13 14 15
A client experiences panic attacks when confronted with riding in elevators. The therapist is teaching the client ways to relax while incrementally exposing the client to getting on an elevator. This technique is called A) systematic desensitization. B) flooding. C) cognitive restructuring. D) exposure therapy.
Ans: A Feedback: One behavioral therapy often used to treat phobias is systematic (serial) desensitization, in which the therapist progressively exposes the client to the threatening object in a safe setting until the client's anxiety decreases. Flooding is a form of rapid desensitization in which a behavioral therapist confronts the client with the phobic object (either a picture or the actual object) until it no longer produces anxiety. Cognitive restructuring involves challenging the client's irrational beliefs. Exposure therapy is similar to flooding.
Which of the following is true about the use of touch with a client with dissociative identity disorder? A) It is best not to touch the client without his or her permission. B) Make sure the client knows the touch is friendly and supportive. C) Touch the client only if you are in his or her direct line of vision. D) Touching will convey a sense of security to the client.
A) It is best not to touch the client without his or her permission. Feedback: Clients interpret touch differently, so it is important to assess each client's comfort with being touched; these clients often have a history of abuse, so permission should be given before touch is used.
A client is learning to cope with anxiety and stress. The expected outcome is that the client will A) change reactions to stressors. B) ignore situations that cause stress. C) limit major stressors in his or her life. D) avoid anxiety at all costs.
Ans: A Feedback: Stress and anxiety in life are unavoidable; managing the effects of stress is a reasonable goal for treatment. It is not possible or desirable to avoid anxiety at all costs as anxiety is a warning that the client is not dealing with stress effectively. Learning to heed this warning and to make needed changes is a healthy way to deal with the stress of daily events.
Which of the following best explains the etiology of anxiety disorders from an interpersonal perspective? A) Anxiety is learned in childhood through interactions with caregivers. B) Anxiety is learned throughout life as a response to life experiences. C) Anxiety stems from an unconscious attempt to control awareness. D) Anxiety results from conforming to the norms of a cultural group.
Ans: A Feedback: Interpersonal theory proposes that caregivers can communicate anxiety to infants or children through inadequate nurturing, agitation when holding or handling the child, and distorted messages. In adults, anxiety arises from the person's need to conform to the norms and values of his or her cultural group. Psychoanalytic theories describe reducing anxiety through the use of defense mechanisms. Defense mechanisms are cognitive distortions that a person uses unconsciously to maintain a sense of being in control of a situation, to lessen discomfort, and to deal with stress.
When teaching a client with generalized anxiety disorder, which is the highest priority for the nurse to teach the client to avoid? A) Caffeine B) High-fat foods C) Refined sugars D) Sodium
Ans: A Feedback: The effects of caffeine are similar to some anxiety symptoms, and, therefore, caffeine ingestion will worsen anxiety. The other types of foods are also potentially harmful to physical as well as psychological health, but the worst offender is caffeine.
Which of the following is an important part of therapeutic communication for clients who have OCD? A) To encourage the client to keep the obsession secret. B) To encourage the client to discuss his or her obsession with the nurse. C) The nurse must have the same obsession as the client. D) The nurse must instruct the client to discuss the obsession
Ans: B The nurse encourages the client to talk about the feelings and to describe them in as much detail as the client can tolerate. Because many clients try to hide their rituals and to keep obsessions secret, discussing these thoughts, behaviors, and resulting feelings with the nurse is an important step. It is not necessary for the nurse to have the same obsession as the client
Which of the following statements by the nurse would be most appropriate to a colleague who very quietly and numbly tells the nurse that she had arrived at the scene of an automobile-pedestrian accident and unsuccessfully performed CPR on a victim 3 days ago? The nurse and her colleague are sitting in the break room and no one else is present. A) "Tell me what you saw." B) "That is horrible!" C) "Why did you perform CPR?" D) "I know how you feel; the same thing happened to me several years ago and I never recovered."
A) "Tell me what you saw." Feedback: One of the most effective ways of avoiding pathologic responses to trauma is effectively dealing with the trauma soon after it occurs. Describing what the colleague saw may be very helpful to him or her. "That is horrible," is a judgment and is not likely to be helpful. "Why did you perform CPR," might make the colleague feel defensive. "I know how you feel; the same thing happened to me several years ago and I never recovered," is nonsupportive and robs the colleague of any hope that he or she will recover.
