prep u chapter 68

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 client has been diagnosed with obsessive-compulsive anxiety disorder. The nurse would expect to find which of the following clinical manifestations?

Persistent unwanted thoughts

As anxiety is uneasiness without a readily identifiable cause and fear is a response to a known entity, there are many places which evoke an anxious or fearful response in people without anxiety disorders. Which of the following is not such a place?

bed

A new client in a residential treatment center is anxious, fearful, and lonely. What is the nurse's first step in the relationship with this client?

building trust

Heather is beginning a new job and is feeling anxious about her performance. Which of the following types of anxiety can improve functioning?

Mild

Which statement by a family member most closely reflects accurate understanding of the most common symptoms of posttraumatic stress disorder (PTSD)?

"My son started having bad dreams 6 months after returning from war."

The client has an order for an anxiolytic agent, lorazepam. Which of the following statements by the client would indicate that client education about this medication has been effective?

"This medication will relax me so I can focus on problem solving."

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 of the following responses is best?

"People with anxiety disorders generally find that the anxiety interferes with daily activities."

The nurse has instructed a client with panic disorder about how to use the technique of positive self-talk. The nurse determines that the client has understood the instructions when the client verbalizes which statement to use during an impending panic attack?

"I can handle this anxiety; it will be over shortly."

Which statement is typical of a client with social phobia?

"I know I can't accept that award for my brother."

A client diagnosed with panic disorder with agoraphobia is talking with the nurse about the progress made in treatment. Which statement indicates a positive client response?

"I went to the mall with my friend last Saturday."

A client is experiencing an anxiety attack. Which of these responses by the nurse would be most helpful for the client?

"I will stay with you."

A patient's medication regimen for treatment of anxiety has been changed from a benzodiazepine to buspirone (BuSpar). The patient asks the nurse what makes this medication safer than the benzodiazepine he has taken. What is the nurse's best response?

"It will not produce sedation like benzodiazepines."

A 25-year-old mother of two children younger than 6 years is very protective and will not allow them to play outdoors at all for fear of tick bites. She is worn out from cleaning the house from top to bottom every day. She asks the nurse how she can stop worrying so much. What is the most appropriate response from the nurse?

"Tell me your concerns about the children playing in your backyard."

A client whose mother was diagnosed with an anxiety disorder asks whether psychobiologic disorders are hereditary. What is the nurse's response?

"There can be a genetic predisposition."

A client who is experiencing a panic attack states, "I am going to die. I feel like I am suffocating." What is the nurse's best response?

"You are having a panic attack. I will not leave you alone."

During the admission assessment, a client with a panic disorder begins to hyperventilate and says, "I'm going to die if I don't get out of here right now!" What's the nurse's best response?

"You're having a panic attack. I'll stay here with you."

Which of the following clients is most likely to be at risk for drug dependence and difficulties with withdrawal?

A woman who has been taking lorazepam (Ativan) for several months after witnessing a traumatic motor vehicle accident.

When traveling alone and away from home, a client experiences trembling and palpitations. These symptoms have impeded the client from leaving her home. The nurse would correctly note that these are symptoms of which type of phobia?

Agoraphobia

The nurse is caring for a client who describes a fear of being in places that are difficult or embarrassing to leave. The client wants assistance to stop these troubling symptoms, which are beginning to impair social and occupational functioning. The nurse is able to plan care after determining that these are symptoms of:

Agoraphobia.

Which activities would be reasonable to teach a client who is prone to moderate to severe anxiety? Select all that apply.

All answers are correct.

Panic disorder is treated with cognitive-behavioral techniques and deep breathing and relaxation, in addition to which of the following?

Antianxiety medications

Which of the following treatment approaches has been proven to be the most beneficial for the client diagnosed with an anxiety disorder?

Antianxiety medications combined with psychotherapy

A client states to the nurse, "I am always worried about something. Sometimes I feel so overwhelmed because I have no one to help me." Which nursing assessment would be most fitting for the client at this time?

Anxiety

When discussing various types of anxiolytic medications with a client, the nurse recognizes that which of the following medications has the lowest potential for abuse?

