Nokea
Alprazolam is prescribed for a patient experiencing acute anxiety. Health teaching should include which instructions?
- A. Report drowsiness.
- B. Eat a tyramine-free diet.
- C. Avoid alcoholic beverages.
- D. Adjust dose and frequency based on anxiety level.
Correct Answer: C
Rationale: Drinking alcohol or taking other anxiolytic medications along with the prescribed benzodiazepine should be avoided because depressant effects of both drugs will be potentiated. Tyramine-free diets are necessary only with monoamine oxidase inhibitors (MAOIs). Drowsiness is an expected effect and needs to be reported only if it is excessive. Patients should be taught not to deviate from the prescribed dose and schedule for administration.
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For a patient experiencing panic, which nursing intervention should be implemented first?
- A. Teaching relaxation techniques
- B. Administering an anxiolytic medication
- C. Providing calm, brief, directive communication
- D. Gathering a show of force in preparation for gaining physical control
Correct Answer: C
Rationale: Calm, brief, directive verbal interaction can help the patient gain control of the overwhelming feelings and impulses related to anxiety. Patients experiencing panic-level anxiety are unable to focus on reality; thus, learning relaxation techniques is virtually impossible. Administering an anxiolytic medication should be considered if providing calm, brief, directive communication is ineffective. Although the patient is disorganized, violence may not be imminent, ruling out the intervention of preparing for physical control until other, less-restrictive measures are proven ineffective.
Two staff nurses applied for promotion to nurse manager. Initially, the nurse not promoted had feelings of loss but then became supportive of the new manager by helping make the transition smooth and encouraging others. Which term best describes the nurse's response?
- A. Altruism
- B. Sublimation
- C. Suppression
- D. Passive aggression
Correct Answer: A
Rationale: Altruism is the mechanism by which an individual deals with emotional conflict by meeting the needs of others and vicariously receiving gratification from the responses of others. The nurse's reaction is conscious, not unconscious. No evidence of aggression is exhibited, and no evidence of conscious denial of the situation exists. Passive aggression occurs when an individual deals with emotional conflict by indirectly and unassertively expressing aggression toward others.
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.
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.
A patient with a mass in the left upper lobe of the lung is scheduled for a biopsy. The patient has difficulty understanding the nurse's comments and asks, 'What are they going to do?' Assessment findings on the patient include a tremulous voice, respirations 28 breaths per minute, and pulse rate 110 beats/min. What is the patient's level of anxiety?
- A. Mild
- B. Moderate
- C. Severe
- D. Panic
Correct Answer: B
Rationale: Moderate anxiety causes the individual to grasp less information and reduces his or her problem-solving ability to a less-than-optimal level. Mild anxiety heightens attention and enhances problem-solving abilities. Severe anxiety causes great reduction in the perceptual field. Panic-level anxiety results in disorganized behavior.