Three years after the death of her father in an ICU, the infection prevention nurse was visiting an ICU in a different hospital to complete a chart review. At one point, the nurse looked at a bed where the patient who had the same diagnosis as her father had and saw her father's facial features on the patient and had a sense of panic. In a few moments, the nurse realized that the patient in the bed was not her father. Which of these manifestations of PTSD was this nurse experiencing? A) A flashback B) Emotional numbing C) Hyperarousal D) A dream
A) A flashback Feedback: This nurse was experiencing a flashback where similar circumstances triggered a sensation that the stressful experience were happening again.
Which of the following are events that a person may experience, witness, or be confronted by that may trigger posttraumatic stress disorder (PTSD)? Select all that apply. A) Being a survivor of a tsunami that resulted in thousands of deaths B) Being stranded at the office during a typical winter storm that was anticipated C) Being a marine in a combat situation where the entire platoon was wiped out except for one person D) Being hidden in a closet and hearing the entire family murdered by someone who broke into the home E) Watching televised segments of the moment when the plane hit the second tower on 9/11
A) Being a survivor of a tsunami that resulted in thousands of deaths C) Being a marine in a combat situation where the entire platoon was wiped out except for one person D) Being hidden in a closet and hearing the entire family murdered by someone who broke into the home E) Watching televised segments of the moment when the plane hit the second tower on 9/11 Feedback: Examples of events that may cause PTSD include someone experiencing, witnessing, or being confronted by a traumatic event such as a natural disaster, combat, or an assault. The person with PTSD was exposed to an event that posed actual or threatened death or serious injury and responded with intense fear, helplessness, or terror. Being a survivor of a tsunami that resulted in thousands of deaths, being a marine in a combat situation where the entire platoon was wiped out except for one person, and being hidden in a closet and hearing the entire family murdered by someone who broke into the house would be situations where the person was exposed to an event that posed actual or threatened death or serious injury and responded with intense fear, helplessness, or terror.
A man is discovered wandering the street, looking confused and stepping out into traffic. When emergency responders approach the man, he cannot recall his name or where he lives. The responders transport the man to the mental health crisis unit for further evaluation. Which of the following are the man most likely suffering from? Select all that apply. A) Depersonalization disorder B) Dissociative identity disorder C) Repressed memories D) Dissociative amnesia E) False memory syndrome
A) Depersonalization disorder B) Dissociative identity disorder D) Dissociative amnesia Feedback: With dissociative amnesia, the client cannot remember important personal information. With dissociative personality disorder, the client displays two or more distinct identities or personality states that recurrently take control of his or her behavior. With depersonalization disorder, the client has persistent or recurring feeling of being detached from his or her mental processes or body (depersonalization) or sensation of being in a dream-like state where the environment seems foggy or unreal (derealization). The client is not psychotic or out of touch with reality. Repressed memories are when a person is unable to consciously recall memories of childhood abuse. False memory syndrome can occur during psychotherapy when the client is encouraged to imagine false memories of childhood sexual abuse.
Which of the following should be an action of a nurse who is having feelings of judgment regarding a client's contributory behavior to an automobile accident that resulted in deaths? A) Discussing the nurse's personal feelings with a peer or a counselor B) Acknowledging the judgment regarding the client's contributory behavior to the client C) Sharing the client's horror and encouraging him or her to avoid thinking about it D) Letting the client know that he or she is now traumatized beyond repair
A) Discussing the nurse's personal feelings with a peer or a counselor Feedback: When the traumatized client causes a car accident that injured or killed others, it may be more challenging to provide unconditional support and withhold judgment of the client's contributory behavior. Remaining nonjudgmental of the client is important, but does not happen automatically. The nurse may need to deal with personal feelings by talking to a peer or counselor. If the nurse is overwhelmed by the violence or death in a situation, the client's feelings of being victimized to traumatized beyond repair are confirmed. Conveying empathy and validating client's feelings and experiences in a calm, yet caring professional, manner are more helpful than sharing the client's horror.
A client is seeking counseling due to difficulty coping with being a victim of a violent attack 16 months ago. The initial medical diagnosis is to rule out posttraumatic stress disorder (PTSD). Which would the nurse assess for when determining the major elements of PTSD? Select all that apply. A) Reexperiencing the trauma through dreams or recurrent and intrusive thoughts B) Showing emotional numbing such as feeling detached from others C) Being on guard, irritable, or experiencing hyperarousal D) Feeling mildly anxious E) Occurs 2 weeks after the trauma
A) Reexperiencing the trauma through dreams or recurrent and intrusive thoughts B) Showing emotional numbing such as feeling detached from others C) Being on guard, irritable, or experiencing hyperarousal Feedback: The three major elements of PTSD are reexperiencing the trauma through dreams or recurrent and intrusive thoughts, showing emotional numbing such as feeling detached from others, and being on guard, irritable, or experiencing hyperarousal. Feeling mildly anxious is not a major element of PTSD as the person is likely to feel very anxious. Occurring 2 weeks after the trauma would likely be acute stress disorder as PTSD symptoms occur 3 months or more after the trauma.
