Anxiety Disorders PREP-U --Unit 3

A client comes to the emergency department because he thinks he is having a heart attack. Further assessment determines that the client is not having a heart attack but is having a panic attack. When beginning to interview the client, which question would be most appropriate for the nurse to use? a) "What did you experience just before and during the attack?" b) "Do you think you will be able to drive home?" c) "What do you think caused you to feel this way?" d) "Are you feeling much better now that you are lying down?"

a

A client spends hours stacking and unstacking towels. She is repeatedly checking to make sure that the towels are in order of color. This behavior is identified as a a) Compulsion b) Phobia c) Derealization d) Obsession

a

According to the DSM-IV-TR, anxiety disorder is considered chronic and generalized when excessive anxiety and worry about two or more life circumstances exist for at least a) 6 months b) 4 months c) 12 months d) 2 months

a

Before eating a meal, a client with obsessive-compulsive disorder must wash her hands for 14 minutes, comb her hair for 114 strokes, and switch the light off and on 44 times. What is the most important treatment goal for this client? a) Gradually decrease the amount of time spent performing rituals. b) Omit one ritualistic behavior every 4 days until all rituals are eliminated. c) Increase the client's acceptance of the need for medication to control rituals. d) Allow ample time for completion of all rituals before each meal.

a

Nearly which percentage of adults is affected by anxiety disorders? a) 25% b) 10% c) 55% d) 40%

a

Susan has begun to wash her hands every hour on the hour because she fears that if germs become embedded in her skin, she will contract cancer. Which of the following would best describe Susan's behavior? a) A compulsion b) A panic attack c) An obsession d) Acute stress disorder

a

The client has an order for an anxiolytic agent, lorazepam (Ativan). Which of the following statements by the client would indicate that client education about this medication has been effective? a) "This medication will relax me so I can focus on problem solving." b) "I will probably always need to take this medication for my anxiety." c) "This medication presents no risk of addiction or dependence." d) "My anxiety will be eliminated if I take this medication as prescribed."

a

The nurse is caring for a client who is being treated in the emergency department for a panic attack. Which of the following nursing interventions would be most appropriate? a) Stay with the client, emphasizing that he is safe and that you will remain with him. b) Demonstrate empathy for the client by trying to mimic the client's state of anxiety. c) Tell the client that you must leave to go report his symptoms to the psychiatrist on duty. d) Tell the client this is an acute exacerbation with a positive prognosis and low morbidity.

a

When a client is experiencing severe anxiety, which of the following is the priority intervention? a) Move the client to a quiet environment b) Offer the client therapy to calm down c) Put the client in seclusion temporarily d) Give the client medication immediately

a

Which of the following clients is most likely to be at risk for drug dependence and difficulties with withdrawal? a) A client with generalized anxiety disorder who has responded well since beginning treatment with fluoxetine (Prozac) earlier in the year b) A woman who has been taking lorazepam (Ativan) for several months after witnessing a traumatic motor vehicle accident c) A man whose obsessive-compulsive disorder (OCD) is being treated long term with paroxetine (Paxil) d) A client who has recently begun treatment with propranolol (Inderal) for the treatment of social phobia

a

Which of the following is inconsistent with panic-level anxiety? a) This level of anxiety can be sustained indefinitely. b) The goal is to lower the client's anxiety to mild or moderate before proceeding with anything else. c) The nurse needs to maintain a nonstimulating environment. d) The nurse should remain with the client until the panic recedes.

a

Which of the following medication classifications used in the treatment of panic disorder can cause physical dependence? a) Benzodiazepines b) Selective serotonin reuptake inhibitors (SSRIs) c) Tricyclic antidepressants (TCAs) d) Serotonin-norepinephrine reuptake inhibitors (SNRIs)

a

A nurse is developing a teaching plan for a client with generalized anxiety disorder, focusing on nutrition. Which of the following would the nurse encourage the client to avoid? Select all that apply. a) Coffee b) Aged cheese c) Citrus juices d) Ginseng e) Milk products

