Anxiety Disorders and Stress NCLEX Practice Quiz: 75 Questions| 2022 update

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 Incorrect 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. Incorrect 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. Incorrect 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. 4. 4. Question Which outcome is most appropriate for Francis who has a dissociative disorder? • A. Francis will deal with uncomfortable emotions on a conscious level. • B. Francis will modify stress with the use of relaxation techniques. • C. Francis will identify his anxiety responses. • D. Francis will use problem-solving strategies when feeling stressed. Incorrect Correct Answer: A. Francis will deal with uncomfortable emotions on a conscious level. Dissociative disorders occur when traumatic events are beyond an individual’s recall because these memories have been “blocked” from conscious awareness. Bringing the feelings associated with these events into conscious awareness and coping with these feelings will decrease the need for dissociation. Explore client’s feelings. Explore feelings that client experienced in response to the stressor; help client understand that the disequilibrium felt is acceptable-indeed, even expected-in times of severe stress. • Option B: Assess for stressors. Identify stressor that precipitated severe anxiety; this information is necessary to the development of an effective plan of client care and problem resolution. Encourage methods for coping. Have the client identify methods of coping with stress in the past and determine whether the response was adaptive or maladaptive. • Option C: Identify behavioral limits and behaviors that are expected. Client needs a clear structure. Expect frequent testing of limits initially. Maintaining limits can enhance feelings of safety in the client. Identify what the client sees as the behaviors and circumstances that lead to the hospitalization. Ascertain client’s understanding of behaviors and responsibility for own actions. • Option D: Ascertain from family/friends how the person interacts with significant people. Is the client always withdrawn, distrustful, hostile, and have continuous physical complaints? Identifying baseline behaviors helps with setting goals. When the client is ready and interested, teach client coping skills to help defuse tension and trouble feelings (e.g., anxiety reduction, assertiveness skills). Increasing skills helps the client use healthier ways to defuse tensions and get needs met. 5. 5. Question The psychiatric nurse uses cognitive-behavioral techniques when working with a client who experiences panic attacks. Which of the following techniques are common to this theoretical framework? Select all that apply. • A. Administering anti-anxiety medication as prescribed. • B. Encouraging the client to restructure thoughts. • C. Helping the client to use controlled relaxation breathing. • D. Helping the client examine evidence of stressors. • E. Questioning the client about early childhood relationships. • F. Teaching the client about anxiety and panic. Incorrect Correct Answers: B, C, D, F These are all appropriate techniques based on the framework of cognitive-behavioral therapy. The main approaches to the treatment of panic disorder include both psychological and pharmacological interventions. Psychological interventions consist of cognitive-behavioral therapy. As an added benefit in patients with a panic disorder that also has concomitant comorbid medical conditions, there are components of their therapeutic regimens which may also secondarily improve their respective medical illnesses. • Option A: Antidepressants and benzodiazepines are the mainstays of pharmacologic treatment. Among the different classes of antidepressants, selective serotonin reuptake inhibitors (SSRIs) are recommended over monoamine oxidase inhibitors and tricyclic antidepressants. SSRIs are considered the first-line treatment option for patients with panic disorder. • Option B: Suggest that the client substitute positive thoughts for negative ones. Emotion connected to thought, and changing to a more positive thought can decrease the level of anxiety experienced. This also gives the client an alternative way of looking at the problem. Include the client in making decisions related to selection of alternative coping strategies. Allowing the client choices provides a measure of control and serves to increase feelings of self-worth. • Option C: Breathing training is a method of reducing panic symptomatology by utilizing capnometry biofeedback to decrease the number of episodes of hyperventilation. Several of these slow breathing techniques have been shown to benefit patients with asthma and hypertension. Hyperventilation reduction can help patients with cardiovascular disease. Anxiety and stress-reduction techniques can lower adverse outcomes in cardiovascular illness by decreasing sympathetic activity. • Option D: 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. Discuss the process of thinking about the feared object/situation before it occurs. Anticipation of a future phobic reaction allows the client to deal with the physical manifestations of fear. • Option E: Encourage the client to share the seemingly unnatural fears and feelings with others, especially the nurse therapist. Clients are often reluctant to share feelings for fear of ridicule and may have repeatedly been told to ignore feelings. Once the client begins to acknowledge and talk about these fears, it becomes apparent that the feelings are manageable. • Option F: Explore things that may lower fear level and keep it manageable (e.g. singing while dressing, repeating a mantra, practicing positive self-talk while in a fearful situation); provides the client with a sense of control over the fear. Distracts the client so that fear is not totally focused on and allowed to escalate. Educate the patient and/or SO that anxiety. disorders are treatable. Pharmacological therapy is an effective treatment for anxiety disorders; treatment regimen may include antidepressants and anxiolytics. 6. 