QUIZ 3: Anxiety, Obsessive-Compulsive, and Related Disorders Depressive disorders &Suicide and Non suicidal Self-Injury

The nurse is preparing a staff education session about depression in adolescents. Which statement by a staff member indicates teaching has been effective?
1. "Adolescents are not likely to suffer from depression."
2. "Depressed adolescents normally seek immediate treatment."
3. "Many symptoms are attributed to normal adjustments of adolescents."
4. "Suicide is not common among depressed adolescents."

3
This statement would indicate effective teaching because many symptoms of depression may be attributed to normal adjustments of adolescents.

Which highest priority outcome would the nurse add to the plan of care for a depressed client?
1. The client will promise to remain safe.
2. The client will discuss feelings with staff and family by day three.
3. The client will establish a trusting relationship with the nurse.
4. The client will not harm self during hospital stay.

4
The nurse's highest priority should be that the client will not harm self during the hospital stay. Client safety should always be the nurse's highest priority.

The nurse is assisting with electroconvulsive therapy (ECT). What is the rationale for administering 100% oxygen to a client during and after ECT?
1. To prevent brain damage from the electrical impulse of the procedure
2. To prevent decreased blood pressure, pulse, and respiration owing to electrical stimulation
3. To prevent anoxia resulting from medication-induced paralysis of respiratory muscles
4. To prevent blocked airway, resulting from seizure activity

3
The nurse administers 100 percent oxygen during and after ECT to prevent anoxia resulting from medication-induced paralysis of respiratory muscles. Because succinylcholine paralyzes respiratory muscles, the client is oxygenated with pure oxygen during and after the treatment, except for the brief interval of electrical stimulation, until spontaneous respirations return.

Which action should the nurse take when a depressed client refuses electroconvulsive therapy (ECT)?
1. Accept the client's decision
2. Inform the client that the procedure is mandatory
3. Tell the client that the signature verifies informed consent
4. Call the family to receive approval

1
The nurse should accept the client's decision. Consent for ECT may be withdrawn at any time.

The nurse is caring for a client with major depressive disorder who is withdrawn, uncommunicative, and secludes self in room. Which nursing diagnosis should the nurse add to the plan of care?
1. Spiritual distress
2. Social isolation
3. Low self-esteem
4. Powerlessness

2
The client's withdrawn and uncommunicative behavior and secluding self in the room indicates social isolation. Other behaviors include seeks to be alone, dysfunctional interaction with others and discomfort in social situations.

The client with major depressive episode is experiencing command hallucination for self-harm. Which intervention should be the nurse's priority at this time?
1. Obtaining an order for locked seclusion until client is no longer suicidal
2. Conducting 15-minute checks to ensure safety
3. Placing the client on one-to-one observation while continuing to monitor suicidal ideations
4. Encouraging client to express feelings related to suicide

3
The nurse's priority intervention when a depressed client hears voices commanding self-harm is to place the client on one-to-one observation while continuing to monitor suicidal ideations. By providing one-to-one observation, the nurse will be able to interrupt any attempts at suicide.

The nurse assesses a client with major depressive disorder. Which assessment finding would the nurse observe?
1. Sadness subsides quickly
2. Promiscuous behaviors
3. Unable to feel any pleasure
4. Excessive spending sprees

3
The client being unable to feel any pleasure meets the diagnosis requirements of major depressive disorder.

Which statement by a client who is beginning tricyclic antidepressant therapy indicates successful teaching?
1. "I will continue to take this medication even if the symptoms have not subsided."
2. "I will start to see results in about 2 weeks."
3. "I will continue to smoke."
4. "I will start to cut down on my alcohol intake and have only one glass of wine at supper."

1
This statement indicates successful teaching. Clients should continue to take the medication even if symptoms have not subsided. The therapeutic effect may not be seen for as long as 4 weeks.

The nurse is preparing a presentation about Beck's cognitive theory. Which cognitive distortion would the nurse include in the teaching session?
1. Negative expectation of the environment 2. Negative expectation of the present
3. Negative expectation of the career
4. Negative expectation of the family

1
Negative expectations of the environment is one of the three cognitive distortions in Beck's Cognitive Theory. The other two are negative expectations of the self and future.

The nurse discovers a client has a history of divorce, job loss, family estrangement, and cocaine abuse. Which theory explains the etiology of this client's depressive symptoms?
1. Psychoanalytic theory
2. Object loss theory
3. Learning theory
4. Cognitive theory

3
The nurse should assess that, according to learning theory, this client's depressive symptoms may have resulted from repeated failures. The learning theory is a model of "learned helplessness" in which multiple life failures cause the client to abandon future attempts to succeed and leads to depression.

The nurse performs a full physical health assessment on an older adult client admitted with a diagnosis of major depressive disorder. What is the rationale for the nurse's assessment?
1. The attention during the assessment is beneficial in decreasing social isolation in the elderly.
2. Depression can generate somatic symptoms that can mask actual physical disorders.
3. Physical health complications are likely to arise from antidepressant therapy.
4. Depressed geriatric clients avoid addressing physical health and ignore medical problems.

2
The nurse should determine that an older adult client with a diagnosis of major depressive disorder needs a full physical health assessment, because depression can generate somatic symptoms that can mask actual physical disorders. Many medical conditions, including endocrinological, neurological, nutritional, and metabolic disorders, often present with classic symptoms of depression.

The nurse is preparing an antidepressant medication for a 13-year-old client who is experiencing major depressive disorder. Which FDA-approved medication should the nurse administer?
1. Paroxetine (Paxil)
2. Sertraline (Zoloft)
3. Citalopram (Celexa)
4. Escitalopram (Lexapro)

4
Escitalopram (Lexapro) was FDA approved in 2009 for treatment of major depression in adolescents aged 12 to 17 years. Fluoxetine (Prozac) has also been approved by the FDA to treat depression in children and adolescents. All antidepressants carry an FDA warning for increased risk of suicide in children and adolescents

Which characteristic would help a nurse distinguish between dysthymia and major depressive disorder (MDD)?
1. Dysthymia is associated with the menstrual cycle.
2. Dysthymia is a chronically depressed mood.
3. MDD lasts for at least 2 years.
4. MDD does not have delusions or hallucinations

2
Dysthymia is somewhat milder than MDD but the essential feature is a chronically depressed mood for most of the day, more days than not, for at least 2 years.

The nurse is teaching the depressed client about bupropion (Wellbutrin). Which statement by the client indicates effective teaching?
1. "I will begin to wear short sleeves when outdoors."
2. "I will not take two pills if I miss a dose."
3. "I will discontinue the medication when my depression is gone."
4. "I will stand up smoothly and quickly to keep my balance."

2
This statement indicates effective teaching. Clients should never double up on a dose if they miss a day, as this could increase the risk of seizures or other adverse reactions.

