Anxiety Disorders ::: PSYCH Test 1
A patient with anxiety disorder has excessive anxiety and worries about multiple life circumstances. For how long would this patient experience these feelings before the anxiety disorder would be considered chronic and generalized? 2 months 4 months 6 months 12 months
6 months Explanation: For generalized anxiety disorder, the diagnostic criteria listed include unrealistic or excessive anxiety and worry about two or more life circumstances for 6 months or more, during which time these concerns exist for a majority of days.
Which client would not be able to undergo a magnetic resonance imaging scan (MRI)? A client with a diagnosed anxiety disorder A client with a pacemaker A client who is obese A client with a longstanding history of claustrophobia
A client with a pacemaker Explanation: Clients with pacemakers or metal implants, such as heart valves or orthopedic devices, cannot undergo an MRI. There are not contraindications for obese clients can to undergo an MRI. Clients who are claustrophobic or those with anxiety can have an MRI but may need special intervention such as sedation.
Clients taking benzodiazepines, especially older adult clients, are at high risk for which effect?
Falls
Clients taking benzodiazepines, especially older adult clients, are at high risk for which effect? -Heart failure -Falls -Hepatic failure -Constipation
Falls Explanation: Clients taking benzodiazepines, especially older adult clients, are at high risk for falls and should be counseled on fall prevention measures. Constipation can occur at any time in an older adult due to the lack of fluid or fiber intake. Benzodiazepine use does not indicate high risk for heart failure or hepatic failure.
A client is prescribed an anxiolytic agent. What would be most important for the nurse to include in the teaching? "Increase the amount of fiber in your diet." "Be sure not to stop the drug abruptly." "Try other measures to help you relax, too." "Take the drug with meals if necessary."
"Be sure not to stop the drug abruptly." Explanation: Although taking the drug with meals, increasing fiber intake (to prevent constipation), and using additional measures to promote relaxation would be helpful instructions, it would be most important for the nurse to warn the client not to stop the drug abruptly. There is a risk for withdrawal if anxiolytics, both benzodiazepines and barbiturates, are stopped abruptly.
A female client is prescribed a benzodiazepine for anxiety. She asks the nurse if she can stop the drug when she feels better. What is the nurse's best response? -"Benzodiazepines may cause physiologic dependence, and withdrawal symptoms will occur if the drug is stopped abruptly." -"Benzodiazepines may cause physiologic dependence, and withdrawal symptoms will occur if the drug's dosages are tapered." -"Benzodiazepines do not cause physiologic dependence, and withdrawal symptoms will not occur if the drug is stopped abruptly." -"Benzodiazepines may cause physiologic dependence, but withdrawal symptoms will not occur if the drug is stopped abruptly."
"Benzodiazepines may cause physiologic dependence, and withdrawal symptoms will occur if the drug is stopped abruptly." Explanation: Benzodiazepines are widely used for anxiety and insomnia and are also used for several other indications. They have a wide margin of safety between therapeutic and toxic doses and are rarely fatal, even in overdose, unless combined with other CNS depressant drugs, such as alcohol. They are schedule IV drugs under the Controlled Substances Act. They are drugs of abuse and may cause physiologic dependence; therefore, withdrawal symptoms occur if the drugs are stopped abruptly.
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?" -"It sounds to me like you're doing a good job." -"Your worries are a feature of your anxiety disorder. Tell yourself that you have nothing to worry about." -"Why do you think you'll be fired?"
"Has something changed at work that is causing you to worry?" Explanation: The nurse begins an assessment by simply asking the client if he or she is currently feeling anxious or worried or has experienced these feelings recently. The nurse also asks the client about obsessive thinking patterns, worrying, compulsions and repetitive activity, specific phobias, and exposure to traumatic events. Once the nurse has determined that signs and symptoms of anxiety do exist, the nurse assesses the possible underlying causes and inquires about family history, recent life events, current stress level, personal history of anxiety, medical and medication history, history of substance abuse, and other possible causes of the anxiety.