6. Question Marty is pacing and complains of racing thoughts. Nurse Lally asks the client if something upsetting happened, and Marty’s response is vague and not focused on the question. Nurse Lally assess Marty’s level of anxiety as: • A. Mild • B. Moderate • C. Severe • D. Panic Incorrect Correct Answer: C. Severe When the client has difficulty focusing and exhibits excessive motor activity, the level of anxiety is severe. Severe anxiety is intensely debilitating, and symptoms of severe anxiety meet key diagnostic criteria for clinically-significant anxiety disorder. People with severe anxiety typically score higher on scales of distress and lower on functioning. Severe anxiety symptoms also frequently co-occur with major depression, which can contribute to greater disability. • Option A: Mild anxiety is characterized by increased alertness and problem-solving ability. Although often described as sub-clinical or clinically non-significant, mild anxiety can impact emotional, social, and professional functioning. Mild anxiety symptoms may present as social anxiety or shyness and can be experienced in early childhood through to adulthood. If left unaddressed, mild anxiety can lead to maladaptive coping strategies or more severe mental conditions. • Option B: Moderate anxiety is characterized by the ability to focus on central concerns but the inability to problem-solve without assistance. People with moderate levels of anxiety have more frequent or persistent symptoms than those with mild anxiety, but still have better daily functioning than someone with severe anxiety or panic disorder. For example, people with moderate anxiety may report experiencing symptoms such as feeling on edge, being unable to control their worrying or being unable to relax several days or the majority of days in a week, but not every day. Although moderate anxiety symptoms are disruptive, people with moderate anxiety may have success in managing their anxiety with the help of a doctor or self-help strategies. • Option D: Panic level of anxiety is characterized by complete inability to focus and reduced perceptions. Panic level anxiety, or panic disorder, is characterized by frequent, recurring and unexpected panic attacks. Panic attacks usually last around 10 minutes. The triggers for panic attacks vary from person to person, and the cause of an attack may be familiar to a person or unknown. 7. 7. Question Nurse Martha is teaching her students about anxiety medications; she explains that benzodiazepines affect which brain chemical? • A. Acetylcholine • B. Gamma-aminobutyric acid (GABA) • C. Norepinephrine • D. Serotonin Incorrect Correct Answer: B. Gamma-aminobutyric acid (GABA) Anti Anxiety medications stimulate the neurotransmitter GABA, which is a chemical associated with relaxation. The other options are not affected by benzodiazepines. Benzodiazepines are a class of drugs that act upon benzodiazepine receptors (BZ-R) in the central nervous system (CNS). The receptor is a protein composed of five transmembrane subunits that form a chloride channel in the center, i.e., GABA-A receptor. The five subunits consist of two alpha, two beta, and one gamma subunit. The extracellular portions of the alpha and beta subunit proteins form a receptor site for gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter. • Option A: The extracellular portions of the alpha and gamma subunit proteins form a binding site for benzodiazepines. Activation of the BZ-R causes a conformational change to a central pore, which allows the entrance of chloride ions into the neuron. The influx of the chloride anion hyperpolarizes the neuron, resulting in the decreased firing of action potentials of that neuron. • Option C: Flumazenil is a GABA-A receptor antagonist, acting to reverse the sedative effects of benzodiazepines. Flumazenil functions through competitive inhibition of the alpha-gamma subunit of the GABA-A receptor. Administration of flumazenil should be carried out judiciously, as it may precipitate withdrawal seizures. Of note, one multi-center trial found that patients with excessive benzodiazepine ingestion could become “re-sedated” after flumazenil began to wear off. • Option D: Benzodiazepine administration can be performed by providing small doses of the medication until the desired effect (i.e., sedation, cessation of seizure activity, anxiolysis) has been achieved. It should be noted that with intravenous administration, it may take 3 to 5 minutes to achieve a CNS drug concentration adequate to produce the desired effect. Therefore, the adequate time between doses should be allowed to prevent oversedation of the patient. 8. 8. Question Mandy, a nurse who works at Nurseslabs Rehabilitation Center is assessing a client for recent stressful life events. She recognizes that stressful life events are both: • A. Desirable and growth-promoting • B. Positive and negative • C. Undesirable and harmful • D. Predictable and controllable Incorrect Correct Answer: B. Positive and negative The concept of stressful life events is based on the research of Holmes and Rahe, who found that both positive and negative changes result in stress. Stressful life events, or life event stressors, are undesirable, unscheduled, nonnormative, and/or uncontrollable discrete, observable events with a generally clear onset and offset that usually signify major life changes. Stressful life events have significant negative consequences for both physical and psychological well-being. • Option A: Broadly defined, stressors are events or conditions that threaten the operating integrity of an organism (Wheaton & Montazer, 2010). The concepts of stress and stressor were first introduced by Hans Selye (1956) whose experiments indicated that repeated and prolonged exposure to noxious conditions and stimuli increased susceptibility to disease and illness in laboratory animals. • Option C: Stressful life events are not always undesirable and harmful. The second approach defines stressful events as those that are consensually seen as harmful or threatening (e.g., Brown & Harris 1989, Cohen et al. 2016). Imminence of harm, intensity, duration, and the extent to which an event is objectively uncontrollable are all factors that contribute to the potential magnitude of consensual threat (Lazarus & Folkman 1984, Rabkin & Struening 1976). As mentioned above, although the magnitude of the threat represented by different life events is often thought to be cumulative (e.g., as assumed by stressful life event checklists), there is also evidence that the maximum risk for disease occurs when a single event meets a high criterion for threat (Wethington et al. 1995), with additional events not adding to the total risk. • Option D: Some stressful life events can be predictable and controllable; however, many life events are entirely unpredictable. With some limited exceptions (e.g., natural disasters, accidental deaths of friends or family members), stressful event exposures do not occur at random but instead are influenced by both individual differences in environmental circumstances and psychological characteristics. Personality factors may also be hidden causes of stressor exposure. For example, divorce is more common in those whose personality is characterized by greater neuroticism or lesser conscientiousness and agreeableness (Roberts et al. 2007). In addition, some cognitive styles, such as a tendency to attribute negative events to stable, global, and internal causes, can lead individuals to experience more stressful life events. 9. 