Nokea
A patient has the nursing diagnosis anxiety as evidenced by an inability to control compulsive cleaning. Which phrase referring to the likely trigger correctly completes the etiological portion of the diagnosis?
- A. Ensuring the health of household members
- B. Attempting to avoid interactions with others
- C. Having persistent thoughts about bacteria, germs, and dirt
- D. Needing approval for cleanliness from friends and family
Correct Answer: C
Rationale: Many compulsive rituals accompany obsessive thoughts. The patient uses these rituals to relieve anxiety. Unfortunately, the anxiety relief is short lived, and the patient must frequently repeat the ritual. The other options are unrelated to the dynamics of compulsive behavior.
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A patient tells the nurse, 'I wanted my health care provider to prescribe diazepam for my anxiety disorder, but buspirone was prescribed instead. Why?' The nurse's reply should be based on the knowledge of which characteristic of buspirone?
- A. It does not produce blood dyscrasias.
- B. It is not known to cause dependence.
- C. It can be administered as needed.
- D. It is faster acting than diazepam.
Correct Answer: B
Rationale: Buspirone is considered effective in the long-term management of anxiety because it is not habituating. Because it is long acting, buspirone is not valuable as an as-needed or as a fast-acting medication. The fact that buspirone does not produce blood dyscrasias is less relevant in the decision to prescribe buspirone.
A patient approaches the nurse and impatiently blurts out, 'You've got to help me! Something terrible is happening. My heart is pounding.' The nurse responds, 'It's almost time for visiting hours. Let's get your hair combed.' Which approach has the nurse used?
- A. Bringing up an irrelevant topic
- B. Responding to physical needs
- C. Addressing false cognitions
- D. Focusing
Correct Answer: A
Rationale: The patient is experiencing anxiety. The nurse has closed off patient-centered communication by changing the subject. The introduction of an irrelevant topic makes the nurse feel better. The nurse may be uncomfortable dealing with the patient's severe anxiety. The nurse has not responded to the patient's physical needs. There is no evidence of false cognition. Focusing is a therapeutic communication technique used to concentrate attention on a single issue.
A patient experiences an episode of severe anxiety. Of these medications in the patient's medical record, which is most appropriate to administer as a short-term therapy?
- A. Buspirone
- B. Lorazepam
- C. Amitriptyline
- D. Desipramine
Correct Answer: B
Rationale: Lorazepam is a benzodiazepine medication used to treat anxiety on a short-term basis only. Buspirone is long acting and not useful as an as-needed drug. Amitriptyline and desipramine are tricyclic antidepressants and considered second- or third-line agents.
A person has minor physical injuries after an automobile accident. The person is unable to focus and says, 'I feel like something awful is going to happen.' This person has nausea, dizziness, tachycardia, and hyperventilation. What is this person's level of anxiety?
- A. Mild
- B. Moderate
- C. Severe
- D. Panic
Correct Answer: C
Rationale: The person whose anxiety is severe is unable to solve problems and may have a poor grasp of what is happening in the environment. Somatic symptoms such as those described are usually present. The individual with mild anxiety is only mildly uncomfortable and may even find his or her performance enhanced. The individual with moderate anxiety grasps less information about a situation and has some difficulty with problem solving. The individual in panic-level anxiety demonstrates significantly disturbed behavior and may lose touch with reality.
Which assessment questions are most relevant to ask a patient with possible obsessive-compulsive disorder?
- A. Have you been a victim of a crime or seen someone badly injured or killed?
- B. Are there certain social situations that cause you to feel especially uncomfortable?
- C. Do you have to do things in a certain way to feel comfortable?
- D. Is it difficult to keep certain thoughts out of awareness?
- E. Do you do certain things over and over again?
Correct Answer: C,D,E
Rationale: The correct questions refer to obsessive thinking and compulsive behaviors. The incorrect responses are more pertinent to a patient with suspected posttraumatic stress disorder or with suspected social anxiety disorder (social phobia).