The nurse is caring for a client that begins crying uncontrollably and states, "I am so scared to be here, what if I die?" Which is the best response by the nurse? -"You don't have to worry, we will take good care of you." -"Let's perform some breathing exercises to reduce your anxiety." -"You are getting worked up over something you have no control over." -"Why are you having so much stress about being here."
"Let's perform some breathing exercises to reduce your anxiety." Explanation: The most therapeutic response that the nurse can give to reduce the client's obvious level of stress is to help with breathing exercises and teach the client how to perform them when a stressful situation occurs. Asking the question why is not therapeutic and will not add any data to the outcome. Giving false reassurance is a nontherapeutic response.
A 70-year-old male client asks why he is receiving a lower dose of zaleplon than his son. As part of the nurse's teaching plan, which explanation will the nurse give this client? -"Older adults metabolize the drug at the same speed as younger adults; I will check the dosage with your health care provider." -"Older adults metabolize the drug more quickly, but due to renal dysfunction, the medication must be reduced." -"Older adults do not need as much of the medication for the desired effect as a younger adult does." -"Older adults metabolize the drug more slowly, and half-lives are longer than in younger adults."
"Older adults metabolize the drug more slowly, and half-lives are longer than in younger adults." Explanation: In older adults, most non-benzodiazepines are metabolized more slowly, and half-lives are longer than in younger adults. Exceptions are lorazepam and oxazepam, whose half-lives and dosages are the same for older adults as for younger ones. The recommended initial dose of zaleplon or zolpidem is 5 mg, one half of the initial dose recommended for younger adults. Dosages of eszopiclone should also be reduced for older adults, beginning with 1 mg initially, not to exceed 2 mg at bedtime.
A client comes to the emergency department because they think they are having a heart attack. Further assessment determines that the client is not having a heart attack but is having a panic attack. When beginning to interview the client, which question would be most appropriate for a nurse to ask? -"What did you experience just before and during the attack?" -"Are you feeling much better now that you are lying down?" -"What do you think caused you to feel this way?" -"Do you think you will be able to drive home?"
"What did you experience just before and during the attack?"
A client comes to the emergency department because they think they are having a heart attack. Further assessment determines that the client is not having a heart attack but is having a panic attack. When beginning to interview the client, which question would be most appropriate for a nurse to ask? -"What did you experience just before and during the attack?" -"Are you feeling much better now that you are lying down?" -"Do you think you will be able to drive home?" -"What do you think caused you to feel this way?"
"What did you experience just before and during the attack?" Explanation: After it has been determined that the client does not have other medical problems, the nurse should assess for the characteristic symptoms of panic attack, focusing the questions on what the client was experiencing just before and during the attack. Asking the client if they feel better provides no information for the nurse and lying down may or may not be effective. Asking the client if they think they can drive home is a question that can be asked much later in the interview, after the attack subsides and the client is stable. Asking the client about what caused the attack is inappropriate because numerous stimuli, both external and internal, can provoke an attack. Most clients will not be able to identify a specific cause. The focus of care is on the characteristics of the attack.
An older adult reporting concerns of anxiety is prescribed diazepam (Valium) by a health care provider. The provider asks the office nurse to explain the problematic side effects of this medication to the client. Which instruction is most important for the nurse to emphasize about this drug? -"You may experience minor urine incontinence from time to time." -"You need to use this medication cautiously because it can cause dependence." -"You may find that you have temporary memory disturbances." -"You may feel dizzy and be prone to falls after taking this medication."
"You may feel dizzy and be prone to falls after taking this medication." Explanation: Diazepam (Valium) is a benzodiazepine and may cause incontinence, memory disturbances, and dizziness in older adults. However, the risk for falls because of dizziness is a major concern, and this information needs to be emphasized with the client.
Anxiolytic drugs can be used in the management of which conditions? (Select all that apply.) Alcohol withdrawal Seizures Diabetic neuropathy Hypertension Panic attacks
Alcohol withdrawal Seizures Panic attacks Anxiolytic drugs can be used in the management of anxiety disorder, panic attacks, pre-anesthetic sedation, muscle relaxation, convulsions, seizures, and alcohol withdrawal.
