Anxiety Unit Chapter 10&15 Book, ATI Cpt 4 9 11 &19

Which statement by a patient who has been taught cognitive reframing indicates that the teaching was successful? "I do not have the ability to handle that job." "I can be successful if I do all the things required to learn the job." "I may be fired from the job but eventually I will find something else to do with my life." "I can never learn all there is to know for the job."

"I can be successful if I do all the things required to learn the job." Correct Cognitive reframing changes the individual's perceptions of stress by reassessing a situation and replacing irrational beliefs with more positive self-statements. The other options are all negative cognitive distortions that would prevent the individual from success. Text page: 177

A client who is experiencing great stress associated with a disturbing new diagnosis asks the nurse, "Do you think saying a prayer would help?" The answer the nurse should give is "Of course you may pray if you wish. I'll leave you alone." "At the moment we should continue the stress assessment." "Shall I call the chaplain for you?" "If you find comfort in prayer, I'd encourage you to pray."

"If you find comfort in prayer, I'd encourage you to pray." Correct People who include spiritual solutions to physical or mental distress often gain a sense of comfort and support that could aid in healing and lowering stress. Even prayer, by itself, can elicit the relaxation response, which is known to reduce stress physically, emotionally, and immunologically.

Myla, a 29-year-old patient admitted with anxiety, states, "my counselor keeps talking about my stressors. What exactly are stressors?" Your best response to the patient would be: "Stressors are events that happen that threaten your current functioning and require you to adapt." "Stressors are complicated neuro stimuli that cause mental illness." "It's best if you ask questions like that of your provider for a complete answer." "Instead of focusing on what stressors are, let's explore your coping skills."

"Stressors are events that happen that threaten your current functioning and require you to adapt." Correct This is the best explanation of stressors. Stressors are not complicated neuro stimuli; telling the patient to address these questions to her provider fails to educate the patient, which is the nurse's responsibility. Exploring coping skills would be a good intervention at a later time but does not address the patient's question and changes the subject.

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." A helpful response for the nurse to make would be "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?" Correct 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. REF: Page 286-287

5. A client who is under a great deal of stress tells a nurse, "I just don't know how to handle all my problems. So many things are going on that I don't do anything about, because I'm not sure how to start or what to do." Based on this information, the nurse should plan for a client outcome regarding A. decision making. B. anxiety. C. acceptance of health status. D. ability to perform self-care.

A This client describes an inability to make decisions; she is experiencing negative feelings about herself and her life due to problems with decision making. The client does seem anxious, but there is no data to show that achieving self-control over anxiety would be beneficial. There is no data to prove relevance for either option C or D.

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. Correct In many instances, when one anxiety disorder is present, a second one coexists. 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.

4. A client says she is experiencing increased stress because her significant other is, "pressuring me and my kids to go live with him. I love him, but I'm not ready to do that." She also states that her significant other, "keeps nagging at my oldest son, which makes me mad, since he's my son, not his." Which of the following is a coping strategy that the nurse might suggest for this client? A. Learn to reframe the situation. B. Use assertiveness techniques. C. Exercise regularly. D. Rely on the support of a close friend.

B Assertiveness techniques would assist this client to make her feelings known and to request a change of behavior without using blaming or other negative communications. Reframing the situation is not appropriate, because the stressor does not seem to be caused by irrational thoughts. Exercise and talking to a close friend might decrease the client's stress, but they would not change the situation

Which approach to reducing client stress is most effective in people with low to moderate hypnotic ability? Meditation Breathing exercises Journal keeping Biofeedback

Biofeedback Correct Biofeedback is usually thought to be most effective in people with low to moderate hypnotic ability. For people with hypnotic ability, meditation, progressive muscle relaxation, and other cognitive-behavioral therapy techniques produce the most rapid reduction in clinical symptoms. REF: Page 177

3. A nurse knows that teaching has been effective if a client who is taking a benzodiazepine for longterm treatment of anxiety states which of the following? A. "I will only take the medication at bedtime." B. "I will be able to keep taking this drug if I become pregnant." C. "I will not stop taking the drug abruptly." D. "I will need to take this medication the rest of my life."

C A client who takes a benzodiazepine over a long period of time may develop a physical dependence on the medication and may experience withdrawal symptoms if the medication is abruptly discontinued.

