Chp 15 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? Encouraging the client to take slow, deep breaths Verbalizing mild disapproval of the anxious behavior Asking the client what he means when he says "I am dying." Offering an explanation about why the symptoms are occurring

Encouraging the client to take slow, deep breaths 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

Glossophobia

Fear of speaking in public or of trying to speak.

SSRIs

Fluoxetine, paroxetine, sertraline, citalopram.

Obsessions vs compulsions

Obsessions: repeated intrusive uncontrollable thoughts/impulses that cause distress Compulsions: repeated physical/mental behaviors that are done in RESPONSE to an obsession

Maladaptive use of defense mechanisms

Occurs when one or several defense mechanisms are used in excess disallowing goals to be acheived

A male patient is running from chair to chair in the solarium. He is wide-eyed and keeps repeating, "they are coming! They are coming!" He neither follows staff direction nor responds to verbal efforts to calm him. The level anxiety can be assessed as:

Panic Panic-level anxiety results in markedly disorganized, disturbed behavior including confusion, shouting, and hallucinating. Individuals may be unable to follow directions and may need external limits to ensure safety

Severe to panic leads of anxiety interventions

Priority nursing interventions are to provide for the safety of the Pt's and others and to meet physical needs fluids and rest to Prevent exhaustion - anxiety-reduction measures may Take the form of guiding The person to aquiet environment. The use of medication and Restraints and seclusion may have to be considered - as always, both medications and restraints should be used Only after other less-restrictive interventions have to be Considered

Duloxetine (Cymbalta)

SNRI antidepressant

Venlafaxine (Effexor)

SNRI antidepressant -good option

A potential problem for a patient diagnosed with severe obsessive-compulsive disorder is

Sleep disturbance Patients who must engage in compulsive rituals for anxiety relief rarely are afforded relief for any prolonged period. THe high anxiety level and need to perform the ritual may interfere with sleep

Anxiety

The condition of feeling uneasy or worried about what may happen -Dread from a real or Percieved threat, apprehension, uncertainty

A nurse observes a patient who often pulls out his or her hair. What appropriate condition does the nurse report to the primary health care provider based upon this observation?

The patient has trichotillomania Psychiatric patients often pull out their hair to relieve stress. Trichorrhexis is a defect in the hair shaft where the hair becomes thin and breaks of easilily Trichophagia is when a patient secretly swallow the pulled hair Rapunzel syndrome is when the masses of hair present in the stomach

A 72-year-old patient diagnosed with Parkinson's disease and anxiety. The healthcare provider prescribes a benzodiazepine. The nurse questions this prescription based on what fact related to this classification of medications?

This medication would increase the patient's risk for falls.

Antidepressants

a class of psychotropic medications used for the treatment of anxiety - sSRI's are the ist one of treatment -benzodiazepines-risk of dependence, acute treatment only

xenophobia

a fear or hatred of foreigners or strangers

The nurse assesses an adult who is socially withdrawn and hoards. Which nursing diagnoses most likely apply to this individual? (Select all that apply.)

a. Ineffective home maintenance c. Chronic low self-esteem e. Risk for injury Shame regarding the appearance of one's home is associated with hoarding. The behavior is usually associated with chronic low self-esteem. Hoarding results in problems of home maintenance, which may precipitate injury. The self-concept may be affected, but not body image.

pyrophobia

abnormal fear of fire

Benzodiazepines

anti-anxiety drugs - acute procedure only, gad, panic disorders, agoraphobia -quick onset / fast acting

The initial nursing action for a newly admitted anxious client is to A. assess the client's use of defense mechanisms. B. assess the client's level of anxiety. C. limit environmental stimuli. D. provide antianxiety medication.

assess the client's level of anxiety.

When alprazolam is prescribed for a patient who experiences acute anxiety, health teaching should include instructions to a. report drowsiness. b. eat a tyramine-free diet. c. avoid alcoholic beverages. d. adjust dose and frequency based on anxiety level.

c. avoid alcoholic beverages. Drinking alcohol or taking other anxiolytics along with the prescribed benzodiazepine should be avoided because depressant effects of both drugs will be potentiated. Tyramine-free diets are necessary only with monoamine oxidase inhibitors (MAOIs). Drowsiness is an expected effect and needs to be reported only if it is excessive. Patients should be taught not to deviate from the prescribed dose and schedule for administration.

A patient undergoing diagnostic tests says, "Nothing is wrong with me except a stubborn chest cold." The spouse reports the patient smokes, coughs daily, lost 15 pounds, and is easily fatigued. Which defense mechanism is the patient using? a. Displacement b. Regression c. Projection d. Denial

d. Denial Denial is an unconscious blocking of threatening or painful information or feelings. Regression involves using behaviors appropriate at an earlier stage of psychosexual development. Displacement shifts feelings to a more neutral person or object. Projection attributes one's own unacceptable thoughts or feelings to another.

A nurse conducts a clinical interview with children to assess types of anxiety. Which scale does the nurse use to measure phobias present in the children

fear questionnaire is measuring phobias present in patients The patients are asked about the different types of fear which they experience. The rating is given according to the intensity. Yale-brown OCD scale is used to measure severity of compulsive behavior. Hoarding scale self-report is used to measure hoarding in a patient Panic severity scale is used to measure panic symptoms

Adaptive use of defense mechanisms

helps people lower anxiety to achieve goals in acceptable ways

A possible outcome criterion for a patient diagnosed with anxiety disorder is

patient demonstrates effective coping strategies

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

teach the client to limit caffeine intake. Caffeine is an antagonist of antianxiety medication. None of the other options present accurate information regarding lorazepam.

The nurse assesses a patient who complains of loneliness and episodes of anxiety. Which statement by the patient is mostly likely if this patient also has agoraphobia?

"Being afraid to go out seems ridiculous, but I can't go out the door." Individuals who are agoraphobic generally acknowledge that the behavior is not constructive and that they do not really like it. The symptom is ego dystonic. However, patients will state they are unable to change the behavior. Agoraphobics are not optimistic about change. Most families are dissatisfied when family members refuse to leave the house.

Interventions for anxiety

- Milieu therapy, opportunity to learn and practice anxiety Reduction techniques -Psychoeducation about anxiety and what it does to your body -community resources -coping skills, -stress management

Severe Anxiety Interventions

-decrease environmental stimuli -speak in a calm low voice - use firm short, simple sentences -pt are feeling out of control, so they need to know they are safe from their own impulses -remain with client - give client simple choices -make sure client is physically comfortable - set clear limits on unsafe or inappropriate behavior -work with client if it helps to calm them down

Thought stopping

A cognitive-behavioral method in which the client learns to stop having anxiety-provoking thoughts. -pt may be directed to say stop out loud or to use a rubber band - the distraction briefly blocks the automatic thoughts and cues the patient to select an alternative, More positive idea -after exercise the pt gives the command silently

systematic desensitization

A type of exposure therapy that associates a pleasant relaxed state with gradually increasing anxiety-triggering stimuli. -through a series of steps from least frightening to frightening - introducing a feather -the pt is taught to use a relaxation technique at each step when anxiety becomes overwhelming Commonly used to treat phobias. '

Two staff nurses applied for promotion to nurse manager. The nurse not promoted initially had feelings of loss but then became supportive of the new manager by helping make the transition smooth and encouraging others. Which term best describes the nurse's response?

Altruism Altruism is the mechanism by which an individual deals with emotional conflict by meeting the needs of others and receiving gratification vicariously or from the responses of others. The nurse's reaction is conscious rather than unconscious. There is no evidence of suppression. Intellectualization is a process in which events are analyzed based on remote, cold facts and without passion, rather than incorporating feeling and emotion into the processing. Reaction formation is when unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite behavior or emotion.

An obsession is defined as 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. a recurrent, persistent thought or impulse. obsessions are thoughts, impulses or images that persist and recur so that they cannot be dismissed from the mind

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 A. altruism. B. denial. C. undoing. D. suppression.

