has anxiety disorder. The client is flushed, perspiring profusely, and experiencing palpitations. The client begins to scream, "I am going to die! This is it! I am having a heart attack!" The nurse should determine the client's level of anxiety to be which of the following?

• A. 

  Moderate

• B. 

  Panic

• C. 

  Severe

• D. 

  Mild

B. 

Panic

This client’s manifestations indicate the panic level of anxiety and are manifestations of a panic disorder.

Incorrect Answers:A. In moderate anxiety, the perceptual field narrows, but the client is able to cope with some assistance. This client’s manifestations indicate a higher level of anxiety.

C. In severe anxiety, the perceptual field is scattered, and the client is not able to focus on anything except relieving the anxiety. This client’s manifestations indicate a high level of anxiety.

D. Mild anxiety allows the client to perceive reality in sharp focus, and actual problem-solving becomes more effective. This client’s manifestations indicate a higher level of anxiety.

A nurse is admitting a client who has antisocial personality disorder to an acute care unit. The client is admitted under a court order following the theft and destruction of a car. Which of the following behaviors should the nurse expect the client to display?

• A. 

  Relief about finally receiving care

• B. 

  Anger with the nursing staff for hospitalizing him against his will

• C. 

  Withdrawal from others due to shame over his recent actions

• D. 

  Remorse for stealing and destroying the car

B. 

Anger with the nursing staff for hospitalizing him against his will

A client who has antisocial personality disorder exhibits a low frustration level and can quickly become angry and aggressive when the situation does not meet his or her will or desires.

Incorrect Answers:A. A client who has antisocial personality disorder exhibits a pattern of irresponsible behavior that lacks morals and ethics and brings the client into conflict with society. The client views this behavior as justified and does not perceive the need for help.

C. Clients with antisocial behavior do not view their behavior objectively and rarely experience any anxiety or guilt for their actions.

D. Clients who have antisocial behavior usually display a sense of entitlement and rarely express any remorse for their illegal or unethical actions.

A nurse is caring for a client who has a new diagnosis of colon cancer. Shortly after the client receives the diagnosis, the nurse enters the client’s room. The client begins yelling, "I’ve received terrible care here, and no one bothers to help me." The nurse should recognize that the client is demonstrating which of the following defense mechanisms?

• A. 

  Denial

• B. 

  Displacement

• C. 

  Reaction formation

• D. 

  Projection

B. 

Displacement

The nurse should identify displacement as the redirection of thoughts, feelings, and impulses from an object that causes to anxiety to a safer, more acceptable one. In this scenario, the client is redirecting anxiety about the diagnosis to the staff members who are providing care.

Incorrect Answers:A. Denial is the refusal to accept reality while acting as if a painful event, thought, or feeling does not exist.

C. Reaction formation occurs when the client exhibits a behavior or emotion that is the opposite of what the client actually feels.

D. Projection occurs when the client attributes undesired impulses to another person.

findings should the nurse identify as an adverse effect of this medication?

• A. 

  Arthralgia

• B. 

  Photophobia

• C. 

  Xerostomia

• D. 

  Bradycardia

C. 

Xerostomia

Buspirone can cause xerostomia or dry mouth. Other adverse effects include headache, nausea, and insomnia.

Incorrect Answers: A. Buspirone is more likely to cause myalgia than arthralgia.

B. Buspirone is more likely to cause blurry vision than photophobia.

D. Buspirone is more likely to cause tachycardia than bradycardia.

A nurse is caring for a client who has schizophrenia and is admitted to the mental health unit. The client has a history of aggression and is observed continually pacing the hallway in an agitated manner over the past hour. Which of the following responses should the nurse make?

• A. 

  "It's a beautiful day outside. Let's take a walk together."

• B. 

  "Sit down and we'll try out a relaxation exercise."

• C. 

  "Would you like your anti-anxiety medication now?"

• D. 

  "You are pacing back and forth. Can you tell me what you are feeling?"

D. 

"You are pacing back and forth. Can you tell me what you are feeling?"

