Ch 27: Anxiety Disorders: Management of Anxiety and Panic

20. A client with generalized anxiety disorder states that the client is worried about the client's job. The client never feels like the client has control over the client's responsibilities, even though the client puts in extra hours. The client adds that the client is afraid the client will be fired. Which response by the nurse is most therapeutic? a) "Has something changed at work that is causing you to worry?" b) "Why do you think you'll be fired?" c) "It sounds to me like you're doing a good job" d) "Your worries are a feature of your anxiety disorder. Tell yourself that you have nothing to worry about"

a) "Has something changed at work that is causing you to worry?" Pg. The nurse begins an assessment by simply asking the client if he or she is currently feeling anxious or worried or has experienced these feelings recently. The nurse also asks the client about obsessive thinking patterns, worrying, compulsions and repetitive activity, specific phobias, and exposure to traumatic events. Once the nurse has determined that signs and symptoms of anxiety do exist, the nurse assesses the possible underlying causes and inquires about family history, recent life events, current stress level, personal history of anxiety, medical and medication history, history of substance abuse, and other possible causes of the anxiety.

58. The nurse recognizes that which client is most likely experiencing generalized anxiety disorder (GAD)? a) 40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months b) 30-year-old business executive who reports being anxious about attending the meetings and social events that are the executive's job responsibilities c) 22-year-old soldier who served in the Middle East who "cannot sleep" and is facing criminal charges for hurting someone in a barroom brawl d) 70-year-old whose spouse died 1 year ago who has "no desire to leave my house" and reports severe fatigue

a) 40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months Pg. 482 The nurse recognizes that the client most likely experiencing GAD is a 40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months. GAD is characterized by excessive worry and feelings of anxiety at least 50% of the time for 6 months or more. The client with GAD has three or more of the following symptoms: uneasiness, irritability, muscle tension, fatigue, difficulty thinking, and sleep alterations. The military veteran is most likely experiencing posttraumatic stress disorder (PTSD), the older adult may be experiencing depression, and the business executive may have social phobia.

63. Which nursing assessment is most appropriate for an older client presenting with reports of generalized anxiety? a) Assess for depression b) Assess for dementia c) Assess for panic attacks d) Assess for elder abuse

a) Assess for depression Pg. 482 Late-onset generalized anxiety disorder (GAD) is usually associated with depression. Although less common, panic attacks can occur in later life and are often related to depression or a physical illness such as cardiovascular, GI, or chronic pulmonary diseases. While the remaining options are appropriate, they are not associated with the possible comorbid conditions of GAD.

43. The nurse is educating a client and family about managing panic attacks after discharge from treatment. The nurse includes which in the discharge teaching? Select all that apply. a) Continued practice of relaxation techniques b) Lessening the amount of daily responsibilities c) Development of a regular exercise program d) Continued development of positive coping skills e) Weaning off of medications as necessary

a) Continued practice of relaxation techniques c) Development of a regular exercise program d) Continued development of positive coping skills Pg. 474 Client/family education for panic disorder includes reviewing breathing control and relaxation techniques, discussing positive coping strategies, encouraging regular exercise. Medication should be adhered to as prescribed; the client may or may not be instructed to wean off of medications. Daily responsibilities cannot be avoided, but rather should be successfully accomplished.

50. The nurse documents that the client is in a state of panic anxiety when she is observed doing which of the following? a) Crying hysterically and complaining of a shortness of breath prior to a cardiac procedure b) The client refuses to have her blood pressure taken in her left arm because she is sure something bad will happen c) Reporting that she "can't sleep a wink" if she is not in her own bed d) Wringing her hands and asking staff when they think she will have another heart attack

a) Crying hysterically and complaining of a shortness of breath prior to a cardiac procedure Pg. An anxiety state occurs as the result of a stressful situation in which the person loses control of her or his emotions. So, the nurse would document that the client is in a state of panic anxiety when the nurse observes the client crying hysterically and complaining of shortness of breath after being told that she has been scheduled for a cardiac procedure.

42. Which term describes feelings of being disconnected from oneself, as seen in a panic attack? a) Depersonalization b) Automatisms c) Agoraphobia d) Derealization

a) Depersonalization Pg. 464 Depersonalization describes feelings of being disconnected from oneself, as seen in a panic attack. Automatisms are automatic, unconscious mannerisms. Derealization is sensing that things are not real. Agoraphobia is a fear of being outside.

53. When assessing an older adult client who has newly been diagnosed with an anxiety disorder, the mental health nurse's priority is to carry out which task? a) Determine the client's risk for self-harm or harm to others b) Determine the effects that culture has had on the client's anxiety issues c) Assess for physical conditions that may affect anxiety d) Obtain a thorough history, focusing on the client's physiologic functioning

a) Determine the client's risk for self-harm or harm to others Pg. 461 The first step in the assessment process is to identify the client's level of anxiety and to determine whether a threat of self-harm or harm to others exists. In any situation where the client history is not known, the nursing priority is safety.