Denial Involves escaping unpleasant reality by ignoring its existence

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

Fear of dying Panic attacks in Latin Americans and Northern Europeans often involve sensations of choking, smothering, numbness or tingling, as well as fear of dying.

If the record mentions that the patient habitually relies of rationalization, the nurse might expect the patient to

Justify illogical ideas and feelings Rationalization involves Justifying illogical ideas, unreasonable ideas or feelings by developing logical explanations that satisfy the teller and the listener

A patient with an abdominal mass is scheduled for a biopsy. The patient has difficulty understanding the nurse's comments and asks, "What do you mean? What are they going to do?" Assessment findings include tremulous voice, respirations 28, and pulse 110. What is the patient's level of anxiety?

Moderate Moderate anxiety causes the individual to grasp less information and reduces problem-solving ability to a less-than-optimal level. Mild anxiety heightens attention and enhances problem solving. Severe anxiety causes great reduction in the perceptual field. Panic-level anxiety results in disorganized behavior.

Delusionary thinking is a characteristic of which form of anxiety? Chronic anxiety Acute anxiety Severe anxiety Panic level anxiety

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

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? Projection Rationalization Reaction formation Undoing

Reaction formation 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.

Which nursing intervention would be helpful when caring for a patient diagnosed with an anxiety disorder? Express mild amusement over symptoms. Arrange for patient to spend time away from others. Advise patient to minimize exercise to conserve endorphins. Reinforce use of positive self-talk to change negative assumptions.

Reinforce use of positive self-talk to change negative assumptions. Rationale This technique is a variant of cognitive restructuring. "I can't do that" is changed to "I can do it if I try."

Fluoxetine

SSRI antidepressant-watch for tremors since this can cause serotonin syndrome w/in 2-72 - most activation

A person has minor physical injuries after an auto accident. The person is unable to focus and says, "I feel like something awful is going to happen." This person has nausea, dizziness, tachycardia, and hyperventilation. What is the person's level of anxiety?

Severe The person whose anxiety is severe is unable to solve problems and may have a poor grasp of what is happening in the environment. Somatic symptoms such as those described are usually present. The individual with mild anxiety is only mildly uncomfortable and may even find his or her performance enhanced. The individual with moderate anxiety grasps less information about a situation and has some difficulty with problem solving. The individual in panic will demonstrate markedly disturbed behavior and may lose touch with reality.

Benzodiazepines

The most common group of antianxiety drugs, which includes Lorazepam Diazepam Clonazepam (Valium) alprazolam (Xanax)

monophobia

an abnormal fear of being the only one there; fear of being alone

Specific phobias

any of the disorders characterized by extreme and irrational fear of a particular object or situation - characterized by experience of high levels of anxiety or fear in response to specific objects -could be crippling anxiety and daily functioning is compromised and people go to great lengths to Avoid the feared situation or object - tend to run in families such as first degree relatives

A patient says, "I have to wash my hands five times before I can eat breakfast." what behavior is the patient demonstrating?

compulsion Patient is demonstrating a ritualistic behavior Obsessions are perfectionism, superstition and contamination

nyctophobia

fear of darkness

Mysophobia

fear of dirt and germs

acrophobia

fear of heights

Trichotilomania

recurrent pulling out of one's hair resulting in hair loss. Repeated attempts to decrease/stop.

A patient receives a new prescription for sertraline (Zoloft) 50 mg daily. The patient phones the nurse and says, "I read on the internet that this drug is for depression. I have social anxiety, not depression." Which response should the nurse provide? "The website was incorrect. Sertraline is an antianxiety medication rather than an antidepressant. "Thank you for informing us of this error. I will discuss the situation with your health care provider and call you back shortly." "Certain antidepressant medications work well for managing anxiety. It may take several weeks for you to feel the full benefit." "It is important for you to take the medication. Try to have confidence in your health care provider's judgment about how to help you."

"Certain antidepressant medications work well for managing anxiety. It may take several weeks for you to feel the full benefit." Rationale Selective serotonin reuptake inhibitors ( SSRIs) are considered the first line of defense in most anxiety disorders, including social anxiety. Sertraline and paroxetine (Paxil) are SSRIs with calming effects. The nurse should provide accurate information to the patient and respond therapeutically to evidence that the patient is trying to selfeducate via the internet.

A nurse assesses a patient with a tentative diagnosis of generalized anxiety disorder. Which question would be most appropriate for the nurse to ask?

"Do you find it difficult to control your worrying?" Patients with generalized anxiety disorder frequently engage in excessive worrying. They are less likely to engage in ritualistic behavior, fear social situations, or have been involved in a highly traumatic event.

A cruel and abusive person often uses rationalization to explain the behavior. Which comment demonstrates use of this defense mechanism? "I don't know why I do mean things." "I don't know why I do mean things." "That person should not have provoked me." "I'm really a coward who is afraid of being hurt."

"That person should not have provoked me." Rationalization consists of justifying one's unacceptable behavior by developing explanations that satisfy the teller and attempt to satisfy the listener. The abuser is suggesting that the abuse is not his or her fault; it would not have occurred except for the provocation by the other person. The distracters indicate some measure of acceptance of responsibility for the behavior.

projection (defense mechanism)

- Attributing feelings or impulses unacceptable to ones self to another person. Unconscious rejection of emotionally unacceptable features & Attributing them to others - considered an immature defense mechanism EX: Sue feels a strong sexual attraction to her track coach and tells her friend, "Hes coming on to me!" - a woman has repressed sexual attractions to other women - coming home then work and yelling at the wife. Or bulling Refuses to socialize with women, she fears she will or other Women will make sexual advances to her

SSRI's side/adverse effects

- May induce agitation, anxiety, sleep disturbance, tremor, dizziness sexual dysfunction, tension headache, dry mouth, sweating, weight gain, mild nausea or loose bowel movements - Serious adverse effect: Serotonin Syndrome

Cognitive therapy for anxiety

- Reframe negative thoughts or cognitions that trigger anxiety -cognitive restructuring

flooding therapy

A behavioral treatment for phobias that involves prolonged exposure to a feared stimulus, thereby providing maximal opportunity for the conditioned fear response to be extinguished. - exposes the pt to large amounts of an undesirable stimulus in an effort to extinguish the anxiety Response -the pt learns through prolonged exposure that survival is possible and that anxiety diminishes Spontaneously

A patient experiencing panic suddenly began running and shouting, "I'm going to explode!" Select the nurse's best action.

A patient experiencing panic suddenly began running and shouting, "I'm going to explode!" Select the nurse's best action. Safety needs of the patient and other patients are a priority. Comments to the patient should be simple, neutral, and give direction to help the patient regain control. Running after the patient will increase the patient's anxiety. More than one staff member may be needed to provide physical limits, but using seclusion or physically restraining the patient prematurely is unjustified. Asking the patient to give an example would be futile; a patient in panic processes information poorly.

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

Altruism and sublimation 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

Which category of medication used to treat anxiety has a potential for dependence? Tricyclics Benzodiazepines Selective serotonin reuptake inhibitors Selective serotonin norepinephrine reuptake inhibitors

Benzodiazepines Have a quick onset of action, but can cause dependence, should only be used for short periods. Not for pt who have substance abuse hx.

What statement is true regarding normal anxiety? Select all that apply. A degree of anxiety is necessary and healthy Unlike fear, it is a reaction to a specific danger It is a factor in the achievement of personal goals It motivates people to make and survive change in their lives It provides the energy needed to achieve tasks related to living

A degree of anxiety is necessary and healthy It is a factor in the achievement of personal goals It motivates people to make and survive change in their lives It provides the energy needed to achieve tasks related to living Rationale Normal anxiety is a healthy reaction necessary for survival. It provides the energy needed to carry out the tasks involved in living and striving toward goals. Anxiety motivates people to make and survive change. Fear is a reaction to a specific danger, whereas anxiety is a vague sense of dread related to an unspecified or unknown danger.