Using the nursing process, the nurse should first collect data from the client. By asking the client to identify feelings of anxiety, the nurse promotes trust and can assist the client with decreasing anxiety before an episode of aggression occurs.

Incorrect Answers:A. The nurse should offer a distraction to help calm the client and provide a positive outlet for energy; however, there is another statement the nurse should make first.

B. The nurse should assist the client to learn positive coping skills and relaxation techniques to decrease anxiety; however, there is another statement the nurse should make first.

C. The nurse should offer a PRN anti-anxiety medication if other less restrictive interventions fail; however, there is another statement the nurse should make first.

A nurse is teaching a client who has agoraphobia about systematic desensitization. Which of the following comments should the nurse include in the teaching?

• A. 

  "You will watch from a secure location as your therapist goes to public spaces."

• B. 

  "You will start your therapy by staying in a public space until your anxiety decreases."

• C. 

  "You will be instructed to say 'stop!' out loud when you become anxious in public spaces."

• D. 

  "You will slowly be exposed to increasing levels of public spaces."

D. 

"You will slowly be exposed to increasing levels of public spaces."

The nurse should inform the client that she will be gradually exposed to the feared situation under controlled conditions until she learns to overcome the anxious response.

Incorrect Answers:A. Encouraging the client to watch as the therapist acts as a role model in anxiety-provoking situations is an example of modeling, not systematic desensitization.

B. Sudden exposure of the client to the undesirable stimulus is an example of flooding, not systematic desensitization.

C. Saying "stop!" to interrupt a negative thought is an example of thought stopping, not systematic desensitization.

A nurse is administering oral hydroxyzine to a client. Which of the following adverse effects should the nurse instruct the client to expect?

• A. 

  Diarrhea

• B. 

  Anxiety

• C. 

  Nausea and vomiting

• D. 

  Dry mouth

 D. 

Dry mouth

Hydroxyzine has anticholinergic properties. Dry mouth is a common adverse effect of this medication. The nurse should instruct the client to take sips of water or suck hard candies to minimize this effect.

Incorrect Answers:A. Diarrhea is not an expected adverse effect of hydroxyzine.

B. Hydroxyzine, an H1-receptor antagonist, is sometimes used to treat anxiety. Anxiety is not an expected adverse effect of the medication.

C. Hydroxyzine has antiemetic properties, thereby reducing the occurrence of nausea and vomiting.

A nurse is caring for a client who has cancer involving the lumbar vertebrae and has been prescribed gabapentin. Which of the following therapeutic effects should the nurse identify for the client when taking this medication?

• A. 

  Reduced cancer-related bone pain

• B. 

  Decreased anxiety and insomnia

• C. 

  Decreased inflammatory response to cancer tumors

• D. 

  Reduced cramping, aching, and burning neuropathic pain

D. 

Reduced cramping, aching, and burning neuropathic pain

The nurse should identify that gabapentin is administered to treat neuropathic pain that is sharp and darting. The medication can also decrease cramping, aching, and burning pain and suppress spontaneous neuronal firing that causes pain.

Incorrect Answers:A. The nurse should identify that etidronate can help reduce cancer-related bone pain in some clients.

B. The nurse should identify that hydroxyzine is an antihistamine that is prescribed to decrease anxiety, nausea, and vomiting. Occasionally, it is used as an adjunctive medication to enhance analgesic effectiveness.

C. The nurse should identify that dexamethasone is a glucocorticoid that can reduce spinal edema from an inflammatory response to cancer tumors that are compressing the spinal cord.

A nurse is providing teaching for a client who has generalized anxiety disorder and a new prescription for lorazepam. Which of the following statements should the nurse include?

• A. 

  "Taking an antacid with the medication will decrease stomach upset."

• B. 

  "Expect the medication to cause insomnia for the first 1 to 2 weeks."

• C. 

  "Drinking caffeinated beverages will decrease the effectiveness of the medication."

• D. 

  "Increase the dosage if the effectiveness of the medication decreases."

: C. 

"Drinking caffeinated beverages will decrease the effectiveness of the medication."