9. Question During a community visit, volunteer nurses teach stress management to the participants. The nurses will most likely advocate which belief as a method of coping with stressful life events? • A. Avoidance of stress is an important goal for living. • B. Control over one's response to stress is possible. • C. Most people have no control over their level of stress. • D. Significant others are important to provide care and concern. Incorrect Correct Answer: B. Control over one’s response to stress is possible. When learning to manage stress, clients find it helpful to believe that they have the ability to control their response to it. It is impossible to avoid stress, which is a normal life experience. With practice, individuals learn to process emotions, thoughts, and sensations as they arise. Individuals learn to modify their reflexive conditioning from automatically reacting or worrying about the future to a more adaptive, measured response with greater awareness of the present moment. The literature is replete with evidence suggesting that, with practice, individuals can become more mindful, increasing their capacity to fully process emotions, thoughts, and sensations as they arise. • Option A: Stress can be positive and growth-enhancing as well as harmful. Effective techniques for stress management are varied. They typically include behaviors that improve physical health, such as nutrition and exercise, but may also incorporate strategies that improve cognitive and emotional functioning. The stress-reduction approach based on mindfulness practices has recently enjoyed an explosion of interest from a variety of healthcare and epidemiological researchers. The concept of mindfulness, which originates from practices of Buddhism, is defined as a focused awareness of one’s experience, and a purposeful and non-judgmental focus on the present moment. • Option C: The belief that one has some control is a significant factor in minimizing stress response. Paradoxically, positive changes seem especially likely to occur when one can let go of the struggle of trying to change or control the process. This perspective lies at the core of empirically validated acceptance-based intervention models. A focus on the present moment can potentially help decondition habitual reaction patterns and increase response flexibility. From a cognitive perspective, this suggests that viewing present circumstances as new and unique experiences increases one’s capacity for generating multiple alternative response options. • Option D: Novice mindfulness practitioners also engage in “informal” practice as they learn to observe their own thoughts and sensations and explore a new stance as a nonjudgmental observer of their own life. Attending one’s own experience may set up a dynamic cognitive interaction that can facilitate a capacity to respond to ongoing experiences as if they are occurring for the first time, typically referred to as “beginner’s mind.” This interrupts the automatic processes of relying on previously conditioned stress reactions. 10. 10. Question Genevieve only attends social events when a family member is also present. She exhibits behavior typical of which anxiety disorder? • A. Agoraphobia • B. Generalized anxiety disorder • C. Obsessive-compulsive disorder • D. Post-traumatic stress disorder Incorrect Correct Answer: A. Agoraphobia Agoraphobia is a disorder characterized by avoidance of situations in which escape may not be possible or help may be unavailable. Agoraphobia is the anxiety that occurs when one is in a public or crowded place, from which a potential escape is difficult, or help may not be readily available. It is characterized by the fear that a panic attack or panic-like symptoms may occur in these situations. Individuals with agoraphobia, therefore, strive to avoid such situations or locations. • Option B: Generalized anxiety disorder is one of the most common mental disorders. Up to 20% of adults are affected by anxiety disorders each year. Generalized anxiety disorder produces fear, worry, and a constant feeling of being overwhelmed. Generalized anxiety disorder is characterized by persistent, excessive, and unrealistic worry about everyday things. This worry could be multifocal such as finance, family, health, and the future. It is excessive, difficult to control, and is often accompanied by many non-specific psychological and physical symptoms. Excessive worry is the central feature of generalized anxiety disorder. • Option C: Obsessive-compulsive disorder (OCD) is often a disabling condition consisting of bothersome intrusive thoughts that elicit a feeling of discomfort. To reduce the anxiety and distress associated with these thoughts, the patient may employ compulsions or rituals. These rituals may be personal and private, or they may involve others to participate; the rituals are to compensate for the ego-dystonic feelings of the obsessional thoughts and can cause a significant decline in function. • Option D: 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. The Diagnostic and Statistical Manual of Mental Disorders(DSM-5) has included PTSD in the new category of Trauma- and Stress-related Disorders. 11. 11. Question Mr. Johnson was recently admitted to a psychiatric unit because of severe obsessive-compulsive behavior. Which initial response by the nurse would be most therapeutic for him? • A. Accepting the client's ritualistic behaviors. • B. Challenging the client's need for rituals. • C. Expressing concern about the harmfulness of the client's rituals. • D. Limiting the client's rituals that are excessive. Incorrect Correct Answer: A. Accepting the client’s ritualistic behaviors It is important to accept the client’s need to perform ritualistic behaviors in this situation; admission to a psychiatric unit is stressful, and this client will tend to increase rituals when anxious. Other options are not appropriate for a newly admitted client. Initially meet the client’s dependency needs as necessary. Sudden and complete elimination of avenues for dependency would create anxiety and will burden the client more. • Option B: During the beginning of treatment, allow plenty of time for rituals. Do not be judgmental or verbalize disapproval of the behavior. To deny the client this activity can precipitate panic level of anxiety. Encourage independence and give positive reinforcement for independent behaviors. Positive reinforcement enhances self-esteem and encourages the repetition of desired behaviors. • Option C: Support and encourage the client’s efforts to explore the meaning and purpose of the behavior. The client may be unaware of the relationship between emotional problems and compulsive behaviors. Recognition and acceptance of problems are important before a change can occur. Gradually limit the amount of time allotted for ritualistic behavior as the client becomes more involved in unit activities. Anxiety is minimized when the client is able to replace ritualistic behaviors with more adaptive ones. • Option D: Encourage the recognition of situations that provoke obsessive thoughts or ritualistic behaviors. Recognition of precipitating factors is the first step in teaching the client to interrupt escalation of anxiety. Provide positive reinforcement for non-ritualistic behaviors. Positive reinforcement enhances self-esteem and encourages the repetition of desired behaviors. 