Undoing - defense mechanism

A person try's to make up for an action from an act or communication Maladaptive: performing often ritualistic activity in order to relieve anxiety about unconscious drives (e.g. washing hands after murder; noisy teen cleans room without being asked) (undo the murder by washing hands)

mild anxiety

Adaptive and motivates for change/Awareness heightened/Learning enhanced/Seldom a problem - more vigilant, heightened attention, sharp focus - more acute perceptual field - a person experiencing mild anxiety sees, hears, and grasps more information and problem solving becomes more effective -considers alternative indecision-making Physiological response: - some discomfort from sympathetic arousal -sensitive to startle, irritable, venous habits - physical symptoms may include slight discomfort, restlessness, Nail biting, foot or finger tapping, fidgeting, s impatient, -may be constructive because anxiety may be signal that Something in the persons life needs attention or is dangerous

A patient just learned that a family member was diagnosed with a serious illness. At this time, the patient is pacing, distracted, breathing rapidly, complaining of nausea, and having trouble focusing on anything other than the family member's illness. Which initial nursing comment is most therapeutic?

Address the patient by name and say. "you are safe. First take a deep breath." The patient is experiencing severe anxiety, so the perceptual field is reduced greatly. The person may be dazed and confused. Behavior is automatic and usually includes somatic symptoms (e.g, headache, nausea, dizziness, insomnia, trembling, hyperventilation, palpitations. Appropriate nursing interventions are to provide for safety and offer firm, short and simple statements. When the person's anxiety levels lowers, feelings can be explored. Threats to calm down and false reassurance are not therapeutic and will be ineffective during this level of anxiety.

A patient is fearful of riding in elevators and always takes the stairs. Which brain structure is involved in this fear and behavior? Thalamus Amygdala Hypothalamus Pituitary gland

Amygdala Rationale The amygdala plays a role in anxiety disorders. It alerts the brain to the presence of danger and brings about fear or anxiety to preserve the system. Memories with emotional significance are stored in the amygdala and are implicated in phobic responses. The thalamus relays sensory information to other brain centers. The hypothalamus is involved in regulation of the autonomic nervous system. The pituitary gland secretes regulatory hormones.

A teenager changes study habits to earn better grades after initially failing a test. This behavioral change is likely a result of A. a rude awakening. B. normal anxiety. C. trait anxiety. D. altruism.

B. normal anxiety. Is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions

A patient is diagnosed with generalized anxiety disorder (GAD). The nursing assessment supports this diagnosis when the patient reports Repeatedly verbalizing prayers helps the patient feel relaxed That eating in public makes the patient extremely uncomfortable That the symptoms started right after the patient was robbed at gunpoint Being so worried the patient hasn't been able to work for the last 12 months

Being so worried the patient hasn't been able to work for the last 12 months Rationale GAD is characterized by symptomology that lasts six months or longer.

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

Being unable to work for the last 12 months. GAD is characterized by symptomatology that lasts 6 months or longer. None of the other descriptions would support the diagnosis.

Working to help the patient view an occurrence in a more positive light is called which of the following? a. Flooding b. Desensitization c. Response prevention d. Cognitive restructuring

Cognitive restructuring purpose of Cognitive restructuring is to change the individuals negative view of an event or situation to a view that remains consistent with the facts but that is more positive

A child is extremely upset because of being constantly bullied by peers for having a short stature. While giving advice to the child, the nurse states, "Your stature is not going to affect your fitness. You could always excel in other aspects like sports and academics." Which defense mechanism is the nurse encouraging in the child? Dissociation Identification Displacement Compensation

Compensation Rationale The advice given by the nurse indicates that the nurse is trying to counterbalance the perceived deficiencies in the child and advising him or her to focus on other activities. The nurse is encouraging the positive use of compensation as a defense mechanism. Displacement is a defense mechanism wherein an individual transfers the emotions related to a particular person or situation to a nonthreatening person or object. Identification is a defense mechanism wherein an individual tries to imitate the characteristics of another person or group. Dissociation is a defense mechanism wherein an individual mentally separates himself or herself from unpleasant situations.

A patient is experiencing moderate anxiety. The nurse encourages the patient to talk about feelings and concerns. What is the rationale for this intervention?

Concerns stated aloud become less overwhelming and help problem solving begin. All principles listed are valid, but the only rationale directly related to the intervention of assisting the patient to talk about feelings and concerns is the one that states that concerns spoken aloud become less overwhelming and help problem solving begin.

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

Depression may occur prior to onset of anxiety. 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.

The primary purpose of performing a physical examination before beginning treatment for any anxiety disorder is to Protect the nurse legally Establish the nursing diagnoses of priority Obtain information about the patient's psychosocial background. Determine whether the anxiety is primary or secondary in origin

Determine whether the anxiety is primary or secondary in origin Rationale The symptoms of anxiety can be caused by a number of physical disorders or are said to be caused by an underlying physical disorder. The treatment for secondary anxiety is treatment of the underlying cause.

Which medication is FDA approved for treatment of anxiety in children? Sertraline Fluoxetine Clomipramine Duloxetine

Duloxetine 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).

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

Fear is a response to a specific danger; anxiety is a response to an unknown danger. Fear is a response to an objective danger; anxiety is a response to a subjective danger. This information helps identify the correct option.

A woman gets a report of abnormal cells from a Pap smear. She calls her attorney to prepare a will and tells her family, "I won't be around much longer." Which nursing diagnosis and etiology best apply to this situation? Deficient knowledge related to reasons for Pap smears. Disturbed thought processes related to malignant cancer. Fear related to misinterpretation and misinformation about Pap tests. Risk-prone health behavior related to a negative vision for the future.

Fear related to misinterpretation and misinformation about Pap tests. Rationale Fear is a response to a perceived threat or danger that may inhibit problem-solving and lead to apprehension about the future. The person is ill-informed about the diagnosis and misinterprets the potential outcome. Deficient knowledge about the diagnosis is an indication for informing the patient. There is no indication that the woman has disturbed thought process. The woman is not displaying risk prone behaviors.

A woman gets a report of abnormal cells from a routine pap test. She anxiously says to her spouse, " I have cancer/ It probably has spread all over my body." Which nursing diagnosis and etiology best apply to this situation

Fear related to misinterpretation and misinformation about pap tests anxiety has a unknown or unrecognized source, whereas fear is a reaction to a specific threat. There is no evidence of spiritual distress or ineffective coping at this point. The patient's anxiety is moderate.

sublimation (defense mechanism)

Is an uncounscious process of substituting mature & socially - a positive defense mechanism, positive way to protect ego acceptable activity for immature & unacceptable impulses Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive. EX: Mom of son killed by drunk driver, president of MADD. -use of sublimation is always constructive Adaptive use: a woman who's angry with her boss writes a short Essay

Buspirone is prescribed for a patient with anxiety. Which instruction should the nurse provide to this patient?

It will take two to four weeks for your to feel the full benefit Buspirone is an alternative anti-anxiety medication that does not cause dependence, but two to four weeks are required for it to reach full effects. It should be taken with food. The drug may be used for long-term treatment and should be taken regularly Aged cheese products should be avoided when taking MAOIs

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

Justifies illogical ideas and feelings. 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.

Which therapeutic intervention can the nurse implement personally to help a patient diagnosed with a mild anxiety disorder regain control? Flooding Modeling Thought stopping Systematic desensitization

Modeling Rationale Modeling calm behavior in the face of anxiety or unafraid behavior in the presence of a feared stimulus are interventions that can be used independently. Flooding, thought stopping, and systematic desensitization require agreement of the treatment team.

