Chapter 14: Anxiety (PrepU)
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." "With the development of more life skills and a demonstration of continued success in life, your anxiety will shrink and eventually disappear." "Every time you feel anxious, try to focus on how much easier your life would be if you didn't experience anxiety so often." "If you address the causes of your anxiety head-on, you will find that you can recover from it without medications or therapy."
"Anxiety is a feeling that is experienced by everyone at some point and it can never be completely removed from one's life." Explanation: It is therapeutic to foster in clients the understanding that the experience of anxiety is natural and inevitable. It would be inaccurate to promise recovery with increased success in life and self-discipline. Clients with anxiety are likely to be well aware of how much easier their lives would be without recurring 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 experience a fight-or-flight response when threatened." "People with anxiety disorders generally find that the anxiety interferes with daily activities." "Normal anxiety does not result in feelings of dread or restlessness." "Normal anxiety occurs in response to everyday stressors."
"People with anxiety disorders generally find that the anxiety interferes with daily activities." Explanation: Pathologic anxiety is suspected if a person feels anxious when no real threat exists, when a threat has passed long ago but continues to impair the person's functioning, or when a person substitutes adaptive coping mechanisms with maladaptive ones.
A client comes to the emergency department because the client thinks the client is having a heart attack. Further assessment determines that the client is not having a heart attack but is having a panic attack. When beginning to interview the client, which question would be most appropriate for the nurse to ask? "Are you feeling much better now that you are lying down?" "What did you experience just before and during the attack?" "Do you think you will be able to drive home?" "What do you think caused you to feel this way?"
"What did you experience just before and during the attack?" After it has been determined that the client does not have other medical problems, the nurse should assess for the characteristic symptoms of panic attack, focusing the questions on what the client was experiencing just before and during the attack. Asking the client if the client feels better provides no information for the nurse, and lying down may or may not be effective. Asking the client if the client thinks the client can drive home is a question that can be asked much later in the interview, after the attack subsides and the client is stable. Asking the client about what caused the attack is inappropriate because numerous stimuli, both external and internal, can provoke an attack. Most clients will not be able to identify a specific cause. The focus of care is on the characteristics of the attack.
The client reports that the client feels anxious when interacting socially with others and "never seems to know what to say." Which question indicates the nurse has a sound understanding of interpersonal theory as it relates to anxiety? "What kind of relationship do you have with your parents?" "Do other members of your family have similar problems?" "How long have you experienced these problems?" "What have you tried to help manage your feelings and discomfort?"
"What kind of relationship do you have with your parents?" Explanation: According to interpersonal theory, caregivers can communicate anxiety to infants or children through inadequate nurturing. Individuals who are exposed to poor parental nurturing may develop poor self-esteem or poor communication skills. The other options, although assessment-oriented questions, do not necessarily relate directly to this client's specific problem.
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? "I'm thankful that I have a way to manage my problems." "Defense mechanisms provide a sense of control over the uncontrollable." "I'm not sure when I'm actually using a defense mechanism." "When I have a problem, I just deny it until it goes away."
"When I have a problem, I just deny it until it goes away." Explanation: The dependence on one or two defense mechanisms also can inhibit emotional growth, lead to poor problem-solving skills, and create difficulty with relationships. Denial should not be used to deal with all of one's problems. None of the remaining options present untrue or troubling statements regarding defense mechanisms.
What does desensitization refer to? A systematic way to replace a panic response with a relaxation response A cognitive technique for replacing a worry with a positive statement Exposing the client to an anxiety-producing stimulus for 1 to 2 hours (flooding) Teaching the client to ignore or become immune to anxiety-producing situations
A systematic way to replace a panic response with a relaxation response Explanation: Systematic desensitization is a classical conditioning technique by which a client learns to replace gradually a panic response with a relaxation response. It is a behavioral therapy used to treat specific phobias, social phobias, agoraphobia, and posttraumatic stress disorder. The client progressively confronts the object of fear in very small, controlled steps while in a deeply relaxed state.
