Nokea
A patient reports having a fear of public speaking. The nurse should be aware that social anxiety disorders (social phobias) are often treated with which type of medication?
- A. Beta blockers
- B. Antipsychotic medications
- C. Tricyclic antidepressant agents
- D. Monoamine oxidase inhibitors
Correct Answer: A
Rationale: Beta blockers, such as propranolol, are often effective in preventing symptoms of anxiety associated with social phobias. Neuroleptic medications are major tranquilizers and not useful in treating social phobias. Tricyclic antidepressants are rarely used because of their side effect profile. MAOIs are administered for depression and only by individuals who can observe the special diet required.
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Which assessment finding indicates that a patient with moderate-to-severe anxiety has successfully lowered the anxiety level to mild?
- A. Patient asks, 'What's the matter with me?'
- B. Patient stays in a room alone and paces rapidly.
- C. Patient successfully concentrates on what the nurse is saying.
- D. Patient states, 'I don't want anything to eat. My stomach is upset.'
Correct Answer: C
Rationale: The ability to concentrate and attend to reality is increased slightly in mild anxiety and decreased in moderate-, severe-, and panic-level anxiety. Patients with high levels of anxiety often ask, 'What's the matter with me?' Staying in a room alone and pacing suggest moderate anxiety. Expressing a lack of hunger is not necessarily a criterion for evaluating anxiety.
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.
A patient performs ritualistic hand washing. What should the nurse do to help the patient develop more effective coping strategies?
- A. Allow the patient to set a hand-washing schedule.
- B. Encourage the patient to participate in social activities.
- C. Encourage the patient to discuss hand-washing routines.
- D. Focus on the patient's symptoms rather than on the patient.
Correct Answer: B
Rationale: Because patients diagnosed with obsessive-compulsive disorder become overly involved in rituals, promoting involvement with other people and activities is necessary to improve the patient's coping strategies. Daily activities prevent the constant focus on anxiety and its symptoms. The other interventions focus on the compulsive symptom.
A person consistently rationalizes their cruel and abusive behavior. Which comment is most characteristic of this person defense mechanism?
- A. I don't know why it happens.
- B. I have always had poor impulse control.
- C. That person should not have provoked me.
- D. Inside I am a coward who is afraid of being hurt.
Correct Answer: C
Rationale: Rationalization consists of justifying one's unacceptable behavior by developing explanations that satisfy the teller and attempt to satisfy the listener. The abuser is suggesting that the abuse is not his or her fault; it would not have occurred except for the provocation by the other person.
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.