The nurse should inform the client that consuming caffeine while taking benzodiazepines such as lorazepam will result in decreased effectiveness of the medication. Caffeine is a stimulant, and lorazepam is a CNS depressant; therefore, these substances will counteract each other. The client should avoid caffeine while taking this medication.

Incorrect Answers: A. Antacids interact with benzodiazepines by delaying absorption.

B. Benzodiazepines are CNS depressants and are expected to cause drowsiness.

D. The client should notify the provider if the medication’s effectiveness decreases. The client should not increase the dosage without a prescription.

A nurse is caring for a client who has anxiety disorder. Which of the following statements by the client should the nurse recognize as demonstrating the defense mechanism of displacement?

• A. 

  "I smoked for years, but now I cannot stand to be around cigarette smoke."

• B. 

  "I didn't get the promotion at work because my boss hates me."

• C. 

  "My partner yelled at me, so I made the cat go outdoors."

• D. 

  "I won't worry about losing my job until my child's break from school is over."

C. 

"My partner yelled at me, so I made the cat go outdoors."

This statement is consistent with the use of displacement. Displacement is the transference of emotions associated with a person, object, or situation to another non-threatening person, object, or situation.

Incorrect Answers:A. This statement is consistent with the use of reaction formation. Reaction formation is when feelings or behaviors that are unacceptable to the client are controlled and kept from awareness by developing the opposite behavior or emotion.

B. This statement is consistent with the use of rationalization. Rationalization consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations.

D. This statement is consistent with the use of suppression. Suppression is the constant denial of a disturbing situation or feeling.

A nurse is caring for a client who has generalized anxiety disorder (GAD). Which of the following goals should the nurse include in the discharge plan of care for this client?

• A. 

  Use whistling or singing as a distraction to control hallucinations.

• B. 

  Make independent decisions about daily events.

• C. 

  Verbalize a realistic perception of personal appearance.

• D. 

  Decrease the use of ritualistic behaviors.

B. 

Make independent decisions about daily events.

A client who has GAD demonstrates indecisiveness and has unrealistic and persistent anxiety most days of the week. This can cause the client to avoid situations that produce anxiety or procrastinate necessary decision-making. The ability to make independent decisions about daily events is a goal the nurse should include in the discharge plan of care for the client.

Incorrect Answers:

A. Whistling or singing are distractions used to decrease hallucinations in clients who have schizophrenia.

C. Clients who have body dysmorphic disorder perceive flaws in their personal appearance.

D. Clients who have obsessive-compulsive disorder use ritualistic behavior to decrease anxiety. A client who has GAD tends to avoid anxiety-producing situations in an attempt to decrease anxiety.

A nurse is providing teaching about stress management to a client who is experiencing anxiety. Which of the following techniques should the nurse recommend to assist the client in identifying his stressors?

• A. 

  Biofeedback

• B. 

  Intellectualization

• C. 

  Journaling

• D. 

  Cognitive reframing

C. 

Journaling

Journaling is a technique that can be used to identify stressors. By recording feelings and responses to events, the client can find the source of everyday stressors and begin the process of stress reduction.

Incorrect Answers:A. Biofeedback is a mind-body relaxation technique that uses instrumentation to monitor physiological responses such as heart rate, blood pressure, and skin temperature.

B. Intellectualization is a defense mechanism that uses facts to examine events rather than responding with emotion. The technique can be adaptive or maladaptive.

D. Cognitive reframing is a relaxation technique that replaces negative self-talk with positive responses. Also known as cognitive restructuring, this technique is designed to reduce stress by giving the client a sense of better control over situations.

A mental health nurse is reviewing a process recording of a therapy session with a client. Which of the following statements should the nurse identify as an example of the communication technique of reflection?

• A. 

  "I notice you are pulling on your hair when we discuss your dismissal."

• B. 

  "That statement made by the other client appears to have upset you."

• C. 

  "Since writing in your journal is frustrating, we should look at this activity more closely."

• D. 

