Stress and Anxiety Nursing Care Plan & Management

EXPLANATION

✔Correct answer:

Helping the client identify and challenge irrational thoughts. Cognitive-behavioral therapy (CBT) is a widely used therapeutic approach, particularly effective for clients experiencing panic attacks and anxiety disorders. It focuses on the relationship between thoughts, feelings, and behaviors. Panic attacks are often fueled by irrational, distorted, or catastrophic thinking (e.g., "I'm going to die" or "I’m losing control"). CBT helps the client recognize these automatic, negative thought patterns and teaches them to challenge and replace these irrational thoughts with more realistic, rational alternatives. By restructuring the way the client thinks, CBT can reduce anxiety and prevent or lessen the severity of panic attacks.

This approach is particularly effective because panic attacks are often triggered by cognitive distortions. Once these thoughts are restructured, the client is better able to control their physiological responses and anxiety levels, reducing the likelihood of future attacks.

Think of irrational thoughts as a faulty alarm system that goes off even when there’s no danger. CBT works like a technician who helps the client reprogram the alarm system so that it only triggers when there is a real threat, not just perceived danger.

When using cognitive-behavioral techniques, Nurse Taylor should guide the client through specific steps to identify and correct distorted thinking patterns. Key interventions may include:

• Teach the client to recognize "automatic thoughts" that arise during or before a panic attack.
• Assist the client in differentiating between rational and irrational thoughts, encouraging logical reflection.
• Work with the client to develop coping strategies and thought-stopping techniques to interrupt negative thinking cycles.
• Incorporate relaxation and breathing exercises to help reduce physiological responses to panic.
• Reinforce gradual exposure to anxiety-provoking situations to build confidence and reduce avoidance behaviors.

✘Incorrect answer options:

Encouraging the client to explore early childhood trauma. This approach is more aligned with psychoanalytic or psychodynamic theories, which focus on uncovering unconscious material or past trauma to understand present behavior. CBT, however, emphasizes current thoughts and behaviors rather than delving into past experiences.

Using hypnosis to uncover unconscious fears. Hypnosis is associated with psychodynamic therapy and is not a typical cognitive-behavioral technique. CBT deals with conscious thought processes rather than attempting to reveal unconscious fears or memories.

Focusing on dream analysis to reveal underlying anxiety. Dream analysis is a hallmark of psychoanalytic therapy, based on Freud’s theories. CBT does not emphasize interpreting dreams, as it is concerned with addressing conscious thought patterns and behaviors affecting the client in the present.

EXPLANATION

✔Correct answer:

The role of self-control and self-esteem. In adolescents diagnosed with anorexia nervosa, issues of self-control and self-esteem are central to both the development and maintenance of the disorder. Anorexia nervosa is often associated with an intense desire to control one’s body, appearance, and eating behaviors as a way to manage underlying feelings of inadequacy, low self-worth, or lack of control in other areas of life. Adolescents with anorexia may have perfectionistic tendencies and a distorted sense of self-worth that is overly tied to their body image. By focusing on self-control and self-esteem, Nurse Megan can help these adolescents understand the psychological factors that drive their behavior and promote healthier ways to build self-worth and manage control.

Educating the group on these issues is critical, as it enables them to see how their eating behaviors are not only about food but also about attempting to achieve a sense of control or confidence. Addressing self-esteem and the need for control can lay the foundation for therapeutic strategies to help them build self-acceptance and develop healthier ways to cope with life challenges.

Think of anorexia as a "control lever" the adolescents feel they can pull when everything else in life feels unpredictable or overwhelming. Building self-esteem is like installing new "control levers" that are healthier and give them a sense of confidence without harming their body.

Nurse Megan can focus on activities and discussions that empower the adolescents to reflect on their self-worth and to develop healthy coping mechanisms. Key interventions might include:

• Encourage group discussions around self-esteem, body image, and the ways they currently define their self-worth.
• Teach positive self-affirmation techniques and ways to build self-esteem outside of body weight or appearance.
• Introduce healthy methods of gaining a sense of control, such as setting achievable goals and practicing assertiveness in daily life.
• Promote cognitive restructuring exercises to help adolescents challenge perfectionistic and self-critical thoughts.
• Collaborate with a multidisciplinary team, including mental health professionals, to reinforce therapy that addresses self-esteem and identity issues.

✘Incorrect answer options:

Techniques for managing anger. While anger management may be relevant to some individuals, it is not a core issue in anorexia nervosa. Anorexia primarily involves issues around self-control, body image, and self-esteem rather than anger, so focusing on anger management may not be as beneficial.

Influence of parental expectations. Parental expectations can contribute to the development of perfectionistic traits in some adolescents, which may play a role in anorexia nervosa. However, discussing self-control and self-esteem directly addresses the psychological and emotional needs of the individuals with anorexia in a more targeted way. Parental influences can be explored in family therapy if needed.

The impact of peer pressure and substance abuse. Peer pressure can influence body image and eating behaviors, but substance abuse is generally not a primary focus in anorexia nervosa treatment. The more fundamental issues of self-control and self-esteem are central to understanding and addressing anorexia nervosa specifically.

EXPLANATION

✔Correct answer:

Jordanne completes a brief flight in an airplane. The primary goal of systematic desensitization is to help the client gradually confront and reduce their fear by progressively exposing them to the feared object or situation—in this case, air travel. Successfully completing a brief flight in an airplane indicates that Jordanne has not only confronted her phobia but has managed her anxiety enough to actually engage in the feared activity. This outcome reflects the practical application of coping strategies learned through systematic desensitization and is a clear indication of progress in treatment for a phobic disorder.

Systematic desensitization typically involves a gradual, step-by-step approach, starting with less anxiety-provoking situations and progressing to the actual feared scenario. By successfully flying on a plane, Jordanne demonstrates that she has moved through the stages of exposure therapy and has achieved a significant reduction in her fear response.

Think of systematic desensitization like climbing a mountain. Each step or stage helps you get closer to the top (overcoming the fear). Successfully reaching the top—completing a flight—is a clear sign that you have conquered the challenges and fears along the way.

As Jordanne progresses through systematic desensitization, Nurse Leah can support her by reinforcing coping skills and evaluating her responses to each stage of exposure. Key considerations include:

• Encourage relaxation techniques (e.g., deep breathing, progressive muscle relaxation) to help manage anxiety during exposure stages.
• Provide positive reinforcement for each successful step Jordanne completes in the desensitization process.
• Assess Jordanne’s anxiety levels at each stage to ensure the exposure is manageable and does not become overwhelming.
• Collaborate with Jordanne to review and adapt her coping strategies if she encounters challenges or heightened anxiety.
• Encourage reflection after each exposure session to reinforce progress and build confidence in her ability to manage her fear.

✘Incorrect answer options:

Jordanne makes plans to take a trip that requires air travel. While planning a trip that involves flying is a positive sign, it does not confirm that Jordanne has successfully overcome her fear to the extent of actually taking a flight. Planning alone does not measure full effectiveness of the desensitization treatment.

Jordanne acknowledges that her fear of flying is irrational. Recognizing that a fear is irrational can be an early step in therapy, but it does not indicate successful desensitization. Many people with phobias are aware that their fears are irrational, yet they still experience intense anxiety when faced with the feared situation.

Jordanne expresses that her fear of flying has lessened. Expressing a reduced level of fear is encouraging, but it does not necessarily mean that Jordanne can successfully engage in air travel. The ultimate goal of systematic desensitization is to enable her to confront the feared situation—actually boarding and flying on an airplane.

EXPLANATION

✔Correct answer:

Stress can overwhelm the immune system, potentially leading to a worsening of symptoms. In autoimmune diseases like rheumatoid arthritis, the immune system mistakenly attacks the body’s own tissues, leading to inflammation and joint pain. Chronic stress can exacerbate this condition by disrupting immune function and increasing inflammation. When a person experiences stress, the body releases stress hormones, such as cortisol and adrenaline, which can suppress certain immune responses but also stimulate other aspects of the immune system, leading to an inflammatory response. Over time, chronic stress can "overwhelm" the immune system, leading to increased inflammation and a worsening of symptoms in autoimmune diseases.

