Psych CH14, Anxiety Prep U, MH EX 2 PREP U CH. 14 Anxiety and Anxiety Disorders, anxiety, ch 14 NCLEX questions

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nxiety. Which statement by the nurse is likely the most therapeutic intervention? "If you address the causes of your anxiety head-on, you will find that you can recover from it without medications or therapy." "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." "With the development of more life skills and a demonstration of continued success in life, your anxiety will shrink and eventually disappear."

"Anxiety is a feeling that is experienced by everyone at some point and it can never be completely removed from one's life."

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? "Every time you feel anxious, try to focus on how much easier your life would be if you didn't experience anxiety so often." "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." "Anxiety is a feeling that is experienced by everyone at some point and it can never be completely removed from one's life."

"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 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? "Normal anxiety occurs in response to everyday stressors." "People with anxiety disorders experience a fight-or-flight response when threatened." "Normal anxiety does not result in feelings of dread or restlessness." "People with anxiety disorders generally find that the anxiety interferes with daily activities."

"People with anxiety disorders generally find that the anxiety interferes with daily activities."

The nurse is assessing a client who recently experienced their first panic attack while at the grocery store. What question should the nurse ask to identify complications of the disorder? "What do you think is the origin of the panic you felt?" "Are you concerned there will be more panic attacks?" "Can you describe how you felt physically during the attack?" "Do you have any problems going out alone to public places?"

"Do you have any problems going out alone to public places?" Rationale:To identify complications of the disorder when assessing a client who recently experienced the client's first panic attack while at a grocery store, the psychiatric nurse asks, "Do you have any problems going out alone to public places?"

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? "Has something changed at work that is causing you to worry?" "Why do you think you'll be fired?" "Your worries are a feature of your anxiety disorder. Tell yourself that you have nothing to worry about." "It sounds to me like you're doing a good job."

"Has something changed at work that is causing you to worry?" 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.

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

"How do you feel about everything that is happening in your life right now?" An open-ended question that prompts the client to describe his or her current feelings is a useful assessment technique.

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

"How do you feel about everything that is happening in your life right now?" 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.

A client asks the nurse, "How can I tell if what I am experiencing is just regular worrying and not an anxiety disorder?" What is the nurse's best response? "If you feel nervous before a big event, you likely have an anxiety disorder." "You have an anxiety disorder if you need medication to help you function." "Trouble falling asleep due to worrying indicates an anxiety disorder." "If you are unable to function occupationally and socially because of the anxiety"

"If you are unable to function occupationally and socially because of the anxiety"

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? "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."

"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.

Which statement by the nurse demonstrates an understanding of the role automatisms have in a panic attack? "The client taps her fingers very rapidly when she is feeling anxious." "She knows that if she taps her fingers she will be able to lessen her anxiety." "I can tell that the more she taps, the less anxiety she is actually feeling." "I discourage her finger tapping since it serves to increase her anxiety level."

"The client taps her fingers very rapidly when she is feeling anxious."

Which statement by the nurse demonstrates an understanding of the role automatisms have in a panic attack? "I discourage her finger tapping since it serves to increase her anxiety level." "I can tell that the more she taps, the less anxiety she is actually feeling." "She knows that if she taps her fingers she will be able to lessen her anxiety." "The client taps her fingers very rapidly when she is feeling anxious."

"The client taps her fingers very rapidly when she is feeling anxious." Automatisms are automatic, unconscious mannerisms associated with anxiety. Examples include tapping fingers, jingling keys, or twisting hair. Automatisms are geared toward anxiety relief and increase in frequency and intensity with the client's anxiety level. None of the remaining options accurately state the fact that the tapping identifies the level of anxiety a client is experiencing but does not manage or less the emotion.

Which statement by the nurse demonstrates an understanding of the role automatisms have in a panic attack? "The client taps her fingers very rapidly when she is feeling anxious." "She knows that if she taps her fingers she will be able to lessen her anxiety." "I discourage her finger tapping since it serves to increase her anxiety level." "I can tell that the more she taps, the less anxiety she is actually feeling."

"The client taps her fingers very rapidly when she is feeling anxious." Rationale:Automatisms are automatic, unconscious mannerisms associated with anxiety. Examples include tapping fingers, jingling keys, or twisting hair. Automatisms are geared toward anxiety relief and increase in frequency and intensity with the client's anxiety level. None of the remaining options accurately state the fact that the tapping identifies the level of anxiety a client is experiencing but does not manage or less the emotion.

A client comes to the emergency due to symptoms of a potential heart attack. Further assessment determines that the client is not having a heart attack but is having a panic attack. When beginning to interview the client, which question would be most appropriate for the nurse to ask? "What did you experience just before and during the attack?" "What do you think caused you to feel this way?" "Are you feeling much better now that you are lying down?" "Do you think you will be able to drive home?"

"What did you experience just before and during the attack?"

After reviewing various etiologic theories associated with panic disorder, the nurse demonstrates understanding of the psychodynamic theory, identifying which as the underlying cause? Conditioning Separation or loss Heritability Activation of stress hormone

Separation or loss

A client comes to the emergency department because the client thinks the client is having a heart attack. Further assessment determines that the client is not having a heart attack but is having a panic attack. When beginning to interview the client, which question would be most appropriate for the nurse to ask? "What did you experience just before and during the attack?" "What do you think caused you to feel this way?" "Do you think you will be able to drive home?" "Are you feeling much better now that you are lying down?"

"What did you experience just before and during the attack?" After it has been determined that the client does not have other medical problems, the nurse should assess for the characteristic symptoms of panic attack, focusing the questions on what the client was experiencing just before and during the attack. Asking the client if the client feels better provides no information for the nurse, and lying down may or may not be effective. Asking the client if the client thinks the client can drive home is a question that can be asked much later in the interview, after the attack subsides and the client is stable. Asking the client about what caused the attack is inappropriate because numerous stimuli, both external and internal, can provoke an attack. Most clients will not be able to identify a specific cause. The focus of care is on the characteristics of the attack.

The client reports that the client feels anxious when interacting socially with others and "never seems to know what to say." Which question indicates the nurse has a sound understanding of interpersonal theory as it relates to anxiety? "Do other members of your family have similar problems?" "What kind of relationship do you have with your parents?" "What have you tried to help manage your feelings and discomfort?" "How long have you experienced these problems?"

"What kind of relationship do you have with your parents?" According to interpersonal theory, caregivers can communicate anxiety to infants or children through inadequate nurturing. Individuals who are exposed to poor parental nurturing may develop poor self-esteem or poor communication skills

Which statement, made by a client diagnosed with an anxiety disorder, should trigger the nurse's concern about the client's understanding of the use of defense mechanisms? "I'm not sure when I'm actually using a defense mechanism." "Defense mechanisms provide a sense of control over the uncontrollable." "I'm thankful that I have a way to manage my problems." "When I have a problem, I just deny it until it goes away."

"When I have a problem, I just deny it until it goes away." Rationale: The dependence on one or two defense mechanisms also can inhibit emotional growth, lead to poor problem-solving skills, and create difficulty with relationships. Denial should not be used to deal with all of one's problems. None of the remaining options present untrue or troubling statements regarding defense mechanisms

Which statement, made by a client diagnosed with an anxiety disorder, should trigger the nurse's concern about the client's understanding of the use of defense mechanisms? "I'm not sure when I'm actually using a defense mechanism." "I'm thankful that I have a way to manage my problems." "When I have a problem, I just deny it until it goes away." "Defense mechanisms provide a sense of control over the uncontrollable."

"When I have a problem, I just deny it until it goes away." The dependence on one or two defense mechanisms also can inhibit emotional growth, lead to poor problem-solving skills, and create difficulty with relationships. Denial should not be used to deal with all of one's problems. None of the remaining options present untrue or troubling statements regarding defense mechanisms.