The most important factor in the person's stress response is what? Strength of the immune system Supportive friends Relaxation techniques Adaptive coping strategies
Adaptive coping strategies Explanation: The most important factor in a person's stress response is the ability of engage in adaptive coping behaviors. This ability can assist a person in developing resilience, or the ability to "bounce back" when faced with stress and stressful situations. The immune system, having a supportive network of friends, and understanding of relaxation techniques are also influencing factors when considering how an individual responds to stress; however, the correct option relates to an internal, sustainable strength that comes from adaptive coping.
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? Direct the client to continue deep breathing. Take the client on a walk around the unit. Take the client to the dayroom as a distraction. Administer the prescribed PRN anxiolytic medication.
Administer the prescribed PRN anxiolytic medication. Explanation: The client is experiencing severe anxiety. The client tells the nurse the client has tried other strategies but they have not been effective. Given the client's report of symptoms, it would be appropriate to administer a dose of the prescribed PRN anxiolytic medication. Once the client is experiencing a decrease in the uncomfortable physiologic symptoms associated with the severe anxiety, it will be easier to engage the client in nonpharmacological interventions, such as deep breathing, to manage any residual signs and symptoms of the anxiety.
Which medication classification has been found to be effective in reducing or eliminating panic attacks? Antidepressants Anticholinergics Antipsychotics Antimanics
Antidepressants Explanation: Tricyclic and monoamine oxidase inhibitor antidepressants have been found to be effective in treating clients with panic attacks. Why these drugs help control panic attacks is not clearly understood. Anticholinergic agents, which are smooth-muscle relaxants, relieve physical symptoms of anxiety but do not relieve the anxiety itself. Antipsychotic drugs are inappropriate because clients who experience panic attacks are not psychotic. Mood stabilizers are not indicated because panic attacks are rarely associated with mood changes.
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 People who experience anxiety tend to use maladaptive coping mechanisms Obsessive-compulsive behavior is often the result of abandonment
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 Explanation: When explaining the difference between anxiety and fear, the mental health nurse shares that anxiety involves experiencing subjective, uncomfortable feelings resulting from unknown causes. At some point in time, all people experience anxiety, as this is a normal human response to a threat or stress. It is inaccurate to say that people who experience anxiety tend to use maladaptive coping mechanisms. Obsessive compulsive disorder is a complex anxiety disorder that not only has its roots in abandonment, but there are multiple factors contributing to why this anxiety disorder may be present in individuals.
A biologic theory explains anxiety disorders in which way? Based in genetics with clinical symptoms being a result of chromosomal influence Rooted in episodes of physical or psychological abuse that occurred at times of developmental growth Originated from disappointments resulting from an exaggerated sense of self-worth Caused by substance abuse, particularly narcotics, resulting in damage to the brain's receptors
Based in genetics with clinical symptoms being a result of chromosomal influence Explanation: Research has provided solid evidence that anxiety disorders have a basis in genetics, with clinical symptoms a result of chromosomal influence.
A client responds to bad news regarding test results by crying uncontrollably. What is the term for this response to a stressor? Adaptation Homeostasis Coping mechanism Defense mechanism
Coping mechanism Explanation: When a person is in a threatening situation, immediate responses occur. Those responses, which are often involuntary, are called coping responses. The change that takes place as a result of the response to a stressor is adaptation.
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? Cognitive therapy Deep breathing Desensitization Problem-solving
Deep breathing Explanation: Helping the client focus on deep breathing can decrease the hyperarousal involved in panic attacks. It is also an opportunity for the therapist to teach the client self-help and adaptive coping mechanisms for panic attacks.
When assessing an elderly client who has newly been diagnosed with an anxiety disorder, the mental health nurse's priority is to carry out which task? Determine the client's risk for self-harm or harm to others Obtain a thorough history, focusing on the client's physiologic functioning Assess for physical conditions that may affect anxiety Determine the effects that culture has had on the client's anxiety issues
Determine the client's risk for self-harm or harm to others Explanation: 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 diagnosed with anxiety disorder has been prescribed benzodiazepine drugs. The nurse is explaining the possible side effects of the medications. Which side effects of the drug explained by the nurse is correct? Select all that apply. Agitation Dry mouth Blurred vision Constipation Vomiting
Dry mouth Blurred vision Constipation Explanation: Dry mouth, blurred vision, and constipation are known side effects of benzodiazepines. Agitation and vomiting are not known to occur with benzodiazepines. These side effects are associated with nonbenzodiazepine drugs that are used to treat anxiety like buspirone.
