Author Question: A patient describes feelings of anxiety and fear when speaking in front of an audience and is having ... (Read 29 times)

jilianpiloj · **on:** Jul 23, 2018

A patient describes feelings of anxiety and fear when speaking in front of an audience and is having difficulty at work because of an inability to present information at meetings three or four times each year.

The patient is reluctant to take long-term medications. The nurse will expect the provider to order which treatment?
a. Alprazolam (Xanax) as needed
b. Cognitive behavioral therapy
c. Paroxetine (Paxil)
d. Psychotherapy

Question 2

During an admission history, a patient reports a frequent need to return to a room multiple times to make sure an iron or other appliance is unplugged. What does the nurse understand about this patient's behavior?

a. It helps the patient reduce anxiety about causing a fire.
b. It usually is treated with clomipramine (Anafranil).
c. It seems perfectly normal to the patient.
d. It will best respond to deep brain stimulation.

peter · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: A
This patient is describing social anxiety disorder; the symptoms are related to performance only and are not generalized to all social situations. Because this patient must speak in front of an audience only three or four times per year, a PRN medication can be used. Cognitive behavioral therapy is used for OCD. Paroxetine must be used continuously for at least 1 year. Psychotherapy can be used but is more effective when used in combination with drugs.

Answer to Question 2

ANS: A
Patients with OCD have compulsive behaviors, such as repeatedly checking to make sure appliances have been unplugged. The compulsion is a ritualized behavior resulting from obsessive anxiety or fear that something bad will happen, such as starting a fire with an overheated appliance. Clomipramine is not a first-line drug for treating OCD. Patients usually understand that compulsive behaviors are excessive and senseless but are unable to stop. Deep brain stimulation is indicated for patients in whom other treatments have failed; its effectiveness at reducing symptoms has been shown to be about 40.