2. Which of the following is an antidote for benzodiazepine overdose or toxicity? A. Buspirone (BuSpar) B. Venlafaxine (Effexor) C. Flumazenil (Romazicon) D. Naloxone (Narcan)

C Flumazenil is a benzodiazepine receptor antagonist, which specifically reverses an overdose of benzodiazepines. Buspirone is a nonbarbiturate anxiolytic, and venlafaxine (Effexor) is an atypical antidepressant used for anxiety disorders. Naloxone is an opioid antagonist used to reverse an overdose of opioids, such as morphine sulfate

2. During an assessment, a client tells the nurse, "I remove my old makeup and apply new makeup every hour or so because I look horrible." The nurse should understand that this behavior is consistent with which of the following disorders? A. Generalized anxiety disorder B. Panic disorder C. Obsessive compulsive disorder D. Posttraumatic stress disorder

C Obsessive compulsive disorder is characterized by repetitive, unreasonable behaviors used to reduce anxiety, such as the hourly reapplication of makeup. Generalized anxiety disorder is characterized by excessive worry over multiple concerns for more than 6 months. In panic disorder, the client has recurrent panic attacks. Post traumatic stress disorder causes repeated re-experiencing of a traumatic event.

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

Client demonstrates effective coping strategies. Correct Option A is the only desirable outcome listed.

5. A client has been taking paroxetine (Paxil) to treat an anxiety disorder for several weeks. The client calls the nurse to say that he has been grinding his teeth during the night, which causes pain in his mouth and insomnia for his wife. Which of the following measures may be used to manage the client's concern? (Select all that apply.) Concurrent administration of buspirone Administration of a different SSRI Use of a mouth guard Changing to a different class of antianxiety medication Increasing the dose of paroxetine

Concurrent administration of buspirone, use of a mouth guard, changing to a different class of antianxiety medication are all ways to manage bruxism. Any SSRI may cause bruxism, so changing to another SSRI will not be effective. Increasing the dose of paroxetine will exacerbate the side effect.

Studies of clients diagnosed with posttraumatic stress disorder suggest that the stress response of which of the following is considered abnormal? Brainstem Hypothalamus-pituitary-adrenal system Frontal lobe Limbic system

Hypothalamus-pituitary-adrenal system Correct Studies of clients with posttraumatic stress disorder suggest that the stress response of the hypothalamus-pituitary-adrenal system is abnormal.

Which nursing diagnosis would be most useful for clients with anxiety disorders? Excess fluid volume Disturbed body image Ineffective role performance Disturbed personal identity

Ineffective role performance Correct Anxiety disorders often interfere with the usual role performance of clients. Consider the client with agoraphobia who cannot go to work, or the client with obsessive-compulsive disorder who devotes time to the ritual rather than to parenting. REF: Page 287

What tool might be useful in assessing the amount of stress a client has experienced in the past year? NANDA Handbook DSM-IV-TR Quick Mental Status Assessment Life-Changing Event Questionnaire

Life-Changing Event Questionnaire Correct This questionnaire calls for the client to review events of the past year and score each. This is the only tool listed that assesses stress. REF: Page 1733 (Table 10-3)

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

Modeling Correct Modeling calm behavior in the face of anxiety or unafraid behavior in the presence of a feared stimulus are interventions that can be independently used. The other options require agreement of the treatment team. REF: Page 290-291

Which medication is FDA approved for treatment of anxiety in children? Lorazepam (benzodiazepine) Fluoxetine (selective serotonin reuptake inhibitor) Clomipramine (tricyclic antidepressant) None of the above

None of the above Correct There are no medications with FDA approval for children with anxiety disorders; however, medications approved for other age groups are often prescribed. None of the other options are FDA approved to treat anxiety in children (see the previous sentence).Text page: 296

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 Correct 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.

Which nursing intervention would be helpful when caring for a client diagnosed with an anxiety disorder? Express mild amusement over symptoms. Arrange for client to spend time away from others. Advise client 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. Correct This technique is a variant of cognitive restructuring. "I can't do that" is changed to "I can do it if I try." REF: Page 300-301

4. A client has been taking buspirone (BuSpar) for 3 days to treat an anxiety disorder. He calls the community mental health facility and tells the nurse that the medication has not helped him to sleep at all, and that he is still feeling anxious. How should the nurse reply?

