Chapter 16: Anxiety and Panic Disorders: Nursing Care of Persons with Anxiety and Panic
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? "Anxiety is a feeling that is experienced by everyone at some point and it can never be completely removed from one's life." "If you address the causes of your anxiety head-on, you will find that you can recover from it without medications or therapy." "With the development of more life skills and a demonstration of continued success in life, your anxiety will shrink and eventually disappear." "Every time you feel anxious, try to focus on how much easier your life would be if you didn't experience anxiety so often."
"Anxiety is a feeling that is experienced by everyone at some point and it can never be completely removed from one's life." 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.
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? "As soon as your medications reach therapeutic level, you can omit the therapy." "Medications combined with therapy help you change how well you function." "You cannot get the full effect of your medications without cognitive therapy as well." "Both therapies are effective. You can eventually choose one or the other."
"Medications combined with therapy help you change how well you function." 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.
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? "People with anxiety disorders generally find that the anxiety interferes with daily activities." "Normal anxiety does not result in feelings of dread or restlessness." "People with anxiety disorders experience a fight-or-flight response when threatened." "Normal anxiety occurs in response to everyday stressors."
"People with anxiety disorders generally find that the anxiety interferes with daily activities." 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.
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? "This medication presents no risk of addiction or dependence." "I will probably always need to take this medication for my anxiety." "This medication will relax me so I can focus on problem solving." "My anxiety will be eliminated if I take this medication as prescribed."
"This medication will relax me so I can focus on problem solving." 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.
A client is currently experiencing a panic attack. Which is the most appropriate response by the nurse? "There is nothing here to harm you." "What are you feeling right now?" "You are safe. Take a deep breath." "Just try to relax."
"You are safe. Take a deep breath." Saying "You are safe. Take a deep breath" reassures and redirects the client. Telling the client to relax is simplistic and ineffective. The nurse should follow reassurance ("There is nothing here to harm you") with redirection. Asking the client to describe his or her feelings does not provide reassurance or redirection.
The nurse recognizes that who is the client most likely experiencing generalized anxiety disorder (GAD)? 40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months 30-year-old business executive who reports being anxious about attending the meetings and social events that are the executive's job responsibilities 70-year-old whose spouse died 1 year ago who has "no desire to leave my house" and reports severe fatigue 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
40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months
A patient with anxiety disorder has excessive anxiety and worries about multiple life circumstances. For how long would this patient experience these feelings before the anxiety disorder would be considered chronic and generalized? 12 months 4 months 2 months 6 months
6 months
Which client is most likely to be at risk for drug dependence and difficulties with withdrawal? A client with generalized anxiety disorder who has responded well since beginning treatment with fluoxetine earlier in the year A man whose obsessive-compulsive disorder is being treated long term with paroxetine A woman who has been taking lorazepam for several months after witnessing a traumatic motor vehicle accident A client who has recently begun treatment with propranolol for the treatment of social phobia
A woman who has been taking lorazepam for several months after witnessing a traumatic motor vehicle accident The potential for dependence and difficulties with withdrawal is much higher with benzodiazepines than with beta-blockers or SSRIs.
What is the term for the change that takes place in response to a stressor? Positive movement Adaptation Negative movement Rehabilitation
Adaption When a person is in a threatening situation, immediate and often involuntary responses occur. The change that takes place in response to a stressor is adaptation.
When traveling alone and away from home, a client experiences trembling and palpitations. These symptoms have impeded the client from leaving her home. The nurse would correctly note that these are symptoms of which type of phobia? OCD Agoraphobia Obsession Compulsion
Agoraphobia Agoraphobia occurs when the client travels away from home and experiences anxiety, with symptoms such as palpitations and trembling.
During which phase of the general adaptation syndrome is the "fight or flight" response activated? Inflammatory Resistance Exhaustion Alarm
Alarm The alarm reaction is defensive and anti-inflammatory but self-limiting. During the resistance stage, adaptation to the noxious stressor occurs and cortisol activity is still increased. The inflammatory state is not part of the general adaptation syndrome. During the exhaustion stage, endocrine activity increases, and this has negative effects on the body systems that can lead to death.