  "Give me an example of a time when you felt no one understood you."

B. 

"That statement made by the other client appears to have upset you."

Reflective statements are useful in assisting a client with identifying emotions and ideas. This therapeutic communication technique validates the client's emotions and encourages the client to reflect more deeply on the emotion.

Incorrect Answers:A. To assist the client in noticing behaviors, the nurse can use the therapeutic technique of making observations. This allows the client to gain an understanding between the emotions being felt and the topic of discussion or thoughts the client might be having. This method of communication promotes mutual understanding of perceptions between the client and the nurse.

C. To delve more deeply into an important topic, the nurse can use the therapeutic technique of focusing. This method of communication is useful when the client jumps from topic to topic. The nurse should avoid using focusing during periods of client anxiety because this can increase the client's anxiety.

D. To assist a client in explaining a vague concept such as "no one understands me," the nurse can use the therapeutic technique of seeking clarification. This method of communication increases the nurse's understanding of the client's point of view, which can enhance the nurse-client relationship.

A nurse is providing discharge teaching for a female client with anxiety disorder who has a new prescription for lorazepam. Which of the following instructions should the nurse include in the teaching?

• A. 

  "This medication can be safely taken during pregnancy."

• B. 

  "This medication must be discontinued by gradual tapering over time."

• C. 

  "An extra dose of the medication can be taken at bedtime if you experience insomnia."

• D. 

  "You should monitor your blood glucose levels closely while taking the medication."

B. 

"This medication must be discontinued by gradual tapering over time."

Rapid withdrawal from lorazepam has been associated with manifestations of withdrawal (e.g. anxiety, sleeplessness, and irritability). It is discontinued by gradually tapering over time to avoid any adverse responses.

Incorrect Answers:A. Lorazepam is contraindicated for use during pregnancy.

C. The nurse should inform the client not to increase the dosage without consulting the provider.

D. Lorazepam has no known effect on blood glucose levels; therefore, monitoring is not necessary while taking this medication.

A nurse in the emergency department is assessing a client who has generalized anxiety disorder. Which of the following actions should the nurse take first?

• A. 

  Instruct the client to use guided imagery

• B. 

  Move the client to a quiet area

• C. 

  Assist the client in identifying his coping skills

• D. 

  Allow the client time to express his feelings

B. 

Move the client to a quiet area

The greatest risk to this client is increased anxiety; therefore, the nurse should first move the client to a quiet area to decrease excessive stimuli.

 

Incorrect Answers:A. The nurse should instruct the client to use guided imagery to decrease anxiety; however, the nurse should take another action first.

C. The nurse should assist the client to identify coping skills to decrease anxiety; however, the nurse should take another action first.

D. The nurse should give the client time to express feelings to decrease anxiety; however, the nurse should take another action first.

A nurse is caring for a client who has obsessive-compulsive disorder. Which of the following actions should the nurse take when dealing with the client’s ritualistic behaviors?

• A. 

  Plan the client’s schedule to allow time to perform rituals

• B. 

  Verbalize disapproval of ritualistic behavior

• C. 

  Place the client in protective isolation

• D. 

  Increase stimuli in the client’s immediate surroundings

A. 

Plan the client’s schedule to allow time to perform rituals

The nurse should allow sufficient time for the client to perform rituals early in the treatment. This will help keep anxiety levels manageable and prevent the precipitation of panic anxiety.

Incorrect Answers:B. Negative reinforcement decreases the client’s self-esteem and could increase the repetition of negative behaviors

C. There is no indication that the client is at risk of harm. Isolation would increase the likelihood of a panic attack.

D. The nurse should ensure the client’s immediate surroundings involve minimal stimuli to avoid increasing the client’s level of anxiety.

A nurse is caring for a client who is receiving treatment for alcohol detoxification. Which of the following medications should the nurse expect to administer during this phase of the client’s care?

• A. 

  Buprenorphine

• B. 

  Diazepam

• C. 

  Varenicline

• D. 

  Rimonabant

B. 