A fireman survived a fire after escaping a blaze. Several other firefighters were trapped in the burning building and died. After working with this firefighter in counseling, the nurse evaluates which of the following as positive outcomes for this client? Which will the nurse evaluate as positive outcomes for this client? Select all that apply. A) The client will verbalize feelings of stress related to returning to work. B) The client will express guilt openly through nondestructive means. C) The client will identify a social support system within the community. D) The client will report nightmares and flashbacks of the fire.
A) The client will verbalize feelings of stress related to returning to work. B) The client will express guilt openly through nondestructive means. C) The client will identify a social support system within the community. Feedback: Treatment outcomes for clients who have survived trauma or abuse may include verbalizing feelings, expressing emotions nondestructively, and establishing a social support system in the community. An absence of stress is an unrealistic outcome. Reporting symptoms of PTSD such as nightmares and flashbacks does not indicate positive treatment outcomes.
The police find a woman wandering around a parking lot, singing very loudly. They bring her to the hospital; she has no knowledge of what she has been doing for the past 12 hours and is dressed in unfamiliar clothing. This is an example of A) dissociation. B) manipulation. C) psychosis. D) regression.
A) dissociation. Feedback: The client experienced a temporary alteration in conscious awareness. This situation is not an example of manipulation. The woman is not experiencing psychosis. Regression occurs when there is a retreat to an earlier stage of development and comfort.
Which of the following statements about the assessment of persons with anxiety and anxiety disorders is most accurate? A) When an elder person has an onset of anxiety for the first time in his or her life, it is possible that the anxiety is associated with another condition. B) Panic attacks are the most common late-life anxiety disorders. C) An elder person with anxiety may be experiencing ruminative thoughts. D) Agoraphobia that occurs in late life may be related to trauma experienced or anticipated.
Ans: A Feedback: Anxiety that starts for the first time in late life is frequently associated with another condition such as depression, dementia, physical illness, or medication toxicity or withdrawal. Phobias, particularly agoraphobia, and GAD are the most common late-life anxiety disorders. Most people with late-onset agoraphobia attribute the start of the disorder to the abrupt onset of a physical illness or as a response to a traumatic event such as a fall or mugging. Ruminative thoughts are common in late-life depression and can take the form of obsessions such as contamination fears, pathologic doubt, or fear of harming others.
A client states, "I will just die if I don't get this job." The nurse then asks the client, "What will be the worst that will happen if you don't get the job?" The nurse is using this response to A) appraise his situation more realistically. B) assist the client to make alternative plans for the future. C) assess if the client has health problems compounded by stress. D) clarify the client's meaning.
Ans: A Feedback: Decatastrophizing involves the therapist's use of questions to more realistically appraise the situation. The therapist may ask, "What is the worst that could happen? Is that likely? Could you survive that? Is that as bad as you imagine?"
Which of the following theories about anxiety is based upon intrapsychic theories? A) A person's innate anxiety is the stimulus for behavior. B) Anxiety is generated from problems in interpersonal relationships. C) A nurse can help the client to achieve health by attending to interpersonal and physiologic needs. D) Anxiety is learned through experiences.
Ans: A Feedback: Theories of anxiety can be classified as intrapsychic/psychoanalytic theories, interpersonal theories, and behavioral theories. Freud's intrapsychic theory views a person's innate anxiety as the stimulus for behavior. Interpersonal theories include Sullivan's theory that anxiety is generated from problems in interpersonal relationships and Peplau's belief that humans exist in interpersonal and physiologic realms. Behavioral theorists view anxiety as being learned through experiences.
Which of the following interventions by the nurse will increase the client's sense of security? A) Allowing the client to perform the rituals B) Distracting the client from rituals with other activities C) Encouraging the client to talk about the purpose of the rituals D) Stopping the client from performing the rituals
Ans: A The client performs rituals to decrease anxiety and will feel most secure when performing the rituals. The other choices would not promote a sense of security of the client
Which of the following is the most important variable in determining the likelihood of success in improving life for a client with OCD? A) The client must be willing to make changes in his or her behavior. B) The client must acknowledge that the behavior is not in his or her control. C) The client must allow the nurse to decide the appropriate intervention for him or her. D) The client must be willing to try all new relaxation techniques.
