Ch 15 Anxiety and Obsessive-Compulsive Related Disorders

2 (The advice given by the nurse indicates that the nurse is trying to counterbalance the perceived deficiencies in the child and advising him or her to focus on other activities. The nurse is encouraging the positive use of compensation as a defense mechanism. Displacement is a defense mechanism wherein an individual transfers the emotions related to a particular person or situation to a nonthreatening person or object. Identification is a defense mechanism wherein an individual tries to imitate the characteristics of another person or group. Dissociation is a defense mechanism wherein an individual mentally separates himself or herself from unpleasant situations.)

A child is extremely upset because of being constantly bullied by peers for having a short stature. While giving advice to the child, the nurse states, "Your stature is not going to affect your fitness. You could always excel in other aspects like sports and academics." Which defense mechanism is the nurse encouraging in the child? 1 Displacement 2 Compensation 3 Identification 4 Dissociation

4 (Panic-level anxiety results in markedly disorganized, disturbed behavior, including confusion, shouting, and hallucinating. Individuals may be unable to follow directions and may need external limits to ensure safety.)

A male patient is running from chair to chair in the solarium. He is wide-eyed and keeps repeating, "They are coming! They are coming!" He neither follows staff direction nor responds to verbal efforts to calm him. The level of anxiety can be assessed as 1 Mild 2 Moderate 3 Severe 4 Panic

4 (Anxiety has an unknown or unrecognized source, whereas fear is a reaction to a specific threat. There is no evidence of spiritual distress or ineffective coping at this point. The patient's level of anxiety is moderate. While the body image may be disturbed, it is not related to malignant cancer. There is no evidence the self-esteem is disturbed.)

A woman gets a report of abnormal cells from a routine pap test. She anxiously says to her spouse, "I have cancer. It probably has spread all over my body." Which nursing diagnosis and etiology best apply to this situation? 1 Ineffective coping related to panic level anxiety 2 Self-esteem disturbance related to outcome of pap test 3 Disturbed body image related to malignant cervical cancer 4 Fear related to misinterpretation and misinformation about pap tests

3 (Symptoms of severe anxiety evident in this scenario are confusion, diaphoresis (sweating), withdrawal, rapid speech, and a perceptual field that is reduced greatly and distorted. The perceptual field is heightened in mild anxiety. In moderate anxiety, the ability to think clearly is hampered, but learning and problem solving can still take place. In panic, communication is unintelligible or there is an inability to speak.)

After a year of diarrhea, a patient has a colonoscopy. As the health care provider explains the findings, the patient rapidly says, "You're talking too fast. I can't understand you. All I can hear is a buzz from the fluorescent lights." The patient is wet with perspiration. Which level of anxiety is evident? 1 Mild 2 Moderate 3 Severe 4 Panic

2 (The presence of anxiety may cause an individual to consider suicide as a means of finding comfort and peace. Suicide assessment is appropriate for any patient with higher levels of anxiety.)

An important question to ask during the assessment of a patient diagnosed with anxiety disorder is 1 "How often do you hear voices?" 2 "Have you ever considered suicide?" 3 "How long has your memory been bad?" 4 "Do your thoughts always seem jumbled?"

4 (Panic level anxiety is the most extreme level and results in markedly disturbed thinking.)

Delusionary thinking is a characteristic of 1 Chronic anxiety 2 Acute anxiety 3 Severe anxiety 4 Panic level anxiety

2 (When moderate anxiety is present, the individual's perceptual field is reduced and the patient is not able to see the entire picture of events.)

Selective inattention is first noted when experiencing anxiety that is 1 Mild 2 Moderate 3 Severe 4 Panic

2 (Altruism and sublimation are known as mature defenses. They cannot be used in unhealthy ways. Altruism results in resolving emotional conflicts by meeting the needs of others, and sublimation substitutes socially acceptable activity for unacceptable impulses.)