A client has sought treatment because of the overwhelming anxiety the client experiences regarding the safety of the client's young children. The client admits that the client will not normally let the client's children leave the client's sight for fear that they will be abducted, abused, or injured. The client is unable to function at work as a result of this anxiety. The nurse would recognize that this client experiences which condition? Fear Signal anxiety Derealization Anticipatory anxiety
Anticipatory anxiety Explanation: Anticipatory anxiety exists in the context of phobia. People with phobias develop anticipatory anxiety even when thinking about possibly encountering the dreaded phobic situation (i.e., danger to the client's children). The anticipatory anxiety in this case is so severe that the client is unable to function in certain situations leading to hardship. Signal anxiety refers to the natural anxiety mechanism that communicates danger or motivation for needed change. Fear refers to feeling afraid or threatened by a clearly identifiable external stimulus that presents a danger to a person. Derealization refers to a stage in the experience of anxiety when a person senses that things are not real.
Which medication classification has been found to be effective in reducing or eliminating panic attacks? Antimanics Anticholinergics Antipsychotics Antidepressants
Antidepressants Explanation: Tricyclic and monoamine oxidase inhibitor antidepressants have been found to be effective in treating clients with panic attacks. Why these drugs help control panic attacks is not clearly understood. Anticholinergic agents, which are smooth-muscle relaxants, relieve physical symptoms of anxiety but do not relieve the anxiety itself. Antipsychotic drugs are inappropriate because clients who experience panic attacks are not psychotic. Mood stabilizers are not indicated because panic attacks are rarely associated with mood changes.
Which medication classification has been found to be effective in reducing or eliminating panic attacks? Antipsychotics Antidepressants Anticholinergics Antimanics
Antidepressants Explanation: Tricyclic and monoamine oxidase inhibitor antidepressants have been found to be effective in treating clients with panic attacks. Why these drugs help control panic attacks is not clearly understood. Anticholinergic agents, which are smooth-muscle relaxants, relieve physical symptoms of anxiety but do not relieve the anxiety itself. Antipsychotic drugs are inappropriate because clients who experience panic attacks are not psychotic. Mood stabilizers are not indicated because panic attacks are rarely associated with mood changes.
Which drug used to treat anxiety would be appropriate for a client who is a school teacher and is concerned about feeling sedated at work? Alprazolam Buspirone Lorazepam Diazepam
Buspirone Explanation: Buspirone does not cause as much sedation and functional impairment as lorazepam, alprazolam, and diazepam. However, it can cause dizziness, nausea, headache, nervousness, lightheadedness, or excitement.
A client with a high-pressure job temporarily requires an anxiolytic that has no sedative properties. What medication is most likely to meet this client's needs? Zaleplon Buspirone Diphenhydramine Meprobamate
Buspirone Explanation: Buspirone has no sedative, anticonvulsant, or muscle relaxant properties, but it does reduce the signs and symptoms of anxiety. Zaleplon causes sedation and is used for short-term treatment of insomnia. Meprobamate has some anticonvulsant properties and central nervous system relaxing effects. Diphenhydramine is an antihistamine that can be sedating.
Which agent has no sedative, anticonvulsant, or muscle relaxant properties but does reduce the signs and symptoms of anxiety? Buspirone Meprobamate Zaleplon Diphenhydramine
Buspirone Explanation: Buspirone has no sedative, anticonvulsant, or muscle relaxant properties, but it does reduce the signs and symptoms of anxiety. Diphenhydramine is an antihistamine that can be sedating. Zaleplon causes sedation and is used for short-term treatment of insomnia. Meprobamate has some anticonvulsant properties and CNS-relaxing effects.
Which medication classifications used in the treatment of panic disorder can cause physical dependence? -Tricyclic antidepressants (TCAs) -Selective serotonin reuptake inhibitors (SSRIs) -Serotonin-norepinephrine reuptake inhibitors (SNRIs) -Benzodiazepines
Benzodiazepines
Clients taking benzodiazepines need education about what? Interactions with monoamine oxidase inhibitors (MAOIs) Avoiding cheeses and smoked meats Concomitant use of alcohol Avoiding spending too much time in the sun
Concomitant use of alcohol Explanation: Benzodiazepines have long been the drugs of choice for treatment of anxiety disorders. They can induce a physical dependence and can induce severe withdrawal symptoms and intense rebound anxiety when discontinued abruptly. They potentiate the effects of alcohol and other sedative hypnotics, are commonly abused, and have several significant side effects. The most common adverse effects are sedation, ataxia, loss of coordination, slurred speech, memory impairment, paradoxical agitation, and dizziness. They also cause psychomotor impairment.
