243 PrepU Ch. 27 Anxiety Disorders: Management of Anxiety and Panic

A nurse is conducting a seminar for a group of individuals at the community center about anxiety. The nurse determines that the seminar was successful based on which group statement?

"Anxiety cannot be completely eliminated from life."

The nurse is providing care for a psychiatric-mental health client who has a diagnosis of anxiety. Which statement by the nurse is likely the most therapeutic intervention?

"Anxiety is a feeling that is experienced by everyone at some point and it can never be completely removed from one's life."

A client with generalized anxiety disorder states that the client is worried about the client's job. The client never feels like the client has control over the client's responsibilities, even though the client puts in extra hours. The client adds that the client is afraid the client will be fired. Which response by the nurse is most therapeutic?

"Has something changed at work that is causing you to worry?"

Which question in the assessment of a client with anxiety is most clinically appropriate?

"How do you feel about everything that is happening in your life right now?"

A nurse is giving a presentation on mental health promotion to college students. One student asks the nurse to explain the difference between normal anxiety and an anxiety disorder. Which response is best?

"People with anxiety disorders generally find that the anxiety interferes with daily activities."

A 25-year-old pregnant mother of two children under age 6 is very protective and will not allow her children to play outdoors for fear of tick bites. She is worn out from cleaning the house from top to bottom every day. She asks the nurse how she can stop worrying so much. What is the most appropriate response for the nurse?

"Tell me your concerns about the children playing in your backyard."

The client has an order for an anxiolytic agent, lorazepam (Ativan). Which of the following statements by the client would indicate that client education about this medication has been effective?

"This medication will relax me so I can focus on problem solving."

A client is currently experiencing a panic attack. Which is the most appropriate response by the nurse?

"You are safe. Take a deep breath."

The nurse recognizes that which client is most likely experiencing generalized anxiety disorder (GAD)?

40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months

A client is currently experiencing panic. Which action would be most appropriate for the nurse to do?

Allow the client to pace

What part of the brain is thought to be involved in the production of anxiety as a result of the identification of incoming sensory information as threatening?

Amygdala

Panic disorder is treated with cognitive-behavioral techniques and deep breathing and relaxation, in addition to which of the following?

Antianxiety medications

Which medication classification has been found to be effective in reducing or eliminating panic attacks?

Antidepressants

When teaching a client with generalized anxiety disorder, which is the priority for the nurse to teach the client to avoid?

Caffeine

All of the following pharmacological agents are useful in treating anxiety disorders except which ones?

Calcium channel blockers

The nurse is educating a client and family about managing panic attacks after discharge from treatment. The nurse includes which in the discharge teaching? Select all that apply.

Continued practice of relaxation techniques Development of a regular exercise program Continued development of positive coping skills

A young parent tells the nurse, "I can't stop smoking. That is what I do to make myself feel better." What is the term used to describe this behavior?

Coping mechanism

The nurse documents that the client is in a state of panic anxiety when she is observed doing which of the following?

Crying hysterically and complaining of a shortness of breath prior to a cardiac procedure

The client has been defensive toward communication with the nurse today. Which can be a positive outcome of using defense mechanisms?

Defense mechanisms can help a person to reduce anxiety.

Which term describes feelings of being disconnected from oneself as seen in a panic attack?

Depersonalization

A client is experiencing a panic attack. Which term describes sensing that things are not real?

Derealization

When assessing an older adult client who has newly been diagnosed with an anxiety disorder, the mental health nurse's priority is to carry out which task?

Determine the client's risk for self-harm or harm to others

The nurse is conducting an admission assessment of a client who has a history of generalized anxiety disorder. After gauging the client's level of anxiety, what other assessment should the nurse prioritize?

Determining whether there is potential for the client to harm himself or herself or others

A nurse is assessing a client and determines that the client is experiencing severe anxiety based on which finding?

Distorted sensory awareness

A client states that the client has just had an argument with the client's spouse over the phone. What can the nurse expect that the client's sympathetic nervous system has stimulated the client's adrenal gland to release?

