Chapter 68: Caring for Clients with Anxiety Disorders

A client has been diagnosed with obsessive-compulsive anxiety disorder. The nurse would expect to find which of the following clinical manifestations?

Persistent unwanted thoughts

A client with an anxiety disorder tells the nurse that her condition is causing her difficulty in solving problems. Place in the correct order the steps the nurse would use to assist the client with problem-solving.

behavior and cognitive

A nurse asks a client who is having an anxiety attack to count slowly backward from 100. What is the benefit of this intervention?

Distraction redirects the client's attention from distressing physiologic symptoms to the task at hand.

Heather is beginning a new job and is feeling anxious about her performance. Which of the following types of anxiety can improve functioning?

Mild

A client has a history of anxiety disorders and is being seen by a psychologist. When the client is feeling increasingly anxious, what should the nurse be aware of during client education sessions?

Perception of information narrows.

The nurse enters the client's room and finds the client anxiously pacing the floor. The client begins shouting at the nurse, "Get out of my room!" The best intervention by the nurse would be to:

Stand at the doorway and say, "You seem upset."

Situations that may induce social phobia include:

situations where one must perform in front of others. eating with others in a restaurant. attending a party where some attendees may be strangers.

A patient's medication regimen for treatment of anxiety has been changed from a benzodiazepine to buspirone (BuSpar). The patient asks the nurse what makes this medication safer than the benzodiazepine he has taken. What is the nurse's best response?

"It will not produce sedation like benzodiazepines."

The nurse has instructed a client with panic disorder about how to use the technique of positive self-talk. The nurse determines that the client has understood the instructions when the client verbalizes which statement to use during an impending panic attack?

"I can handle this anxiety; it will be over shortly."

Which statement is typical of a client with social phobia?

"I know I can't accept that award for my brother."

A 25-year-old mother of two children younger than 6 years is very protective and will not allow them to play outdoors at all for fear of tick bites. She is worn out from cleaning the house from top to bottom every day. She asks the nurse how she can stop worrying so much. What is the most appropriate response from the nurse?

"Tell me your concerns about the children playing in your backyard."

During the admission assessment, a client with a panic disorder begins to hyperventilate and says, "I'm going to die if I don't get out of here right now!" What's the nurse's best response?

"You're having a panic attack. I'll stay here with you."

Susan has begun to wash her hands every hour on the hour because she fears that if germs become embedded in her skin, she will contract cancer. Which of the following would best describe Susan's behavior?

A compulsion

What does desensitization refer to?

A systematic way to replace a panic response with a relaxation response.

Which of the following clients is most likely to be at risk for drug dependence and difficulties with withdrawal?

A woman who has been taking lorazepam (Ativan) for several months after witnessing a traumatic motor vehicle accident.

A client who is recovering from alcoholism and is a member of a nurse-run treatment group has decided to move to another state to be closer to family. What is the nurse's role in this situation?

Advocate for the client's move.

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?

Agoraphobia

Panic disorder is treated with cognitive-behavioral techniques and deep breathing and relaxation, in addition to which of the following?

Antianxiety medications

When discussing various types of anxiolytic medications with a client, the nurse recognizes that which of the following medications has the lowest potential for abuse?

Buspirone (BuSpar)

Which of the following is classified as a nonbenzodiazepine?

Buspirone (BuSpar)

All of the following pharmacological agents are useful in treating anxiety disorders except:

Calcium channel blockers

The nurse is aware that all the following pharmacological agents are useful in treating anxiety disorders except:

Calcium channel blockers

A client spends hours arranging and rearranging furniture in his room. This behavior is identified as a:

Compulsion

A client spends hours stacking and unstacking towels. She is repeatedly checking to make sure that the towels are in order of color. This behavior is identified as a:

Compulsion

Nursing interventions that are appropriate for all clients with anxiety disorders are to reduce anxiety and

Develop alternative responses to anxiety-provoking situations

Severe levels of anxiety result in what?

Distorted sensory awareness

In teaching a client who has been prescribed a benzodiazepine for panic disorder, the nurse must be certain to:

Educate the client that this medication has a high risk for withdrawal symptoms, and he should not discontinue without a doctor's supervision.

Generalized anxiety disorder (GAD) is characterized by what?

Excessive worry or anxiety lasting more than 6 months

A 21-year-old woman has been recently diagnosed with agoraphobia. Which of the following situations is most likely to cause the woman anxiety?

