Chapter 14

The nurse is caring for a client who is anxious and loudly swearing. A staff member pulls the nurse aside and tells them "you are sweaty and flushed, are you alright?" Which initial action(s) by the nurse are most appropriate? Select all that apply.

Recognize the symptoms as a stress response. Reflect on whether actions are therapeutic.

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

Reduction of autonomic arousal

The nurse observes a client that is attending their first group therapy session, exhibiting anxious behaviors. Which is the priority action for the nurse to take to promote comfort when attending the session?

Remain calm when approaching and encouraging the client to attend.

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?

adaptive coping skills will be developed

An adult client is being treated in the outpatient clinic for anxiety related to endocrine dysfunction. Which disorder will the nurse document in the client's medical record?

anxiety disorder due to another medical condition

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.

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 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

A client with a panic disorder is prescribed a selective serotonin reuptake inhibitor (SSRI). For which reason would the nurse expect the client to also be prescribed a long-acting benzodiazepine?

it produces less symptoms when discontinued Treatment of panic disorder may include benzodiazepines concurrently with antidepressants for the first 4 weeks and then tapering to a maintenance dose. This strategy provides rapid symptom relief but avoids the complications of long-term benzodiazepine use. Benzodiazepines with a long-half life accumulate in the body but are removed more slowly and produce less intense symptoms when discontinued.

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

mild

The nurse is caring for a client that is diagnosed with an anxiety disorder. The client reports chest pain and has dilated pupils, a heart rate of 126, and a BP of 168/102 mmHg. Which stage of anxiety does the nurse document the client is experiencing?

panic

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 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

The most important factor in the person's stress response is what?

Adaptive coping strategies

A client asks the nurse, "How can I tell if what I am experiencing is an anxiety disorder and not regular worrying?" Which is the nurse's best response?

"Anxiety disorders impair your ability to function occupationally and socially."

The nurse is assessing a client who recently experienced their first panic attack while at the grocery store. What question will the nurse ask to identify complications of the disorder?

"Do you have any problems going out alone to public places?"

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?" 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.

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

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

The nurse reviews techniques to enhance cognitive functioning for a client with a panic disorder. Which client statement indicates that teaching has been effective?

"I will use positive coping statements that I have prepared."

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?

"Let's perform some breathing exercises to reduce your anxiety."

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."

The nurse is educating a client that is experiencing mild anxiety. Which statement made by the client indicates that the education is effective?

"Some degree of anxiety is beneficial for learning."

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.

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 diagnosed with panic disorder is being admitted to the psychiatric-mental health unit for panic attacks. Which client outcome would be appropriate in the immediate phase of care?

"The client will respond to relaxation techniques with staff assistance and demonstrate a decreased anxiety level within 2 to 3 days."

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?"

A group of new nurses is reviewing information about anxiety disorders in preparation for their first day on the job. The lead nurse providing this information believes that the new nurses demonstrate understanding of the material when they make what statement?

"Women experience anxiety disorders more often than do men." Women experience anxiety disorders more often than do men by a 2:1 ratio. Anxiety disorders are the most common of the psychiatric illnesses treated by health care providers. They tend to be chronic and persistent illnesses with full recovery more likely among those who do not have other mental or physical illnesses. Anxiety disorders are the most common condition of adolescents, with one in three having an anxiety disorder.

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

Allow the client to pace

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

40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months GAD is characterized by excessive worry and feelings of anxiety at least 50% of the time for 6 months or more. The client with GAD has three or more of the following symptoms: uneasiness, irritability, muscle tension, fatigue, difficulty thinking, and sleep alterations.

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

Panic disorder is treated with cognitive-behavioral techniques, deep breathing, and relaxation, in addition to what?

Antidepressants

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

Antidepressants

A client who was discharged from the inpatient facility is sitting in the dayroom waiting for their transportation. Suddenly the client starts throwing papers and stomping their feet. Which initial action is appropriate?

Assess the use of defense mechanisms. The most appropriate initial action is the assessment of whether the client is displaying a defense mechanism of acting out when experiencing anxiety. Clients who are preparing to leave the inpatient unit are likely to feel anxious about the impending change.

A biologic theory explains anxiety disorders in which way?

Based in genetics with clinical symptoms being a result of chromosomal influence

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

Determine the client's risk for self-harm or harm to others The first step in the assessment process is to identify the client's level of anxiety and to determine whether a threat of self-harm or harm to others exists. In any situation where the client history is not known, the nursing priority is safety.

A client responds to bad news regarding test results by crying uncontrollably. What is the term for this response to a stressor?

Coping mechanism

An adult client being admitted to the psychiatric-mental health unit is experiencing severe anxiety. What is the nurse's priority action for the client?

Decrease the client's anxiety level.

An adult client being admitted to the psychiatric-mental health unit is experiencing severe anxiety. What is the nurse's priority action for the client?