17. Which assessment question is most likely to allow the nurse to differentiate between anxiety disorder due to a general medical condition and psychological factors affecting a medical condition? a) Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first b) Asking the client to provide a detailed explanation of his or her medical problem to determine if the presentation is typical of the problem c) Reviewing the client's previous medication administration record and the client's current list of medications d) Questioning the client about the clinician who first diagnosed the medical problem

a) Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first Pg. Considering the relationship of anxiety with the onset, exacerbation, or remission of the general medical condition can help determine whether a medical condition contributes to anxiety or vice versa. The client's medication list, the identity of the clinician who diagnosed the disease, and the client's symptoms are all aspects of the assessment process, but these are less likely to establish the primary cause.

27. A nurse is preparing a plan of care for a client with anxiety. Which elements would the nurse likely include? Select all that apply. a) Identifying treatment modalities b) Providing supportive feedback c) Using appropriate coping skills d) Using restraint when panic develops e) Involving family for support, if appropriate

a) Identifying treatment modalities b) Providing supportive feedback c) Using appropriate coping skills e) Involving family for support, if appropriate Pg. 480 Appropriate measures to include in the plan of care for a client with anxiety include: introducing appropriate coping skills, identifying alternate treatment modalities, involving family and support persons when appropriate, and providing feedback that is supportive to the client. Restraint is always a last resort.

64. Which is one characteristic that differentiates generalized anxiety disorder (GAD) and panic disorder? a) In GAD, the person usually does not experience eruptions of acute anxiety b) Panic disorders are more easily treated than GAD c) GAD is characterized by occasional, unexpected panic attacks d) In panic disorder, the person suffers from a chronic state of elevated anxiety

a) In GAD, the person usually does not experience eruptions of acute anxiety Pg. 482 GAD is characterized by the pervasive existence of severe anxiety with no apparent cause. Panic disorder is characterized by acute onset of panic levels of anxiety.

56. A nurse is caring for a client with generalized anxiety disorder. When the client starts trembling and perspiring, the nurse becomes uncomfortable and anxious; develops cold, clammy hands; and has a racing pulse. When the nurse responds in this way during an interaction, what will the client most likely develop? a) Increased anxiety b) Claustrophobia c) Fatigue d) Improved self-esteem

a) Increased anxiety Pg. 464 Anxiety is transmissible interpersonally. The client who detects the nurse's anxiety usually experiences heightening of anxiety rather than fatigue. Claustrophobia is rarely the outcome of empathized anxiety. Improved self-esteem would not result from empathic anxiety.

59. The nurse is teaching a class to a group of individuals diagnosed with anxiety disorders. When describing the underlying cause of these disorders, which information would the nurse mostlikely include? a) Neurotransmitter involvement b) Inactivation of stress hormones c) Distorted thinking patterns d) A heritable predisposition unrelated to brain abnormalities

a) Neurotransmitter involvement Pg. 467 According to current research, anxiety disorders have several possible causes. The etiology of anxiety disorders include biologic theories that address neurotransmitters, a substantial familial predisposition to panic disorder with an estimated heritability along wtih brain abnormalities in the "fear network" (amygdala, hippocampus, thalamus, midbrain, pons, medulla, and cerebellum) and changes in volume in different brain areas. Activation of stress hormones are also thought to play a role.

61. A client says to the nurse, "I just can't talk in front of the group. I'm trembling and I feel like I'm going to pass out." The nurse assesses the client's anxiety to be at which level? a) Severe b) Mild c) Moderate d) Panic

a) Severe Pg. 462 Physiologic responses to severe anxiety include headache, nausea, vomiting, diarrhea, trembling, rigid stance, vertigo, pale, tachycardia, and chest pain. Vertigo can cause a sensation of "passing out." A client who is panicking would not be able to articulate his or her state.

48. A group of nursing students are reviewing signs and symptoms of anxiety. The students demonstrate a need for additional review when they identify what? a) Tearfulness b) Motor excitement c) Extreme restlessness d) Palpitations

a) Tearfulness Pg. 462 The clinical symptoms of anxiety are numerous. They are generally classified as physiologic, psychological or emotional, behavioral, and intellectual or cognitive responses to stress. The clinical symptoms may vary according to the level of anxiety exhibited by the client. Tearfulness and sadness are symptoms of depression, not of anxiety.

41. A psychiatric health nurse is preparing a presentation for a group of colleagues on anxiety disorders. As part of the presentation the nurse plans to discuss the concept of interoceptive conditioning. Which information would the nurse most likely include in this discussion? a) There is an association between physical symptoms and a panic attack b) The person experiences a phobic avoidance of the event c) A person links an adverse event with a previous neutral event d) A recent loss is the initiating event that leads to a panic attack

a) There is an association between physical symptoms and a panic attack Pg. Interoceptive conditioning involves an association between physical discomfort, such as dizziness or palpitations and an impending panic attack. Classic conditioning theory suggests that one learns a fear response by linking an adverse or fear-provoking event, such as a car accident, with a previously neutral event, such as crossing a bridge. One becomes conditioned to associate fear with crossing a bridge. This is also called phobic avoidance. Psychodynamic theories address anxiety as developing after separation and loss.