Linn is a 42-year-old woman who is in the process of moving house after her divorce. She reports experiencing bouts of increased anxiety recently. How can the nurse best explain the physiological adaptation that occurs during fight or flight to this client? An increase in blood flow to the muscles A decrease in heart rate and blood pressure A decrease in blood clotting ability An increased immune response and digestion
An increase in blood flow to the muscles The widespread effects of the fight-or-flight response include an increase in heart rate, blood pressure, breathing rate, perspiration, blood flow to the muscles, and blood-clotting ability; a decrease in saliva production, digestion, and immune response; and a release of stored glycogen.
Panic disorder is treated with cognitive-behavioral techniques and deep breathing and relaxation, in addition to which of the following? Anticonvulsants Antianxiety medications CNS depressants Antipsychotics
Antianxiety medications 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.
Which medication classifications used in the treatment of panic disorder can cause physical dependence? Selective serotonin reuptake inhibitors (SSRIs) Serotonin-norepinephrine reuptake inhibitors (SNRIs) Tricyclic antidepressants (TCAs) Benzodiazepines
Benzodiazepines 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.
When teaching a client with generalized anxiety disorder, the nurse instructs the client to avoid which of the following? Sodium Caffeine High-fat foods Refined sugars
Caffeine The effects of caffeine are similar to some anxiety symptoms, and, therefore, caffeine ingestion will worsen anxiety
All of the following pharmacological agents are useful in treating anxiety disorders except which ones? Benzodiazepines Calcium channel blockers Tricyclic antidepressants Selective serotonin reuptake inhibitors (SSRIs)
Calcium channel blockers 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.
The client has been defensive toward communication with the nurse today. Which can be a positive outcome of using defense mechanisms? Defense mechanisms can lead to poor problem-solving skills. Defense mechanisms can inhibit emotional growth. Defense mechanisms can help a person to reduce anxiety. Defense mechanisms can create difficulty with relationships.
Defense mechanisms can help a person to reduce anxiety. Defense mechanisms can help a person to reduce anxiety. This is the only positive outcome of using defense mechanisms. Overdependence on defense mechanisms can inhibit emotional growth, lead to poor problem-solving skills, and create difficulty with relationships. These are all negative outcomes of using defense mechanisms
A client is experiencing a panic attack. Which term describes sensing that things are not real? Depersonalization Derealization Agoraphobia Automatisms
Derealization 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.
Nursing interventions that are appropriate for all clients with anxiety disorders are to reduce anxiety and ... Learn to control primitive impulses Develop alternative responses to anxiety-provoking situations Strive for insight through psychoanalysis Accept the fact that underlying conflicts cannot be treated
Develop alternative responses to anxiety-provoking situations A primary client outcome is improved adaptive coping skills.
The nurse plans to teach a client about dietary modifications to manage diabetes. Teaching would be most effective if the client displayed which characteristic? Focused only on immediate task Faster rate of speech Narrowed perceptual field Heightened focus
Heightened focus 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.
The nurse is assessing a client and finds two enlarged supraclavicular lymph nodes. The nurse asks the client how long these enlarged nodes have been there. The client states, "I can't remember. A long time I think. Do I have cancer?" The nurse is aware that that body responds to stress. Which is an immediate physiologic response to stress the nurse would expect to see in this client? Decrease in blood glucose levels Increased blood pressure Pupil constriction Vasodilation of peripheral blood vessels
Increased blood pressure The nurse is assessing a client and finds two enlarged supraclavicular lymph nodes. The nurse asks the client how long these enlarged nodes have been there. The client states, "I can't remember. A long time I think. Do I have cancer?" The nurse is aware that that body responds to stress. Which is an immediate physiologic response to stress the nurse would expect to see in this client?
A client diagnosed with panic disorder has been receiving medication therapy, which is being discontinued. A nurse would be alert for possible withdrawal symptoms if the client was receiving what? Duloxetine Lorazepam Fluvoxamine Escitalopram
Lorazepam Discontinuation of benzodiazepines, such as lorazepam, places the client at risk for withdrawal symptoms. Withdrawal is not associated with duloxetine, a serotonin-norepinephrine reuptake inhibitor, or escitalopram or fluvoxamine, selective serotonin reuptake inhibitors.