A client is taking phenelzine (Nardil). Which statement by the client should cause the nurse to intervene?
1. "I cannot use over-the-counter medications for my colds."
2. "I have to cut out eating my raisin bran every morning."
3. "I will have to avoid pepperoni pizza when eating with my friends."
4. "I am taking diet pills to lose weight for my friend's wedding."

4
The nurse would have to intervene because this is an incorrect statement and needs to be corrected. The client cannot take diet pills and phenelzine, a MAOI, together because this could cause a life-threatening hypertensive crisis.

The depressed client is receiving light therapy. Which instruction would the nurse share with the client?
1. "White LED lights will be used with protective glasses to block ultraviolet rays." 2. "You will sit in front of the light box with your eyes open."
3. "The light sessions will start out at 5 minutes and work up to 30 minute intervals."
4. "Vagal stimulation from the light waves will help release melatonin in the brain."

2
The individual sits in front of the box with the eyes open (although the client should not look directly into the light).

Which scale would a nurse practitioner use to assess a depressed client?
1. Zung Depression Scale
2. Hamilton Depression Rating Scale
3. Beck Depression Inventory
4. AIMS Depression Rating Scale

2
One of the most widely used clinician-administered scales is the Hamilton Depression Rating Scale. The original version contains 17 items and is designed to measure mood, guilty feelings, suicidal ideation, sleep disturbances, anxiety levels, and weight loss.

The nurse is caring for a client with a postpartum emotional disorder. Which postpartum disorder is correctly matched with its presenting symptoms?
1. Baby blues (lack of concentration, agitation, guilt, and an abnormal attitude toward bodily functions)
2. Moderate postpartum depression (irritability, loss of libido, sleep disturbances, expresses concern about inability to care for baby)
3. Maternity blues (overprotection of infant, severe guilt, depressed mood, lack of concentration)
4. Postpartum depression with psychotic features (transient depressed mood, decisive, abnormal fear of child abduction, suicidal ideations)

2
The symptoms listed are characteristic of moderate postpartum depression and include fatigue, irritability, loss of appetite, sleep disturbances, loss of libido, and expressions of great concern about her inability to care for her baby.

The nurse determines that a depressed client is using the cognitive distortion of "automatic thoughts." Which client statement is evidence of the "automatic thought" of discounting positives?
1. "It's all my fault for trusting him."
2. "I don't play games. I never win."
3. "She never visits, because she thinks I don't care."
4. "Growing plants is so easy. Any old fool can grow a rose."

4
Stating, "Growing plants is so easy. Any old fool can grow a rose," is an example of discounting positives. Examples of automatic thoughts in depression include discounting positives; for example, "The other questions were so easy. Any dummy could have gotten them right."

A client is prescribed transdermal selegiline (Emsam) for depressive symptoms. Which action would the nurse take to administer this medication?
1. Apply new patch to the lower abdomen. 2. Apply new patch to inner surface of upper arm.
3. Place new patch on dry, intact skin.
4. Place direct heat to new patch for a tight seal.

3
The patch is applied to dry, intact skin at approximately the same time each day.

After 5 months of taking nortriptyline (Aventyl) for depressive symptoms, a client reports that the medication doesn't seem as effective as before. Which question should the nurse ask to determine the cause of this problem?
1. "Are you consuming foods high in tyramine?"
2. "How many packs of cigarettes do you smoke daily?"
3. "Do you drink any alcohol?"
4. "When did you last eat yogurt?"

2
The nurse would ask this question. Nortriptyline is a tricyclic antidepressant. Smoking should be avoided while receiving tricyclic therapy. Smoking increases the metabolism of tricyclics, requiring an adjustment in dosage to achieve the therapeutic effect.

An older adult client has a diagnosis of dysthymic disorder. Which signs and symptoms should the nurse expect the client to exhibit? (Select all that apply.) 1. Sad mood on most days 2. Mood rating of 2 out of 10 for the past 6 months 3. Labile mood 4. Sad mood for the past 3 years after spouse's death 5. Pressured speech when communicating

1,4

The client experiences sadness and melancholia in September continuing through November. Which factors should a nurse identify as most likely to contribute to the etiology of these symptoms? (Select all that apply.) 1. Gender differences in social opportunities 2. Increased production of melatonin 3. Hyposecretion of cortisol 4. Less exposure to natural sunlight 5. Blockade of histamine reuptake

2,4

The depressed client is prescribed a monoamine oxidase inhibitor (MAOI). Which statements by the client should indicate to a nurse that the discharge teaching about this medication has been successful? (Select all that apply.) 1. "I'll have to let my surgeon know about this medication before I have my cholecystectomy." 2. "I guess I will have to give up my glass of red wine with dinner." 3. "I'll have to be very careful about reading food labels." 4. "I'm going to drink my caffeinated coffee in the morning." 5. "I'll be sure not to stop this medication abruptly."

1,2,3,5

The nurse is teaching about the diagnosis disruptive mood dysregulation disorder (DMDD). Which information should the nurse include? (Select all that apply.) 1. Symptoms include verbal rages or physical aggression toward people or property. 2. Temper outbursts must be present in at least two settings (at home, at school, or with peers). 3. DMDD is characterized by severe recurrent temper outbursts. 4. The temper outbursts are manifested only behaviorally. 5. Symptoms of DMDD must be present for 18 or more months to meet diagnostic criteria.

1,2,3

The nurse discovers a client's suicide note that details the time, place, and means to commit suicide. Which would be the priority nursing intervention and the rationale for this action?
1.
Administering lorazepam (Ativan) prn, because the client is angry about the discovery of the note
2.
Establishing room restrictions, because the client's threat is an attempt to manipulate the staff
3.
Placing this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide
4.
Calling an emergency treatment team meeting, because the client's threat must be addressed

Answer: 3
Rationale:
1
This action would not be appropriate and could be considered a restraint.
2
Establishing room restrictions does not keep the client safe in the immediate situation.
3
The priority nursing action would be to place this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide. The appropriate nursing diagnosis for this client would be risk for suicide.
4
The client's immediate safety is a priority; this action may be appropriate at a later time.

During the planning of care for a suicidal client, which correctly written outcome would be a nurse's first priority?
1.
The client will not physically harm self.
2.
The client will express hope for the future by day three.
3.
The client will establish a trusting relationship with the nurse.
4.
The client will remain safe during the hospital stay.

Answer: 4
Rationale:
1
This answer choice is incorrectly written. Correctly written outcomes must be client focused, measurable, realistic, and contain a time frame. Without a time frame, an outcome cannot be correctly evaluated.
2
This option may take longer to achieve and therefore not be the nurse's first priority.
3
This option is important, but safety must be established first.
4
The nurse's priority would be that the client will remain safe during the hospital stay. Client safety would always be the nurse's priority.