12. 12. Question Nurse Vicky is assessing a newly admitted client for symptoms of post-traumatic stress disorder (PTSD). Which symptoms are typically seen with this diagnosis? Select all that apply. • A. Anger with numbing of other emotions. • B. Exaggerated startle response. • C. Feeling that one is having a heart attack. • D. Frequent thoughts about contamination. • E. Frequent nightmares. • F. Survivor's guilt. Incorrect Correct Answers: A, B, E, F These are common symptoms of PTSD. Option C is common in panic disorder, and option D is characteristic of obsessive-compulsive disorder. 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. The Diagnostic and Statistical Manual of Mental Disorders(DSM-5) has included PTSD in the new category of Trauma- and Stress-related Disorders. • Option A: On the mental status examination, the patient would likely mention poor sleep and concentration, frequent nightmares and flashbacks related to the event, guilt or negative emotions associated with the reminder, avoidance, and increased vigilance. There is a persistent inability to experience a positive emotion such as happiness, satisfaction, or love. • Option B: Furthermore, problems with sleep and concentration, irritability, increased reactivity, increased startle response, hypervigilance, avoidance of traumatic triggers also occur. There is a significant impairment in social, occupational, and other areas of functioning. However, the symptoms of PTSD overlap with acute stress disorder. For a patient to be diagnosed as PTSD, the duration of the symptoms must be more than one month. • Option C: In order to make an accurate diagnosis of panic disorder, it is important to differentiate the two entities from each other. According to DSM V, panic disorder can be diagnosed if recurrent unexpected panic attacks are happening followed by one month or more of persistent concern over having more attacks, along with a change in the behavior of the individual to avoid a situation in which they attribute the attack to. • Option D: Obsessive-compulsive disorder (OCD) is often a disabling condition consisting of bothersome intrusive thoughts that elicit a feeling of discomfort. To reduce the anxiety and distress associated with these thoughts, the patient may employ compulsions or rituals. These rituals may be personal and private, or they may involve others to participate; the rituals are to compensate for the ego-dystonic feelings of the obsessional thoughts and can cause a significant decline in function. • Option E: 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. • Option F: Negative alterations in mood and cognition that began or worsened after the traumatic event, as evidenced by persistent negative emotional state, including fear, guilt, anger, or shame; persistent distorted cognition that leads the individual to blame self or others for causing the traumatic event. 13. 13. Question Jordanne is a client with a fear of air travel. She is being treated in a mental institution for phobic disorder. The treatment method involves systematic desensitization. The nurse would consider the treatment successful if: • A. Jordanne plans a trip requiring air travel. • B. Jordanne takes a short trip on an airplane. • C. Jordanne recognizes the unrealistic nature of the fear of riding on airplanes. • D. Jordanne verbalizes a decreased fear of air travel. Incorrect Correct Answer: B. Jordanne takes a short trip on an airplane. Systematic desensitization is a behavioral technique in which the client with a specific phobia is gradually able to work through hierarchical fears until the most fearful situation is encountered. In this case, the most fearful is riding an airplane. Systematic desensitization (gradual systematic exposure of the client to the feared situation under controlled conditions) allows the client to begin to overcome the fear, become desensitized to the fear. Note: Implosion or flooding (continuous, rapid presentation of the phobic stimulus) may show quicker results than systematic desensitization, but relapse is more common, or the client may become terrified and withdraw from therapy. • Option A: Explore client’s perception of threat to physical integrity or threat to self-concept. It is important to understand the client’s perception of the phobic object or situation in order to assist with the desensitization process. Present and discuss the reality of the situation with the 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 fear can progress. • Option C: 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. • Option D: This response may occur earlier in treatment, but not indicative of success. Generally, a phobic individual recognizes that his fear is disproportionate to the things he fears. Explore things that may lower fear level and keep it manageable (e.g. singing while dressing, repeating a mantra, practicing positive self-talk while in a fearful situation). Provides the client with a sense of control over the fear. Distracts the client so that fear is not totally focused on and allowed to escalate. 14. 14. Question Nurse Kerrick observes Toni who is hospitalized on an eating disorder unit during mealtimes and for 1 hour after eating. An explanation for this intervention is: • A. To develop a trusting relationship. • B. To maintain focus on the importance of nutrition. • C. To prevent purging behaviors. • D. To reinforce the behavioral contact. Incorrect Correct Answer: C. To prevent purging behaviors. Toni may experience increased anxiety during treatment and, therefore, may resume behaviors designed to prevent weight gain, such as vomiting or excessive exercise. Supervise the patient during mealtimes and for a specified period after meals (usually one hour). This prevents vomiting during or after eating. Avoid room checks and other control devices whenever possible. External control reinforces feelings of powerlessness and therefore is usually not helpful. • Option A: Use a consistent approach. Sit with the patient while eating; present and remove food without persuasion and comment. Promote a pleasant environment and record intake. Patient detects urgency and may react to pressure. Any comment that might be seen as coercion provides focus on food. When staff responds in a consistent manner, the patient can begin to trust staff responses. The single area in which the patient has exercised power and control is food or eating, and he or she may experience guilt or rebellion if forced to eat. Structuring meals and decreasing discussions about food will decrease power struggles with the patient and avoid manipulative games. • Option B: Establish a minimum weight goal and daily nutritional requirements. Malnutrition is a mood-altering condition, leading to depression and agitation and affecting cognitive function and decision-making. Improved nutritional status enhances thinking ability, allowing initiation of psychological work. Make a selective menu available, and allow the patient to control choices as much as possible. Patient who gains confidence in herself and feels in control of the environment is more likely to eat preferred foods. • Option D: Maintain a regular weighing schedule, such as Monday and Friday before breakfast in the same attire, and graph results. Provides an accurate ongoing record of weight loss or gain. Also diminishes obsessing about changes in weight. Weigh with back to scale (depending on program protocols). Although some programs prefer the patient to see the results of the weighing, this can force the issue of trust in the patient who usually does not trust others. 