The defense mechanisms that can be used only in healthy ways include 1 Suppression and humor 2 Altruism and sublimation 3 Idealization and splitting 4 Reaction formation and denial

1 (Ataque de nervios (attack of the nerves) is a culture-bound syndrome that is seen in undereducated, disadvantaged females of Hispanic ethnicity.)

A cultural characteristic that may be observed in a teenage, female Hispanic patient in times of stress is to 1 Suddenly begin to tremble severely 2 Exhibit stoic behavior 3 Report both nausea and vomiting 4 Laugh inappropriately

3 (Clinicians and researchers have shown clearly that anxiety disorders frequently co-occur with other psychiatric problems. Several studies suggest that other psychiatric disorders coexist about 90% of the time in people with generalized anxiety or panic disorder. Anxiety disorders are comorbid with major depression at a rate of 60%; in this type of comorbidity, anxiety symptoms tend to happen before depressive symptoms. While conduct disorder, alcohol use disorder, and obsessive-compulsive disorder are possibilities, the most likely comorbid problem is depression.)

A new patient is diagnosed with generalized anxiety disorder. It is most important for the nurse to assess this patient for which additional problem? 1 Conduct disorder 2 Alcohol use disorder 3 Major depressive disorder 4 Obsessive-compulsive disorder

3 (Fear questionnaire is used to measure phobias present in the patients. The patients are questioned about the different types of fear which they experience. The rating is given according to the intensity. Yale-Brown obsessive-compulsive scale is used to measure the severity of compulsive behavior. Hoarding scale self-report is used to measure hoarding in a patient. Panic disorder severity scale is used to measure panic symptoms.)

A nurse conducts a clinical interview with children to assess types of anxiety. Which scale does the nurse use to measure phobias present in the children? 1 Yale-Brown obsessive-compulsive scale 2 Hoarding scale self-report 3 Fear questionnaire 4 Panic disorder severity scale

2 (In flooding, the patient is exposed to the fear stimuli repeatedly. With prolonged exposure to the fear, the patient learns to overcome and survive the fear. In modeling, the staff and nurse act as role models and demonstrate appropriate behavior to the fear stimuli. In response prevention, the nurse doesn't allow the patient to perform the ritual response. It can be used in obsessive-compulsive patients. Thought-stopping is used to interrupt the negative thoughts in the patient. The nurse recommends that patients snap a rubber band on their wrist to cause a distraction from negative thoughts.)

A nurse is caring for a patient with claustrophobia. The primary health care provider instructed the nurse to leave the patient in a closed room for 30 minutes daily. Which behavioral therapy was the nurse instructed to implement? 1 Modeling 2 Flooding 3 Response prevention 4 Thought-stopping

2 (Psychiatric patients often pull out hair to relieve stress. This condition is called trichomoniasis, an impulse control disorder). Trichorrhexis is a defect in the hair shaft where the hair becomes thin and breaks off easily. Patients who secretly swallow the pulled hair have a condition called trichophagia. The masses of hair present in the stomach are referred to as Rapunzel syndrome.

A nurse observes a patient who often pulls out his or her hair. What appropriate condition does the nurse report to the primary health care provider based on this observation? 1 The patient has trichorrhexis. 2 The patient has trichotillomania. 3 The patient has trichophagia. 4 The patient has Rapunzel syndrome.

2 (Defenses against anxiety can be adaptive or maladaptive. Suppression is a conscious, deliberate effort to avoid painful and anxiety-producing memories. Repression is an unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness. In this scenario, the patient is aware of the memory. Rationalization consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations. Intellectualization is a process in which events are analyzed based on facts and without passion, rather than including feeling and emotion.)

