chp 14
Anxiety disorder is considered chronic and generalized when excessive anxiety and worry about two or more life circumstances exist for at least ...
6 months
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.
Which medication classifications used in the treatment of panic disorder can cause physical dependence?
benzodiazepines
What anxiolytic medications decreased the potential for abuse?
buspirone
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
paroxetine
paxil SSRI
moderate
person can still process information, solve problems, and learn new things with assistance from others. Client has difficulty concentrating independently; can be redirected to the topic
Which condition involves a persistent, irrational fear attached to an object or situation that objectively does not pose a significant danger?
phobic disorders
A 30-year-old client who has been unemployed secondary to the client's 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 anxiety disorder
A young parent tells the nurse, "I can't stop smoking. That is what I do to make myself feel better." What is the term used to describe this behavior?
coping mechanism
The nurse 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 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."
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."
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 client is currently experiencing panic. Which action would be most appropriate for the nurse to do?
Allow the client to pace
A biologic theory explains anxiety disorders in which way?
Based in genetics with clinical symptoms being a result of chromosomal influence
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
What is the rationale for why a nurse should be aware of your own feelings and level of discomfort?
Anxiety is communicated interpersonally. Being with an anxious client can raise your anxiety own anxiety level.
What is the rationale for moving the client to a quiet area with minimal or decreased stimuli such as a small room of seclusion area?
Anxious behaviors can be escalated by external stimuli. In a large area, the client can feel lost and panicky, but a smaller room can enhance a sense of security.
A hospitalized client states that the client is having difficulty resting. Which intervention would help promote rest?
Assisting the client with deep-breathing exercises
Buspirone
Buspar non-benzodiazepine
Clonidine
Catapres Beta blocker
propranolol
Inderal alpha adrenergic agonist social anxiety
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
Generalized anxiety disorder (GAD) is characterized by what criteria?
Excessive worry or anxiety lasting more than 6 months
Alprazolam is a benzodiazpeine, which affects which neurotransmitter that is dysfunctional in anxiety?
GABA
Clonazepam
Klonopin Benzodiazepine
Chlordiazepoxide
Librium Benzodiazepine
If a client is is taking a medication and is experience drug dependence and is having difficulty withdrawing. What is the client most likely taking?
Lorazepam - benzodiazepine for several months
What is the rationale for PRN medications and why they may be indicated for high levels of anxiety, delusions, disorganized thoughts?
Medication may be necessary to decrease anxiety at a level which the client can feel safe
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."
Fluoxetine
Prozac SSRI
What medication is used to treat social phobia?
SSRI
A person with panic disorder may be prescribed?
SSRI Benzodiazepine for short term use
Which medication classification has been used to treat social phobia?
SSRI's
What is the rationale for encouraging the client to identify supportive resources in the community or on the internet?
Supportive resources can assist the client in the ongoing management of his or her anxiety and decrease social isolation
A Benzodiazepine is being taken for panic attacks. What should the nurse be certain to do for the client?
Tell the client to not stop taking the benzodiazepine without supervision The med has high withdrawal symptoms
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.
The nurse is assessing a client with anxiety. Which behavior might indicate that the client has moderate anxiety?
The client is nervous and agitated.
What is the rationale for helping the client see that mild anxiety can not be a positive catalyst for change and does not need to be avoided?
The client may feel that all anxiety is bad and not useful.
What is the rationale for avoiding asking or forcing the client to make choices?
The client may not make sound decisions or may be unable to make decisions or solve problems
What is the rationale for remaining calm in your approach to the client?
The client will feel more secure if you are calm and if the client feels you in control of the situation.
What is the rationale for encouraging the client to identify and pursue relationships, personal interests, hobbies or recreational activities that may appeal to the client?
The client's anxiety may have prevented him or her from engaging in relationships or activities recently but these can be helpful in building confidence and having a focus on something other than anxiety
The nurse at the student health center is seeing a group of nursing students who are interested in reducing their stress level. The nurse identifies guided imagery as an appropriate intervention. What does guided imagery involve?
The mindful use of a word, phrase, or visual image, which allows oneself to be distracted and temporarily escape from stressful situations
Imipramine
Tofranil tricyclic
A nurse assesses a client and determines that the client is experiencing mild anxiety based on what?
Using appropriate coping skill 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 would the nurse likely include? Select all that apply.
Using appropriate coping skill Identifying treatment modalities Involving family for support, if appropriate Providing supportive feedback
What is the rationale for teaching the client to use relaxation techniques independently?