32. A nurse is talking with a client who has experienced panic attacks. The client asks the nurse, "What causes these attacks?" Which information would the nurse most likely integrate into the response about the etiology of panic disorders? a) There is evidence of a substantial familial predisposition to panic disorder b) Neurologic abnormalities are a rare occurrence with panic disorder c) There is a strong evidence supporting a psychodynamic influence d) The link between panic disorders and neurotransmitters is lacking

a) There is evidence of a substantial familial predisposition to panic disorder Pg.467 There appears to be a substantial familial predisposition to panic disorder with an estimated heritability of 48%. Certain neurologic abnormalities have also been identified in clients with panic disorder. The most common abnormalities are found in the "fear network" of the brain, that is, the amygdala, hippocampus, thalamus, midbrain, pons, medulla, and cerebellum. Research shows a reduction in volume in some areas and increases in different brain areas. Research is establishing associations between the neurotransmitter pathways involved in regulation of the monoamine mechanism. Psychodynamic theories explain that anxiety develops after separation and loss. A great number of patients link their initial panic attack with recent personal losses. However, at this point the empirical evidence is inadequate for a psychodynamic explanation. It remains unclear why some patients develop panic disorder while others with similar experiences develop other disorders.

52. Why must nurses understand why anxiety occurs and how anxiety behaviors work? Select all that apply. a) To help nurses to function at a high level b) So the nurse can identify that his or her own needs are more important than the clients c) To help understand the role anxiety plays in performing nursing responsibilities d) To help the nurse to mask his or her own feelings of anxiety e) To provide better care for the client

a) To help nurses to function at a high level c) To help understand the role anxiety plays in performing nursing responsibilities e) To provide better care for the client Pg. Nurses must understand why and how anxiety behaviors work, not just for client care but to help understand the role anxiety plays in performing nursing responsibilities. Nurses are expected to function at a high level and to avoid allowing their own feelings and needs to hinder the care of their clients, but as emotional beings, nurses are just as vulnerable to stress and anxiety as others, and they have needs of their own. Clients' emotional needs always supersede those of nurses. Dealing with anxiety is a healthy way does not involve "masking" such feelings.

4. A nurse is conducting a seminar for a group of individuals at the community center about anxiety. The nurse determines that the seminar was successful based on which group statement? a) "Fear is feeling threatened by an unknown entity" b) "Anxiety cannot be completely eliminated from life" c) "Anxiety is always harmful" d) "Anxiety and fear are the same"

b) "Anxiety cannot be completely eliminated from life" Pg. 468 Anxiety is distinguished from fear, which is feeling afraid or threatened by a clearly identifiable external stimulus that represents danger to the person. Anxiety is unavoidable in life and can serve many positive functions, such as motivating the person to take action to solve a problem or to resolve a crisis.

16. A client is currently experiencing panic. Which action would be most appropriate for the nurse to do? a) Ask the client repeated questions about feelings b) Allow the client to pace c) Urge the client to engage in vigorous exercise d) Employ the use of negative self-talk

b) Allow the client to pace Pg. 481 With panic, the nurse should stay with the client. Allow pacing and walk with the client. No content inputs to the client's thinking should be made by the nurse. Asking repeated questions and teaching would be inappropriate because the client is already over-stressed. The client should use positive self-talk. Encouraging vigorous exercise would increase the physiological arousal associated with panic and should be avoided until the client is calm. Exercise should be encouraged for prevention and to promote mental wellness.

3. All of the following pharmacological agents are useful in treating anxiety disorders except which ones? a) Benzodiazepines b) Calcium channel blockers c) Tricyclic antidepressants d) Selective serotonin reuptake inhibitors (SSRIs)

b) Calcium channel blockers Pg. Tricyclic antidepressants and SSRIs are known to be useful in reducing anxiety and are sometimes useful in treating the anxiety disorders. Benzodiazepines are an excellent choice for the treatment of symptoms of anxiety; however, they are extremely addictive and should only be given in the case of true anxiety disorders. Calcium channel blockers are not used in treating anxiety disorders.

2. A young parent 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) Coping mechanism c) Caregiver burden d) Crisis

b) Coping mechanism Pg. Mild anxiety is often managed without conscious thought by coping mechanisms, which are behaviors used to decrease stress and anxiety. There are many typical behaviors used as coping mechanisms, including smoking.

5. A client is experiencing a panic attack. Which term describes sensing that things are not real? a) Automatisms b) Derealization c) Depersonalization d) Agoraphobia

b) Derealization Pg. 482 Derealization is sensing that things are not real. Automatisms are automatic, unconscious mannerisms. Depersonalization describes feelings of being disconnected from oneself, as seen in a panic attack. Agoraphobia is a fear of being outside.

37. The nurse is conducting an admission assessment of a client who has a history of generalized anxiety disorder. After gauging the client's level of anxiety, what other assessment should the nurse prioritize? a) Determining the client's understanding of factors that contribute to his or her anxiety b) Determining whether there is potential for the client to harm himself or herself or others c) Obtaining a set of vital signs including apical heart rate and oxygen saturation d) Assessing the client's insight into his or her condition and gauging orientation and judgment

b) Determining whether there is potential for the client to harm himself or herself or others Pg. In the nursing assessment of the client with anxiety, a priority assessment is determining whether the client poses a threat to himself or herself or to others.

