ANXIETY DISORDERS AND STRESS
NCLEX PRACTICE QUIZ: 75
QUESTIONS
1. 1. Question
Chuck is a 20-year-old student diagnosed with obsessive-
compulsive behavior. A psychiatrist prescribes clomipramine
(Anafranil) to treat his condition. Nurse Nicolette understands the
rationale for this treatment is that the clomipramine:
o A. Increases dopamine levels
o B. Increases serotonin levels
o C. Decreases norepinephrine levels
o D. Decreases GABA levels
Correct Answer: B. Increases serotonin levels
According to the psychobiological theory, dysregulation of the
neurotransmitter serotonin is thought to contribute to obsessive-
compulsive behavior. Clomipramine (Anafranil) is used to
increase serotonin levels, thereby decreasing the need for
obsessive-compulsive behaviors. The only FDA-approved use for
clomipramine is for the treatment of the obsessive-compulsive
disorder (OCD) in ages 10 and older. Clomipramine was the first
FDA-approved medication for OCD in 1989. For the treatment of
OCD, a meta-analysis found clomipramine was more effective
than sertraline, fluoxetine, and fluvoxamine.
Option A: Clomipramine is a tertiary amine belonging
to the class of medications known as tricyclic
antidepressants (TCA). It is a dibenzazepine TCA.
Clomipramine is a serotonin reuptake inhibitor (S-RI)
with a stronger affinity for the serotonin transporter
(SERT), compared to other TCAs and S-RIs. The
resulting action of clomipramine increases
serotonergic and noradrenergic transmission.
Option C: Metabolism of clomipramine is primarily
through the liver via oxidation by CYP450 2D6. The
, half-life of clomipramine is 17 to 28 hours.
Clomipramine is then metabolized to the steady-state
active metabolite desmethyl clomipramine by CYP450
1A2. Desmethyl clomipramine has more noradrenergic
activity than serotonergic.
Option D: Experts often use fluvoxamine, a CYP450
1A2 inhibitor, with clomipramine in treatment-resistant
OCD. By adding the CYP450 1A2 inhibitor, the
conversion from clomipramine to desmethyl
clomipramine is blocked, resulting in increased
serotonergic activity. The onset of action of
clomipramine is usually between 6 to 12 weeks for
OCD; it may treat anxiety or insomnia immediately. If
the patient achieves OCD remission with
clomipramine, treatment should continue indefinitely.
2. 2. Question
A nurse at Nurseslabs Medical Center is developing a care plan
for a female client with post-traumatic stress disorder. Which of
the following would she do initially?
A. Instruct the client to use distraction techniques to
cope with flashbacks.
B. Encourage the client to put the past in proper
perspective.
C. Encourage the client to verbalize thoughts and
feelings about the trauma.
D. Avoid discussing the traumatic event with the client.
Correct Answer: C. Encourage the client to verbalize
thoughts and feelings about the trauma.
Planning care for a client with post-traumatic stress disorder
would involve helping the client to verbalize thoughts and
feelings about the trauma. This will help the client work through
the strong emotions connected with the trauma and, therefore
foster the belief that she is able to cope. Maintain a calm, non-
threatening manner while working with the client. Anxiety is
contagious and may be transferred from health care provider to
, client or vice versa. The client develops a feeling of security in
presence of a calm staff person.
Option A: Encourage the client’s participation in
relaxation exercises such as deep breathing,
progressive muscle. Relaxation exercises are effective
nonchemical ways to reduce anxiety. relaxation,
guided imagery, meditation and so forth. Maintain
calmness in your approach to the client. The client will
feel more secure if you are calm and if the client feels
you are in control of the situation.
Option B: This may be possible later after the client is
able to verbalize strong emotions. Present and discuss
the reality of the situation with client in order to
recognize aspects that can be changed and those that
cannot. The client must accept the reality of the
situation before the work of reducing the fear can
progress.
Option D: Avoiding discussion would be
inappropriate. Encourage the client to explore
underlying feelings that may be contributing to
irrational fears. Help the client to understand how
facing these feelings, rather than suppressing them,
can result in more adaptive coping abilities.
Verbalization of feelings in a non-threatening
environment may help the client come to terms with
unresolved issues.
