When developing a care plan for a client with generalized anxiety disorder (GAD), which of the following interventions should not be included?

Correct Answer: A

Rationale: When caring for a client with generalized anxiety disorder (GAD), it is essential to consider therapeutic interventions. Encouraging the client to avoid anxiety-provoking situations is not recommended as it can reinforce their anxiety. Teaching relaxation techniques, encouraging the expression of feelings, and providing a structured daily routine are beneficial strategies in managing generalized anxiety disorder by promoting coping skills and emotional expression while fostering stability and predictability.

Correct Answer: C

Rationale: Generalized anxiety disorder (GAD) is characterized by persistent and excessive anxiety and worry about various aspects of life, such as work, health, or social interactions, lasting at least six months. The disorder manifests through a cluster of symptoms that are primarily related to heightened psychological and physiological arousal, but increased energy (Choice C) is not among them. **Why Choice C (Increased energy) is incorrect for GAD:** GAD is associated with chronic fatigue and exhaustion rather than increased energy. The constant state of hyperarousal and worry depletes mental and physical resources, often leading to feelings of being drained or overwhelmed. Patients with GAD may report difficulty concentrating or feeling mentally exhausted due to the relentless nature of their anxiety. Increased energy is more characteristic of conditions like mania (seen in bipolar disorder) or hyperthyroidism, where heightened activity and restlessness are paired with elevated energy levels. In contrast, GAD sufferers may feel restless (Choice D) but not energized—this restlessness stems from nervous energy, not a surplus of productive or sustained vigor. **Why Choice A (Excessive worry) is correct for GAD:** Excessive worry is the hallmark symptom of GAD. Individuals with this disorder struggle to control their worry, which is disproportionate to actual stressors and persists across multiple domains of life. This worry is intrusive, difficult to manage, and often irrational, significantly impairing daily functioning. Unlike situational anxiety, which subsides when a stressor resolves, the anxiety in GAD is pervasive and chronic, making this symptom a core diagnostic criterion. **Why Choice B (Muscle tension) is correct for GAD:** Muscle tension is a common physical manifestation of GAD, resulting from the body's prolonged stress response. Chronic anxiety leads to sustained muscle contraction, particularly in the neck, shoulders, and back, causing discomfort or pain. This symptom reflects the autonomic nervous system's hyperactivity, a key feature of anxiety disorders. Unlike increased energy, muscle tension aligns with the somatic complaints frequently reported in GAD, such as headaches or gastrointestinal distress, further validating its association with the disorder. **Why Choice D (Restlessness) is correct for GAD:** Restlessness in GAD presents as an inability to relax, fidgeting, or feeling "on edge." This symptom arises from the persistent state of psychological agitation and physiological arousal characteristic of the disorder. However, it is distinct from increased energy; restlessness in GAD is uncomfortable and nonproductive, often accompanied by fatigue rather than a sense of vitality. It reflects the tension and unease central to GAD, unlike the euphoric or goal-directed energy seen in other psychiatric conditions. In summary, while excessive worry, muscle tension, and restlessness are consistent with the diagnostic profile of GAD, increased energy contradicts the disorder's typical presentation, which is marked by depletion rather than enhancement of energy reserves. The correct answer is C because it represents a symptom inconsistent with the clinical picture of GAD, whereas the other choices align with established diagnostic criteria.

Correct Answer: D

Rationale: Deep breathing exercises, progressive muscle relaxation, and mindfulness meditation are commonly used relaxation techniques to manage anxiety. Cognitive restructuring is a cognitive-behavioral technique aimed at changing negative thought patterns and beliefs, not a relaxation technique. It focuses on altering cognitive distortions rather than inducing physical relaxation responses.

Correct Answer: A

Rationale: The nurse should not monitor for tardive dyskinesia as it is a potential long-term side effect of antipsychotic medications. However, the nurse should monitor for neuroleptic malignant syndrome, orthostatic hypotension, and hyperglycemia as these are common side effects associated with antipsychotic medications. Tardive dyskinesia is characterized by involuntary movements of the face, tongue, and extremities and may develop after prolonged use of antipsychotic drugs.

Correct Answer: C

Rationale: Interventions for a client with major depressive disorder should focus on promoting activities, adequate nutrition, hydration, and monitoring for suicidal ideation. Verbalizing feelings is a crucial part of therapy for clients with depression as it helps in processing emotions and seeking support. Therefore, discouraging verbalization of feelings is not appropriate and goes against therapeutic principles.