1. The nurse plans to teach a client about dietary modifications to manage diabetes. Teaching would be most effective if the client displayed which characteristic? a) Narrowed perceptual field b) Heightened focus c) Faster rate of speech d) Focused only on immediate task

b) Heightened focus Pg. 462 Mild anxiety is associated with increased learning ability. It involves a sensation that something is different and warrants special attention. Sensory stimulation increases and helps the person focus attention to learn, solve problems, think, act, feel, and protect himself or herself. Mild anxiety often motivates people to make changes or to engage in goal-directed activity. Focusing only on immediate task, a faster rate of speech, and a narrowed perceptual field are associated with moderate levels of anxiety.

39. During which type of anxiety does a person's perceptual field actually increase? a) Panic b) Mild c) Moderate d) Severe

b) Mild Pg. 462 During mild anxiety, a person's perceptual field widens slightly, and the person is able to observe more than before and to see relationships. During moderate anxiety, the perceptual field narrows slightly. The person does not notice what goes on peripheral to the immediate focus but can do so if attention is directed there by another observer. The perceptual field is greatly reduced in severe anxiety. During panic anxiety, the perceptual field is reduced to a detail, which is usually "blown up."

22. A client is seeking treatment for a specific phobia. The nurse in the anxiety disorders clinic documents that the client's anxiety is related to exposure to the phobic object. Which is a realistic outcome for anxiety self-control in this situation? a) Avoid the feared object whenever possible b) Practice relaxation techniques and report decreased physiological sensations associated with thoughts of the feared object c) Face the feared object without supportive assistance d) State that the fear of the object is unrealistic and inappropriate

b) Practice relaxation techniques and report decreased physiological sensations associated with thoughts of the feared object Pg. When the client is able to relax in the presence of thoughts, pictures, or the phobic object, the client will begin to experience a sense of control over the phobia. Avoiding the object is unrelated to anxiety self-control. Facing feared objects alone does not foster changes in behavior, and understanding does not automatically convey behavioral change associated with anxiety self-control.

34. Relaxation techniques help clients with anxiety disorders because they can promote what? a) Increase in sympathetic stimulation b) Reduction of autonomic arousal c) Increase in the metabolic rate d) Release of cortisol

b) Reduction of autonomic arousal Pg. 461 Regularly inducing the relaxation response reduces the general level of autonomic arousal in anxious clients. It lowers blood pressure, heart rate, metabolic rate, and oxygen demands. This physiologic effect may result from effects on the production of cortisol, a hormone the body releases in response to stress. Cortisol is helpful during the fight-or-flight response, but its prolonged presence in chronically anxious or stressed clients can inhibit the immune system and have other deleterious effects on the body.

55. When developing a plan of care for a client diagnosed with panic disorder, which nursing diagnosis would be considered the priority? a) Anxiety b) Risk for self-directed violence c) Social isolation d) Powerlessness

b) Risk for self-directed violence Pg. 464 People with panic disorder are often depressed and consequently are at high risk for suicide. Adolescents with panic disorder may be at higher risk for suicidal thoughts and attempt suicide more often than other adolescents. Other diagnoses that are appropriate for this client population, although not the priority, include powerlessness, social isolation, and anxiety.

10. The nurse enters a client's room and finds the client pacing anxiously. The client begins shouting at the nurse, "Get out of my room!" What is the most appropriate intervention by the nurse? a) Turn and walk out of the room without saying anything b) Stand at the doorway and say, "You seem upset" c) Approach the client and ask, "What's wrong?" d) Call for help and say, "Calm down"

b) Stand at the doorway and say, "You seem upset" Pg. 481 Staying with the client while allowing personal space is an important and safe intervention; this therapeutic communication technique is designed to get the client to communicate feelings. It may not be safe for the nurse to approach the client. Help is not needed at this time, and saying, "Calm down," is not effective. Turning and walking away from the client may seem like rejection and may worsen the client's anxiety as well as damage the nurse-client relationship.

49. A nurse assesses a client and determines that the client is experiencing mild anxiety based on what? a) The client has focused attention on a small area b) The client is aware and alert c) The client is selectively inattentive d) The client voices feelings of unreality

b) The client is aware and alert Pg. 462 A client who is mildly anxious is aware, alert, sees, hears, and grasps more than before. Selective inattention reflects moderate anxiety. Focusing attention on a small area reflects severe anxiety. Feelings of unreality are associated with panic.

54. A client states, "I will just die if I don't get this job." The nurse then asks the client, "What will be the worst thing that will happen if you don't get the job?" Why does the nurse ask this question? a) To clarify the client's meaning b) To help the client appraise their situation more realistically c) To assess whether the client has health problems compounded by stress d) To assist the client to make alternative plans for the future

b) To help the client appraise their situation more realistically Pg. Decatastrophizing involves the therapist's use of questions to more realistically appraise the situation. The therapist may ask, "What is the worst that could happen? Is that likely? Could you survive that? Is that as bad as you imagine?" The goal is not to gain information or assess the client but to promote a reduction in anxiety.