Nearly what percentage of adults are affected by anxiety disorders? 0.1 0.4 0.25 0.5

0.25 Rationale:Nearly 25% of adults are affected by anxiety disorders.

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? 4 months 6 months 12 months 2 months

6 months

6 months For generalized anxiety disorder, the diagnostic criteria listed include unrealistic or excessive anxiety and worry about two or more life circumstances for 6 months or more, during which time these concerns exist for a majority of days

6 months Rationale:For generalized anxiety disorder, the diagnostic criteria listed include unrealistic or excessive anxiety and worry about two or more life circumstances for 6 months or more, during which time these concerns exist for a majority of days.

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

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.

The nurse is assessing a client with anxiety. Which behavior might indicate that the client has moderate anxiety? The client is focused in an activity. The client is nervous and agitated. The client has impaired cognitive skills. The client is unable to communicate verbally.

A client who is moderately anxious has a disturbing feeling that something is wrong. This causes nervousness and agitation. Increased concentration and attention is seen in clients having mild anxiety. Cognitive skills are impaired in clients who have severe anxiety. Inability to communicate verbally indicates that the client is panicking.

Which client is most likely to be at risk for drug dependence and difficulties with withdrawal? A man whose obsessive-compulsive disorder is being treated long term with paroxetine 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 A client with generalized anxiety disorder who has responded well since beginning treatment with fluoxetine earlier in the year

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

Which client is most likely to be at risk for drug dependence and difficulties with withdrawal? A woman who has been taking lorazepam for several months after witnessing a traumatic motor vehicle accident A man whose obsessive-compulsive disorder is being treated long term with paroxetine A client who has recently begun treatment with propranolol for the treatment of social phobia A client with generalized anxiety disorder who has responded well since beginning treatment with fluoxetine earlier in the year

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

Which client is most likely to be at risk for drug dependence and difficulties with withdrawal? A woman who has been taking lorazepam for several months after witnessing a traumatic motor vehicle accident 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 client who has recently begun treatment with propranolol for the treatment of social phobia

the most important factor in the person's stress response is what? Adaptive coping strategies Supportive friends Relaxation techniques Strength of the immune system

Adaptive coping strategies The most important factor in a person's stress response is the ability of engage in adaptive coping behaviors. This ability can assist a person in developing resilience, or the ability to "bounce back" when faced with stress and stressful situations

A client approaches the nurse on an inpatient psychiatric hospital unit crying, trembling, and feeling nauseous. The client states, "I've tried everything, I still feel so anxious." Which action by the nurse would be most appropriate? Take the client on a walk around the unit. Direct the client to continue deep breathing. Take the client to the dayroom as a distraction. Administer the prescribed PRN anxiolytic medication.

Administer the prescribed PRN anxiolytic medication.

A client comes to the emergency department because the client thinks the client is having a heart attack. Further assessment determines that the client is not having a heart attack but is having a panic attack. When beginning to interview the client, which question would be most appropriate for the nurse to ask? "Are you feeling much better now that you are lying down?" "What did you experience just before and during the attack?" "Do you think you will be able to drive home?" "What do you think caused you to feel this way?"

After it has been determined that the client does not have other medical problems, the nurse should assess for the characteristic symptoms of panic attack, focusing the questions on what the client was experiencing just before and during the attack. Asking the client if the client feels better provides no information for the nurse, and lying down may or may not be effective. Asking the client if the client thinks the client can drive home is a question that can be asked much later in the interview, after the attack subsides and the client is stable. Asking the client about what caused the attack is inappropriate because numerous stimuli, both external and internal, can provoke an attack. Most clients will not be able to identify a specific cause. The focus of care is on the characteristics of the attack.

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

Allow the client to pace

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

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

Allow the client to pace 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.

What part of the brain is thought to be involved in the production of anxiety as a result of the identification of incoming sensory information as threatening? Amygdala Cerebellum Brainstem Cerebral cortex

Amygdala

A client has sought treatment because of the overwhelming anxiety the client experiences regarding the safety of the client's young children. The client admits that the client will not normally let the client's children leave the client's sight for fear that they will be abducted, abused, or injured. The client is unable to function at work as a result of this anxiety. The nurse would recognize that this client experiences which condition? Fear Derealization Anticipatory anxiety Signal anxiety

Anticipatory anxiety Anticipatory anxiety exists in the context of phobia. People with phobias develop anticipatory anxiety even when thinking about possibly encountering the dreaded phobic situation (i.e., danger to the client's children). The anticipatory anxiety in this case is so severe that the client is unable to function in certain situations leading to hardship. Signal anxiety refers to the natural anxiety mechanism that communicates danger or motivation for needed change. Fear refers to feeling afraid or threatened by a clearly identifiable external stimulus that presents a danger to a person. Derealization refers to a stage in the experience of anxiety when a person senses that things are not real.

Anticipatory anxiety anticipatory anxiety exists in the context of phobia. People with phobias develop anticipatory anxiety even when thinking about possibly encountering the dreaded phobic situation (i.e., danger to the client's children). The anticipatory anxiety in this case is so severe that the client is unable to function in certain situations leading to hardship

Panic disorder is treated with cognitive-behavioral techniques, deep breathing, and relaxation, in addition to what? Antidepressants Anticonvulsants Antipsychotics Central nervous system depressants

Antidepressants

The mental health nurse knows that which medication classification has been found to be effective in reducing or eliminating panic attacks? Antimanics Antidepressants Anticholinergics Antipsychotics

Antidepressants

Which medication classification has been found to be effective in reducing or eliminating panic attacks? Antimanics Antipsychotics Anticholinergics Antidepressants

Antidepressants Rationale: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.

A hospitalized client states that the client is having difficulty resting. Which intervention would help promote rest? Assisting the client with deep-breathing exercises Encouraging the client to take prescribed sedatives daily Offering the client a cup of tea Leaving the client's door open so the client can see into the hallway

Assisting the client with deep-breathing exercises Deep-breathing exercises are beneficial to promoting rest as they help the client to relax. The client's door should be closed to reduce noise and distractions. Tea contains caffeine, which acts as a stimulant. While sedatives may be used occasionally for assistance with rest, regular use isn't advised because dependence may develop.

Which of the following is a behavioral symptom of anxiety? Tremors Apprehension Avoidance Impatience

Avoidance

Clients taking benzodiazepines need education about what? Avoiding cheeses and smoked meats Interactions with monoamine oxidase inhibitors (MAOIs) Avoiding spending too much time in the sun Concomitant use of alcohol

Benzodiazepines have long been the drugs of choice for treatment of anxiety disorders. They can induce a physical dependence and can induce severe withdrawal symptoms and intense rebound anxiety when discontinued abruptly. They potentiate the effects of alcohol and other sedative hypnotics, are commonly abused, and have several significant side effects. The most common adverse effects are sedation, ataxia, loss of coordination, slurred speech, memory impairment, paradoxical agitation, and dizziness. They also cause psychomotor impairment.

Buspirone has been prescribed for a client with anxiety. When providing health education, the nurse should describe what benefit of this medication over other anxiolytics? decreased risk of hepatic injury less central nervous system depression rapid onset and short duration sublingual administration

Buspirone is a newer anxiolytic drug that does not cause sedation or muscle relaxation. It is preferred when the client needs to be alert such as when driving or working. Buspirone does not have a reduced risk of hepatic injury relative to other anxiolytics, nor does it have a faster onset and shorter duration. It is administered orally, not sublingually.

When discussing various types of anxiolytic medications with a client, the nurse recognizes that which medication has the lowest potential for abuse? Alprazolam Diazepam Buspirone Lorazepam

Buspirone is a nonbenzodiazepine medication that does not have abuse potential. Benzodiazepines such as alprazolam, lorazepam, and diazepam have abuse potential and may become addictive.

A client spends hours stacking and unstacking towels. The client is repeatedly checking to make sure that the towels are in order of color. What term is used to identify this behavior? Compulsion Derealization Obsession Phobia

Compulsion Compulsions are ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety. A phobia is an illogical, intense, persistent fear of a specific object or a social situation that causes extreme distress and interferes with normal functioning. An obsession is a recurrent, persistent, intrusive, and unwanted thought, image, or impulse that causes marked anxiety and interference with interpersonal, social, or occupational function. Derealization is sensing that things are not real.