Diazepam

The nurse should expect to administer diazepam to a client during alcohol detoxification. Anti-anxiety agents like chlordiazepoxide and diazepam are long-acting CNS depressants that are used to minimize the manifestations of alcohol withdrawal.

Incorrect Answers:A. The nurse should expect to administer buprenorphine to a client during opiate detoxification.

C. The nurse should expect to administer varenicline to a client who has nicotine use disorder.

D. The nurse should expect to administer rimonabant to a client who has nicotine use disorder.

A nurse is talking with a client who has an anxiety disorder. The client states, “I have something important to tell you, but you have to promise to keep it a secret." Which of the following responses should the nurse make?

• A. 

  "Anything you tell me is kept private between the two of us."

• B. 

  "I feel uncomfortable being asked to keep a secret for you."

• C. 

  "Why do you feel that this information needs to be kept private?"

• D. 

  "I might have to share this information with your provider."

D. 

"I might have to share this information with your provider."

The nurse should be honest with the client so that the client can decide whether to share the information. The information the client shares can be vital for the treatment plan and can present a safety risk for the client or others. Therefore, the nurse may be legally obligated to share the information with the client's provider and health care team.

Incorrect Answers:

A. The nurse should be honest with the client and cannot legally agree to keep information just between himself/herself and the client.

B. The nurse should focus on the client's feelings and encourage therapeutic communication. Blocking further communication could prevent the client from sharing information that may be vital for the treatment plan.

C. The nurse should avoid asking a "why" question, as this may be perceived as accusatory and can place the client in an uncomfortable and defensive position. This type of nontherapeutic response blocks further communication and prevents the client from sharing information that may be vital for the treatment plan.

A nurse is preparing to administer a benzodiazepine to a client who has generalized anxiety disorder. The nurse should tell the client to expect which of the following adverse effects?

• A. 

  Tinnitus

• B. 

  Bradycardia

• C. 

  Halitosis

• D. 

  Sedation

D. 

Sedation

The nurse should tell the client to expect sedation as an adverse effect of benzodiazepines because of these drugs’ CNS-depression effects.

Incorrect Answers:A. Tinnitus is not an adverse effect of benzodiazepines.

B. Tachycardia, not bradycardia, is a potential adverse effect of benzodiazepines.

C. Halitosis is not an adverse effect of benzodiazepines.

A nurse is planning care for a client who has a physical dependence on alprazolam and must discontinue the medication. Which of the following actions should the nurse include in the plan?

• A. 

  Taper the medication gradually over several weeks

• B. 

  Encourage participation in stimulating physical activity

• C. 

  Monitor the client for a return of anxiety for up to 72 hr following discontinuation of the medication

• D. 

  Implement restraints and seclusion as needed

 A. 

Taper the medication gradually over several weeks

The nurse should plan to taper the dosage of alprazolam gradually over several weeks, possibly months. This gradual reduction in dosage reduces the manifestations of withdrawal.

Incorrect Answers:B. The nurse should provide the client with a calm, low-stimulation environment to decrease the anxiety and physical manifestations that can result from alprazolam withdrawal.

C. The nurse should plan to monitor the client over at least 3 weeks following discontinuation of the medication for a return of anxiety manifestations.

D. It is not necessary to restrain or seclude the client during withdrawal from alprazolam. Restraints are considered restrictive, and the nurse should promote the least restrictive environment.

A nurse is providing teaching to a client who has a new prescription for buspirone. Which of the following statements by the client indicates an understanding of the teaching?

• A. 

  "I need to watch for signs of dehydration."

• B. 

  "I need to have my kidney function monitored while taking this medication."

• C. 

  "I should take this medication on an empty stomach."

• D. 

  "I might not notice the effects of this medication for several weeks."

D. 

"I might not notice the effects of this medication for several weeks."

The effects of buspirone develop slowly. The initial response takes at least a week, and a peak response takes several weeks. Because of the delayed action, buspirone should not be taken as a PRN medication for the relief of anxiety.

Incorrect Answers:A. Buspirone does not cause dehydration.