A client diagnosed with major depressive disorder with psychotic features hears voices commanding self-harm. The client refuses to commit to developing a plan for safety. Which would be the nurse's priority intervention at this time?
1.
Obtaining an order for locked seclusion until client is no longer suicidal
2.
Conducting 15-minute checks to ensure safety
3.
Placing the client on one-to-one observation while monitoring suicidal ideations
4.
Encouraging the client to express feelings related to suicide

Answer: 3
Rationale:
1
Seclusion may be excessive for this client.
2
Checks every 15 minutes would be inadequate for this client.
3
The nurse's priority intervention when a client hears voices commanding self-harm is to place the client on one-to-one observation while continuing to monitor suicidal ideation.
4
Although it is important to encourage the client to express their feelings, the client's physical safety is the priority.

A client with a history of three suicide attempts has been taking fluoxetine (Prozac) for 1 month. The client suddenly presents with a bright affect, rates mood at 9/10, and is much more communicative. Which action would be the nurse's priority at this time?
1.
Give the client off-unit privileges as positive reinforcement.
2.
Encourage the client to share mood improvement in group.
3.
Increase frequency of client observation.
4.
Request that the psychiatrist reevaluate the current medication protocol.

Answer:3
Rationale:
1
The client would not be given off-unit privileges, as this could be unsafe.
2
Group involvement is important, but client safety must take priority.
3
The nurse would be aware that a sudden increase in mood rating and change in affect could indicate that the client is at risk for suicide and client observation would be more frequent. Suicide risk may occur early during treatment with antidepressants. The return of energy may bring about an increased ability to act out self-destructive behaviors prior to attaining the full therapeutic effect of the antidepressant medication.
4
Medication can be reevaluated after client safety has been established.

A client is admitted to an inpatient unit after a suicide attempt. The health-care provider prescribes amitriptyline (Elavil) for the client. Which would the nurse expect to be initiated to maintain this client's safety upon discharge?
1.
Provide a 6-month supply of Elavil to ensure long-term compliance.
2.
Provide a 3-day supply of Elavil with refills contingent on follow-up appointments.
3.
Provide a pill dispenser as a memory aid.
4.
Provide education regarding the avoidance of foods containing tyramine.

Answer: 2
Rationale:
1
This amount of medication may be enough for the client to overdose.
2
The health-care provider would provide no more than a 3-day supply of Elavil with refills contingent on follow-up appointments as an appropriate intervention to maintain the client's safety. Tricyclic antidepressants have a narrow therapeutic range and can be used in overdose to commit suicide. Distributing limited amounts of the medication decreases this potential. In addition, clients may gain energy to carry out a suicide once they begin to have more energy from taking the antidepressants.
3
Providing a pill dispenser will not prevent suicide.
4
Educating the patient about foods containing tyramine will not prevent an overdose.

During a one-to-one session with a client, the client states, "Nothing will ever get better," and, "Nobody can help me." Which nursing diagnosis is most appropriate for this client?
1.
Powerlessness R/T altered mood AEB client statements
2.
Risk for injury R/T altered mood AEB client statements
3.
Risk for suicide R/T altered mood AEB client statements
4.
Hopelessness R/T altered mood AEB client statements

Answer: 4
Rationale:
1
The client is experiencing hopelessness. This diagnosis would be inappropriate.
2
Risk for injury has not been identified based on the client's statement.
3
Risk for suicide has not been identified.
4
The client's statements indicate the problem of hopelessness. Prior to assigning either risk for injury or risk for suicide, a further evaluation of the client's suicidal ideations and intent would be necessary.

The treatment team is making a discharge decision regarding a previously suicidal client. Which client assessment information should a nurse recognize as contributing to the team's decision?
1.
No previous admissions for major depressive disorder
2.
Vital signs stable; no psychosis noted
3.
Adheres to medication regimen; able to problem-solve life issues
4.
Participates in a plan for safety; family agrees to constant observation

Answer: 4
Rationale:
1
History of admissions does not focus on suicide prevention.
2
Assessment of vital signs does not focus on suicide prevention.
3
Compliance with medication regimen does not focus on suicide prevention.
4
Participation in a plan of safety and constant family observation will decrease the risk for self-harm.

The family of a suicidal client is very supportive and requests more facts related to caring for their family member after discharge. Which information would the nurse provide?
1.
Address only serious suicide threats to avoid the possibility of secondary gain.
2.
Promote trust by verbalizing a promise to keep suicide attempt information within the family.
3.
Offer a private environment to provide needed time alone at least once a day.
4.
Be available to actively listen, support, and accept feelings.

Answer: 4
Rationale:
1
Addressing only serious suicide threats would not be helpful to the client.
2
Keeping suicide attempts a secret in the family does not help the client.
3
Providing alone time does not help the client.
4
Being available to actively listen, support, and accept feelings increases the potential that a client would confide suicidal ideations to family members.

A stockbroker commits suicide after being convicted of insider trading. In speaking with the family, which statement by the nurse demonstrates accurate and appropriate sharing of information?
1.
"Your grieving will subside within 1 year; until then, I recommend antidepressants."
2.
"Support groups are available specifically for survivors of suicide, and I would be glad to work with the health-care provider to locate one in this area."
3.
"The only way to deal effectively with this kind of grief is to write a letter to the brokerage firm to express your anger with them."
4.
"Since stigmatization often occurs in these situations, it would be best if you avoid discussing the suicide with anyone."

Answer: 2
Rationale:
1
All individuals grieve differently. It is not appropriate for the nurse to say when an individual's grief will subside, and it is not within the nurse's scope of practice to recommend medications.
2
Bereavement following suicide is complicated by the complex psychological impact of the act on those close to the victim. Support groups for survivors can provide a meaningful resource for grief work.
3
It is not appropriate for the nurse to recommend appropriate actions for the client to take, such as writing a letter to the firm to express anger.
4
It may be beneficial for the family to discuss the suicide with a grief counselor. However, it is outside the nurse's scope of practice to provide referrals.

After years of dialysis, an 84-year-old client states, "I'm exhausted, depressed, and done with these attempts to keep me alive." Which question would the nurse ask the client's spouse when preparing a discharge plan of care?
1.
"Have there been any changes in appetite or sleep?"
2.
"How often is your spouse left alone?"
3.
"Has your spouse been following a diet and exercise program consistently?"
4.
"How would you characterize your relationship with your spouse?"

Answer: 2
Rationale:
1
Changes in appetite or sleep do not accurately indicate risk for suicide.
2
This client has many risk factors for suicide. The client would have increased supervision to decrease likelihood of self-harm.
3
Asking about diet and exercise do not assess risk for suicide.
4
Asking about the client's relationship with his spouse does not accurately assess the risk for suicide.

Which information would the nursing instructor include about suicide in the elderly population when teaching nursing students?
1.
Elderly people use less lethal means to commit suicide.
2.
Although the elderly comprise less than 13 percent of the population, they account for 15 percent of all suicides.
3.
Suicide is the second leading cause of death among the elderly.
4.
It is normal for elderly individuals to express a desire to die, because they have come to terms with their mortality.