Buspirone (BuSpar)

Which of the following is classified as a nonbenzodiazepine?

Buspirone (BuSpar)

When teaching a client with generalized anxiety disorder, the nurse instructs the client to avoid which of the following?

Caffeine

All of the following pharmacological agents are useful in treating anxiety disorders except:

Calcium channel blockers

The nurse is aware that all the following pharmacological agents are useful in treating anxiety disorders except:

Calcium channel blockers

A client spends hours arranging and rearranging furniture in his room. This behavior is identified as a:

Compulsion

A client spends hours stacking and unstacking towels. She is repeatedly checking to make sure that the towels are in order of color. This behavior is identified as a:

Compulsion

The nurse is planning a presentation to a group of nursing students on the topic of anxiety disorders. Which of the following would the nurse include when describing panic disorder?

Individuals may believe they are having a heart attack when a panic attack occurs.

What would be the most appropriate activity to suggest for a client experiencing anxiety?

Daily walks.

Nursing interventions that are appropriate for all clients with anxiety disorders are to reduce anxiety and

Develop alternative responses to anxiety-provoking situations

A nurse asks a client who is having an anxiety attack to count slowly backward from 100. What is the benefit of this intervention?

Distraction redirects the client's attention from distressing physiologic symptoms to the task at hand.

In teaching a client who has been prescribed a benzodiazepine for panic disorder, the nurse must be certain to:

Educate the client that this medication has a high risk for withdrawal symptoms, and he should not discontinue without a doctor's supervision.

A client with panic disorder is experiencing difficulty sleeping and is up at the nurses' station late at night. What will best help the client achieve healthy sleeping patterns?

Encourage the use of relaxation exercises or techniques.

Generalized anxiety disorder (GAD) is characterized by what?

Excessive worry or anxiety lasting more than 6 months

A group of students is reviewing information about social phobia in preparation for an oral class presentation on this topic. Which of the following would the students expect to include when describing a person with this condition? Select all that apply.

Fear that others will judge them negatively Demonstrate a distorted view of their own capabilities Exaggerate personal flaws

Posttraumatic stress disorder (PTSD) has been diagnosed in a sexually assaulted female client. Which of the following manifestations is the most consistent with PTSD?

Flashbacks

A 21-year-old woman has been recently diagnosed with agoraphobia. Which of the following situations is most likely to cause the woman anxiety?

Going to a crowded, outdoor market on her own.

A client with an anxiety disorder tells the nurse that her condition is causing her difficulty in solving problems. Place in the correct order the steps the nurse would use to assist the client with problem-solving.

Identifying problems Determining their causes Exploring possible solutions Examining the pros and cons of each option Selecting the choice that is most compatible with personal values

Which finding would the nurse expect to see in a client with agoraphobia who's experiencing a panic attack?

Inability to be alone in public places

A client diagnosed with obsessive-compulsive disorder (OCD) is attempting to resist a compulsion. Based on this finding, the nurse should assess the client for:

Increased anxiety

Working with a client with obsessive-compulsive disorder (OCD), a nurse notices that the client is attempting to resist his compulsion. While working with this client, the nurse should anticipate which concern with the client?

Increased anxiety.

Anxiety has both healthy and harmful aspects depending on its degree and duration as well as on how well the person copes with it. Which level of anxiety helps the client focus attention to learn, problem solve, think, act, feel, and protect himself or herself?

Mild

Why are older adults with impaired kidney functions at an increased risk for toxicity when administering antianxiety medications?

Kidneys excrete antianxiety agents.

The mental health nurse is gathering a health history on a new client. The client is constantly pacing the floor and stating that he is about to die. The nurse would classify this level of anxiety as which of the following?

Moderate

When a client is experiencing severe anxiety, which of the following is the priority intervention?

Move the client to a quiet environment

When implementing interventions to ensure the safety of a client with anxiety disorder, why is it best to have only one nurse generally interact with the client?

Multiple sources of stimulation add to agitation.

A female client describes her unpredictable episodes of acute anxiety as "just awful." She says that she feels like she's about to die and can hardly breathe. The nurse recognizes that the symptoms described by the client are associated with which condition?