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? Endorphins Dopamine Epinephrine Testosterone
Epinephrine Explanation: In the sympathetic-adrenal-medullary response to stress, the sympathetic nervous system stimulates the adrenal gland to release epinephrine and norepinephrine. Corticotropin-releasing factor, adrenocorticotropic hormone (ACTH), and glucocorticoids are released in the hypothalamic-pituitary response to stress.
Nursing interventions for physical stress related illness should include what? Assessing the need for increased dose of benzodiazepines Attending group therapy Establishing daily routines of meals and sleeping Fostering use of a social support system
Establishing daily routines of meals and sleeping Explanation: Individuals experiencing or at risk for untoward stress responses may benefit from a number of biologic interventions. The importance of (re-)establishing regular routines for activities of daily living (e.g., eating, sleeping, self-care, and leisure time) cannot be overstated. As well as ensuring adequate nutrition, sleep and rest, and hygiene, a routine may help to structure an individual's time and give them a sense of personal control or mastery.
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? Reviewing the client's previous medication administration record and the client's current list of medications Questioning the client about the clinician who first diagnosed the medical problem Asking the client to provide a detailed explanation of his or her medical problem to determine if the presentation is typical of the problem Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first
Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first Explanation: Considering the relationship of anxiety with the onset, exacerbation, or remission of the general medical condition can help determine whether a medical condition contributes to anxiety or vice versa. The client's medication list, the identity of the clinician who diagnosed the disease, and the client's symptoms are all aspects of the assessment process, but these are less likely to establish the primary cause.
Generalized anxiety disorder (GAD) is characterized by what criteria? Excessive worry or anxiety lasting more than 6 months Flashbacks and feelings of unreality Fear of going outdoors Behavioral changes in response to panic attacks
Excessive worry or anxiety lasting more than 6 months Explanation: GAD is usually characterized by chronic and excessive worry and anxiety more days than not, occurring for at least 6 months and involving many aspects of the person's life.
The nurse is assessing a client with anxiety. What symptom indicates that the the client has adopted a maladaptive behavior in response to stress? Tachycardia Dyspnea Headache Pedal edema
Headache Explanation: Tension headache and pain syndromes in an anxious client indicate that the client has not responded to the stress effectively. Tachycardia and dyspnea are the signs related to the flight and fight response to stress, an automatic physiologic response. Pedal edema is not associated with stress.
A nurse is assessing a client with anxiety. Which signs and symptoms would the nurse attribute to sympathetic nervous stimulation? Select all that apply. Pressure to urinate Fainting Heart racing Hypertension Bradycardia
Heart racing Hypertension Explanation: 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 Fluoxetine Sertraline Lorazepam
Imipramine Explanation: The TCAs include imipramine, nortriptyline, and norpramine. Fluoxetine and sertraline are selective serotonin reuptake inhibitors (SSRIs). Lorazepam is a benzodiazepine.Which medication classification has been used to treat social phobia? Selective serotonin reuptake inhibitors (SSRIs) Monoamine oxidase inhibitors (MAOIs) Tricyclic antidepressants (TCAs) Nonbenzodiazepines
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. Increase the speed of the assessment in order to ensure that it is completed sooner and inform the client that the nurse is doing so. Provide education regarding the level of anxiety that the client may be experiencing. Explain to the client that the client's current feelings of anxiety have the potential to foster better coping skills in the future.
Inform the client that the assessment can be postponed if the client is finding it overwhelming. Explanation: If a client becomes agitated during an assessment, it is appropriate for the nurse to tell the client that the nurse can continue the assessment later. Performing the assessment faster or persisting is likely to exacerbate the client's anxiety. It would be inappropriate for the nurse to provide education regarding anxiety during a time that the client is restless and agitated. This indicates the client is experiencing moderate anxiety, narrowing the perceptual field to the immediate task. The client would not be receptive to any education provided. It would be inappropriate to tell the client that the client's current anxiety will serve a later purpose.