a d

A client arrives on the psychiatric unit exhibiting restlessness, disorientation, incoherent speech, agitation, purposeless physical activity, and suicidal ideations. Which of the following is the priority nursing diagnosis for this client? a) Ineffective individual coping b) Risk for injury c) Hopelessness d) Disturbed identity

b

A client diagnosed with obsessive-compulsive disorder (OCD) is attempting to resist a compulsion. Based on this finding, the nurse should assess the client for a) Depression b) Increased anxiety c) Excessive fear d) Feelings of failure

b

A group of nursing students is giving a presentation to classmates on adaptive and maladaptive responses to stress. When talking about assessing coping strategies in patients, the nursing students discuss the use of drugs and alcohol to reduce stress. What is most important for the students to point out about these coping behaviors? a) They are adaptive behaviors. b) They increase the risk of illness. c) They are effective coping behaviors. d) They do not really reduce stress in the body.

b

A hospitalized client states that he's having difficulty resting. Which intervention would help promote rest? a) Encouraging the client to take prescribed sedatives daily b) Assisting the client with deep-breathing exercises c) Leaving the client's door open so he can see into the hallway d) Offering the client a cup of tea

b

A patient has come to the clinic to discuss the stress she is experiencing because of failing two exams at school. Initially, she described her failures as "the worst thing that has ever happened to me," and she stated, "There is absolutely nothing I can do to pass this course now." In response to the nurse's questions, the nurse finds out there are three more equally weighted exams scheduled for the course in question. The nurse and patient collaborate and decide to use interventions to facilitate emotion-focused coping. Which additional comment from the patient would the nurse identify as providing support for this decision? a) "You've got to figure out something for me to do to get me out of this situation!" b) "I overreacted; surely together we can figure out something for me to do." c) "This is a waste of time because absolutely nothing you or I can do will make it any better." d) "This is the worst thing that could ever happen to me. I'm nothing but a failure."

b

All except which of the following are considered clinical symptoms of anxiety? a) Palpitations b) Tearfulness and sadness c) Extreme restlessness d) Motor excitement

b

In the stress response, which of the following is consistent with activation of the sympathetic nervous system? a) Decreased heart rate b) Increased blood sugar c) Decreased blood sugar d) Decreased blood pressure

b

The efforts one takes to manage situations that have been appraised as being potentially harmful or stressful refers to a) Disintegrate b) Coping c) Emotional support d) Cognitive approach

b

The nurse enters the client's room and finds the client anxiously pacing the floor. The client begins shouting at the nurse, "Get out of my room!" The best intervention by the nurse would be to a) Say, "I'm leaving now, but I'll be back." b) Stand at the doorway and say, "You seem upset." c) Call for help and say, "Calm down." d) Approach the client and ask, "What's wrong?"

b

Treatment for anxiety disorders usually involves medication and therapy. Which of the following should be included in a teaching plan for a client prescribed a benzodiazepine? a) Consuming caffeine in moderation b) Rising slowly from a lying or sitting position c) Stopping a drug if sedation develops d) Maintaining a fluid restriction

b

Which of the following questions in the assessment of a client with anxiety is most clinically appropriate? a) "Does your anxiety make you feel less valuable and competent as a person?" b) "How do you feel about everything that is happening in your life right now?" c) "What can I give you to make you feel less anxious right now?" d) "Do you think that you're justified in feeling anxious right now?"

b

Which of the following would not be an initial intervention for the client with acute anxiety? a) Maintaining a nonstimulating environment b) Touching the client in an attempt to comfort him c) Encouraging the client to verbalize feelings and concerns d) Use of open-ended communication techniques

b

You are the nurse caring for a patient who has just been diagnosed with cancer. The patient states that he will "never be able to cope with this situation." What are you aware that coping is? a) Coping is a physiologic measure used to deal with change, and he will physically adapt. b) Coping is the physiologic and psychological processes that people use to adapt to change. c) Coping is the human need for faith and hope, which create change. d) Coping is a social measure used to deal with change and loss.