After considering the following information, which nursing intervention would have priority when a patient is experiencing an "attack of the nerves" (ataque de nervios)? Explaining that these symptoms are related to extreme anxiety Taking the person's pulse to monitor for possible cardiac dysrhythmias Minimizing the risk for fainting by encouraging the person to take slow, deep breaths Moving the person away from stairs and furniture so as to minimize injury from a fall

Moving the person away from stairs and furniture so as to minimize injury from a fall Rationale This is a disorder found primarily among Hispanic populations in response to stressful events, such as a death, acute family discord, or witnessing an accident. Symptoms are dramatic, and people afflicted by ataque de nervios exhibit sudden trembling, faintness, palpitations, out-of-control shouting, heat that moves from the chest to head, and seizure-like activities. While all the interventions are appropriate, priority is given to the active intervention that focuses on the risk for injury resulting from a possible fall if fainting or seizure activity occurs.

normal anxiety

Necessary for survival; motivates and helps us adapt to change and make necessary changes improves performance -nomal anxiety motivates for survival change, constructive behavior such as studying

Compulsions (OCD)

Particular acts that the person feels driven to perform over and over again that reduce anxiety Ex: a person who has an obsessive fear of germs might engage in the compulsion of repeatedly washing his hands -ritualistic behaviors an individual feels dnven to perform in attempt toreduce anxiety or prevent An imagined calamity Hand-washing, ordering, checking or mental

Which statement is true regarding obsessive-compulsive disorder (OCD)? Behaviors suggestive of OCD usually begin in infancy. Hospitalization is often necessary for persons diagnosed with OCD. Patients diagnosed with OCD should be assessed regularly for risks for suicide. Compulsions are repetitive thoughts, whereas obsessions are ritualistic behaviors.

Patients diagnosed with OCD should be assessed regularly for risks for suicide. Rationale Safety is a priority. People suffering from high levels of anxiety may become desperate and attempt suicide. Anxiety disorders, which include obsessive-compulsive disorder, frequently co-occur with other psychiatric problems, particularly major depression. Obsessive-compulsive disorder can begin in childhood, with symptoms present as early as age three, but symptoms would not be expected in infancy. People with obsessive-compulsive disorders rarely need hospitalization unless they are suicidal or have compulsions that cause injury. Compulsions are ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety. Obsessions are thoughts, impulses, or images that persist, recur, and cannot be dismissed from the mind.

Two staff nurses applied for a charge nurse position. After the promotion was announced, the nurse who was not promoted said, "The nurse manager had a headache the day I was interviewed." Which defense mechanism is evident?

Projection Projection is the hallmark of blaming, scapegoating, prejudicial thinking, and stigmatizing others. Conversion involves the unconscious transformation of anxiety into a physical symptom. Introjection involves intense, unconscious identification with another person. Splitting is the inability to integrate the positive and negative qualities of oneself or others into a cohesive image.

A patient tells a nurse, "My best friend is a perfect person. She is kind, considerate, good-looking, and successful with every task. I could have been like her if I had the opportunities, luck, and money she's had." This patient is demonstrating

Rationalization Rationalization consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller as well as the listener. Denial is an unconscious process that would call for the nurse to ignore the existence of the situation. Projection operates unconsciously and would result in blaming behavior. Compensation would result in the nurse unconsciously attempting to make up for a perceived weakness by emphasizing a strong point.

An individual experiences sexual dysfunction and blames it on a partner by calling the person unattractive and unromantic. Which defense mechanism is evident?

Rationalization involves unconsciously making excuses for one's behavior, inadequacies, or feelings. Regression involves the unconscious use of a behavior from an earlier stage of emotional development. Compensation involves making up for deficits in one area by excelling in another area. Introjection is an unconscious, intense identification with another person.

A primary health care provider instructed a nurse to give cognitivebehavioral therapy to a patient with social phobia. What intervention is appropriate for the patient during the cognitive-behavior therapy? Re-evaluate the patient's situation. Support the patient's beliefs . Give an opinion on patient's thoughts. Calm the patient through isolation from peers.

Re-evaluate the patient's situation. The patients must be given cognitive-behavioral therapy to remove the negative feelings. The nurse should re-evaluate the situation realistically. The nurse should develop a positive insight in the patient by replacing the negative thoughts. The nurse should not support the patient's negative beliefs. It can further disrupt the patient's beliefs. The nurse should not give her own opinion on the patient's thoughts as it may make the patient feel rejected. The nurse should not isolate the patient from peers as it can cause withdrawal and aggression in the patient. The nurse should encourage the patient to mingle with peers.

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; Undoing Projection Rationalization Reaction formation

Reaction formation Rationale Reaction formation keeps unacceptable feelings or behaviors out of awareness by developing the opposite behavior or emotion.

A person speaking about a rival for a significant other's affection says in an emotional, syrupy voice, "What a lovely person. That's someone I simply adore." The individual is demonstrating

Reaction formation . Reaction formation is an unconscious mechanism that keeps unacceptable feelings out of awareness by using the opposite behavior. Instead of expressing hatred for the other person, the individual gives praise. Denial operates unconsciously to allow an anxiety-producing idea, feeling, or situation to be ignored. Projection involves unconsciously disowning an unacceptable idea, feeling, or behavior by attributing it to another. Repression involves unconsciously placing an idea, feeling, or event out of awareness.

After three weeks of hemoptysis (coughing blood), a person finally seeks treatment. A chest x-ray film is taken and the person waits for the results. When the health care provider explains the report, the person complains, "I can't understand what you're saying. You're talking so fast. All I hear is a loud clicking on my watch." The patient is wet with perspiration. Which level of anxiety is evident?

Severe Rationale Indicators of severe anxiety include cognitive, narrowed perceptual field, selective attention, distortion of time/events, detachment, physical reactions such as diaphoresis, tense muscles, and decreased hearing. Mild anxiety is demonstrated by normal vital signs, minimal muscle tension, broad perceptual field, and awareness of environmental and internal stimuli. There are also feelings of relative comfort, a relaxed appearance, and automatic performance. Moderate anxiety is demonstrated by slightly elevated vital signs; moderate muscle tension; alert, narrow, or focused attention; and inability to problem solve, learn, and be attentive. There is also a feeling of readiness, energy, ability to learn, and interest in the situation. Panic is characterized by a distinct inability to respond to any stimuli other than those occurring internally and a sense of being out of control, physically and emotionally.

After reviewing the following information, which anxiety disorder is a 14-year-old male at greatest risk for developing?

Social anxiety Rationale Social anxiety has a prevalence of 8.2% in adolescents aged 13 to 17, with equal prevalence in men and women. Of generalized anxiety, social anxiety, panic, and specific phobias, social anxiety presents the greatest risk for this individual.

body dysmorphic disorder

Somatoform disorder where a person is preoccupied with a slight physical anomaly or imagined defect in appearance

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

Suddenly tremble severely 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 patient attempted suicide three days ago. When the nurse asks about the related events, the patient says, "I don't want to think about that now, but maybe we could talk about it later." Which defense mechanism has the patient used?

Suppression Rationale Defenses against anxiety can be adaptive or maladaptive. Suppression is a conscious, deliberate effort to avoid painful and anxiety-producing memories. Repression is an unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness . In this scenario, the patient is aware of the memory. Rationalization consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations. Intellectualization is a process in which events are analyzed based on facts and without passion, rather than including feeling and emotion.

A 3-year-old child is admitted for an extensive stay in an acute care hospital. The parents will be able to visit only on weekends. The nurse bases emotional care of the child on the understanding that

The child is at risk for physical illnesses resulting from the separation. Rationale Children who have been separated from their mothers, especially if placed in an impersonal environment, show a decline in physical health. Resiliency will not be sufficient to overcome the effects of separation from parents. The nursing staff may attempt to be substitutes for the parents, but at this age, the child will be aware of the separation and experience the negative effects. Stimulation will address cognitive and development needs but not emotional ones.