A patient attempted suicide three days ago. When the nurse asks about the related events, the patient says, "I don't want to think about that now, but maybe we could talk about it later." Which defense mechanism has the patient used? 1 Repression 2 Suppression 3 Rationalization 4 Intellectualization

3 (Compulsions are ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety or prevent an imagined calamity. Performing the compulsive act temporarily reduces anxiety, but because the relief is only temporary, the compulsive act must be repeated again and again. A phobia is a persistent, irrational fear of a specific object, activity, or situation that leads to a desire for avoidance, or actual avoidance, of the object, activity, or situation. Obsessions are thoughts, impulses, or images that persist and recur, so that they cannot be dismissed from the mind even though the individual attempts to do so. Obsessions often seem senseless to the individual who experiences them (ego-dystonic), and their presence causes severe anxiety. Trichotillomania refers to hair pulling disorder.)

A patient counts everything; for example, the patient counts the number of steps to the bathroom, rings of the telephone, and cups in the pantry. How should the nurse document this finding? 1 Phobia 2 Obsession 3 Compulsion 4 Trichotillomania

2 (Lorazepam is a benzodiazepine commonly prescribed for short-term management of anxiety. These medications may make it unsafe to handle mechanical equipment, such as a lawn mower. It would be safe for the patient to sew, play video games, and prepare meals.)

A patient diagnosed with panic disorder begins a new prescription for lorazepam (Ativan). The nurse should provide instructions to discontinue which of this patient's usual daily activities? 1 Sewing 2 Mowing the lawn 3 Playing video games 4 Preparing dinner for the family

2 (Chlordiazepoxide (Librium) belongs to the benzodiazepine class of antianxiety drugs. It causes congenital anomalies in the fetus; therefore, the patient should avoid becoming pregnant. As caffeine decreases the efficacy of the benzodiazepines, the nurse should suggest the patient avoid drinking coffee and tea. The nurse should suggest continuing medication after 3 to 4 months. Abruptly stopping the medication can cause withdrawal symptoms like dry mouth, tremors, and convulsions.)

A patient diagnosed with panic disorder is prescribed chlordiazepoxide (Librium). What is the most appropriate suggestion by the nurse? 1 Change the medication if there is insomnia. 2 Follow contraceptive methods. 3 Coffee and tea are fine to drink and won't interact with the medication. 4 Stop the medication after 3 months

3 (Severe anxiety is characterized by feelings of falling apart and impending doom, impaired cognition, and severe somatic symptoms such as headache and pounding heart.)

A patient frantically reports to the nurse "You have got to help me! Something terrible is happening. I can't think. My heart is pounding, and my head is throbbing." The nurse should assess the patient's level of anxiety as 1 Mild 2 Moderate 3 Severe 4 Panic

4 (Patients with obsessive-compulsive disorder may avoid eating and drinking because they are distracted by rituals. The nurse should ensure that the patient gets proper nutrition. The nurse should check the weight of the patient three times a week and record it. The patient avoids food; therefore, the snacks should be nutritious enough to meet the nutritional demand of the patient. Allowing the family members to be with the patient during meals will not help to improve the patient's nutrition and may just further distract the patient from eating. The nurse should not give food frequently to the patient because it does not get at the root of the problem, which is the distraction of rituals. The nurse should not give only fluids to the patient as this would further risk the patient's nutrition. Instead, the nurse should encourage the patient to have complete meals.)

A patient in treatment for obsessive-compulsive disorder skips meals and sometimes avoids food. What appropriate measures does the nurse take to ensure proper nutrition in the patient? 1 The nurse allows the patient's family members to be present during meals. 2 The nurse provides food frequently to the patient. 3 The nurse substitutes fluids for the patient rather than food. 4 The nurse provides nutritious snacks to the patient.

2 (GAD is characterized by symptomology that lasts six months or longer.)

A patient is diagnosed with generalized anxiety disorder (GAD). The nursing assessment supports this diagnosis when the patient reports 1 That the symptoms started right after the patient was robbed at gunpoint 2 Being so worried the patient hasn't been able to work for the last 12 months 3 That eating in public makes the patient extremely uncomfortable 4 Repeatedly verbalizing prayers helps the patient feel relaxed

3 (A response that helps the patient identify the precipitant stressor is most therapeutic.)

