Chapter 46: Care of Patients with Anxiety, Mood, and Eating Disorders My Nursing Test Banks

Chapter 46: Care of Patients with Anxiety, Mood, and Eating Disorders

MULTIPLE CHOICE

1. The nurse observes a coworker who is always behind because he checks and rechecks the accuracy of his medication dosages. Even after being reassured his dosages are correct, he checks them again. The nurse suspects her coworker to be suffering from:

a.

perfectionism.

b.

phobic disorder.

c.

obsessive-compulsive disorder (OCD).

d.

general anxiety disorder.

ANS: C

When a person has an obsessive-compulsive disorder (OCD), he experiences an obsession, recurrent or intrusive thoughts that he cannot stop thinking about, and these thoughts create anxiety. A compulsive act is an act that the person feels compelled to perform. For example, a person may experience anxiety and so performs repetitive handwashing in an attempt to reduce that anxiety. Time spent in these thoughts and rituals can become overwhelming to the point of interfering with normal life.

DIF: Cognitive Level: Application REF: 1047 OBJ: 3 (theory)

TOP: OCD: Signs KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

2. While the nurse is helping the dialysis patient dress to go to her dialysis treatment, the patient bursts into tears and says, I cant go! I cant stand another day in that awful place. I will die if I have to go! The nurses best intervention would be to:

a.

stop the dressing process, sit down, and calmly ask, Lets talk about how you are feeling.

b.

continue to dress the patient and say, Youll feel better after you have had your dialysis treatment.

c.

stop the dressing process and ask, Are you aware that you can get sicker if you dont go?

d.

continue dressing the patient and say, Well have to hurry if you are to eat breakfast before you go.

ANS: A

A calm and supportive attitude will help the patient identify feelings.

DIF: Cognitive Level: Analysis REF: 1046 OBJ: 1 (theory)

TOP: Moderate Anxiety: Intervention KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

3. The night nurse finds a patient who broke both legs in a car accident 2 weeks ago awake and crying at 2:00 AM. When the nurse asks if she wants a sedative to sleep, the patient confesses that she relives the accident in her dreams and is fearful to go to sleep. The nurse recognizes signs of:

a.

post-traumatic stress disorder (PTSD).

b.

phobic disorder.

c.

obsessive-compulsive disorder (OCD).

d.

panic level of anxiety.

ANS: A

Individuals with post-traumatic stress disorder (PTSD) have endured one or more extreme life-threatening events, and the remembrance of these events now produces feelings of intense horror, with recurrent symptoms of anxiety and nightmares or flashbacks.

DIF: Cognitive Level: Application REF: 1047 OBJ: 4 (theory)

TOP: PTSD: Signs KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

4. The nurse clarifies that anxiety disorders differ from normal anxiety in that anxiety disorders:

a.

develop into suicidal tendencies.

b.

are seldom controlled.

c.

interfere with effective functioning.

d.

make maintenance of relationships impossible.

ANS: C

Anxiety disorders interrupt normal day-to-day functioning in the workplace and in family settings.

DIF: Cognitive Level: Knowledge REF: 1046 OBJ: 2 (theory)

TOP: Normal Anxiety vs. Debilitating Anxiety

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

5. The nurse is aware that unless effective intervention occurs for demonstrated anxiety disorders, the anxiety will:

a.

be self-limiting.

b.

force the person to seek medical intervention.

c.

develop into a full-blown psychosis.

d.

return at a greater level of severity.

ANS: D

If interventions are not applied at a lower level of anxiety, the anxiety will build to greater severity with greater interruption of effective functioning.

DIF: Cognitive Level: Comprehension REF: 1045-1046 OBJ: 1 (theory)

TOP: Anxiety: Need for Intervention KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity

6. The nurse reminds the patient who has just been prescribed diazepam (Valium) to use it with caution as this drug can cause:

a.

dependency.

b.

urine retention.

c.

severe dehydration.

d.

hallucinations.