Anxiety has both healthy and harmful aspects depending on its degree and duration as well as on how well the person copes with it. Which level of anxiety helps the client focus attention to learn, problem solve, think, act, feel, and protect himself or herself? Moderate Mild Severe Panic
Mild 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 he or she cannot complete tasks. Panic anxiety reduces the perceptual field to focus on the self, and the client cannot process any environmental stimuli.
Which level of anxiety helps the client focus the client's attention to learn, problem solve, think, act, feel, and protect himself or herself? Moderate Mild Panic Severe
Mild In mild anxiety, sensory stimulation increases and helps the client focus the client's attention to learn, solve problems, and think. Moderate anxiety causes the client to have difficulty concentrating independently, but he or she can be redirected to the topic. Severe anxiety causes the client to have a reduced perceptual field and he or she cannot complete tasks. Panic anxiety reduces the perceptual field to focus on the self, and the client cannot process any environmental stimuli.
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? mild moderate panic severe
Mild 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.
When a client is experiencing panic, which is the priority intervention? Give the client medication immediately. Physically restrain the client. Move the client to a quiet environment. Offer the client therapy to calm down.
Move the client to a quiet environment. Decreasing external stimuli will help lower the client's anxiety level. The client's safety is priority. Anxious behavior can be escalated by external stimuli. In a large area, the client can feel lost and panicked, but a smaller room can enhance a sense of security. Medicating the client would be inappropriate. Restraint should only be used as a last resort. Therapy can be appropriate once the client's anxiety level decreases.
A nurse is working with a client who is learning to cope with anxiety and stress. What outcome does the nurse expect for the client? Anxiety will be avoided at all costs Situations that cause stress will be ignored Reactions to stressors will change Major stressors in the client's life will be limited
Relations to stressors with you change! Stress and anxiety in life are unavoidable; managing the effects of stress is a reasonable goal for treatment. It is not possible or desirable to avoid anxiety at all costs as anxiety is a warning that the client is not dealing with stress effectively. Learning to heed this warning and to make needed changes is a healthy way to deal with the stress of daily events.Healthy stress management does not involve "ignoring" stressors. Limiting the presence of stressors does not necessarily increase the client's ability to cope with existing stressors.
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? Severe Mild Moderate Panic
Severe Physiologic responses to severe anxiety include headache, nausea, vomiting, diarrhea, trembling, rigid stance, vertigo, pale, tachycardia, and chest pain. Vetigo can cause a sensation of "passing out." A client who is panicking would not be able to articulate his or her state.
Which condition involves a persistent, irrational fear attached to an object or situation that objectively does not pose a significant danger? Obsessive-compulsive disorder Specific phobia Posttraumatic stress disorder Generalized anxiety disorder
Specific phobia Specific phobia is a disorder marked by persistent fear of clearly discernible, circumscribed objects or situations, which often leads to avoidance behaviors. Posttraumatic stress disorder can occur following exposure to an actual or threatened traumatic event such as death, serious injury, or sexual violence. In obsessive-compulsive disorder, affected clients have both obsessions and compulsions and believe that they have no control over them, which results in devastating consequences for the individuals. Generally speaking, clients with generalized anxiety disorder feel frustrated, disgusted with life, demoralized, and hopeless. They may state that they cannot remember a time that they did not feel anxious. They experience a sense of ill-being and uneasiness and a fear of imminent disaster.
When a parent observes the parent's young child heading toward a busy road the parent becomes stressed, feeling the parent's heart pounding, breathing heavily, and hands becoming wet with perspiration. Which physiological system is activated with the parent's "fight or flight" reaction to this danger? Motherly response system Sympathetic nervous system Central nervous system Parasympathetic nervous system
Sympathetic nervous system The sympathetic nervous system activates the fight or flight response quickly as a survival response that results in an increased heart and respiratory rate, moist hands and feet, and dilated pupils. The parasympathetic system is most active in nonstressful events. The motherly instinct is not a proven physiological system.
A client reports the client has been experiencing increased stress at work. The client has been managing the stress by drinking 2-3 glasses of wine per evening. Despite the nurse recommending that drinking alcohol is not an effective way to manage the stress, the client reports it is unlikely that the client will be able to stop. Which statement explains why this will be difficult for the client? The client has no adaptive coping mechanisms. Drinking alcohol is more socially acceptable than taking medications. The client is probably physically dependent on alcohol. A few glasses of wine each night is not necessarily a problem.