A patient is displaying symptomology reflective of a panic attack. To help the patient regain control, the nurse responds, 1 "You need to calm yourself." 2 "What is it that you would like me to do to help you?" 3 "Can you tell me what you were feeling just before your attack?" 4 "I will get you some medication to help calm you."

2 (The amygdala plays a role in anxiety disorders. It alerts the brain to the presence of danger and brings about fear or anxiety to preserve the system. Memories with emotional significance are stored in the amygdala and are implicated in phobic responses. The thalamus relays sensory information to other brain centers. The hypothalamus is involved in regulation of the autonomic nervous system. The pituitary gland secretes regulatory hormones.)

A patient is fearful of riding in elevators and always takes the stairs. Which brain structure is involved in this fear and behavior? 1 Thalamus 2 Amygdala 3 Hypothalamus 4 Pituitary gland

1 (Patients who must engage in compulsive rituals for anxiety relief rarely are afforded relief for any prolonged period. The high anxiety level and need to perform the ritual may interfere with sleep.)

A potential problem for a patient diagnosed with severe obsessive-compulsive disorder is 1 Sleep disturbance 2 Excessive socialization 3 Command hallucinations 4 Altered state of consciousness

1 (The patients must be given cognitive-behavioral therapy to remove the negative feelings. The nurse should re-evaluate the situation realistically. The nurse should develop a positive insight in the patient by replacing the negative thoughts. The nurse should not support the patient's negative beliefs. It can further disrupt the patient's beliefs. The nurse should not give her own opinion on the patient's thoughts as it may make the patient feel rejected. The nurse should not isolate the patient from peers as it can cause withdrawal and aggression in the patient. The nurse should encourage the patient to mingle with peers.)

A primary health care provider instructed a nurse to give cognitive-behavioral therapy to a patient with social phobia. What intervention is appropriate for the patient during the cognitive-behavior therapy? 1 Re-evaluate the patient's situation. 2 Support the patient's beliefs. 3 Give an opinion on patient's thoughts. 4 Calm the patient through isolation from peers

3 (Dysmorphic disorders are characterized by a preoccupation with an imagined defective body part. Dysmorphic patients often pay excessive attention to body parts that they imagine to be defective. As a result, they may develop obsessive-compulsive behaviors such as often checking the mirrors. In obsessive-compulsive disorder patients perform repeated activities or rituals. In hoarding disorder the patient accumulates and collects all materials for future use. Patients with panic disorder may have an unusual fear of future events.)

A student nurse observes that a patient often looks at her reflection in the mirror. What is the most appropriate diagnosis the student nurse could make from the patient's behavior? 1 The patient has obsessive-compulsive disorder. 2 The patient has hoarding disorder. 3 The patient has body dysmorphic disorder. 4 The patient has panic disorder.

2 (Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions. TB's research shows that "trait anxiety" means it's part of the person's makeup to be anxious and worry about things).

A teenager changes study habits to earn better grades after initially failing a test. This behavioral change is likely a result of 1 A rude awakening 2 Normal anxiety 3 Trait anxiety 4 Altruism

2 (Fear is a response to a perceived threat or danger that may inhibit problem-solving and lead to apprehension about the future. The person is ill-informed about the diagnosis and misinterprets the potential outcome. Deficient knowledge about the diagnosis is an indication for informing the patient. There is no indication that the woman has disturbed thought process. The woman is not displaying risk prone behaviors.)

A woman gets a report of abnormal cells from a Pap smear. She calls her attorney to prepare a will and tells her family, "I won't be around much longer." Which nursing diagnosis and etiology best apply to this situation? 1 Deficient knowledge related to reasons for Pap smears. 2 Fear related to misinterpretation and misinformation about Pap tests. 3 Disturbed thought processes related to malignant cancer. 4 Risk-prone health behavior related to a negative vision for the future.