Ans: A The most important variable is that the client is willing to make changes in his or her behavior. The nurse must not interrupt the client from performing rituals as this will cause anxiety, and the client will need to begin the ritual again. The client and nurse together must determine which interventions will be used. The client will likely need to use relaxation techniques but should have input into deciding which ones
Which of the following are important for the nurse to remember when teaching relaxation and behavioral techniques to a client with OCD? Select all that apply. A) It is important to teach the client to use relaxation techniques when the client's anxiety is low. B) The nurse may teach the client about relaxation techniques when the client is experiencing anxiety. C) The client must be willing to engage in exposure and response prevention. D) The client must be forced to use relaxation techniques. E) It is unnecessary to assess the baseline of ritualistic behaviors in the client with OCD
Ans: A, B, C The intervention should take place when the client's anxiety is low, so he or she can learn more effectively. The nurse may teach the client about relaxation techniques when the client is experiencing anxiety. The client must be willing to engage in exposure and response prevention. The client cannot be forced to use relaxation techniques. It is necessary to assess the baseline of frequency and duration of anxiety and ritualistic behaviors in the client with OCD.
The nurse correctly identifies that which of OCDs self-soothing behaviors may involve self-destruction of the body of a person who has OCD? Select all that apply. A) Dermatillomania B) Trichotillomania C) Onychophagia D) Kleptomania E) Oniomania
Ans: A, B, C Dermatillomania, or skin-picking, is a self-soothing behavior; that is, the behavior is an attempt of people to soothe or comfort themselves, not that picking itself is necessarily a positive sensation. Trichotillomania, or chronic, repetitive hair pulling, is a self-soothing behavior that can cause distress and functional impairment. Onychophagia, or nail biting, is a self-soothing behavior. Kleptomania, or compulsive stealing, and oniomania, or compulsive buying, are reward-seeking behaviors.
The student nurse correctly identifies that which of the following are characteristics of hoarding disorder? Select all that apply. A) Excessive acquisition of animals or apparently useless things B) Cluttered living spaces that become uninhabitable C) Significant distress or impairment for the individual D) Obsessive cleaning of environment E) Disposing of articles that are of no value
Ans: A, B, C Hoarding involves excessive acquisition of animals or apparently useless things; cluttered living spaces that become uninhabitable; and significant distress or impairment for the individual. Obsessive cleaning of the environment and disposing of articles that are of no value are not characteristics of hoarding
Which of the following are cognitive-behavioral therapy techniques that may be used effectively with anxious clients? Select all that apply. A) Positive reframing B) Decatastrophizing C) Assertiveness training D) Humor E) Unlearning
Ans: A, B, C, E Feedback: Positive reframing means turning negative messages into positive messages. Decatastrophizing involves the therapist's use of questions to more realistically appraise the situation. Assertiveness training helps the person take more control over life situations. Positive reframing, decatastrophizing, and assertiveness training are cognitive-behavioral therapy techniques. Humor is not a cognitive-behavioral therapy technique. Unlearning is the theory underlying behavioral therapy.
The nurse knows that which of the following are stages in Selye's general adaptation syndrome? Select all that apply. A) Alarm reaction stage B) Resistance stage C) Coping stage D) Exhaustion stage E) Panic stage
Ans: A, B, D Feedback: The stages in Selye's general adaptation syndrome include the alarm reaction stage, the resistance stage, and the exhaustion stage. Selye did not identify either a coping stage or a panic stage.
The nursing student correctly identifies which of the following statements are true of the etiology of OCD? Select all that apply. A) The cognitive model for OCD etiology focuses on childhood and environmental experiences of growing up. B) The etiology of OCD is not definitively explained at this time. C) OCD is caused by immune dysfunction. D) The primary etiology of OCD is genetics. E) Cognitive models may partially explain why people develop OCD.
