A client diagnosed with generalized anxiety disorder (GAD) is started on buspirone. Which statement made by the client indicates teaching has been effective? The client verbalizes that:

Clonazepam is to be used for long-term therapy in conjunction with buspirone.

Clonazepam is to be used short-term until the buspirone takes full effect.

Buspirone should be taken as needed until clonazepam takes full effect.

Tolerance could result with long-term use of buspirone.

Answer and Explanation

The Correct Answer is B

Choice A Reason:

Clonazepam is to be used for long-term therapy in conjunction with buspirone.

This statement is incorrect. Clonazepam, a benzodiazepine, is typically used for short-term relief of anxiety symptoms due to its potential for dependence and tolerance1. Long-term use of benzodiazepines is generally avoided in favor of medications like buspirone, which do not carry the same risks of dependence.

Choice B Reason:

Clonazepam is to be used short-term until the buspirone takes full effect.

This is the correct response. Buspirone takes several weeks to achieve its full therapeutic effect. During this period, clonazepam may be used to manage acute anxiety symptoms. Once buspirone reaches its full effect, clonazepam can be tapered off to avoid long-term use and potential dependence.

Choice C Reason:

Buspirone should be taken as needed until clonazepam takes full effect.

This statement is incorrect. Buspirone is not intended for as-needed use; it must be taken consistently to maintain stable blood levels and achieve its therapeutic effect. Clonazepam, on the other hand, is used for short-term relief and should not be relied upon for long-term management of anxiety.

Choice D Reason:

Tolerance could result with long-term use of buspirone.

This statement is incorrect. Unlike benzodiazepines, buspirone does not typically cause tolerance or dependence with long-term use. It is considered a safer option for chronic management of anxiety disorders.

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Correct Answer is ["A","B"]

Explanation

The correct answer is a, b.

Choice A Reason:

The statement “Organize clinical observations” is correct. One of the primary functions of the Mental Status Exam (MSE) is to systematically organize clinical observations. This includes assessing the client’s appearance, behavior, mood, and cognitive functions. By organizing these observations, healthcare providers can create a comprehensive picture of the client’s current mental state, which is crucial for diagnosis and treatment planning.

Choice B Reason:

The statement “Obtain information about the client’s medical history” is correct. The MSE often involves gathering detailed information about the client’s medical history, including past mental health issues, treatments, and any relevant medical conditions. This information helps in understanding the client’s baseline mental status and identifying any changes or abnormalities. It also aids in creating an effective treatment plan tailored to the client’s specific needs.

Choice C Reason:

The statement “Establish limit setting” is incorrect. While limit setting is an important aspect of managing certain mental health conditions, it is not a primary function of the MSE. Limit setting typically involves establishing boundaries and rules to manage behaviors, which is more relevant in therapeutic settings rather than during the assessment phase. The MSE focuses on evaluating the client’s current mental state rather than setting behavioral limits.

Choice D Reason:

The statement “Determine the client’s IQ” is incorrect. The MSE is not designed to measure a client’s intelligence quotient (IQ)4. Instead, it assesses cognitive functions such as memory, attention, and orientation. IQ tests are specialized assessments that require specific tools and are conducted separately from the MSE. The MSE provides a general overview of cognitive functioning but does not quantify intelligence.

A. Ask open-ended questions. B. Focus on what is happening in the here and now. C. Assume knowledge of what is meant when the client talks about “they.” D. Limit contact to one or two short interactions daily.

Correct Answer is B

Explanation

Choice A Reason:

Ask open-ended questions.

While asking open-ended questions can be useful in many therapeutic settings, it may not be the best approach when dealing with delusional clients. Open-ended questions can sometimes lead to more elaborate delusional thinking and may not help in grounding the client in reality. Instead, focusing on the present moment and concrete reality can be more effective in managing delusions.

Choice B Reason:

Focus on what is happening in the here and now.

This is the correct response. Focusing on the present moment helps to ground the client in reality and can reduce the intensity of delusional thoughts. By directing the client’s attention to their immediate environment and current activities, the nurse can help the client stay connected to reality and reduce the impact of their delusions.

Choice C Reason:

Assume knowledge of what is meant when the client talks about “they.”

Assuming knowledge of what the client means when they refer to “they” can reinforce delusional thinking. It is important for the nurse to clarify and understand the client’s perspective without validating the delusion. This approach helps maintain a therapeutic relationship while not reinforcing false beliefs.

Choice D Reason:

Limit contact to one or two short interactions daily.

Limiting contact to one or two short interactions daily is not an effective strategy for managing delusions. Clients with delusions often need consistent and supportive interactions to help them stay grounded in reality. Frequent, brief interactions can provide the necessary support and reassurance without overwhelming the client.

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A client diagnosed with generalized anxiety disorder (GAD) is started on buspirone. Which statement made by the client indicates teaching has been effective? The client verbalizes that:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse recognizes that a function of the Mental Status Exam is to:

Correct Answer is ["A","B"]

Explanation

Which of the following nursing strategies would be most appropriate when caring for an individual who is delusional?

Correct Answer is B

Explanation

A nurse is assessing a client who is disoriented to time and place. What additional findings would support a diagnosis of delirium? (Select all that apply.)

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