2 (Social anxiety has a prevalence of 8.2% in adolescents aged 13 to 17, with equal prevalence in men and women. Of generalized anxiety, social anxiety, panic, and specific phobias, social anxiety presents the greatest risk for this individual. TB adds: specific phobias, when broken into the sexes, has a prevalence for males at 5.3%, but the onset is at a much lower age. Social anxiety, when broken into the sexes, is 4.1% for males, and the onset is average age 13, which is much more likely for this 14-year old male who is at risk of "developing", which refers to onset)

After reviewing the following information, which anxiety disorder is a 14-year-old male at greatest risk for developing? 1 Generalized anxiety 2 Social anxiety 3 Panic 4 Specific phobias

2 (Implications for Nursing Practice identified by the study encouraged nurses to promote a prescription of daily exercise. Including an age ability appropriate exercise into a patient's daily routine best implements the conclusion of this research. Although educating the patients to the connection between neurotrophin BDNF and anxiety, coordinating the patient's diagnostic testing to determine neurotrophin BDNF levels, and including an orientation to the various exercise equipment available on the unit as a part of the admission process are appropriate, these interventions do not directly implement exercise into a patient's daily routine.)

After reviewing the following information, which intervention best demonstrates the importance of the research findings? 1 Educate the patients to the connection between neurotrophin brain-derived neurotrophic factor (BDNF) and anxiety. 2 Include an age- and ability-appropriate exercise routine in each patient's daily routine. 3 Coordinate the patient's diagnostic testing to determine neurotrophin BDNF levels. 4 Include an orientation to the various exercise equipment available on the unit as part of the admission process.

3 (Indicators of severe anxiety include: cognitive, narrowed perceptual field, selective attention, distortion of time/events, detachment, physical reactions such as diaphoresis, tense muscles, and decreased hearing. Mild anxiety is demonstrated by: normal vital signs, minimal muscle tension, broad perceptual field, and awareness of environmental and internal stimuli. There are also feelings of relative comfort, a relaxed appearance, and automatic performance. Moderate anxiety is demonstrated by: slightly elevated vital signs, moderate muscle tension, alert, narrow or focused attention, and inability to problem solve, learn, and be attentive. There is also a feeling of readiness, energy, ability to learn, and interest in the situation. Panic is characterized by a distinct inability to respond to any stimuli other than those occurring internally and a sense of being out of control, physically and emotionally.)

After three weeks of hemoptysis (coughing blood), a person finally seeks treatment. A chest x-ray film is taken and the person waits for the results. When the health care provider explains the report, the person complains, "I can't understand what you're saying. You're talking so fast. All I hear is a loud clicking on my watch." The patient is wet with perspiration. Which level of anxiety is evident? 1 Mild 2 Moderate 3 Severe 4 Panic

3 (Anxiety is a part of everyday life. Normal anxiety is a healthy reaction necessary for survival. It provides the energy needed to carry out the tasks involved in living and striving toward goals. Anxiety motivates people to make and survive change. It prompts constructive behaviors. In this scenario, announcing a vegetarian dinner indicates the adult has adapted to the anxiety-producing situation. Cancelling the dinner and leaving guests unattended are dysfunctional responses. Saying the oven malfunctioned demonstrates maladaptive use of displacement.)

An adult invites 14 guests for Thanksgiving dinner. Just before the guests arrive, the adult notices the turkey is burned and inedible. Which behavior by this adult indicates adaptive coping? The adult: 1 Goes to bed and leaves the guests unattended. 2 Telephones all the guests and cancels the invitation for dinner. 3 Says to the guests, "We are having a vegetarian Thanksgiving dinner this year." 4 Tells the guests, "My oven malfunctioned. You will have to eat burned turkey."

2 (Obsessions are thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind.)

An obsession is defined as 1 Thinking of an action and immediately taking the action 2 A recurrent, persistent thought or impulse 3 An intense irrational fear of an object or situation 4 A recurrent behavior performed in the same manner

1 (Panic disorder with agoraphobia is characterized by recurrent panic attacks combined with agoraphobia. Agoraphobia involves intense, excessive anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available if a panic attack occurred.)