Ans: A, B, E Different studies of the etiology of OCD show promise, but have yet to definitively explain how or why people develop OCD. Cognitive models of OCD have been long accepted as a partial explanation for OCD. The cognitive model focuses on childhood and environmental experiences of growing up. Heritable, genetic factors are a significant influence on thinking, and environmental influences are not solely responsible. Immune dysfunction may play a role in the etiology of OCD
Which of the following are reasons that the nurse must understand why and how anxiety behaviors work? Select all that apply. A) To provide better care for the client B) To help understand the role anxiety plays in performing nursing responsibilities C) To help the nurse to mask his or her own feelings of anxiety D) So the nurse can identify that his or her own needs are more important than the clients E) To help nurses to function at a high level
Ans: A, B, E Feedback: Nurses must understand why and how anxiety behaviors work, not just for client care but to help understand the role anxiety plays in performing nursing responsibilities. Nurses are expected to function at a high level and to avoid allowing their own feelings and needs to hinder the care of their clients, but as emotional beings, nurses are just as vulnerable to stress and anxiety as others, and they have needs of their own.
Which techniques would be most effective for a client who has situational phobias? Select all that apply. A) Flooding B) Reminding the person to calm down C) Systematic desensitization D) Assertiveness training E) Decatastrophizing
Ans: A, C Feedback: Systematic desensitization is when the therapist progressively exposes the client to a threatening object in a safe setting until the client's anxiety decreases. Flooding is a form of rapid desensitization in which the behavior therapist confronts the client with the phobic object until it no longer produces anxiety. Systematic desensitization and flooding are behavioral therapies used in the treatment of phobias. Assertiveness training would help the person to take more control over life situations. Decatastrophizing helps the client to realistically appraise the situation. These are both used for general anxiety. When a person is exposed to a phobic object, the person is not likely in control. Reminding a person to calm down is not at all an effective way to manage anxiety.
Which of the following statements about the use of defense mechanisms in persons with anxiety disorders are accurate? Select all that apply. A) Defense mechanisms are a human's attempt to reduce anxiety. B) Persons are usually aware when they are using defense mechanisms. C) Defense mechanisms can be harmful when overused. D) Defense mechanisms are cognitive distortions. E) The use of defense mechanisms should be avoided. F) Defense mechanisms can control the awareness of anxiety.
Ans: A, C, D, F Feedback: Freud described defense mechanisms as the human's attempt to control awareness of and to reduce anxiety. Defense mechanisms are cognitive distortions that a person uses unconsciously to maintain a sense of being in control of a situation, to lessen discomfort, and to deal with stress. Because defense mechanisms arise from the unconscious, the person is unaware of using them. Some people overuse defense mechanisms, which stops them from learning a variety of appropriate methods to resolve anxiety-producing situations. The dependence on one or two defense mechanisms also can inhibit emotional growth, lead to poor problem-solving skills, and create difficulty with relationships.
When a client is experiencing a panic attack while in the recreation room, what interventions are the nurse's first priorities? Select all that apply. A) Provide a safe environment. B) Request a prescription for an antianxiety agent. C) Offer the client therapy to calm down D) Ensure the client's privacy. E) Engage the client in recreational activities.
Ans: A, D Feedback: During a panic attack, the nurse's first concern is to provide a safe environment and to ensure the client's privacy. If the environment is overstimulating, the client should move to a less stimulating place. 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. An antianxiety agent may be helpful, but it is not the priority. It would likely be stimulating to engage the client in recreational activities.
The nurse is educating a client and family about managing panic attacks after discharge from treatment. The nurse includes which of the following in the discharge teaching? Select all that apply. A) Continued development of positive coping skills B) Weaning off of medications as necessary C) Lessening the amount of daily responsibilities D) Continued practice of relaxation techniques E) Development of a regular exercise program
Ans: A, D, E Feedback: Client/family education for panic disorder includes reviewing breathing control and relaxation techniques, discussing positive coping strategies, encouraging regular exercise, emphasizing the importance of maintaining prescribed medication regimen and regular follow-up, describing time management techniques such as creating "to do" lists with realistic estimated deadlines for each activity, crossing off completed items for a sense of accomplishment, saying "no," and stressing the importance of maintaining contact with community and participating in supportive organizations. Medication should be adhered to as prescribed. Daily responsibilities cannot be avoided, rather should be successfully accomplished.
The nursing student understands correctly when identifying which objective is appropriate for all clients with anxiety disorders? A) The client will experience reduced anxiety and accept the fact that underlying conflicts cannot be treated. B) The client will experience reduced anxiety and develop alternative responses to anxiety-provoking situations. C) The client will experience reduced anxiety and learn to control primitive impulses. D) The client will experience reduced anxiety and strive for insight through psychoanalysis.
Ans: B Feedback: A primary client outcome is improved adaptive coping skills.