Clients taking benzodiazepines need education about what? Interactions with monoamine oxidase inhibitors (MAOIs) Avoiding cheeses and smoked meats Concomitant use of alcohol Avoiding spending too much time in the sun

Concomitant use of alcohol

Concomitant use of alcohol Benzodiazepines have long been the drugs of choice for treatment of anxiety disorders. They can induce a physical dependence and can induce severe withdrawal symptoms and intense rebound anxiety when discontinued abruptly. They potentiate the effects of alcohol and other sedative hypnotics, are commonly abused, and have several significant side effects. The most common adverse effects are sedation, ataxia, loss of coordination, slurred speech, memory impairment, paradoxical agitation, and dizziness. They also cause psychomotor impairment.

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. Weaning off of medications as necessary Development of a regular exercise program Lessening the amount of daily responsibilities Continued development of positive coping skills Continued practice of relaxation techniques

Continued development of positive coping skills Continued practice of relaxation techniques Development of a regular exercise program

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? Crisis Caregiver burden Coping mechanism Defense mechanism

Coping mechanism Mild anxiety is often managed without conscious thought by coping mechanisms, which are behaviors used to decrease stress and anxiety.

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? Coping mechanism Caregiver burden Defense mechanism Crisis

Coping mechanism 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.

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? Parasympathetic nervous system Sympathetic nervous system Motherly response system Central nervous system

Correct response: Sympathetic nervous system Explanation: 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 nurse in a psychiatric inpatient unit is caring for a client with generalized anxiety disorder. As part of the client's treatment, the psychiatrist orders lorazepam, 1 mg by mouth three times per day. During lorazepam therapy, the nurse should remind the client to: avoid caffeine. avoid aged cheeses. stay out of the sun. maintain an adequate salt intake.

Correct response: avoid caffeine. Explanation: Ingesting 500 mg or more of caffeine can significantly alter the anxiolytic effects of lorazepam. Other dietary restrictions are unnecessary. Staying out of the sun or using sunscreens is required when taking phenothiazines. An adequate salt intake is necessary for clients receiving lithium.

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? "It sounds to me like you're doing a good job." "Your worries are a feature of your anxiety disorder. Tell yourself that you have nothing to worry about." "Has something changed at work that is causing you to worry?" "Why do you think you'll be fired?"

Correct response: "Has something changed at work that is causing you to worry?" Explanation: 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.

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

Correct response: "How do you feel about everything that is happening in your life right now?" Explanation: 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.

A nurse notices that a client with obsessive-compulsive disorder dresses and undresses several times each day. Which comment by the nurse would be most therapeutic? "I saw you change clothes several times today. Do you find this tiring?" "It might be helpful if you dress only once per day so you will not be so tired." "It must really bother you to change your clothes so often. How can I help?" "I see that you are a perfectionist about the clothes you wear."

Correct response: "I saw you change clothes several times today. Do you find this tiring?" Explanation: Mentioning to the client that changing clothes so often may be tiring focuses on the client's feelings rather than making an assumption. This helps reduce the intensity of the client's ritualistic behavior, thereby promoting trust and rapport. Suggesting to the client to dress only once per day and implying that the client's behavior is bothersome or foolish would convey disapproval, impede trust and rapport, promote dysfunctional behavior, and worsen anxiety. Saying to the client that "you are a perfectionist about the clothes you wear" is sarcastic and does not promote trust and rapport. The client has been dressing and undressing repetitively in response to anxiety not perfectionism. The client already knows the need for repetitive dressing and undressing is frustrating and wants to be understood instead of misunderstood. Perfectionism is more reflective of obsessive-compulsive personality disorder instead of obsessive-compulsive disorder.

A 40-year-old client is admitted for a surgical biopsy of a suspicious lump in the left breast. The client is tearfully writing a letter to the client's two children and tells the nurse, "I want to leave this for my children in case anything goes wrong today." Which response by the nurse would be most therapeutic? "In case anything goes wrong? What are your thoughts and feelings right now?" "I can understand that you're nervous, but this really is a minor procedure. You'll be back in your room before you know it." "Try to take a few deep breaths and relax. I have some medication that will help." "I'm sure your children know how much you love them. You'll be able to talk to them on the phone in a few hours."

Correct response: "In case anything goes wrong? What are your thoughts and feelings right now?" Explanation: By acknowledging how the client feels, this response encourages discussion about what the client is thinking and feeling. Minimizing the client's feelings or offering empty reassurances isn't therapeutic or helpful. Deep breathing and preoperative medication would be appropriate only after the client has expressed the fears and dealt with them.

The nurse in the emergency department (ED) is caring for a client who suffers recurrent panic attacks. The client states, "I want to know what causes these panic attacks so I can do something to keep it from happening again." Which responses by the nurse is correct? Select all that apply. "Panic attacks are not your fault. They are thought to be caused by high levels of epinephrine." "No one really knows what causes panic attacks." "There are no treatments for panic attacks outside of behavioral modification therapy." "Psychological factors and social triggers can contribute to panic attacks." "Some people believe that panic attacks are caused by an abnormal pathway in the brain."

Correct response: "Panic attacks are not your fault. They are thought to be caused by high levels of epinephrine." "Psychological factors and social triggers can contribute to panic attacks." Explanation: An excess of epinephrine (NE) is thought to be a causative factor. There are specific neurotransmitters and areas of the brain that are responsible for the perceptions and symptoms of a panic attack. Medications act on these specific areas of the brain to lessen the occurrence of panic attacks. Psychological factors and social conditions may contribute but are not causative of panic attacks. The answer, "Some people believe that panic attacks are caused by an abnormal pathway in the brain" is incorrect. Neurological deficits may be present in other anxiety disorders, such as obsessive compulsive disorder, but are not associated with panic attacks.

Which statement by the nurse demonstrates an understanding of the role automatisms have in a panic attack? "The client taps her fingers very rapidly when she is feeling anxious." "I discourage her finger tapping since it serves to increase her anxiety level." "She knows that if she taps her fingers she will be able to lessen her anxiety." "I can tell that the more she taps, the less anxiety she is actually feeling."

Correct response: "The client taps her fingers very rapidly when she is feeling anxious." Explanation: Automatisms are automatic, unconscious mannerisms associated with anxiety. Examples include tapping fingers, jingling keys, or twisting hair. Automatisms are geared toward anxiety relief and increase in frequency and intensity with the client's anxiety level. None of the remaining options accurately state the fact that the tapping identifies the level of anxiety a client is experiencing but does not manage or less the emotion.

A client approaches the nurse on an inpatient psychiatric hospital unit crying, trembling, and feeling nauseous. The client states, "I've tried everything, I still feel so anxious." Which action by the nurse would be most appropriate? Direct the client to continue deep breathing. Take the client on a walk around the unit. Take the client to the dayroom as a distraction. Administer the prescribed PRN anxiolytic medication.

Correct response: Administer the prescribed PRN anxiolytic medication. Explanation: The client is experiencing severe anxiety. The client tells the nurse the client has tried other strategies but they have not been effective. Given the client's report of symptoms, it would be appropriate to administer a dose of the prescribed PRN anxiolytic medication. Once the client is experiencing a decrease in the uncomfortable physiologic symptoms associated with the severe anxiety, it will be easier to engage the client in nonpharmacological interventions, such as deep breathing, to manage any residual signs and symptoms of the anxiety.