Panic disorder

A client is admitted to the emergency department with diaphoresis, chest pain, vertigo, and palpitations. On initial assessment, it appears there is no physiologic basis for these complaints. The client is seen by the psychiatric emergency room nurse who, on recognition that the client has had four similar episodes in the past month, suspects what condition?

Panic disorder.

A client has a history of anxiety disorders and is being seen by a psychologist. When the client is feeling increasingly anxious, what should the nurse be aware of during client education sessions?

Perception of information narrows.

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

Phobic disorders

A client was in a plane crash a year ago and several people were killed. The client is now experiencing nightmares, insomnia, headaches, loss of appetite, and fatigue. Which disorder is the client most likely experiencing?

Posttraumatic stress disorder

Flashbacks and feelings of unreality are associated with which of the following?

Posttraumatic stress disorder (PTSD)

A client lost her home and beloved family dog in a flood. Months later, she tells the nurse that even though she and her family are nicely settled into a new home, she finds it hard to "feel anything." She says she can't concentrate on simple tasks, thinks about the flood incessantly, and fears losing control. She reports that she becomes extremely anxious whenever the flood is mentioned and must leave the room if people talk about it. The admitting nurse suspects she has:

Posttraumatic stress disorder (PTSD).

Clients taking benzodiazepines need education about which of the following?

Potentiation of alcohol effects

A client is diagnosed with agoraphobia. Of which of the following is this client afraid?

Public spaces

A client is admitted to an inpatient psychiatric unit for treatment of obsessive-compulsive symptoms. Obsessive-compulsive disorder (OCD) is associated with:

Repetitive thoughts and recurring impulses

Which of the following is the primary concern for a client with panic-level anxiety?

Safety

A 30-year-old woman who has been unemployed secondary to her anxiety disorder states that she would like to have a job where she is alone and no one needs to evaluate her work. The nurse interprets these comments as an indicator of which of the following?

Social phobia

A new client at an outpatient mental health service states, "When I have to face new people or situations—any situations in public, really—I start to perspire. My face gets so red I want to hide. I'm so afraid of embarrassing myself in public that I end up embarrassing myself. The words just can't come out. . . I'm a disaster!" The intake nurse can interpret these statements as indications of:

Social phobia.

The nurse enters the client's room and finds the client anxiously pacing the floor. The client begins shouting at the nurse, "Get out of my room!" The best intervention by the nurse would be to:

Stand at the doorway and say, "You seem upset."

The nurse is caring for a 53-year-old male client with posttraumatic stress disorder who's experiencing a frightening flashback. The nurse can best offer reassurance of safety and security through which nursing action?

Staying with the client

Which of the following would be an appropriate intervention for a client experiencing an anxiety attack?

Staying with the client and speaking in short sentences

A client with a diagnosis of generalized anxiety disorder wants to stop taking his lorazepam. Which important fact should the nurse discuss with the client about discontinuing the medication?

Stopping the drug can cause withdrawal symptoms.

Which behavior modification technique is useful in the treatment of phobias?

Systematic desensitization

All except which of the following are considered clinical symptoms of anxiety?

Tearfulness and sadness

A client with obsessive-compulsive disorder describes all doorknobs as being contaminated with a variety of viruses. He cleans each knob three times with paper towels before use. Such behavior allows the client to:

Temporarily reduce anxiety

A woman diagnosed with obsessive-compulsive disorder comes to the clinic with her husband. During the visit, the husband states, "She's always checking and rechecking to make sure that all of the appliances are turned off before we go out. It's nerve-wracking. We can never get out of the house on time. Isn't checking once enough?" An understanding of which of the following would the nurse need to incorporate into the response?

The client performs the ritual to relieve anxiety temporarily.

A nurse is caring for a client with social phobia. Which statement is most accurate regarding clients with social phobia?

They avoid social situations.

For a client with anxiety disorder who is taking antianxiety medication, why should the nurse instruct the client to avoid stimulating drugs such as nonprescription diet pills?

They stimulate the sympathetic nervous system.

The nurse should avoid which of the following interventions when dealing with a client having a panic attack?

