Chapter 15 Evolve Questions (Anxiety and Obsessive-Compulsive Disorders)

Which medication is FDA approved for treatment of anxiety in children? A. Sertraline B. Fluoxetine C. Clomipramine D. Duloxetine

d (A few drugs are approved specifically for anxiety and obsessive-compulsive disorders in children and adolescents. The FDA approved the selective SNRI duloxetine (Cymbalta) in 2014 for children aged 7 to 17 years for generalized anxiety disorder. The FDA has approved four medications for use in children with obsessive-compulsive disorder. They are clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine (Luvox), and sertraline (Zoloft).)

When prescribed lorazepam (Ativan) 1 mg po qid for 1 week for generalized anxiety disorder, the nurse should A. question the physician's order because the dose is excessive. B. explain the long-term nature of benzodiazepine therapy. C. teach the client to limit caffeine intake. D. tell the client to expect mild insomnia.

c (Caffeine is an antagonist of antianxiety medication. None of the other options present accurate information regarding lorazepam.)

The nurse is caring for a patient on day 1 post surgical procedure. The patient becomes visibly anxious and short of breath, and states, "I feel so anxious! Something is wrong!" What action should the nurse take initially in response to the patient's actions? A. Reassure the patient that what they are feeling is normal anxiety and do deep breathing exercises with her. B. Use the call light to inquire whether the patient has been prescribed prn anxiety medication. C. Call for staff help and assess the client's vital signs. D. Reassure the patient that you will stay until the anxiety subsides.

c (In anxiety caused by a medical condition, the individual's symptoms of anxiety are a direct physiological result of a medical condition, such as hyperthyroidism, pulmonary embolism, or cardiac dysrhythmias. In this case, Lana is postoperative and could be experiencing a pulmonary embolism, as evidenced by the shortness of breath and anxiety. She needs immediate evaluation for any serious medical condition. The other options would all be appropriate after it has been determined that no serious medical condition is causing the anxiety.)

Panic attacks in Latin American individuals often involve demonstration of which behavior? A. Repetitive involuntary actions B. Blushing C. Fear of dying D. Offensive verbalizations

c (Panic attacks in Latin Americans and Northern Europeans often involve sensations of choking, smothering, numbness or tingling, as well as fear of dying. This information directs you to the correct options.)

The record mentions states that the client habitually relies on rationalization. The nurse might expect the client to present with what behavior? A. Makes jokes to relieve tension. B. Misses appointments. C. Justifies illogical ideas and feelings. D. Behaves in ways that are the opposite of his or her feelings.

c (Rationalization involves justifying illogical or unreasonable ideas or feelings by developing logical explanations that satisfy the teller and the listener. None of the other options present with this behavior.)

A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, and "burns" money that could be better spent to feed the poor is demonstrating which ego defense mechanism? A. Projection B. Rationalization C. Reaction formation D. Undoing

c (Reaction formation keeps unacceptable feelings or behaviors out of awareness by developing the opposite behavior or emotion. This behavior is not associated with any of the other options.)

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

c (Response prevention is a technique by which the client is prevented from engaging in the compulsive ritual. A form of behavior therapy, response prevention is never undertaken without physician approval. None of the other options reflect accurate information regarding this form of therapy.)

A client frantically reports to the nurse that "You have got to help me! Something terrible is happening. I can't think. My heart is pounding, and my head is throbbing." The nurse should assess the client's level of anxiety as A. mild. B. moderate. C. severe. D. panic.

c (Severe anxiety is characterized by feelings of falling apart and impending doom, impaired cognition, and severe somatic symptoms such as headache and pounding heart. Mild and moderate levels of anxiety do not demonstrate these feels while panic is even more intense than the scenario implies.)

A Gulf War veteran is entering treatment for post-traumatic stress disorder. What assessment is of importance to this particular client? A. Ascertain how long ago the trauma occurred. B. Find out if the client uses acting-out behavior. C. Determine the use of chemical substances for anxiety relief. D. Establish whether the client has chronic hypertension related to high anxiety.

c (Substance abuse often coexists with post-traumatic stress disorder. It is often the client's way of self-medicating to gain relief of symptoms.)

A cultural characteristic that may be observed in a teenage, female Hispanic client in times of stress would include what behavior? A. Suddenly tremble severely B. Exhibit stoic behavior C. Report both nausea and vomiting D. Laugh inappropriately

a (Ataque de nervios (attack of the nerves) is a culture-bound syndrome that is seen in undereducated, disadvantaged females of Hispanic ethnicity. None of the other options are associated with this cultural response to stress.)