The initial response to buspirone takes 1 week, but it may take several weeks to reach its therapeutic peak. The medication has no hypnotic effect, so it does not promote sleep.Advise the client to try nonmedication measures to promote sleep.

Scenario: A father enters the emergency department with his son, who has just been hit by a car. The father was supposed to be watching the 6 year old while the child's mother was out shopping; however, the child slipped out of the house and wandered into the street in front of his home. At the hospital, the child is immediately sent to surgery and is in critical condition. The father, who is still in the emergency department waiting room, is very distraught and is wailing loudly. He demonstrates an inability to be still, his hands are shaking, and he is frequently dropping his keys. "It should have been me," he moans. Others in the waiting room are starting to appear anxious and are complaining about the disturbance. 4. What level of anxiety is the father experiencing? What data support this description? 5. Identify three nursing interventions for the father.

What level of anxiety is the father experiencing? What data support this description? This man demonstrates severe anxiety. He has an extremely reduced attention span, psychomotor agitation, and he is yelling. Identify three nursing interventions for the father. Appropriate interventions include: remaining with the father; providing a safe and secure environment; assessing for and responding to themes noted in his communication; using firm, short, simple statements to communicate with him; and addressing comfort and safety needs by providing fluids and nutrition

An obsession is defined as thinking of an action and immediately taking the action. a recurrent, persistent thought or impulse. an intense irrational fear of an object or situation. a recurrent behavior performed in the same manner.

a recurrent, persistent thought or impulse. Correct Obsessions are thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind.

The first stage of the general adaptation syndrome can be characterized as eustress. adaptive. maladaptive. psychological.

adaptive. Correct The initial adaptive response of the general adaptation syndrome prepares the individual to fight or flee in the face of acute stress.

The defense mechanisms that can only be used in healthy ways include suppression and humor. altruism and sublimation. idealization and splitting. reaction formation and denial.

altruism and sublimation. Correct 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.

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

assess the client's level of anxiety. Correct The priority nursing action is the assessment of the client's anxiety level.

It can be said that the onset of most anxiety disorders occurs before the age of 20 years. before the age of 40 years. after the age of 40 years. scattered throughout the life span.

before the age of 40 years. Correct Epidemiology reports indicate that the onset of most anxiety disorders occurs before age 40 years YEA Kathy is over 40! Whew

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

being so worried he hasn't been able to work for the last 12 months. Correct GAD is characterized by symptomatology that lasts 6 months or longer. REF: Page 286

A client with hypertension uses an automatic cycling blood pressure cuff with audible changing tones. The client uses relaxation techniques to lower her blood pressure and is informed of her ongoing success by the tone. This process describes biofeedback. guided imagery. therapeutic touch. assertiveness training.

biofeedback. Correct Biofeedback is a technique for gaining conscious control over unconscious processes. The scenario describes one method that might accomplish this. REF: Page 177

Lana is out of surgery and on the medical-surgical unit for recovery. You visit her the day after her surgical procedure. While you are in the room, Lana becomes visibly anxious and short of breath, and she states, "I feel so anxious! Something is wrong!" Your best action is to: reassure Lana that she is experiencing normal anxiety and do deep breathing exercises with her. use the call light to inquire whether Lana has any prn anxiety medication. call for help and assess Lana's vital signs. tell Lana you will stay with her until the anxiety subsides.

call for help and assess Lana's vital signs. Correct In anxiety caused by a medical condition, the individual's symptoms of anxiety are a direct physiological result of a medical condition, such as hyperthyroidism, pulmonary embolism, or cardiac dysrhythmias. In this case Lana is postoperative and could be experiencing a pulmonary embolism, as evidenced by the shortness of breath and anxiety. She needs immediate evaluation for any serious medical condition. The other options would all be appropriate after it has been determined that no serious medical condition is causing the anxiety.Text page: 287

Stress reduction is not likely to result in reduced pain. lower blood pressure. decreased cognitive functions. decreased gastrointestinal problems.

decreased cognitive functions. Correct Stress reduction should benefit the individual by increasing cognitive ability rather than decreasing it.