The client has no adaptive coping mechanisms. Clients learn to reduce the anxiety they feel in either functional or dysfunctional ways. The nurse first explores with the client what techniques the client has used in the past and helps the client identify and enhance those strategies that are most beneficial. The nurse and client identify maladaptive coping strategies, such as social withdrawal or alcohol use, and replace them with adaptive strategies that suit the client's personal, cultural, and spiritual values. The nurse should not ask the client to give up coping mechanisms, even maladaptive ones, without offering other adaptive mechanisms.
Which of the following is inconsistent with panic-level anxiety? The nurse should remain with the client until the panic recedes. The nurse needs to maintain a nonstimulating environment. This level of anxiety can be sustained indefinitely. The goal is to lower the client's anxiety to mild or moderate before proceeding with anything else.
This level of anxiety can 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.
Which would not be an initial intervention for the client with acute anxiety? Encouraging the client to verbalize feelings and concerns Maintaining a nonstimulating environment Use of open-ended communication techniques Touching the client in an attempt to comfort the client
Touching the client in an attempt to comfort the client The nurse should evaluate carefully the use of touch because clients with high anxiety may interpret touch by a stranger as a threat and pull away abruptly. Use open-ended questions, encouraging the client to verbalize feelings and concerns, and maintain a nonstimulating environment.
After teaching a group of mental health nursing students about the care of a client experiencing a panic attack, the instructor determines that additional education is required when the students identify which as an appropriate intervention? Providing the client with a safe, quiet, and private place Approaching the client in a calm, confident manner Encouraging the client to verbalize feelings and concerns Touching the client in an attempt to comfort the client
Touching the client in an attempt to comfort the client For the client experiencing a panic attack, the nurse must establish rapport and trust with the anxious client before using therapeutic touch. Touching an anxious client may actually increase anxiety. Trust can be established by approaching the client in a calm and confident manner; providing a place that is quiet, safe, and private; and encouraging the client to verbalize feelings and concerns.
When a psychiatrist prescribes alprazolam for acute anxiety experienced by a client with agoraphobia, health teaching should include which instructions? avoid alcoholic beverages adjust dose and frequency of ingestion based on anxiety level eat a tyramine-free diet report drowsiness
avoid alcohol beverages 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.
A 30-year-old client who has been unemployed secondary to the client's anxiety disorder states that the client would like to have a job where the client is alone and no one needs to evaluate the client's work. The nurse interprets these comments as an indicator of what? Agoraphobia Obsessive-compulsive disorder Panic disorder Social anxiety disorder
social anxiety disorder Social anxiety disorder, previously termed social phobia, involves a persistent fear of social or performance situations in which embarrassment may occur. Exposure to a feared social or performance situation nearly always provokes immediate anxiety and may trigger panic attacks. People with social anxiety disorder fear that others will scrutinize their behavior and judge them negatively. They often do not speak up in crowds out of fear of embarrassment. They go to great lengths to avoid feared situations. If avoidance is not possible, they suffer through the situation with visible anxiety. Agoraphobia is fear or anxiety triggered by about two or more situations, such as using public transportation, being in open spaces, being in enclosed places, standing in line, being in a crowd, or being outside of the home alone. When these situations occur, the individual believes that something terrible might happen and that escape may be difficult. In obsessive-compulsive disorder, affected patients have both obsessions and compulsions and believe that they have no control over them, which results in devastating consequences for the individuals. Panic is an extreme, overwhelming form of anxiety often experienced when an individual is placed in a real or perceived life-threatening situation. The person's ability to function in everyday life is significantly disrupted.
A client who experiences panic anxiety around dogs is sitting in a room with a dog and the client's nurse therapist. The nurse therapist is using which behavioral intervention for this type of anxiety? Implosion therapy Relaxation exercise Systematic desensitization Biofeedback
systemic desensitization Systematic desensitization refers to the exposure of a person to a fear-producing situation in a systematized manner to decrease a phobic disorder. Implosion therapy, while similar, is not the technique described in this option. This scenario lacks the physical control techniques implemented by relaxation exercise, and it lacks the auditory and/or visual techniques implemented by biofeedback.