A client who is demonstrating a moderate level of anxiety tells the nurse, "I am so anxious, and I do not know what to do." Which response should the nurse make initially? A. "What things have you done in the past that helped you feel more comfortable?" B. "Let's try to focus on that adorable little granddaughter of yours." C. "Why don't you sit down over there and work on that jigsaw puzzle?" D. "Try not to think about the feelings and sensations you're experiencing."

a (Because the client is not able to think through the problem and arrive at an action that would lower anxiety, the nurse can assist by asking what has worked in the past. Often what has been helpful in the past can be used again. While distraction may be helpful in some situations, it is not the initial intervention.)

Generally, which statement regarding ego defense mechanisms is true? A. They often involve some degree of self-deception. B. They are rarely used by mentally healthy people. C. They seldom make the person more comfortable. D. They are usually effective in resolving conflicts.

a (Most ego defense mechanisms, with the exception of the mature defenses, alter the individual's perception of reality to produce varying degrees of self-deception. This information helps eliminate the other options as the correct statement.)

What is a possible outcome criterion for a client diagnosed with anxiety disorder? A. Client demonstrates effective coping strategies. B. Client reports reduced hallucinations. C. Client reports feelings of tension and fatigue. D. Client demonstrates persistent avoidance behaviors.

a (Option A is the only desirable outcome listed for this diagnosis.)

Inability to leave one's home because of avoidance of severe anxiety suggests the existence of which anxiety disorder? A. Panic attacks with agoraphobia B. Obsessive-compulsive disorder C. Posttraumatic stress response D. Generalized anxiety disorder

a (Panic disorder with agoraphobia is characterized by recurrent panic attacks combined with agoraphobia. Agoraphobia involves intense, excessive anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available if a panic attack occurred. None of the other options are associated with this form of anxiety.)

A client experiencing a panic attack keeps repeating, "Im dying, I can't breathe.". What action by the nurse should be most therapeutic initially? A. Encouraging the client to take slow, deep breaths B. Verbalizing mild disapproval of the anxious behavior C. Asking the client what he means when he says "I am dying." D. Offering an explanation about why the symptoms are occurring

a (Slow diaphragmatic breathing can induce relaxation and reduce symptoms of anxiety. Often the nurse has to tell the client to "breathe with me" and keep the client focused on the task. The slower breathing also reduces the threat of hypercapnia with its attendant symptoms. The client needs help to regain composure and stabilize vital signs; the only option that addresses these issues is the correct option.)

The nurse anticipates that the nursing history of a client diagnosed with obsessive compulsive disorder (OCD) will reveal what common assessment data? Select all that apply. A. A history of childhood trauma B. A sibling with the disorder C. A history of sexual abuse D. A previous suicide attempt E. An eating disorder

a, b, c, e (Sexual and physical abuse in childhood or trauma increases the risk of this disorder. Genetics are strongly associated with this disorder. First-degree relatives have twice the risk. OCD tends to occur along with anxiety disorders 76% of the time. Other comorbid conditions include major depressive disorder, bipolar disorder, and eating disorders. Suicide while a concern is not among the most common issues for the client diagnosed with OCD.)

What defense mechanisms can only be used in healthy ways? A. Suppression and humor B. Altruism and sublimation C. Idealization and splitting D. Reaction formation and denial

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

A 72-year-old patient diagnosed with Parkinson's disease is demonstrating behaviors associated with anxiety and has had several falls lately and is reluctant to take medications as prescribed. When his provider orders lorazepam, 1 mg PO bid, the nurse questions the prescription based primarily on what fact? A. The client may become addicted faster than younger patients. B. The client is at risk for falls. C. The client has a history of nonadherence with medications. D. The client should be treated with cognitive therapies because of his advanced age.

b (An important nursing intervention is to monitor for side effects of the benzodiazepines, including sedation, ataxia, and decreased cognitive function. In a patient who has a history of falls, lorazepam would be contraindicated because it may cause sedation and ataxia leading to more falls. There is no evidence to suggest that elderly patients become addicted faster than younger patients. A history of nonadherence would not lead to you to question this drug order. Medication and other therapies are used congruently with all age levels.)

A man continues to speak of his wife as though she were still alive, 3 years after her death. This behavior suggests the use of which ego defense mechanism? A. Altruism B. Denial C. Undoing D. Suppression

b (Denial involves escaping unpleasant reality by ignoring its existence. This is not the outcome of any of the other options.)

A client is diagnosed with generalized anxiety disorder (GAD). The nursing assessment supports this diagnosis when the client reports which information? A. Symptoms started right after being robbed at gunpoint. B. Being unable to work for the last 12 months. C. Eating in public makes the client extremely uncomfortable. D. Repeated verbalizing prayers results in a relaxed feeling.

b (GAD is characterized by symptomatology that lasts 6 months or longer. None of the other descriptions would support the diagnosis.)