A client has sought treatment because of the overwhelming anxiety the client experiences regarding the safety of the client's young children. The client admits that the client will not normally let the client's children leave the client's sight for fear that they will be abducted, abused, or injured. The client is unable to function at work as a result of this anxiety. The nurse would recognize that this client experiences which condition? Signal anxiety Fear Derealization Anticipatory anxiety

Correct response: Anticipatory anxiety Explanation: Anticipatory anxiety exists in the context of phobia. People with phobias develop anticipatory anxiety even when thinking about possibly encountering the dreaded phobic situation (i.e., danger to the client's children). The anticipatory anxiety in this case is so severe that the client is unable to function in certain situations leading to hardship. Signal anxiety refers to the natural anxiety mechanism that communicates danger or motivation for needed change. Fear refers to feeling afraid or threatened by a clearly identifiable external stimulus that presents a danger to a person. Derealization refers to a stage in the experience of anxiety when a person senses that things are not real.

The nurse is teaching a client prescribed the antianxiety agent chlordiazepoxide. The nurse should incorporate which instruction into the teaching plan? Avoid taking antianxiety drugs with alcohol. Take the medication at the same time each day, avoiding taking at bedtime. Take antianxiety drugs in the morning with breakfast or a snack. Avoid consuming items with tyramine when taking antianxiety agents.

Correct response: Avoid taking antianxiety drugs with alcohol. Explanation: The client should be instructed to avoid alcohol while taking chlordiazepoxide because alcohol potentiates the drug's CNS depressant effect. Taken at bedtime, this drug will induce sleep and can potentiate the effects of other drugs. Chlordiazepoxide comes in capsule form and can usually be taken with water any time of day. Tyramine is restricted with monoamine oxidase inhibitors, not antianxiety agents.

The nurse is teaching a client diagnosed with a generalized anxiety disorder how to effectively cope with severe distress. Which interventions would the nurse use to promote effective coping with anxiety? Select all that apply. Discuss previous methods that were effective in handling stress. Encourage the client to limit to a mutually decided amount of time spent on worrying. Help the client to establish a goal and develop a plan to meet the goal. Teach the client how to label feelings and how to express them. Discuss ways to examine the reality of fears. Assist the client to acknowledge the major consequences of blaming others.

Correct response: Discuss previous methods that were effective in handling stress. Encourage the client to limit to a mutually decided amount of time spent on worrying. Help the client to establish a goal and develop a plan to meet the goal. Teach the client how to label feelings and how to express them. Explanation: To promote effective skills, the nurse would focus on having the client identify successful coping skills used in the past and on building on the client's knowledge of the disorder. Setting a mutually agreed upon limit on the amount of time spent worrying gives the client boundaries and acknowledges the concerns. Establishing a goal and planning to meet the goal allows the client to engage in solving the problem and exercise control over the stressful situation. Labeling and expressing feelings is a healthy way to acknowledge feelings. Clients with schizophrenia, not generalized anxiety disorder, require help with focusing on reality-based behaviors. Clients who demonstrate oppositional behavior tend to blame others instead of taking responsibility for their inappropriate behavior.

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? Reviewing the client's previous medication administration record and the client's current list of medications Questioning the client about the clinician who first diagnosed the medical problem Asking the client to provide a detailed explanation of his or her medical problem to determine if the presentation is typical of the problem Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first

Correct response: Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first Explanation: 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.

When a client is experiencing panic, which is the priorityintervention? Give the client medication immediately. Move the client to a quiet environment. Offer the client therapy to calm down. Physically restrain the client.

Correct response: Move the client to a quiet environment. Explanation: 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.

Relaxation techniques help clients with anxiety disorders because they can promote what? Reduction of autonomic arousal Increase in sympathetic stimulation Release of cortisol Increase in the metabolic rate

Correct response: Reduction of autonomic arousal Explanation: 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.

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? Systematic desensitization Implosion therapy Relaxation exercise Biofeedback

Correct response: Systematic desensitization Explanation: 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.

A client is worried and states, "I just know I won't be able to sleep before my surgery." What sleeping pattern would the nurse anticipate? The client will likely not be able to sleep. The worry will make the client fall asleep quickly. The client will probably not be able to stay asleep. The client will likely sleep all night.

Correct response: The client will likely not be able to sleep. The expectation that the onset of sleep will be difficult increases the person's anxiety. The anxiety floods the brain with stimulating chemicals that interfere with relaxation, which is a prerequisite for natural sleep. Given the client's anxiety about the surgery, as well as the expectation that they will not sleep, it is likely that the client will not be able to sleep. Worry may cause exhaustion, but it will not cause the client to fall asleep quickly. Since the client will likely not sleep, the nurse does not anticipate patterns of wakening for the client.

A client periodically has acute panic attacks. These attacks are unpredictable and have no apparent association with a specific object or situation. During an acute panic attack, the client may experience: a decreased perceptual field. a decreased heart rate. a decreased respiratory rate. heightened concentration.

Correct response: a decreased perceptual field. Explanation: Panic is the most severe level of anxiety. During a panic attack, a client's perceptual field, narrows. The client becomes more self-focused, less aware of surroundings, and unable to process information from the environment. The client's decreased perceptual field impairs attention and ability to concentrate. During an acute panic attack, the client may experience an increase, not a decrease, in heart and respiratory rates, resulting from stimulation of the sympathetic nervous system.

Which nursing intervention is focused on the primary goal of anxiety management and treatment? assessing the client's ability to implement stress management techniques effectively helping the client identify ways to eliminate all sources of stress in his or her daily life educating the client concerning the use of medications to manage anxiety disorders assessing the client for possible symptoms of panic disorder

Correct response: assessing the client's ability to implement stress management techniques effectively Explanation: 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.

A nurse notices that a client with obsessive-compulsive disorder washes the hands for long periods each day. How should the nurse respond to this compulsive behavior? by setting aside times during which the client can focus on the behavior by urging the client to reduce the frequency of the behavior as rapidly as possible by calling attention to or trying to prevent the behavior by discouraging the client from verbalizing his anxieties

Correct response: by setting aside times during which the client can focus on the behavior Explanation: The nurse should set aside times during which the client is free to focus on the compulsive behavior or obsessive thoughts. The nurse should urge the client to reduce the frequency of the compulsive behavior gradually, not rapidly. The nurse shouldn't call attention to the behavior or try to prevent it. Trying to prevent the behavior may frighten and hurt the client. The nurse should encourage the client to verbalize anxieties to help distract attention from the compulsive behavior.

A client admitted to the unit is visibly anxious. The nurse documents what assessment finding as an expected finding in a client experiencing mild to moderate anxiety? dyspnea chest pain increased heart rate drop in blood pressure

Correct response: increased heart rate Explanation: During anxiety, the sympathetic nervous system is activated. This can result in increased heart rate and cardiac contractility, leading to an increase in cardiac output and blood pressure (BP = CO x HR). The client's respiratory rate may increase, but unless the client is experiencing a panic attack, neither dyspnea nor chest pain should be present. If these present with mild anxiety, the nurse would not document these as an expected finding.

A client who is a painter recently fractured a tibia and can't work. The client worries about finances. To treat the client's anxiety, the physician orders buspirone, 5 mg by mouth three times per day. Which drugs interact with buspirone? beta-adrenergic blockers antineoplastic drugs antiparkinsonian drugs monoamine oxidase (MAO) inhibitors

Correct response: monoamine oxidase (MAO) inhibitors Explanation: Buspirone interacts only with MAO inhibitors, producing a hypertensive reaction. Administration of beta-adrenergic blockers, antineoplastic drugs, or antiparkinsonian drugs wouldn't cause an interaction, so they can be administered simultaneously with buspirone.

A client arrives on the psychiatric unit exhibiting extreme excitement, disorientation, incoherent speech, agitation, frantic and aimless physical activity, and grandiose delusion. Which nursing diagnosis takes highest priority for this client at this time? ineffective coping hopelessness risk for injury disturbed personal identity

Correct response: risk for injury Explanation: This client is at increased risk for injury because of severe hyperactivity, disorientation, and agitation. Although ineffective coping, hopelessness, and disturbed personal identity also are appropriate diagnoses, the client's safety takes highest priority. The nurse should take immediate action to protect the client from injury.