During which type of anxiety does a person's perceptual field actually increase? Mild Moderate Severe Panic
Mild Explanation: During mild anxiety, a person's perceptual field widens slightly, and the person is able to observe more than before and to see relationships. -During moderate anxiety, the perceptual field narrows slightly. The person does not notice what goes on peripheral to the immediate focus but can do so if attention is directed there by another observer. -The perceptual field is greatly reduced in severe anxiety. -During panic anxiety, the perceptual field is reduced to a detail, which is usually "blown up."
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." Reporting, "I just can't relax; I've got things to do." Telling another client that "there is nothing they can do for me; I just know it's really bad." Demonstrating difficulty actually verbalizing anxious feelings
Pacing and repeatedly asking staff what time the "doctor will be here." Explanation: The nurse documents that a client diagnosed with an anxiety disorder is experiencing moderate anxiety when the nurse observes the client pacing and repeatedly asking staff members when the doctor will arrive. Moderate anxiety is characterized by wandering attention. The client may require repeated redirection, such as in this scenario.
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? Obsessive-compulsive disorder (OCD) Panic disorder Acute stress disorder Nightmares
Panic disorder Explanation: Propranolol is used in the treatment of panic disorder, but it is not a common pharmacological intervention for OCD, acute stress disorder, or nightmares.
A client experiencing stress has tachycardia and tachypnea. On the basis of the physiological model of the general adaptation syndrome, in which stage is this client? Stress Alarm reaction Resistance Exhaustion
Resistance Explanation: The client is experiencing stress and has increased cardiac and respiratory function. This indicates that the client is in the resistance stage, where the body becomes ready for fight, flight, or freeze response. -In the alarm reaction stage, stress stimulates the body and the body prepares for its defense needs. -In the exhaustion stage, the person has negatively responded to stress. -There is no such stage as stress stage according to the model.
Which should be included in a teaching plan for a client prescribed a benzodiazepine? Rise slowly from a lying or sitting position Maintain a fluid restriction Consume caffeine in moderation Stop taking drug if sedation develops
Rise slowly from a lying or sitting position Explanation: Clients taking a benzodiazepine should rise slowly from a lying or sitting position. The client should drink adequate fluids, avoid caffeine, and not stop taking the drug abruptly.
A nurse is developing a plan of care for a client with panic disorder that will include pharmacologic therapy. Which would the nurse most likely expect to administer? Benzodiazepine Selective serotonin reuptake inhibitor (SSRI) Monoamine oxidase inhibitor (MAOI) Tricyclic antidepressant (TCA)
Selective serotonin reuptake inhibitor (SSRI) Explanation: Although all of the agents can be used to treat panic disorder, SSRIs are recommended as the first drug option for treatment. -Benzodiazepines (antianxiety agents) are used only for short periods of time. -MAOIs are reserved for clients who do not respond to SSRIs or serotonin-norepinephrine reuptake inhibitors. -The use of TCAs is declining.
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 Benzodiazepines Antihypertensives Tricyclic antidepressants
Selective serotonin reuptake inhibitors Explanation: Serotonin, the indolamine neurotransmitter usually implicated in psychosis and mood disorders. Although antihypertensives and benzodiazepines may be used, the selective serotonin reuptake inhibitors are recommended as the first drug option in the treatment of clients with panic disorder. They have the best safety profile, and if side effects occur, they tend to be present early in treatment before the therapeutic effect takes place. Tricyclic antidepressants are not typically used to treat panic disorder.
Which medication classification has been used to treat social phobia? Selective serotonin reuptake inhibitors (SSRIs) Monoamine oxidase inhibitors (MAOIs) Tricyclic antidepressants (TCAs) Nonbenzodiazepines
Selective serotonin reuptake inhibitors (SSRIs) Explanation: SSRIs are used to treat clients with social phobia because they significantly reduce social anxiety and phobic avoidance. Benzodiazepines are also used to reduce anxiety caused by phobias.