Decrease the client's anxiety level. When anxiety becomes severe, the client can no longer pay attention or take in information. The nurse's goal must be to lower the person's anxiety level to moderate or mild before proceeding with anything else. The client will not be able to problem solve or learn while experiencing severe anxiety. The nurse should stay with the client, not leave them alone, while experiencing severe anxiety because of the safety risks present.

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

Depersonalization 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.

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

Distorted sensory awareness

A client with an anxiety disorder spends most free time alone. Which strategy would the nurse suggest to develop a sense of connection with others?

Engage in a recreational activity.

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 In the sympathetic-adrenal-medullary response to stress, the sympathetic nervous system stimulates the adrenal gland to release epinephrine and norepinephrine.

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 providing education to a client regarding panic disorder. Which will the nurse include when preparing the education? Select all that apply.

Explain use of adaptive coping skills. Describe alternate nonpharmacological treatment modalities. Involve family and support persons when appropriate. Provide feedback to support the client. A nursing role in providing client education regarding anxiety includes introducing appropriate coping skills, identifying alternate treatment modalities, involving family and support persons when appropriate, and providing feedback that is supportive to the client. . The nurse should arrange to evaluate the success of the intervention and adjust the treatment plan accordingly.

A 21-year-old client has been recently diagnosed with agoraphobia. Which situation is mostlikely to cause the client anxiety?

Going to a crowded, outdoor market independently

A client comes in for a therapy session and begins to have a panic attack. The therapist asks the client to sit 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?

Guided imagery Guided imagery involves imagining a safe, enjoyable place to relax. In desensitization, the therapist progressively exposes the client to the threatening object in a safe setting until the client's anxiety decreases. Decatastrophizing involves the therapist's use of questions to more realistically appraise the situation. In progressive relaxation, the client progressively tightens, holds, and then relaxes muscle groups while letting tension flow from the body through rhythmic breathing.

While conducting a class on anxiety and stress reduction, a nurse describes the symptoms of anxiety (including panic), informing the class that the physical symptoms of a panic attack can mimic what?

Heart attack

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 Heart racing and hypertension are anxiety signs and symptoms related to sympathetic nervous stimulation. Pressure to urinate, fainting, and bradycardia are related to parasympathetic nervous stimulation.

Which is considered a tricyclic antidepressant (TCA) used in the treatment of clients with panic disorder?

Imipramine

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 nurse is providing a client information about the etiology of generalized anxiety disorder (GAD). The client demonstrates understanding of this information when they identify which item as representing the basis for this disorder?

Intense worry and stress about life

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

Is conducive to concentration and problem solving

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 Propranolol is used in the treatment of panic disorder

A client is diagnosed with a panic disorder. Which action will the nurse take when the client arrives for an appointment in the community clinic?

Provide a list of community resources.

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

Providing the client with a comforting touch

A 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) SSRIs are used to treat clients with social phobia because they significantly reduce social anxiety and phobic avoidance. Some benzodiazepines (e.g., alprazolam [Xanax]) and nonbenzodiazepines (e.g., buspirone [BuSpar]) are also used to reduce anxiety caused by phobias. MAOIs and TCAs are generally used to treat depression if SSRIs have been ineffective. Antihistamines have a number of uses, and some (e.g., hydroxyzine ([Vistaril, Atarax]) can be used to treat anxiety, but they are not indicated for social phobia.

The mental health nurse is gathering a health history on a new client. The nurse has difficulty getting the client's attention, and the client is pacing the floor and concerned only with stating that they are about to die. The nurse would classify this level of anxiety as what?

Severe

A client is experiencing a panic attack in the clinic waiting room. Which is the priority action by the nurse?

Sit with the client and let them know they are safe and the attack will be over soon.

A client has been unemployed related to frequent absences due to an anxiety disorder and informs the nurse they would like to have a job working alone without someone evaluating their performance. How will the nurse interpret this comment?

Social anxiety disorder is the cause for the client's behavior.

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?

Social phobia

Which condition involves a persistent, irrational fear attached to an object or situation that objectively does not pose a significant danger?

Specific phobia

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.

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 The sympathetic nervous system activates the fight or flight response quickly as a survival response that results in an increased heart and respiratory rate, moist hands and feet, and dilated pupils. The parasympathetic system is most active in nonstressful events.

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

The client has insufficient adaptive coping mechanisms.

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

The client is aware and alert A client who is mildly anxious is aware, alert, sees, hears, and grasps more than before. Selective inattention reflects moderate anxiety. Focusing attention on a small area reflects severe anxiety. Feelings of unreality are associated with panic.

The nurse is assessing a client with anxiety. Which behavior might indicate that the client has moderate anxiety?

The client is nervous and agitated. 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 is often late to school and makes poor grades in most of the client's subjects.

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

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

The 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.

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?

The client with a high anxiety level experiencing disorganized thoughts.

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 have an enhanced sense of security. 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.