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 altruism. denial. undoing. suppression.

denial. Correct Denial involves escaping unpleasant reality by ignoring its existence.

A Gulf War veteran is entering treatment for post-traumatic stress disorder. An important facet of assessment is to ascertain how long ago the trauma occurred. find out if the client uses acting-out behavior. determine use of chemical substances for anxiety relief. establish whether the client has chronic hypertension related to high anxiety.

determine use of chemical substances for anxiety relief. Correct Substance abuse often coexists with post-traumatic stress disorder. It is often the client's way of self-medicating to gain relief of symptoms. REF: Page 286-287

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 client's psychosocial background. determine whether the anxiety is primary or secondary in origin.

determine whether the anxiety is primary or secondary in origin. Correct 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.

An effective stress-reduction technique a nurse might teach an individual with performance anxiety is assertiveness. journal keeping. diaphragmatic breathing. restructuring and setting priorities.

diaphragmatic breathing. Correct Changing the breathing pattern can be highly effective in aborting or mitigating the high anxiety level associated with performance anxiety.

Panic attacks in Latin American individuals often involve repetitive involuntary actions. blushing. fear of dying. offensive vebalizations.

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

A symptom commonly associated with panic attacks is obsessions. apathy. fever. fear of impending doom.

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

Selective inattention is first noted when experiencing anxiety that is mild. moderate. severe. panic.

moderate. Correct 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.

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

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

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. Correct Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions.

You are providing teaching to Lana, a preoperative patient just before surgery. She is becoming more and more anxious as you talk. She begins to complain of dizziness and heart pounding, and she is trembling. She seems confused. Your best response is to: reinforce the preoperative teaching by restating it slowly. have Lana read the teaching materials instead of verbal instruction. have a family member read the preoperative materials to Lana. not attempt any teaching at this time.

not attempt any teaching at this time. Correct 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.Text page: 279

Meditation is successful in promoting stress reduction because it prevents endorphin release. changes the client's energy field. quiets the sympathetic nervous system. activates the parasympathetic nervous system.

quiets the sympathetic nervous system. Correct Sympathetic nervous system stimulation prepares the body for fight or flight in response to stress. Meditation reduces this state of alert. REF: Page 167

High-quality social support relationships have attributes that include constructive criticism. minor conflict. continuous feedback. reciprocal closeness.

reciprocal closeness. Correct High-quality social support relationships are relatively conflict free, close, confiding, and reciprocal.

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

repression. Correct Repression is a defense mechanism that excludes unwanted or unpleasant experiences, emotions, or ideas from 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. Correct Severe anxiety is characterized by feelings of falling apart and impending doom, impaired cognition, and severe somatic symptoms such as headache and pounding heart. REF: Page 279-280

A potential problem for a client diagnosed with severe obsessive-compulsive disorder is sleep disturbance. excessive socialization. command hallucinations. altered state of consciousness.

sleep disturbance. Correct Clients who must engage in compulsive rituals for anxiety relief are rarely afforded relief for any prolonged period. The high anxiety level and need to perform the ritual may interfere with sleep.REF: 286

Self-help groups are useful for reducing stress because they provide the individual with the stress mediator identified as social support. cultural support. life satisfaction. cognitive reframing.

social support. Correct Self-help groups often provide a high level of social support. Members meet and are encouraged and sustained by others who share the same problem. REF: Page 170-171

An Asian client would be most likely to respond to stress by the subjective experience of anxiety. somatic complaints. memory deficiencies. sensory perceptual alterations.

somatic complaints. Correct The overwhelming majority of Asians, Africans, and Central Americans not only express subjective distress in somatic terms, but actually experience this distress somatically, such that psychological interpretations of suffering may not be much use cross-culturally.

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. Caffeine is an antagonist of antianxiety medication.

teach the client to limit caffeine intake. Correct Caffeine is an antagonist of antianxiety medication. REF: Page 296-297

A client is experiencing a panic attack. The nurse can be most therapeutic by telling 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

telling the client to take slow, deep breaths. Correct 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. REF: Page 284 (Table 15-3)

The physiologic basis for the success of guided imagery is β-endorphin release raises the pain threshold. imagery raises the body level of cortisol and epinephrine. the sympathetic nervous system is stimulated to produce a quiet state. brain catecholamines are less available to transmit pain impulses.

