ANXIETY EAQ's
After her child's visit to the pediatrician a mother tells the nurse that she is concerned that an antidepressant has been prescribed for her adolescent son. What is the best response by the nurse? 1 - "Tell me more about what's bothering you." 2 - "You need to speak with the primary healthcare provider about your concern." 3 - "Are you sure it's not a medication for attention deficit disorder?" 4 - "Didn't the primary healthcare provider tell you why your son needs an antidepressant?"
1 - "Tell me more about what's bothering you." RATIONALE: Reflecting the parent's feelings provides an opportunity for further exploration. It is the nurse's responsibility to assess the mother's concerns before planning further interventions. Implying that either the primary healthcare provider or the mother is wrong is a nontherapeutic response. Implying that the mother didn't listen or understand is a judgmental, nontherapeutic response.
One morning a nurse on the psychiatric unit finds a client curled up in the fetal position in the corner of the dayroom. What is an appropriate initial inference for the nurse to make about the client? 1 - The client is feeling more anxious today. 2 - The client is trying to hide from the staff. 3 - The client is tired and probably did not sleep well last night. 4 - The client is physically ill and experiencing abdominal discomfort.
1 - The client is feeling more anxious today. RATIONALE: The fetal position represents regressive behavior; regression is a way of responding to overwhelming anxiety. No data are available to indicate that the client is trying to hide, is tired, or is physically ill; further assessment would be necessary to support these other interpretations.
What characteristics are commonly associated with adolescent depression? Select all that apply. 1 - Exercising daily 2 - Having suicidal ideation 3 - Exhibiting tearfulness 4 - Having poor muscle tone 5 - Avoiding previously enjoyed activities and relationships
2 - Having suicidal ideations 3 - Exhibiting tearfulness 5 - Avoiding previously enjoyed activities and relationships RATIONALE: Having suicidal ideation, exhibiting tearfulness, and avoiding previously enjoyed activities and relationships are characteristic features of depression. Having poor muscle tone and performing physical exercise routine are uncommon in depressed adolescents.
What characteristic of anxiety is associated with a diagnosis of conversion disorder? 1 - Free-floating 2 - Relieved by the symptom 3 - Consciously felt by the client 4 - Projected onto the environment
2 - Relieved by the symptoms RATIONALE: The client's anxiety results from being unable to choose psychologically between two conflicting actions. The conversion to a physical disability removes the choice and therefore eases the anxiety. The anxiety is not free floating or diffuse but rather localized and converted to a physical disability. The conversion of the anxiety to a physical disability occurs on an unconscious level; the original anxiety no longer exists, and the client generally is not anxious about the physical disability. The anxiety is internalized into a physical symptom, not projected onto the environment.
What does the nurse recall is the major defense mechanism used by an individual with a phobic disorder? 1 - Splitting 2 - Regression 3 - Avoidance 4 - Conversion
3 - Avoidance RATIONALE: The person transfers anxieties to activities or objects, usually inanimate objects, which are then avoided to decrease anxiety. Splitting is the compartmentalization of opposite affective states and the inability to integrate the positive and negative aspects of others or self. Regression, the return to an earlier, more comfortable level of development, is not the defense mechanism used by someone with a phobia. Conversion, the transfer of a mental conflict to a physical symptom, is not the defense mechanism used by someone with a phobia.
Besides providing reassurance, what should nursing interventions for a client who is hyperventilating be focused on? 1 - Administering oxygen 2 - Using an incentive spirometer 3 - Having the client breathe into a paper bag 4 - Administering an IV containing bicarbonate ions
3 - Having the client breathe into a paper bag RATIONALE: Reassurance decreases anxiety and slows respirations; the bag is used so that exhaled carbon dioxide can be rebreathed to resolve respiratory alkalosis and return the client to an acid-base balance. Administering oxygen is not necessary because there is no evidence of hypoxia. Using an incentive spirometer is used to prevent atelectasis. The client is already alkalotic; bicarbonate ions will increase the problem.
A nurse is caring for a client with a somatoform disorder. What should the nurse anticipate that this client will do? 1 - Write down conversations to facilitate the recall of information. 2 - Monopolize conversations about the anxiety being experienced. 3 - Redirect the conversation with the nurse to physical symptoms. 4 - Start a conversation asking the nurse to recommend palliative care.
3 - Redirect the conversation with the nurse to physical symptoms RATIONALE: Clients with somatoform disorders are preoccupied with the symptoms that are being experienced and usually do not want to talk about their emotions or relate them to their current situation. Clients with somatoform disorders do not seek opportunities to discuss their feelings. Memory problems are not associated with somatoform disorders. These clients want and seek treatment, not palliative care.