A client comes in for a therapy session and begins to have a panic attack. The therapist asks the client to relax in the chair and then gently asks the client to imagine the client in a very safe and calm place. This technique, often useful in anxiety disorders, is called what? -Desensitization -Deep breathing -Problem-solving -Cognitive therapy
Deep breathing Explanation: Helping the client focus on deep breathing can decrease the hyperarousal involved in panic attacks. It is also an opportunity for the therapist to teach the client self-help and adaptive coping mechanisms for panic attacks.
A client comes in for a therapy session and begins to have a panic attack. The therapist asks the client to relax in the chair and then gently asks the client to imagine the client in a very safe and calm place. This technique, often useful in anxiety disorders, is called what? Desensitization Deep breathing Problem-solving Cognitive therapy
Deep breathing Explanation: Helping the client focus on deep breathing can decrease the hyperarousal involved in panic attacks. It is also an opportunity for the therapist to teach the client self-help and adaptive coping mechanisms for panic attacks.
Which term describes feelings of being disconnected from oneself as seen in a panic attack? Agoraphobia Depersonalization Automatisms Derealization
Depersonalization Explanation: Depersonalization describes feelings of being disconnected from oneself as seen in a panic attack. Derealization is sensing that things are not real. Automatisms are automatic, unconscious mannerisms. Agoraphobia is a fear of being outside.
A nurse is assessing a client and determines that the client is experiencing severe anxiety based on which finding? A heightened sense of awareness Eagerness for more information Distorted sensory awareness Goal directed behavior
Distorted sensory awareness Explanation: In severe anxiety, perception becomes increasingly distorted, sensory input diminishes, and processing of sensory stimuli becomes scattered and disorganized.
Nursing interventions for physical stress related illness should include what? Fostering use of a social support system Assessing the need for increased dose of benzodiazepines Establishing daily routines of meals and sleeping Attending group therapy
Establishing daily routines of meals and sleeping Explanation: Individuals experiencing or at risk for untoward stress responses may benefit from a number of biologic interventions. The importance of (re-)establishing regular routines for activities of daily living (e.g., eating, sleeping, self-care, and leisure time) cannot be overstated. As well as ensuring adequate nutrition, sleep and rest, and hygiene, a routine may help to structure an individual's time and give them a sense of personal control or mastery.
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? -Questioning the client about the clinician who first diagnosed the medical problem -Reviewing the client's previous medication administration record and the client's current list of medications -Asking the client to provide a detailed explanation of his or her medical problem to determine if the presentation is typical of the problem -Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first
Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first Explanation: Considering the relationship of anxiety with the onset, exacerbation, or remission of the general medical condition can help determine whether a medical condition contributes to anxiety or vice versa. The client's medication list, the identity of the clinician who diagnosed the disease, and the client's symptoms are all aspects of the assessment process, but these are less likely to establish the primary cause.
Benzodiazepines increase which neurotransmitter function? -GABA -Norepinephrine -Acetylcholine -Serotonin
GABA Explanation: Drugs that increase GABA function, such as benzodiazepines, are used to treat anxiety and to induce sleep. Benzodiazepines do not increase the function of serotonin, norepinephrine, or acetylcholine.
Benzodiazepines increase which neurotransmitter function? Serotonin Norepinephrine Acetylcholine GABA
GABA Explanation: Drugs that increase GABA function, such as benzodiazepines, are used to treat anxiety and to induce sleep. Benzodiazepines do not increase the function of serotonin, norepinephrine, or acetylcholine.