Answer: 2
Rationale:
The elderly do not necessarily use less lethal means of committing suicide.
2
Although the elderly comprise less than 13 percent of the population, they account for 15 percent of all suicides.
3
Suicide is not the second leading cause of death among the elderly.
4
An expressed desire to die is not normal in any age group.

A nurse is caring for a client who has threatened to commit suicide by hanging. The client states, "I'm going to use a knotted shower curtain when no one is around." Which information would determine the nurse's plan of care for this client?
1.
The more specific the plan is, the more likely the client will attempt suicide.
2.
Clients who talk about suicide rarely actually commit it.
3.
Clients who threaten suicide should be observed every 15 minutes
4.
After a brief assessment, the nurse would avoid the topic of suicide.

Answer: 1
Rationale:
1
Clients who have specific plans are at greater risk for suicide.
2
Clients who talk about suicide should be taken seriously; a client who has a plan is more likely to carry out the plan.
3
One-to-one supervision would be provided for any client who threatens suicide, not an every 15 minute check in
4
The nurse should be direct and upfront when discussing suicide with clients and their families.

A suicidal client says to the nurse, "There's nothing to live for anymore." Which is the most appropriate nursing reply?
1.
"Why don't you consider doing volunteer work in a homeless shelter?"
2.
"Let's discuss the negative aspects of your life."
3.
"Things will look better in the morning."
4.
"It sounds like you are feeling pretty hopeless."

Answer: 4
Rationale:
1
This question does not help the client open up about feelings.
2
This statement does not help the client discuss feelings
3
This statement may be degrading to the client's feelings.
4
This statement verbalizes the client's implied feelings and allows him or her to validate and explore them. This statement also shows empathy toward the client and may help them open up and discuss their feelings.

Which statement best describes the classification of suicide?
1.
Suicide is a DSM-5 diagnosis.
2.
Suicide is a mental disorder.
3.
Suicide is a behavior.
4.
Suicide is an antisocial affliction.

Answer: 3
Rationale:
1
Suicide is not a diagnosis that is found in DSM-5.
2
Suicide is not considered a mental disorder.
3
Suicide is considered a behavior. It is defined as the act of taking one's own life.
4
Suicide is not an affliction.

Which documented intervention would the nurse implement first when caring for a severely depressed client?
1.
Communicate therapeutically.
2.
Observe the client.
3.
Provide a hazard-free environment.
4.
Assess suicide risk.

Answer: 4
Rationale:
1
After assessing suicide risk, the nurse can communicate therapeutically.
2
After assessing suicide risk, the nurse can observe the client.
3
After assessing suicide risk, the nurse can provide a hazard-free environment.
4
Assessment is the first step of the nursing process to gain needed information to determine further appropriate interventions. Suicide risk assessment would always be the first step taken when working with depressed or suicidal clients.

Which is a correctly written, appropriate outcome for a client with a history of suicide attempts who is currently exhibiting symptoms of low self-esteem by isolating self?
1.
The client will not physically harm self.
2.
The client will express three positive self-attributes by day four.
3.
The client will reveal a suicide plan.
4.
The client will establish a trusting relationship.

Answer: 2
Rationale:
1
This outcome may take time for the client to commit to.
2
Although the client has a history of suicide attempts, the current problem is isolative behaviors based on low self-esteem. Outcomes would be client-centered, specific, realistic, and measurable and contain a time frame.
3
This outcome may be a big step for the client.
4
This outcome may not be realistic right away for the client.

Which statement made by a nursing student indicates that learning regarding suicide has been successful?
1.
"Suicidal threats and gestures would be considered manipulative and/or attention-seeking."
2.
"Suicide is the act of a psychotic person."
3.
"All suicidal individuals are mentally ill."
4.
"Between 50 and 80 percent of all people who kill themselves have a history of a previous attempt."

Answer: 4
Rationale:
1
This statement is inaccurate regarding suicide and would not help the student provide care to clients.
2
This statement is untrue regarding suicide.
3
This statement is a common myth about suicide. Although many who attempt suicide are extremely unhappy, or clinical depressed, they are not all mentally ill.
4
It is true that between 50 and 80 percent of all people who kill themselves have a history with a previous attempt.

A nurse is caring for four clients diagnosed with major depressive disorder. When considering each client's belief system, the nurse would conclude which client would potentially be at higher risk for suicide than the other clients?
1.
Roman Catholic
2.
Protestant
3.
Atheist
4.
Muslim

Answer: 3
Rationale:
1
Depressed men and women who consider themselves affiliated with a religion such as Roman Catholicism, may be less likely to attempt suicide than their nonreligious counterparts.
2
Depressed men and women who consider themselves affiliated with a religion are less likely to attempt suicide than their nonreligious counterparts.
3
According to studies, depressed individuals who are associated with a religion are less likely to attempt suicide than their nonreligious counterparts, such as those associated with atheism. Therefore, this client may be at higher risk than the other clients.
4
Depressed clients with religious affiliation are less likely to attempt suicide than their nonreligious counterparts.

Which strategy is most important to implement initially with a suicidal client?
1.
Ask a direct question such as, "Do you ever think about killing yourself?"
2.
Ask the client, "Please rate your mood on a scale from 1 to 10."
3.
Establish a trusting nurse-client relationship.
4.
Apply the nursing process to the planning of client care.

Answer: 1
Rationale:
1
The risk of suicide is greatly increased if the client has suicidal ideations, if the client has developed a plan, and particularly if the means exist for the client to execute the plan.
2
Asking client to rate mood does not help assess suicide risk.
3
Establishing a nurse-client relationship does not help assess suicide risk.
4
Applying the nursing process to planning does not help assess suicide risk.

A client is newly committed to an inpatient psychiatric unit. Which nursing intervention best lowers this client's risk for suicide?
1.
Encouraging participation in the milieu to promote hope
2.
Developing a strong personal relationship with the client
3.
Observing the client at intervals determined by assessed data
4.
Encouraging and redirecting the client to concentrate on happier times

Answer: 3
Rationale:
1
Encouraging participation does not best lower the client's risk for suicide.
2
Developing a personal relationship with the client does not best lower the client's risk for suicide.
3
The nurse would observe the actively suicidal client continuously for the first hour after admission. After a full assessment, the treatment team will determine the observation status of the client. Observation of the client allows the nurse to interrupt any observed suicidal behaviors.
4
Encouraging and redirecting the client does not best lower the client's risk for suicide.

Which client data indicates that a suicidal client is participating in a plan for safety?
1.
Compliance with antidepressant therapy
2.
A mood rating of 9/10
3.
Disclosing a plan for suicide to staff
4.
Expressing feelings of hopelessness to nurse

Answer: 3
Rationale:
1
Compliance with antidepressant therapy does not indicate the client participating in a plan for safety.
2
A mood rating of 9/10 does not indicate the client participating in a plan for safety.
3
A degree of the responsibility for the suicidal client's safety is given to the client. When a client shares with staff a plan for suicide, the client is participating in a plan for safety by communicating thoughts of self-harm that would initiate interventions to prevent suicide.
4
Expressing feelings of hopelessness do not indicate the client participating in a plan for safety.