β-endorphin release raises the pain threshold. Correct Guided imagery stimulates release of β-endorphins, a brain chemical that raises the individual's pain threshold. In so doing, the guided imagery is responsible for making the client more comfortable. REF: Page 176

3. Which of the following is an appropriate nursing strategy when trying to give necessary information to a client with moderate anxiety? A. Reassure the client that everything will be okay. B. Encourage the client to talk about her feelings of anxiety. C. Ignore the client's anxiety so that she will not be embarrassed. D. Demonstrate a calm manner while using simple and clear language

D Giving information simply and calmly will help the client grasp essential facts. Offering false reassurance is a nontherapeutic intervention. Trying to make the client verbalize her feelings may offer more distraction. Ignoring the anxiety will not help the client manage the situation.

Delusionary thinking is a characteristic of chronic anxiety. acute anxiety. severe anxiety. panic level anxiety.

panic level anxiety. Correct Panic level anxiety is the most extreme level and results in markedly disturbed thinking.

Jacob is a college student whose friend recently committed suicide. Jacob rates his stress as low. Melissa was also friends with the person who committed suicide, but she rates her stress as high. The difference in how Jacob and Melissa rate their stress may be explained by: projection. denial. perception. repression.

perception. Correct Perception, which is influenced by gender, culture, age, and life experience, plays a part in how someone will respond to a stress. The perception of a stressor determines the person's emotional and psychological reactions to it. The other options are all defense mechanisms that do not explain the difference in reactions to a stressor. Text page: 170

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 projection. rationalization. reaction formation. undoing.

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

Scenario: A client, who is speaking to a nurse, describes herself as feeling "anxious and tired all the time." She cannot understand why, since she is very happy. She recently moved to the area to start a new job for a large corporation. She purchased a new and much larger home for herself and her three children, ages 5, 8, and 12. The children were all moved into new schools successfully and are making new friends. The client's family and friends are all back in the previous city where she lived, but she has been so busy with work that she has not had time to phone or write to them. The client states she has not been able to sleep and has lost weight in the 2 months since the move. 1. List the stressors that impact this client. 2. What symptoms of increased stress can be observed in this client? 3. Describe two stress-relieving activities that the nurse could recommend that would not require the client to learn new techniques, or to see a therapist or specially trained professional.

1. List the stressors that impact this client. Recent move Purchase of a larger home Placing three children into new schools Sudden decrease of support systems New job Lack of free time 2. What symptoms of increased stress can be observed in this client? The client states that she feels anxious and tired all the time. She also has sleep disturbances and has had weight loss. 3. Describe two stress-relieving activities that the nurse could recommend that would not require the client to learn new techniques, or to see a therapist or specially trained professional. The client could be advised to increase physical exercise by doing things such as walking, swimming, or yoga. She could also begin to keep a journal. If she has learned meditation techniques in the past, she could try them again now

4. A nurse observes a client who is pacing and wringing his hands. The client states being worried since last year that his son will die a horrible death. The nurse should understand that these symptoms are consistent with which of the following disorders? A. Generalized anxiety disorder B. A specific phobia C. Posttraumatic stress disorder D. Obsessive compulsive disorder

A Generalized anxiety disorder is characterized by worry of long duration and without cause. The symptoms described are not those of a specific phobia. Posttraumatic stress disorder causes repeated re-experiencing of a traumatic event. Obsessive compulsive disorder is characterized by repetitive unreasonable behaviors, such as handwashing, to reduce anxiety

1. When assessing a client who states that she has been dealing with constant anxiety for the past few weeks, the nurse should use which of the following communication techniques? A. Ask open-ended questions. B. Provide reassurance. C. Minimize the client's symptoms. D. Offer advice.

A Open-ended questions allow the client to tell the nurse about her anxiety. Providing reassurance, minimizing the symptoms, and offering advice are examples of nontherapeutic communication that may be dismissive of the client's concerns.