A nurse is caring for an elderly patient undergoing antianxiety treatment. The patient is to be administered antianxiety drugs parenterally. What precautions should be taken by the nurse? Have resuscitative equipment ready. Provide fiber-rich food. Provide plenty of fluids. Arrange for a blood transfusion.
Have resuscitative equipment ready. Explanation: The nurse should have resuscitative equipment ready because elderly patients may experience apnea and cardiac arrest during the treatment. Providing fiber-rich food and plenty of fluids is not a precautionary measure during the parenteral administration of the drug. The need for a blood transfusion would not arise during the treatment.
The nurse is assessing a client and finds two enlarged supraclavicular lymph nodes. The nurse asks the client how long these enlarged nodes have been there. The client states, "I can't remember. A long time I think. Do I have cancer?" The nurse is aware that that body responds to stress. Which is an immediate physiologic response to stress the nurse would expect to see in this client? Vasodilation of peripheral blood vessels Decrease in blood glucose levels Increased blood pressure Pupil constriction
Increased blood pressure Explanation: An initial response to stress, as seen by the fight-or-flight response, is an increase in the client's heart rate and blood pressure. Vasoconstriction leads to the increase in blood pressure. Blood glucose levels increase, supplying more readily available energy, and pupils dilate.
A nurse is caring for a patient who is prescribed flurazepam. Which is an effect of flurazepam? Induces sleep Decreases stress Eases pain Improves circulation
Induces sleep Explanation: Flurazepam induces sleep. Adrenergic drugs help to relieve stress. Analgesics are used to ease pain. Circulation can be improved by exercising.
A client has been admitted to the surgical floor and is scheduled for an elective minor procedure. During the health history, the client informs the nurse of difficulty sleeping until a few weeks ago when a hormone was recommended by a neighbor and started. To what hormone is this client referring? -Soy -Flaxseed -Melatonin -Progesterone
Melatonin Explanation: Melatonin is a hormone produced by the pineal gland. Melatonin has been used to treat insomnia, relieve jet lag, and improve the effectiveness of the immune system. Soy and Flaxseed are not hormones. Progesterone is a hormone but not used to promote sleep.
The daughter of an older adult client asks the nurse if her father should be aware of any special precautions while taking lorazepam (Ativan). What is the nurse's best response? -Monitor for muscle stiffness and rigid body posture. -Monitor his urine output closely, due to the risk of kidney damage. -Monitor for increased signs of confusion or forgetfulness. -Monitor for a yellowish color in the eyes and easy bruising, due to liver damage.
Monitor for increased signs of confusion or forgetfulness. Explanation: Recent studies link the chronic use of benzodiazepines by those over 65 years of age to a greater chance of developing dementia. Antianxiety drugs are not known to cause kidney or liver damage but should be used cautiously in elderly clients, and in clients with impaired liver function or impaired kidney function. Antianxiety drugs more likely can cause muscle relaxation than rigidity. A symptom of withdrawal from antianxiety drugs is muscle tension.
What would lead the nurse to suspect that a client is experiencing withdrawal symptoms associated with benzodiazepine use? Hypotension Nightmares Urinary retention Dry mouth
Nightmares Explanation: Signs and symptoms of benzodiazepine withdrawal include nightmares, nausea, headache, and malaise. Dry mouth, hypotension, and urinary retention are adverse effects associated with benzodiazepine use.
Relaxation techniques help clients with anxiety disorders because they can promote what? Release of cortisol Increase in sympathetic stimulation Reduction of autonomic arousal Increase in the metabolic rate
Reduction of autonomic arousal Explanation: Regularly inducing the relaxation response reduces the general level of autonomic arousal in anxious clients. It lowers blood pressure, heart rate, metabolic rate, and oxygen demands. This physiologic effect may result from effects on the production of cortisol, a hormone the body releases in response to stress. Cortisol is helpful during the fight-or-flight response, but its prolonged presence in chronically anxious or stressed clients can inhibit the immune system and have other deleterious effects on the body. Chapter 14: Anxiety and Anxiety Disorders - Page 223
A 30-year-old client who has been unemployed secondary to anxiety disorder states that the client would like to have a job where the client is alone and no one needs to evaluate the client's work. The nurse interprets these comments as an indicator of what? Panic disorder Obsessive-compulsive disorder Social phobia Agoraphobia
Social phobia Explanation: Social phobia represents a persistent, irrational fear of and compelling desire to avoid situations in which the person may be exposed to unfamiliar people or to the scrutiny of others. Additionally, the person harbors the fear of behaving in a way that may prove humiliating or embarrassing. The person will experience marked anticipatory anxiety if confronted with such a situation and will attempt to avoid it.
