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A nurse who has worked with a client diagnosed with generalized anxiety disorder (GAD) when he was an inpatient on the psychiatric unit sees the client in the waiting room of the outpatient psychiatric clinic. The client motions to the nurse to come over so he can tell the nurse how things have been going since he was discharged. While talking with the client, the nurse determines that the client?s therapy has been effective when the client states which of the following?
- A. I am still experiencing quite a bit of stress at home and at work; things are different at home than they were in the hospital.
- B. When my mother-in-law comes over now, I go out to my workshop and work on one of my projects.
- C. I?m still drinking coffee; I can?t quit after drinking it all these years.
- D. I?ve learned having a beer after I get home from work helps me relax.
Correct Answer: B
Rationale: Going to the workshop (B) indicates effective coping by using a constructive activity to manage stress from a trigger (mother-in-law?s visits). Persistent stress (A) suggests ineffective therapy, coffee (C) can worsen anxiety, and alcohol use (D) is an unhealthy coping mechanism.
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A nurse is developing a teaching plan for a client with generalized anxiety disorder, focusing on nutrition. Which of the following would the nurse encourage the client to avoid? Select all that apply.
- A. Coffee
- B. Ginseng
- C. Milk products
- D. Citrus juices
- E. Aged cheese
Correct Answer: A,B
Rationale: Coffee (A) and ginseng (B) are stimulants that can exacerbate anxiety symptoms in GAD. Milk products (C), citrus juices (D), and aged cheese (E) are not typically contraindicated unless specific sensitivities exist.
A client with panic disorder who has been prescribed sertraline in conjunction with alprazolam comes to the clinic for a follow-up. The client states, I stopped taking the alprazolam about 2 days ago. I was feeling really sleepy and tired. Which of the following would alert the nurse to suspect possible withdrawal? Select all that apply.
- A. Metallic taste
- B. Irritability
- C. Dry, flushed skin
- D. Tremor
- E. Muscle flaccidity
Correct Answer: B,D
Rationale: Abrupt cessation of alprazolam, a benzodiazepine, can cause withdrawal symptoms like irritability (B) and tremor (D) due to central nervous system rebound. Metallic taste (A), dry skin (C), and muscle flaccidity (E) are not typical withdrawal symptoms.
The nurse has instructed a client with panic disorder about how to use the technique of positive self-talk. The nurse determines that the client has understood the instructions when the client verbalizes which statement to use during an impending panic attack?
- A. I am feeling very nervous right now.
- B. I can handle this anxiety; it will be over shortly.
- C. I am taking medication to eliminate these symptoms.
- D. Relax your muscles, relax your muscles.
Correct Answer: B
Rationale: Positive self-talk (B) involves reassuring statements that empower the client to manage anxiety, such as affirming control and the transient nature of the attack. Stating nervousness (A) reinforces anxiety, medication reliance (C) is not self-talk, and muscle relaxation (D) is a different technique.
A nurse is preparing an in-service presentation about panic disorders and associated theories related to the cause. When describing the cognitive-behavioral concepts associated with panic disorders, which of the following would the nurse expect to address?
- A. Personal losses
- B. Conditioned response
- C. Early separation
- D. Dysfunctional family communication
Correct Answer: B
Rationale: Cognitive-behavioral theory links panic disorder to a conditioned response (B), where physical sensations are misinterpreted as catastrophic, triggering panic. Personal losses (A), early separation (C), and dysfunctional communication (D) are more relevant to psychoanalytic theories.
After teaching a class about the biochemical theories associated with panic disorder, the instructor determines a need for additional teaching when the students identify which neurotransmitter as being implicated?
- A. Dopamine
- B. Serotonin
- C. Norepinephrine
- D. Gamma-aminobutyric acid (GABA)
Correct Answer: A
Rationale: Serotonin (B), norepinephrine (C), and GABA (D) are implicated in panic disorder due to their roles in anxiety regulation. Dopamine (A) is primarily linked to psychosis and reward, not panic, indicating a misunderstanding.