Generalized Anxiety Disorder
The nurse is reviewing the care plan for the patient with generalized anxiety disorder and determines that the patient is to exercise for at least 30 minutes every day. Which question should the nurse ask the patient to determine if the patient is achieving this outcome? "Are you planning to join a gym when you're discharged?" "How much exercise did you do before you were admitted?" "Would you like it if I signed you up for a group yoga retreat or an aerobics class?" "What type of exercise are you doing, how frequently are you exercising and how long are you exercising?"
"Are you planning to join a gym when you're discharged?" Asking the patient about his or her ability to manage his or her health care needs may help with discharge planning, but this does not determine if the patient is currently achieving goals. "How much exercise did you do before you were admitted?" Asking the patient about what occurred prior to discharge is a beneficial assessment question, but it does not address if the patient is currently achieving goals. "Would you like it if I signed you up for a group yoga retreat or an aerobics class?" This question focuses on a nursing action and does not adequately extract the information the nurse needs to determine if the patient is achieving the outcome. "What type of exercise are you doing, how frequently are you exercising and how long are you exercising?" the patient about his or her ability to manage his or her health care needs allows the nurse to evaluate the patient's progress toward identified outcomes. This is a part of the evaluation phase of the nursing process.
A patient is undergoing cognitive therapy to help control symptoms of anxiety. Which statement made by the patient indicates an understanding of cognitive behavioral therapy? "My anxiety is due to a childhood traumatic experience." "I like it when my therapist puts me in that deep, relaxed state." "I no longer believe that my mistakes will result in catastrophic outcomes." "During my sessions, my therapist uses biofeedback to relax and comfort me."
"My anxiety is due to a childhood traumatic experience." Behavior therapy identifies the root cause of anxiety that stems from a traumatic experience that occurred earlier in the patient's life. "I like it when my therapist puts me in that deep, relaxed state." During systematic desensitization, the patient is placed in a deeply relaxed state while phobic stimuli are introduced. "I no longer believe that my mistakes will result in catastrophic outcomes." Cognitive behavioral therapy shows patients alternative ways of thinking to decrease anxiety. "During my sessions, my therapist uses biofeedback to relax and comfort me." Milieu therapy uses techniques of relaxation, meditation, and biofeedback to promote patient relaxation and comfort.
Which DSM-V criteria are used to diagnose generalized anxiety disorder? Select all that apply. Anxiety and worry that occurs occasionally Worry that is controlled with behavior modification Anxiety and worry that makes it difficult for the individual to function Fear that worry and anxiety symptoms will be negatively evaluated Anxiety and worry that cannot be attributed to another mental disorder or substance abuse
Anxiety and worry that occurs occasionally Occasional anxiety is not one of the criteria for diagnosing generalized anxiety disorder. Worry that is controlled with behavior modification Worry that is controlled with behavior modification is not a part of generalized anxiety disorder. Anxiety and worry that makes it difficult for the individual to function Anxiety and worry that makes it difficult for an individual to function is part of the criteria used to diagnose generalized anxiety disorder. Fear that worry and anxiety symptoms will be negatively evaluated Fear that worry and anxiety symptoms will be negatively evaluated is not one of the criteria for diagnosing generalized anxiety disorder. Anxiety and worry that cannot be attributed to another mental disorder or substance abuse Anxiety and worry that cannot be attributed to another mental disorder or substance abuse is part of the criteria used to diagnose generalized anxiety disorder.
The health care team is caring for a patient with GAD. Which intervention should the team initiate first for this patient? Begin behavioral therapy Limit visitors to reduce stimuli Provide a supportive environment Sedate the patient and place in isolation
Begin behavioral therapy Therapies such as behavioral therapy may be initiated to help the patient manage anxiety, but this is not the initial focus of care. Limit visitors to reduce stimuli It is not necessary to limit visitors, unless this is what the patient wishes. Provide a supportive environment Support and reassurance are the first interventions for people experiencing anxiety because they make the patient feel safe. Sedate the patient and place in isolation The patient with anxiety is not sedated and placed in isolation as an initial intervention. Sedation is used when patient exhibits combative behavior.