For generalized anxiety disorder, the diagnostic criteria listed include unrealistic or excessive anxiety and worry about two or more life circumstances for 6 months or more, during which time these concerns exist for a majority of days.

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? Daily consumption of large amounts of alcohol A history of obsessive-compulsive disorder A history of severe trauma in childhood Difficulty with maintaining boundaries

Daily consumption of large amounts of alcohol

Which term describes feelings of being disconnected from oneself as seen in a panic attack? Derealization Automatisms Agoraphobia Depersonalization

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

Which term describes feelings of being disconnected from oneself as seen in a panic attack? Automatisms Derealization Agoraphobia Depersonalization

Depersonalization describes feelings of being disconnected from oneself as seen in a panic attack. Derealization is sensing that things are not real.

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

Determine the client's risk for self-harm or harm to others

A nurse is assessing a client suffering from stress and anxiety. The most common physiologic response to stress and anxiety is: sedation. diarrhea. vertigo. urticaria.

Diarrhea is the most common physiologic response to stress and anxiety. Sedation, vertigo, and urticaria could also be related to stress and anxiety but they don't occur as commonly as diarrhea.

A client states that the client has just had an argument with the client's spouse over the phone. What can the nurse expect that the client's sympathetic nervous system has stimulated the client's adrenal gland to release? Testosterone Endorphins Dopamine Epinephrine

Epinephrine In the sympathetic-adrenal-medullary response to stress, the sympathetic nervous system stimulates the adrenal gland to release epinephrine and norepinephrine. Corticotropin-releasing factor, adrenocorticotropic hormone (ACTH), and glucocorticoids are released in the hypothalamic-pituitary response to stress.

Epinephrine n the sympathetic-adrenal-medullary response to stress, the sympathetic nervous system stimulates the adrenal gland to release epinephrine and norepinephrine.

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

Establishing daily routines of meals and sleeping 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.

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? Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first Asking the client to provide a detailed explanation of his or her medical problem to determine if the presentation is typical of the problem Questioning the client about the clinician who first diagnosed the medical problem Reviewing the client's previous medication administration record and the client's current list of medications

Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first 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.

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? Exhaustion Fight-or-flight response Severe anxiety Defense mechanism

Fight-or-flight response

A 21-year-old client has been recently diagnosed with agoraphobia. Which situation is most likely to cause the client anxiety? Going to a crowded, outdoor market independently Having the client's work performance closely scrutinized by a supervisor Having a blood sample drawn and experiencing mild pain Gaining 5 pounds and being unable to exercise vigorously

Going to a crowded, outdoor market independently Agoraphobia is the fear of being alone in public places from which the person thinks escape would be difficult or help would be unavailable if he or she were incapacitated

A client comes in for a therapy session and begins to have a panic attack. The therapist asks the client to sit in the chair and then gently asks the client to imagine the client in a very safe and calm place. This technique, often useful in anxiety disorders, is called what? Decatastrophizing Progressive relaxation Guided imagery Desensitization

Guided imagery Guided imagery involves imagining a safe, enjoyable place to relax. In desensitization, the therapist progressively exposes the client to the threatening object in a safe setting until the client's anxiety decreases

A nurse is assessing a client with anxiety. Which signs and symptoms would the nurse attribute to sympathetic nervous stimulation? Select all that apply. Hypertension Heart racing Fainting Pressure to urinate Bradycardia

Hypertension Heart racing Rationale:Heart racing and hypertension are anxiety signs and symptoms related to sympathetic nervous stimulation. Pressure to urinate, fainting, and bradycardia are related to parasympathetic nervous stimulation.

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

Hypertensive crisis

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

In GAD, the person usually does not experience eruptions of acute 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? Vasodilation of peripheral blood vessels Decrease in blood glucose levels Pupil constriction Increased blood pressure

Increased blood pressure An initial response to stress, as seen by the fight-or-flight response, is an increase in the client's heart rate and blood pressure. Vasoconstriction leads to the increase in 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? Increased blood pressure Pupil constriction Vasodilation of peripheral blood vessels Decrease in blood glucose levels

A client receiving benzodiazepine therapy as treatment for panic disorder comes to the emergency department for evaluation. The nurse suspects the client is experiencing benzodiazepine withdrawal based on which of the following findings? Select all that apply. Hypersomnia Irritability Apprehension Agitation Sour taste

Irritability Apprehension Agitation

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? Will interfere with her cognitive abilities Is conducive to concentration and problem solving May be transferred to her tutor and result in test anxiety Is pathologic and warrants postponing the test

Is conducive to concentration and problem solving 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.

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." "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." "If you address the causes of your anxiety head-on, you will find that you can recover from it without medications or therapy."

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.

Lorazepam is commonly given along with a neuroleptic agent. What is the purpose of administering the drugs together? to reduce anxiety and potentiate the neuroleptic's sedative action to counteract the neuroleptic's extrapyramidal effects to manage depressed clients to increase a client's level of awareness and concentration

Lorazepam, when taken with a neuroleptic such as haloperidol, potentiates the neuroleptic's sedating effect and is used to treat severely agitated clients. Lorazepam wouldn't be given to counteract extrapyramidal effects. Both drugs can cause depression, so they aren't used to treat depression. The drugs' depressant effect would decrease concentration, not increase it.

During which type of anxiety does a person's perceptual field actually increase? Panic Severe Mild Moderate

Mild 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 which type of anxiety does a person's perceptual field actually increase? Panic Moderate Severe Mild

Mild 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."

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 Severe Mild Panic

Mild Rationale: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.

The mental health nurse is gathering a health history on a new client. The client is constantly pacing the floor and is concerned only with stating that the client is about to die. The nurse would classify this level of anxiety as what? Mild Euphoria Moderate Severe

Moderate Rationale:In moderate anxiety, the client experiences a narrowing of the ability to concentrate. The client paces, has voice tremors, and has an increased rate of speech. During euphoria, the client experiences an exaggerated feeling of well-being that is not directly proportional to a specific circumstance or situation. Mild anxiety causes the client to have an increased alertness to inner feelings or the environment. During severe anxiety, the client is able to focus on only small or scattered details.

When a client is experiencing panic, which is the priority intervention? Physically restrain the client. Move the client to a quiet environment. Offer the client therapy to calm down. Give the client medication immediately.

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.

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 most likely include? Inactivation of stress hormones A heritable predisposition unrelated to brain abnormalities Distorted thinking patterns Neurotransmitter involvement

Neurotransmitter involvement

The nurse has read in a client's admission record that the client has been taking propranolol for psychiatric, rather than medical, reasons. The nurse should recognize that the client likely has a history of which mental health condition? Obsessive-compulsive disorder (OCD) Panic disorder Nightmares Acute stress disorder

Panic disorder Propranolol is used in the treatment of panic disorder, but it is not a common pharmacological intervention for OCD, acute stress disorder, or nightmares.

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 experience a fight-or-flight response when threatened." "People with anxiety disorders generally find that the anxiety interferes with daily activities." "Normal anxiety does not result in feelings of dread or restlessness." "Normal anxiety occurs in response to everyday stressors."

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.

A client has become increasingly afraid to ride in elevators. While in an elevator one morning, the client experiences shortness of breath, palpitations, dizziness, and trembling. A physician can find no physiological basis for these symptoms and refers the client to a psychiatric clinical nurse specialist for outpatient counseling sessions. Which type of therapy is most likely to reduce the client's anxiety level? psychoanalytically oriented psychotherapy group psychotherapy systematic desensitization referral for evaluation for electroconvulsive therapy

Phobias are commonly viewed as learned responses to anxiety that can be unlearned through certain techniques such as behavior modification. Systematic desensitization, a form of behavior modification, attempts to reduce anxiety, and thereby eradicate the phobia, through gradual exposure to anxiety-producing stimuli. Psychoanalytically oriented therapy also may be effective in this situation, but years of treatment are required to achieve results. Group psychotherapy could be used as an adjunct treatment to increase the client's self-esteem and reduce generalized anxiety. Electroconvulsive therapy is reserved primarily for clients with severe depression or psychosis who respond poorly to other treatments; it's rarely indicated for phobic disorders.

