# An adult client newly diagnosed with generalized anxiety disorder is seen in a primary care clinic for initial treatment planning. The client reports persistent worry, muscle tension, and trouble falling asleep for the past several months, drinks coffee each morning, and has just been prescribed sertraline daily with lorazepam available for occasional severe anxiety episodes. The nurse is teaching the client about managing symptoms while the SSRI reaches full effect. Which instructions should the nurse include in this teaching? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=558434&lang=en > language: en > subject: Crisis Intervention > category: PSI ## Question An adult client newly diagnosed with generalized anxiety disorder is seen in a primary care clinic for initial treatment planning. The client reports persistent worry, muscle tension, and trouble falling asleep for the past several months, drinks coffee each morning, and has just been prescribed sertraline daily with lorazepam available for occasional severe anxiety episodes. The nurse is teaching the client about managing symptoms while the SSRI reaches full effect. Which instructions should the nurse include in this teaching? Select all that apply. 1 Advise the client to take the prescribed lorazepam every evening to prevent nighttime worry. 2 Encourage the client to begin structured cognitive behavioral therapy sessions along with medication management. 3 Explain that the prescribed sertraline may take several weeks before anxiety symptoms clearly improve. 4 Recommend establishing a regular exercise routine, such as brisk walking, several times each week. 5 Suggest increasing morning coffee intake to help offset medication-related drowsiness during the day. 6 Instruct the client to stop the sertraline independently if mild nausea occurs this week. ## Explanation Initial management of generalized anxiety disorder typically combines pharmacologic and nonpharmacologic strategies while accounting for medication onset and safe use of adjunct agents. Teaching should reinforce that the prescribed SSRI needs several weeks before its full benefit appears, that structured psychotherapy such as cognitive behavioral therapy strengthens coping skills during that period, and that a regular exercise routine offers additional symptom relief without added risk. Actions that turn an as-needed anxiolytic into routine nightly use, encourage stimulant intake that can heighten anxious arousal, or advise stopping a newly started antidepressant for an expected early side effect fall outside safe, evidence-based initial teaching and require provider input or further assessment before acting. ## In-depth explanation Correct Answer Choices 2, 3, 4 Clinical Reasoning Initial management of generalized anxiety disorder typically combines pharmacologic and nonpharmacologic strategies while accounting for medication onset and safe use of adjunct agents. Teaching should reinforce that the prescribed SSRI needs several weeks before its full benefit appears, that structured psychotherapy such as cognitive behavioral therapy strengthens coping skills during that period, and that a regular exercise routine offers additional symptom relief without added risk. Actions that turn an as-needed anxiolytic into routine nightly use, encourage stimulant intake that can heighten anxious arousal, or advise stopping a newly started antidepressant for an expected early side effect fall outside safe, evidence-based initial teaching and require provider input or further assessment before acting. Option Review - Incorrect — Lorazepam is prescribed only for occasional severe anxiety episodes, so instructing nightly use exceeds the current order and risks tolerance rather than addressing the underlying disorder. - Correct — Cognitive behavioral therapy combined with medication is a first-line approach for generalized anxiety disorder because it helps the client restructure worry patterns while the SSRI takes effect. - Correct — Explaining that sertraline requires several weeks to reach full therapeutic effect helps the client maintain realistic expectations and continue the medication despite delayed symptom relief. - Correct — Regular aerobic exercise such as brisk walking is a supportive nonpharmacologic strategy that can reduce anxiety symptoms and complements the medication and therapy plan. - Incorrect — Increasing caffeine intake can worsen anxiety symptoms such as restlessness and sleep disturbance, making this suggestion inappropriate for a client beginning anxiety treatment. - Incorrect — Advising the client to discontinue sertraline independently for mild early nausea is outside the nurse's role and could interrupt necessary treatment before the provider evaluates the symptom. Sources 12026 NCLEX-RN Test Plan 2NIMH: Generalized Anxiety Disorder ## Clinical scenario An adult newly diagnosed with generalized anxiety disorder starts daily sertraline and receives as-needed lorazepam for severe anxiety episodes, reporting persistent worry, muscle tension, and poor sleep. ## Related questions - [A nurse is admitting a 32-year-old client to an inpatient mental health unit with a diagno…](https://mymerci.kr/pages/nclex_q.php?qn_id=360525&lang=en) - [A 28-year-old client with schizophrenia is admitted to the inpatient psychiatric unit. 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