This explanation helps Mr. Jamison understand that while stress itself does not directly cause rheumatoid arthritis, it can worsen symptoms by impacting immune function. Managing stress through relaxation techniques, regular exercise, and a supportive environment can help reduce inflammation and improve his overall quality of life.

Imagine the immune system as a security team that protects the body. When under chronic stress, it’s like giving the security team too many conflicting instructions, causing them to mistakenly attack parts of the body instead of protecting it properly. This worsens inflammation, as seen in autoimmune conditions like rheumatoid arthritis.

To support Mr. Jamison in managing the relationship between stress and rheumatoid arthritis, Nurse Carla can suggest various interventions:

• Teach relaxation techniques, such as deep breathing exercises, progressive muscle relaxation, or mindfulness, to help reduce stress.
• Encourage regular, gentle exercise, like walking or yoga, which can improve joint mobility, reduce inflammation, and alleviate stress.
• Educate Mr. Jamison about maintaining a balanced diet rich in anti-inflammatory foods, which can support immune health.
• Discuss stress management techniques and refer him to support groups for individuals with rheumatoid arthritis to help manage emotional challenges.
• Help Mr. Jamison establish a consistent routine for medication and self-care, as maintaining stability can reduce stress related to his condition.

✘Incorrect answer options:

Stressful experiences have no impact on the physical symptoms of a disease. This statement is incorrect, as stress is known to impact physical health significantly, especially in chronic conditions like rheumatoid arthritis. Stress can exacerbate symptoms by increasing inflammation and weakening immune regulation.

Emotional distress from stress can trigger painful feelings, which are harmful to those with chronic illness. While stress can certainly contribute to emotional pain, which may indirectly worsen physical symptoms, this explanation does not fully capture the direct effect of stress on the immune system and inflammation in autoimmune diseases.

The body's stress response is activated during major life disruptions. Although this is true, it doesn’t fully answer Mr. Jamison’s question about how stress specifically affects rheumatoid arthritis. The correct answer explains the connection between stress, immune function, and symptom exacerbation more clearly.

EXPLANATION

✔Correct answer:

Nurse Erin should encourage the client to report any sexual function changes so that medication adjustments can be made if necessary. When educating a patient about the potential side effects of sertraline (Zoloft), it is important for Nurse Erin to provide comprehensive information in a way that acknowledges potential issues without causing unnecessary anxiety. Sexual side effects, such as difficulty with arousal, erectile dysfunction, or decreased libido, are known side effects of SSRIs (Selective Serotonin Reuptake Inhibitors) like sertraline. Encouraging Mr. Thompson to report any changes in sexual function ensures that he feels comfortable discussing these sensitive issues and knows that options are available if he experiences distressing side effects.

This approach allows Nurse Erin to open a line of communication, making it easier for Mr. Thompson to bring up any concerns that may arise. If sexual side effects do occur, the healthcare provider can consider medication adjustments, such as dosage reduction, switching to a different antidepressant with fewer sexual side effects, or exploring adjunct treatments to mitigate the impact on sexual function.

Think of Nurse Erin as a mechanic informing a driver about a possible minor issue with the car. By encouraging the driver to report any signs, the mechanic can address the issue early and avoid bigger problems down the road, ensuring the car (or in this case, Mr. Thompson's well-being) operates smoothly.

When discussing sensitive side effects, Nurse Erin should consider strategies that promote openness and empower the patient to take an active role in managing potential side effects:

• Explain the potential for sexual side effects in a straightforward and non-judgmental manner to reduce stigma and normalize the conversation.
• Encourage Mr. Thompson to keep a journal of any changes in mood, energy, or side effects, including sexual function, which can help during follow-up appointments.
• Reassure Mr. Thompson that if side effects occur, they are manageable and that adjustments can be made to improve his comfort and quality of life.
• Provide resources or suggest consulting a specialist, such as a psychiatrist or a sexual health counselor, if Mr. Thompson expresses significant concerns.
• Follow up regularly to monitor for any side effects, emphasizing that Mr. Thompson’s quality of life and comfort are priorities in his treatment.

✘Incorrect answer options:

Nurse Erin should avoid discussing sexual side effects to prevent causing anxiety about potential erectile dysfunction. Avoiding discussion of side effects is not a therapeutic approach. By not mentioning sexual side effects, Nurse Erin may leave Mr. Thompson unprepared and hesitant to discuss them if they arise. Addressing potential side effects upfront promotes openness and proactive management.

Nurse Erin should inform the client that his sexual desire is likely to decrease while taking this medication. It is not accurate to say that sexual desire is "likely" to decrease for every patient, as side effects vary. This statement may cause unnecessary worry and could be misleading if Mr. Thompson does not experience sexual side effects.

Nurse Erin should tell the client that sexual side effects are normal but will improve as his depression subsides. While some side effects may improve over time, sexual side effects related to SSRIs do not always resolve as depression improves. This statement may provide false reassurance and could discourage Mr. Thompson from reporting issues if they persist.

EXPLANATION

✔Correct answer:

Agoraphobia. Claire’s description of only attending social events when accompanied by a family member and her fear of being in situations where help might not be available are hallmark symptoms of agoraphobia. Agoraphobia is an anxiety disorder characterized by the fear of being in places or situations where escape may be difficult or help unavailable, particularly in situations that involve open spaces, crowds, or public transportation. Individuals with agoraphobia often avoid leaving their home alone or entering places that may trigger intense fear or panic, unless they have someone with them for reassurance.

The fear of experiencing a panic attack or becoming incapacitated in public drives the avoidance behaviors seen in agoraphobia. Claire's reliance on a family member for support and her anxiety about situations where she may not receive immediate help strongly suggest this diagnosis.

Think of agoraphobia like being afraid to drive a car unless someone is there to help in case it breaks down. The fear of being unable to get help in an uncomfortable or difficult situation makes the person avoid driving altogether, unless they have someone to rely on.

When caring for a client with agoraphobia, interventions should focus on reducing avoidance behaviors and gradually exposing the client to feared situations in a controlled, supportive manner. Key strategies include:

• Encourage the use of graded exposure therapy, which involves gradually facing the feared situations to reduce anxiety over time.
• Teach relaxation and breathing exercises to help manage physiological symptoms of anxiety when in feared situations.
• Use cognitive-behavioral therapy (CBT) techniques to help the client challenge irrational thoughts about being in public spaces.
• Support the use of positive reinforcement for small achievements in facing feared situations, such as attending a social event without a family member.
• Assess for any use of avoidance behaviors, and work with the client to slowly decrease dependence on safety behaviors (e.g., needing to be with someone).

✘Incorrect answer options:

Generalized anxiety disorder. While generalized anxiety disorder (GAD) involves excessive, uncontrollable worry about various aspects of life, it is not characterized by the specific avoidance of places or situations due to fear of being trapped or without help. Claire’s behavior points more toward agoraphobia due to her avoidance of certain environments unless accompanied by someone.

Obsessive-compulsive disorder. Obsessive-compulsive disorder (OCD) involves intrusive, repetitive thoughts (obsessions) and ritualistic behaviors (compulsions) aimed at reducing anxiety. Claire does not describe obsessive thoughts or compulsive behaviors, making OCD an unlikely diagnosis here.

Post-traumatic stress disorder. Post-traumatic stress disorder (PTSD) involves re-experiencing a traumatic event through flashbacks, nightmares, and avoidance of triggers related to the trauma. Claire does not report trauma-related symptoms or avoidance of triggers tied to a past event, suggesting that PTSD is not the correct diagnosis.

EXPLANATION

✔Correct answer:

Mrs. Montez expresses her anxiety verbally instead of displacing it into physical symptoms. Somatoform disorders (now more commonly referred to as somatic symptom disorders) are characterized by a focus on physical symptoms that cause significant distress or impairment, even when no medical explanation for these symptoms can be found. Patients with somatic symptom disorder often have difficulty expressing emotional distress, and instead, they may convert or "displace" these feelings into physical complaints.