Which of the following examples illustrates eustress? A college student fails an exam. A bride is planning for her wedding. A man is laid off from his job. An adolescent gets into a fight at school. Eustress is the result of a positive perception toward a stressor, such as having a baby, planning a wedding, or getting a new job. The other options all describe distress, or a negative energy. Text page: 169

A bride is planning for her wedding. Correct Eustress is the result of a positive perception toward a stressor, such as having a baby, planning a wedding, or getting a new job. The other options all describe distress, or a negative energy. Text page: 169

2. A client in a primary care facility just learned that she must have a breast biopsy. As the nurse tries to give her information about the procedure, he notices that the client is perspiring and pale. Her breathing is rapid at about 28/min, and she says, "You'll have to excuse me; I don't quite understand what you're trying to tell me." The nurse should assess the client's anxiety as A. mild. B. moderate. C. severe. D. panic.

B Moderate anxiety decreases problem solving and may hamper one's ability to understand information. Vital signs may increase somewhat, and the person is visibly anxious. In mild anxiety, the person's ability to understand information may actually increase. Severe anxiety causes restlessness, decreased perception, and an inability to take direction. During a panic attack, the person is completely distracted, unable to function, and may lose touch with reality.

5. A client hospitalized in an acute care mental health facility ritualistically cleans the sink in her bathroom multiple times daily. The outcome identified by the treatment team is that the client should use more effective coping measures. To achieve the desired outcome, the nurse should A. suggest that the client work with the maintenance staff in cleaning unit bathrooms. B. focus on the client's symptoms rather than on her feelings. C. encourage the client to participate in a variety of unit activities. D. enforce a strict schedule for the client's use of the bathroom.

C Encouraging the client to participate in unit activities and become involved with other people helps to decrease involvement in the ritualistic behavior and encourages coping skills. Encouraging the client to clean focuses on the ritual. The nurse should focus on client feelings rather than on symptoms, because these feelings are what cause the symptoms. Enforcing a strict schedule for the client's use of the bathroom is punitive and will not assist her to use more effective coping measures.

A client is displaying symptomatology reflective of a panic attack. In order to help the client regain control, the nurse responds, "You need to calm yourself." "What is it that you would like me to do to help you?" "Can you tell me what you were feeling just before your attack?" "I will get you some medication to help calm you."

"Can you tell me what you were feeling just before your attack?" Correct A response that helps the client identify the precipitant stressor is most therapeutic.REF: Page 284-285

An important question to ask during the assessment of a client diagnosed with anxiety disorder is "How often do you hear voices?" "Have you ever considered suicide?" "How long has your memory been bad?" "Do your thoughts always seem jumbled?"

"Have you ever considered suicide?" Correct The presence of anxiety may cause an individual to consider suicide as a means of finding comfort and peace. Suicide assessment is appropriate for any client with higher levels of anxiety.

3. Which of the following is an appropriate nursing intervention for a client experiencing a panic attack? A. Teach the client relaxation techniques. B. Show the client how to change his behavior. C. Distract the client with a television show. D. Stay with the client and remain quiet.

D During a panic attack, the client is unable to think about anything except the symptoms being experienced. The nurse should stay with the client. The client will not be able tobe distracted and will not be able to concentrate in order to learn new material. Otherinterventions should be postponed until after the attack

What would a client experience during a progressive relaxation session? Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed Being attached to a machine that monitors a physical parameter and receiving audible feedback about the state of that parameter Having a nurse enter the client's energy field to rebalance it and bring harmony Being led into a positive imaginary sensory experience

Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed Correct Instruction on sequential tensing and relaxing muscles provides a description of Benson's method of progressive relaxation. Being attached to a machine that uses sound describes biofeedback. Rebalancing an energy field describes therapeutic touch. Positive imaging describes a component of guided imagery. REF: Page 175

Jerry is a 72-year-old patient with Parkinson's disease and anxiety. He is living by himself and has had several falls lately. His provider orders lorazepam, 1 mg PO bid, for anxiety. You question this order because: Jerry may become addicted faster than younger patients. Jerry is at risk for falls. Jerry has a history of nonadherence with medications. Jerry should be treated with cognitive therapies rather than medication because of his advanced age.