Which of the following is most critical to assess when determining risk for suicide for a client newly admitted to an inpatient psychiatric unit?
1.
Family history of depression
2.
The client's orientation to reality
3.
The client's history of suicide attempts
4.
Family support systems

Answer: 3
Rationale:
1
Family history of depression is not critical to determining risk for suicide.
2
Client's orientation to reality not critical to determining risk for suicide.
3
A history of suicide attempts places a client at a higher risk for current suicide behaviors. Knowing this specific data will alert the nurse to the client's risk. Of those who commit suicide, 50-80 percent had a previous attempt.
4
Family support systems are not critical to determining risk for suicide.

According to statistics, which ethnic group is at highest risk for suicide?
1.
African American
2.
Alaskan Native
3.
Asian
4.
White

Answer: 4
Rationale:
1
African Americans are at third highest risk for suicide, following whites and American Indians/Alaska Natives
2
Alaska Natives (and American Indians) are at second highest risk for suicide, following whites.
3
Asians are at fifth highest risk for suicide, following whites, American Indians/Alaska Natives, African Americans, and Hispanic Americans.
4
Statistics show whites are at highest risk for suicide.

A father finds his teenage child has carried out suicide by hanging the morning after they have an argument. Which paternal grief responses would a nurse anticipate? (Select all that apply.)
1.
"I can't believe this is happening."
2.
"If only I had been more understanding."
3.
"How dare he do this to me!"
4.
"I'm just going to have to accept that he was gay."
5.
"Well, that was a selfish thing to do."

Answer: 1, 2, 3
Rationale:
1
Suicide of a family member can induce a whole gamut of feelings in the survivors, including this response of shock.
2
Suicide of a family member can induce a whole gamut of feelings in the survivors, including guilt, such as the sentiment expressed here.
3
This response exemplifies an anger response. Suicide of a family member can induce a whole gamut of feelings in the survivors, including anger.
4
Stating, "I'm just going to have to accept that he was gay," reflects acceptance and understanding.
5
Stating, "Well, that was a selfish thing to do," reflects acceptance and understanding.

1. A nursing instructor is teaching about specific phobias. Which student statement indicates to the instructor that teaching
has been effective?
1. "These clients recognize their fear as excessive and frequently seek treatment."
2. "These clients have a panic level of fear that is overwhelming and unreasonable."
3. "These clients experience symptoms that mirror a cerebrovascular accident."
4. "These clients experience the symptoms of tachycardia, dysphagia, and
diaphoresis."

1. ANS: 2
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Differentiate among the terms stress, anxiety and fear.
Page: 449
Heading: Core Concept > Panic
Integrated Processes: Teaching and Learning
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Evaluating
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 This statement does not indicate understanding.
2 The nursing instructor should evaluate that learning has occurred when the
student knows that clients with phobias have a panic level of fear that is
overwhelming and unreasonable. Phobia is fear cued by a specific object or
situation in which exposure to the stimuli produces an immediate anxiety
response. Even though the disorder is relatively common among the general
population, people seldom seek treatment unless the phobia interferes with
ability to function.
3 This statement indicates that further teaching is necessary.
4 This statement indicates that teaching has not been effective.

Which nursing statement to a client about social anxiety disorder versus schizoid personality disorder (SPD) is most
accurate?
1. "Clients diagnosed with social anxiety disorder can manage anxiety without
medications, whereas clients diagnosed with SPD can only manage anxiety with
medications."
2. "Clients diagnosed with SPD are distressed by the symptoms experienced in
social settings, whereas clients diagnosed with social anxiety disorder are not."
3. "Clients diagnosed with social anxiety disorder avoid interactions only in social
settings, whereas clients diagnosed with SPD avoid interactions in all areas of
life."
4. "Clients diagnosed with SPD avoid interactions only in social settings, whereas
clients diagnosed with social anxiety disorder tend to avoid interactions in all
areas of life."

2. ANS: 3
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Differentiate among the terms stress, anxiety and fear.
Page: 451-453
Heading: Application of the Nursing Process—Assessment > Phobias
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Evaluating
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 Clients with social anxiety disorder may need medication to manage symptoms.
2 Clients with SPD are distressed by symptoms experienced in all settings.
3 Clients diagnosed with social anxiety disorder avoid interactions only in social
settings, whereas clients diagnosed with SPD avoid interactions in all areas of
life. Social anxiety disorder is an excessive fear of situations in which a person
might do something embarrassing or be evaluated negatively by others.
4 This statement in not accurate regarding SPD.

What symptoms should the nurse recognize that differentiate a client diagnosed with panic disorder from a client
diagnosed with generalized anxiety disorder (GAD)?
1. GAD is acute in nature, and panic disorder is chronic.
2. Chest pain is a common GAD symptom, whereas this symptom is absent in panic
disorders.
3. Hyperventilation is a common symptom in GAD and rare in panic disorder.
4. Depersonalization is commonly seen in panic disorder and absent in GAD.

ANS: 4
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Differentiate among the terms stress, anxiety and fear.
Page: 449-451
Heading: Application of the Nursing Process—Assessment
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Evaluating
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 Generalized anxiety disorder is chronic in nature.
2 Clients do not often experience chest pain or hyperventilation with GAD, but do
with panic disorder.
3 Hyperventilation occurs with panic disorder.
4 The nurse should recognize that a client diagnosed with panic disorder
experiences depersonalization, whereas a client diagnosed with GAD would not.
Depersonalization refers to being detached from oneself when experiencing
extreme anxiety.

Which treatment should the nurse identify as most appropriate for clients diagnosed with generalized anxiety disorder?
1. Long-term treatment with diazepam (Valium)
2. Acute symptom control with citalopram (Celexa)
3. Long-term treatment with buspirone (BuSpar)
4. Acute symptom control with ziprasidone (Geodon)

NS: 3
The other options are not appropriate treatment for clients diagnosed with generalized anxiety disorder.
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Discuss various modalities relevant to treatment of anxiety, obsessive-compulsive, and related disorders.
Page: 470
Heading: Psychopharmacology
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 Long-term treatment with diazepam (Valium) is not appropriate treatment for
clients diagnosed with generalized anxiety disorder.
2 Acute symptom control with citalopram (Celexa) is not appropriate treatment for
clients diagnosed with generalized anxiety disorder.
3 The nurse should identify that an appropriate treatment for clients diagnosed
with GAD is long-term treatment with buspirone. Buspirone is an anxiolytic
medication that is effective in 60% to 80% of clients diagnosed with GAD.
Buspirone takes 10 to 14 days for alleviation of symptoms but does not have the
dependency concerns of other anxiolytics.
4 Acute symptom control with ziprasidone (Geodon) is not

Which symptoms should the nurse recognize that differentiate a client diagnosed with obsessive-compulsive disorder
(OCD) from a client diagnosed with obsessive-compulsive personality disorder?
1. Clients diagnosed with OCD experience both obsessions and compulsions, and
clients diagnosed with obsessive-compulsive personality disorder do not.
2. Clients diagnosed with obsessive-compulsive personality disorder experience
both obsessions and compulsions, and clients diagnosed with OCD do not.
3. Clients diagnosed with obsessive-compulsive personality disorder experience
only obsessions, and clients diagnosed with OCD experience only compulsions.
4. Clients diagnosed with OCD experience only obsessions, and clients diagnosed
with obsessive-compulsive personality disorder experience only compulsions.