The primary goal of treatment is to help the patient recognize the link between their emotional states and physical symptoms. A key indicator of treatment success is when the patient begins to express their anxiety and emotional distress verbally, rather than unconsciously manifesting it through physical symptoms. This behavioral change indicates that Mrs. Montez is developing healthier coping mechanisms and gaining insight into the psychological factors contributing to her somatic complaints. By expressing her emotions directly, she can manage her anxiety more effectively without needing to rely on physical symptoms to communicate her distress.

Think of physical symptoms as a "code" that hides underlying emotional issues. When Mrs. Montez begins to express her anxiety in words rather than physical symptoms, it’s like breaking the code and communicating her feelings more clearly.

To support patients like Mrs. Montez in achieving this outcome, nurses can implement therapeutic strategies focused on emotional awareness and healthy expression:

• Encourage the patient to discuss emotions, stressors, and anxieties openly during sessions.
• Teach coping skills and stress management techniques, such as deep breathing, mindfulness, and relaxation exercises, to help the patient manage anxiety without resorting to physical symptoms.
• Use therapeutic communication techniques to help the patient explore the connection between emotional distress and physical symptoms.
• Provide education on the mind-body connection and reassure the patient that her symptoms are real, but influenced by psychological factors.
• Reinforce positive behaviors, such as verbalizing feelings, to help the patient recognize and build on these healthier coping mechanisms.

✘Incorrect answer options:

Mrs. Montez self-medicates instead of frequently switching healthcare providers. Self-medicating is not a desirable outcome, as it may lead to inappropriate or harmful medication use. Frequently switching healthcare providers is common in somatic symptom disorders, but reducing this behavior alone does not indicate a deeper resolution of the underlying issues. The focus should be on helping the patient express emotions constructively, not on self-medication.

Mrs. Montez acknowledges that her physical symptoms correlate with increased anxiety. While recognizing the connection between anxiety and physical symptoms is a positive step, it is not as complete as expressing anxiety verbally. Full therapeutic progress involves both insight and the ability to communicate emotional distress without using physical symptoms.

Mrs. Montez spends time researching medical treatments for various conditions. This behavior may reflect ongoing health anxiety or a preoccupation with physical symptoms rather than improvement. It suggests that Mrs. Montez is still focused on physical explanations for her distress, rather than addressing the psychological factors behind her somatic symptoms.

EXPLANATION

✔Correct answer:

They are generally more effective than conventional medical treatments. While alternative treatments like herbal therapy and therapeutic touch offer benefits such as aligning with cultural beliefs, promoting self-care, and fostering a holistic connection between the mind, body, and spirit, it is a misconception that they are generally more effective than conventional medical treatments. In many cases, these complementary approaches can support well-being, reduce stress, and enhance quality of life, but they are typically not a substitute for evidence-based medical treatments, especially for serious or life-threatening conditions.

Conventional medical treatments are based on rigorous scientific research and are designed to address specific health issues with proven efficacy. In contrast, alternative treatments may lack standardized evidence for treating specific medical conditions and should be used alongside, rather than as replacements for, conventional therapies. Nurse Julie should emphasize that while these alternative approaches can complement medical treatment, they should not be relied upon solely for managing significant health conditions.

Think of conventional medicine as the engine of a car that provides essential power, while alternative therapies are like the oil that keeps the engine running smoothly. The engine (medical treatment) is necessary to drive the car, but the oil (alternative therapies) can help improve its performance and longevity.

When educating patients on complementary and alternative therapies, Nurse Julie can provide guidance on safe and effective integration with conventional treatments:

• Encourage patients to discuss any alternative therapies they are considering with their healthcare provider to ensure there are no contraindications with existing treatments.
• Educate patients on the importance of using complementary therapies as an adjunct, rather than a replacement, for conventional medical treatments, particularly for serious health conditions.
• Provide information on evidence-based complementary practices, such as mindfulness and relaxation techniques, which have been shown to help reduce stress.
• Emphasize the importance of using reputable sources and licensed practitioners when pursuing alternative therapies to ensure safety and efficacy.
• Respect and support patients' cultural beliefs regarding health and wellness, acknowledging that holistic approaches can offer meaningful benefits when used appropriately.

✘Incorrect answer options:

They align well with many cultural belief systems. Many alternative therapies have roots in traditional and cultural practices, making them resonate well with various cultural belief systems. This is a valid advantage of alternative treatments.

They encourage individuals to actively manage their own health. Alternative therapies often empower individuals to take an active role in their health by participating in practices that promote self-care and well-being. This is a recognized benefit of these approaches.

They foster a connection between the mind, body, and spirit. Alternative therapies emphasize holistic wellness, addressing physical, mental, and spiritual health. This interconnected approach is a genuine advantage of alternative treatments and appeals to individuals seeking a comprehensive approach to health.

EXPLANATION

✔Correct answer:

Starting a medically supervised refeeding program. The most immediate treatment priority for a newly admitted patient with anorexia nervosa is to address the physical health risks associated with severe malnutrition, including electrolyte imbalances, organ dysfunction, and potential complications like refeeding syndrome. Starting a medically supervised refeeding program is critical to stabilize Rachel's physical condition, as anorexia nervosa can lead to life-threatening complications if nutritional deficiencies are not promptly addressed. A structured refeeding program helps to restore essential nutrients, carefully increasing caloric intake while monitoring for signs of refeeding syndrome—a potentially dangerous condition involving shifts in electrolytes and fluids that can occur when nutrition is reintroduced too quickly.

Once Rachel’s physical health is stabilized through refeeding and her risk of acute medical complications has been minimized, other aspects of her treatment, such as body image perception, family dynamics, and psychological therapy, can be prioritized. However, the immediate focus must be on ensuring her safety and addressing critical physiological needs.

Imagine trying to repair the engine of a car with an empty gas tank. Before working on complex issues, you need to first refuel the car to make sure it can function. Similarly, for Rachel, restoring her physical health through refeeding is essential before tackling psychological and emotional issues.

When initiating a refeeding program for a patient with anorexia nervosa, Nurse Kelly must implement the following steps to ensure safe and effective treatment:

• Monitor vital signs, electrolyte levels (especially potassium, phosphorus, and magnesium), and cardiac function closely to detect signs of refeeding syndrome.
• Begin with a low-calorie diet and gradually increase caloric intake under medical supervision to prevent overwhelming the body with sudden nutrient loads.
• Observe the patient for any signs of gastrointestinal discomfort, edema, or other complications as caloric intake increases.
• Provide education to the patient about the importance of nutritional intake, while being sensitive to any anxiety or resistance related to eating.
• Collaborate with a multidisciplinary team, including a dietitian and mental health professional, to address both the physical and psychological aspects of anorexia nervosa over time.

✘Incorrect answer options:

Assessing Rachel's perception of her body image. Although addressing body image distortion is an important component of long-term treatment for anorexia nervosa, it is not the immediate priority upon admission. The primary focus must be on stabilizing her physical health before moving to psychological issues.

Understanding the dynamics of her family interactions. Family dynamics often play a significant role in the development and maintenance of eating disorders, and understanding these dynamics is essential for long-term treatment. However, addressing immediate physical health concerns, such as malnutrition, takes precedence over family assessment in the initial stages of care.

Encouraging Rachel to develop more independence in her care. While promoting independence is an important therapeutic goal, it is not the immediate priority for someone newly admitted with anorexia nervosa who may be in a compromised physical state. In the initial stages, Rachel needs structured care to ensure her safety and health stabilization.

EXPLANATION

✔Correct answer:

Accepting and acknowledging the patient's need to perform rituals. When Nurse Amanda is welcoming John to the psychiatric unit, her primary goal should be to build trust and rapport, which are essential for any therapeutic relationship, especially in a psychiatric setting. By accepting and acknowledging John’s need to perform rituals, she conveys understanding and empathy, which can help John feel safe, respected, and less judged. This approach is crucial for individuals with obsessive-compulsive disorder (OCD), as their compulsive behaviors are often deeply rooted in anxiety and fear. Acknowledging his rituals shows respect for his current coping mechanism without reinforcing or directly challenging it, which might cause distress early in treatment.

In the initial phase, the focus should not be on changing or eliminating John’s behaviors but on understanding his experience and creating a supportive environment. Over time, and with John's trust, more targeted interventions can be introduced, such as cognitive-behavioral strategies to gradually reduce his reliance on rituals. However, abruptly challenging or limiting his rituals at this stage could increase his anxiety and hinder the therapeutic relationship.

