An involuntarily committed client, when offered a dinner tray, pushes it off the bedside table onto the floor. Which intervention should a nurse prioritize to address this behavior?

Correct Answer: D

Rationale: In this scenario, the most appropriate intervention would be to prioritize setting firm limits on the behavior with staff support. By establishing boundaries, the nurse can convey clear expectations to the client and promote a therapeutic environment. Setting limits also helps in managing challenging behaviors and maintaining a safe space for both the client and staff members. This approach can prevent potential escalation of the behavior and provide structure and consistency in the therapeutic relationship. It is essential to address the behavior promptly and assertively, emphasizing respect and safety for all individuals involved.

Correct Answer: D

Rationale: One key way a nurse can differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD) is by observing the presence of depersonalization. Depersonalization, which is the feeling of being detached from oneself or feeling like things are unreal, is commonly seen in panic disorder and absent in GAD. Clients with panic disorder often experience sudden, intense episodes of anxiety known as panic attacks, during which depersonalization may occur. In contrast, GAD is characterized by persistent and excessive worry or anxiety about various aspects of life, but depersonalization is not a hallmark symptom of GAD. This distinction can aid the nurse in making an accurate diagnosis and providing appropriate care for the client.

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: C

Rationale: Systematic desensitization is a type of behavior therapy that is commonly used to treat phobias, including a fear of crossing bridges. The therapy involves exposing the individual to the feared object or situation in a gradual and systematic manner. By starting with less anxiety-provoking steps and gradually progressing to more anxiety-inducing steps, the individual can learn to manage their fear response and increase their tolerance to anxiety. This approach helps the client to confront their fears in a controlled and manageable way, allowing them to eventually overcome their phobia. Therefore, the explanation that should be conveyed to the client is that through a series of increasingly anxiety-provoking steps, their tolerance to anxiety will gradually increase.

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.