What can be said about the comorbidity of anxiety disorders? A. Anxiety disorders generally exist alone. B. Depression may occur prior to onset of anxiety. C. Anxiety disorders virtually never coexist with mood disorders. D. Substance abuse disorders rarely coexist with anxiety disorders.

b (In many instances, major depression may occur prior to the onset of panic disorder or may occur at the same time. Clinicians and researchers have clearly shown that anxiety disorders frequently co-occur with other psychiatric problems. Major depression often co-occurs and produces a greater impairment with poorer response to treatment.)

An obsession is defined as what? A. Thinking of an action and immediately taking the action B. A recurrent, persistent thought or impulse C. An intense irrational fear of an object or situation D. A recurrent behavior performed in the same manner

b (Obsessions are thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind. None of the remaining statements are accurate when defining the term obsession.)

A client's daughter states, "My mother lives with me since my dad died 6 months ago. For the past couple of months, every time I need to leave the house for work or anything else, Mom becomes extremely anxious and cries that something terrible is going to happen to me. She seems OK except for these times, but it's affecting my ability to go to work." This information supports that the client may be experiencing which anxiety-related disorder? A. Panic disorder B. Adult separation anxiety disorder C. Agoraphobia D. Social anxiety disorder

b (People with separation anxiety disorder exhibit developmentally inappropriate levels of concern over being away from a significant other. There may also be fear that something horrible will happen to the other person. Adult separation anxiety disorder may begin in childhood or adulthood. The scenario doesn't describe panic disorder. Agoraphobia is characterized by intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available. Social anxiety disorder, also called social phobia, is characterized by severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others.)

A 20-year-old was sexually molested at age 10, but he can no longer remember the incident. Which ego defense mechanism is in use? A. Projection B. Repression C. Displacement D. Reaction formation

b (Repression is a defense mechanism that excludes unwanted or unpleasant experiences, emotions, or ideas from conscious awareness. This is not the outcome of any of the other options.)

Selective inattention is first noted when experiencing which level of anxiety? A. Mild B. Moderate C. Severe D. Panic

b (When moderate anxiety is present, the individual's perceptual field is reduced and the client is not able to see the entire picture of events. This is not an initial characteristic of any of the other levels of anxiety.)

The nurse caring for a client experiencing a panic attack anticipates that the psychiatrist would order a stat dose of which classification of medications? A. Standard antipsychotic medication. B. Tricyclic antidepressant medication. C. Anticholinergic medication. D. A short-acting benzodiazepine medication.

d (A short-acting benzodiazepine is the only type of medication listed that would lessen the client's symptoms of anxiety within a few minutes. Anticholinergics do not lower anxiety; tricyclic antidepressants have very little antianxiety effect and have a slow onset of action; and a standard antipsychotic medication will lower anxiety but has a slower onset of action and the potential for more side effects.)

What is the major distinction between fear and anxiety? A. Fear is a universal experience; anxiety is neurotic. B. Fear enables constructive action; anxiety is dysfunctional. C. Fear is a psychological experience; anxiety is a physiological experience. D. Fear is a response to a specific danger; anxiety is a response to an unknown danger.

d (Fear is a response to an objective danger; anxiety is a response to a subjective danger. This information helps identify the correct option.)

Delusionary thinking is a characteristic of which form of anxiety? A. Chronic anxiety B. Acute anxiety C. Severe anxiety D. Panic level anxiety

d (Panic level anxiety is the most extreme level and results in markedly disturbed thinking greater than in any of the other options.)

The nurse is providing teaching to a preoperative patient just before surgery. The patient is becoming more and more anxious and begins to report dizziness and heart pounding. The patient also appears confused and is trembling noticeably. Considering the scenario, what decision should the nurse make? A. To reinforce the preoperative teaching by restating it slowly. B. Have the patient read the teaching materials instead of providing verbal instruction. C. Have a family member read the preoperative materials to the patient. D. Do not attempt any further teaching at this time.

d (Patients experiencing severe anxiety, as the symptoms suggest, are unable to learn or solve problems. The other options would not be effective because you are still attempting to teach someone who has a severe level of anxiety.)

A symptom commonly associated with panic attacks? A. Obsessions B. Apathy C. Fever D. Fear of impending doom

d (The feelings of terror present during a panic attack are so severe that normal function is suspended, the perceptual field is severely limited, and misinterpretation of reality may occur. None of the other symptoms are associated with a panic attack.)

Working to help the client view an occurrence in a more positive light is referred to by which term? A. Flooding B. Desensitization C. Response prevention D. Cognitive restructuring

d (The purpose of cognitive restructuring is to change the individual's negative view of an event or a situation to a view that remains consistent with the facts but that is more positive. This is not necessarily true of any of the other options.)