Using relaxation techniques can give the client confidence in having control over anxiety.
Diazepam
Valium benzodiazepine
Alprazolam
Xanax benzodiazepine
What is the term for the change that takes place in response to a stressor?
adaptation
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
What should teaching include for someone with agoraphobia taking alprazolam?
avoid alcohol because alprazolam is a benzodiazepine
What should teaching include for someone that is taking MAOI's?
avoid tyramines
What is not used to treat anxiety disorders?
calcium channel blockers
The nurse walks into the client's room and finds the client sobbing uncontrollably. When the nurse asks what the problem is, the client responds, "I am so scared. I have never known anyone who goes into a hospital and comes out alive." On this client's care plan the nurse notes a nursing diagnosis of ineffective coping related to stress. What is the best outcome to be expected for this client?
client will adapt relaxation techniques to reduce stress
What is the rationale for use of short, simple, and clear statements?
clients ability to deal with abstractions or complexity is impaired
A client spends hours stacking and unstacking towels. The client is repeatedly checking to make sure that the towels are in order of color. What term is used to identify this behavior?
compulsion
Clients taking benzodiazepines need education about what?
concomitant use of alcohol
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?
deep breathing
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
Which term describes feelings of being disconnected from oneself as seen in a panic attack?
depersonalization
moderate anxiety
disturbing feeling that something is definitely wrong; person becomes nervous or agitated
What neurotransmitter is affected in schizophrenia?
dopamine
side effects of nonbenzodiazepine
drowsiness, agitation, restlessness, dizziness, headache, weakness, nausea, vomiting
side effects of benzodiazepine
drowsiness, sedation, poor coordination, impaired memory, dizziness, sexual dysfunction, blurred vision, dry mouth, increased potential for abuse/dependence, headache, fatigue, constipation
If a client with anxiety disorder is prescribed a benzodiazepine, what are the potential side effects?
dry mouth, blurred vision, constipation
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
fear
feeling afraid or threatened by a clearly identifiable external stimulus that represents danger to the person
A 21-year-old client has been recently diagnosed with agoraphobia. Which situation is most likely to cause the client anxiety?
going to a crowded, outdoor market independently
What is a tricyclic prescribed for panic disorder?
imipramine
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
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 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
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 conductive to concentration and problem solving
A client diagnosed with panic disorder has been receiving medication therapy, which is being discontinued. A nurse would be alert for possible withdrawal symptoms if the client was receiving what?
lorazepam
What would be included in client education about lorazepam?
medication will relax to focus on problem solving
A client reports the client is beginning a new job and is feeling anxious about the client's performance. The nurse can explain which type of anxiety can actually improve functioning?
mild
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
During which type of anxiety does a person's perceptual field actually increase?
mild
meprobarnate
miltown, equanil non-benxodiazepine
When a client is experiencing panic, which is the priority intervention?
move the client to a quiet environment
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
What is the rationale for encouraging the client's participation in relaxation exercises such as deep breathing, PMR, meditation, and imagining being in a quiet, peaceful place?
relaxation exercises are effective, nonmechanical ways to reduce anxiety
What would be included in a teaching plan for a client on benzodiazepines?
rise slowly from lying or sitting
A school health nurse is meeting with the parents of a 6-year-old child who has been selectively mute. The nurse is offering the parents education regarding this problem. The nurse can tell the parents that what is true about selective mutism?
selective mutisim is associated with social anxiety
mild anxiety
sensation that something is different and warrants special attention
mild
sensory stimulation that increases and helps the person focus, solve problems, think, act, feel, and protect himself or herself
oxazepam
serax benzodiazepine
What neurotransmitter is affected in depression?
serotonin
Anxiety disorder is considered chronic and generalized when excessive anxiety and worry about two or more life circumstances exist for at least ...
stay with the client and remain calm
Which would be an appropriate intervention for a client experiencing an anxiety attack?
staying with the client and speaking in short sentences
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
All except which are considered clinical symptoms of anxiety?
tearfulness and sadness
What is the rationale for remaining with the client at all times when levels of anxiety are severe or panic?
the clients safety is a priority. A highly anxious client should not be left alone- his or her anxiety will escalate
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 a client in an attempt to comfort the client
Chlorazepate
tranxene Benzodiazepine
anxiety
vague feeling of dread or apprehension; response to external or internal stimulus that represents danger to the person
Hydroxyzine
vistaril, atarax antihistamine
sertraline
zoloft SSRI