A nurse is working with a client to develop assertive communication skills. The nurse documents achievement of treatment outcomes when the client makes a statement such as, A) "I'm sorry. I'm not picking this up very quickly." B) "I feel upset when you interrupt me." C) "You are pushing me too hard." D) "I'm not going to let people push me around anymore."
Ans: B Feedback: Assertiveness training helps the person take more control over life situations. Techniques help the person negotiate interpersonal situations and foster self- assurance. They involve using "I" statements to identify feelings and to communicate concerns or needs to others.
A client who suffers from frequent panic attacks describes the attack as feeling disconnected from himself. The nurse notes in the client's chart that the client reports experiencing A) hallucinations. B) depersonalization. C) derealization. D) denial.
Ans: B Feedback: During a panic attack, the client may describe feelings of being disconnected from himself or herself (depersonalization) or sensing that things are not real (derealization). Denial is not admitting reality. Hallucinations involve sensing something that is not there.
The student nurse correctly identifies that which one of the following statements applies to the parasympathetic nervous system? A) It is activated during the alarm reaction stage. B) It is activated during the resistance stage. C) It is activated during the exhaustion stage. D) It is commonly referred to as the fight, flight, or freeze response.
Ans: B Feedback: In the alarm reaction stage, stress stimulates the body to send messages to the hypothalamus to the glands, which stimulates the sympathetic nervous system. Sympathetic nerve fibers "charge up" the vital signs at any hint of danger to prepare the body's defenses—fight, flight, or freeze. The adrenal glands release adrenaline (epinephrine), which causes the body to take in more oxygen, dilate the pupils, and increase arterial pressure and heart rate while constricting the peripheral vessels and shunting blood from the gastrointestinal and reproductive systems and increasing glycogenolysis to release free glucose for the heart, muscles, and central nervous system. When the danger has passed, parasympathetic nerve fibers reverse this process and return the body to normal operating conditions until the next sign of threat reactivates the sympathetic nervous system. During the resistance stage of the generalized anxiety syndrome, if the threat has ended, the parasympathetic nervous system is stimulated and the body responses relax. If the threat persists, the body will eventually enter the exhaustion stage when the body stores are depleted as a result of the continual arousal of the physiologic responses and little reserve capacity.
Which of the following would be key points for the nurse to remember when working with persons who are suffering from anxiety disorders? A) It is important for the nurse to "fix" the client's problems. B) Remember to practice techniques to manage stress and anxiety in your own life. C) If you have any uncomfortable feelings, do not tell anyone about them. D) Remember that only people who suffer from anxiety disorders have stress that can interfere with daily life and work.
Ans: B Feedback: It is critical for the nurse to remember to practice techniques to manage stress and anxiety in his or her own life. Remember that everyone occasionally suffers from stress and anxiety that can interfere with daily life and work. It is important for the nurse to avoid falling into the pitfall of trying to "fix" the client's problems. It is important that the nurse should discuss any uncomfortable feelings with a more experienced nurse for suggestions on how to deal with his or her feelings toward these clients.
A student is preparing to give a class presentation. A few minutes before the presentation is to begin, the student seems nervous and distracted. The student is looking at and listening to the peer speaker and occasionally looking at note cards. When the peer speaker asks a question of the group, the student is able to answer correctly. The professor understands that the student is likely experiencing which level of stress? A) Mild B) Moderate C) Severe D) Panic
Ans: B Feedback: Moderate anxiety is the disturbing feeling that something is definitely wrong; the person becomes nervous or agitated. In moderate anxiety, the person can still process information, solve problems, and learn new things with assistance from others. He or she has difficulty concentrating independently but can be redirected to the topic. Mild anxiety is a sensation that something is different and warrants special attention. Sensory stimulation increases and helps the person focus attention to learn, solve problems, think, act, feel, and protect himself or herself. As the person progresses to severe anxiety and panic, more primitive survival skills take over, defensive responses ensue, and cognitive skills decrease significantly. A person with severe anxiety has trouble thinking and reasoning.
The student nurse correctly identifies that which one of the following statements is true regarding clients with OCD? A) Since the client is aware that his or her behavior is bizarre, the client should just stop the behavior. B) Clients with OCD seem normal on the outside but suffer from overwhelming fear and anxiety. C) Once a person is successfully treated for OCD, he or she has been cured. D) Persons with OCD must avoid stress.
Ans: B Most times, clients with OCD seem normal on the outside but suffer from overwhelming fear and anxiety. OCD is often chronic in nature, with symptoms that wax and wane over time. Just because the client has some success in managing thoughts and rituals, it does not mean he or she will never need professional help in the future. It is not likely possible for persons with OCD to avoid stress.