15. 15. Question Marlyn is diagnosed with anorexia nervosa and is admitted to the special eating disorder unit. The initial treatment priority for her is: • A. To determine her current body image. • B. To identify family interaction patterns. • C. To initiate a refeeding program. • D. To promote the client's independence. Incorrect Correct Answer: C. To initiate a refeeding program. The physical need to reestablish near-normal weight takes priority because of the physiologic, life-threatening consequences of anorexia. Maintain a regular weighing schedule, such as Monday and Friday before breakfast in the same attire, and graph results; provides an accurate ongoing record of weight loss or gain. Also diminishes obsessing about changes in weight. Make a selective menu available, and allow the patient to control choices as much as possible. Patient who gains confidence in herself and feels in control of the environment is more likely to eat preferred foods. • Option A: Establish a minimum weight goal and daily nutritional requirements. Malnutrition is a mood-altering condition, leading to depression and agitation and affecting cognitive function and decision-making. Improved nutritional status enhances thinking ability, allowing initiation of psychological work. Weigh with back to scale (depending on program protocols). Although some programs prefer the patient to see the results of the weighing, this can force the issue of trust in the patient who usually does not trust others. • Option B: Involve the patient in setting up or carrying out a program of behavior modification. Provide a reward for weight gain as individually determined; ignore the loss. Provides structured eating situations while allowing the patient some control in choices. Behavior modification may be effective in mild cases or for short-term weight gain. • Option D: Use a consistent approach. Sit with the patient while eating; present and remove food without persuasion and comment. Promote a pleasant environment and record intake. Patient detects urgency and may react to pressure. Any comment that might be seen as coercion provides focus on food. When staff responds in a consistent manner, the patient can begin to trust staff responses. The single area in which the patient has exercised power and control is food or eating, and he or she may experience guilt or rebellion if forced to eat. Structuring meals and decreasing discussions about food will decrease power struggles with the patient and avoid manipulative games. 16. 16. Question The nurse evaluates the treatment of Mrs. Montez with somatoform disorder as successful if: • A. Mrs. Montez practices self-medication rather than changing health care providers. • B. Mrs. Montez recognizes that physical symptoms increase anxiety level. • C. Mrs. Montez researches treatment protocols for various illnesses. • D. Mrs. Montez verbalizes anxiety directly rather than displacing it. Incorrect Correct Answer: D. Mrs. Montez verbalizes anxiety directly rather than displacing it. Mrs. Montez with somatoform disorder unconsciously displaces anxiety onto physical symptoms. The ability to recognize and verbalize anxious feelings directly rather than displacing them is a criterion of treatment success. Clients may keep a detailed journal of their physical symptoms; the nurse might ask them to describe the situation at the time such as whether they were alone or with others, whether any disagreements were occurring, and so forth. • Option A: Teach the client coping strategies. Emotion-focused strategies include progressive relaxation, deep breathing, guided imagery, and distractions such as music or other activities; problem-focused coping strategies include problem-solving methods, applying the process to identified problems, and role-playing interactions with others. • Option B: Provide education about feared or actual medical conditions. This helps the client understand the condition in a more realistic light and helps alleviate fear and anxiety about a particular health concern. Discuss symptoms with the client and when they began, what makes them better or worse and how they have been managing these symptoms. This helps make a more definitive diagnosis and helps determine how to best treat the client. Helping the client determine the etiology of symptoms helps them to recognize and avoid situations that make symptoms worse. • Option C: This indicates the continuation of the problem. Encourage behavior modification such as praising the client and offering more attention when symptoms improve. Change the focus from what’s wrong to what’s right. Helps the client feel accomplished and more positive about improvements in health condition instead of focusing on the symptoms. 17. 17. Question Which of the following attitudes from a nurse would hinder a discussion with an adolescent client about sexuality? • A. Accepting • B. Matter-of-fact • C. Moralistic • D. Non Judgemental Incorrect Correct Answer: C. Moralistic Adolescents are not likely to feel free to ask questions and participate in a discussion if the nurse has a moralistic attitude toward sexual issues. Having an accepting, matter-of-fact, or nonjudgmental attitude will be helpful in allowing adolescents to feel comfortable discussing sexual issues. • Option A: Consider own emotions and values and what it is important for you to transmit. Pay attention to what the child is seeing and hearing in the media (television, movies, video games, social media posts, music, and so forth). Monitor social media use and limit Internet access to common family spaces as much as possible. Take advantage of the many teachable moments in the media. • Option B: Use teachable moments to have conversations related to a variety of topics on a regular basis. Teachable moments include major life events and everyday occurrences, and they can be spontaneous or scripted in advance. Solicit the help of close family and/or friends who may be trusted adults for the child. It is beneficial to have a network of supportive and “askable” adults. • Option D: Establish a common language for talking about sexuality and create conversational ground rules to foster a nonjudgmental atmosphere. Be clear and candid and admit when you do not know the answer. Working together to find answers may be rewarding. It is always okay to say, “I don’t know” or “I need to think about that.” 18. 