Imagine John’s rituals as a "safety blanket" he uses to manage his anxiety. In the initial interaction, Nurse Amanda would not abruptly take the blanket away but would instead sit with him and show understanding of why he needs it, which can foster trust and pave the way for future steps toward change.

In the early stages of working with a client like John, nurses can focus on supportive measures that promote a sense of security while building rapport. Effective interventions might include:

• Observe John’s rituals without interference initially, allowing him to feel comfortable and unjudged.
• Use therapeutic communication techniques to help John discuss his feelings around the rituals, which may provide insight into his anxieties and fears.
• Reassure John that he is in a safe space where his behaviors will be respected, fostering an open and non-threatening environment.
• Gradually explore with John the thoughts and feelings that drive his rituals, once trust is established, as a step toward eventual intervention.
• Educate John about the unit’s structure and provide a predictable environment, which can reduce the overall stress that may worsen obsessive-compulsive behaviors.

✘Incorrect answer options:

Directly challenging the patient's reliance on rituals. Challenging John’s behaviors directly may feel confrontational and increase his anxiety, as these rituals are his way of managing overwhelming stress. This approach can damage trust and is not recommended as an initial response.

Voicing concerns about the potential harm caused by the rituals. Expressing concern about harm can be helpful at later stages, but initially, this may make John feel judged or defensive, as he likely perceives the rituals as protective rather than harmful. Immediate focus should be on building rapport, not addressing potential harm.

Setting limits on the rituals that seem particularly excessive. While setting limits can be useful in later stages of treatment, establishing boundaries around rituals too soon may lead to increased resistance or anxiety. Early interactions should focus on acceptance to allow John to feel safe and respected.

EXPLANATION

✔Correct answer:

Encourage the client to express her thoughts and emotions regarding the trauma. The initial approach in treating a client with post-traumatic stress disorder (PTSD) involves establishing a therapeutic relationship and creating a safe environment where the client feels comfortable expressing their thoughts and emotions related to the trauma. Encouraging Sarah to express her emotions is a key step in processing the traumatic experience, helping to reduce the emotional burden and allowing her to begin the journey toward healing. Expressing these emotions can also help Nurse Laura assess the severity of Sarah's PTSD and identify triggers, which will guide further interventions.

Providing emotional support and active listening are essential elements of early PTSD care. It is critical that Sarah feels heard and validated without being rushed or forced into discussing aspects of the trauma prematurely. This patient-centered approach aligns with trauma-informed care principles, which emphasize safety, trust, and empathy. By encouraging Sarah to share at her own pace, Nurse Laura helps to establish rapport and build a foundation for future therapeutic interventions.

Imagine Sarah's mind as a closet filled with tangled wires (representing her traumatic thoughts). Encouraging her to express her feelings is like slowly taking out each wire and gently untangling them one by one, making it easier to understand and manage each emotion as it comes out.

Initial interventions for PTSD focus on providing a non-judgmental space for the client to begin discussing the trauma. Specific actions may include:

• Actively listen to the client without judgment, allowing them to discuss their trauma when they feel ready.
• Use therapeutic communication techniques such as reflection and clarification to help the client process their emotions.
• Monitor for signs of emotional distress, such as anxiety or agitation, and offer support or relaxation techniques if necessary.
• Collaborate with the interdisciplinary team to implement trauma-informed therapies, such as cognitive-behavioral therapy (CBT) or eye movement desensitization and reprocessing (EMDR), at the appropriate stage.
• Ensure the client feels safe and supported throughout the therapeutic process, and respect their pacing and comfort levels when discussing the trauma.

✘Incorrect answer options:

Teach the client distraction methods to manage flashbacks. While distraction techniques can be beneficial in later stages of treatment to help manage flashbacks, this is not the initial step in caring for a client with PTSD. The priority is to allow the client to express their feelings about the trauma first, rather than focusing on symptom management before addressing the underlying emotions.

Guide the client in placing the past into proper perspective. Although re-framing the trauma and helping the client see the event in a different light is important, it is a later-stage intervention in PTSD treatment. Initially, Nurse Laura should focus on building trust and helping Sarah express her emotions before working on cognitive restructuring.

Refrain from discussing the traumatic event with the client. Avoiding discussion of the trauma altogether would prevent the client from beginning the healing process. While it is important not to force a discussion, it is equally important to encourage the client to talk about the trauma when they feel ready. Refraining from discussing the trauma could inadvertently validate avoidance behaviors, which are a hallmark symptom of PTSD and counterproductive to treatment.

EXPLANATION

✔Correct answer:

Validate that the complaints feel real to the patient, while gently redirecting him to other concerns and issues. The most therapeutic approach for Mr. Lawson, who is preoccupied with bodily complaints despite the absence of physical findings, is to validate his experience and then gently redirect his focus. This approach is especially effective in patients with somatic symptom disorder, where physical complaints persist without a medical cause. Validating his feelings acknowledges that, while no physical cause has been found, his distress is genuine and deserving of empathy. This validation can build trust and help reduce his anxiety.

After validating his experience, Nurse Daniel can gently redirect Mr. Lawson’s focus to other aspects of his well-being, such as emotional or psychological concerns. This can encourage Mr. Lawson to explore underlying stressors or anxieties that may be contributing to his physical complaints, without feeling dismissed or ignored. The therapeutic goal is to help the patient shift away from a fixation on physical symptoms and consider other dimensions of health that might contribute to his overall well-being.

Imagine Mr. Lawson’s focus on physical complaints as him being "stuck" on one radio station. Nurse Daniel’s role is to acknowledge the station he’s tuned into, then gently help him try tuning into other stations (areas of life) that might offer new insights and relieve his anxiety.

When working with patients like Mr. Lawson, nurses can employ therapeutic strategies that encourage exploration beyond physical symptoms, while maintaining a compassionate approach. Interventions include:

• Use therapeutic communication techniques, such as reflection and open-ended questions, to explore the patient’s feelings and concerns without reinforcing the somatic focus.
• Gently introduce discussions about emotional or stress-related factors that could influence physical well-being.
• Encourage healthy coping mechanisms, such as mindfulness, relaxation techniques, or journaling, which can help alleviate distress.
• Establish a regular schedule for discussing his concerns, which can prevent excessive focus on physical symptoms while ensuring he feels heard.
• Collaborate with mental health professionals if appropriate, as cognitive-behavioral therapy (CBT) can be effective in helping patients manage somatic symptom disorder.

✘Incorrect answer options:

Confront the patient about the lack of physical findings by challenging the complaints directly. Confronting or challenging Mr. Lawson about the absence of physical findings could be perceived as dismissive and increase his defensiveness. This approach is likely to damage trust and may lead to further preoccupation with his symptoms.

Disregard the complaints but encourage the patient to track all symptoms in a list. Disregarding the complaints may make Mr. Lawson feel ignored, which can exacerbate his distress. While tracking symptoms can be beneficial, it should be done with empathy and only if it serves a therapeutic purpose, not as a way to disregard his concerns.

Carefully listen to all the complaints and inquire about specific symptoms. While listening is essential, focusing solely on physical symptoms without redirection may inadvertently reinforce his preoccupation with bodily complaints. This approach does not help him shift his focus to potential emotional or psychological contributors to his distress.

EXPLANATION

✔Correct answers:

Bradycardia, Hypotension, Irregular or missed menstrual periods, Refusal to maintain a healthy minimum weight. Anorexia nervosa is an eating disorder characterized by an intense fear of gaining weight, a distorted body image, and a refusal to maintain a minimum healthy body weight. This disorder can lead to significant physiological changes due to extreme caloric restriction and malnutrition. The correct answers reflect common physical and behavioral symptoms associated with anorexia nervosa:

• Bradycardia: Anorexia nervosa often leads to a slow heart rate (bradycardia) as a result of malnutrition, which can affect the body’s ability to maintain normal heart function. Bradycardia is a common finding in individuals with anorexia and is a response to the body’s metabolic slowdown in an attempt to conserve energy.
• Hypotension: Low blood pressure (hypotension) is another typical finding due to the body’s weakened state from malnutrition and dehydration. Hypotension may also be related to electrolyte imbalances and the loss of muscle mass, including the cardiac muscle.
• Irregular or missed menstrual periods: Menstrual irregularities, including amenorrhea (missed periods), are common in anorexia nervosa. This results from the body’s response to low body fat and insufficient energy intake, which disrupts the normal hormonal regulation necessary for menstruation.
• Refusal to maintain a healthy minimum weight: A hallmark of anorexia nervosa is the refusal to maintain a body weight at or above a minimally normal weight for age and height. Individuals with anorexia often have a distorted body image and go to extreme lengths to avoid weight gain, resulting in dangerously low body weight.

