Ch 14 - PrepU Anxiety
The nurse recognizes that who is the client 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 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?
6 months
The overall goals of care for individuals experiencing a stress response are to focus on interventions to develop ... You Selected:
positive coping skills.
Which statement, made by a client diagnosed with an anxiety disorder, should trigger the nurse's concern about the client's understanding of the use of defense mechanisms?
"When I have a problem, I just deny it until it goes away."
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 client tells the nurse that the client has been worried and tearful lately because of pressures at work. The client states, "My partner tells me that it's 'stress' and 'anxiety,' but doesn't everyone have that? What is anxiety anyway?" Which response would be most appropriate for the nurse to provide about the nature of anxiety?
"Anxiety is a sense of psychological distress."
The nurse is assessing a client who recently experienced their first panic attack while at the grocery store. What question should the nurse ask to identify complications of the disorder?
"Do you have any problems going out alone to public places?"
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 statement by the nurse demonstrates an understanding of the role automatisms have in a panic attack?
"The client taps her fingers very rapidly when she is feeling anxious."
A client comes to the emergency department because the client thinks the client is 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 the nurse to ask?
"What did you experience just before and during the attack?"
The client reports that the client feels anxious when interacting socially with others and "never seems to know what to say." Which question indicates the nurse has a sound understanding of interpersonal theory as it relates to anxiety?
"What kind of relationship do you have with your parents?"
Nearly what percentage of adults are affected by anxiety disorders?
25%
What does desensitization refer to?
A systematic way to replace a panic response with a relaxation response
Which client is most likely to be at risk for drug dependence and difficulties with withdrawal?
A woman who has been taking lorazepam for several months after witnessing a traumatic motor vehicle accident
What is the term for the change that takes place in response to a stressor?
Adaptation
The most important factor in the person's stress response is what?
Adaptive coping strategies
A client approaches the nurse on an inpatient psychiatric hospital unit crying, trembling, and feeling nauseous. The client states, "I've tried everything, I still feel so anxious." Which action by the nurse would be most appropriate?
Administer the prescribed PRN anxiolytic medication.
A client is currently experiencing panic. Which action would be most appropriate for the nurse to do?
Allow the client to pace
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?
Anticipatory anxiety
Which medication classification has been found to be effective in reducing or eliminating panic attacks?
Antidepressants
Panic disorder is treated with cognitive-behavioral techniques, deep breathing, and relaxation, in addition to what?
Antidepressants Panic disorder is treated with cognitive-behavioral techniques, deep breathing and relaxation, and medication such as benzodiazepines, selective serotonin reuptake inhibitors, tricyclics, and antihypertensives, such as clonidine and propranolol.
When explaining the difference between anxiety and fear, the mental health nurse shares what? Select all that apply.
Anxiety involves experiencing subjective, uncomfortable feelings resulting from unknown causes Fear results in objective, physical responses caused by real danger Anxiety is likely to result from an attempt to overcome stress
A 25-year-old client tells the nurse that the client has been worried and tearful lately because of pressures at work. The client states, "My partner tells me that it's 'stress' and 'anxiety,' but doesn't everyone have that? What is anxiety anyway?" Which response would be most appropriate for the nurse to provide about the nature of anxiety?
Anxiety is a sense of psychological distress."
A hospitalized client states that the client is having difficulty resting. Which intervention would help promote rest?
Assisting the client with deep-breathing exercises
A biologic theory explains anxiety disorders in which way?
Based in genetics with clinical symptoms being a result of chromosomal influence
When discussing various types of anxiolytic medications with a client, the nurse recognizes that which medication has the lowest potential for abuse?
Buspirone
All of the following pharmacological agents are useful in treating anxiety disorders except which ones?
Calcium channel blockers
Clients taking benzodiazepines need education about what?
Concomitant use of alcohol
Which factor has the least influence on achieving mental health for the client who has anxiety disorder?
The client is often late to school and makes poor grades in most of the client's subjects.
A client responds to bad news regarding test results by crying uncontrollably. What is the term for this response to a stressor?
Coping mechanism
Humans are able to adapt to physiological and psychological threats. Which is key to a person's adaptation to these situations?
Coping mechanisms
Which term describes feelings of being disconnected from oneself as seen in a panic attack?
Depersonalization
When assessing an elderly 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
A nurse is assessing a client and determines that the client is experiencing severe anxiety based on which finding?