Which condition involves a persistent, irrational fear attached to an object or situation that objectively does not pose a significant danger? Posttraumatic stress disorder Obsessive-compulsive disorder Generalized anxiety disorder Specific phobia
Specific phobia Explanation: Specific phobia is a disorder marked by persistent fear of clearly discernible, circumscribed objects or situations, which often leads to avoidance behaviors. Posttraumatic stress disorder can occur following exposure to an actual or threatened traumatic event such as death, serious injury, or sexual violence. In obsessive-compulsive disorder, affected clients have both obsessions and compulsions and believe that they have no control over them, which results in devastating consequences for the individuals. Generally speaking, clients with generalized anxiety disorder feel frustrated, disgusted with life, demoralized, and hopeless. They may state that they cannot remember a time that they did not feel anxious. They experience a sense of ill-being and uneasiness and a fear of imminent disaster.
A client who experiences panic anxiety around dogs is sitting in a room with a dog and the client's nurse therapist. The nurse therapist is using which behavioral intervention for this type of anxiety? Relaxation exercise Implosion therapy Systematic desensitization Biofeedback
Systematic desensitization Explanation: Systematic desensitization refers to the exposure of a person to a fear-producing situation in a systematized manner to decrease a phobic disorder. Implosion therapy, while similar, is not the technique described in this option. This scenario lacks the physical control techniques implemented by relaxation exercise, and it lacks the auditory and/or visual techniques implemented by biofeedback.
All except which are considered clinical symptoms of anxiety? Tearfulness and sadness Palpitations Extreme restlessness Motor excitement
Tearfulness and sadness Explanation: The clinical symptoms of anxiety are numerous. They are generally classified as physiologic, psychological or emotional, behavioral, and intellectual or cognitive responses to stress. The clinical symptoms may vary according to the level of anxiety exhibited by the client. Tearfulness and sadness are symptoms of depression, not of anxiety.
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 few glasses of wine each night is not necessarily a problem. -Drinking alcohol is more socially acceptable than taking medications. -The client is probably physically dependent on alcohol.
The client has insufficient adaptive coping mechanisms. Explanation: Clients learn to reduce the anxiety they feel in either functional or dysfunctional ways. The nurse first explores with the client what techniques the client has used in the past and helps the client identify and enhance those strategies that are most beneficial. The nurse and client identify maladaptive coping strategies, such as social withdrawal or alcohol use, and replace them with adaptive strategies that suit the client's personal, cultural, and spiritual values. The nurse should not ask the client to give up coping mechanisms, even maladaptive ones, without offering other adaptive mechanisms.
The nurse is assessing a client with anxiety. Which behavior might indicate that the client has moderate anxiety? -The client is unable to communicate verbally. -The client has impaired cognitive skills. -The client is nervous and agitated. -The client is focused in an activity.
The client is nervous and agitated. Explanation: A client who is moderately anxious has a disturbing feeling that something is wrong. This causes nervousness and agitation. Increased concentration and attention is seen in clients having mild anxiety. Cognitive skills are impaired in clients who have severe anxiety. Inability to communicate verbally indicates that the client is panicking.
Which factor has the least influence on achieving mental health for the client who has anxiety disorder? -The client was raised in a household with high stress and frequent geographic moves. -The client's mother often related to the client in ways that reflected the mother's high level of anxiety. -The client's mother also suffered from an anxiety disorder. -The client is often late to school and makes poor grades in most of the client's subjects.
The client is often late to school and makes poor grades in most of the client's subjects. Explanation: Being late to school and making poor grades are behaviors that indicate that the client is having difficulty; they are not factors influencing the development of the client's anxiety disorder.