A nurse observes a patient's parents at an intensive care unit. The nurse assumes that the patient's parents have moderate anxiety. Which symptom of anxiety did the nurse find in the patient's parents? Select all that apply. The parents were talking in a trembling voice. The parents were having increased rate of respiration. The mother is tapping her foot and the father is chewing his lip. The parents were confused and unable to make any decisions The parents were making decisions to solve the problem very effectively.

The parents were talking in a trembling voice. The parents were having increased rate of respiration. Rationale People having moderate anxiety have voice tremors and tend to talk in a trembling voice. They show increased pulse rate and respiratory rate. They also cannot make decisions to solve the problem at an optimum level. People with mild anxiety exhibit mild tension-relieving behavior such as foot or finger tapping and lip chewing. In severe anxiety, people are usually confused and are unable to make decisions.

What characteristics are associated with moderate anxiety? Select all that apply The person engages in selective inattention. Learning and problem solving are no longer possible. People routinely describe a feeling of "impending doom." Gastric discomfort and headaches sometimes are reported. The sympathetic nervous system begins to control vital signs.

The person engages in selective inattention. Gastric discomfort and headaches sometimes are reported. The sympathetic nervous system begins to control vital signs. Rationale The person experiencing moderate anxiety sees, hears, and grasps less information and may demonstrate selective inattention, in which only certain things in the environment are seen or heard unless they are pointed out. Sympathetic nervous system symptoms begin to kick in. The individual may experience tension, pounding heart, increased pulse and respiratory rate, perspiration, and mild somatic symptoms (e.g., gastric discomfort, headache, urinary urgency). The ability to think clearly is hampered, but learning and problem solving can still take place, although not at an optimal level. A feeling of impending doom is associated with severe anxiety.

Hoarding Disorder

a disorder in which individuals feel compelled to save items and become very distressed if they try to discard them, resulting in an excessive accumulation of items

modeling therapy

a type of therapy characterized by watching and imitating models that demonstrate desirable behaviors -demonstrate the appropriate behavior in feared situation, and then the pt demonstrates it. Example: role model riding in an elevator for phobia

A nurse assesses an individual who commonly experiences anxiety. Which comment by this person indicates the possibility of obsessive-compulsive disorder? a. "I check where my car keys are eight times." b. "My legs often feel weak and spastic." c. "I'm embarrassed to go out in public." d. "I keep reliving a car accident."

a. "I check where my car keys are eight times." Recurring doubt (obsessive thinking) and the need to check (compulsive behavior) suggest obsessive-compulsive disorder. The repetitive behavior is designed to decrease anxiety but fails and must be repeated. Stating "My legs feel weak most of the time" is more in keeping with a somatic disorder. Being embarrassed to go out in public is associated with an avoidant personality disorder. Reliving a traumatic event is associated with posttraumatic stress disorder.

A patient in the emergency department shows disorganized behavior and incoherence after a friend suggested a homosexual encounter. In which room should the nurse place the patient?

a. An interview room furnished with a desk and two chairs Individuals experiencing severe to panic-level anxiety require a safe environment that is quiet, nonstimulating, structured, and simple. A room with a desk and two chairs provides simplicity, few objects with which the patient could cause self-harm, and a small floor space in which the patient can move about. A small, empty storage room without windows or furniture would feel like a jail cell. The nurse's office or a room with an examining table and instrument cabinets may be over-stimulating and unsafe.

A nurse plans health teaching for a patient diagnosed with generalized anxiety disorder who begins a new prescription for lorazepam. What information should be included? (Select all that apply)

a. Caution in use of machinery c. The importance of caffeine restriction d. Avoidance of alcohol and other sedatives Caffeine is a central nervous system stimulant that acts as an antagonist to the benzodiazepine lorazepam. Daily caffeine intake should be reduced to the amount contained in one cup of coffee. Benzodiazepines are sedatives, thus the importance of exercising caution when driving or using machinery and the importance of not using other central nervous system depressants such as alcohol or sedatives to avoid potentiation. Benzodiazepines do not require a special diet. Food will reduce gastric irritation from the medication.

A student says, "Before taking a test, I feel very alert and a little restless." Which nursing intervention is most appropriate to assist the student?

a. Explain that the symptoms result from mild anxiety and discuss the helpful aspects. Teaching about symptoms of anxiety, their relation to precipitating stressors, and, in this case, the positive effects of anxiety will serve to reassure the patient. Advising the patient to discuss the experience with a health care provider implies that the patient has a serious problem. Listening without comment will do no harm but deprives the patient of health teaching. Antioxidant vitamin supplements are not useful in this scenario.

A child was placed in a foster home after being removed from abusive parents. The child is apprehensive and overreacts to environmental stimuli. The foster parents ask the nurse how to help the child. Which interventions should the nurse suggest?

a. Use a calm manner and low voice. b. Maintain simplicity in the environment. e. Explain and reinforce reality to avoid distortions. The child has moderate anxiety. A calm manner will calm the child. A simple, structured, predictable environment is desirable to decrease anxiety provoking and reduce stimuli. Calm, simple explanations that reinforce reality validate the environment. Repetition is often needed when the individual is unable to concentrate because of elevated levels of anxiety. Opportunities for play and exercise should be provided as avenues to reduce anxiety. Physical movement helps channel and lower anxiety. Play helps by allowing the child to act out concerns.

A patient fearfully runs from chair to chair crying, "They're coming! They're coming!" The patient does not follow the staff's directions or respond to verbal interventions. The initial nursing intervention of highest priority is to a. provide for the patient's safety. b. encourage clarification of feelings. c. respect the patient's personal space. d. offer an outlet for the patient's energy.

a. provide for the patient's safety. Safety is of highest priority because the patient experiencing panic is at high risk for self-injury related to increased non-goal-directed motor activity, distorted perceptions, and disordered thoughts. Offering an outlet for the patient's energy can occur when the current panic level subsides. Respecting the patient's personal space is a lower priority than safety. Clarification of feelings cannot take place until the level of anxiety is lowered.

What mental health disorder can be a direct physiological result of hyperthyroidism?

anxiety panic attacks are a key feature of panic disorders Generalized anxiety disorder is excessive worry, which is out of proportion to the true impact of events or situations. It is often comorbid with major depressive disorder and other anxiety disorders. OCD is characterized by both obsession and compulsions that may occur due to a genetic disposition or trauma

Which assessment questions would be most appropriate for the nurse to ask a patient with possible obsessive-compulsive disorder? (Select all that apply.)

b. "Are there others in your family who must do things in a certain way to feel comfortable? d. "Is it difficult to keep certain thoughts out of your awareness?" e. "Do you do certain things over and over again?" The correct questions refer to obsessive thinking and compulsive behaviors. There is likely a genetic correlation to the disorder. The incorrect responses are more pertinent to a patient with suspected posttraumatic stress disorder or with suspected social phobia.

A woman is 5'7", 160 lbs. and wears a size 8 shoe. She says, "My feet are huge. I've asked three orthopedists to surgically reduce my feet." This person tries to buy shoes to make her feet look smaller and, in social settings, conceals both feet under a table or chair. Which health problem is likely? a. Social anxiety disorder b. Body dysmorphic disorder c. Separation anxiety disorder d. Obsessive-compulsive disorder due to a medical condition

b. Body dysmorphic disorder ANS: B Body dysmorphic disorder refers to a preoccupation with an imagined defect in appearance in a normal-appearing person. The patient's feet are proportional to the rest of the body. In obsessive-compulsive or related disorder due to a medical condition, the individual's symptoms of obsessions and compulsions are a direct physiological result of a medical condition. 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. People with separation anxiety disorder exhibit developmentally inappropriate levels of concern over being away from a significant other.