b

A client is learning to cope with anxiety and stress. The expected outcome is that the client will a) Limit major stressors in his or her life b) Revise his or her lifestyle c) Change reactions to stressors d) Ignore situations that cause stress

c

A client who has been admitted for an appendectomy states, "I'm really afraid of the surgery because my mother died when she was admitted for an emergency surgery." When preparing to work with the client about her anxiety about the surgery, you recognize what? a) The client has "signal anxiety," which is always the first symptom of anxiety. b) The client is expressing "free-floating anxiety" and needs to have medication in order to bring it under control. c) The client is expressing her fear about the surgery. Her fear is her body's physiologic and emotional response to a known danger. d) The client has "trait anxiety," and this reflects her anger toward her mother's surgeon

c

A client with obsessive-compulsive disorder has been taking fluoxetine for 1 month. The client tells the nurse, "These pills are making me sick. I think I'm getting a brain tumor because of the headaches." Which response by the nurse would be most appropriate? a) "Let's talk about how often you have been performing the rituals lately." b) "Have you been practicing your deep breathing and relaxation exercises?" c) "These medications have side effects that can cause increased headaches." d) "Tell me how many times you have washed your hands toda

c

A nurse has completed an assessment of a patient who is experiencing significant stress. The assessment revealed intense anger and acting out behaviors along with statements of negative emotions. Which nursing diagnosis would be most appropriate? a) Hopelessness b) Disturbed though processes c) Ineffective coping d) Low self-esteem

c

A patient can protect himself from the negative effects of stress through which of the following? a) Previous experiences b) Health c) Social and emotional resources d) Medication

c

A patient who has been awaiting the results of a bone marrow biopsy for several days is experiencing stress as a result of uncertainty and the possibility that abnormal cell growth may be detected. A physical examination and blood work would most likely yield which of the following results? a) Increased respiratory rate; increased levels of testosterone b) Increased gastrointestinal motility; decreased thyroid-stimulating hormone c) Increased blood pressure and heart rate; increased antidiuretic hormone (ADH) d) Pupil dilation; increased somatomedin C

c

A young mother tells the nurse, "I can't stop smoking. That is what I do to make myself feel better." What is the term used to describe this behavior? a) defense mechanism b) caregiver burden c) coping mechanism d) crisis

c

An adolescent client reveals that she is about to take a math test from her tutor. Nursing assessment reveals mild anxiety. You explain that this level of anxiety does what? a) May be transferred to her tutor and result in test anxiety b) Will interfere with her cognitive abilities c) Is conducive to concentration and problem solving d) Is pathologic and warrants postponing the test

c

In teaching a client who has been prescribed a benzodiazepine for panic disorder, the nurse must be certain to do what? a) Instruct the client that if he has palpitations, he should contact his physician immediately because of the risk for arrhythmias with this medication. b) Instruct the client to come in every other week to get blood drawn and monitor for agranulocytosis. c) Educate the client that this medication has a high risk for withdrawal symptoms, and he should not discontinue without a doctor's supervision. d) Educate the client that this medication will interact with certain food groups.

c

Nursing interventions that are appropriate for all clients with anxiety disorders are to reduce anxiety and a) Learn to control primitive impulses b) Accept the fact that underlying conflicts cannot be treated c) Develop alternative responses to anxiety-provoking situations d) Strive for insight through psychoanalysis

c

One major difference between post-traumatic stress disorder (PTSD) and the other anxiety disorders is that a) Prozac usually works best with PTSD. b) the person experiences acute anxiety with feelings of panic. c) symptoms begin after exposure to a traumatic stressor. d) the person has physiological reactions, not just psychological ones.

c

Panic disorder is treated with cognitive-behavioral techniques and deep breathing and relaxation, in addition to which of the following? a) CNS depressants b) Antipsychotics c) Antianxiety medications d) Anticonvulsants

c

Panic disorder is treated with cognitive-behavioral techniques, deep breathing, and relaxation, in addition to which of the following? a) Antipsychotics b) Anticonvulsants c) Antianxiety medications d) CNS depressants

c

The nurse has instructed a client with panic disorder about how to use the technique of positive self-talk. The nurse determines that the client has understood the instructions when the client verbalizes which statement to use during an impending panic attack? a) "I am feeling very nervous right now." b) "Relax your muscles, relax your muscles." c) "I can handle this anxiety; it will be over shortly." d) "I am taking medication to eliminate these symptoms."