Touching the client

The mental health nurse is developing a plan of care for a client experiencing acute anxiety. Which of the following would not be included in the plan of care for this client?

Touching the client in an attempt to comfort him

Which of the following would not be an initial intervention for the client with acute anxiety?

Touching the client in an attempt to comfort him

An employee left work suddenly due to experiencing palpitations, a smothering sensation, and light-headedness. This individual was due to meet with a supervisor for an important meeting later in the day. This person is most likely experiencing:

a panic attack.

A client, brought to the hospital in an agitated state, is admitted to a psychiatric unit for observation and treatment. While putting away personal effects, the client is talking rapidly and folding and unfolding garments several times. The client can't seem to settle down. Which nursing assessment would be of top priority at this time?

anxiety

Anxiety differs from fear, but the terms often are used interchangeably. Anxiety is a vague uneasy feeling, the cause of which is not readily identifiable. Fear is a feeling of terror in response to someone or something specific that a person perceives as dangerous or threatening. A client reports not having slept in 3 days for unexplainable reasons. The client reports having recent difficulties at work and is fearful about job stability. This client's condition would be described as:

anxiety.

A client is developing increasing symptoms of anxiety disorder and reports having urges to self harm. The nurse secures admission to a residential treatment facility and the client begins to shout at the nurse for betraying trust and ruining the client's life. What is the nurse's role in this situation?

assuring the client's safety

Which actions would be considered obsessive-compulsive? Select all that apply.

cleaning something repetitively hoarding unneeded items counting money repetitively

Psychotherapy involves talking with a psychiatrist, psychologist, clinical nurse specialist, or mental health counselor. Which types of therapy may be used with clients with anxiety disorders. Select all that apply.

cognitive therapy behavioral therapy

Clients using antianxiety drugs should be cautious when driving or performing tasks requiring mental alertness because antianxiety drugs may cause:

drowsiness.

A client is experiencing considerable stress while going through a divorce. She states her in-laws blame her drinking as the cause of the divorce. She adds, "These days, a few glasses of wine in the evenings help calm my nerves." A coping strategy the nurse might suggest is:

employing previously learned deep breathing and muscle relaxation techniques

A client reports constant anxiety that has lasted for the past 7 months. The client is concerned about job stability, personal relationships, and finances. This client's disorder is most likely:

generalized anxiety disorder.

At the encouragement of her husband, a client has sought care because of the overwhelming anxiety she experiences surrounding her young children's safety. The client admits that she will not normally let her children leave her sight for fear that they will be abducted, abused or injured and that she lives with a constant, underlying anxiety for their safety. The nurse would recognize that this client experiences:

generalized anxiety.

One of the major differences between generalized anxiety disorder (GAD) and panic disorder is that:

in GAD, the person usually does not experience eruptions of acute anxiety.

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:

is conducive to concentration and problem solving.

Beta-adrenergic blocking drugs are frequently prescribed for people with social phobia. This category of drugs does not cause sedation, tolerance, or addiction. They do, however:

lower blood pressure.

A client reports experiencing nightmares or flashbacks that cause sudden waking in a panicked state. The anxiety disorder the client is most likely experiencing is:

posttraumatic stress disorder.

When implementing nursing interventions for a client with anxiety disorder, it is important for the nurse to stay with the client during periods of severe anxiety in order to:

restore control to a more comfortable level.

A client appears confused and has trouble focusing on what the nurse is saying. The client reports nausea and dizziness, has tachycardia, and is hyperventilating. She tells the nurse that she feels as though something awful is going to happen. The nurse should assess the client's level of anxiety as:

severe

Situations that may induce social phobia include:

situations where one must perform in front of others. eating with others in a restaurant. attending a party where some attendees may be strangers.

Sharon is admitted for an appendectomy. As the nurse enters the room to prep Sharon for surgery, she is breathing rapidly, sweating, restless, and anxious. The nurse's most therapeutic intervention at this time would be to:

speak to Sharon with simple, short directions in a soothing voice, and do not ask her to make choices about positioning or comfort.

One major difference between posttraumatic stress disorder (PTSD) and the other anxiety disorders is that:

symptoms begin after exposure to a traumatic stressor.