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

Practice the techniques when relatively calm.

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

Providing supportive feedback Identifying treatment modalities Using appropriate coping skills Involving family for support, if appropriate

Relaxation techniques help clients with anxiety disorders because they can promote what? Increase in sympathetic stimulation Reduction of autonomic arousal Release of cortisol Increase in the metabolic rate

Reduction of autonomic arousal 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.

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 his name. The nurse determines that the client is experiencing anxiety. Which of the following should be the nurse's first action? Proceed with wound care quickly Replace the dressing on the wound Get the assistance of another nurse Ask the client to describe his feelings

Replace the dressing on the wound

Which should be included in a teaching plan for a client prescribed a benzodiazepine? Stop taking drug if sedation develops Consume caffeine in moderation Maintain a fluid restriction Rise slowly from a lying or sitting position

Rise slowly from a lying or sitting position Clients taking a benzodiazepine should rise slowly from a lying or sitting position. The client should drink adequate fluids, avoid caffeine, and not stop taking the drug abruptly.

Which should be included in a teaching plan for a client prescribed a benzodiazepine? Rise slowly from a lying or sitting position Stop taking drug if sedation develops Consume caffeine in moderation Maintain a fluid restriction

Rise slowly from a lying or sitting position Rationale:Clients taking a benzodiazepine should rise slowly from a lying or sitting position. The client should drink adequate fluids, avoid caffeine, and not stop taking the drug abruptly.

Which medication classification has been used to treat social phobia? Selective serotonin reuptake inhibitors (SSRIs) Monoamine oxidase inhibitors (MAOIs) Tricyclic antidepressants (TCAs) Nonbenzodiazepines

SSRIs are used to treat clients with social phobia because they significantly reduce social anxiety and phobic avoidance. Benzodiazepines are also used to reduce anxiety caused by phobias.

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

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.

Which is the primary concern for a client with panic-level anxiety? Emotional needs Social support Safety Physiologic needs

Safety Rationale:During panic-level anxiety, the person's safety is the primary concern. He or she cannot perceive potential harm and may have no capacity for rational thought. Emotional needs, physiologic needs, and social support are important but not the primary concern.

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? Benzodiazepines Tricyclic antidepressants Selective serotonin reuptake inhibitors Antihypertensives

Selective serotonin reuptake inhibitors

According to psychodynamic theorists, anxiety develops from which of the following? Separation and loss Learned response Exposure to panicogenic substances Interoceptive conditioning

Separation and loss

A nurse determines that a client who is experiencing anxiety is using relief or primitive survival behaviors. The nurse determines that the client is experiencing which degree of anxiety? Panic Severe Mild Moderate

Severe Rationale:A client experiencing severe anxiety typically uses relief behaviors. With mild anxiety, the client is easily able to recognize and name anxiety. With moderate anxiety, the client is usually able to state that he or she is anxious. With panic, the client is perplexed and self-absorbed.

A 30-year-old client who has been unemployed secondary to 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? Obsessive-compulsive disorder Panic disorder Agoraphobia Social phobia

Social phobia Social phobia represents a persistent, irrational fear of and compelling desire to avoid situations in which the person may be exposed to unfamiliar people or to the scrutiny of others. Additionally, the person harbors the fear of behaving in a way that may prove humiliating or embarrassing. The person will experience marked anticipatory anxiety if confronted with such a situation and will attempt to avoid it.

In speaking with a client with moderate anxiety, the client becomes tangential discussing unrelated topics. To help the client's attention from wandering, which is an effective intervention? The nurse should speak in short and simple sentences. The nurse should remain with the client until the anxiety is reduced. The nurse should speak in a soft and calm voice. The nurse should take the client to a nonstimulating environment.

Speaking in short, simple, and easy-to-understand sentences has been shown to be effective with clients with moderate anxiety whose attention wanders. Not leaving the client alone unless the anxiety is reduced and speaking in a soft voice are interventions used with a client with severe anxiety. If the client has panic-level anxiety, the nurse should give primary attention to the safety of the client and move the client to a nonstimulating environment.

Which condition involves a persistent, irrational fear attached to an object or situation that objectively does not pose a significant danger? Posttraumatic stress disorder Generalized anxiety disorder Specific phobia Obsessive-compulsive 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.

A client presents to the nurses' station with symptoms of a panic attack, including shortness of breath, dizziness, trembling, and nausea. Which is the nurse's first intervention? Teach the client relaxation techniques. Administer PRN antianxiety medication. Stay with the client, and offer support. Help the client identify triggers for anxiety.

Staying with the client and offering support will provide a sense of security. Never leave a client alone during a panic attack. Teaching relaxation techniques and helping the client identify triggers are not appropriate during an acute panic attack, but they are important interventions when the client is calmer and able to receive information. Administering anxiety medication isn't the best initial action, because they don't take effect immediately.

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

Tearfulness Rationale: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.

Which would be an appropriate intervention for a client experiencing an anxiety attack? Turning on the lights and opening the windows so that the client does not feel crowded Leaving the client alone Staying with the client and speaking in short sentences Turning on stereo music

Staying with the client and speaking in short sentences Appropriate nursing interventions for an anxiety attack include using short sentences, staying with the client, decreasing stimuli, remaining calm, and medicating as needed. Leaving the client alone, turning on a stereo or lights, and opening windows may increase the client's anxiety.

Which would be an appropriate intervention for a client experiencing an anxiety attack? Turning on stereo music Staying with the client and speaking in short sentences Turning on the lights and opening the windows so that the client does not feel crowded Leaving the client alone

Staying with the client and speaking in short sentences Rationale:Appropriate nursing interventions for an anxiety attack include using short sentences, staying with the client, decreasing stimuli, remaining calm, and medicating as needed. Leaving the client alone, turning on a stereo or lights, and opening windows may increase the client's anxiety.

The nurse knows that which statement is true about stress and anxiety? All people handle stress in the same way. Stress is a person's reaction to anxiety. Anxiety occurs when a person has trouble dealing with life situations, problems, and goals. Stress is the wear and tear that life causes on the body.

Stress is the wear and tear that life causes on the body.

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? Central nervous system Parasympathetic nervous system Motherly response system Sympathetic nervous system

Sympathetic nervous system

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? Relaxation exercise Biofeedback Implosion therapy Systematic desensitization

Systematic 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.

Which is a cardiovascular response of the sympathetic nervous system? Bradypnea Bradycardia Hypotension Tachycardia

Tachycardia Rationale:Tachycardia is a cardiovascular response of the sympathetic nervous system. Bradypnea, hypotension, and bradycardia are responses of the parasympathetic system. Sympathetic cardiovascular responses to stress include increased heart rate, cardiac contractility, and cardiac output; increased blood pressure; and peripheral vasoconstriction.

A client at an outpatient psychiatric clinic has been experiencing anxiety. The nurse would like to suggest activities for the client to do in their spare time. What would be an appropriate activity for the nurse to suggest to the client? Select all that apply. taking up a hobby board games daily walks bingo stretching exercises

Taking daily walks and stretching exercises allow the client to expend energy and establish a trusting, neutral relationship with the nurse. Taking up a hobby will help the client change their attention and focus from negative anxiety to more positive and relaxed thoughts. The other suggestions are higher stimulation activities that insert competition and added anxiety to the situation.

A nurse is seeing a client prior to discharge after being admitted to hospital for suicidal ideation. As the nurse begins the discharge process, the client closes the eyes and begins rapid, shallow breathing. The client also begins to shake and perspire profusely. Which actions should the nurse take? Select all that apply. Assess the client for suicidal ideation. Talk to the client in a comforting manner. Ask the client to spend some time alone. Reassure the client of being safe. Take the client to a quiet space.

Talk to the client in a comforting manner. Reassure the client of being safe. Take the client to a quiet space.