Think of the body as a car running on very low fuel. It slows down its functions (like the heart rate and blood pressure) to conserve energy, and non-essential functions (like menstruation) are temporarily shut off to keep the car running as long as possible.

When assessing and caring for an adolescent with anorexia nervosa, the school nurse should take into consideration both the physical and psychological aspects of the disorder:

• Monitor vital signs regularly, especially heart rate and blood pressure, to assess for bradycardia and hypotension.
• Discuss the importance of a balanced diet and the health risks associated with severe caloric restriction.
• Encourage the adolescent to engage in mental health counseling to address body image issues and fear of weight gain.
• Assess for signs of malnutrition and dehydration, as well as electrolyte imbalances, which may require medical intervention.
• Work closely with the student’s parents and healthcare providers to develop a comprehensive treatment plan for recovery.

✘Incorrect answers:

Persistent pain in various areas of the body. Persistent physical pain is not a typical symptom of anorexia nervosa. While some individuals with malnutrition may experience muscle weakness or aches, generalized persistent pain is more commonly associated with other conditions, such as somatic symptom disorders.

Fear of developing a serious illness. Individuals with anorexia nervosa typically fear weight gain rather than developing a serious illness. The fear is centered on body image and control over weight, rather than a general fear of illness or disease.

Increased energy levels. Increased energy levels are not characteristic of anorexia nervosa. In fact, individuals with anorexia often experience fatigue and decreased energy due to malnutrition and caloric restriction.

EXPLANATION

✔Correct answers:

Anger accompanied by emotional numbing, Heightened startle reflex, Persistent nightmares, Feelings of guilt for surviving. Post-traumatic stress disorder (PTSD) is a mental health condition triggered by experiencing or witnessing a traumatic event. The hallmark symptoms of PTSD can be grouped into several categories, including re-experiencing symptoms, hyperarousal, avoidance, and negative changes in mood and cognition. The correct answers reflect common symptoms associated with PTSD:

• Anger accompanied by emotional numbing: People with PTSD may experience intense anger and irritability, along with emotional numbing. Emotional numbing, or feeling detached from one’s emotions, is a common coping mechanism used to avoid painful feelings related to trauma.
• Heightened startle reflex: This is a symptom of hyperarousal. Individuals with PTSD often exhibit an exaggerated startle response and may be easily startled by loud noises or sudden movements. This hypervigilance keeps them on edge, as if they are constantly anticipating danger.
• Persistent nightmares: Nightmares and flashbacks are part of the re-experiencing symptoms of PTSD. These vivid dreams often replay aspects of the traumatic event, causing significant distress and interfering with sleep.
• Feelings of guilt for surviving: Survivors of trauma, especially those who have lived through events where others were harmed or killed, may experience “survivor’s guilt.” This feeling of guilt is common in PTSD and can contribute to a negative view of oneself, further complicating recovery.

Imagine PTSD like an “alarm system” that stays on even after the threat is gone. The heightened startle reflex, emotional numbing, and nightmares all act as signs that the alarm system (mind and body) is still reacting as if the danger is ongoing.

When working with patients exhibiting symptoms of PTSD, Nurse Vicky can take a trauma-informed approach that promotes safety and trust. Interventions may include:

• Create a calm and safe environment for the patient, and avoid sudden loud noises or unexpected movements that might trigger the startle reflex.
• Encourage the patient to discuss their symptoms, including any nightmares or flashbacks, in a supportive, non-judgmental setting.
• Educate the patient on relaxation techniques, such as deep breathing and grounding exercises, to help manage hyperarousal and emotional numbness.
• Validate feelings of survivor’s guilt and work with the patient to reframe negative self-perceptions.
• Consider referrals to mental health professionals specializing in trauma-focused therapies, such as cognitive-behavioral therapy (CBT) or eye movement desensitization and reprocessing (EMDR).

✘Incorrect answer options:

Sensation similar to experiencing a heart attack. While individuals with PTSD may experience panic attacks that can mimic symptoms of a heart attack, such sensations are more commonly associated with panic disorder. PTSD is primarily characterized by re-experiencing, hyperarousal, and avoidance symptoms.

Recurrent worries about contamination. This is more typical of obsessive-compulsive disorder (OCD), where individuals may have intrusive thoughts or obsessions about contamination. It is not a common symptom of PTSD.

Increase in appetite. Increased appetite is not commonly associated with PTSD. Many individuals with PTSD experience a decrease in appetite, often due to heightened anxiety, stress, or depression.

EXPLANATION

✔Correct answer:

A conflict between mother and child regarding separation and individuation. According to psychoanalytic theory, anorexia nervosa is often seen as stemming from issues related to separation and individuation in the relationship between the mother and child. Psychoanalytic theorists suggest that anorexia nervosa may develop as the adolescent struggles to establish a sense of independence and control over her own identity. In cases where the mother may be overly controlling or involved, the child may use eating behaviors—specifically, the refusal to eat—as a way to assert autonomy and differentiate herself from parental expectations.

This struggle for independence is seen as a symbolic attempt to separate from the mother’s influence. By controlling food intake, the adolescent may unconsciously seek to gain control over her body and establish her own identity, which is often challenging in a highly enmeshed or dependent relationship with the mother.

Think of the mother-daughter relationship like two magnets that are very close together. Anorexia serves as a way for the daughter to "push back" and create space, allowing her to feel like she has control over something (her body) as she strives for independence.

In the treatment of anorexia nervosa, it is essential to address not only the physical aspects of the disorder but also the psychological dynamics that may contribute to it. Nurse Leah should consider the following approaches:

• Work with the patient and family to explore and understand the relational dynamics that may contribute to issues of control and autonomy.
• Encourage the use of therapeutic modalities such as family therapy, which can help address underlying relational conflicts and promote healthier boundaries.
• Provide individual counseling to support the patient’s journey towards establishing a healthy sense of self and independence.
• Educate the family on the importance of allowing the patient to make decisions and develop autonomy within a supportive framework.
• Collaborate with a multidisciplinary team, including mental health professionals, to address the complex psychological and emotional factors involved in anorexia nervosa.

✘Incorrect answer options:

Gaining secondary benefits by controlling eating behaviors. Although individuals with anorexia may experience secondary gains, such as increased attention or concern from family, this explanation aligns more with behavioral theories. The psychoanalytic perspective is more focused on deep-seated relational conflicts, particularly around autonomy and identity, rather than secondary benefits.

Family dynamics that create enmeshed relationships. While enmeshed family dynamics are often associated with eating disorders, particularly in family systems theory, this does not fully capture the psychoanalytic perspective. Psychoanalytic theory specifically emphasizes the conflict around separation and individuation between mother and child, not simply enmeshment.

The internalization of thinness as the ideal body image. The pressure to conform to societal standards of thinness is more related to sociocultural theories. While cultural ideals of thinness can play a role in the development of anorexia, the psychoanalytic perspective focuses more on the individual’s struggle with autonomy and separation rather than societal influences alone.

EXPLANATION

✔Correct answer:

Gamma-aminobutyric acid (GABA). Benzodiazepines work by enhancing the effect of gamma-aminobutyric acid (GABA), the primary inhibitory neurotransmitter in the central nervous system (CNS). GABA helps to reduce neuronal excitability by binding to GABA receptors, thereby calming the brain's activity. When benzodiazepines bind to GABA receptors, they increase GABA's inhibitory effects, leading to sedative, anxiolytic (anti-anxiety), and muscle-relaxant properties. This makes benzodiazepines particularly effective in treating acute anxiety, panic disorders, insomnia, and other conditions that involve hyperactivity of the CNS.