B. Buspirone does not have an adverse effect on kidney function.

C. While taking buspirone with food can delay its absorption, food increases the bioavailability of the medication, allowing it to be more active. Furthermore, taking buspirone with food can lessen the gastrointestinal irritation that it can cause.

A nurse is providing teaching to a client who has generalized anxiety disorder and a new prescription for buspirone. Which of the following statements by the client indicates an understanding of the teaching?

• A. 

  "This medication can cause dependence."

• B. 

  "I should take a dose of my medication when I start to feel anxious."

• C. 

  "It’s important for me to take my medication 30 min before bedtime."

• D. 

  "I should expect to feel the full effect of my medication in 2 to 4 weeks."

D. 

"I should expect to feel the full effect of my medication in 2 to 4 weeks."

The desired response from buspirone can begin within 7 to 10 days; however, the full effect of this medication takes 2 to 4 weeks to occur.

Incorrect Answers:A. Buspirone is an anxiolytic medication that differs significantly from benzodiazepines. This medication does not cause sedation and has no abuse potential.

B. Because the therapeutic effects of buspirone are delayed, it should not be taken on an as-needed or PRN basis.

C. Buspirone is a nonsedating medication; therefore, the client does not need to take it 30 minutes before bedtime. Buspirone should be taken with food to decrease the possibility of nausea. It is generally taken 2 to 3 times daily in divided doses.

A nurse is caring for a client with ADHD who has recently started taking lithium. For which of the following findings should the nurse monitor when evaluating the effectiveness of the medication?

• A. 

  Increased attention span

• B. 

  Decreased anxiety

• C. 

  Reduced aggression

• D. 

  Weight loss

C. 

Reduced aggression

Clients who have ADHD can experience a low tolerance for frustration, which can result in aggressive behaviors. Although psychosocial interventions should include developing coping mechanisms and cognitive behavior therapy, the client might require medication to manage aggressive behaviors. The nurse should monitor for reduced aggression when a client who has ADHD is taking a mood stabilizer such as lithium. Additional outcomes of mood-stabilizing medications include decreased impulsivity.

Incorrect Answers:A. The nurse should monitor for increased attention span, reduced impulsivity, and reduced distractibility in a client who has ADHD and is taking a stimulant medication such as methylphenidate.

B. A non-stimulant selective norepinephrine-reuptake inhibitor such as atomoxetine is used for clients who develop anxiety when taking stimulant-based medications to manage ADHD. However, decreased anxiety is not an expected outcome of lithium.

D. The nurse should monitor for adverse effects such as weight loss in a client who has ADHD and is taking a stimulant medication such as methylphenidate. However, weight gain, not weight loss, is an expected outcome of lithium.

A nurse is teaching a client who has generalized anxiety disorder to perform a deep-breathing exercise. Which of the following actions should the nurse instruct the client to take?

• A. 

  Utilize chest breathing

• B. 

  Breathe in through the nose

• C. 

  Keep the shoulders erect

• D. 

  Repeat the exercise for at least 10 minutes for effectiveness

 B. 

Breathe in through the nose

When using deep-breathing exercises, clients should breathe in through their noses, hold their breath for about 3 seconds, and then exhale through their mouths.

Incorrect Answers:A. Slow abdominal breathing is used for deep-breathing exercises.

C. Clients should relax their shoulders while engaging in deep-breathing exercises.

D. Deep-breathing exercises can be repeated for 2 to 5 minutes for effectiveness.

A nurse is collecting data from a client who has generalized anxiety disorder (GAD). Which of the following findings should the nurse expect?

• A. 

  Restlessness

• B. 

  Choking sensations

• C. 

  Paresthesias

• D. 

  Excessive sleepiness

A. 

Restlessness

Clients who have GAD are irritable and restless. They tend to worry excessively over circumstances others might consider minor.

Incorrect Answers:B. Feeling a choking sensation is more common in clients who have panic disorder.

C. Paresthesias are more common in clients who have panic disorder.

D. Sleep deprivation is common among clients who have GAD, which often causes daytime fatigue.