FNP Anxiety Management Practice Questions

A minimal change in the GAD-7 score after ten weeks at the maximum therapeutic dose indicates clear non-response. The most appropriate approach is to switch to a different medication class, such as a serotonin-norepinephrine reuptake inhibitor. Maintaining the dose is ineffective since the trial duration is already adequate. Adding a daily benzodiazepine is not recommended for long-term anxiety management due to tolerance and dependence risks. Exceeding the maximum recommended dose of sertraline increases the risk of adverse effects without offering proven clinical benefit.

The primary goal of CBT in PTSD is to reduce avoidance behaviors and improve daily functioning, rather than completely eliminating all anxiety. Driving on the highway demonstrates functional improvement and successful exposure. Option B is correct because she is functioning well despite experiencing mild anxiety. Option A is incorrect because eliminating all anxiety is an unrealistic therapeutic goal. Option C is contraindicated because benzodiazepines can interfere with fear extinction during trauma therapy. Option D is incorrect because an inpatient referral is an inappropriate level of care for mild, manageable residual symptoms.

In hospice care, mild sedation and a decreased respiratory rate are expected and acceptable side effects of morphine for dyspnea, provided the patient rouses easily. The plan of care is effective because his breathing is easier and he is comfortable. Decreasing the dose (B) risks returning his severe dyspnea. Administering naloxone (C) is contraindicated as it will precipitate withdrawal and severe distress. Switching to a benzodiazepine (D) is inappropriate because opioids remain the gold standard for dyspnea, and benzodiazepines do not treat the physiological sensation of breathlessness as effectively.

The final step of the SPIKES protocol is Strategy and Summary, which involves outlining a clear plan for the future to reduce patient anxiety and confusion. Option C effectively establishes a tangible next step for the patient. Option A reverts to the Perception step, which is used at the beginning of the encounter. Option B overwhelms the patient with excessive information; during the strategy phase, information should be given in manageable chunks rather than exhaustive lists. Option D reverts to the Invitation step, which should have been clarified before the diagnosis was delivered.

The USPSTF recommends against PSA-based screening for men 70 and older because the harms generally outweigh the benefits, especially for those with a limited life expectancy. Option C uses therapeutic communication to explain the guideline rationale regarding competing risks. Option A inappropriately orders a non-indicated test just to treat anxiety. Option B is incorrect as a digital rectal exam is not recommended for routine screening. Option D is an unnecessary referral that increases healthcare burden without clinical justification.

Eszopiclone is a nonbenzodiazepine hypnotic with a relatively long half-life. Patients must be instructed to dedicate at least seven to eight hours of sleep time to prevent severe next-day psychomotor impairment and memory issues. Taking the medication after a heavy dinner delays its absorption and onset. Limiting sleep to six hours exacerbates morning impairment. The medication is designed to treat, not cause, early morning awakenings.

An initial increase in anxiety and jitteriness is a common activation syndrome seen two weeks after starting an activating medication like fluoxetine. Because this is a known transient effect and full efficacy takes four to six weeks, providing reassurance and maintaining the current dose is the best approach. Increasing the dose would likely worsen the jitteriness. Stopping or switching the medication prematurely prevents an adequate therapeutic trial and misinterprets a common early side effect as a true treatment failure.

For patients with an intermediate 10-year risk (7.5% to 19.9%) who are uncertain about statin therapy, clinicians should assess for risk-enhancing factors. Chronic inflammatory conditions like rheumatoid arthritis significantly accelerate atherogenesis and favor statin initiation. Option B is incorrect because while migraines with aura have some cardiovascular associations, they are not formal ASCVD risk-enhancing factors in the current lipid guidelines. Options C and D are incorrect as asthma and anxiety do not independently enhance atherosclerotic risk or alter the primary prevention decision pathway.

At eight weeks, a drop from 16 to 12 indicates a partial response but the patient remains highly symptomatic. Because the patient tolerates the medication well, maximizing the current selective serotonin reuptake inhibitor dose is the preferred next step over switching or augmenting. Maintaining the current dose is incorrect because the patient has not reached remission after an adequate initial trial, so waiting longer without a change will likely leave them symptomatic. Switching to duloxetine or adding buspirone are secondary strategies reserved for when maximizing the primary agent fails or causes intolerable side effects.

It is highly common for patients with anorexia nervosa to experience a temporary increase in psychological distress, anxiety, and body image distortion as they begin to gain weight. The brain's cognitive recovery often lags behind physical weight restoration. Therefore, Option D is the best evaluation; the distress is an expected hurdle, not a sign that the nutritional plan is failing as suggested in Option B. Option A is incorrect because a 2-pound gain over a month is a safe, appropriate outpatient rate, not a massive fluid shift. Option C misinterprets eating disorder-related anxiety as psychosis.