38. A nurse is assessing the vital signs of a client in the cardiac clinic. The nurse observes the client's blood pressure and heart rate are higher than what is normally expected for this client. The client tells the nurse, "I'm always so nervous when I come to the clinic." The nurse interprets the client's statement and vital signs as reflecting which situation? a) Severe anxiety b) Fight-or-flight response c) Defense mechanism d) Exhaustion

b) fight-or-flight response Pg. The client in the scenario is experiencing some anxiety in response to the assessment. As a result, the autonomic nervous system response to fear and anxiety generates the fight-or-flight response. The heart rate and blood pressure have increased because they are "charged up" to prepare the body's defenses. Severe anxiety is the state into which a person progresses in which panic begins and there is a decline in cognitive skills. Although this client is anxious, his ability to articulate himself in a rational way indicates the client is experiencing mild to moderate anxiety, not severe. Defense mechanisms refer to cognitive distortions that a person unconsciously uses to maintain a sense of control of a situation to deal with the stress.

47. The nurse is providing care for a psychiatric-mental health client who has a diagnosis of anxiety. Which statement by the nurse is likely the most therapeutic intervention? a) "With the development of more life skills and a demonstration of continued success in life, your anxiety will shrink and eventually disappear" b) "If you address the causes of your anxiety head-on, you will find that you can recover from it without medications or therapy" c) "Anxiety is a feeling that is experienced by everyone at some point and it can never be completely removed from one's life" d) "Every time you feel anxious, try to focus on how much easier your life would be if you didn't experience anxiety so often"

c) "Anxiety is a feeling that is experienced by everyone at some point and it can never be completely removed from one's life" Pg. It is therapeutic to foster in clients the understanding that the experience of anxiety is natural and inevitable. It would be inaccurate to promise recovery with increased success in life and self-discipline. Clients with anxiety are likely to be well aware of how much easier their lives would be without recurring anxiety.

28. A nurse is giving a presentation on mental health promotion to college students. One student asks the nurse to explain the difference between normal anxiety and an anxiety disorder. Which response is best? a) "Normal anxiety occurs in response to everyday stressors" b) "Normal anxiety does not result in feelings of dread or restlessness" c) "People with anxiety disorders generally find that the anxiety interferes with daily activities" d) "People with anxiety disorders experience a fight-or-flight response when threatened"

c) "People with anxiety disorders generally find that the anxiety interferes with daily activities" Pg. 475 Pathologic anxiety is suspected if a person feels anxious when no real threat exists, when a threat has passed long ago but continues to impair the person's functioning, or when a person substitutes adaptive coping mechanisms with maladaptive ones.

14. 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 presents no risk of addiction or dependence" b) "My anxiety will be eliminated if I take this medication as prescribed" c) "This medication will relax me so I can focus on problem solving" d) "I will probably always need to take this medication for my anxiety"

c) "This medication will relax me so I can focus on problem solving" Pg. 476 Anxiolytics are designed for short-term use to relieve anxiety. These drugs are designed to relieve anxiety so that the person can deal more effectively with whatever crisis or situation is causing stress. Benzodiazepines have a tendency to cause dependence. Clients need to know that antianxiety agents are aimed at relieving symptoms such as anxiety but do not treat the underlying problems that cause the anxiety.

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

c) Anti-anxiety medications Pg. 476 Panic disorder is treated with cognitive-behavioral techniques; deep breathing and relaxation; and antianxiety medication, such as benzodiazepines, SSRIs, tricyclics, and antihypertensives, such as Catapres and Inderal.

19. Which nursing intervention is focused on the primary goal of anxiety management and treatment? a) Helping the client identify ways to eliminate all sources of stress in his or her daily life b) Assessing the client for possible symptoms of panic disorder c) Assessing the client's ability to implement stress management techniques effectively d) Educating the client concerning the use of medications to manage anxiety disorders

c) Assessing the client's ability to implement stress management techniques effectively Pg. For people with anxiety disorders, it is important to emphasize that the goal is effective management of stress and anxiety, not the total elimination of anxiety. Learning anxiety management techniques and effective methods for coping with life and its stresses is essential for overall improvement in life quality. Although medication is important to relieve excessive anxiety, it does not solve or eliminate the problem entirely. While assessment is appropriate, it is not directly associated with the management and treatment of the original disorder.

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

c) Benzodiazepines Pg. 476 SSRIs, SNRIs, TCAs, monoamine oxidase inhibitors (MAOIs), and antianxiety medication (benzodiazepines) have been shown to be effective in panic disorders. Benzodiazepines are well tolerated but physical dependence is a potential side effect, and they carry the risk of withdrawal symptoms upon discontinuation of use.

40. When teaching a client with generalized anxiety disorder, the nurse instructs the client to avoid which of the following? a) Sodium b) Refined sugars c) Caffeine d) High-fat foods

c) Caffeine Pg. 474 The effects of caffeine are similar to some anxiety symptoms, and, therefore, caffeine ingestion will worsen anxiety.

