Psychiatric Medications Q 11
One morning, nurse Diane finds a disturbed client curled up in the fetal position in the corner of the dayroom. The most accurate initial evaluation of the behavior would be that the client is:
A. Physically ill and experiencing abdominal discomfort.
B. Tired and probably did not sleep well last night.
C. Attempting to hide from the nurse.
D. Feeling more anxious today.
Correct Answer: D. Feeling more anxious today
The fetal position represents regressed behavior. Regression is a way of responding to overwhelming anxiety. Validate observations by asking the patient, “Are you feeling anxious now?” Anxiety is a highly individualized, normal physical and psychological response to internal or external life events.
Option A: Assess physical reactions to anxiety. Anxiety also plays a role in somatoform disorders, which are characterized by physical symptoms such as pain, nausea, weakness, or dizziness that have no apparent physical cause. Recognize awareness of the patient’s anxiety. Since a cause of anxiety cannot always be identified, the patient may feel as though the feelings being experienced are counterfeit. Acknowledgment of the patient’s feelings validates the feelings and communicates acceptance of those feelings.
Option B: Use presence, touch (with permission), verbalization, and demeanor to remind patients that they are not alone and to encourage expression or clarification of needs, concerns, unknowns, and questions. Being supportive and approachable promotes communication. Consider the patient’s use of coping strategies that the patient has found effective in the past. This enhances the patient’s sense of personal mastery and confidence.
Option C: Observe how the patient uses coping techniques and defense mechanisms to cope with anxiety. Asking questions requiring informative answers helps identify the effectiveness of coping strategies currently used by the patient. This approach may help the patient feel like he or she is contributing to patient care. Coping strategies may include reading, journaling, or physical activity such as taking a walk. Defense mechanisms are used by people to preserve the ego and manage anxiety. Some defense mechanisms are highly adaptive in managing anxiety, such as humor, sublimation, or suppression. Other defense mechanisms may lead to less adaptive behavior, especially with long-term use. These defense mechanisms include displacement, repression, denial, projection, and self-image splitting.