The calming effect of GABA is crucial for managing anxiety symptoms, as anxiety is often associated with an overactive nervous system. By enhancing GABA's function, benzodiazepines help slow down brain activity and reduce the physiological and psychological symptoms of anxiety.

Think of GABA as the brain's "brake pedal" that helps slow down excessive mental activity. Benzodiazepines make that brake pedal more effective, allowing the brain to calm down and reducing anxiety, similar to how pressing the brake in a car slows it down more effectively.

When administering or teaching about benzodiazepines, it is important for nurses to monitor for potential side effects and complications. Consider the following:

• Monitor for signs of sedation, drowsiness, or impaired coordination, as these are common side effects of benzodiazepines.
• Educate the patient on the risks of dependence or withdrawal if benzodiazepines are used long-term, and ensure that the medication is taken as prescribed.
• Assess for signs of respiratory depression, especially in higher doses or when combined with other CNS depressants like alcohol.
• Encourage non-pharmacological interventions for anxiety, such as relaxation techniques or cognitive-behavioral therapy (CBT), as adjuncts to medication.

✘Incorrect answer options:

Acetylcholine. Acetylcholine is involved in the parasympathetic nervous system and plays a role in muscle activation and memory, but it is not the primary neurotransmitter targeted by benzodiazepines. Benzodiazepines affect GABA, not acetylcholine.

Norepinephrine. Norepinephrine is associated with the body's "fight or flight" response and helps regulate mood and arousal. It is often involved in stress responses and depression, but benzodiazepines do not directly target norepinephrine. Instead, they work by enhancing GABA’s inhibitory effects.

Serotonin. Serotonin is a neurotransmitter involved in mood regulation, anxiety, and depression. While medications like selective serotonin reuptake inhibitors (SSRIs) target serotonin to manage anxiety and depression, benzodiazepines primarily enhance GABA activity, not serotonin.

EXPLANATION

✔Correct answer:

Ego-dystonic. In psychology, the term ego-dystonic refers to behaviors, thoughts, or feelings that are in conflict with a person’s self-image or ideal self. When a behavior is ego-dystonic, the individual experiences distress, shame, or guilt because they recognize that the behavior is inconsistent with how they wish to see themselves. In Glenda’s case, her binge eating and purging behaviors are causing feelings of shame and guilt, which indicates that these actions are not aligned with her self-perception or values. This makes bulimia ego-dystonic for her, as she feels uncomfortable and distressed about her actions.

In contrast, ego-syntonic refers to behaviors or feelings that are consistent with a person’s self-image or acceptable to them, often leading them to be less aware of or distressed by these behaviors. For example, in some cases of anorexia nervosa, the individual may view extreme dietary restriction as consistent with their self-image, making it ego-syntonic.

Think of ego-dystonic behaviors like wearing clothes that don’t fit you properly. You feel uncomfortable because they don’t align with your usual style or self-image, much like Glenda feels uncomfortable with her behaviors because they don’t match her ideal self.

When working with patients for whom certain behaviors are ego-dystonic, it is important to offer support that helps them address the guilt and shame associated with these actions. Key interventions may include:

• Provide a non-judgmental, empathetic environment where the patient feels safe discussing their behaviors and associated feelings of shame or guilt.
• Engage in cognitive-behavioral therapy (CBT) techniques to help the patient identify and reframe negative thoughts that contribute to shame and guilt.
• Educate the patient on the nature of their disorder, emphasizing that the behaviors are part of the condition and do not define their self-worth.
• Encourage the patient to explore healthier coping mechanisms and work on building self-compassion to reduce self-blame.
• Monitor for any signs of self-harm or depressive symptoms that may arise due to persistent feelings of guilt and low self-esteem.

✘Incorrect answer options:

Ego-distorting. This is not a standard psychological term used to describe behaviors in relation to self-perception. “Ego-dystonic” is the correct term for behaviors that cause internal conflict with one’s self-image.

Ego-enhancing. Ego-enhancing behaviors are those that boost one’s self-esteem or self-image. Glenda’s binge eating and purging behaviors are associated with feelings of shame and guilt, making them ego-dystonic rather than ego-enhancing.

Ego-syntonic. Ego-syntonic refers to behaviors that are in harmony with a person’s self-image or values, meaning they are not a source of distress or guilt. In Glenda’s case, her bulimic behaviors are ego-dystonic, as they conflict with her self-perception and cause distress.

EXPLANATION

✔Correct answer:

Alex will address uncomfortable emotions on a conscious level. The most appropriate outcome for a client with a dissociative disorder is for the individual to confront and process uncomfortable emotions on a conscious level. Dissociative disorders often involve disruptions in memory, identity, or perception of reality, frequently stemming from the inability to integrate distressing or traumatic emotions into conscious awareness. The dissociative mechanisms act as a defense strategy, allowing the individual to disconnect from painful memories or emotions. Therefore, the primary therapeutic goal is to help the client, such as Alex, gradually access and process these emotions without dissociating.

By addressing his emotions consciously, Alex will begin to reduce the dissociative episodes and gain better emotional regulation. This outcome aligns with a key aspect of treatment in dissociative disorders, which often involves reintegrating fragmented aspects of the client's identity or memory. Processing these emotions at a conscious level facilitates healing and fosters a more cohesive sense of self, which is critical for recovery.

Think of dissociative behavior like closing a door to a messy room in your house to avoid dealing with it. Addressing emotions on a conscious level is like opening that door, recognizing the mess, and starting to clean and organize the room, rather than pretending it doesn't exist.

To help Alex achieve this outcome, Nurse Kelly should implement interventions that encourage safe emotional expression and build emotional resilience. These may include:

• Use therapeutic communication techniques to guide Alex in discussing his emotions and experiences.
• Collaborate with a mental health professional to integrate trauma-focused therapies like cognitive-behavioral therapy (CBT) or psychotherapy.
• Provide a calm, supportive environment where Alex feels safe to explore distressing emotions.
• Monitor for signs of increased anxiety or distress, which may trigger dissociative responses, and provide grounding techniques if needed.
• Educate Alex on the importance of gradual exposure to emotional experiences, helping him reconnect with his thoughts and feelings at a manageable pace.

✘Incorrect answer options:

Alex will manage stress by applying relaxation techniques. While stress management is important in many psychiatric conditions, this goal is too general and does not specifically address the core issue in dissociative disorders. The primary challenge in dissociative disorders is the disconnection from emotions, so the focus should be on addressing and integrating these emotions rather than merely managing stress.

Alex will recognize his anxiety responses. Recognizing anxiety responses may be helpful, but it is a secondary goal in treating dissociative disorders. The primary objective is for Alex to confront and process the underlying emotions or trauma that are being dissociated. Recognizing anxiety alone does not address the dissociative mechanisms that are in place.

Alex will implement problem-solving strategies when under stress. While problem-solving skills are important for managing everyday stressors, this outcome does not target the specific needs of a client with dissociative disorders. Dissociation is more about emotional disconnection, not necessarily an inability to solve problems. The goal should focus on addressing the dissociative processes rather than just teaching stress-coping mechanisms.

EXPLANATION

✔Correct answer:

Severe. Marty's pacing, racing thoughts, and difficulty responding clearly to Nurse Lally's questions are indicative of severe anxiety. At this level, the individual’s perceptual field is greatly narrowed, and they may have difficulty focusing on anything other than their current distress. Severe anxiety often results in disorganized speech, difficulty concentrating, and an inability to engage in effective communication. Marty's unclear response and the physical symptom of pacing suggest he is having trouble processing external stimuli, which is characteristic of severe anxiety.

In severe anxiety, individuals experience a significant reduction in their ability to perceive their environment. Their focus may be limited to one or two details, or they may be overly focused on their internal discomfort. This leads to impaired communication and difficulty responding appropriately to questions or interacting with others, as observed in Marty’s case.

Imagine trying to have a conversation while a loud alarm is blaring right next to your ear. You would struggle to concentrate on what the other person is saying because all your attention would be on the disruptive noise (the internal distress Marty is feeling). Severe anxiety acts like that alarm, making it hard for him to process and respond clearly.