Epinephrine

Nursing interventions for physical stress related illness should include what?

Establishing daily routines of meals and sleeping

Which assessment question is most likely to allow the nurse to differentiate between anxiety disorder due to a general medical condition and psychological factors affecting a medical condition?

Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first

A nurse is assessing the vital signs of a client in the cardiac clinic. The nurse observes the client's blood pressure and heart rate are higher than what is normally expected for this client. The client tells the nurse, "I'm always so nervous when I come to the clinic." The nurse interprets the client's statement and vital signs as reflecting which situation?

Fight-or-flight response

A client asks how the client's prescribed alprazolam helps the client's anxiety disorder. The nurse explains while teaching the client about medications that antianxiety medications such as alprazolam affect the function of which neurotransmitter that is believed to be dysfunctional in anxiety disorders?

Gamma-aminobutyric acid (GABA)

The nurse plans to teach a client about dietary modifications to manage diabetes. Teaching would be most effective if the client displayed which characteristic?

Heightened focus

Concomitant use of antidepressants with monoamine oxidase inhibitors (MAOIs) can cause which life-threatening drug interaction?

Hypertensive crisis

A nurse is assessing a client and notes that the client is exhibiting affective mainfestations of anxiety. Which manifestation would the nurse most likely assess?

Irritability

An adolescent client reveals that she is about to take a math test from her tutor. Nursing assessment reveals mild anxiety. The nurse explains that this level of anxiety does what?

Is conducive to concentration and problem solving

A client diagnosed with panic disorder has been receiving medication therapy, which is being discontinued. A nurse would be alert for possible withdrawal symptoms if the client was receiving what?

Lorazepam

After teaching a client about possible side effects of benzodiazepines, the nurse determines that additional teaching is needed when the client identifies which of the following as a possible side effect of the drug?

Metallic taste

Anxiety has both healthy and harmful aspects depending on its degree and duration as well as on how well the person copes with it. Which level of anxiety helps the client focus attention to learn, problem solve, think, act, feel, and protect himself or herself?

Mild

A nurse seems nervous and distracted before giving a presentation. The nurse is watching the guest speaker and occasionally reviewing note cards. When the guest speaker asks a question of the group, the nurse answers correctly in a high-pitched voice. The nurse is most likely demonstrating which degree of anxiety?

Moderate

The nurse is teaching a class to a group of individuals diagnosed with anxiety disorders. When describing the underlying cause of these disorders, which information would the nurse most likely include?

Neurotransmitter involvement

Which are cognitive-behavioral therapy techniques that may be used effectively with anxious clients? Select all that apply.

Positive reframing Decatastrophizing Assertiveness training

A nursing instructor is describing the care of a client with acute anxiety to a class of nursing students. The instructor determines that more education is necessary when the students identify which intervention as appropriate?

Providing the client with a comforting touch

A nurse is working with a client who is learning to cope with anxiety and stress. What outcome does the nurse expect for the client?

Reactions to stressors will change

Relaxation techniques help clients with anxiety disorders because they can promote what?

Reduction of autonomic arousal

When developing a plan of care for a client diagnosed with panic disorder, which nursing diagnosis would be considered the priority?

Risk for Self-Directed Violence

A client arrives on the psychiatric unit exhibiting restlessness, disorientation, incoherent speech, agitation, purposeless physical activity, and suicidal ideations. Which of the following is the priority nursing diagnosis for this client?

Risk for injury

A nurse is providing care to a client with social anxiety disorder. Based on the nurse's understanding of pharmacotherapy, which medication would the nurse anticipate being used as part of the treatment plan?

Selective serotonin reuptake inhibitors (SSRIs)

Which medication classification has most commonly been used to treat social phobia?

Selective serotonin reuptake inhibitors (SSRIs)

According to psychodynamic theorists, anxiety develops from which of the following?

Separation and loss

After reviewing various etiologic theories associated with panic disorder, the nurse demonstrates understanding of the psychodynamic theory, identifying which as the underlying cause?