Which concept describes the development of anxiety that is acquired through observation and modeling of other people? Classical conditioning Social learning model Genetic predisposition General adaptation syndrome
Classical conditioning Classical conditioning is a learned response to environmental stimuli, and is not learned from other people. Social learning model The social learning model describes the development of anxiety as learned through the observation and modeling of parents or peers. Genetic predisposition Genetic predisposition is the genetic influence of anxiety and does not involve observing or modeling others. General adaptation syndrome General adaptation syndrome is not the development of anxiety through learned observation from other people.
Reducing anxiety through the use of relaxation exercises and meditation is an example of which therapeutic intervention? Cognitive therapy Behavior therapy Milieu management Systematic desensitization
Cognitive therapy Cognitive therapy is not completed through the use of relaxation exercises and meditation. CBT is problem-focused therapy aided by a therapist to focus on specific strategies to address stressors or symptoms. Behavior therapy Behavior therapy is not accomplished by the utilization of relaxation and meditation. Behavior therapy is a broad therapy approach focused on behaviors and the factors that are causing them. Milieu management Milieu management is a treatment for anxiety, which utilizes relaxation exercises, meditation, and biofeedback to promote relaxation and comfort and reduce tension. Systematic desensitization Relaxation exercises and meditation are not associated with systematic desensitization. Systematic desensitization involves exposing the individual to progressively anxiety-provoking situations.
A patient is exhibiting moderate levels of anxiety. Which nursing intervention is appropriate for this patient? Engage the patient in the unit activities. Ask the patient to identify the cause of anxiety. Moving the person to a quiet area with minimal stimuli. Encourage the patient to join the next group therapy meeting.
Engage the patient in the unit activities. Patients who are anxious do not need to be around a group of people and excessive stimuli. Overstimulation may potentiate and exacerbate a patient's anxiety. Ask the patient to identify the cause of anxiety. Encouraging the patient to express feelings help decrease levels of anxiety. Moving the person to a quiet area with minimal stimuli. A patient with moderate levels of anxiety does not require being moved to a quiet area. Being secluded from others can increase anxiety. Encourage the patient to join the next group therapy meeting. Patients who are anxious are not able to focus enough to contribute to a group meeting.
Generalized anxiety disorder (GAD) is associated with which physical symptoms? Select all that apply. Fatigue Insomnia Bradycardia Hypotension Muscle tension
Fatigue Fatigue is a classic physical symptom of GAD. Insomnia Insomnia is a classic physical symptom of GAD. Bradycardia Bradycardia is a slow pulse, which is not a physical symptom of GAD. Tachycardia and palpitations are classic physical symptoms of GAD. Hypotension Hypertension, rather than hypotension, is a classic physical symptom of GAD. Muscle tension Muscle tension is a classic physical symptom of GAD.
A patient with generalized anxiety disorder is taking an herbal remedy for treatment. The psychiatric nurse practitioner caring for the patient asks the patient to discontinue the herbal remedy. What is the psychiatric nurse practitioner's rationale for this action? Herbal remedies cause extensive side effects. Herbal remedies are not covered by insurance. Herbal remedies can cause symptoms of psychosis. Herbal remedies can delay diagnosis of major depression or anxiety disorders.
Herbal remedies cause extensive side effects. All medications, including herbal remedies, have side effects. Herbal remedies do not necessarily cause extensive side effects in all patients. Herbal remedies are not covered by insurance. Treatment not being covered by insurance is not a potential negative consequence of a patient seeking integrative care. Herbal remedies can cause symptoms of psychosis. Some herbal remedies may have negative side effects, but they do not cause psychosis. Herbal remedies can delay diagnosis of major depression or anxiety disorders. People who use complementary/alternative medicine (CAM) often delay seeking help from conventional medical providers, which can cause a delay in the diagnosis of major depression and anxiety disorders.