ANS: A

Valium can cause a physiologic and a psychological dependence.

DIF: Cognitive Level: Comprehension REF: 1048 OBJ: 3 (theory)

TOP: Diazepam (Valium): Dependency KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

7. The nurse encourages the patient with generalized anxiety disorder (GAD) that buspirone (BuSpar) has the benefit of:

a.

less time to reach therapeutic level.

b.

decreased risk of dependence.

c.

increased sedation.

d.

inhibiting serotonin reuptake.

ANS: B

BuSpar creates less dependency and decreased sedation.

DIF: Cognitive Level: Comprehension REF: 1048 OBJ: 3 (theory)

TOP: Buspirone (BuSpar): Benefits KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

8. A resident in a long-term care facility who has generalized anxiety disorder (GAD) enters the dining room on her walker and discovers that her regular place has been taken by a visitor. The resident becomes agitated and says, I need my place so I can eat! I cant eat unless I am in my place! The nurses most effective intervention would be to say:

a.

Go sit with Mrs. Smith right now. There is no one else at her table now.

b.

Well eat over here for lunch and at your regular place for supper.

c.

Dont be silly! That chair is no different from any other chair in the room.

d.

If you dont eat, you will be hungry.

ANS: B

A calm voice and relaxed attitude will help the anxious patient to mimic the nurses behavior. All other responses will not help in reducing the patients anxiety.

DIF: Cognitive Level: Application REF: 1045-1047 OBJ: 4 (theory)

TOP: Anxiety: Intervention KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

9. An older adult resident in a long-term care facility has come to the desk for the fourth time in an hour with various minor complaints. He continues to wander about aimlessly. The nurse examines the patients chart and finds the newly prescribed drug that may explain his anxious behavior, which would be:

a.

Tylenol 32 mg PO every 4 hours for pain.

b.

theophylline 100 mg bid for asthma.

c.

bisacodyl tabs 2 prn for constipation.

d.

lisinopril 10 mg bid for hypertension.

ANS: B

The drug theophylline makes patients feel anxious and restless. Tylenol, bisacodyl, and lisinopril do not typically have this effect.

DIF: Cognitive Level: Analysis REF: 1050 OBJ: 2 (theory)

TOP: Anxiety vs. Drug Reaction KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

10. After having refused lunch and dinner because her regular chair was occupied at breakfast, the resident in a long-term care facility asks for a snack. The nurse should take this opportunity to sit down with the resident and say:

a.

You are hungry now. Is there something else you could have done besides refuse to eat?

b.

Here is your snack. Maybe you wont be so quick to refuse meals the next time you dont get your way.

c.

Refusing meals is not the answer. You must eat.

d.

Why in the world did you leave the dining room without eating?

ANS: A

After acute anxiety passes, the nurse should focus on helping the resident recognize the behavior that was exhibited and how to deal more effectively with the anxiety.

DIF: Cognitive Level: Analysis REF: 1046 OBJ: 4 (theory)

TOP: Anxiety: Intervention KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

11. A resident in the long-term care facility has been in a manic stage for 2 days. He has not slept and cannot focus long enough to eat a meal. The nurse can enhance his nutrition by:

a.

insisting he sit down and eat at the table at regular mealtimes.

b.

spoon-feeding him at the table at regular mealtimes.

c.

handing him small glasses of high-protein drinks every hour.

d.

making up a game about who can finish a meal first.

ANS: C

Mania is an elevation in mood that includes increased grandiosity or irritability that is present for at least 1 week. A manic person may exhibit pressured speech, which is talking that is loud and rapid and difficult to interrupt; or flight of ideas, where the speaker goes from topic to topic with little or no connection. There is an inability to concentrate, a decreased need for sleep or nutrients, and an increase in goal-directed activity, impulsive spending, and hypersexuality. Unstable and frequently changing, or labile, behavior is often seen in manic patients; a mood of frivolity and joking can rapidly change to agitation and extreme paranoia. The agitation and irritability seen in manic patients can often lead to aggressive behavior. Because of the manic patients abbreviated focus, eating an entire meal may not be possible. Offering a small amount of high-energy foods and drinks every hour will support nutrition until the manic behavior is under control.