3. 3. Question
A group of community nurses sees and plans care for various
clients with different types of problems. Which of the following
clients would they consider the most vulnerable to post-
traumatic stress disorder?
A. An eight (8)-year-old boy with asthma who has
recently failed a grade in school.
B. A 20-year-old college student with DM who
experienced date rape.
C. A 40-year-old widower who has recently lost his wife
to cancer.
, D. A wife of an individual with a severe substance abuse
problem.
Correct Answer: B. A 20-year-old college student with DM
who experienced date rape
Post-traumatic stress disorder is caused by the experience of
severe, specific trauma. Rape is a severely traumatic event.
Posttraumatic stress disorder (PTSD) is a syndrome that results
from exposure to real or threatened death, serious injury, or
sexual assault. Following the traumatic event, PTSD is common
and is one of the serious health concerns that is associated with
comorbidity, functional impairment, and increased mortality with
suicidal ideations and attempts.
Option A: The development of posttraumatic stress
disorder in individuals is linked to a large number of
factors. These include experiencing a traumatic event
such as a severe threat or a physical injury, a near-
death experience, combat-related trauma, sexual
assault, interpersonal conflicts, child abuse, or after a
medical illness. Chronic PTSD occurs in patients who
are unable to recover from the trauma due to
maladaptive responses.
Option C: The risk factors for the development of
PTSD include biological and psychological factors such
as gender (more prevalent in women), childhood
adversities, pre-existing mental illness, low
socioeconomic status, less education, lack of social
support. Nature and the severity of the trauma are
also accountable while determining the risk factors for
PTSD.
Option D: Although this situation is certainly stressful,
they are not at the level of severe trauma. The
symptoms of PTSD include persistently re-
experiencing the traumatic event, intrusive thoughts,
nightmares, flashbacks, dissociation(detachment from
oneself or reality), and intense negative emotional
(sadness, guilt) and physiological reaction on being
exposed to the traumatic reminder.[1] Furthermore,
problems with sleep and concentration, irritability,
increased reactivity, increased startle response,
hypervigilance, avoidance of traumatic triggers also
occur.
NCLEX PRACTICE QUIZ: 75
QUESTIONS
1. 1. Question
Chuck is a 20-year-old student diagnosed with obsessive-
compulsive behavior. A psychiatrist prescribes clomipramine
(Anafranil) to treat his condition. Nurse Nicolette understands the
rationale for this treatment is that the clomipramine:
o A. Increases dopamine levels
o B. Increases serotonin levels
o C. Decreases norepinephrine levels
o D. Decreases GABA levels
Correct Answer: B. Increases serotonin levels
According to the psychobiological theory, dysregulation of the
neurotransmitter serotonin is thought to contribute to obsessive-
compulsive behavior. Clomipramine (Anafranil) is used to
increase serotonin levels, thereby decreasing the need for
obsessive-compulsive behaviors. The only FDA-approved use for
clomipramine is for the treatment of the obsessive-compulsive
disorder (OCD) in ages 10 and older. Clomipramine was the first
FDA-approved medication for OCD in 1989. For the treatment of
OCD, a meta-analysis found clomipramine was more effective
than sertraline, fluoxetine, and fluvoxamine.
Option A: Clomipramine is a tertiary amine belonging
to the class of medications known as tricyclic
antidepressants (TCA). It is a dibenzazepine TCA.
Clomipramine is a serotonin reuptake inhibitor (S-RI)
with a stronger affinity for the serotonin transporter
(SERT), compared to other TCAs and S-RIs. The
resulting action of clomipramine increases
serotonergic and noradrenergic transmission.
Option C: Metabolism of clomipramine is primarily
through the liver via oxidation by CYP450 2D6. The
, half-life of clomipramine is 17 to 28 hours.
Clomipramine is then metabolized to the steady-state
active metabolite desmethyl clomipramine by CYP450
1A2. Desmethyl clomipramine has more noradrenergic
activity than serotonergic.