For a client like Marty experiencing severe anxiety, the priority is to reduce the anxiety level before attempting to gather further information. The nurse should:

• Provide a calm, quiet environment to help reduce external stimuli that may worsen the anxiety.
• Use short, clear, and direct communication, as the client’s ability to process complex information may be impaired.
• Encourage the client to engage in deep breathing exercises or other relaxation techniques to help manage the physical symptoms of anxiety (e.g., pacing, rapid heart rate).
• Assess for any physical risks, such as dehydration or exhaustion, if the pacing has been prolonged.
• Monitor for potential escalation into panic-level anxiety and ensure that the client feels safe and supported.

✘Incorrect answer options:

Mild. Mild anxiety is characterized by slight restlessness, increased awareness, and a sharpening of senses, but it does not typically impair communication or cause disorganized thought processes. Marty’s pacing and inability to clearly respond indicate a higher level of anxiety.

Moderate. In moderate anxiety, a person's perceptual field begins to narrow, and they may focus more on the immediate concern, but they can still engage in conversation and respond appropriately, even if somewhat distracted. Marty's disorganized response suggests that his anxiety level is more severe than moderate.

Panic. In panic-level anxiety, the individual may experience a complete loss of the ability to focus or respond, feel detached from reality, or exhibit erratic, uncontrollable behavior. While Marty is pacing and has racing thoughts, his behavior does not indicate the total disorganization or intense fear seen in panic-level anxiety.

EXPLANATION

✔Correct answer:

Positive and negative. Nurse Claire’s understanding of stressful life events is accurately reflected by the idea that these events can be both positive and negative. Stress is a natural response to significant life changes, and while many people associate stress with negative experiences (e.g., death, divorce, financial issues), it can also arise from positive events, such as getting married, starting a new job, or having a baby. These positive events are still considered stressors because they require adaptation, even though they are desirable or associated with personal growth.

The key concept in understanding stress is that it is not limited to negative experiences. Eustress, or "positive stress," occurs in response to life events that are motivating or challenging, while distress refers to negative stress that can be overwhelming or harmful. Both forms of stress can trigger physiological and psychological responses in the body.

Imagine a balloon being blown up. Whether you're inflating it quickly (a negative stressor) or slowly (a positive stressor), the balloon (your body) still experiences tension. Both positive and negative events require you to "stretch" and adapt, leading to stress responses.

When evaluating clients for stress, it is important for nurses to assess all aspects of life changes, both positive and negative. Nurses can help clients recognize that positive events can also lead to stress and provide coping strategies for both types of stressors:

• Encourage the client to verbalize feelings about recent life events, both positive and negative.
• Help the client identify coping mechanisms that can manage both eustress and distress.
• Educate the client on relaxation techniques to reduce the physiological impacts of stress (e.g., deep breathing, progressive muscle relaxation).
• Assess for any signs of chronic stress that may be affecting the client’s overall well-being, such as fatigue, sleep disturbances, or anxiety.
• Work with the client to develop a balanced approach to managing life transitions, particularly those that are associated with positive but overwhelming change.

✘Incorrect answer options:

Desirable and growth-promoting. While some stressful events can be desirable and lead to personal growth (e.g., a promotion, getting married), not all stressors are positive or lead to growth. Many stressors can be negative, distressing, and harmful, such as losing a job or experiencing a serious illness.

Undesirable and harmful. This statement only reflects one side of stress and does not account for positive stressors that also require adaptation. Stress is not always harmful or undesirable, as positive life events can cause stress as well.

Predictable and controllable. Stressful life events are often unpredictable and outside of the person’s control. For example, the death of a loved one or a natural disaster cannot be predicted or controlled. Not all stressful events follow a predictable pattern, and they can sometimes occur suddenly.

EXPLANATION

✔Correct answer:

A moralistic viewpoint. When discussing sensitive topics such as sexual health with adolescent patients, it is crucial for healthcare providers to maintain a supportive and open attitude. A moralistic viewpoint is likely to create a barrier to communication, as it can come across as judgmental or disapproving. Adolescents, like Alex, are often sensitive to perceived judgment, and a moralistic attitude could make them feel uncomfortable or ashamed, discouraging them from openly sharing their concerns or asking questions. This approach may also reinforce stigma or guilt around sexual health topics, which can hinder effective education and support.

Instead, adopting an accepting, matter-of-fact, and non-judgmental approach is more likely to create a safe environment where the patient feels free to express themselves without fear of criticism. Such an environment is essential for promoting honest and open discussions about sexual health, allowing the nurse to provide accurate information and guidance.

Think of a moralistic attitude as a "closed door." If Nurse Clara approaches the conversation with judgment, it’s like shutting the door on Alex, preventing him from feeling comfortable sharing. An open attitude is like keeping the door wide open, encouraging trust and communication.

To facilitate an open and effective conversation about sexual health, Nurse Clara should focus on creating a safe and respectful environment. Key approaches include:

• Use open-ended questions that allow the patient to share their thoughts and concerns without feeling judged.
• Maintain a neutral, accepting tone, avoiding any statements or expressions that may imply judgment or disapproval.
• Provide factual information in a clear and straightforward manner to empower the patient with knowledge.
• Encourage the patient to ask questions and express any confusion or concerns they may have about their sexual health.
• Respect the patient’s privacy and confidentiality, reinforcing that their questions and concerns are valid and important.

✘Incorrect answer options:

An accepting attitude. An accepting attitude would foster a safe environment, making it easier for the patient to feel comfortable discussing sensitive issues. Acceptance is essential for promoting open communication and would not act as a barrier.

A matter-of-fact approach. A matter-of-fact approach can help normalize discussions about sexual health, making the patient feel more at ease. This approach avoids unnecessary emotional reactions and is generally supportive of open communication.

A non-judgmental demeanor. A non-judgmental demeanor encourages trust and openness, as the patient is less likely to feel criticized or ashamed. This approach is conducive to productive discussions about sexual health and would not create a barrier.

EXPLANATION

✔Correct answer:

A 20-year-old college student with diabetes who survived a date rape incident. Among the listed options, the 20-year-old college student who survived a date rape incident is the most at risk for developing post-traumatic stress disorder (PTSD). PTSD often arises following a traumatic event that involves actual or threatened death, serious injury, or sexual violence. Survivors of sexual trauma, such as rape, are particularly vulnerable to PTSD due to the intense fear, helplessness, and violation they experience during and after the event. In this case, the college student’s traumatic experience of date rape fits the criteria of trauma that can precipitate PTSD.

Sexual violence is a known trigger for PTSD, and individuals who experience it often face lingering emotional and psychological effects, such as flashbacks, hypervigilance, and avoidance of situations that remind them of the event. The combination of emotional trauma and the ongoing challenges of managing a chronic illness like diabetes can further increase the student’s vulnerability to PTSD by exacerbating stress and impairing coping mechanisms.

Imagine the mind as a glass that can only hold so much water (stress and trauma). A traumatic event like sexual assault is like pouring too much water into the glass all at once, causing it to overflow (leading to the development of PTSD). Even if the person tries to cope, the emotional load may become too much to bear without help.

Community nurses must prioritize interventions for clients at high risk for PTSD by addressing both physical and emotional needs. For this college student, essential actions include:

• Provide emotional support and a safe, non-judgmental space for the client to share her experiences and emotions when she is ready.
• Encourage referral to a mental health professional, such as a therapist or counselor, for trauma-informed care like cognitive-behavioral therapy (CBT) or exposure therapy.
• Assess for co-existing conditions such as depression, anxiety, or substance use disorders, which can occur alongside PTSD.
• Educate the client about self-care strategies and encourage participation in support groups, particularly for survivors of sexual assault.
• Help the client manage the additional stress of her chronic illness (diabetes) by coordinating care and offering support in diabetes management to reduce overall stress levels.

✘Incorrect answer options:

An 8-year-old boy with asthma who recently failed a grade in school. While failing a grade may be stressful for a child, this situation does not typically involve the intense trauma required to trigger PTSD. Academic struggles are more likely to lead to anxiety or depression rather than PTSD, which requires a significant traumatic event involving life-threatening or violent experiences.