36. A nurse is reviewing the medical record of a client diagnosed with anxiety disorder. Which information would the nurse interpret as suggestive of a common comorbidity associated with anxiety? a) A history of obsessive-compulsive disorder b) Difficulty with maintaining boundaries c) Daily consumption of large amounts of alcohol d) A history of severe trauma in childhood

c) Daily consumption of large amounts of alcohol Pg. 477 Patients may experience more than one anxiety disorder, depression, eating disorder, substance use or abuse, or schizophrenia. Although people with panic disorder are thought to have more somatic issues than the general population, panic disorder does correlate with some medical conditions, including vertigo, cardiac disease, gastrointestinal disorders, asthma, and those related to cigarette smoking.

51. Concomitant use of antidepressants with monoamine oxidase inhibitors (MAOIs) can cause which life-threatening drug interaction? a) Sedation b) Hypotensive crisis c) Hypertensive crisis d) Risk of seizures

c) Hypertensive crisis Pg. All antidepressant medications interact with MAOIs, causing hypertensive crises. Concomitant use should be avoided.

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

c) Is conducive to concentration and problem solving Pg. 478 Mild anxiety is often helpful to individuals and can assist in maintaining concentration and problem-solving abilities. Moderate to severe anxiety can begin to inhibit an individual's coping because these levels create physiologic responses (such as tachycardia and sweating) and psychological responses (such as loss of concentration and inability to focus) that may prevent the person from functioning adequately, interfere with cognitive abilities, and become pathologic if not treated adequately.

11. When assessing a client with anxiety, the nurse should recognize that anxiety may often be a result of what? a) Cognitive deficits b) Fluid and electrolyte imbalances c) Medications d) Organic brain changes

c) Medications Pg. Numerous medications from a variety of drug classes have the potential to cause anxiety. This contribution is more common than anxiety resulting from an organic brain change, a cognitive deficit, or a fluid and electrolyte imbalance, though each is a clinical possibility.

6. A nurse is reading an article about anxiety and the behaviors of individuals when different degrees of anxiety are experienced. The nurse demonstrates understanding of the article, identifying which degree of anxiety as being evidenced by a client's cognitive process being focused only on the person's defense? a) Moderate b) Severe c) Panic d) Mild

c) Panic Pg. 478 Panic anxiety reduces the perceptual field to focus on the self, and the client cannot process any environmental stimuli. In mild anxiety, sensory stimulation increases and helps the person focus attention to learn, solve problems, and think. Moderate anxiety causes the person to have difficulty concentrating independently but can be redirected to the topic. Severe anxiety causes the person to have a reduced perceptual field, and the client cannot complete tasks.

26. The nurse is caring for clients in the outpatient unit. Which would be key points for the nurse to remember when working with clients who are suffering from anxiety disorders? a) If the nurse has any uncomfortable feelings, do not tell anyone about them b) It is important for the nurse to "fix" the clients' problems c) Remember to practice techniques to manage stress and anxiety in the nurse's own life d) Remember that only people who suffer from anxiety disorders have stress that can interfere with daily life and work

c) Remember to practice techniques to manage stress and anxiety in the nurse's own life Pg. It is critical for the nurse to remember to practice techniques to manage stress and anxiety in his or her own life. Remember that everyone occasionally suffers from stress and anxiety that can interfere with daily life and work. It is important for the nurse to avoid falling into the pitfall of trying to "fix" the clients' problems. It is important that the nurse should discuss any uncomfortable feelings with a more experienced nurse for suggestions on how to deal with his or her feelings toward these clients.

57. A client is diagnosed with panic disorder. When considering the neurochemical theory of the disorder, which would the nurse expect to administer as the drug of choice initially? a) Tricyclic antidepressants b) Benzodiazepines c) Selective serotonin reuptake inhibitors d) Antihypertensives

c) Selective serotonin reuptake inhibitors Pg. 476 Serotonin, the indolamine neurotransmitter usually implicated in psychosis and mood disorders. Although antihypertensives and benzodiazepines may be used, the selective serotonin reuptake inhibitors are recommended as the first drug option in the treatment of clients with panic disorder. They have the best safety profile, and if side effects occur, they tend to be present early in treatment before the therapeutic effect takes place. Tricyclic antidepressants are not typically used to treat panic disorder.

33. Which medication classification has most commonly been used to treat social phobia? a) Nonbenzodiazepines b) Monoamine oxidase inhibitors (MAOIs) c) Selective serotonin reuptake inhibitors (SSRIs) d) Tricyclic antidepressants (TCAs)

c) Selective serotonin reuptake inhibitors (SSRIs) Pg. 483 SSRIs are used to treat clients with social anxiety disorder because they significantly reduce social anxiety and phobic avoidance. Benzodiazepines are also used to reduce anxiety caused by phobias.