Going to a crowded, outdoor market on her own.

A client with an anxiety disorder tells the nurse that her condition is causing her difficulty in solving problems. Place in the correct order the steps the nurse would use to assist the client with problem-solving.

Identifying problems Determining their causes Exploring possible solutions Examining the pros and cons of each option Selecting the choice that is most compatible with personal values

A client diagnosed with obsessive-compulsive disorder (OCD) is attempting to resist a compulsion. Based on this finding, the nurse should assess the client for:

Increased anxiety

Why are older adults with impaired kidney functions at an increased risk for toxicity when administering antianxiety medications?

Kidneys excrete antianxiety agents.

Clients with a social phobia would most likely fear which situation?

Meeting strangers

When a client is experiencing severe anxiety, which of the following is the priority intervention?

Move the client to a quiet environment

When implementing interventions to ensure the safety of a client with anxiety disorder, why is it best to have only one nurse generally interact with the client?

Multiple sources of stimulation add to agitation.

A client lost her home and beloved family dog in a flood. Months later, she tells the nurse that even though she and her family are nicely settled into a new home, she finds it hard to "feel anything." She says she can't concentrate on simple tasks, thinks about the flood incessantly, and fears losing control. She reports that she becomes extremely anxious whenever the flood is mentioned and must leave the room if people talk about it. The admitting nurse suspects she has:

Posttraumatic stress disorder (PTSD).

Clients taking benzodiazepines need education about which of the following?

Potentiation of alcohol effects

Which of the following is the primary concern for a client with panic-level anxiety?

Safety

A 30-year-old woman who has been unemployed secondary to her anxiety disorder states that she would like to have a job where she is alone and no one needs to evaluate her work. The nurse interprets these comments as an indicator of which of the following?

Social phobia

A new client at an outpatient mental health service states, "When I have to face new people or situations—any situations in public, really—I start to perspire. My face gets so red I want to hide. I'm so afraid of embarrassing myself in public that I end up embarrassing myself. The words just can't come out. . . I'm a disaster!" The intake nurse can interpret these statements as indications of:

Social phobia.

A client with a diagnosis of generalized anxiety disorder wants to stop taking his lorazepam. Which important fact should the nurse discuss with the client about discontinuing the medication?

Stopping the drug can cause withdrawal symptoms.

All except which of the following are considered clinical symptoms of anxiety?

Tearfulness and sadness

Which of the following would not be an initial intervention for the client with acute anxiety?

Touching the client in an attempt to comfort him

A client, brought to the hospital in an agitated state, is admitted to a psychiatric unit for observation and treatment. While putting away personal effects, the client is talking rapidly and folding and unfolding garments several times. The client can't seem to settle down. Which nursing assessment would be of top priority at this time?

anxiety

Psychotherapy involves talking with a psychiatrist, psychologist, clinical nurse specialist, or mental health counselor. Which types of therapy may be used with clients with anxiety disorders. Select all that apply.

cognitive therapy behavioral therapy

Clients using antianxiety drugs should be cautious when driving or performing tasks requiring mental alertness because antianxiety drugs may cause:

drowsiness.

A client is experiencing considerable stress while going through a divorce. She states her in-laws blame her drinking as the cause of the divorce. She adds, "These days, a few glasses of wine in the evenings help calm my nerves." A coping strategy the nurse might suggest is:

employing previously learned deep breathing and muscle relaxation techniques

A client who has a history of drug addiction and is having thoughts of self harm has indicated willingness to abide by the recommendations the nurse might make. What is the nurse's role in helping this client?

exploring possible solutions determining the cause of the problem(s) identifying problems

A client reports constant anxiety that has lasted for the past 7 months. The client is concerned about job stability, personal relationships, and finances. This client's disorder is most likely:

generalized anxiety disorder.

Beta-adrenergic blocking drugs are frequently prescribed for people with social phobia. This category of drugs does not cause sedation, tolerance, or addiction. They do, however:

lower blood pressure.

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?

mild

Sharon is admitted for an appendectomy. As the nurse enters the room to prep Sharon for surgery, she is breathing rapidly, sweating, restless, and anxious. The nurse's most therapeutic intervention at this time would be to:

speak to Sharon with simple, short directions in a soothing voice, and do not ask her to make choices about positioning or comfort.

One major difference between posttraumatic stress disorder (PTSD) and the other anxiety disorders is that:

symptoms begin after exposure to a traumatic stressor.