A patient performs ritualistic hand washing. Which action should the nurse implement to help the patient develop more effective coping?

b. Encourage the patient to participate in social activities. Because obsessive-compulsive patients become overly involved in the rituals, promotion of involvement with other people and activities is necessary to improve coping. Daily activities prevent constant focus on anxiety and symptoms. The other interventions focus on the compulsive symptom.

A nurse wants to teach alternative coping strategies to a patient experiencing severe anxiety. Which action should the nurse perform first? a. Verify the patient's learning style. b. Lower the patient's current anxiety. c. Create outcomes and a teaching plan. d. Assess how the patient uses defense mechanisms.

b. Lower the patient's current anxiety. A patient experiencing severe anxiety has a markedly narrowed perceptual field and difficulty attending to events in the environment. A patient experiencing severe anxiety will not learn readily. Determining preferred modes of learning, devising outcomes, and constructing teaching plans are relevant to the task but are not the priority measure. The nurse has already assessed the patient's anxiety level. Use of defense mechanisms does not apply.

A patient preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is most appropriate? a. Reassure the patient that all nurses are skilled in providing postoperative care. b. Present the information again in a calm manner using simple language. c . Tell the patient that staff is prepared to promote recovery. d. Encourage the patient to express feelings to family.

b. Present the information again in a calm manner using simple language. Giving information in a calm, simple manner will help the patient grasp the important facts. Introducing extraneous topics as described in the distracters will further scatter the patient's attention.

A patient fearfully runs from chair to chair crying, "They're coming! They're coming!" The patient does not follow the staff's directions or respond to verbal interventions. Which nursing diagnosis has the highest priority? a. Fear b. Risk for injury c. Self-care deficit d. Disturbed thought processes

b. Risk for injury A patient experiencing panic-level anxiety is at high risk for injury related to increased non-goal-directed motor activity, distorted perceptions, and disordered thoughts. Data are not present to support a nursing diagnosis of self-care deficit or disturbed thought processes. The patient may have fear, but the risk for injury has a higher priority.

A patient experiencing moderate anxiety says, "I feel undone." An appropriate response for the nurse would be: a. "What would you like me to do to help you?" b. "Why do you suppose you are feeling anxious?" c. "I'm not sure I understand. Give me an example." d. "You must get your feelings under control before we can continue."

c. "I'm not sure I understand. Give me an example." ANS: C Increased anxiety results in scattered thoughts and an inability to articulate clearly. Clarifying helps the patient identify thoughts and feelings. Asking the patient why he or she feels anxious is nontherapeutic; the patient likely does not have an answer. The patient may be unable to determine what he or she would like the nurse to do in order to help. Telling the patient to get his or her feelings under control is a directive the patient is probably unable to accomplish.

A patient diagnosed with obsessive-compulsive disorder has this nursing diagnosis: Anxiety related to __________ as evidenced by inability to control compulsive cleaning. Which phrase correctly completes the etiological portion of the diagnosis?

c. persistent thoughts about bacteria, germs, and dirt Many compulsive rituals accompany obsessive thoughts. The patient uses these rituals for anxiety relief. Unfortunately, the anxiety relief is short lived, and the patient must frequently repeat the ritual. The other options are unrelated to the dynamics of compulsive behavior.

A patient counts everything; the patient counts the number of steps to the bathroom, rings of telephone, and cups in pantry. how should the nurse document this finding?

compulsion is a ritualistic behavior that an individual feels driven to perform in an attempt to reduce anxiety or prevent imagined calamity, Performing the compulsive act temporarily reduces anxiety, the relief is only temporary, the compulsive act must be repeated again and again. A phobia is a persistent irrational fear of a specific object, activity, or situation that leads to a desired for avoidance, or actual avoidance of the object, activity or situation. obsessions are thoughts, impulses or images that persist and recur, so that they cannot be dismissed from the mind even though the individual attempts to do so. Obsessions often seem senseless to the individual who experiences them (ego-dystonic) and their presence causes severe anxiety.

. For a patient experiencing panic, which nursing intervention should be implemented first? a. Teach relaxation techniques. b. Administer an anxiolytic medication. c. Prepare to implement physical controls. d. Provide calm, brief, directive communication

d. Provide calm, brief, directive communication Calm, brief, directive verbal interaction can help the patient gain control of overwhelming feelings and impulses related to anxiety. Patients experiencing panic-level anxiety are unable to focus on reality; thus, learning relaxation techniques is virtually impossible. Administering anxiolytic medication should be considered if providing calm, brief, directive communication is ineffective. Although the patient is disorganized, violence may not be imminent, ruling out the intervention of preparing for physical control until other less-restrictive measures are proven ineffective.

A person who has been unable to leave home for more than a week because of severe anxiety says, "I know it does not make sense, but I just can't bring myself to leave my apartment alone." Which nursing intervention is appropriate? a. Help the person use online video calls to provide interaction with others. b. Advise the person to accept the situation and use a companion. c. Ask the person to explain why the fear is so disabling. d. Teach the person to use positive self-talk techniques.

d. Teach the person to use positive self-talk techniques. Positive self-talk, a form of cognitive restructuring, replaces negative thoughts such as "I can't leave my apartment" with positive thoughts such as "I can control my anxiety." This technique helps the patient gain mastery over the symptoms. The other options reinforce the sick role.

A patient checks and rechecks electrical cords related to an obsessive thought that the house may burn down. The nurse and patient explore the likelihood of an actual fire. The patient states this event is not likely. This counseling demonstrates principles of a. flooding. b. desensitization. c. relaxation technique. d. cognitive restructuring.

d. cognitive restructuring. Cognitive restructuring involves the patient in testing automatic thoughts and drawing new conclusions. Desensitization involves graduated exposure to a feared object. Relaxation training teaches the patient to produce the opposite of the stress response. Flooding exposes the patient to a large amount of an undesirable stimulus in an effort to extinguish the anxiety response.

A person who feels unattractive repeatedly says, "Although I'm not beautiful, I am smart." This is an example of a. repression. b. devaluation. c. identification. d. compensation.

d. compensation. Compensation is an unconscious process that allows us to make up for deficits in one area by excelling in another area to raise self-esteem. Repression unconsciously puts an idea, event, or feeling out of awareness. Identification is an unconscious mechanism calling for imitation of mannerisms or behaviors of another. Devaluation occurs when the individual attributes negative qualities to self or others.

zoophobia

fear of animals

agoraphobia

fear or avoidance of situations, such as crowds or wide open places, where one has felt loss of control and panic Excessive anxiety or fear about being in places or situations from which escape may be difficult Or embarrassing The feared places are avoided in effort to control anxiety - being alone outside, being alone at home, traveling in a car, bus, airplane, being on a bridge, elevator - maybe debilitating and life constricting. But can be more tolerable in the company of others -adverse childhood or stressful events are associated with agoraphobia -genetics: agoraphobia has a strong heritability

A patient experiences a sudden episode of severe anxiety. Of these medications in the patient's medical record, which is most appropriate to give as a prn anxiolytic?

lorazepam Lorazepam is a benzodiazepine used to treat anxiety. It may be given as a prn medication. Buspirone is long acting and is not useful as a prn drug. Amitriptyline and desipramine are tricyclic antidepressants and considered second- or third-line agents.

A student says, "Before taking a test, I feel very alert and a little restless." The nurse can correctly assess the student's experience as

mild anxiety. Mild anxiety is rarely obstructive to the task at hand. It may be helpful to the patient because it promotes study and increases awareness of the nuances of questions. The incorrect responses have different symptoms.

Selective inattention is first noted when experiencing anxiety that is

moderate anxiety Rationale When moderate anxiety is present, the individual's perceptual field is reduced and the patient is not able to see the entire picture of events.