18. Question Nurse Wayne is planning a psychoeducational discussion for a group of adolescent clients with anorexia nervosa. Which of the following topics would Nurse Wayne select to enhance understanding about central issues in this disorder? • A. Anger management • B. Parental expectations • C. Peer pressure and substance abuse • D. Self-control and self-esteem Incorrect Correct Answer: D. Self-control and self-esteem Self-control and self-esteem are central issues for clients with eating disorders. Such clients feel a loss of self-control over their life and experience diminished self-esteem and severe doubts about their self-worth. The individual tries to gain a sense of self-control through food and exercise since this is the one and only aspect of their life they are able to control. Choosing to engage in binging, extreme dieting, purging and other obsessive behaviors relating to body image and weight loss are attempts to “self-treat” their lack of control in other aspects of their life where they have no control. • Option A: The American Psychological Association (APA) has shown that past abuse or trauma, low-self esteem, bullying, poor parental relationships, borderline personality disorder, substance abuse, non-suicidal self-injury disorder (NSSI), a perfectionistic personality, difficulty communicating negative emotions, difficulty resolving conflict, and genetics are known underlying triggers that contribute to the development of an eating disorder. • Option B: Maternal psychopathology such as negative expressed emotion, the thrive for perfectionism, and maternal encouragement of weight loss can lead to the development of eating disorders in children and teenagers. The obsessions of binging and purging are brought on by low-self esteem, fear, and anxiety and therefore an individual will binge, purge or exercise excessively to only be relieved of these unhealthy emotions and feelings temporarily until feelings of self-blame and guilt follow. • Option C: The first-line treatment for all eating disorders is psychotherapy, which encompasses a broad range of therapy approaches such as cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) which aim to recognize and reduce the harmful thoughts and emotions associated with the eating disorder and works to develop productive coping mechanisms and tools to help the individual engage in positive thoughts, emotions, and behaviors in order to overcome their past traumas and low-self esteem. 19. 19. Question Nurse Gina understands that her client Glenda who is bulimic feels shame and guilt over binge eating and purging. This disorder is therefore considered: • A. Ego-distorting • B. Ego-dystonic • C. Ego-enhancing • D. Ego-syntonic Incorrect Correct Answer: B. Ego-dystonic An ego-dystonic disorder is one in which the client views behaviors or symptoms as incongruent with self-image and therefore feels guilt, shame, and distress about the symptoms. Ego-dystonic refers to thoughts, impulses, and behaviors that are felt to be repugnant, distressing, unacceptable or inconsistent with one’s self-concept. • Option A: To say that the ego is distorted is simply to say that the mental apparatus is in a state of disordered function, and we cannot pursue this matter fruitfully unless we know exactly what part or layer of the ego is distorted and how and when and why, and with what other psychic reactions the ego-distortion is associated. • Option C: Ego enhancement has been offered as the psychological mechanism that drives differences in judgments about effects on self and others. Findings indicate that although ego enhancement does not appear to directly influence either third-person perception or its relationship to support for government control, it does play a moderating role in regulating the relationship between perceived effects and support for controls, especially in the case of perceived effects on others. • Option D: An ego-syntonic disorder is one which the client views behaviors as congruent with her self-image (as in anorexia nervosa). Ego-syntonic refers to instincts or ideas that are acceptable to the self; that are compatible with one’s values and ways of thinking. They are consistent with one’s fundamental personality and beliefs. 20. 20. Question The psychoanalytic theory explains the etiology of anorexia nervosa as: • A. The achievement of secondary gain through control of eating. • B. A conflict between mother and child over separation and individualization. • C. Family dynamics that lead to enmeshment of members. • D. The incorporation of thinness as an ideal body image. Incorrect Correct Answer: B. A conflict between mother and child over separation and individualization. According to psychoanalytic theory, early mother-child dynamics lead to difficulty with a child establishing a sense of separateness from the mother. Control of eating becomes one area in which the child establishes a sense of independence. Anorexia nervosa is an expression of ego-defective development arising from varying degrees of failure to resolve the process of developing a sense of individuality. There result primitive aggression, archaic guilt, and great difficulties in establishing an integrated sense of sexual identity. • Option A: This is the behavioral view of anorexia nervosa. For disorders that belong in the Behavioral Perspective, the behavior shown by the patient is the cardinal abnormality, whether it is the behavior of self-starving, purging, alcohol consumption, dysfunctional sexual behavior, or other actions. A psychiatrically abnormal behavior is required. Absent the behavior, absent the disorder. • Option C: This reflects the family theory view of anorexia nervosa, which deals with the issue of lack of generational boundaries. Family systems theory views anorexia nervosa not only as a product of dysfunctional transactional patterns within a family, but also as a crucial stabilizing element within the family. With regard to family factors, recent studies have found associations between the difficulties of adolescents with EDs and family functioning, but no study, to our best knowledge, has investigated the impact of family psychopathological profiles on the adolescents’ psychopathological symptoms, differentiating for different types of EDs, during adolescence. • Option D: This characterizes the sociocultural view of anorexia nervosa, which identifies thinness as being a culturally determined ideal. According to the sociocultural model, internalization of the thin ideal leads to body dissatisfaction and subsequent negative affect and dieting behaviors which increase the risk for eating disorder development. 21. 