The nurse is administering a sedative drug to a client before the magnetic resonance imaging (MRI) procedure. What are the possible reasons for which the nurse had to sedate the client? Select all that apply. -The client may have claustrophobia. -The client may have high blood pressure. -The client may have severe anxiety. -The client has a pacemaker. -The client has not given consent for having the MRI.
The client may have claustrophobia. The client may have severe anxiety. Explanation: The MRI procedure requires the client to lie down in a small closed chamber and be motionless for approximately 45 minutes. A client who has claustrophobia or severe anxiety may not be able to cooperate during the procedure. Thus, such clients require sedation. Clients with high blood pressure can undergo this procedure safely. High blood pressure is not an indication for the client to be sedated before procedure. Pacemakers are contraindicated for MRI. If the client has not given consent for MRI, the procedure should not be performed.
The nurse is assessing clients in the behavioral health unit. For which client will the nurse identify that a prn medication should be administered to control anxiety? -A client that is experiencing mild anxiety prior to talking with the therapist. -A client that is admitted and being oriented to the unit and states, "I am nervous." -The client with a high anxiety level experiencing disorganized thoughts. -A client that will be discharged home with a spouse today.
The client with a high anxiety level experiencing disorganized thoughts. Explanation: PRN medications may be indicated for high levels of anxiety, delusions, or disorganized thoughts. Medication may be necessary to decrease anxiety to a level at which the client can feel safe. The other situations that the clients are experiencing do not warrant the administration of an antianxiety medication.
A nurse is caring for a client who has panic attack. The nurse takes the client in a small, isolated room. How would this intervention benefit the client? Choose the best answer. The client would be able to demonstrate relaxation techniques. The client would be able to understand what the nurse is saying. The client would return to rational thought. The client would have an enhanced sense of security.
The client would have an enhanced sense of security. Explanation: A client with panic-level anxiety should be taken to a small, isolated room. This is to reduce any external stimuli that could escalate anxiety. Taking the client to a small room would make the client feel more protected and secured. A client experiencing a panic attack may lose rational thought; however, this intervention would not directly improve thought processes. The client would not be able to demonstrate relaxation techniques in a panic laden state. This intervention would not enhance the client's ability to understand what the nurse is saying.
A group of nursing students is reviewing information about child abuse (child mistreatment) and neglect and their effect on children. The students demonstrate understanding of the information when they identify which statements as accurate? Select all that apply. -Children who are abused (mistreated) may experience a fear of failure but are motivated to achieve. -The effects of child abuse (child mistreatment) are manifested in multiple ways. -Vulnerability to abuse (mistreatment) depends on the child's age and sex. -Most children who are abused (mistreated) exhibit signs that are readily apparent. -Evidence of child abuse (child mistreatment) is often clear-cut.
The effects of child abuse (child mistreatment) are manifested in multiple ways. Vulnerability to abuse (mistreatment) depends on the child's age and sex. Explanation: The effects of physical abuse, emotional abuse, and neglect are enormous and manifest in multiple ways. Emotional abuse may be inflicted without physical injury to the child, but it is what most seriously affects children. Children may also be physically or sexually abused, but the psychological impact of the abuse remains with the child after the bruises, burns, and broken bones have healed, often leading to a variety of psychological responses. Many children who are abused (mistreated) respond in a manner that goes unnoticed by most adults, such as extreme efforts to please, withdrawal, and generalized anxiety. Additional effects of abuse (mistreatment) and neglect on school performance include a lack of motivation to achieve, fear of failure, an inability to establish positive relationships with unfamiliar adults, poor performance on standardized tests, lower grades, higher dependence on teachers, more trips out of the classroom as a result of behavioral problems, more suspensions, and lower social competence. Vulnerability to child abuse (child mistreatment) depends, in part, on the child's age and sex. Young children between birth and 2 years of age are most at risk of physical abuse, and girls are at greater risk of sexual abuse than boys. The nurse is obligated to report suspicion of abuse (mistreatment) or neglect to the proper authorities; this does not require the nurse to prove the abuse (mistreatment) or neglect has occurred. Often, reporting involves a judgment call on the part of the nurse, and as such, the evidence is not clear-cut.