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

Tearfulness 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.

All except which are considered clinical symptoms of anxiety? Tearfulness and sadness Motor excitement Palpitations Extreme restlessness

Tearfulness and sadness 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.

The nurse understands that a certain level of anxiety is required in a client for effective learning. Which anxiety-related symptom indicates the client may be able to learn effectively? The client has increased muscle tension. The client is speaking in a high-pitch voice. The client has heightened awareness. The client is trembling.

The client has heightened awareness.

A client reports experiencing increased stress at work. The client has been managing the stress by drinking 2 or 3 glasses of wine per evening. Despite the nurse recommending that drinking alcohol is not an effective way to manage the stress, the client feels it will be difficult to stop drinking. Which statement explains why this will be difficult for the client? The client is probably physically dependent on alcohol. Drinking alcohol is more socially acceptable than taking medications. A few glasses of wine each night is not necessarily a problem. The client has insufficient adaptive coping mechanisms.

The client has insufficient adaptive coping mechanisms.

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? A few glasses of wine each night is not necessarily a problem. Drinking alcohol is more socially acceptable than taking medications. The client is probably physically dependent on alcohol. The client has no adaptive coping mechanisms.

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.

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

The client is aware and alert

The nurse is assessing a client with anxiety. Which behavior might indicate that the client has moderate anxiety? The client is unable to communicate verbally. The client has impaired cognitive skills. The client is nervous and agitated. The client is focused in an activity.

The client is nervous and agitated. A client who is moderately anxious has a disturbing feeling that something is wrong. This causes nervousness and agitation. Increased concentration and attention is seen in clients having mild anxiety. Cognitive skills are impaired in clients who have severe anxiety. Inability to communicate verbally indicates that the client is panicking.

A client diagnosed with anxiety disorder is prescribed buspirone. What priority teaching will the nurse provide? Buspirone can cause immediate bradycardia. Buspirone blood levels need to be checked 1 week after initiating the drug. Buspirone can cause neuroleptic malignant syndrome. Buspirone has a delayed therapeutic effect of between 14 to 30 days.

The client should be informed that the drug's therapeutic effect might not be achieved for 14 to 30 days. The client must be instructed to continue taking the drug as directed. Tachycardia, not bradycardia, is a reported effect of buspirone. Blood level checks are not necessary. Neuroleptic malignant syndrome has not been reported with this drug.

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

The client states, "I understand what I need to do, and I'm ready to do it so I'm back to normal."

The nurse is caring for a client diagnosed with anxiety disorder. The client is demonstrating difficulty concentrating and is preoccupied with feelings of helplessness. When creating the plan of care, which goal would be most appropriate for this client? The client will avoid stimuli that induces anxiety. The client will identify the source of anxiety. The client will display ability to cope with anxiety. The client will show interest in activities.

The client will display ability to cope with anxiety. Coping is a process used by individuals to manage anxiety, and may be effective or ineffective. Anxiety disorders are diagnosed when anxiety no longer functions as a signal of danger, or a motivation for needed change but becomes chronic and permeates major portions of the person's life, resulting in maladaptive behaviors and emotional disability. Nurses encounter anxious clients and families in a variety of situations. The nurse must first assess the person's anxiety level because this determines what interventions are likely to be effective. When working with an anxious person, the nurse must remain calm and in control. The goal for the client with anxiety is ultimately to be able to cope with anxiety. During the treatment the client will have to identify the source of anxiety, be able to adapt to stimuli that produces anxiety, and show interest in activities that previously caused anxiety.

A nurse is caring for a client who has panic attack. The nurse takes the client in a small, isolated room. How would this intervention benefit the client? Choose the best answer. The client would have an enhanced sense of security. The client would be able to understand what the nurse is saying. The client would be able to demonstrate relaxation techniques. The client would return to rational thought.

The client would have an enhanced sense of security. A client with panic-level anxiety should be taken to a small, isolated room. This is to reduce any external stimuli that could escalate anxiety. Taking the client to a small room would make the client feel more protected and secured. A client experiencing a panic attack may lose rational thought; however, this intervention would not directly improve thought processes. The client would not be able to demonstrate relaxation techniques in a panic laden state. This intervention would not enhance the client's ability to understand what the nurse is saying.

The most important factor in the person's stress response is what? Strength of the immune system Supportive friends Relaxation techniques Adaptive coping strategies

The most important factor in a person's stress response is the ability of engage in adaptive coping behaviors. This ability can assist a person in developing resilience, or the ability to "bounce back" when faced with stress and stressful situations. The immune system, having a supportive network of friends, and understanding of relaxation techniques are also influencing factors when considering how an individual responds to stress; however, the correct option relates to an internal, sustainable strength that comes from adaptive coping.

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 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 70-year-old whose spouse died 1 year ago who has "no desire to leave my house" and reports severe fatigue 30-year-old business executive who reports being anxious about attending the meetings and social events that are the executive's job responsibilities

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. The other options provided do not describe conditions of GAD.

In speaking with a client with moderate anxiety, the client becomes tangential discussing unrelated topics. To help the client's attention from wandering, which is an effective intervention? The nurse should speak in a soft and calm voice. The nurse should remain with the client until the anxiety is reduced. The nurse should speak in short and simple sentences. The nurse should take the client to a nonstimulating environment.

The nurse should speak in short and simple sentences. Speaking in short, simple, and easy-to-understand sentences has been shown to be effective with clients with moderate anxiety whose attention wanders. Not leaving the client alone unless the anxiety is reduced and speaking in a soft voice are interventions used with a client with severe anxiety. If the client has panic-level anxiety, the nurse should give primary attention to the safety of the client and move the client to a nonstimulating environment.

etiology of panic disorders? There is evidence of a substantial familial predisposition to panic disorder Neurologic abnormalities are a rare occurrence with panic disorder The link between panic disorders and neurotransmitters is lacking There is a strong evidence supporting a psychodynamic influence

There is evidence of a substantial familial predisposition to panic disorder

A client is admitted to the acute psychiatric care unit after 2 weeks of increasingly erratic behavior. The client is unkempt, has lost approximately 9 lb (4 kg), has been sleeping poorly, and exhibits hyperactivity. The client loudly denies the need for hospitalization. What priority intervention will the nurse apply? providing adequate hygiene asking the client to go eat a meal in the day room decreasing environmental stimulation orientating the client to the unit activities

This client is at increased risk for injuring self or others. Decreasing environmental stimulation, a measure the nurse may take independently, may reduce the client's hyperactivity. Providing adequate hygiene is an appropriate nursing intervention but isn't the highest priority. Because the overall goal is to reduce the client's hyperactivity, orientating him to unit activities is contraindicated. Asking the client to go eat a meal in the day room is contraindicated because there is risk for harm to self or others and it is likely there will be more stimulation in the day room.

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

This level of anxiety can be sustained indefinitely.

After learning that a roommate is HIV-positive, a client asks a nurse about moving to another room on the psychiatric unit because the client no longer feels "safe." What should the nurse do first? Move the client to another room. Ask the client to describe the fears. Move the client's roommate to a private room. Explain that such a move wouldn't be therapeutic for the client or the roommate.

To intervene effectively, the nurse must first understand the client's fears. After exploring the fears, the nurse may move the client or roommate or explain why such a move wouldn't be therapeutic, as needed.

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

Using appropriate coping skills Providing supportive feedback Identifying treatment modalities Involving family for support, if appropriate Rationale: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.