ANS: 1
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.
Page: 455-456
Heading: Obsessive-Compulsive Disorder
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Analysis (Analyzing)
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 A client diagnosed with OCD experiences both obsessions and compulsions.
Clients with obsessive-compulsive personality disorder exhibit a pervasive
pattern of preoccupation with orderliness, perfectionism, mental and
interpersonal control, but do not experience obsessions and compulsions.
2 Clients with OCD experience obsessions and compulsions. Clients with
obsessive-compulsive personality disorder do not.
3 The nurse would not recognize these symptoms as differentiating the disorders.
4 This statement is inaccurate regarding these disorders.

A cab driver, stuck in traffic, becomes lightheaded, tremulous, diaphoretic, tachycardic, and dyspneic. A work-up in an
emergency department reveals no pathology. Which medical diagnosis should the nurse suspect, and what nursing diagnosis
should be the nurse's first priority?
1. Generalized anxiety disorder and a nursing diagnosis of fear
2. Mild anxiety disorder and a nursing diagnosis of anxiety
3. Pain disorder and a nursing diagnosis of altered role performance
4. Panic disorder and a nursing diagnosis of anxiety

ANS: 4
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.
Page: 449-450
Heading: Panic Disorder
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Analysis [Analyzing]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 Generalized anxiety disorder and a nursing diagnosis of fear does not capture the
client's symptoms.
2 Mild anxiety disorder and a nursing diagnosis of anxiety does not capture the
client's symptoms.
3 Pain disorder and a nursing diagnosis of altered role performance does not
capture the client's symptoms.
4 The nurse should suspect that the client has exhibited signs and symptoms of a
panic disorder. The priority nursing diagnosis should be anxiety. Panic disorder
is characterized by recurrent, sudden-onset

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 response?
1. "I know it's frightening, but try to remind yourself that this will only last a short
time."
2. "Death from a panic attack happens so infrequently that there is no need to
worry."
3. "Most people who experience panic attacks have feelings of impending doom."
4. "Tell me why you think you are going to die every time you have a panic attack."

ANS: 1
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.
Page: 449-450
Heading: Panic Disorder
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 The most appropriate nursing response to the client's concerns is to empathize
with the client and provide encouragement that panic attacks only last a short
period. Panic attacks usually last minutes but can, rarely, last hours.
2 This statement is not the most appropriate nursing response.
3 When the nurse states that "Most people who experience panic attacks..." the
nurse depersonalizes and belittles the client's feeling.
4 This statement is not therapeutic for the client.

A nursing instructor is teaching about the medications used to treat panic disorder. Which student statement indicates
that teaching has been effective?
1. "Clonazepam (Klonopin) is particularly effective in the treatment of panic
disorder."
2. "Clozapine (Clozaril) is used off-label in long-term treatment of panic disorder."
3. "Doxepin (Sinequan) can be used in low doses to relieve symptoms of panic
attacks."
4. "Buspirone (BuSpar) is used for its immediate effect to lower anxiety during
panic attacks."

ANS: 1
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.
Page: 470-472
Heading: Medications for Specific Disorders > For Panic and Generalized Anxiety Disorders
Integrated Processes: Teaching and Learning
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 The student indicates learning has occurred when he or she states that
clonazepam is a particularly effective treatment for panic disorder. Clonazepam
is a type of benzodiazepine in which the major risk is physical dependence and
tolerance, which may encourage abuse. It can be used on an as-needed basis to
reduce anxiety and its related symptoms.
2 This statement indicates that teaching has not been effective.
3 This statement indicates that further teaching is necessary.
4 This statement does not indicate understanding.

A family member is seeking advice about an older 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 response?
1. "My mother also worries unnecessarily. I think it is part of the aging process."
2. "Anxiety is considered abnormal when it is out of proportion to the stimulus
causing it and when it impairs functioning."
3. "From what you have told me, you should get her to a psychiatrist as soon as
possible."
4. "Anxiety is a complex phenomenon and is effectively treated only with
psychotropic medications."

ANS: 2
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.
Page: 449-450
Heading: Application of the Nursing Process—Assessment > Panic Disorder
Integrated Processes: Teaching and Learning
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 This statement is not therapeutic to the family member.
2 The most appropriate response by the nurse is to explain to the family member
that anxiety is considered abnormal when it is out of proportion and impairs
functioning. Anxiety is a normal reaction to a realistic danger or threat to
biological integrity or self-concept.
3 This statement is misleading to the family member.
4 This statement is inaccurate and misleading.

A client is experiencing a severe panic attack. Which nursing intervention would meet this client's physiological need?
1. Teach deep breathing relaxation exercises.
2. Place the client in a Trendelenburg position.
3. Have the client breathe into a paper bag.
4. Administer the ordered prn buspirone (BuSpar).

NS: 3
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.
Page: 461-462
Heading: Table 18-3 Care Plan for the Client with Anxiety, Obsessive-Compulsive, and Related Disorder
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 Relaxations exercises would not replace needed carbon dioxide in the blood.
2 Placing the client in Trendelenburg would not be an effective measure.
3 The nurse can meet this client's physiological need by having the client breathe
into a paper bag. Hyperventilation may occur during periods of extreme anxiety.
Hyperventilation causes the amount of carbon dioxide (CO2) in the blood to
decrease, possibly resulting in lightheadedness, rapid heart rate, shortness of
breath, numbness or tingling in the hands or feet, and syncope. If
hyperventilation occurs, assist the client to breathe into a small paper bag held
over the mouth and nose. Six to 12 natural breaths should be taken, alternating
with short periods of diaphragmatic breathing.
4 BuSpar is not a fast acting antianxiety medication, and, therefore, would not
help the client's anxiety.

A college student is unable to take a final exam due to severe test anxiety. Instead of studying, the student relieves
stress by attending a movie. Which priority nursing diagnosis should the campus nurse assign for this client?
1. Non-adherence R/T test taking
2. Ineffective role performance R/T helplessness
3. Altered coping R/T anxiety
4. Powerlessness R/T fear

ANS: 3
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.
Page: 463
Heading: Table 18-3 Care Plan for the Client with Anxiety, Obsessive-Compulsive, and Related Disorders
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Analysis [Analyzing]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 Non-adherence R/T test taking does not accurately capture what the client is
experiencing.
2 Ineffective role performance R/T helplessness does not accurately capture what
the client is experiencing.
3 The priority nursing diagnosis for this client is altered coping R/T anxiety. The
nurse should assist in implementing interventions that will improve the client's
healthy coping skills and reduce anxiety.
4 Powerlessness R/T fear does not accurately capture what the client is
experiencing.