Jerry is at risk for falls. Correct 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. Text page: 296-297

6. Match the specific anxiety disorder with its characteristics. Obsessive compulsive disorder Panic disorder Generalized anxiety disorder Agoraphobia Social phobia Posttraumatic stress disorder A. Traumatic event causing symptoms months after the event takes place B. Excessive worries for more than 6 months C. Fear of speaking or interacting in public D. Symptoms including chest pain, palpitations, a feeling that one is about to die E. Fear of being out in open spaces F. Ritualistic compulsions and recurrent thoughts

Obsessive compulsive disorder=F Panic disorder =D Generalized anxiety disorder=B Agoraphobia =E Social phobia= C Posttraumatic stress disorder =A

Which behavior would be characteristic of an individual who is displacing anger? Lying Stealing Slapping Procrastinating

Procrastinating Correct A passive-aggressive person deals with emotional conflict by indirectly and unassertively expressing aggression toward others. Procrastination is an expression of resistance.

1. Match each defense mechanism below with the letter of the behavior that best illustrates it. Reaction formation Denial . Displacement Rationalization Sublimation A. A child is punished by his mother and sent to his room, where he begins to kick and break apart a favorite toy B. A woman who just lost her job, because she frequently was late for work, tells friends that it will be much better for her family if she stays home every day. C. A woman who just lost an election to a hated rival declares, "She is such a sweet person, and I really like her!" D. A heavy smoker diagnosed with lung cancer says, "I'm coughing because I have that cold that everyone has been getting." E. A husband feels very angry with his wife, so he goes outside and begins energetically cutting up firewood with an axe

Reaction formation =C Denial =D Displacement =A Rationalization=B Sublimation=E

1. A nurse working in a mental health clinic is providing teaching to a client with a new prescription for diazepam (Valium) for generalized anxiety disorder. The client had originally told her provider that she took no other medications. However, before leaving the clinic, she says to the nurse, "Oh, I forgot that I do take a sleeping pill at night for insomnia, and I also usually drink a glass of wine before bedtime to make sure I sleep." What should be the nurse's concerns about this information, and what interventions are necessary?

Taking a benzodiazepine concurrently with other CNS depressants, including alcohol, can cause an overdose marked by increased sedation, lack of coordination, and confusion. This information should be reported to the provider before the client leaves the clinic.

Melissa, whose friend recently committed suicide, asks you some ways she could cope with her stress regarding the event. Which of the following options would be appropriate to discuss with Melissa? Isolation for a short time so that the pain isn't reinforced by explaining her feelings over and over Antianxiety medication to help her relax Starting a hobby to keep her mind off the troubling event Talking with friends and attending a loss support group

Talking with friends and attending a loss support group Correct Social supports and support groups are two effective ways to cope with stress and stressful events. Isolation is never a healthy option; talking about feelings usually decreases stress, not increases. There is no evidence to suggest Melissa is anxious. Trying to "keep her mind off" the stressor does not develop coping mechanisms to deal with stress but rather encourages not dealing with the problem. Text page: 170-171

What factor exerts the greatest influence on the degree to which various life events upset a specific individual? The individual's perception of the event The individual's degree of spirituality The effect of the individual's health-sustaining behaviors The amount of social support available to the individual

The individual's perception of the event Correct Researchers have looked at the degree to which various life events upset specific individuals. They have found that the perception of a recent life event determines the person's emotional and psychological reactions to it. For example, a man in his 40s who has a new baby, has just purchased a home, and is laid off with 6 months' severance pay may feel the stress of a lost job more intensely than a man who is 62 years old, financially secure, and asked to take an early retirement.

he nurse caring for a client experiencing a panic attack anticipates that the psychiatrist would order a stat dose of standard antipsychotic medication. tricyclic antidepressant medication. anticholinergic medication. a short-acting benzodiazepine medication.

a short-acting benzodiazepine medication. Correct 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.REF: Page 296

The nurse anticipates that the nursing history of a client diagnosed with obsessive compulsive disorder (OCD) will reveal a history of childhood trauma. a sibling with the disorder. an eating disorder. a phobia as well.

a sibling with the disorder. Correct Research shows that first-degree biological relatives of those with OCD have a higher frequency of the disorder than exists in the general population. REF: Page 290

Stella brings her mother, Dorothy, to the mental health outpatient clinic. Dorothy has a history of anxiety. Stella and Dorothy both give information for the assessment interview. Stella states, "My mother lives with me since my dad died 6 months ago. For the past couple of months, every time I need to leave the house for work or anything else, Mom becomes extremely anxious and cries that something terrible is going to happen to me. She seems OK except for these times, but it's affecting my ability to go to work." You suspect: panic disorder. adult separation anxiety disorder. agoraphobia. social anxiety disorder.