Separation or loss

The nurse enters the client's room and finds the client anxiously pacing the floor. The client begins shouting at the nurse, "Get out of my room!" The best intervention by the nurse would be to

Stand at the doorway and say, "You seem upset."

The nurse knows that which statement is true about stress and anxiety?

Stress is the wear and tear that life causes on the body.

A client experiences panic attacks when confronted with riding in elevators. The therapist is teaching the client ways to relax while incrementally exposing the client to getting on an elevator. This technique is called what?

Systematic desensitization

A nurse is seeing a client prior to discharge after being admitted to hospital for suicidal ideation. As the nurse begins the discharge process, the client closes the eyes and begins rapid, shallow breathing. The client also begins to shake and perspire profusely. Which actions should the nurse take? Select all that apply.

Talk to the client in a comforting manner. Take the client to a quiet space. Reassure the client of being safe.

A group of nursing students are reviewing signs and symptoms of anxiety. The students demonstrate a need for additional review when they identify what?

Tearfulness

A client reports experiencing increased stress at work. The client has been managing the stress by drinking 2 or 3 glasses of wine per evening. Despite the nurse recommending that drinking alcohol is not an effective way to manage the stress, the client feels it will be difficult to stop drinking. Which statement explains why this will be difficult for the client?

The client has insufficient adaptive coping mechanisms.

A nurse assesses a client and determines that the client is experiencing mild anxiety based on what?

The client is aware and alert

The nurse can be confident that the client diagnosed with an anxiety disorder will respond well to treatment when which of the following situations or conditions are present?

The client states, "I understand my symptoms and what I need to do to help myself, and I'm ready to do it so I'm back to normal."

The nursing student understands correctly when identifying which objective is appropriate for all clients with anxiety disorders?

The client will experience reduced anxiety and develop alternative responses to anxiety-provoking situations.

A psychaitric-mental health nurse is preparing a presentation for a group of colleagues on anxiety disorders. As part of the presentation the nurse plans to discuss the concept of interoceptive conditioning. Which information would the nurse most likely include in this discussion?

There is an association between physical symptoms and a panic attack.

Which of the following is inconsistent with panic-level anxiety?

This level of anxiety can be sustained indefinitely.

Why must nurses understand why anxiety occurs and how anxiety behaviors work? Select all that apply.

To help nurses to function at a high level To provide better care for the client To help understand the role anxiety plays in performing nursing responsibilities

A client states, "I will just die if I don't get this job." The nurse then asks the client, "What will be the worst that will happen if you don't get the job?" Why does the nurse ask this question?

To help the client appraise their situation more realistically

Which would not be an initial intervention for the client with acute anxiety?

Touching the client in an attempt to comfort the client

A nurse is preparing a plan of care for a client with anxiety. Which elements would the nurse likely include? Select all that apply.

Using appropriate coping skills Identifying treatment modalities Involving family for support, if appropriate Providing supportive feedback

Which statement about the assessment of persons with anxiety and anxiety disorders is most accurate?

When an older adult experiences anxiety for the first time in his or her life, the anxiety may be associated with another condition.

Which nursing assessment is most appropriate for an older client presenting with reports of generalized anxiety?

assess for depression

Which nursing intervention is focused on the primary goal of anxiety management and treatment?

assessing the client's ability to implement stress management techniques effectively

A nurse is seeing a client who is having severe to panic level anxiety after a physical assault months previously. The client tells the nurse, "When the panic starts I feel like I am watching myself through a window." The nurse can most accurately describe this experience as:

depersonalization.

During which type of anxiety does a person's perceptual field actually increase?

mild

A nurse detects that a client is experiencing panic-level anxiety. Which intervention should be immediately implemented?

provide calm, brief, directive communication

A school health nurse is meeting with the parents of a 6-year-old child who has been selectively mute. The nurse is offering the parents education regarding this problem. The nurse can tell the parents that what is true about selective mutism?

selective mutism is associated with social anxiety