A client living in a beachfront community is seeking help with an extreme fear of bridges, which is interfering with
daily functioning. The psychiatric nurse practitioner decides to try systematic desensitization. Which explanation of this
treatment should the nurse provide?
1. "Using your imagination, we will attempt to achieve a state of relaxation."
2. "Because anxiety and relaxation are mutually exclusive states, we can attempt to
substitute a relaxation response for the anxiety response."
3. "Through a series of increasingly anxiety-provoking steps, we will gradually
increase your tolerance to anxiety."
4. "In one intense session, you will be exposed to a maximum level of anxiety that
you will learn to tolerate."

ANS: 3
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.
Page: 461-465
Heading: Table 18-3 Care Plan for the Client with Anxiety, Obsessive-Compulsive, and Related Disorders
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 The client does not use imagination during the process of systematic
desensitization.
2 This statement is not accurate regarding systematic desensitization.
3 The nurse should explain to the client that when participating in systematic
desensitization, he or she will go through a series of increasingly anxietyprovoking
steps that will gradually increase tolerance. Systematic
desensitization was introduced by Joseph Wolpe in 1958 and is based on
behavioral conditioning principles.
4 Systematic desensitization does not occur in only one session.

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?
1. The client will refrain from ritualistic behaviors during daylight hours.
2. The client will wake early enough to complete rituals prior to breakfast.
3. The client will participate in three unit activities by day three.
4. The client will substitute a productive activity for rituals by day one.

ANS: 2
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.
Page: 455-456
Heading: Obsessive-Compulsive Disorder
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 This may not be realistic for the client.
2 An appropriate initial client outcome is for the client to wake early enough to
complete rituals prior to breakfast.
3 Participating in three activities on the first day may not be realistic for this
client.
4 The nurse should plan realistic outcomes for the client.

A nurse is providing discharge teaching to a client taking a benzodiazepine. Which client statement would indicate a
need for further follow-up instructions?
1. "I will need scheduled blood work in order to monitor for toxic levels of this
drug."
2. "I won't stop taking this medication abruptly because there could be serious
complications."
3. "I will not drink alcohol while taking this medication."
4. "I won't take extra doses of this drug because I can become addicted."

ANS: 1
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.
Page: 470
Heading: Psychopharmacology
Integrated Processes: Teaching and Learning
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 The client indicates a need for additional information about taking
benzodiazepines when stating the need for blood work to monitor for toxic
levels. This intervention is used when taking lithium (Eskalith) for the treatment
of bipolar disorder.
2 The client should not be stopped abruptly.
3 The drug should not be taken in conjunction with alcohol.
4 The client should understand that taking extra doses of a benzodiazepine may
result in addiction.

The nurse is providing education to a client diagnosed with anxiety. Which statement by the client indicates that
teaching has been effective?
1. "There is nothing that I can do to that will reduce anxiety."
2. "Medication is available, but only for those who have had anxiety for a year or
more."
3. "If I ignore the symptoms of anxiety, it will go away."
4. "Practicing yoga or meditation may help reduce my anxiety."

ANS: 4
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Discuss various treatment modalities relevant to treatment of anxiety, obsessive-compulsive, and related disorders.
Page: 464
Heading: Obsessive-Compulsive Disorder
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 There are many actions that the client can take to reduce anxiety.
2 Medication is available for the treatment of anxiety, regardless of time that the
client has been diagnosed.
3 Ignoring the symptoms of anxiety does not make it go away.
4 Practicing yoga or meditation may help reduce the symptoms of anxiety.

A client is newly diagnosed with obsessive-compulsive disorder and spends 45 minutes folding clothes and rearranging
them in drawers. Which nursing intervention would best address this client's problem?
1. Distract the client with other activities whenever ritual behaviors begin.
2. Report the behavior to the psychiatrist to obtain an order for medication dosage
increase.
3. Lock the room to discourage ritualistic behavior.
4. Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors.

ANS: 4
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.
Page: 463
Heading: Table 18-3 Care Plan for the Client with Anxiety, Obsessive-Compulsive, and Related Disorders
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 Attempting to distract the client is not an appropriate intervention, because it
does not help the client gain insight.
2 Seeking medication increase is not an appropriate intervention, because it does
not help the client gain insight.
3 Locking the client's room is not an appropriate intervention, because it does not
help the client gain insight.
4 The nurse should discuss with the client the anxiety-provoking triggers that
precipitate the ritualistic behavior. If the client is going to be able to control
interrupting anxiety, he or she must first learn to recognize precipitating factors.

A nursing student questions an instructor regarding the order for fluvoxamine (Luvox) 300 mg daily for a client
diagnosed with obsessive-compulsive disorder. Which instructor response is most accurate?
1. High doses of tricyclic medications will be required for effective treatment of
OCD.
2. Selective serotonin reuptake inhibitor (SSRI) doses, in excess of what is effective
for treating depression, may be required for OCD.
3. The dose of Luvox is low because of the side effect of daytime drowsiness.
4. The dose of this SSRI is outside the therapeutic range and needs to be questioned.

ANS: 2
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.
Page: 472
Heading: Medications for Specific Disorders > For Obsessive-Compulsive Disorder
Integrated Processes: Teaching and Learning
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 High doses of tricyclic medications are not required for treatment of OCD.
2 The most accurate instructor response is that SSRI doses in excess of what is
effective for treating depression may be required in the treatment of OCD.
SSRIs have been approved by the Food and Drug Administration for the
treatment of OCD.
3 Common side effects include headache, sleep disturbances, and restlessness.
4 The dosage is needed for effective treatment.

A client is prescribed alprazolam (Xanax) for acute anxiety. What client history should cause a nurse to question this
order?
1. History of alcohol use disorder
2. History of personality disorder
3. History of schizophrenia
4. History of hypertension

ANS: 1
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.
Page: 471
Heading: Table 18-4 Antianxiety Agents
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 The nurse should question a prescription of alprazolam for acute anxiety if the
client has a history of alcohol use disorder. Alprazolam is a benzodiazepine used
in the treatment of anxiety and has an increased risk for physiological
dependence and tolerance. A client with a history of substance use disorder may
be more likely to abuse other addictive substances.
2 History of personality disorder would not cause the nurse to question the order.
3 History of schizophrenia would not cause the nurse to question the order.
4 History of hypertension would not cause the nurse to question the order.