A 40-year-old widower who has recently lost his wife to cancer. Grief following the loss of a spouse, while deeply emotional and potentially overwhelming, does not usually lead to PTSD. Grieving is a natural process, and though this widower may experience depression or complicated grief, PTSD is more commonly triggered by traumatic events involving violence or severe threats to one’s life.

The wife of a person struggling with severe substance abuse. The wife of an individual with severe substance abuse issues may experience chronic stress, anxiety, or depression, but unless she has experienced direct trauma related to violence, physical abuse, or a life-threatening situation, she is not as likely to develop PTSD. The stress experienced by living with a person struggling with addiction, while significant, usually does not meet the criteria for trauma required to develop PTSD.

EXPLANATION

✔Correct answer:

It enhances serotonin levels. Clomipramine (Anafranil) is a tricyclic antidepressant that is primarily used to treat obsessive-compulsive disorder (OCD). Its effectiveness in managing OCD is attributed to its ability to increase the levels of serotonin in the brain. Serotonin is a neurotransmitter that plays a crucial role in mood regulation, anxiety, and behaviors associated with OCD. In individuals with OCD, it is believed that serotonin dysfunction contributes to the repetitive thoughts and compulsive behaviors characteristic of the disorder. Clomipramine works by inhibiting the reuptake of serotonin into the presynaptic neurons, which results in higher levels of serotonin in the synaptic cleft and improved transmission of serotonin signals between neurons. This helps in reducing OCD symptoms by stabilizing mood and anxiety levels.

Imagine serotonin as a type of fuel that keeps a car engine running smoothly (the brain). If there isn't enough fuel (serotonin), the engine may start to malfunction (leading to anxiety or compulsions). Clomipramine acts like a fuel-saving device, preventing too much fuel from being wasted, thereby ensuring that the engine has enough to keep running properly.

Clomipramine, like other medications used for OCD, requires careful monitoring to ensure patient safety and effectiveness of treatment. Here are key nursing interventions to keep in mind:

• Educate the patient about possible side effects of clomipramine, such as dry mouth, dizziness, and sedation, which are common with tricyclic antidepressants.
• Monitor for signs of serotonin syndrome, a potentially life-threatening condition caused by excessive accumulation of serotonin, especially if the patient is on other serotonergic medications.
• Advise the patient on adherence to medication, as it may take several weeks to observe significant improvement in OCD symptoms.
• Provide emotional support and resources for cognitive-behavioral therapy (CBT), which is often combined with pharmacotherapy for OCD.

✘Incorrect answer options:

It boosts dopamine levels. While dopamine dysfunction is linked to certain mental health conditions such as schizophrenia and Parkinson’s disease, it is not the primary neurotransmitter targeted by clomipramine in OCD treatment. Clomipramine works mainly by affecting serotonin, not dopamine.

It reduces norepinephrine levels. Clomipramine does affect norepinephrine reuptake to some degree, but its therapeutic effects in OCD are primarily due to its action on serotonin. Norepinephrine modulation is more relevant in managing mood disorders like depression rather than OCD.

It lowers GABA levels. GABA (gamma-aminobutyric acid) is an inhibitory neurotransmitter that reduces neuronal excitability. It is more associated with anxiety disorders and conditions like epilepsy. Clomipramine does not have a direct effect on GABA levels and instead targets serotonin reuptake.

EXPLANATION

✔Correct answer:

To deter any attempts at purging behavior. The primary reason for monitoring a patient with an eating disorder during mealtime and for one hour afterward is to deter any attempts at purging behavior. Many individuals with eating disorders, especially those with bulimia nervosa, may attempt to engage in purging behaviors (e.g., self-induced vomiting or misuse of laxatives) after eating to prevent weight gain and alleviate feelings of guilt or anxiety related to food intake. By maintaining close observation during and after meals, Nurse Hannah helps to reduce the likelihood of these harmful behaviors, ensuring that Lily can digest and absorb the nutrients from her meal.

This observation period is a standard intervention in the management of eating disorders, as it provides a safe and controlled environment to support healthier eating habits and reduce the cycle of disordered behaviors. Consistent monitoring helps patients to tolerate the post-meal period and gradually reduce the compulsive urge to purge.

Imagine a guard standing near a treasure to prevent it from being stolen. In this case, the "treasure" is the nourishment from the meal, and the observation period acts like a guard, protecting the body's need for nutrients from the urge to purge.

When monitoring a patient during and after meals, nurses should focus on creating a supportive environment while discouraging purging behaviors. Important interventions include:

• Observe the patient discreetly to minimize feelings of shame or embarrassment, while ensuring they do not engage in purging behaviors.
• Encourage open communication with the patient about any feelings of anxiety or discomfort related to eating, providing emotional support as needed.
• Reinforce positive behaviors and coping strategies that can help the patient manage urges to purge.
• Educate the patient on the physical harm caused by purging behaviors, emphasizing the importance of allowing the body to absorb nutrients.
• Collaborate with the healthcare team to develop a behavioral plan that gradually reduces the need for constant observation as the patient progresses in their recovery.

✘Incorrect answer options:

To foster a trusting relationship with the patient. Although building trust is important in caring for patients with eating disorders, the primary purpose of post-meal observation is to prevent purging behaviors. Trust-building is achieved over time and through consistent, empathetic care, rather than solely through observation during and after meals.

To emphasize the importance of proper nutrition. While nutritional education is an important part of treatment for eating disorders, the immediate goal of the observation period is to deter purging behaviors, not to provide nutrition education. Education on proper nutrition is typically addressed through counseling and dietitian support.

To reinforce the terms of the behavioral contract. Behavioral contracts may indeed be used in eating disorder treatment to set clear expectations, but the main purpose of post-meal observation is to prevent purging, not merely to reinforce the terms of a contract. Contracts can support the intervention but are not the primary reason for close monitoring after meals.

EXPLANATION

✔Correct answer:

It is possible to control how one responds to stress. Volunteer nurses educating the community about stress management are most likely to emphasize the belief that it is possible to control how one responds to stress. This concept aligns with cognitive-behavioral principles, which teach that while we may not be able to avoid stressors entirely, we can control how we interpret and respond to them. By developing healthy coping mechanisms, individuals can mitigate the negative effects of stress, improving their physical and emotional well-being.

Stress management techniques such as mindfulness, relaxation exercises, time management, and cognitive restructuring help individuals take control of their stress responses. By consciously changing their perception of a stressor, people can reduce their stress levels and respond in a more adaptive, calm, and effective way. This approach focuses on resilience and self-efficacy, empowering individuals to feel that they can manage the challenges they face.

Imagine stress like a storm. You can't always control when or where the storm will hit, but you can control how you prepare for it and how you react. Having an umbrella, wearing a raincoat, or staying indoors are all ways to protect yourself, just as using stress management techniques helps you cope with life’s storms.

When educating about stress management, nurses can provide specific strategies to help individuals gain control over their stress responses:

• Teach relaxation techniques, such as deep breathing, progressive muscle relaxation, or meditation, to reduce physiological symptoms of stress.
• Promote cognitive restructuring to help individuals challenge and change negative thought patterns that exacerbate stress.
• Encourage healthy lifestyle habits, such as regular physical activity, balanced nutrition, and adequate sleep, which support better stress management.
• Educate individuals about problem-solving skills and time management to help reduce stress related to feeling overwhelmed by tasks or responsibilities.
• Encourage social support networks, as healthy relationships can provide emotional and practical support when coping with stress.

✘Incorrect answer options:

Avoiding stress entirely is key to a healthy life. It is impossible to avoid all stress. Some stress is a natural and inevitable part of life, and learning how to manage it effectively is more beneficial than attempting to avoid it altogether. Avoiding stress entirely is neither realistic nor adaptive.

People generally have no control over their stress levels. This statement is incorrect, as individuals can control how they perceive and respond to stressors, even if they cannot always control the stressors themselves. The goal of stress management is to empower individuals to take control over their responses and build resilience.

Having significant others is crucial for providing care and support. While having social support is an important part of coping with stress, it is not the primary or sole focus of stress management. People can still manage stress effectively through personal coping strategies, even if they do not have a strong social support system. Social support is one component, but personal control over stress responses is equally critical.