According to evidence, which of these treatment approaches are more effective in the treatment of anxiety? Hypnosis Behavioral desensitization Complementary therapy Cognitive behavioral therapy
Hypnosis Hypnosis is not found to be the most effective treatment for anxiety disorders. Behavioral desensitization Behavioral desensitization is not found to be the most effective treatment for anxiety disorders. Complementary therapy Complementary therapy is not found to be the most effective treatment for anxiety disorders. Cognitive behavioral therapy Evidence suggests that cognitive behavioral therapy for anxiety disorders is more effective than for other disorders.
The treatment team wants to gain a better understanding of the specific situations that provoke anxiety in a patient they are treating. Which treatment would they most likely choose? Hypnosis Behavior theory Behavioral desensitization Systematic desensitization
Hypnosis Hypnosis is not the process used to introduce phobic stimuli to the patient with anxiety. Behavior theory Behavior theory is not the process used to introduce phobic stimuli to the patient with anxiety. Behavioral desensitization Behavioral desensitization is not the process used to introduce phobic stimuli to the patient with anxiety. Systematic desensitization Systematic desensitization is the process of exposing progressively anxiety-provoking situations to an individual.
The health care team is managing the care of a patient with moderate anxiety. Which interventions should the team implement for this patient? Select all that apply. Interacting with the patient in a positive manner Keeping the patient busy with activities to reduce worry Including the patient in the interdisciplinary plan of care Recognizing and intervening early when behaviors escalate Introducing the patient to as many staff members as possible to enhance coping
Interacting with the patient in a positive manner The health care team can support the hospitalized patient with anxiety through remaining positive. Patients need support and reassurance. Building a trusting relationship is an initial step. Keeping the patient busy with activities to reduce worry The health care team can support the hospitalized patient with anxiety through reducing stimulation in the environment, not through trying to keep the patient busy. Including the patient in the interdisciplinary plan of care The health care team can support the hospitalized patient with anxiety by including the patient's input when developing the interdisciplinary plan of care. The patient should be encouraged to participate actively in planning. By sharing decision making with the patient the team increases the likelihood that positive outcomes will be attained. Recognizing and intervening early when behaviors escalate The health care team can support the hospitalized patient with anxiety through recognition and early intervention of escalating or problem behaviors. The health care team focuses on developing a plan of care that promotes safety, assessing the patient's risks for self-harm, and promotes a calm and safe environment. Introducing the patient to as many staff members as possible to enhance coping The health care team can support the hospitalized patient with anxiety through the provision of calm and consistent care, not through the use of many staff members.
Which nursing interventions promote self-care in the anxious patient? Select all that apply. Minimize stimuli Engage in positive self-talk Encourage showering and grooming Suggest cognitive behavioral therapy Ensure adequate nutrition and fluid intake
Minimize stimuli Minimizing stimuli is not a nursing intervention that addresses self-care activities. Engage in positive self-talk Positive self-talk is not a nursing intervention that addresses self-care activities. Encourage showering and grooming Showering and grooming is a nursing intervention that promotes self-care activities in the patient with anxiety. Suggest cognitive behavioral therapy Cognitive behavioral therapy is not a nursing intervention that addresses self-care activities. Ensure adequate nutrition and fluid intake Ensuring adequate nutrition and fluid intake is a self-care activity intervention for the patient with anxiety.
Charles Darwin studied the relationship between the adrenal medulla and emotions. Which chemical, produced in the adrenal medulla, causes the fight or flight response? Oxytocin Dopamine Serotonin Epinephrine
Oxytocin Oxytocin is not the chemical that causes the fight or flight response. Oxytocin is a hormone and neuropeptide produced in the hypothalamus and secreted by the post-pituitary gland. Dopamine Dopamine is not the chemical that causes the fight or flight response. Dopamine is a neurotransmitter that regulates movement and emotional responses. Serotonin Serotonin is not the chemical that causes the fight or flight response. Serotonin is a neurotransmitter that affects most brain cell activity from one area to another. Epinephrine The adrenal medulla produces epinephrine, which causes the fight or flight response.