During her aunt's wake, a 4-year-old child runs up to the casket before her mother can stop her. An appointment is
made with a nurse practitioner when the child starts twisting and pulling out hair. Which nursing diagnosis should the nurse
practitioner assign to this child?
1. Complicated grieving
2. Altered family processes
3. Ineffective coping
4. Body image disturbance

ANS: 3
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.
Page: 461
Heading: Table 18-2 Assigning Nursing Diagnoses to Behaviors Commonly Associated with Anxiety, Obsessive-Compulsive,
and Related Disorders
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Analysis [Analyzing]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 The child is not suffering from complicated grieving.
2 The child is not suffering from altered family process.
3 Ineffective coping is defined as an inability to form a valid appraisal of the
stressors, inadequate choices of practiced responses, or inability to use available
resources. This child is coping with the anxiety generated by viewing her
deceased aunt by pulling out hair. If this behavior continues, a diagnosis of hairpulling
disorder, or trichotillomania, may be assigned.
4 The client is not suffering from body image disturbance.

A nursing instructor is teaching about the symptoms of agoraphobia. Which student statement indicates that teaching
has been effective?
1. Onset of symptoms most commonly occurs in early adolescence and persists until
midlife.
2. Onset of symptoms most commonly occurs in the 20s and 30s and persists for
many years.
3. Onset of symptoms most commonly occurs in the 40s and 50s and persists until
death.
4. Onset of symptoms most commonly occurs after the age of 60 and persists for at
least 6 years.

ANS: 2
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.
Page: 451
Heading: Phobias
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1 This statement indicates that teaching has not been effective.
2 The onset of the symptoms of agoraphobia most commonly occurs in the 20s
and 30s and persists for many years.
3 This statement indicates that further teaching is necessary.
4 This statement is inaccurate and indicates a need for further education.

A college student has been diagnosed with generalized anxiety disorder. Which of the following symptoms should the
campus nurse expect this client to exhibit? (Select all that apply.)
1. Fatigue
2. Anorexia
3. Hyperventilation
4. Insomnia
5. Irritability

ANS: 1, 4, 5
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.
Page: 450
Heading: Generalized Anxiety Disorder
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1. The nurse should expect that a client diagnosed with GAD would experience fatigue.
2. The client would not likely experience anorexia.
3. The client would not likely experience hyperventilation.
4. The nurse should expect that a client diagnosed with GAD would experience
insomnia.
5. The nurse should expect that a client diagnosed with GAD would experience
irritability.

A nurse is discussing treatment options with a client whose life has been negatively impacted by claustrophobia. Which
of the following commonly used behavioral therapies for phobias should the nurse explain to the client? (Select all that apply.)
1. Benzodiazepine therapy
2. Systematic desensitization
3. Imploding (flooding)
4. Assertiveness training
5. Aversion therapy

ANS: 2, 3
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.
Page: 468
Heading: Treatment Modalities > Behavior Therapy
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1. Benzodiazepine therapy would not be an appropriate treatment option for the client
and could possibly worsen the client's phobia.
2. The nurse should explain to the client that systematic desensitization and imploding
are the most common behavioral therapies used for treating phobias. Systematic
desensitization involves the gradual exposure of the client to anxiety-provoking
stimuli.
3. The nurse should explain to the client that systematic desensitization and imploding
are the most common behavioral therapies used for treating phobias. Imploding is the
intervention used in which the client is exposed to extremely frightening stimuli for
prolonged periods of time.
4. Assertiveness training would not be an appropriate treatment option for the client and
could possibly worsen the client's phobia.
5. Aversion therapy would not be an appropriate treatment option for the client and could
possibly worsen the client's phobia.

A nurse has been caring for a client diagnosed with generalized anxiety disorder. Which of the following nursing
interventions would address this client's symptoms? (Select all that apply.)
1. Encourage the client to recognize the signs of escalating anxiety.
2. Encourage the client to avoid any situation that causes stress.
3. Encourage the client to employ newly learned relaxation techniques.
4. Encourage the client to cognitively reframe thoughts about situations that
generate anxiety.
5. Encourage the client to avoid caffeinated products.

ANS: 1, 3, 4, 5
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.
Page: 461-465
Heading: Table 18-3 Care Plan for the Client with Anxiety, Obsessive-Compulsive, and Related Disorders
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1. Nursing interventions that address GAD symptoms should include encouraging the
client to recognize signs of escalating anxiety.
2. Avoiding situations that cause stress is not an appropriate intervention. Avoidance
does not help the client overcome anxiety and not all situations are easily avoidable.
3. Nursing interventions that address GAD symptoms should include encouraging the
client to employ relaxation techniques.
4. Nursing interventions that address GAD symptoms should include encouraging the
client to cognitively reframe thoughts about anxiety-provoking situations.
5. Nursing interventions that address GAD symptoms should include encouraging the
client to avoid caffeinated products.

An attractive female client presents with high anxiety levels because of her belief that her facial features are large and
grotesque. Body dysmorphic disorder (BDD) is suspected. Which of the following additional symptoms would support this
diagnosis? (Select all that apply.)
1. Mirror checking
2. Excessive grooming
3. History of an eating disorder
4. History of delusional thinking
5. Skin picking

ANS: 1, 2, 5
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.
Page: 456-457
Heading: Body Dysmorphic Disorder
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback
1. The DSM-5 lists preoccupation with one or more perceived defects or flaws in
physical appearance that are not observable or appear slight to others as a diagnostic
criterion for the diagnosis of BDD. Also listed is that at some point during the course
of the disorder, the person has performed repetitive behaviors, such as mirror
checking.
2. The DSM-5 lists preoccupation with one or more perceived defects or flaws in
physical appearance that are not observable or appear slight to others as a diagnostic
criterion for the diagnosis of BDD. Also listed is that at some point during the course
of the disorder, the person has performed repetitive behaviors, such as excessive
grooming.
3. History of eating disorders is not a symptom that support the diagnosis of body
dysmorphic disorder.
4. History of delusional thinking is not a symptom that support the diagnosis of body
dysmorphic disorder.
5. The DSM-5 lists preoccupation with one or more perceived defects or flaws in
physical appearance that are not observable or appear slight to others as a diagnostic
criterion for the diagnosis of BDD. Also listed is that at some point during the course
of the disorder, the person has performed repetitive behaviors, such as skin picking.

25. Traits associated with schizoid, obsessive-compulsive, and _____________________ personality disorders are
commonly seen in clients with the diagnosis of BDD.

25. ANS:
narcissistic
Page: 456-457
Heading: Body Dysmorphic Disorder
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback: Traits associated with schizoid, obsessive-compulsive, and narcissistic personality disorders are not uncommon in
clients with the diagnosis of BDD.
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.

26. Antianxiety drugs are also called ______________________ and minor tranquilizers.

26. ANS:
anxiolytics
Chapter: Chapter 18, Anxiety, Obsessive-Compulsive, and Related Disorders
Objective: Describe various types of anxiety, obsessive-compulsive, and related disorders and identify symptomatology
associated with each.
Page: 470
Heading: Psychopharmacology
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback: Antianxiety drugs are also called anxiolytics and minor tranquilizers. Antianxiety agents are used in the treatment of
anxiety disorders, anxiety symptoms, acute alcohol withdrawal, skeletal muscle spasms, convulsive disorders, status epilepticus,
and preoperative sedation.