A client is prescribed a serotonin-norepinephrine reuptake inhibitor. The nurse would identify that which of the following is most commonly prescribed? Venlafaxine Fluoxetine Paroxetine Duloxetine

Venlafaxine

A client who recently developed paralysis of the arms is diagnosed with functional neurologic symptom disorder after tests fail to uncover a physical cause for the paralysis. Which intervention should the nurse include in the care plan for this client? exercising the client's arms regularly insisting that the client eat without assistance working with the client rather than with the family teaching the client how to use nonpharmacologic pain-control methods

To maintain the integrity of the affected areas and prevent muscle wasting and contractures, the nurse should help the client perform regular passive range-of-motion exercises with the arms. The nurse shouldn't insist that the client use the arms to perform such functions as eating without assistance, because the client can't consciously control the symptoms and move the arms; such insistence may anger the client and endanger the therapeutic relationship. The nurse should include family members in the client's care because they may be contributing to the client's stress or conflict and are essential to helping the client regain function of the arms. The client isn't experiencing pain and, therefore, doesn't need education regarding pain management.

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? Encouraging the client to verbalize feelings and concerns Approaching the client in a calm, confident manner Touching the client in an attempt to comfort the client Providing the client with a safe, quiet, and private place

Touching the client in an attempt to comfort the client

Which would not be included in the plan of care for a client diagnosed with acute anxiety? Encouraging the client to verbalize feelings and concerns Providing the client with a safe, quiet, and private place Approaching the client in a calm, confident manner Touching the client in an attempt to comfort the client

Touching the client in an attempt to comfort the client Rationale:The emergency 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.

Which would not be an initial intervention for the client with acute anxiety? Touching the client in an attempt to comfort the client Maintaining a nonstimulating environment Encouraging the client to verbalize feelings and concerns Use of open-ended communication techniques

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.

All of the following pharmacological agents are useful in treating anxiety disorders except which ones? Tricyclic antidepressants Selective serotonin reuptake inhibitors (SSRIs) Benzodiazepines 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.

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

Using appropriate coping skill Identifying treatment modalities Involving family for support, if appropriate Providing supportive feedback 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.

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

Using appropriate coping skills Identifying treatment modalities Involving family for support, if appropriate Providing supportive feedback

A psychiatric nurse visits a client at home. The client tells the nurse that he or she experiences chest pain, shortness of breath, and sweating whenever leaving home. The client has been unable to go to work for six weeks. The nurse recognizes this problem as which behavior? claustrophobia agoraphobia acrophobia mysophobia

agoraphobia

severe anxiety

an increased level of anxiety when more primitive survival skills take over, defensive responses ensue, and cognitive skills decrease significantly; person with severe anxiety has trouble thinking and reasoning the perceptual field is greatly reduced in severe anxiet

Which nursing assessment is most appropriate for an older client presenting with reports of generalized anxiety? assess for depression assess for panic attacks assess for elder abuse assess for dementia

assess for depression

Which nursing assessment is most appropriate for an older client presenting with reports of generalized anxiety? assess for panic attacks assess for depression assess for dementia assess for elder abuse

assess for depression Rationale: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.

Which nursing intervention is focused on the primary goal of anxiety management and treatment? assessing the client for possible symptoms of panic disorder educating the client concerning the use of medications to manage anxiety disorders helping the client identify ways to eliminate all sources of stress in his or her daily life assessing the client's ability to implement stress management techniques effectively

Which nursing intervention is focused on the primary goal of anxiety management and treatment? helping the client identify ways to eliminate all sources of stress in his or her daily life assessing the client's ability to implement stress management techniques effectively educating the client concerning the use of medications to manage anxiety disorders assessing the client for possible symptoms of panic disorder

assessing the client's ability to implement stress management techniques effectively 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.

Which nursing intervention is focused on the primary goal of anxiety management and treatment? helping the client identify ways to eliminate all sources of stress in his or her daily life assessing the client's ability to implement stress management techniques effectively assessing the client for possible symptoms of panic disorder educating the client concerning the use of medications to manage anxiety disorders

assessing the client's ability to implement stress management techniques effectively Rationale: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.

Automatisms

automatic, unconscious mannerisms associated with anxiety. Examples include tapping fingers, jingling keys, or twisting hair. Automatisms are geared toward anxiety relief and increase in frequency and intensity with the client's anxiety level.

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: depersonalization. decatastrophizing. demonstrating automatisms. derealization.

depersonalization.

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: depersonalization. demonstrating automatisms. decatastrophizing. derealization.

depersonalization.

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: decatastrophizing. depersonalization. derealization. demonstrating automatisms.

depersonalization. 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.

In teaching a client who has been prescribed a benzodiazepine for panic disorder, the nurse must be certain to do what? Instruct the client to come in every other week to get blood drawn and monitor for agranulocytosis. Educate the client that this medication will interact with certain food groups. Instruct the client that if the client has palpitations, the client should contact the client's physician immediately because of the risk for dysrhythmias with this medication. Educate the client that this medication has a high risk for withdrawal symptoms, and the client should not discontinue without a doctor's supervision.

educate the client that this medication has a high risk for withdrawal symptoms, and the client should not discontinue without a doctor's supervision. The benzodiazepines have a high risk for withdrawal symptoms, and the client needs to be educated as to this fact. The benzodiazepines do not interact with certain food groups like monoamine oxidase inhibitors do.

agoraphobia

fear of being outside

Moderate anxiety

he 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 observe

Decatastrophizing involves

he therapist's use of questions to more realistically appraise the situation.

A nurse is assessing a client with anxiety. Which signs and symptoms would the nurse attribute to sympathetic nervous stimulation? Select all that apply. Fainting Hypertension Pressure to urinate Bradycardia Heart racing

heart racing, htn

Panic anxiety

intense anxiety, may be a response to a life-threatening situation the perceptual field is reduced to a detail, which is usually "blown up."

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? severe mild panic moderate

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.

Fear

refers to feeling afraid or threatened by a clearly identifiable external stimulus that presents a danger to a person. Derealization refers to a stage in the experience of anxiety when a person senses that things are not real.

Signal anxiety

refers to the natural anxiety mechanism that communicates danger or motivation for needed change.

A school health nurse is meeting with the parents of a 6-year-old child who has been selectively mute. The nurse is offering the parents education regarding this problem. The nurse can tell the parents that what is true about selective mutism? parenting does not play a role in selective mutism selective mutism arises from child abuse children with selective mutism should be home-schooled. selective mutism is associated with social anxiety

selective mutism is associated with social anxiety Selective mutism is diagnosed in children when they fail to speak in social situations even though they are able to speak. There is a high level of social anxiety in these situations. It would be most accurate for the nurse to explain to the parents that selective mutism is associated with social anxiety. Parenting plays a role in perpetuating selective mutism because there is a cycle of avoidance that can be enabled or encouraged when the child continuously wants to avoid social settings. Selctive mutism does not necessarily arise from child abuse. Factors such as a shy disposition or family history of anxiety are most likely to be associated with selective mutism. By home-schooling a child who displays selective mustism, opportunities to learn to manage anxiety through exposure to the anxiety provoking stimuli (social settings) are lost. The child learns that avoiding is a healthy way of managing anxiety.

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 Panic Moderate

severe

After a client has been prescribed on fluoxetine (Prozac) for a diagnosis of anxiety disorder, which of the following information should the nurse be sure to include in the client teaching? sometimes in the first week of treatment, the client may experience heightened feelings of anxiety, but these will pass when you become accustomed to the new medication. this medication can cause addiction, so the client will need to keep the doses constant. the client may experience dry mouth and drowsiness during the first 2 days of treatment. this medication takes up to 3 months to be effective, so the client should be told to be patient.

sometimes in the first week of treatment, the client may experience heightened feelings of anxiety, but these will pass when you become accustomed to the new medication.

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? Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first Reviewing the client's previous medication administration record and the client's current list of medications Asking the client to provide a detailed explanation of his or her medical problem to determine if the presentation is typical of the problem Questioning the client about the clinician who first diagnosed the medical problem

stablishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first

progressive relaxation,

the client progressively tightens, holds, and then relaxes muscle groups while letting tension flow from the body through rhythmic breathing.

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? The client has a no history of other psychiatric disorders 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." The client readily agrees to immediately notify the mental health care team if symptoms reoccur after discharge The client has a family that is truly willing and capable of supporting him during the treatme

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. 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.

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