Which level of anxiety is healthy because it provides a signal that something is not right? Panic Severe anxiety Moderate anxiety Normal anxiety
Panic The most extreme level of anxiety is panic and is not healthy. Persons in a state of panic have markedly disturbed behavior. Severe anxiety Severe anxiety is not healthy and is characterized by a greatly reduced perceptual field. Moderate anxiety Mild or moderate anxiety levels can be healthy because they signal that something is not right. Mild levels of anxiety increase awareness. Normal anxiety Normal anxiety is required for humans and provides energy to carry out our daily lives. Normal anxiety does not signal that something is wrong.
Which concepts are most important for the nurse to utilize in the anxious patient's plan of care? Select all that apply. Pharmacological goals Problem solving interventions Understanding levels of anxiety Behavioral theories of mental health Defensive patterns used in response to anxiety
Pharmacological goals The nurse should understand the pharmacological goals of the mental health patient, but this is not a part of the initial nursing care planning process. Problem solving interventions The nurse should understand the problem-solving interventions for the mental health patient, but these are not a part of the initial nursing care planning process. Understanding levels of anxiety The psychiatric mental health nurse must understand the level of anxiety to appropriately determine the patient's severity. Behavioral theories of mental health The nurse should understand behavioral theories of the mental health patient, but this is not a part of the initial nursing care planning process. Defensive patterns used in response to anxiety The psychiatric mental health nurse must understand the defense patterns to appropriately determine the patient's severity.
The nurse is caring for a patient with generalized anxiety disorder who is experiencing moderate symptoms. What is the nurse's first step in caring for this patient? Problem-solve with the patient Develop goals with the patient Reduce the patient's level of anxiety Examine the patient's coping behaviors
Problem-solve with the patient Problem-solving cannot occur when the patient is experiencing moderate-to-severe anxiety. Develop goals with the patient Once the level of anxiety is reduced, the nurse can assist the patient in developing goals. Reduce the patient's level of anxiety Reducing the level of anxiety and its associated symptoms is the first step in the nurse-patient relationship. Examine the patient's coping behaviors Once the level of anxiety is reduced, the nurse can assist the patient in examining coping behaviors.
A patient is admitted to the hospital with panic levels of anxiety as evidenced by delusions, poor impulse control, and an inability to problem solve. Which nursing intervention, implemented immediately, will allow the patient to participate in psychotherapy? Tell the patient to take a walk Encourage patient positive self-talk Ask the patient to identify coping techniques Teach the patient measures to reduce tension
Tell the patient to take a walk Severe to panic levels of anxiety must be reduced for the patient to be able to have meaningful participation in psychotherapy. Taking a brisk walk or exercising helps the patient regain self-control. Encourage patient positive self-talk Encouraging positive self-talk is more appropriate for lower levels of anxiety. Ask the patient to identify coping techniques Patients who are extremely anxious cannot focus enough to think clearly. Teach the patient measures to reduce tension Teaching measures to reduce tension are more effectively taught in patients with lower levels of anxiety.
A patient with anxiety has been taking a benzodiazepine for several weeks. The psychiatrist adds an antidepressant to the patient's medication regimen. What education does the nurse anticipate providing to the patient? The benzodiazepine should be doubled. The benzodiazepine can be used as needed. The benzodiazepine should be discontinued. The benzodiazepine must be slowly tapered off.
The benzodiazepine should be doubled. If an antidepressant is added to the treatment plan, the benzodiazepine dose is not doubled. Benzodiazepines have sedative effects and would further enhance the sedative effects of the antidepressant. The benzodiazepine can be used as needed. If an antidepressant is added to the treatment plan, the benzodiazepine is not used on an "as needed" basis. Benzodiazepines are prescribed for a short-term basis only because of adverse side effects and the risk for dependency on the medication. The benzodiazepine should be discontinued. If an antidepressant is added to the treatment plan, the benzodiazepine is not discontinued abruptly. The benzodiazepine must be slowly tapered off. If an antidepressant is added to the treatment plan, the patient must be slowly tapered off the benzodiazepine to avoid adverse withdrawal symptoms including agitation, anxiety, sweating, insomnia, and confusion.
