A client diagnosed with panic disorder states, When an attack happens, I feel like I am going to die. Which is the most appropriate nursing reply?

Correct Answer: A

Rationale: Option A, "I know it's frightening, but try to remind yourself that this will only last a short time," is the most appropriate nursing reply. This response acknowledges the client's feelings of fear and impending doom during a panic attack while also providing reassurance that the attack is temporary. It validates the client's experience without dismissing the intensity of their emotions and offers a coping strategy to help manage the anxiety during an attack. This response shows empathy and understanding, which can help build trust with the client and foster a therapeutic relationship.

Correct Answer: B

Rationale: The most accurate reply would be B. Selective serotonin reuptake inhibitor (SSRI) doses, in excess of what is effective for treating depression, may be required for obsessive-compulsive disorder (OCD). This is because higher doses of SSRIs are often needed to effectively treat OCD compared to depression. Fluvoxamine (Luvox) is an SSRI commonly used for OCD, and doses higher than those used for depression are often necessary to achieve therapeutic effects in OCD patients. Therefore, it is important for the instructor to explain to the nursing student that the dose of fluvoxamine (Luvox) for OCD at 300 mg daily is within the therapeutic range for treating OCD.

Correct Answer: D

Rationale: The major maladaptive client response to panic disorder is clients developing compulsions to deal with anxiety. Panic disorder is a type of anxiety disorder characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms such as heart palpitations, shortness of breath, and dizziness. In an attempt to cope with the overwhelming anxiety associated with panic attacks, individuals may develop compulsions or rituals. These compulsions can vary widely and often serve as a way for the individual to try and regain a sense of control or alleviate their anxiety. This response is maladaptive because while the compulsions may provide temporary relief, they do not address the root cause of the anxiety and can contribute to the cycle of panic attacks.

Correct Answer: A

Rationale: In caring for a client with generalized anxiety disorder (GAD), selecting appropriate nursing interventions is crucial for promoting their well-being. In this scenario, the correct intervention is option A: Encourage the client to recognize the signs of escalating anxiety. This intervention is effective because it empowers the client to identify early warning signs of anxiety, enabling them to utilize coping strategies before the symptoms worsen. Option B, encouraging the client to avoid any situation that causes stress, is incorrect. Avoidance can reinforce anxiety in the long run by limiting the client's ability to confront and manage their fears. Teaching avoidance can perpetuate avoidance behaviors, which are counterproductive in treating anxiety disorders. Option C, encouraging the client to employ newly learned relaxation techniques, is a helpful intervention. However, in the context of GAD, simply relying on relaxation techniques may not address the underlying cognitive distortions and patterns of anxious thinking that contribute to the disorder. Option D, encouraging the client to cognitively reframe thoughts about situations that generate anxiety, is also a valuable intervention. Cognitive restructuring helps clients challenge and change maladaptive thought patterns that fuel anxiety. However, in this specific scenario, recognizing the signs of escalating anxiety takes precedence as an initial step before implementing cognitive reframing techniques. Educationally, understanding the rationale behind each intervention equips nursing students with the knowledge to provide holistic care for clients with GAD. By prioritizing interventions that empower clients, challenge avoidance behaviors, and address cognitive distortions, nurses can effectively support individuals in managing their anxiety symptoms.

Correct Answer: B

Rationale: This statement suggests that the physical symptoms Carly is experiencing may be serving as a secondary gain for her. Despite medical tests showing no evidence of a brain tumor, Carly's continued belief that her headaches are due to a serious condition could be providing her with a sense of significance or attention. This belief may also help her avoid dealing with underlying emotional issues or stressors, providing a psychological benefit as well. This points towards secondary gains related to the somatic symptom disorder.