Distorted sensory awareness
A client diagnosed with anxiety disorder has been prescribed benzodiazepine drugs. The nurse is explaining the possible side effects of the medications. Which side effects of the drug explained by the nurse is correct? Select all that apply.
Dry mouth Blurred vision Constipation
In teaching a client who has been prescribed a benzodiazepine for panic disorder, the nurse must be certain to do what?
Educate the client that this medication has a high risk for withdrawal symptoms, and the client should not discontinue without a doctor's supervision.
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
The nurse is assessing a client with anxiety. What symptom indicates that the the client has adopted a maladaptive behavior in response to stress?
Headache
A nurse is assessing a client with anxiety. Which signs and symptoms would the nurse attribute to sympathetic nervous stimulation? Select all that apply.
Heart racing Hypertension
Which is considered a tricyclic antidepressant (TCA) used in the treatment of clients with panic disorder?
Imipramine
Which is one characteristic that differentiates generalized anxiety disorder (GAD) and panic disorder?
In GAD, the person usually does not experience eruptions of acute anxiety.
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?
Increased blood pressure
During the admission assessment of a 27-year-old client who has been diagnosed with an anxiety disorder, the nurse observes that the client is becoming increasingly restless and agitated. How should the nurse respond to this development?
Inform the client that the assessment can be postponed if the client is finding it overwhelming.
A group of students is reviewing information about the etiology of generalized anxiety disorder (GAD). The students demonstrate understanding of this information when they identify which as representing the bases for this disorder?
Intense worry and stress about work or simple family life
A nursing role in providing client education regarding panic disorder includes which of the following? (Select all that apply.)
Introduction of appropriate coping skills Identification of alternate treatment modalities Involving family and support persons when appropriate Providing feedback to support the client
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
When assessing a client with anxiety, the nurse should recognize that anxiety may often be a result of what?
Medications
The mental health nurse is gathering a health history on a new client. The client is constantly pacing the floor and is concerned only with stating that the client is about to die. The nurse would classify this level of anxiety as what?
Moderate In moderate anxiety, the client experiences a narrowing of the ability to concentrate. The client paces, has voice tremors, and has an increased rate of speech. During euphoria, the client experiences an exaggerated feeling of well-being that is not directly proportional to a specific circumstance or situation. Mild anxiety causes the client to have an increased alertness to inner feelings or the environment. During severe anxiety, the client is able to focus on only small or scattered details.
When a client is experiencing panic, which is the priority intervention?
Move the client to a quiet environment.
The nurse can document correctly that a client diagnosed with an anxiety disorder is experiencing moderate anxiety when the nurse observes the client doing what?
Pacing and repeatedly asking staff what time the "doctor will be here."
The nurse has read in a client's admission record that the client has been taking propranolol for psychiatric, rather than medical, reasons. The nurse should recognize that the client likely has a history of which mental health condition?
Panic disorder
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
Relaxation techniques help clients with anxiety disorders because they can promote what?
Reduction of autonomic arousal
A client experiencing stress has tachycardia and tachypnea. On the basis of the physiological model of the general adaptation syndrome, in which stage is this client?
Resistance
Which should be included in a teaching plan for a client prescribed a benzodiazepine?
Rise slowly from a lying or sitting position
Which is the primary concern for a client with panic-level anxiety?
Safety
A nurse is developing a plan of care for a client with panic disorder that will include pharmacologic therapy. Which would the nurse most likely expect to administer?
Selective serotonin reuptake inhibitor (SSRI)
A client is diagnosed with panic disorder. When considering the neurochemical theory of the disorder, which would the nurse expect to administer as the drug of choice initially?
Selective serotonin reuptake inhibitors
Which medication classification has been used to treat social phobia?
Selective serotonin reuptake inhibitors (SSRIs)
A nurse determines that a client who is experiencing anxiety is using relief or primitive survival behaviors. The nurse determines that the client is experiencing which degree of anxiety?
Severe
A client who has been diagnosed with panic disorder visits the clinic and experiences a panic attack. The client tells the nurse, "I'm so nervous. My hands are shaking, and I'm sweating. I feel as if I'm having a stroke right now." What would be the priority intervention at this time?
Stay with the client while remaining calm.
A client who has been diagnosed with panic disorder visits the clinic and experiences a panic attack. The client tells the nurse, "I'm so nervous. My hands are shaking, and I'm sweating. I feel as if I'm having a stroke right now." What would be the priority intervention at this time?