DIF: Cognitive Level: Application REF: 1052 OBJ: 6 (theory)

TOP: Manic Behavior: Nutritional Support

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

12. The nurse is aware that chlorpromazine (Thorazine) is given along with lithium carbonate because:

a.

lithium takes up to 2 weeks to reach therapeutic level.

b.

Thorazine reduces the threat of lithium toxicity.

c.

Thorazine lowers blood pressure.

d.

Thorazine synergizes the lithium.

ANS: A

Lithium takes up to 2 weeks to take effect. Thorazine modifies the manic behavior in the interim.

DIF: Cognitive Level: Application REF: 1051 OBJ: 6 (theory)

TOP: Lithium: Properties KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

13. A patient who has been on lithium for 5 days walks up the hall singing loudly and gaily greets everyone he sees. He is a little unsteady in his walker. He asks for more ice water saying he is very thirsty and complaining of insomnia. The nurse would report the observation of:

a.

manic behavior.

b.

unsteady gait.

c.

thirst.

d.

insomnia.

ANS: B

The ataxic gait should be reported immediately as a sign of lithium toxicity. It is too soon in therapy for the mania to be controlled. Thirst and insomnia are expected side effects of lithium, but not toxic ones.

DIF: Cognitive Level: Analysis REF: 1051 OBJ: 6 (theory)

TOP: Lithium: Side Effects KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

14. The nurse takes into consideration that when a depressed person presents herself as sad the term takes on the meaning of being:

a.

fatigued and gloomy.

b.

physically unclean.

c.

hopeless and worthless.

d.

suicidal.

ANS: C

The depressed person feels unworthy and hopeless. Depression does not automatically mean that the patient is suicidal. If there is a delusional state of being physically unclean, the patients condition has deteriorated into a psychosis.

DIF: Cognitive Level: Application REF: 1051 OBJ: 6 (theory)

TOP: Depression: Affect KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity

15. The depressed patient who has been taking amitriptyline (Elavil) for the past 2 weeks complains of still feeling depressed and wants to abandon the drug. The nurses most helpful response would be:

a.

All drugs dont work for all people. I will talk to the physician about a new order for a different drug.

b.

You probably should quit taking Elavil if it is not helping you.

c.

Sometimes drinking a small glass of wine with meals helps.

d.

These drugs take several weeks to become effective.

ANS: D

It can take up to 4 weeks before symptoms are relieved by tricyclics.

DIF: Cognitive Level: Application REF: 1056 OBJ: 6 (theory)

TOP: Tricyclic Antidepressants: Delayed Effect

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

16. Antidepressant therapy has been effective and the suicidal patient verbalizes that he feels better. The nurse is aware that at this time, the:

a.

risk of self-harm increases.

b.

patient gains insight to his previous desire for suicide.

c.

suicidal precautions can be relaxed.

d.

antidepressive medication doses can be reduced.

ANS: A

The risk of suicide is greater now that the patient has increased energy to plan and complete the suicide.

DIF: Cognitive Level: Comprehension REF: 1058 OBJ: 7 (theory)

TOP: Suicide: Increased Risk KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity

17. The nurse is aware that the basic drive behind the patients anorexia nervosa is to:

a.

be sexually desirable by staying slender.

b.

be involved with preparation of food, but not eating it.

c.

punish self by denial of adequate nutrition.

d.

gain a sense of control by limiting food intake.

ANS: D

Anorexia nervosa is characterized by the patients refusal to maintain minimal body weight or eat adequate quantities of food. There is a disturbance in the perception of body shape and size and an extreme fear of becoming fat. The patient strives for perfection and control by controlling caloric intake. The person with anorexia nervosa gains a sense of control by limiting food intake.