c

To facilitate understanding of a crisis involves the mental health nurse to a) Focus on long-term resolutions to prevent reoccurrence of the crisis b) Allow the crisis to escalate to reach a quicker resolution c) Listen and assist the client to articulate their feelings d) Provide direction of next steps for the client to take

c

Which of the following is classified as a nonbenzodiazepine? a) Lorazepam (Ativan) b) Diazepam (Valium) c) Buspirone (BuSpar) d) Chlordiazepoxide (Librium)

c

You are the nurse caring for a 51-year-old male who has just been diagnosed with stage IV colon cancer. You note the patient now has an increased blood pressure and heart rate. His respiratory rate has increased. You spend time talking with this patient and you note that his vital signs are now back in the normal range. What would you note has happened? a) Cortisol levels are decreasing. b) Endocrine activity has increased. c) The patient is adapting to noxious stressors. d) The sympathetic response has been activated.

c

A client spends hours arranging and rearranging furniture in his room. This behavior is identified as a a) Derealization b) Obsession c) Phobia d) Compulsion

d

A client who experiences paralyzing anxiety at the sight of a dog is supported in the act of sitting in a room with the animal. This is an example of the alternative behavioral technique called a) Relaxation exercise b) Implosion therapy c) Biofeedback d) Systematic desensitization

d

A client with a panic disorder has been prescribed a benzodiazepine medication. Which of the following would the nurse emphasize as a risk associated with using this medication? a) Agitation b) Fecal impaction c) Dietary restrictions d) Withdrawal symptoms

d

A nurse who has worked with a client diagnosed with generalized anxiety disorder (GAD) when he was an inpatient on the psychiatric unit sees the client in the waiting room of the outpatient psychiatric clinic. The client motions to the nurse to come over so he can tell the nurse how things have been going since he was discharged. While talking with the client, the nurse determines that the client's therapy has been effective when the client states which of the following? a) "I'm still drinking coffee; I can't quit after drinking it all these years." b) "I've learned having a beer after I get home from work helps me relax." c) "I am still experiencing quite a bit of stress at home and at work; things are different at home than they were in the hospital." d) "When my mother-in-law comes over now, I go out to my workshop and work on one of my projects."

d

A patient responds to bad news regarding test results by crying uncontrollably. What is the term for this response to a stressor? a) defense mechanism b) adaptation c) homeostasis d) coping mechanism

d

Sharon is admitted for an appendectomy. As the nurse enters the room to prep Sharon for surgery, she is breathing rapidly, sweating, restless, and anxious. The nurse's most therapeutic intervention at this time would be to a) provide Sharon with instructions; however, provide very limited choices about positioning/comfort measures. b) provide Sharon with information about her surgery, telling her what to expect when she comes out of the recovery room. c) leave the room, providing silence for Sharon until she regains her composure. d) speak to Sharon with simple, short directions in a soothing voice, and do not ask her to make choices about positioning or comfort.

d

The nurse is assessing a patient and finds two enlarged supraclavicular lymph nodes. The nurse asks the patient how long these enlarged nodes have been there. The patient states, "I can't remember. A long time I think. Do I have cancer?" The nurse is aware that that body responds to stress. Which of the following is an immediate physiologic response to stress the nurse would expect to see in this patient? a) Decrease in blood glucose levels b) Pupil constriction c) Vasodilation of peripheral blood vessels d) Increased blood pressure

d

When discussing various types of anxiolytic medications with a client, the nurse recognizes that which of the following medications has the lowest potential for abuse? a) Alprazolam (Xanax) b) Lorazepam (Ativan) c) Diazepam (Valium) d) Buspirone (BuSpar)

d

Which of the following conditions triggers the general adaptation syndrome? a) The placebo effect b) Helplessness c) Eustress d) Distress

d

Which of the following is a sympathetic-adrenal medullary response to stress? a) Decreased blood glucose level b) Constricted pupils c) Mental confusion d) Increased heart rate

d