29. The nurse can be confident that the client diagnosed with an anxiety disorder will respond well to treatment when which of the following situations or conditions are present? a) The client has a family that is truly willing and capable of supporting him during the treatment b) The client has a no history of other psychiatric disorders c) The client states, "I understand my symptoms and what I need to do to help myself, and I'm ready to do it so I'm back to normal" d) The client readily agrees to immediately notify the mental health care team if symptoms reoccur after discharge

c) The client states, "I understand my symptoms and what I need to do to help myself, and I'm ready to do it so I'm back to normal" Pg. Clients who respond well to treatment generally self-disclose an understanding of their clinical symptoms, are able to identify causes, and exhibit coping skills to promote behavioral change. This is evident when the client states, "I understand what I need to do, and I'm ready to do it so I'm back to normal."

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

d) "How do you feel about everything that is happening in your life right now?" Pg. An open-ended question that prompts the client to describe his or her current feelings is a useful assessment technique. Offering medications or other solutions, asking if the client feels justified in his or her feelings, and questioning the client's self-worth are not normally appropriate, or effective, assessment techniques.

31. A client asks the nurse, "Why do I have to go to counseling? Why can't I just take medications?" What would be the most appropriate response by the nurse? a) "As soon as your medications reach therapeutic level, you can omit the therapy" b) "You cannot get the full effect of your medications without cognitive therapy as well" c) "Both therapies are effective. You can eventually choose one or the other" d) "Medications combined with therapy help you change how well you function"

d) "Medications combined with therapy help you change how well you function" Pg. 484 Treatment for anxiety disorders usually involves medication and therapy. This combination produces better results than either one alone. These interventions complement one another and are not mutually exclusive. The effectiveness of medications is not wholly dependent on cognitive therapy.

46. Which medication classification has been found to be effective in reducing or eliminating panic attacks? a) Antipsychotics b) Anticholinergics c) Antimanics d) Antidepressants

d) Antidepressants Pg. 480 Tricyclic and monoamine oxidase inhibitor antidepressants have been found to be effective in treating clients with panic attacks. Why these drugs help control panic attacks is not clearly understood. Anticholinergic agents, which are smooth-muscle relaxants, relieve physical symptoms of anxiety but do not relieve the anxiety itself. Antipsychotic drugs are inappropriate because clients who experience panic attacks are not psychotic. Mood stabilizers are not indicated because panic attacks are rarely associated with mood changes.

9. When a psychiatrist prescribes alprazolam for acute anxiety experienced by a client with agoraphobia, health teaching should include which instructions? a) Adjust dose and frequency of ingestion based on anxiety level b) Report drowsiness c) Eat a tyramine-free diet d) Avoid alcoholic beverages

d) Avoid alcoholic beverages Pg. 477 Drinking alcohol or taking other anxiolytics along with the prescribed benzodiazepine should be avoided because depressant effects of both drugs will be potentiated. Consuming a tyramine-free diet is necessary only with monoamine oxidase inhibitors. Drowsiness is an expected effect of this medication and needs to be reported only if it is excessive. Clients should be taught not to deviate from the prescribed dose and schedule for administration.

12. A client 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) Coping mechanism Pg. 461 When a person is in a threatening situation, immediate responses occur. Those responses, which are often involuntary, are called coping responses. The change that takes place as a result of the response to a stressor is adaptation.

24. A nurse is seeing a client who is having severe to panic level anxiety after a physical assault months previously. The client tells the nurse, "When the panic starts I feel like I am watching myself through a window." The nurse can most accurately describe this experience as: a) Demonstrating automatisms b) Derealization c) Decatastrophizing d) Depersonalization

d) Depersonalization Pg. Depersonalization is a feeling that the client may describe as being disconnected from herself, such as watching oneself. This is common when individuals experience panic levels of anxiety. Derealization refers to the sensation that things are not real or surreal during panic levels of anxiety. Decatastrophizing refers to a treatment approach used by therapists in which the client is asked questions in order to urge the client to develop a more realistic appraisal of the situation causing the anxiety. Automatisms are automatic, unconscious mannerisms that are geared toward relief of anxiety and increase in intensity and frequency with a rise in the client's anxiety level.

45. A nurse is assessing a client and determines that the client is experiencing severe anxiety based on which finding? a) A heightened sense of awareness b) Goal directed behavior c) Eagerness for more information d) Distorted sensory awareness

d) Distorted sensory awareness Pg. 462 In severe anxiety, perception becomes increasingly distorted, sensory input diminishes, and processing of sensory stimuli becomes scattered and disorganized.

35. Nursing interventions for physical stress related illness should include what? a) Assessing the need for increased dose of benzodiazepines b) Fostering use of a social support system c) Attending group therapy d) Establishing daily routines of meals and sleeping

d) Establishing daily routines of meals and sleeping Pg. 475 Individuals experiencing or at risk for untoward stress responses may benefit from a number of biologic interventions. The importance of (re-)establishing regular routines for activities of daily living (e.g., eating, sleeping, self-care, and leisure time) cannot be overstated. As well as ensuring adequate nutrition, sleep and rest, and hygiene, a routine may help to structure an individual's time and give them a sense of personal control or mastery.