How should a nurse intervene when a confused and anxious client voids on the floor in the sitting room of the mental health unit? 1 - Make the client mop the floor. 2 - Restrict the client's fluids for the rest of the day. 3 - Toilet the client more frequently with supervision. 4 - Withhold the client's privileges each time the client voids on the floor.
3 - Toilet the client more frequently with supervision. RATIONALE: The client is voiding on the floor not to express hostility but because of confusion. Taking the client to the toilet frequently reduces the risk of voiding in inappropriate places. Making the client mop the floor is a form of punishment for something the client cannot control. Restricting the client's fluids for the rest of the day is not realistic; it will have no effect on the problem and may lead to physiologic problems. If the client were doing this to express hostility, withholding privileges might be effective, but not when the client is unable to control the behavior.
During a home visit to a client, the nurse identifies tremors of the client's hands. When discussing this assessment, the client reports being nervous, having difficulty sleeping, and feeling as if the collars of shirts are getting tight. Of the additional assessment findings, which one should the nurse report to the practitioner? 1 - Increased appetite 2 - Recent weight loss 3 - Feelings of warmth 4 - Fluttering in the chest
4 - Fluttering in the chest RATIONALE: Many of these problems are associated with hyperthyroidism; palpitations may indicate cardiovascular changes requiring prompt intervention. The increased metabolism associated with hyperthyroidism can lead to heart failure. Although an increased appetite becomes a compensatory mechanism for the increased metabolism associated with hyperthyroidism, it is not life threatening. Although unexplained weight loss can result from catabolism associated with hyperthyroidism, it is not life threatening. Although a feeling of warmth caused by the increased metabolism associated with hyperthyroidism is uncomfortable, it is not life threatening.
Which is the adverse effect of haloperidol? 1 - Ataxia 2 - Asthenia 3 - Insomnia 4 - Gynecomastia
4 - Gynecomastia RATIONALE: Haloperidol is an antipsychotic drug used in the long-term treatment of psychosis. Gynecomastia is one of the adverse effects of this drug. Ataxia, asthenia, and insomnia are the adverse effects of clozapine.
After a prolonged period in a regional hospital far from home to which the parents were unable to travel, an 18-month-old toddler becomes depressed, withdrawn, and apathetic. Eventually the toddler begins playing with toys and relating to others, even strangers. When the parents visit, the child ignores them. The parents tell the nurse that their child has forgotten them. How does the nurse explain the child's behavior? 1 - The nurse suggests that they may be right and that their child will have to get to know them again. 2 - The behavior indicates approval of the staff and the child's understanding that they will not inflict bodily harm. 3 - The behavior reflects acceptance of the hospitalization and that the experience will enhance their child's maturation. 4 - This signifies typical behavior in toddlers who are separated from their parents for prolonged periods and that their child will need special attention from them.
4 - This signifies typical behavior in toddlers who are separated from their parents for prolonged periods and that their child will need special attention from them. RATIONALE: The child has progressed to the third phase of separation anxiety, detachment or denial, in which there is a resignation to the loss of the parents and a superficial appearance of adjustment to the environment. Eighteen-month-old children do not forget their parents. The child's behavior indicates resignation, not acceptance or understanding of the situation. Toddlers who have parental support usually view staff members as unfamiliar, frightening, and often threatening. Acceptance of the hospitalization is often the mistaken interpretation of such behavior.
A nurse is caring for a newly admitted client with obsessive-compulsive disorder. When should the nurse anticipate that the client's anxiety level will increase? 1 - As the day progresses 2 -When family members visit 3 -During a physical assessment by the nurse 4 - When limits are set on the performance of a ritual
4 - When limits are set on the performance of a ritual RATIONALE: Setting limits on the performance of a ritual will increase the client's anxiety. The ritual is a defense that the client needs at this time to control anxiety. The client needs time to develop other defenses before the ritual can be limited. The precipitation of anxiety in a client with obsessive-compulsive disorder is usually unrelated to the time of day. Visits from family members may or may not precipitate anxiety. Researchers have implicated trauma to the basal ganglia or cortical connections or a genetic predisposition as the origin of obsessive-compulsive disorder. A physical assessment by the nurse may or may not precipitate anxiety. The presentation of a nonjudgmental, supportive attitude by the nurse should decrease, not increase, anxiety.