Which of the following is essential for the nurse to communicate to the client with OCD and to the client's family? A) The client's diagnosis should be kept secret from everyone outside the immediate family and friends. B) The importance of medication compliance and that it may be necessary for medication to be changed to find the one that works best. C) It is important for the client to avoid following a routine. D) It is helpful for others to give unsolicited advice about other activities the client with OCD can engage in.
Ans: B Teaching about the importance of medication compliance to combat OCD is essential. It is neither possible nor desirable to keep the client's diagnosis a secret. To accomplish tasks efficiently, the client initially may need additional time to allow for rituals. When the client has completed the ritual or the tie allotted has passed, the client must then engage in the expected activity. At home, the client can continue to follow a daily routine or written schedule that helps him or her to stay on tasks and accomplish activities and responsibilities. It is not helpful for others to give unsolicited advice about other activities the client with OCD can engage in as this will add to the guilt and shame that people with OCD experience
Which of the following statements about the typical history of illness that would be assessed in a client who has OCD is consistent with OCD? A) OCD usually requires hospitalization. B) OCD treatment is usually outpatient. C) OCD only affects the client's ability to perform ADLs and work, not his or her leisure life. D) Most people seek treatment as soon as they observe the symptom
Ans: B The client usually seeks treatment only when obsessions become too overwhelming or when compulsions interfere with daily life (work, ADLs, or leisure) or both. Clients are hospitalized only when they have become completely unable to carry out their daily routines. Most treatment is outpatient. The client often reports that rituals began many years before; some begin as early as childhood. The more responsibility the client has as he or she gets older, the more the rituals interfere with the ability to fulfill these responsibilities
Before eating a meal, a client with obsessive/compulsive disorder must wash her hands for 14 minutes, comb her hair for 114 strokes, and switch the light off and on 44 times. When evaluating the progress of the client, what is the most important treatment objective for this client? A) Allow ample time for completion of all rituals before each meal. B) Gradually decrease the amount of time spent for performing rituals. C) Increase the client's acceptance of the need for medication to control rituals. D) Omit one ritualistic behavior every 4 days until all rituals are eliminated.
Ans: B Treatment has been effective when OCD symptoms no longer interfere with the client's ability to carry out responsibilities. When obsessions occur, the client manages resulting anxiety without engaging in complicated or time-consuming rituals. He or she reports regained control over his or her life and the ability to tolerate and manage anxiety with minimal disruption. Ritualistic behaviors may be decreased gradually over time
The nurse is aware that a person who repeatedly seeks cosmetic surgery to correct a perceived flaw in his or her appearance may have which of the following disorders? A) Hoarding disorder B) Body dysmorphic disorder C) Pyromania D) Body identity integrity disorder
Ans: B Feedback: Body dysmorphic disorder is a preoccupation with imagined or slight defect in physical appearance that causes significant distress for the individual and interferes with functioning in daily life. Elective cosmetic surgery is sought repeatedly to ìfix the flaw,î yet after surgery, the person is still dissatisfied or finds another flaw in appearance. It becomes a vicious cycle. Hoarding disorder is a progressive, debilitating, compulsive disorder that involves excessive acquisition of animals or apparently useless things; cluttered living spaces that become uninhabitable; and significant distress or impairment for the individual. Pyromania is the desire to start fires. Body identity integrity disorder is the term given to people who feel alienated from a part of their body and desire amputation
Which of the following are interpersonal theories regarding the etiologies of major anxiety disorders? Select all that apply. A) Sigmund Freud's theory B) Henry Stack Sullivan's theory C) Hildegard Peplau's theory D) Pavlov's theory
Ans: B, C Feedback: Theories of anxiety can be classified as intrapsychic/psychoanalytic theories, interpersonal theories, and behavioral theories. Freud's intrapsychic theory views a person's innate anxiety as the stimulus for behavior. Interpersonal theories include Sullivan's theory that anxiety is generated from problems in interpersonal relationships and Peplau's belief that humans exist in interpersonal and physiologic realms. Behavioral theorists view anxiety as being learned through experiences.
Which of the following would be appropriate outcomes for a client with OCD? Select all that apply. A) The client will stop engaging in the compulsive activity. B) The client will spend less time performing rituals. C) The client will complete daily routine activities within a realistic time frame. D) The client will conceal the behavior from all persons to avoid anxiety. E) The client will demonstrate effective use of behavior therapy techniques
Ans: B, C, E Outcomes for clients with OCD include the following: ï The client will complete daily routine activities within a realistic time frame. ï The client will demonstrate effective use of relaxation techniques. ï The client will discuss feelings with another person. ï The client will demonstrate effective use of behavior therapy techniques. ï The client will spend less time performing rituals.