Prior to transferring a patient for a scheduled procedure, the patient tells the nurse, "I feel like I am going to die." based on the statement the patient made, what level of anxiety is the patient experiencing?

severe Severe anxiety is associated with a sense of impending doom. Panic would be so severe they cannot communicated Moderate anxiety is characterized by findings that include tension behavior, poor concentration and voice tremors. Mild anxiety is restlessness, irritability and impatience

Which defense mechanism has an adaptive use splitting undoing projection conversion

undoing splitting is pathological projection considered immature and does not have adaptive use conversion is pathological

Repression (defense mechanism)

- Involuntary blocking of unpleasant feelings and experiences from ones awareness. - an unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from an unconscious awareness -something intolerable gets pushed down below your consciousness into the unconsciousness EX: An accident victim can remember about the accident or assault victim is unable to enjoy sex Adaptive use: a mun forgets his wife's birthday after a marital Fight

reaction formation (defense mechanism)

- Preventing unacceptable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors. - when unacceptable feelimp or behaviors are controlled & are Kept out of awareness by developing the opposite behavior or Emotion Adaptive: a recovering alcoholic talks about the evil of drinking Maladaptive: EX: Jane hates nursing. She attended nursing school to please her parents. During career day, she speaks to prospective students about the excellence of nursing as a career. - a women has an unconscious hostility toward her daughter Is over protective & hovers over her to protect her from harm Intertenny with normal growth and development

Denial (defense mechanism)

- Refusing to acknowledge the existence of a real situation or the feelings associated with it.. Maladaptive:: EX: A women drinks alcohol every day and cannot stop, failing to acknowledge that she has a problem. Or keeping clothing From a deceased husband Adaptive use: reacting to a death of a loved one "I don't believe You"

Regression (defense mechanism)

- Responding to stress by retreating to an earlier level of development and the comfort measures associated with that level of functioning. EX: When 2 year old Jay is hospitalized for tonsillitis he will drink only from a bottle, although his mother states he has been drinking from a cup for over 6 months. Maladaptive use-a man who loses a promotion starts complaining to others, hands in sloppy work, misses appointments and comes in late for meetings

Panic attacks interventions

-Support client through the attack, may feel like mi Educate client about the nature of attacks, helping them to see what is happening or happened in the past. - inform that the panic attacks are time limited and may last only 15-20min, then usually subside -the panic attacks don't go on forever - teach them to watch the clock, that in 15 min or 20 min you will start to feel better -Help them develop some cognitive awareness of what's going on with their disorder -Plan ahead for what the client can do when they experience an attack

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 history of childhood trauma A sibling with the disorder A history of sexual abuse A previous suicide attempt An eating disorder

A history of childhood trauma A sibling with the disorder A history of sexual abuse An eating disorder 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.R

What can be said about the comorbidity of anxiety disorders? Anxiety disorders generally exist alone. A second anxiety disorder may coexist with the first. Anxiety disorders virtually never coexist with mood disorders. Substance abuse disorders rarely coexist with anxiety disorders.

A second anxiety disorder may coexist with the first when one anxiety disorder is present, a second one coexists.

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

A short-acting benzodiazepine medication. 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

obsessive-compulsive disorder

An anxiety disorder characterized by unwanted repetitive thoughts (obsession) and/ or actions (compulsions). Pathological obsessions or compulsions caused marked distressed to individuals who often feel humiliation and shame Rituals are time consuming and interfere with normal routines, Social activities, and relationships with others

panic disorder

An anxiety disorder marked by unpredictable minutes-long episodes of intense dread in which a person experiences terror and accompanying chest pain, choking, or other frightening sensations. Sob, dizziness, abdominal distress, sweating chills, hot,, shaking ,nausea, paresthesias, derealization. Going crazy Intense fear & feelings of impending doom _the feelings are so severe that normal functioning is suspended, the perceptual feild is severely limited and misinterpretation of reality may occur - people may believe they one loosing their minds or having a heart attack -Panic attacks canbe out of the blue and a sudden onset may not be in response to stress can last about 10 min and then subside - during the attacks, the person may not be able to articulate the psychological aspects such as fear -people become avoidant of situations where help is not available, may develop feelings of hopelessness. Because they are unable to control the attacks and mall become depressed - alcohol and substance is common

Mild to moderate levels of anxiety interventions

Anxiety decreases client's ability to process, so address anxiety management first! Help client identify: situations in which anxiety increases; triggers? ways reframe cognitions to decrease anxiety and how they see situations what has helped in the past stress-reduction activities (e.g. yoga, mindfulness) Assist in promoting effective coping and problem-solving open ended questions, giving broad openings, and exploring and seeking clarification providing a calm presence, recognizing the anxious person's distress, and being willing to listen

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? Reassure the patient that what they are feeling is normal anxiety and do deep breathing exercises with her. Use the call light to inquire whether the patient has been prescribed prn anxiety medication. Call for staff help and assess the client's vital signs. Reassure the patient that you will stay until the anxiety subsides.

Call for staff help and assess the client's vital signs. 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 anxiet

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

Cognitive restructuring 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

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

Determine the use of chemical substances for anxiety relief. Substance abuse often coexists with post-traumatic stress disorder. It is often the client's way of self-medicating to gain relief of symptoms

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? To reinforce the preoperative teaching by restating it slowly. Have the patient read the teaching materials instead of providing verbal instruction. Have a family member read the preoperative materials to the patient. Do not attempt any further teaching at this time.

Do not attempt any further teaching at this time. 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

Anxiety interventions

Intervention Rationale Help the patient identify anxiety. "Are you comfortable right now?" It is important to validate observations with the patient, name the anxiety, and start to work with the patient to lower anxiety. Anticipate anxiety-provoking situations. Escalation of anxiety to a more disorganizing level is prevented. Use nonverbal language to demonstrate interest (e.g., lean forward, maintain eye contact, nod your head). Verbal and nonverbal messages should be consistent. The presence of an interested person provides a stabilizing focus. Encourage the patient to talk about his or her feelings and concerns. When concerns are stated aloud, problems can be discussed and feelings of isolation decreased. Avoid closing off avenues of communication that are important for the patient. Focus on the patient's concerns. When staff anxiety increases, changing the topic or offering advice is common but leaves the person isolated. Ask questions to clarify what is being said. "I'm not sure what you mean. Give me an example." Increased anxiety results in scattering of thoughts. Clarifying helps the patient identify thoughts and feelings. Help the patient identify thoughts or feelings before the onset of anxiety. "What were you thinking right before you started to feel anxious?" The patient is assisted in identifying thoughts and feelings, and problem solving is facilitated. Encourage problem solving with the patient.∗ Encouraging patients to explore alternatives increases sense of control and decreases anxiety. Assist in developing alternative solutions to a problem through role play or modeling behaviors. The patient is encouraged to try out alternative behaviors and solutions. Explore behaviors that have worked to relieve anxiety in the past. The patient is encouraged to mobilize successful coping mechanisms and strengths. Provide outlets for working off excess energy (e.g., walking, playing ping-pong, dancing, exercising). Physical activity can provide relief of built-up tension, increase muscle tone, and increase endorphin levels.

Benzodiazepine side effects

Mild side effects include Drug dependence, withdrawal slowly Assesses renal function CNS: headache, drowsiness, dizziness, vertigo, cognitive impairment, lethargy, sedation, ataxia, and "hangover effect". paradoxical excitement or nervousness (opposite) of intended responses: anxiety, agitation, talkativeness, loss of control Potentially significant risk for falls in the elderly. Drug withdrawal can cause rebound insomnia. Therefore withdrawal slowly (twitching, tremors, seizures) IV administration can cause hypotension and cardiac arrest Do not combine with alcohol or other CNS depressants > can cause respiratory distress Acute toxicity: drowsiness, lethargy, and confusion > ANTIDOTE: flumazenil (can also give Nolaxone/narcan)

Selective inattention is first noted when experiencing which level of anxiety? Mild Moderate Severe Panic

Moderate 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 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? Having the client repeatedly touch "dirty" objects Not allowing the client to seek reassurance from staff Not allowing the client to wash hands after touching a "dirty" object Telling the client that he or she must relax whenever tension mounts

Not allowing the client to wash hands after touching a "dirty" object 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.

