Social anxiety disorder (ie, social pho-
bia) 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
The nurse is evaluating the plan of care
they experience.
for a client diagnosed with social anx-
iety disorder who has a fear of eating
Treatment of social phobias may include
and drinking in public. Which of the fol-
medication (eg, selective serotonin re-
lowing client statements demonstrate an
uptake inhibitors, benzodiazepines) and
improvement in coping? Select all that
psychotherapy (eg, cognitive-behavioral
apply.
therapy, systematic desensitization) to
assist in developing effective coping
A. "I plan dates involving outdoor activi-
strategies. As part of systematic desensi-
ties, such as hiking, instead of going to
tization, the client is gradually exposed to
dinner and a movie."
the phobic trigger, which in turn decreas-
B. "I sat in the pizza shop and drank a
es anxiety.
cola while watching people eat and then
bought a slice to go."
Effective coping with social phobia is
C. "I started having lunch with my
demonstrated by:
coworkers even though I still become
· Experiencing increased comfort while
very anxious eating in public."
engaging in phobic situations (eg, drink-
D. "I went out of town on the day of the
ing a cola while watching people eat).
company picnic instead of making ex-
· Developing insight and verbalizing feel-
cuses for not eating."
ings about the irrational fear.
· Distracting oneself by focusing on
something other than the phobic situa-
tion (eg, preparing for a meeting while
drinking a latte).
Incorrect Answers
[A. "I plan dates involving outdoor activ-
ities, such as hiking, instead of going to
dinner and a movie."] Avoiding phobic sit-
, NCLEX PN Mental Health
uations (eg, planning activities unrelated
to food, going out of town) reinforces mal-
adaptive 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 excus-
es for not eating."] Avoiding phobic situa-
tions (eg, planning activities unrelated to
food, going out of town) reinforces mal-
E. "I went to a coffee house with my adaptive coping and prevents the client
boss and focused on an upcoming pro- from working through the fear.
ject while drinking a latte."
Educational objective:Social anxiety dis-
order (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 verbaliz-
ing feelings about the phobia, and dis-
tracting oneself during the phobic situa-
tion.
, NCLEX PN Mental Health
Correct Answer: D. "Why did you get so
angry when she ignored you?"
Therapeutic communication allows the
nurse to develop a healthy interpersonal
relationship with the client. A "why" ques-
tion is often avoided as it is viewed nega-
tively by clients and can make them feel
defensive about their choices or emo-
tions.
Incorrect Answers:
[A. "I don't understand what you mean.
Which statement made by the nurse dur-
Can you give me an example?] Asking
ing a therapy session demonstrates a
for an example is asking for clarification
need for further instruction regarding ef-
and is considered a therapeutic commu-
fective therapeutic communication tech-
nication technique.
niques?
[B. "It is doubtful the president is out to
A. "I don't understand what you mean.
get you."] Voicing doubt is a therapeu-
Can you give me an example?
tic communication technique that allows
B. "It is doubtful the president is out to get
the nurse to dispel misconceptions or
you."
delusions without directly confronting the
C. "Tell me more about the day your child
client's beliefs.
died."
D. "Why did you get so angry when she
[C. "Tell me more about the day your child
ignored you?"
died."] Exploring is a therapeutic com-
munication technique that encourages
the client to discuss relevant situations
and feelings. If the client chooses not to
share information, the nurse should re-
spect that decision and not probe further.
Educational objective:For people who
are anxious or overwhelmed, a "why"
question asked by the nurse is often in-
terpreted as being critical, judgmental,
and intrusive. These feelings are damag-
ing to the development of the nurse-client
, NCLEX PN Mental Health
relationship and therapeutic communica-
tion.
Correct Answer: C. "You could not have
anticipated the rape. You did not deserve
or ask for it."
One of the common features of PTSD is
a persistent distorted perception about
the cause of the traumatic event that
leads the affected individuals to blame
themselves or others. Clients may be in
a persistent, negative emotional state of
guilt and/or shame and also believe that
A female client who was the victim of
they are responsible for what happened.
acquaintance rape 2 months ago is re-
This is particularly true in cases of rape.
ceiving therapy for posttraumatic stress
A pervasive culture of "blaming the rape
disorder (PTSD). She says to the nurse,
victim" also contributes to clients' per-
"It's all my fault. I should have known not
ception that the rape was somehow their
to accept a drink from someone I just met
own fault.
in a bar." What is the best response by
the nurse?
Providing a realistic perspective of the
rape may help clients develop a more ob-
jective view of their perceived role in the
traumatic event and may reduce feelings
of self-blame and guilt. The nurse needs
to reinforce repeatedly that rape is never
the victim's fault.
Incorrect Answers:
[A. "It may take time to overcome those
thoughts and feelings."] This is a non-
therapeutic response as it reinforces the
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