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.

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

The nurse explains the purpose of a daily goals sheet to a client experiencing moderate anxiety. Which action would the nurse implement in consideration of the client's level of anxiety?

Use short, simple terms to explain the purpose of the activity.

An adult client diagnosed with panic disorder is being counseled in the clinic. The nurse teaches the client that when they are experiencing severe anxiety or panic, instead of thinking, "I am going to die," the client learns to think, "This is anxiety, and it will go away." Which technique is the nurse utilizing with the client?

positive reframing

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

When an older adult experiences anxiety for the first time in his or her life, the anxiety may be associated with another condition. Anxiety that starts for the first time in late life is frequently associated with another condition such as depression, dementia, physical illness, or medication toxicity or withdrawal. Phobias, particularly agoraphobia, and generalized anxiety disorder are the most common late-life anxiety disorders. Most people with late-onset agoraphobia attribute the start of the disorder to the abrupt onset of a physical illness or as a response to a traumatic event such as a fall or mugging. Ruminative thoughts are common in late-life depression and can take the form of obsessions such as contamination fears, pathologic doubt, or fear of harming others.

An adult client is seeking psychotherapy for an intense fear of traumatic injuries that cause marked distress and difficulty with occupational functioning for the client. Which phobia would the nurse document in the client's medical record?

blood-injection phobia he diagnosis of a phobic disorder is made only when the phobic behavior significantly interferes with the person's life by creating marked distress or difficulty in interpersonal or occupational functioning. Natural environmental phobias include fear of storms, water, heights, or other natural phenomena. Blood-injection phobias include fear of seeing one's own or other's blood, traumatic injury, or an invasive medical procedure such as an injection. Situational phobias include fear of being in a specific situation such as on a bridge or in a tunnel, elevator, small room, hospital, or airplane.

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 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

The nurse is reviewing a treatment plan for an older adult client with a diagnosis of anxiety and difficulty falling asleep. The nurse questions which prescription from the health care provider?

diazepam 10 mg oral daily There is significant evidence that there are many potential risks of prescribing benzodiazepines to older adults and the nurse should question the order for diazepam 10 mg because of the drug class and high dose. The treatment of choice for anxiety disorders in older adults is selective serotonin reuptake inhibitor (SSRI) antidepressants. Initial treatment involves doses lower than the usual starting doses for adults to ensure that the older adult client can tolerate the medication. Orders for the SSRI medication citalopram at the lower dose of 10 mg daily is an appropriate prescription.

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 Flooding is a form of rapid desensitization in which a behavioral therapist confronts the client with the phobic object until it no longer produces anxiety. The goal is to rid the client of the phobia within two sessions. Biofeedback is a slower form of therapy that uses reframing of thought. Decatastrophizing helps the client confront a "worst-case" scenario but is not used in confronting phobias.

An adult client diagnosed with panic disorder is being counseled in the clinic. The nurse teaches the client that when they are experiencing severe anxiety or panic, instead of thinking, "I am going to die," the client learns to think, "This is anxiety, and it will go away." Which technique is the nurse utilizing with the client?

positive reframing Cognitive-behavioral therapy (CBT) is used successfully to treat anxiety disorders. Positive reframing means turning negative messages into positive messages. De-catastrophizing involves the therapist's use of questions to appraise the situation more realistically. The therapist may ask, "What is the worst thing that could happen? Is that likely? Could you survive that? Is that as bad as you imagine?" The client uses thought-stopping and distraction techniques to jolt themselves from focusing on negative thoughts. Assertiveness training helps the person take more control over life situations. These techniques help the person negotiate interpersonal situations and foster self-assurance. They involve using "I" statements to identify feelings and to communicate concerns or needs to others. Examples include "I feel angry when you turn your back while I'm talking."

The nurse is caring for a client with a panic disorder. For which first-line medication would the nurse prepare teaching for this client?

selective serotonin reuptake inhibitors (SSRIs)

A psychiatric-mental health nurse counsels a client experiencing anxiety. Which maladaptive response may result if the anxiety is not controlled for the client?

tension headaches Anxiety causes uncomfortable cognitive, psychomotor, and physiological responses, such as difficulty with logical thought, increasingly agitated motor activity, and elevated vital signs. To reduce these uncomfortable feelings, the person tries to reduce the level of discomfort by implementing new adaptive behaviors or defense mechanisms. Adaptive behaviors can be positive and help the person learn, for example, using imagery techniques to refocus attention on a pleasant scene, practicing sequential relaxation of the body from head to toe and breathing slowly and steadily to reduce muscle tension and vital signs. Negative responses to anxiety can result in maladaptive behaviors such as tension headaches, pain syndromes, and stress-related responses that reduce the efficiency of the immune system. The responses of relaxation of the body, baseline vital signs, and using imagery techniques demonstrate adaptive responses. However, tension headaches may result as a maladaptive response to untreated anxiety.