Inability to leave one's home because of avoidance of severe anxiety suggests the anxiety disorder of 1 Panic attacks with agoraphobia 2 Obsessive-compulsive disorder 3 Posttraumatic stress response 4 Generalized anxiety disorder

3 (Rationalization involves justifying illogical or unreasonable ideas or feelings by developing logical explanations that satisfy the teller and the listener.)

If the record mentions that the patient habitually relies on rationalization, the nurse might expect the patient to 1 Make jokes to relieve tension 2 Miss appointments 3 Justify illogical ideas and feelings 4 Behave in ways that are the opposite of his or her feelings

2 (According to behavioral theory, the patient shows a learned response to specific environmental stimuli. The patient has observed his or her mother's fear of darkness and also developed a fear of darkness. According to psychodynamic theory, anxiety disorder is developed in a person during childhood. It is due to unconscious conflicts in his or her surroundings and the patient develops negative emotions. According to interpersonal theory, the patient develops an emotional distress transmitted from mother or caregivers. According to the cognitive theory, the patient has poor perception of situations. The patient tends to develop a panic attack by thinking about the situation.)

In a clinical interview, a patient says, "My mother and I are afraid of darkness, so we always carry a flashlight with us." Which appropriate theory does the patient demonstrate in this case? 1 Psychodynamic theory 2 Behavioral theory 3 Interpersonal theory 4 Cognitive theory

1 (Mild anxiety causes patients to see, listen, and grasp more information. This helps the patients to focus more on whatever is taught during the teaching session. Mild anxiety is unlikely to improve the patient's expression, comfort level, or willingness to participate. The nurse should involve the patient in discussion so that the patient expresses his or her feelings and should modify the environment of teaching to make the patient comfortable.)

In a teaching session, the nurse uses strategies that would induce a slight degree of anxiety in the patients attending the session. What is the nurse's intention for this action? 1 The patients would be more focused during the session. 2 The patients would be more expressive during the session. 3 The patients would be more comfortable during the session. 4 The patients would be more willing to participate in the session.

3 (Panic attacks in Latin Americans and Northern Europeans often involve sensations of choking, smothering, numbness, or tingling, as well as fear of dying.)

Panic attacks in Latin American individuals often involve 1 Repetitive involuntary actions 2 Blushing 3 Fear of dying 4 Offensive verbalizations

2 (The priority nursing action is the assessment of the patient's anxiety level.)

The initial nursing action for a newly admitted anxious patient is to 1 Assess the patient's use of defense mechanisms 2 Assess the patient's level of anxiety 3 Limit environmental stimuli 4 Provide antianxiety medication

2 (The child makes sketches to project the repressed feelings associated with the death of the parents; this is an example of sublimation. The use of sublimation is always constructive and should be encouraged; the nurse should not ask the caregiver to punish the child as the child is not exhibiting maladaptive behavior. The child is projecting feelings in a constructive and socially acceptable manner and does not require psychological counseling at this time or the need for other activities.)

The nurse is assessing a child in a foster care home. The child's biological parents recently died in an accident. The foster parent tells the nurse that the child projects repressed feelings by making sketches. What should the nurse advise? 1 "You should punish the child for doing this." 2 "Your child is showing constructive behavior." 3 "The child needs to have psychological counseling." 4 "You should ask the child to become involved in other activities."

4 (Patients experiencing severe anxiety, as the symptoms suggest, are unable to learn or solve problems. Restating the preoperative teaching slowly, having the patient read the teaching materials instead of listening to them, and having a familiar family member read the preoperative materials to the patient would not be effective because the nurse is still attempting to teach someone who has a severe level of anxiety.)

The nurse is providing teaching to a preoperative patient just before surgery. The patient is becoming more and more anxious as the information is presented. Soon the patient begins to report dizziness and heart pounding. The nurse observes obvious trembling and the patient appears confused. What is the nurse's immediate intervention? 1 Reinforcing the preoperative teaching by restating it slowly 2 Having the patient read the teaching materials instead of listening to them 3 Having a familiar family member read the preoperative materials to the patient 4 Ceasing any further attempt at preoperative teaching at this time

3 (Response prevention is a technique by which the patient is prevented from engaging in the compulsive ritual. A form of behavior therapy, response prevention is never undertaken without health care provider approval.)