DIF: Cognitive Level: Analysis REF: 1060 OBJ: 9 (theory)

TOP: Anorexia Nervosa: Etiology KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity

18. The patient suspected of having bulimia should be assessed for the classic behavior of this disorder, which is:

a.

bingeing and purging.

b.

refusal to eat.

c.

excessive exercising.

d.

hiding food to make it appear it was eaten.

ANS: A

Patients with bulimia nervosa induce vomiting after consuming large quantities of food. This binge eating occurs in a frenzied state and usually in secrecy; afterward, the patient experiences feelings of shame and self-criticism. Laxatives may be taken to purge the system after the binge. Ninety percent of patients with bulimia are young women.

DIF: Cognitive Level: Comprehension REF: 1060-1061 OBJ: 9 (theory)

TOP: Bulimia: Classic Behavior KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

19. The nurse is caring for a patient admitted with a diagnosis of serotonin syndrome. Which will most likely be included in the plan of treatment?

a.

Antihypertensive medications

b.

Intravenous therapy

c.

Large doses of antianxiety medications

d.

Sedatives

ANS: B

Serotonin syndrome is a potential life-threatening condition that could start 30 minutes to 48 hours after taking the medication. Symptoms include change of mental status, increase in pulse and fluctuation in blood pressure, loss of muscular coordination, and hyperthermia. Treatment includes stopping medication, administering intravenous (IV) fluids, and decreasing temperature.

DIF: Cognitive Level: Application REF: 1057 OBJ: 6 (theory)

TOP: Medication Safety Alert: Serotonin Syndrome

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

MULTIPLE RESPONSE

20. The nurse lists the signs and symptoms of a general anxiety disorder (GAD), which include: (Select all that apply.)

a.

heart rate of over 100 beats/min.

b.

restlessness.

c.

urinary retention.

d.

fatigue.

e.

muscular tension.

ANS: A, B, D, E

A person who experiences persistent, unrealistic, or excessive worry about two or more life circumstances for 6 months or longer is exhibiting symptoms associated with generalized anxiety disorder (GAD). GAD usually develops slowly and is chronic in nature. Dieresis rather than urinary retention is a commonly seen with GAD. All other options listed are characteristics of GAD.

DIF: Cognitive Level: Comprehension REF: 1046 OBJ: 3 (theory)

TOP: GAD: Signs and Symptoms KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

21. The nurse outlines the treatment for a person with anxiety disorders, which include: (Select all that apply.)

a.

anxiolytic medication.

b.

education about disorder.

c.

individual therapy.

d.

relaxation techniques.

e.

stress management.

ANS: A, B, C, D, E

All options are aspects of the treatment of the person with anxiety disorders.

DIF: Cognitive Level: Comprehension REF: 1044-1046 OBJ: 3 (theory)

TOP: Anxiety Disorders: Treatment KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

22. The nurse reviews the nursing considerations related to the administration of lithium, which include: (Select all that apply.)

a.

drug should be taken on an empty stomach.

b.

fluids should be restricted to 1000 mL daily.

c.

ensure frequent blood levels are drawn.

d.

encourage contraception to avoid pregnancy while on drug.

e.

avoid caffeine.

ANS: C, D, E

Lithium should be taken with food, and fluids should be increased to 3000 mL daily.

DIF: Cognitive Level: Comprehension REF: 1051 OBJ: 6 (theory)

TOP: Lithium: Nursing Considerations KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

23. The nurse assesses the patient for the signs and symptoms that characterize a major depressive disorder, which are: (Select all that apply.)

a.

euphoria.

b.

psychomotor retardation.

c.

indecisiveness.

d.

sleep disturbances.

e.

suicidal ideation.