60. A client asks how the client's prescribed alprazolam helps the client's anxiety disorder. The nurse explains while teaching the client about medications that antianxiety medications such as alprazolam affect the function of which neurotransmitter that is believed to be dysfunctional in anxiety disorders? a) Serotonin b) Norepinephrine c) Dopamine d) Gamma-aminobutyric acid (GABA)

d) Gamma-aminobutyric acid (GABA) Pg. 467 GABA is the amino acid neurotransmitter believed to be dysfunctional in anxiety disorders. GABA reduces anxiety, and norepinephrine increases it; researchers believe that a problem with the regulation of these neurotransmitters occurs in anxiety disorders. Serotonin is usually implicated in psychosis and mood disorders. Dopamine is indicated in psychosis.

15. An adolescent who is seeing the school health nurse states, "I won't be able to hang out with my friends on Friday night because I have two essays due Monday." What level of anxiety is the adolescent experiencing? a) Moderate b) Severe c) Panic d) Mild

d) Mild Pg. 462-463 Mild anxiety is characterized by an increase in sensory stimulation that is helping the adolescent focus attention to achieve a goal. The anxiety is positive because it motivates the adolescent but does not interfere with social, occupational, or emotional functioning. The adolescent is still able to concentrate independently without having to be redirected to the topic. Moderate anxiety is characterized by a disturbing feeling that something is wrong. With moderate anxiety, a person can still process information but may have some trouble with concentration and require redirecting to focus. Severe anxiety is characterized by a significant decrease in a person's cognitive skills. If severe anxiety was being experienced, the adolescent would likely have trouble thinking and reasoning. Panic level of anxiety is characterized by physiological responses to anxiety that take over the ability to reason leading to diminished cognitive skills. It would be nearly impossible for the adolescent to make any decisions about how to organize time to complete homework if panic level of anxiety was being experienced.

62. The nurse is teaching a client with an anxiety disorder ways to manage anxiety. The nurse suggests which schedule for practicing relaxation techniques? a) Reserve these techniques for episodes of panic b) Expect to practice the techniques when meeting with a therapist c) Use the techniques as needed when experiencing severe anxiety d) Practice the techniques when relatively calm

d) Practice the techniques when relatively calm Pg. 475 The nurse can teach the client relaxation techniques to use when he or she is experiencing stress or anxiety, including deep breathing, guided imagery and progressive relaxation, and cognitive restructuring techniques. For any of these techniques, it is important for the client to learn and to practice them when he or she is relatively calm. These techniques are most effective when implemented before the client's anxiety reaches a severe level or a panic. The client may be taught these techniques by a therapist but does not usually have an opportunity to practice them during a therapy session.

44. The nurse is teaching about postoperative wound care. As the wound is uncovered, the client begins mumbling, breathing rapidly, and trying to get out of bed, and the client does not respond when the nurse calls the client's name. Which should be the nurse's first action? a) Ask the client to describe the client's feelings b) Proceed with wound care quickly c) Get the assistance of another nurse d) Replace the dressing on the wound

d) Replace the dressing on the wound Pg. The client has severe anxiety; the priority is to lower the client's anxiety level. The first action should be to replace the dressing on the wound to decrease the client's level of anxiety and to prevent contamination of the wound before a new dressing can be applied. Changing the dressing more quickly might exacerbate the client's anxiety. The client appears to be panicking, so the client will likely be unable to describe his or her feelings. Seeking assistance does not help to alleviate the client's anxiety.

13. 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) Hopelessness b) Ineffective individual coping c) Disturbed identity d) Risk for injury

d) Risk for injury Pg. This client is at increased risk for injury because of severe hyperactivity, disorientation, and agitation. The nurse's first action is to provide a safe environment and to ensure the client's privacy. The client's safety takes highest priority. The nurse should take immediate action to protect the client from injury.

30. A nurse is providing care to a client with social anxiety disorder. Based on the nurse's understanding of pharmacotherapy, which medication would the nurse anticipate being used as part of the treatment plan? a) Beta-blockers b) Tricyclic antidepressants (TCAs) c) Benzodiazepines d) Selective serotonin reuptake inhibitors (SSRIs)

d) Selective serotonin reuptake inhibitors (SSRIs) Pg. 476 Pharmacotherapy is a relatively new area of research in treating patients with social anxiety disorder. SSRIs are used to treat those with social anxiety disorder because they significantly reduce social anxiety and phobic avoidance.

23. According to psychodynamic theorists, anxiety develops from which of the following? a) Interoceptive conditioning b) Exposure to panicogenic substances c) Learned response d) Separation and loss

d) Separation and loss Pg. 467 Psychodynamic theories explain that anxiety develops after separation and loss. A great number of clients link their initial panic attack with recent personal losses. Classic conditioning theory suggests that one learns a fear response by linking an adverse, or fear-provoking, event with a previously neutral event. Interoceptive conditioning pairs a somatic discomfort, such as dizziness or palpitations, with an impending panic attack. Identification of neurotransmitter involvement in panic disorder has evolved from neurochemical studies with panicogenic substances known to produce panic attacks.

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

d) This level of anxiety can be sustained indefinitely Pg. 462 Panic-level anxiety cannot be sustained indefinitely. The nurse should remain with the client until the panic recedes and should maintain a nonstimulating environment. The goal is to the lower the client's anxiety to mild or moderate before proceeding with anything else.