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A nurse plans health teaching for a patient diagnosed with generalized anxiety disorder (GAD) who takes lorazepam. What information should be included?
- A. Use caution when operating machinery.
- B. Allow only tyramine-free foods in diet.
- C. Restrict intake of caffeine.
- D. Avoid using alcohol and other sedatives.
- E. Take the medication on an empty stomach.
Correct Answer: A,C,D
Rationale: Caffeine is a central nervous system stimulant that acts as antagonist to the benzodiazepine lorazepam. Daily caffeine intake should be reduced to the amount contained in one cup of coffee. Benzodiazepines are sedatives, thus the importance of exercising caution when driving or using machinery and the importance of not using other central nervous system depressants such as alcohol or sedatives to avoid potentiation. Benzodiazepines do not require a special diet. Food will reduce gastric irritation from the medication.
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A person who has been unable to leave home for more than a week because of severe anxiety says, 'I know it does not make sense, but I just can't bring myself to leave my apartment alone.' Which nursing intervention is appropriate when implementing cognitive restructuring?
- A. Teach the person to use positive self-talk.
- B. Assist the person to apply for disability benefits.
- C. Ask the person to explain why the fear is so disabling.
- D. Advise the person to accept the situation and use a companion.
Correct Answer: A
Rationale: This intervention, a form of cognitive restructuring, replaces negative thoughts such as 'I can't leave my apartment' with positive thoughts such as 'I can control my anxiety.' This technique helps the patient gain mastery over the symptoms. The other options reinforce the sick role.
Which assessment question would be most appropriate for the nurse to ask a patient who is at risk for developing generalized anxiety disorder (GAD)?
- A. Have you been a victim of a crime or seen someone badly injured or killed?
- B. Do you feel especially uncomfortable in social situations involving people?
- C. Do you repeatedly do certain things over and over again?
- D. Do you find it difficult to control your worrying?
Correct Answer: D
Rationale: Patients with GAD frequently engage in excessive worrying. They are less likely to engage in ritualistic behavior, fear social situations, or have been involved in a highly traumatic event.
A patient tells a nurse, 'My new friend is the most perfect person one could imagine - kind, considerate, and good looking. I can't find a single flaw.' This patient is demonstrating which defense mechanism?
- A. Denial
- B. Projection
- C. Idealization
- D. Compensation
Correct Answer: C
Rationale: Idealization is an unconscious process that occurs when an individual attributes exaggerated positive qualities to another. Denial is an unconscious process that calls for the nurse to ignore the existence of the situation. Projection operates unconsciously and results in blaming behavior. Compensation results in the nurse unconsciously attempting to make up for a perceived weakness by emphasizing a strong point.
A student says, 'Before taking a test, I feel a heightened sense of awareness and restlessness.' The nurse can correctly assess that the student's response is a result of what?
- A. Cultural influence
- B. Displacement
- C. Trait anxiety
- D. Mild anxiety
Correct Answer: D
Rationale: Mild anxiety is rarely obstructive to the task at hand. It may be helpful to the patient because it promotes study and increases awareness of the nuances of questions. The incorrect responses have different symptoms.
A patient experiencing moderate anxiety says, 'I feel undone.' An appropriate response for the nurse would be:
- A. Why do you suppose you are feeling anxious?
- B. What would you like me to do to help you?
- C. I'm not sure I understand. Give me an example.
- D. You must get your feelings under control before we can continue.
Correct Answer: C
Rationale: Increased anxiety results in scattered thoughts and an inability to articulate clearly. Clarification helps the patient identify his or her thoughts and feelings. Asking the patient why he or she feels anxious is nontherapeutic, and the patient will not likely have an answer. The patient may be unable to determine what he or she would like the nurse to do to help. Telling the patient to get his or her feelings under control is a directive the patient is probably unable to accomplish.