Which statement regarding generalized anxiety disorder (GAD) is true? The individual's worrying experienced with GAD becomes a coping mechanism. GAD may change the size and function of the pons and medulla of the brain. Diagnosis is confirmed when anxiety and worry occur at least 3 days a week. Environmental and social theorists believe that GAD occurs spontaneously due to past experienced trauma.
The individual's worrying experienced with GAD becomes a coping mechanism. Individuals with GAD experience excessive worrying, which acts as a coping mechanism to prevent negative events from happening. GAD may change the size and function of the pons and medulla of the brain. Scientists are studying the changes in size and function of the amygdala and hippocampus in individuals with GAD. The pons and medulla are part of the brainstem and do not change in the presence of anxiety. Diagnosis is confirmed when anxiety and worry occur at least 3 days a week. The DSM-5 criteria for GAD diagnosis is that excessive anxiety and worry occur more days than not for at least 6 months. Environmental and social theorists believe that GAD occurs spontaneously due to past experienced trauma. Environmental and social theorists believe the anxiety experienced in GAD is a learned response to either environmental stimuli or through the observation and modeling of parents or peers.
The nurse is caring for a patient with severe anxiety. Which assessment finding requires immediate action by the nurse? The patient complains of chronic insomnia that increases anxiety levels. The patient states that severe anxiety symptoms have been present for days. The patient states that anxiety levels are compromising personal relationships. The patient states that thoughts of stressful situations pop into his mind several times a day.
The patient complains of chronic insomnia that increases anxiety levels. Chronic insomnia is a problem in anxiety, but it does not require immediate action by the nurse. The patient states that severe anxiety symptoms have been present for days. Severe anxiety that does not resolve puts the patient at increased risk for suicide. The nurse must intervene immediately to promote safety for this patient. The patient states that anxiety levels are compromising personal relationships. The patient with anxiety is at risk for compromised relationships, but this does not require immediate action by the nurse. The patient states that thoughts of stressful situations pop into his mind several times a day. It is normal for the anxious patient to experience stressful thoughts. Management strives to reduce the frequency of the stressful thoughts.
The psychiatrist admits a patient with severe anxiety to the hospital. Why would hospital admission be required for this patient? The patient is suicidal. The patient develops depression. Symptoms are increasing at night. Medication adjustments are necessary.
The patient is suicidal. Hospital admission may become required if severe symptoms of anxiety persist or if the person is suicidal. The patient develops depression. Depression with anxiety is not an indication for hospital admission, unless the person is at risk for harming self. Symptoms are increasing at night. Increased anxiety at night is not an indication of the need for hospital admission. Medication adjustments are necessary. Medication adjustments can occur on an outpatient basis and do not require hospitalization, unless the person is at risk for harming self.
Which statements are true regarding anxiety and depression? Select all that apply. Treatment for both anxiety and depression is similar. Anxiety is frequently associated with substance abuse. Individuals with both depression and anxiety are at risk for suicide. Depression usually occurs first, and is accompanied by anxiety. Approximately 25% of persons with anxiety also have depression.
Treatment for both anxiety and depression is similar. Treatment for anxiety and depression is similar, and includes relaxation, pharmacological intervention, and therapy. Anxiety is frequently associated with substance abuse. Anxiety is frequently associated with substance abuse. Sufferers may attempt to use medications or alcohol to alleviate symptoms. Individuals with both depression and anxiety are at risk for suicide. Individuals with both depression and anxiety are at high risk for suicide. Depression usually occurs first, and is accompanied by anxiety. The symptoms of anxiety typically appear first, followed by the symptoms of depression. Approximately 25% of persons with anxiety also have depression.Approximately 60% of persons with anxiety also have depression.