All except which are considered clinical symptoms of anxiety? Palpitations Extreme restlessness Motor excitement Tearfulness and sadness
Tearfulness and sadness Explanation: The clinical symptoms of anxiety are numerous. They are generally classified as physiologic, psychological or emotional, behavioral, and intellectual or cognitive responses to stress. The clinical symptoms may vary according to the level of anxiety exhibited by the client. Tearfulness and sadness are symptoms of depression, not of anxiety.
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 is probably physically dependent on alcohol. Drinking alcohol is more socially acceptable than taking medications. The client has no adaptive coping mechanisms. A few glasses of wine each night is not necessarily a problem.
The client has no adaptive coping mechanisms. Explanation: Clients learn to reduce the anxiety they feel in either functional or dysfunctional ways. The nurse first explores with the client what techniques the client has used in the past and helps the client identify and enhance those strategies that are most beneficial. The nurse and client identify maladaptive coping strategies, such as social withdrawal or alcohol use, and replace them with adaptive strategies that suit the client's personal, cultural, and spiritual values. The nurse should not ask the client to give up coping mechanisms, even maladaptive ones, without offering other adaptive mechanisms.
Which factor has the least influence on achieving mental health for the client who has anxiety disorder? The client's mother also suffered from an anxiety disorder. The client was raised in a household with high stress and frequent geographic moves. The client's mother often related to the client in ways that reflected the mother's high level of anxiety. The client is often late to school and makes poor grades in most of the client's subjects.
The client is often late to school and makes poor grades in most of the client's subjects. Explanation: Being late to school and making poor grades are behaviors that indicate that the client is having difficulty; they are not factors influencing the development of the client's anxiety disorder.
A nurse is talking with a client who has experienced panic attacks. The client asks the nurse, "What causes these attacks?" Which information would the nurse most likely integrate into the response about the etiology of panic disorders? There is evidence of a substantial familial predisposition to panic disorder Neurologic abnormalities are a rare occurrence with panic disorder The link between panic disorders and neurotransmitters is lacking There is a strong evidence supporting a psychodynamic influence
There is evidence of a substantial familial predisposition to panic disorder Explanation: There appears to be a substantial familial predisposition to panic disorder with an estimated heritability of 48%. Certain neurologic abnormalities have also been identified in clients with panic disorder. The most common abnormalities are found in the "fear network" of the brain, that is, the amygdala, hippocampus, thalamus, midbrain, pons, medulla, and cerebellum. Research shows a reduction in volume in some areas and increases in different brain areas. Research is establishing associations between the neurotransmitter pathways involved in regulation of the monoamine mechanism. Psychodynamic theories explain that anxiety develops after separation and loss. A great number of patients link their initial panic attack with recent personal losses. However, at this point the empirical evidence is inadequate for a psychodynamic explanation. It remains unclear why some patients develop panic disorder while others with similar experiences develop other disorders.
The nurse is teaching shoulder exercises to a client recovering from a mastectomy. The nurse might view the client's mild anxiety during the session positively, because mild anxiety helps what? Select all that apply. To focus attention to learn To feel and think To motivate to make a change To engage in goal-directed activity To calm restlessness
To focus attention to learn To feel and think To motivate to make a change To engage in goal-directed activity Explanation: During mild anxiety, sensory stimulation increases and helps the client focus attention to learn, solve problems, think, act, and feel. Mild anxiety often motivates the client to make changes or to engage in goal-directed activity. Restlessness is not a symptom of mild anxiety; rather it is seen in moderate anxiety.
A group of students is reviewing information about anxiety disorders in preparation for a class examination. The students demonstrate understanding of the material when they state what? Anxiety disorders rank second to depression in psychiatric illnesses being treated. Women experience anxiety disorders more often than do men. Most anxiety disorders tend to be short term with individuals achieving full recovery. Anxiety disorders are more common among children than among adolescents.
Women experience anxiety disorders more often than do men. Explanation: Women experience anxiety disorders more often than do men by a 2-to-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.