21. Question The school nurse assesses for anorexia nervosa in an adolescent girl. Which of the following findings are characteristic of this disorder? Select all that apply. • A. Bradycardia • B. Hypotension • C. Chronic pain in one or more sites • D. Fear of having a serious illness • E. Irregular or absent menses • F. Refusal to maintain a minimally normal weight Incorrect Correct Answer: A, B, E, F These are all characteristics of anorexia nervosa. Anorexia nervosa is an eating disorder defined by restriction of energy intake relative to requirements, leading to a significantly low body weight. Patients will have an intense fear of gaining weight and distorted body image with the inability to recognize the seriousness of their significantly low body weight. • Option A: Cardiac complications are arguably one of the most severe medical issues stemming from anorexia. Bradycardia (heart rate less than 60 beats per minute) and hypotension (blood pressure less than 90/50) are among the most common physical findings in anorexia, with bradycardia seen in up to 95 percent of patients. • Option B: Bradycardia (pulse 60) and hypotension are among the most common physical findings in patients with anorexia nervosa, with bradycardia seen in up to 95% of patients. Anorexia nervosa should be considered in the differential for unexplained bradycardia in the outpatient setting. Low blood pressure and heart rate universally increase to normal levels after refeeding and restoration of normal weight. • Option C: Chronic pain in one or more sites is common for somatoform pain disorder. The Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) category of Somatic Symptom Disorders and Other Related Disorders represents a group of disorders characterized by thoughts, feelings, or behaviors related to somatic symptoms. This category represents psychiatric conditions because the somatic symptoms are excessive for any medical disorder that may be present. • Option D: Fear of having a serious illness is common in hypochondriasis. Illness anxiety disorder (IAD) is a recent term for what used to be diagnosed as hypochondriasis, or hypochondria. People diagnosed with IAD strongly believe they have a serious or life-threatening illness despite having no, or only mild, symptoms. Yet IAD patients’ concerns are to them very real. Even if they go to doctors and no illnesses are found, they are generally not reassured and their obsessive worry continues. • Option E: Of patients with anorexia nervosa, 20–25 percent may experience amenorrhea before the onset of significant weight loss, and 50–75 percent will experience amenorrhea during the course of dieting and its weight loss. In some patients with anorexia nervosa, amenorrhea occurs only after more marked weight loss. Overall, the development of amenorrhea is most strongly correlated to loss of body weight. • Option F: Many exercise compulsively for extended periods of time. Patients with anorexia nervosa develop multiple complications related to prolonged starvation and purging behaviors. 22. 22. Question Mr. Bartowski who is newly diagnosed with rheumatoid arthritis asks the community nurse how stress can affect his disease. The nurse would explain that: • A. The psychological experience of stress will not affect symptoms of physical disease. • B. Psychological stress can cause painful emotions, which are harmful to a person with an illness. • C. Stress can overburden the body's immune system, and therefore one can experience increased symptoms. • D. The body's stress response is stimulated when there are major disruptions in one's life. Incorrect Correct Answer: C. Stress can overburden the body’s immune system, and therefore one can experience increased symptoms. The stress response causes stimulation of the hypothalamic-pituitary-adrenal axis, which can further compromise an immune system that has been activated by the autoimmune disorder of rheumatoid arthritis. Consequently, the client can expect disease symptoms to exacerbate when under stress. • Option A: Research says that rheumatoid arthritis can be caused by stress. Stress triggers rheumatoid arthritis by setting off the immune system’s inflammatory response in which cytokines are released. Cytokines are chemicals that play an important role in inflammation and can increase the severity of rheumatoid arthritis in some patients. The greater the exposure to stress, the greater the inflammation becomes. This triggers a rheumatoid arthritis flare. • Option B: Around one out of five patients with rheumatoid arthritis has depression due to the illness. Depression, in turn, further aggravates rheumatoid arthritis and leads to a greater number of painful joints, reduced functioning (higher number of days in bed), and increased visits to the doctor’s clinic. All these further affect the patient’s mental health and cause more stress and depression. • Option D: Stress can cause rheumatoid arthritis and rheumatoid arthritis itself can also cause stress. Treatments that don’t work or their side effects might affect the patient’s mind. Joint pain and swelling can make routine activities difficult for the patient. All these things that come with rheumatoid arthritis can make the patient stressed, which can further trigger joint inflammation. 23. 23. Question During a mother’s class, the nurse who is teaching the participants on stress management is questioned about the use of alternative treatments, such as herbal therapy and therapeutic touch. She explains that the advantage of these methods would include all of the following except: • A. They are congruent with many cultural belief systems. • B. They encourage the consumer to take an active role in health management. • C. They promote interrelationships within the mind-body-spirit. • D. They usually work better than traditional medical practice. Incorrect Correct Answer: D. They usually work better than traditional medical practice. Complementary alternative medicine treatments are often used as adjuncts to traditional medical treatment. Although an individual may choose a particular alternative treatment method, there is really no current scientific proof that these methods will work better than traditional medicine. Stress can be effectively managed by Yoga, meditation, mindfulness, healthy eating, exercise, acupressure, acupuncture, building relaxation rituals like massaging or drinking herbal teas such as rose, bamboo, chamomile, peppermint etc. • Option A: Complementary therapies can be described as the health care techniques aimed at integrating physical, mental, and spiritual dimensions. The objective of complementary therapies differs from the allopathic care used in Western medicine, in which the cure of the disease is the result from direct interventions in injured organs. Different classifications have been proposed for complementary therapies. The National Center for Complementary and Alternative Medicine mainly categorizes them as biologically based therapies, mind-body interventions, and manipulative and body-based methods. • Option B: Complementary therapies may help improve a patient’s quality of life and the use of these therapies should be part of a further health care model established toward comprehensive care, offering therapeutic modalities that can strengthen the mind-body-spirit during a patients’ treatment journey. • Option C: Mind-body-based programs can also reduce stress and anxiety associated with the cancer experience. Data from breast cancer populations have suggested that mind-body based complementary therapies (eg, mindfulness, meditation, yoga, Tai Chi, Qigong, guided imagery, and affirmations) have the potential to influence the immune profile of breast cancer patients and survivors, along with decreasing stress levels by helping them in developing a greater sense of emotional balance and well-being. 