Stay with the client while remaining calm. The first nursing intervention should be to stay with the client while remaining calm. A calm presence will help to relax the client. The nurse should use short sentences to provide clear directions and then assist the client to an environment with minimal stimuli. A client experiencing panic is unable to process information, so telling the client that the attack will soon pass would be ineffective. Educating the client on deep-breathing techniques would be appropriate later, after the panic subsides and the client is amenable to hearing and processing information.
The nurse is caring for a client who is being treated in the emergency department for a panic attack. Which nursing intervention would be most appropriate?
Stay with the client, emphasizing that the client is safe and that the nurse will remain with the client.
Which would be an appropriate intervention for a client experiencing an anxiety attack?
Staying with the client and speaking in short sentences
When a parent observes the parent's young child heading toward a busy road the parent becomes stressed, feeling the parent's heart pounding, breathing heavily, and hands becoming wet with perspiration. Which physiological system is activated with the parent's "fight or flight" reaction to this danger?
Sympathetic nervous system
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?
Systematic desensitization
Which is a cardiovascular response of the sympathetic nervous system?
Tachycardia
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
All except which are considered clinical symptoms of anxiety?
Tearfulness and sadness
A client reports the client has been experiencing increased stress at work. The client has been managing the stress by drinking 2-3 glasses of wine per evening. Despite the nurse recommending that drinking alcohol is not an effective way to manage the stress, the client reports it is unlikely that the client will be able to stop. Which statement explains why this will be difficult for the client?
The client has no 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 is assessing a client with anxiety. Which behavior might indicate that the client has moderate anxiety?
The client is nervous and agitated.
The nurse can be confident that the admitted client diagnosed with an anxiety disorder will respond well to treatment when the client which of the following conditions are present?
The client states, "I understand what I need to do, and I'm ready to do it so I'm back to normal."
A client is experiencing moderate anxiety. Which manifestation would the nurse most likely observe? Select all that apply.
The client verbally states, "For some reason, I am feeling anxious now."
The nurse is caring for a client diagnosed with anxiety disorder. The client is demonstrating difficulty concentrating and is preoccupied with feelings of helplessness. When creating the plan of care, which goal would be most appropriate for this client?
The client will display ability to cope with anxiety.
In speaking with a client with moderate anxiety, the client becomes tangential discussing unrelated topics. To help the client's attention from wandering, which is an effective intervention?
The nurse should speak in short and simple sentences.
A nurse is talking with a client who has experienced panic attacks. The client asks the nurse, "What causes these attacks?" Which information would the nurse most likely integrate into the response about the etiology of panic disorders?
There is evidence of a substantial familial predisposition to panic disorder
The nurse is teaching shoulder exercises to a client recovering from a mastectomy. The nurse might view the client's mild anxiety during the session positively, because mild anxiety helps what? Select all that apply.
To focus attention to learn To feel and think To motivate to make a change To engage in goal-directed activity
After teaching a group of mental health nursing students about the care of a client experiencing a panic attack, the instructor determines that additional education is required when the students identify which as an appropriate intervention?
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
A nurse is preparing a plan of care for a client with anxiety. Which elements would the nurse likely include? Select all that apply. You Selected:
Using appropriate coping skills Identifying treatment modalities Involving family for support, if appropriate Providing supportive feedback
A group of students is reviewing information about anxiety disorders in preparation for a class examination. The students demonstrate understanding of the material when they state what?
Women experience anxiety disorders more often than do men.
Which nursing assessment is most appropriate for an older client presenting with reports of generalized anxiety?
assess for depression Late-onset generalized anxiety disorder (GAD) is usually associated with depression. Although less common, panic attacks can occur in later life and are often related to depression or a physical illness such as cardiovascular, GI, or chronic pulmonary diseases. While the remaining options are appropriate, they are not associated with the possible comorbid conditions of GAD
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.
A client with a specific phobia of spiders is seeing a therapist for the first session of treatment. The therapist hands the client a clear container with a large house spider inside. This activity is repeated continuously until the client's fear subsides. Which strategy is being used to treat the client's specific phobia?
flooding
A nurse is seeing a client who is experiencing symptoms of moderate anxiety. She tells the nurse she and her parents disagree over her sexual orientation. Which theory would best explain the course of the client's anxiety?
interpersonal
During which type of anxiety does a person's perceptual field actually increase?
mild
