NCLEX PN MENTAL HEALTH

NCLEX PN MENTAL HEALTH The nurse is evaluating the plan of care for a client diagnosed with social anxiety disorder who has a fear of eating and drinking in public. Which of the following client statements demonstrate an improvement in coping? Select all that apply. A. "I plan dates involving outdoor activities, such as hiking, instead of going to dinner and a movie." B. "I sat in the pizza shop and drank a cola while watching people eat and then bought a slice to go." C. "I started having lunch with my coworkers even though I still become very anxious eating in public." D. "I went out of town on the day of the company picnic instead of making excuses for not eating." E. "I went to a coffee house with my boss and focused on an upcoming project while drinking a latte." Correct answer: B, C, and E. Rationale. Social anxiety disorder (ie, social phobia) is characterized as intense anxiety or fear when exposed to a public or social situation (eg, public speaking, eating or drinking in front of others). Clients who have social anxiety disorder tend to avoid participating in social situations because of the heightened anxiety and insecurity they experience. Treatment of social phobias may include medication (eg, selective serotonin reuptake inhibitors, benzodiazepines) and psychotherapy (eg, cognitive-behavioral therapy, systematic desensitization) to assist in developing effective coping strategies. As part of systematic desensitization, the client is gradually exposed to the phobic trigger, which in turn decreases anxiety. Effective coping with social phobia is demonstrated by: · Experiencing increased comfort while engaging in phobic situations (eg, drinking a cola while watching people eat). · Developing insight and verbalizing feelings about the irrational fear. · Distracting oneself by focusing on something other than the phobic situation (eg, preparing for a meeting while drinking a latte). Incorrect Answers [A. "I plan dates involving outdoor activities, such as hiking, instead of going to dinner and a movie."] Avoiding phobic situations (eg, planning activities unrelated to food, going out of town) reinforces maladaptive coping and prevents the client from working through the fear. [D. "I went out of town on the day of the company picnic instead of making excuses for not eating."] Avoiding phobic situations (eg, planning activities unrelated to food, going out of town) reinforces maladaptive coping and prevents the client from working through the fear. Educational objective:Social anxiety disorder (ie, social phobia) is characterized by intense anxiety or fear when exposed to a public or social situation. Effective coping is demonstrated by experiencing increased comfort when exposed to the phobia, developing insight and verbalizing feelings about the phobia, and distracting oneself during the phobic situation. Which statement made by the nurse during a therapy session demonstrates a need for further instruction regarding effective therapeutic communication techniques? A. "I don't understand what you mean. Can you give me an example? B. "It is doubtful the president is out to get you." C. "Tell me more about the day your child died." D. "Why did you get so angry when she ignored you?" Correct Answer: D. "Why did you get so angry when she ignored you?" Rationale. Therapeutic communication allows the nurse to develop a healthy interpersonal relationship with the client. A "why" question is often avoided as it is viewed negatively by clients and can make them feel defensive about their choices or emotions. Incorrect Answers: [A. "I don't understand what you mean. Can you give me an example?] Asking for an example is asking for clarification and is considered a therapeutic communication technique. [B. "It is doubtful the president is out to get you."] Voicing doubt is a therapeutic communication technique that allows the nurse to dispel misconceptions or delusions without directly confronting the client's beliefs. [C. "Tell me more about the day your child died."] Exploring is a therapeutic communication technique that encourages the client to discuss relevant situations and feelings. If the client chooses not to share information, the nurse should respect that decision and not probe further. Educational objective:For people who are anxious or overwhelmed, a "why" question asked by the nurse is often interpreted as being critical, judgmental, and intrusive. These feelings are damaging to the development of the nurse-client relationship and therapeutic communication.