Ch. 15 Anxiety and Obsessive-Compulsive Disorders

symptoms that occur on a daily basis and may involve issues of sexuality, violence, contamination, illness, or death

OCD

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

a. They often involve some degree of self-deception.

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

b. The client is at risk for falls.

ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxeity to reduce anxeity or prevent an imagined calamity

compulsions

__________________ is contraindicated in patients with impaired hepatic or renal function

buspirone

an alternative anti-anxiety medication that does not cause dependence but 2 to 4 weeks are required for it to reach full effects

buspirone

Your patient is experiencing muscle spasms of the face. As the nurse you realize your patient is experiencing this? a. Oculogyric crisis b. Akathisia c. Acute dystonia d. Early signs of Serotonin Syndrome

c. Acute dystonia

A symptom commonly associated with panic attacks? a. Obsessions b. Apathy c. Fever d. Fear of impending doom

d. Fear of impending doom

Delusionary thinking is a characteristic of which form of anxiety? a. Chronic anxiety b. Acute anxiety c. Severe anxiety d. Panic level anxiety

d. Panic level anxiety

The client on a psychiatric unit has been diagnosed with schizophrenia. He begins to tell the nurse about how he is fearful the CIA is looking for him and monitoring him. You recognize this as what symptom of schizophrenia. a. Magical thinking b. Symbolic speech c. Persecutory delusion d. Paranoia

d. Paranoia

exhibit developmentally inappropriate levels of concern over being away from a significant other

separation anxiety disorder

learning and problem solving are not possible person is dazed and confused

severe anxiety

Sedation Ataxia Decreased cognitive function.

side effects of benzodiazepines

dizziness, nausea, headache, nervousness, lightheadedness, and excitement

side effects of buspirone

Excoriation Disorder

skin picking

severe anxiety or fear provoked by exposure to a social or a perfromance sitution that could be evaluated negatively by others

social anxiety disorder

secretly swallowing the pulled hair is common in this disorder

trichophagia

________________ seems to have a more calming effect than other SSRIs

paroxetine

Persistent and irrational fear of a specific object, activity or situation

phobia

sublimation and altruism are

positive coping mechanisms

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

d. Fear is a response to a specific danger; anxiety is a response to an unknown danger.

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

b. Denial

Escitalopram (Lexapro)

SSRI

Fluoxetine (Prozac)

SSRI

Paroxitine (Paxil)

SSRI

Sertaline (Zoloft)

SSRI

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

b. Depression may occur prior to onset of anxiety.

hair pulling disorder

Trichotillomania

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

a, b, c, and e

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

a. Client demonstrates effective coping strategies.

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

a. Encouraging the client to take slow, deep breaths

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

a. Panic attacks with agoraphobia

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

a. Suddenly tremble severely

People who develop schizophrenia will often experience milder symptoms of the disorder months or years prior to the disorder becoming fully apparent. This phase also includes a. disorganization in speech or thoughts b. polydipsia c. substance abuse d. increase in social activity

a. disorganization in speech or thoughts

use of defense mechanisms that help people lower anxiety to achieve goals in acceptable ways

adaptive

used to treat the somatic and psychological symptoms of anxiety disorders

anti-anxiety drugs

beta blockers, antihistamines, anticonvulsants, and antipsychotics are used to treat

anxiety

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

b. Repression

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

b. A recurrent, persistent thought or impulse

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

b. Altruism and sublimation

Which of the following would be an example of a negative symptom of schizophrenia? a. Falsely believing that you are Queen Elizabeth b. An inability to recognize illness c. Seeing and talking to your dead grandmother d. Believing the FBI is out to get you e. All answers are correct

b. An inability to recognize illness

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

b. Being unable to work for the last 12 months.

Selective inattention is first noted when experiencing which level of anxiety? a. Mild b. Moderate c. Severe d. Panic

b. Moderate

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

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

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

c. Determine the use of chemical substances for anxiety relief.

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

c. Fear of dying

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

c. Justifies illogical ideas and feelings.

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

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

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

c. Reaction formation

Your patient, Sharon, who is diagnosed with schizophrenia is resistant to treatment. You suspect she is cheeking her medications. Which nursing intervention would be the priority intervention for this behavior? a. Hide the medication in her food, so she won't know she is taking it. b. Give her a long lasting injectable medication. c. Seek to change the medication to a fast disintegrating tablet. d. Convey in a clear confident manner that she will benefit from the treatment.

c. Seek to change the medication to a fast disintegrating tablet.

Your patient is experiencing auditory hallucinations. Which of the following nursing interventions is most likely to be helpful to your patient? a. Ask the patient to in detail describe their hallucinations, then say, "You are making this up." b. You the nurse, should ignore the hallucinations so the patient learns to manage these on own c. Teach the patient to use the TV or radio to compete with the hallucinations. Instead ask, What are you hearing? d. Immediately seclude your patient to prevent harm to self or others

c. Teach the patient to use the TV or radio to compete with the hallucinations. Instead ask, What are you hearing?

Which statement below would indicate that your client is experiencing command hallucinations? a. Your patient states, "I hear angels singing." b. A man sees a coat on a shadowy coat rack and says, "Do you see that bear?" c. Your patient states, "God told me my child was evil and I should kill her." d. Your patient states,"when I stop taking Quetiapine (Seroquel), I can hear my guts rot away." Feedback

c. Your patient states, "God told me my child was evil and I should kill her."

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

c. severe.

thoughts, impulses, or images that persist and recur so that they cannot be dismesed from the mind even though the indivual attempts to do so

obsessions

most extreme level of anxiety results on markedly dysregulated behavior

panic

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

d. Cognitive restructuring

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

d. Do not attempt any further teaching at this time.

Which medication is FDA approved for treatment of anxiety in children? a. Sertraline b. Fluoxetine c. Clomipramine d. Duloxetine

d. Duloxetine

Your patient refers to "leafdroppers" as people who let him down.The nurse would recognize this speech alteration as? a. clang association b. magical thinking c. word salad d. neologism

d. neologism

automatic coping styles that protect people from anxiety and maintain see image by blocking feelings, conflucts, and memnoreis

defense mechanism

excessive worry

generalized anxiety disorder

use of defense mechanisms occurs when one or several are used in excess, particualrly in the overuse of immature defenses

maladaptive

increases focus and ability to learn

mild anxiety

decreases sensory perception selective inattention

moderate anxiety

Sudden onset of extreme apprehension or fear, usually associated with feelings of impending doom

panic attack

hallucinations may occur during

panic attacks