Anxiety Disorders and Stress NCLEX Practice Quiz: 75 Questions
1. 1. Question
Chuck is a 20-year-old student diagnosed with obsessive-compulsive
... [Show More] behavior. A psychiatrist prescribes clomipramine (Anafranil) to treat his condition. Nurse Nicolette understands the rationale for this treatment is that the clomipramine:
o A. Increases dopamine levels
o B. Increases serotonin levels
o C. Decreases norepinephrine levels
o D. Decreases GABA levels
Incorrect
Correct Answer: B. Increases serotonin levels
According to the psychobiological theory, dysregulation of the neurotransmitter serotonin is thought to contribute to obsessive-compulsive behavior. Clomipramine (Anafranil) is used to increase serotonin levels, thereby decreasing the need for obsessive-compulsive behaviors. The only FDA-approved use for clomipramine is for the treatment of the obsessive-compulsive disorder (OCD) in ages 10 and older. Clomipramine was the first FDA-approved medication for OCD in 1989. For the treatment of OCD, a meta-analysis found clomipramine was more effective than sertraline, fluoxetine, and fluvoxamine.
• Option A: Clomipramine is a tertiary amine belonging to the class of medications known as tricyclic antidepressants (TCA). It is a dibenzazepine TCA. Clomipramine is a serotonin reuptake inhibitor (S-RI) with a stronger affinity for the serotonin transporter (SERT), compared to other TCAs and S-RIs. The resulting action of clomipramine increases serotonergic and noradrenergic transmission.
• Option C: Metabolism of clomipramine is primarily through the liver via oxidation by CYP450 2D6. The half-life of clomipramine is 17 to 28 hours. Clomipramine is then metabolized to the steady-state active metabolite desmethyl clomipramine by CYP450 1A2. Desmethyl clomipramine has more noradrenergic activity than serotonergic.
• Option D: Experts often use fluvoxamine, a CYP450 1A2 inhibitor, with clomipramine in treatment-resistant OCD. By adding the CYP450 1A2 inhibitor, the conversion from clomipramine to desmethyl clomipramine is blocked, resulting in increased serotonergic activity. The onset of action of clomipramine is usually between 6 to 12 weeks for OCD; it may treat anxiety or insomnia immediately. If the patient achieves OCD remission with clomipramine, treatment should continue indefinitely.
2. 2. Question
A nurse at Nurseslabs Medical Center is developing a care plan for a female client with post-traumatic stress disorder. Which of the following would she do initially?
• A. Instruct the client to use distraction techniques to cope with flashbacks.
• B. Encourage the client to put the past in proper perspective.
• C. Encourage the client to verbalize thoughts and feelings about the trauma.
• D. Avoid discussing the traumatic event with the client.
Incorrect
Correct Answer: C. Encourage the client to verbalize thoughts and feelings about the trauma.
Planning care for a client with post-traumatic stress disorder would involve helping the client to verbalize thoughts and feelings about the trauma. This will help the client work through the strong emotions connected with the trauma and, therefore foster the belief that she is able to cope. Maintain a calm, non-threatening manner while working with the client. Anxiety is contagious and may be transferred from health care provider to client or vice versa. The client develops a feeling of security in presence of a calm staff person.
• Option A: Encourage the client’s participation in relaxation exercises such as deep breathing, progressive muscle. Relaxation exercises are effective nonchemical ways to reduce anxiety. relaxation, guided imagery, meditation and so forth. Maintain calmness in your approach to the client. The client will feel more secure if you are calm and if the client feels you are in control of the situation.
• Option B: This may be possible later after the client is able to verbalize strong emotions. Present and discuss the reality of the situation with client in order to recognize aspects that can be changed and those that cannot. The client must accept the reality of the situation before the work of reducing the fear can progress.
• Option D: Avoiding discussion would be inappropriate. Encourage the client to explore underlying feelings that may be contributing to irrational fears. Help the client to understand how facing these feelings, rather than suppressing them, can result in more adaptive coping abilities. Verbalization of feelings in a non-threatening environment may help the client come to terms with unresolved issues.
3. 3. Question
A group of community nurses sees and plans care for various clients with different types of problems. Which of the following clients would they consider the most vulnerable to post-traumatic stress disorder?
• A. An eight (8)-year-old boy with asthma who has recently failed a grade in school.
• B. A 20-year-old college student with DM who experienced date rape.
• C. A 40-year-old widower who has recently lost his wife to cancer.
• D. A wife of an individual with a severe substance abuse problem.
Incorrect
Correct Answer: B. A 20-year-old college student with DM who experienced date rape
Post-traumatic stress disorder is caused by the experience of severe, specific trauma. Rape is a severely traumatic event. Posttraumatic stress disorder (PTSD) is a syndrome that results from exposure to real or threatened death, serious injury, or sexual assault. Following the traumatic event, PTSD is common and is one of the serious health concerns that is associated with comorbidity, functional impairment, and increased mortality with suicidal ideations and attempts. [Show Less]