Option D: Experts often use fluvoxamine, a CYP450
1A2 inhibitor, with clomipramine in treatment-resistant
OCD. By adding the CYP450 1A2 inhibitor, the
conversion from clomipramine to desmethyl
clomipramine is blocked, resulting in increased
serotonergic activity. The onset of action of
clomipramine is usually between 6 to 12 weeks for
OCD; it may treat anxiety or insomnia immediately. If
the patient achieves OCD remission with
clomipramine, treatment should continue indefinitely.
2. 2. Question
A nurse at Nurseslabs Medical Center is developing a care plan
for a female client with post-traumatic stress disorder. Which of
the following would she do initially?
A. Instruct the client to use distraction techniques to
cope with flashbacks.
B. Encourage the client to put the past in proper
perspective.
C. Encourage the client to verbalize thoughts and
feelings about the trauma.
D. Avoid discussing the traumatic event with the client.
Correct Answer: C. Encourage the client to verbalize
thoughts and feelings about the trauma.
Planning care for a client with post-traumatic stress disorder
would involve helping the client to verbalize thoughts and
feelings about the trauma. This will help the client work through
the strong emotions connected with the trauma and, therefore
foster the belief that she is able to cope. Maintain a calm, non-
threatening manner while working with the client. Anxiety is
contagious and may be transferred from health care provider to
, client or vice versa. The client develops a feeling of security in
presence of a calm staff person.
Option A: Encourage the client’s participation in
relaxation exercises such as deep breathing,
progressive muscle. Relaxation exercises are effective
nonchemical ways to reduce anxiety. relaxation,
guided imagery, meditation and so forth. Maintain
calmness in your approach to the client. The client will
feel more secure if you are calm and if the client feels
you are in control of the situation.
Option B: This may be possible later after the client is
able to verbalize strong emotions. Present and discuss
the reality of the situation with client in order to
recognize aspects that can be changed and those that
cannot. The client must accept the reality of the
situation before the work of reducing the fear can
progress.
Option D: Avoiding discussion would be
inappropriate. Encourage the client to explore
underlying feelings that may be contributing to
irrational fears. Help the client to understand how
facing these feelings, rather than suppressing them,
can result in more adaptive coping abilities.
Verbalization of feelings in a non-threatening
environment may help the client come to terms with
unresolved issues.
3. 3. Question
A group of community nurses sees and plans care for various
clients with different types of problems. Which of the following
clients would they consider the most vulnerable to post-
traumatic stress disorder?
A. An eight (8)-year-old boy with asthma who has
recently failed a grade in school.
B. A 20-year-old college student with DM who
experienced date rape.
C. A 40-year-old widower who has recently lost his wife
to cancer.
, D. A wife of an individual with a severe substance abuse
problem.
Correct Answer: B. A 20-year-old college student with DM
who experienced date rape
Post-traumatic stress disorder is caused by the experience of
severe, specific trauma. Rape is a severely traumatic event.
Posttraumatic stress disorder (PTSD) is a syndrome that results
from exposure to real or threatened death, serious injury, or
sexual assault. Following the traumatic event, PTSD is common
and is one of the serious health concerns that is associated with
comorbidity, functional impairment, and increased mortality with
suicidal ideations and attempts.
Option A: The development of posttraumatic stress
disorder in individuals is linked to a large number of
factors. These include experiencing a traumatic event
such as a severe threat or a physical injury, a near-
death experience, combat-related trauma, sexual
assault, interpersonal conflicts, child abuse, or after a
medical illness. Chronic PTSD occurs in patients who
are unable to recover from the trauma due to
maladaptive responses.
Option C: The risk factors for the development of
PTSD include biological and psychological factors such
as gender (more prevalent in women), childhood
adversities, pre-existing mental illness, low
socioeconomic status, less education, lack of social
support. Nature and the severity of the trauma are
also accountable while determining the risk factors for
PTSD.
Option D: Although this situation is certainly stressful,
they are not at the level of severe trauma. The
symptoms of PTSD include persistently re-
experiencing the traumatic event, intrusive thoughts,
nightmares, flashbacks, dissociation(detachment from
oneself or reality), and intense negative emotional
(sadness, guilt) and physiological reaction on being
exposed to the traumatic reminder.[1] Furthermore,
problems with sleep and concentration, irritability,
increased reactivity, increased startle response,
hypervigilance, avoidance of traumatic triggers also
occur.
