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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.
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A child is placed in a foster home after being removed from parental contact because of both physical and verbal abuse. The child is apprehensive and overreacts to environmental stimuli. The foster parents ask the nurse how to help minimize the child's anxious behaviors. What should the nurse recommend?
- A. Use a calm manner and low voice.
- B. Maintain simplicity in the environment.
- C. Avoid repetition in what is said to the child.
- D. Minimize opportunities for exercise and play.
- E. Explain and reinforce reality to avoid distortions.
Correct Answer: A,B,E
Rationale: The child can be hypothesized to have moderate-to-severe anxiety. A calm manner calms the child. A simple, structured, predictable environment is less anxiety provoking and reduces overreaction to stimuli. Calm, simple explanations that reinforce reality validate the environment. Repetition is often needed when the child is unable to concentrate because of elevated levels of anxiety. Opportunities for play and exercise should be provided as avenues to reduce anxiety. Physical movement helps channel and lower anxiety. Play also helps by allowing the child to act out concerns.
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 with a high level of motor activity runs from chair to chair and cries, 'They're coming! They're coming!' The patient is unable to follow instructions or respond to verbal interventions from staff. Which nursing diagnosis has the highest priority?
- A. Risk for injury
- B. Self-care deficit
- C. Disturbed energy field
- D. Disturbed thought processes
Correct Answer: A
Rationale: A patient who is experiencing panic-level anxiety is at high risk for injury, related to an increase in non-goal-directed motor activity, distorted perceptions, and disordered thoughts. Existing data do not support the nursing diagnoses of self-care deficit or disturbed energy field. This patient has disturbed thought processes, but the risk for injury has a higher priority.
A nurse wishes to teach alternative coping strategies to a patient experiencing severe anxiety. The nurse will first need to:
- A. verify the patient's learning style.
- B. create outcomes and a teaching plan.
- C. lower the patient's current anxiety level.
- D. assess how the patient uses defense mechanisms.
Correct Answer: C
Rationale: A patient experiencing severe anxiety has a significantly narrowed perceptual field and difficulty attending to events in the environment. A patient experiencing severe anxiety will not learn readily. Determining preferred modes of learning, devising outcomes, and constructing teaching plans are relevant to the task but are not the priority measure. The nurse has already assessed the patient's anxiety level. Using defense mechanisms does not apply.
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.