ANS: B, C, D, E

Major depressive disorder is diagnosed when at least five symptoms characteristic of depression have been present for at least 2 weeks. These symptoms include an overwhelming feeling of sadness; inability to feel pleasure or experience interest in daily activities; weight gain or loss not attributed to dieting; sleep disturbances; fatigue or loss of energy; feelings of worthlessness; difficulty in making decisions or concentrating; and suicidal thoughts.

DIF: Cognitive Level: Comprehension REF: 1055 OBJ: 6 (theory)

TOP: Major Depressive Disorder: Diagnostic Criteria

KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

24. The nurse assesses data about a depressed patient that increase the probability of his being suicidal, which are: (Select all that apply.)

a.

owning a gun collection.

b.

living with wife and three children.

c.

being an active member of the local church.

d.

having a plan to shoot himself in a motel.

e.

having a brother that recently committed suicide.

ANS: A, D, E

Suicidal risk increases if the patient has a plan, access to a weapon, and a recent loss.

DIF: Cognitive Level: Application REF: 1059 OBJ: 7 (theory)

TOP: Suicide: Assessment KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

25. A patient is considering having electroconvulsive therapy to treat his severe depression. Which statements indicate the patient has an understanding of the procedure? (Select all that apply.)

a.

My treatment plan will include treatments once every other month.

b.

The shock will cause me to have a short seizure.

c.

This treatment is often more successful than medications.

d.

I will have to be hospitalized the day before and after the treatments for observation.

e.

The treatments will be performed in the early morning hours.

ANS: B, C, E

Electroconvulsive therapy (ECT) is the oldest form of brain stimulation therapy used for severe depression. After several regimens of medication are unsuccessful, or if the patient is severely depressed or actively suicidal, ECT is considered. Evidence suggests that ECT is more effective than pharmacotherapy. ECT consists of electric shock delivered to the brain via electrodes applied to the temples. This shock artificially induces a grand mal seizure lasting 30 to 90 seconds. The patient typically receives 8 to 12 treatments spread over several weeks. ECT is frequently done on an outpatient basis in the early morning.

DIF: Cognitive Level: Application REF: 1057 OBJ: 6 (theory)

TOP: Electroconvulsive Therapy KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Health Promotion and Maintenance

26. The nurse is reviewing the medical history of a patient who is being evaluated for anorexia nervosa. Which characteristic(s) would be consistent with the condition? (Select all that apply.)

a.

Loss of 2 to 3 pounds in the past month

b.

Binge eating

c.

Frequent mood changes

d.

Absence of three consecutive menstrual periods

e.

Body weight less than 85% of what is expected for height and weight

ANS: C, D, E

Anorexia nervosa is characterized by the patients refusal to maintain minimal body weight or eat adequate quantities of food. There is a disturbance in the perception of body shape and size and an extreme fear of becoming fat. The patient strives for perfection and control by controlling caloric intake. Defining characteristics include frequent mood fluctuation, absence of three consecutive menstrual periods, and body weight less than 85% of what is expected for height and weight.

DIF: Cognitive Level: Application REF: 1060 OBJ: 9 (theory)

TOP: Anorexia Nervosa KEY: Nursing Process Step: Diagnosis

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

COMPLETION

27. The nurse points out that a persistent irrational fear of a specific object or situation that causes anxiety that interferes with responsibilities is a(n) _________.

ANS:

phobia

A phobia is an irrational fear of a specific object or situation that renders the person unable to fulfill responsibilities.

DIF: Cognitive Level: Knowledge REF: 1047 OBJ: 2 (theory)

TOP: Phobia: Definition KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

28. The nurse takes into consideration that it is estimated that _____% of the population will have some form of anxiety disorder.

ANS:

25

twenty-five

One person out of four will have symptoms of an anxiety disorder in his or her lifetime.

DIF: Cognitive Level: Knowledge REF: 1045 OBJ: 1 (theory)

TOP: Anxiety: Incidence KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

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