A client with a history of generalized anxiety disorder enters the emergency department complaining of restlessness, irritability, and exhaustion. Vital signs are blood pressure 140/90 mm Hg, pulse 96, and respirations 20.
Based on this assessed information, which assumption would be correct?

The client is exhibiting signs and symptoms of an exacerbation of generalized anxiety disorder.

The client’s signs and symptoms are due to an underlying medical condition.

A physical examination is needed to determine the etiology of the client’s problem.

The client’s anxiolytic dosage needs to be increased.

Answer and Explanation

The Correct Answer is A

Generalized anxiety disorder is a chronic psychiatric condition marked by excessive, persistent worry that is difficult to control. It presents with restlessness, irritability, and fatigue, often accompanied by somatic symptoms like muscle tension, sleep disturbance, and autonomic hyperactivity. Diagnostic criteria require symptoms to persist for at least six months and cause functional impairment. Exacerbations may occur during stress or illness, and vital signs may show mild sympathetic activation without reaching pathological thresholds.

Rationale for correct answers

1. Exacerbation of generalized anxiety disorder is supported by the client’s history and current symptoms—restlessness, irritability, and exhaustion—along with mildly elevated vital signs consistent with sympathetic arousal.

Rationale for incorrect answers

2. No evidence of acute medical illness is present; symptoms align with psychiatric etiology rather than organic pathology.

3. While physical exams are routine, the client’s known diagnosis and symptom pattern already point to a psychiatric cause, making this less immediately relevant.

4. Dosage adjustment requires longitudinal assessment and evaluation of medication adherence, side effects, and therapeutic response—not assumed from a single ED visit.

Take Home Points

Generalized anxiety disorder presents with chronic worry, restlessness, irritability, and fatigue.
Mild sympathetic signs like elevated pulse and BP may occur during exacerbations.
Diagnosis is clinical, based on DSM-5 criteria and exclusion of medical causes.
Management includes psychotherapy and pharmacotherapy; dosage changes require careful evaluation.

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Correct Answer is B

Explanation

Benzodiazepinesare central nervous system depressants that enhance the effect of gamma-aminobutyric acid (GABA), producing sedative, anxiolytic, anticonvulsant, and muscle relaxant effects. They are indicated for short-termmanagement of anxiety, alcohol withdrawal, and procedural sedation. Long-term use is discouraged due to risks of dependence, tolerance, and cognitive impairment. Common side effects include drowsiness, confusion, and respiratory depression. Contraindications include sleep apnea, substance use disorders, and concurrent use with opioids or alcohol due to synergistic CNS depression.

Rationale for correct answers

2.Benzodiazepines are appropriate for short-term treatment of generalized anxiety disorder, alcohol withdrawal, and preoperative sedationdue to their rapid onset and calming effects. These uses align with their pharmacologic profile and safety guidelines for limited duration.

Rationale for incorrect answers

1.Long-term use for PTSD and convulsive disorders is discouraged due to risk of dependenceand tolerance. While benzodiazepines may be used acutely in alcohol withdrawal, chronic use is not recommended.

3.Benzodiazepines are not first-line for obsessive-compulsive disorder or essential hypertension. They may relieve muscle spasms but are not indicated for long-termmanagement of these conditions.

4.Long-term treatment of panic disorder and bipolar mania with benzodiazepines is not standard due to risk of addiction. Alcohol dependence requires structured withdrawal protocols, not maintenance benzodiazepine therapy.

Take Home Points

Benzodiazepines are best suited for short-term use in anxiety, alcohol withdrawal, and procedural sedation.
Long-term use increases risk of dependence, tolerance, and cognitive decline.
They are contraindicated in patients with substance use disorders or respiratory compromise.
SSRIs and other non-addictive agents are preferred for chronic anxiety and mood disorders.

A. Teach the client relaxation techniques. B. Ask the client, “Do you have a plan to commit suicide?” C. Call the physician to obtain a PRN order for an anxiolytic medication. D. Encourage the client to participate in group activities.

Correct Answer is B

Explanation

Suicidal ideationin the context of generalized anxiety disorder (GAD) is a psychiatric emergency requiring immediate risk assessment. GAD is characterized by excessive, persistent worry and physiological symptoms such as restlessness, fatigue, and sleep disturbance. When suicidal thoughts are present, especially with high anxiety and low mood ratings, the priority is to determine intent and plan. This guides the urgency of intervention and safety measures.

Rationale for correct answers

2.Suicide riskand intent assessmentmust be addressed first. Determining whether the client has a plan helps evaluate lethality and immediacy. This guides whether one-to-one observation, hospitalization, or other protective measures are needed.

Rationale for incorrect answers

1.Teaching relaxation techniques is inappropriatewhen suicide risk is active. It does not address the immediate safety concern and assumes the client is stable enough to engage in coping strategies.

3.Calling for a PRN anxiolytic may help reduce anxiety but does not address the suicidal ideation directly. Medication alone is insufficientwithout assessing intent and planning.

4.Encouraging group participation is a long-term therapeuticstrategy. It is not suitable during acute suicidal ideation and may overwhelm the client or increase distress.

Take Home Points

Suicide risk assessment begins with direct questioning about intent and plan.
Generalized anxiety disorder increases suicide risk, especially with comorbid depression.
Immediate safety interventions take precedence over therapeutic or pharmacologic measures.
Relaxation and group therapy are supportive but secondary to crisis evaluation.

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A client with a history of generalized anxiety disorder enters the emergency department complaining of restlessness, irritability, and exhaustion. Vital signs are blood pressure 140/90 mm Hg, pulse 96, and respirations 20. Based on this assessed information, which assumption would be correct?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

In which situation would benzodiazepines be prescribed appropriately?

Correct Answer is B

Explanation

During an intake assessment, a client diagnosed with generalized anxiety disorder rates mood at 3/10, rates anxiety at 8/10, and states, “I’m thinking about suicide.” Which nursing intervention takes priority?

Correct Answer is B

Explanation

A client with a history of generalized anxiety disorder enters the emergency department complaining of restlessness, irritability, and exhaustion. Vital signs are blood pressure 140/90 mm Hg, pulse 96, and respirations 20. Based on this assessed information, which assumption would be correct?

Which of the following symptom assessments would validate the diagnosis of generalized anxiety disorder? Select all that apply.

A nurse is admitting a client diagnosed with generalized anxiety disorder. During the client’s assessment, the nurse determines that which findings would be consistent with generalized anxiety disorder? Select all that apply.

A client recently diagnosed with generalized anxiety disorder is prescribed clonazepam (Klonopin), buspirone (BuSpar), and citalopram (Celexa). Which assessment related to the concurrent use of these medications is most important?

A nurse is caring for a client who has generalized anxiety disorder. Which statement about this client is true?

A client diagnosed with generalized anxiety disorder is getting ready for discharge. Which statement evaluates the client’s cognitive response to nursing interventions?

The nurse has received an evening report. Which client would the nurse need to assess first?

During an assessment, a client diagnosed with generalized anxiety disorder rates anxiety as 9/10 and states, “I have thought about suicide because nothing ever seems to work out for me.” Based on this information, which nursing diagnosis takes priority?

A client with a history of generalized anxiety disorder enters the emergency department complaining of restlessness, irritability, and exhaustion. Vital signs are blood pressure 140/90 mm Hg, pulse 96, and respirations 20.
Based on this assessed information, which assumption would be correct?