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

Panic attacks with agoraphobia 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.

Paroxetine

SSRI antidepressant -Has more calming effect for OCD

An adult invites 14 guests for Thanksgiving dinner. Just before the guests arrive, the adult notices the turkey is burned and inedible. Which behavior by this adult indicates adaptive coping? The adult: Goes to bed and leaves the guests unattended Telephones all the guests and cancels the invitation for dinner Tells the guests, "My oven malfunctioned. You will have to eat burned turkey." Says to the guests, "We are having a vegetarian Thanksgiving dinner this year."

Says to guests, We are having a vegetarian Thanksgiving dinner this year." anxiety is part of everyday life. normal anxiety is a healthy reaction for survival. It provides the energy needed to carry out the tasks involved in living and striving toward goals. Anxiety motivates people to make and survive change. It prompts constructive behaviors. saying that the oven malfunctioned demonstrates maladaptive use of displacement Rationale Anxiety is a part of everyday life. Normal anxiety is a healthy reaction necessary for survival. It provides the energy needed to carry out the tasks involved in living and striving toward goals. Anxiety motivates people to make and survive change. It prompts constructive behaviors. In this scenario, announcing a vegetarian dinner indicates the adult has adapted to the anxiety-producing situation. Cancelling the dinner and leaving guests unattended are dysfunctional responses. Saying the oven malfunctioned demonstrates maladaptive use of displacement.

My mother lives with me since my dad died 6 months ago, 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 okay except for these times, but it is affecting my ability to go to work. This information support which psychiatric diagnosis? Panic disorder Adult separation anxiety disorder Agoraphobia Social anxiety disorder

Separation anxiety disorder people with SAD exhibit developmentally inappropriate levels of concern over being away from a significant other. There may be fear that something horrible will happen to the other person. Adult separation anxiety disorder may begin in childhood or adulthood. agoraphobia is characterized by intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing or which help may 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 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? The client may become addicted faster than younger patients. The client is at risk for falls. The client has a history of nonadherence with medications. The client should be treated with cognitive therapies because of his advanced age.

The client is at risk for falls. 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 student nurse observes that a patient often looks at her reflection in the mirror. What is the most appropriate diagnosis the student nurse could make from the patient's behavior?

The patient has body dysmorphic disorder Dysmorphic disorders are characterized by a preoccupation with an imagined defective body part. Patients often pay attention to body parts that they imagine to be defective. As a result, they may develop obsessive-compulsive behaviors such as often checking mirrors. In obsessive-compulsive disorder, patients perform repeated activities or rituals. In hoarding disorder the patient accumulates and collects all materials for future use Patients with a panic disorder may have an unusual fear of future events

A patient who has to undergo cataract surgery next week complains of chest pain, feeling of choking, and hot flashes. What appropriate diagnosis does the nurse make from the patient's symptoms?

The patient has panic disorder Patients generally panic before surgery and complain of chest pain, breathing difficulty, choking, chills, and hot flashes. Social phobia is a social anxiety disorder characterized by fear when exposed to social groups. Patients will feel distress during public speaking. A patient with separation anxiety disorder is afraid of being isolated or separated from a loved one. It is characterized by gastrointestinal disturbances and headache. Patients who have agoraphobia fear certain places. They avoid going to such places to reduce anxiety.

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

They often involve some degree of self-deception. 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.

Defense mechanisms

Unconscious attempts to protect you from unpleasant or unacceptable thoughts or beliefs, protecting your ego -automatic coping style -overstepping automatically what you believe the right thing to do is. Coming up for a reason why something goes wrong - protects from anxiety -maintain selt-image by blocking feelings, conflicts, memories

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? "What things have you done in the past that helped you feel more comfortable?" "Let's try to focus on that adorable little granddaughter of yours." "Why don't you sit down over there and work on that jigsaw puzzle?" "Try not to think about the feelings and sensations you're experiencing."

What things have you done in the past that helped you feel more comfortable?" 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.

generalized anxiety disorder

an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal -Excessive worry that lasts for months, general state of worry -general avoidance and putting things off results in lateness, or abscence and from school work and overall social isolation -irritability, muscle tension, restlessness, difficulty concentrating -sleep disturbances: person worries about days events past or present, real or imagined -Fatigue: is anoticeable side effects of this sleep deprivation Parental overprotection -geneticically inheritable

Severe anxiety

an increased level of anxiety when more primitive survival skills take over, defensive responses ensue, and cognitive skills decrease significantly; person with severe anxiety has trouble thinking and reasoning Perceptual field: Limited perceptual field, Poor attention, limited ability to pay attention (wah wah) Problem solving: Limited problem solving skills, unable to process data - unable to make thoughtful choices Physiological response: -feelings of dread, impending doom - confusion, disorientation -increased heart rate, increased respirations, diaphoresis, -loud and demanding or withdrawn -nausea, chest pain, dizziness, -Insomnia

Panic level of anxiety

characterized by markedly disturbed behavior; -perceptual field: client is not able to process what is occurring in the environment and may lose touch with reality; environment may seem strange or unreal (derealization), -problem solving disorganized irrational unable to focus extreme fright and horror; Physiological response: Immobile or hyperactive, pacing, running, disorganized communication dysfunction in speech, screaming, shouting,. ~may not talk inability to sleep, delusions, and hallucinations-extreme cases -severe somatic symptoms: sob, palpitations, ferry like they Are having an mi -erratic, uncoordinated, and impulsive, - automatic benanors are used to reduce and relieve anxiety, Although such extorts may be ineffective and lead to Exhaustion

hematophobia

fear of blood

A Symptom commonly associated with panic attacks is Obsessions Apathy Fever Fear of impending doom

fear of impending doom feelings of terror present during a panic attack are so severe that normal function is suspended, the perceptual field is limited severely, and misinterpretation of reality may occur

Astraphobia

fear of thunder and lightning, electrical storms

Hydrophobia

fear of water

A young adult applying for a position is mildly tense but eager to begin the interview. This can be assessed as showing Denial Compensation Normal anxiety Selective inattention

normal anxiety Is a healthy life force needed to carry out the tasks of living and striving towards goals. It prompts constructive actions

response prevention

preventing a client from performing a compulsive behavior with the intent that anxiety will diminish -handwashing - the pt learns that the anxiety will eventually subside and is able to set time limits - do this only in therapy don't stop an OCD person during non therapeutic times

Obsessions

repeated, intrusive, and uncontrollable irrational thoughts or mental images that cause extreme anxiety and distress Recurrent and persistent thoughts, urges, or images that are Experienced, at some time during the disturbances, as intruisive And unwanted and most individuals cause marked anxiety or Distress Counting,

A 20-year-old was sexually molested at age 10, but can no longer remember the incident. The ego defense mechanism in use is

repression is a defense mechanism that excludes unwanted or unpleasant experiences, emotions or ideas from the conscious awareness

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 mild. moderate. severe. panic.

severe. 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.

fear

the usual reaction when a stressor involves real or imagined danger -reaction to specific danger -body reacts to fear of anxiety the same -it invades the central core ot the personality & erodes feelings of self-esteem & self-worth

Moderate anxiety

~Perceptual field less able to process information (seeing-hearing) -narrowed perceptual field as anxiety increases - focused on source of anxiety -less able to pay attention Problem-solving: -selective inattention; less effective then usual -ability to think clearly is hampered, but learning and problem Solving can still take place although not at optimal level Physiological response; - voice shakes and raises in pitch -shaky - mild somatic symptoms e.g. Ui, gi, headache, backache, -sleep disturbance -increased in tension relieving behavior, pacing, increased hr, Increase pulse, increase rr, perspiration