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 restraint when panic develops -Using appropriate coping skills -Involving family for support, if appropriate -Identifying treatment modalities -Providing supportive feedback
Using appropriate coping skills Identifying treatment modalities Involving family for support, if appropriate Providing supportive feedback Appropriate measures to include in the plan of care for a client with anxiety include: introducing appropriate coping skills, identifying alternate treatment modalities, involving family and support persons when appropriate, and providing feedback that is supportive to the client. Restraint is always a last resort.
A 70-year-old patient has just started taking lorazepam 10 days ago for anxiety issues related the death of her husband. She is staying with her daughter for a couple of weeks. The patient's daughter has noticed that her mother is having difficulty walking and seems to be confused at times and calls the clinic to report this to the nurse. The nurse will inform the daughter that: -the drug should be stopped immediately if these effects persist. -a dose adjustment should be made if these symptoms persist. -the drug should be administered intravenously if these effects persist. -no changes should be made at this time; the adverse effects will resolve with continued use.
a dose adjustment should be made if these symptoms persist. Explanation: If ataxia and confusion occur, especially in older adults or in a debilitated patient, dose adjustments should be made if the effects persist. If the drug is stopped immediately, withdrawal symptoms may occur. Intravenous administration or continuing the same dosage and medication would not help relieve ataxia or confusion in the patient.
The nurse is creating a plan of care for a client that has been experiencing stress responses frequently. Which overall goal(s) of care are of the highest priority? positive social support will be received adaptive coping skills will be developed no further stress reactions will be experienced cognitive appraisal will be received
adaptive coping skills will be developed Explanation: The overall goals of care for those individuals actively experiencing a stress response are to eliminate or moderate the stressor (if possible), to reduce untoward effects of the stress response, and to facilitate the maintenance or development of positive coping skills. Social support is not always possible and is does not hold the highest priority in this scenario. It is not a realistic goal to attempt to achieve that eliminates all stress reactions. This is a part of learning how to cope with stress. Goal outcomes for stress response does not correlate with cognition.
Which nursing intervention is focused on the primary goal of anxiety management and treatment? -educating the client concerning the use of medications to manage anxiety disorders -helping the client identify ways to eliminate all sources of stress in his or her daily life -assessing the client's ability to implement stress management techniques effectively -assessing the client for possible symptoms of panic disorder
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: derealization. demonstrating automatisms. depersonalization. decatastrophizing.
depersonalization. Explanation: Depersonalization is a feeling that the client may describe as being disconnected from herself, such as watching oneself. This is common when individuals experience panic levels of anxiety. Derealization refers to the sensation that things are not real or surreal during panic levels of anxiety. Decatastrophizing refers to a treatment approach used by therapists in which the client is asked questions in order to urge the client to develop a more realistic appraisal of the situation causing the anxiety. Automatisms are automatic, unconscious mannerisms that are geared toward relief of anxiety and increase in intensity and frequency with a rise in the client's anxiety level.
An adolescent who is seeing the school health nurse states, "I won't be able to hang out with my friends on Friday night because I have two essays due Monday." What level of anxiety is the adolescent experiencing? mild panic moderate severe
mild Explanation: Mild anxiety is characterized by an increase in sensory stimulation that is helping the adolescent focus attention to achieve a goal. The anxiety is positive because it motivates the adolescent but does not interfere with social, occupational, or emotional functioning. The adolescent is still able to concentrate independently without having to be redirected to the topic. Moderate anxiety is characterized by a disturbing feeling that something is wrong. With moderate anxiety, a person can still process information but may have some trouble with concentration and require redirecting to focus. Severe anxiety is characterized by a significant decrease in a person's cognitive skills. If severe anxiety was being experienced, the adolescent would likely have trouble thinking and reasoning. Panic level of anxiety is characterized by physiological responses to anxiety that take over the ability to reason leading to diminished cognitive skills. It would be nearly impossible for the adolescent to make any decisions about how to organize time to complete homework if panic level of anxiety was being experienced.