adult separation anxiety disorder. Correct People with separation anxiety disorder exhibit developmentally inappropriate levels of concern over being away from a significant other. There may also be fear that something horrible will happen to the other person. Adult separation anxiety disorder may begin in childhood or adulthood. The scenario doesn't describe panic disorder. Agoraphobia is characterized by intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available. Social anxiety disorder, also called social phobia, is characterized by severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others. Text page: 282-283

An advantage of the Holmes and Rahe updated life event and social readjustment scale is that it focuses on the presenting symptoms. identifies the client's perception of events. considers the client's various mediating factors.

assesses stress threshold and potential for future illness. Correct The scoring of this scale gives nurses the capability of predicting a person's potential for future stress-related illness.REF: Page 172

A nurse teaches a client a technique for examining negative thoughts and restating them in positive ways. This technique is called guided imagery. cognitive reframing. wishful thinking. confrontational assertion.

cognitive reframing. Correct Cognitive reframing calls for changing the viewpoint of a situation and replacing it with another viewpoint that fits the facts but is less negative. REF: Page 177-178

The individual initially thinks, "I'll never get through this huge assignment," but then amends the thought to "I can get through the assignment by breaking it into small portions and doing them one by one." This thought process is an example of rationalization. wishful thinking. simple assertion. cognitive reframing.

cognitive reframing. Correct Cognitive reframing involves changing the way one looks at a problem, moving from a negative view to a more positive view. REF: Page 177-178

Working to help the client view an occurrence in a more positive light is called flooding. desensitization. response prevention. cognitive restructuring.

cognitive restructuring. Correct 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.

One effect of stress can be attributed to the stimulation of the hypothalamus-pituitary-adrenal cortex, causing a short-term increase in the heart rate. triglycerides. gluconeogenesis. brain norepinephrine.

gluconeogenesis. Correct An increase in gluconeogenesis, stimulated by the release of cortisol, ensures that increased amounts of glucose are available to the individual. Increased glucose levels heighten and maintain energy levels to meet the demands of a crisis or stressor.

Stress can be attributed to stimulation of the hypothalamus-pituitary-adrenal cortex, and over the long term it can result in insulin resistance. a high resting heart rate. digestive problems. chronic muscle tension.

insulin resistance. Correct Insulin resistance and obesity are considered long-term sequelae of the high blood glucose levels incurred when the body responds to stress.

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

is a response to a specific danger; anxiety is a response to an unknown danger. Correct Fear is a response to an objective danger; anxiety is a response to a subjective danger.

If a client's record mentions that the client habitually relies on rationalization, the nurse might expect the client to make jokes to relieve tension. miss appointments. justify illogical ideas and feelings. behave in ways that are the opposite of his or her feelings.

justify illogical ideas and feelings. Correct Rationalization involves justifying illogical or unreasonable ideas or feelings by developing logical explanations that satisfy the teller and the listener. REF: Page 283 (Table 15-2)

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

often involve some degree of self-deception. Correct 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.

nability to leave one's home because of avoidance of severe anxiety suggests the anxiety disorder of panic attacks with agoraphobia. obsessive-compulsive disorder. posttraumatic stress response. generalized anxiety disorder.

panic attacks with agoraphobia. Correct 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.

A client 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 of anxiety can be assessed as mild. moderate. severe. panic.

panic. Correct 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. REF: Page 293-294

The relaxation response calls upon sympathetic activation. parasympathetic activation. brainstem deactivation. increased cortisol production by the adrenals.

parasympathetic activation. Correct Sympathetic activation prepares the individual for the fight-or-flight response. Parasympathetic activation has the opposite effect.

A cultural characteristic that may be observed in a teenage, female Hispanic client in times of stress is to suddenly tremble severely. exhibit stoic behavior. report both nausea and vomiting. laugh inappropriately.

suddenly tremble severely. Correct Ataque de nervios (attack of the nerves) is a culture-bound syndrome that is seen in undereducated, disadvantaged females of Hispanic ethnicity.REF: Page 291