The plan of care for a patient who has elaborate washing rituals specifies that response prevention is to be used. Which scenario is an example of response prevention? 1 Having patient repeatedly touch "dirty" objects 2 Not allowing patient to seek reassurance from staff 3 Not allowing the patient to wash hands after touching a "dirty" object 4 Telling the patient that he or she must relax whenever tension mounts

4 (The symptoms of anxiety can be caused by a number of physical disorders or are said to be caused by an underlying physical disorder. The treatment for secondary anxiety is treatment of the underlying cause.)

The primary purpose of performing a physical examination before beginning treatment for any anxiety disorder is to 1 Protect the nurse legally 2 Establish the nursing diagnoses of priority 3 Obtain information about the patient's psychosocial background 4 Determine whether the anxiety is primary or secondary in origin

3 (Positive self-concepts result from positive experiences, leading to perceived competence and acceptance. Assisting the patient in identifying such situations will aid in building confidence and one's perception of being competent. Being praised for successes is appropriate, but it must be reserved for situations that the individual recognizes as meaningful. Although stress management techniques are important, they are not linked directly to a sense of competence. Describing how one demonstrates control and competence is applicable but it has limited favor in actually assisting the patient in feeling competent.)

To support best improvement in an anxious individual's sense of control and competence, the nurse: 1 Provides lavish amounts of praise when the individual accomplishes assigned tasks. 2 Educates the individual regarding the usefulness of stress management techniques. 3 Helps the individual identify several stress situations that he or she was successful in managing. 4 Has the individual describe how one demonstrates control and competence over stress

3 (Caffeine is an antagonist of antianxiety medication. TB: I guess 4 mg/day is not excessive)

When prescribed lorazepam (Ativan) 1 mg orally four times a day for one week for generalized anxiety disorder, the nurse should 1 Question the health care provider's prescription because the dose is excessive 2 Explain the long-term nature of benzodiazepine therapy 3 Teach the patient to limit caffeine intake 4 Tell the patient to expect mild insomnia

2 (Benzodiazepines commonly are prescribed for anxiety because they have a quick onset of action; however, because of the potential for dependence, these medications ideally should be used for short periods. Benzodiazepines are not recommended for patients with a known substance abuse history. Tricyclics, selective serotonin reuptake inhibitors, and selective serotonin norepinephrine reuptake inhibitors do not create dependency.)

Which category of medication used to treat anxiety has a potential for dependence? 1 Tricyclics 2 Benzodiazepines 3 Selective serotonin reuptake inhibitors 4 Selective serotonin norepinephrine reuptake inhibitors

4 (This technique is a variant of cognitive restructuring. "I can't do that" is changed to "I can do it if I try.")

Which nursing intervention would be helpful when caring for a patient diagnosed with an anxiety disorder? 1 Express mild amusement over symptoms. 2 Arrange for patient to spend time away from others. 3 Advise patient to minimize exercise to conserve endorphins. 4 Reinforce use of positive self-talk to change negative assumptions

3 (Anxiety is an emotion without a specific object that is provoked by the unknown or by new experiences. Being worried about a test is a common expression of anxiety. An intense dislike for spiders, roller coasters, and parachuting are fears because they are focused.)

Which statement demonstrates an expression of anxiety rather than fear? 1 "I can't stand spiders." 2 "You'd never get me on a roller coaster." 3 "I really dislike knowing that we have a 50-point test tomorrow." 4 "I can't imagine why anyone would want to parachute out of an airplane."

4 (The purpose of cognitive restructuring is to change the individual's negative view of an event or a situation to a view that remains consistent with the facts but that is more positive)

Working to help the patient view an occurrence in a more positive light is called 1 Flooding 2 Desensitization 3 Response prevention 4 Cognitive restructuring