24. 24. Question David is preoccupied with numerous bodily complaints even after a careful diagnostic workup reveals no physiologic problems. Which nursing intervention would be therapeutic for him? • A. Acknowledge that the complaints are real to the client, and refocus the client on other concerns and problems. • B. Challenge the physical complaints by confronting the client with the normal diagnostic findings. • C. Ignore the client's complaints, but request that the client keeps a list of all symptoms. • D. Listen to the client's complaints carefully, and question him about specific symptoms. Incorrect Correct Answer: A. Acknowledge that the complaints are real to the client, and refocus the client on other concerns and problems. After physical factors are ruled out, somatic complaints are thought to be expressions of anxiety. The complaints are real to the client, but the nurse should not focus on them. Prompting the client about other concerns will encourage the expression of anxiety and dependency needs. The nurse must help the client establish a daily routine that includes improved health behaviors. Provide accommodation for the client and make them more comfortable (ie., pillows, temperature, positioning, etc.). This can help the client feel accepted and develop rapport and trust. This can allow the client to feel more comfortable and express their feelings and emotions more readily to the healthcare team. • Option B: Clients may keep a detailed journal of their physical symptoms; the nurse might ask them to describe the situation at the time such as whether they were alone or with others, whether any disagreements were occurring, and so forth. Provide education about feared or actual medical conditions. This can help relieve acute pain and distress that the client may feel, but also helps them learn to control many symptoms through focus and calming the mind. • Option C: Encourage behavior modification such as praising the client and offering more attention when symptoms improve. Change the focus from what’s wrong to what’s right. Helps the client feel accomplished and more positive about improvements in health condition instead of focusing on the symptoms. Encourage the client to keep a journal of symptoms and the events or factors that lead up to the development of symptoms and their resolution. This is a technique of cognitive behavior therapy that helps the client understand what factors (usually stress) that prompt the onset of symptoms. It can also help the client determine a pattern of emotions surrounding the symptoms. • Option D: Discuss symptoms with the client and when they began, what makes them better or worse and how they have been managing these symptoms. Teach coping strategies. Emotion-focused strategies include progressive relaxation, deep breathing, guided imagery, and distractions such as music or other activities; problem-focused coping strategies include problem-solving methods, applying the process to identified problems, and role-playing interactions with others. 25. 25. Question Nurse Kenzo is teaching a client about sertraline (Zoloft), which has been prescribed for depression. A significant side effect is an interference with sexual arousal by inhibiting erectile function. How should Nurse Kenzo approach this topic? • A. Nurse Kenzo should avoid mentioning the sexual side effects to prevent the client from having anxiety about potential erectile problems. • B. Nurse Kenzo should advise the client to report any changes in sexual functioning in case medication adjustments are needed. • C. Nurse Kenzo should explain that the client's sexual desire will probably decrease while on this medication. • D. Nurse Kenzo should tell the client that sexual side effects are expected, but that they will decrease when his depression lifts. Incorrect Correct Answer: B. Nurse Kenzo should advise the client to report any changes in sexual functioning in case medication adjustments are needed. Clients commonly discontinue medications to avoid or correct sexual side effects, but they are less likely to do that when health professionals offer assistance with sexual issues. Generally, clients avoid discussing sexual issues unless health professionals give permission by raising the issue first. Sexual dysfunction is a common side effect of antidepressants and can have a significant impact on the person’s quality of life, relationships, mental health, and recovery. The reported incidence of sexual dysfunction associated with antidepressant medication varies considerably between studies, making it difficult to estimate the exact incidence or prevalence. • Option A: Overall, 73% of the SSRI-treated clients reported adverse sexual side effects; in contrast, to 14% of clients treated with bupropion. The three SSRIs, to an equal degree, significantly decreased libido, arousal, duration of orgasm, and intensity of orgasm below levels experienced pre-morbidly. In comparison, bupropion-treated clients reported significant increases in libido, level of arousal, intensity of orgasm, and duration of orgasm beyond levels experienced premorbidly. • Option C: The sexual problems reported range from decreased sexual desire, decreased sexual excitement, diminished or delayed orgasm, to erection or delayed ejaculation problems. There are a number of case reports of sexual side effects, such as priapism, painful ejaculation, penile anesthesia, loss of sensation in the vagina and nipples, persistent genital arousal, and nonpuerperal lactation in women. • Option D: Because most antidepressants modulate serotonin concentration, it is generally thought that elevated serotonin levels diminish sexual function. Serotonergic nerve terminals target dopamine and norepinephrine pathways in the brain and inhibit their activity, both of these neurotransmitters having a role in the desire and arousal phases of the sexual response cycle. 80% of serotonin is localized in the periphery, where when elevated, it directly reduces sensation in the anatomical structures of the reproductive system as well as diminishing erection, vaginal lubrication, ejaculation, and orgasm. 26. 26. Question Mental health is defined as: • A. The ability to distinguish what is real from what is not. • B. A state of well-being where a person can realize his own abilities can cope with normal stre