Which of the following are features of the thinking of a person who has OCD according to the cognitive model? Select all that apply. A) The person with OCD employs a minimalist approach to all aspects of his or her life. B) The person with OCD believes one's thoughts are overly important and has a need to control those thoughts as they overestimate the threat posed by their thoughts. C) The person with OCD is always aware that his or her behavior is related to OCD. D) The person with OCD is concerned with perfectionism and has an intolerance of uncertainty. E) The person with OCD has an inflated personal responsibility
Ans: B, D, E The cognitive model describes the person's thinking as (1) believing one's thoughts are overly important; that is, ìIf I think it, it will happen,î and therefore having a need to control those thoughts; (2) perfectionism and the intolerance of uncertainty; and (3) inflated personal responsibility (from a strict moral or religious upbringing) and overestimation of the threat posed by one's thoughts. The person with OCD would not employ a minimalist approach to all aspects of his or her lifeóhe or she is likely to perform some tasks at extreme levels. The persons with OCD may not always be aware that their behavior is related to OCD
Which of the following is the desired outcome for a client with OCD? A) That the client will no longer experience any signs or symptoms of OCD B) That the client will no longer experience anxiety C) That the OCD symptoms no longer interfere with the client's responsibilities D) To relieve the client with OCD of any responsibilities
Ans: C Treatment has been effective when OCD symptoms no longer interfere with the client's ability to carry out responsibilities. The client will likely continue to experience signs or symptoms of OCD and anxiety, but the client will be able to manage the resulting anxiety without engaging in complicated or time-consuming rituals. It is not possible or desirable to relieve the client with OCD of any responsibilities
A client asks how his prescribed alprazolam (Xanax) helps his anxiety disorder. The nurse explains that antianxiety medications such as alprazolam affect the function of which neurotransmitter that is believed to be dysfunctional in anxiety disorders? A) Serotonin B) Norepinephrine C) GABA D) Dopamine
Ans: C Feedback: Gamma-aminobutyric acid (GABA) is the amino acid neurotransmitter believed to be dysfunctional in anxiety disorders. GABA reduces anxiety, and norepinephrine increases it; researchers believe that a problem with the regulation of these neurotransmitters occurs in anxiety disorders. Serotonin is usually implicated in psychosis and mood disorders. Dopamine is indicated in psychosis.
The student nurse correctly identifies that according to Selye (1956, 1974), which stage of reaction to stress stimulates the body to send messages from the hypothalamus to the glands and organs to prepare for potential defense needs? A) Resistance B) Exhaustion C) Alarm reaction D) Autonomic
Ans: C Feedback: In the alarm reaction stage, stress stimulates the body to send messages from the hypothalamus to the glands and organs to prepare for potential defense needs. In the resistance stage, the digestive system reduces function to shunt blood to areas needed for defense. The exhaustion stage occurs when the person has responded negatively to anxiety and stress. There is no autonomic stage.
A client is currently experiencing a panic attack. Which of the following is the most appropriate response by the nurse? A) "Just try to relax." B) "There is nothing here to harm you." C) "You are safe. Take a deep breath." D) "What are you feeling right now?"
Ans: C Feedback: Nursing interventions for panic disorder include providing a safe environment and ensuring the client's privacy during a panic attack, remaining with the client during a panic attack, helping the client to focus on deep breathing, talking to the client in a calm, reassuring voice, teaching the client to use relaxation techniques, helping the client to use cognitive restructuring techniques, and the engaging client to explore how to decrease stressors and anxiety-provoking situations.
A client says to the nurse, "I just can't talk in front of the group. I feel like I'm going to pass out." The nurse assesses the client's anxiety to be at which level? A) Mild B) Moderate C) Severe D) Panic
Ans: C Feedback: Physiologic responses to severe anxiety include headache, nausea, vomiting, diarrhea, trembling, rigid stance, vertigo, pale, tachycardia, and chest pain.
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. Which of the following should be the nurse's first action? A) Ask the client to describe his feelings. B) Proceed with wound care quickly. C) Replace the dressing on the wound. D) Get the assistance of another nurse.
Ans: C Feedback: The client has severe anxiety; the priority is to lower the client's anxiety level. The first action should be to replace the dressing on the wound to decrease the client's level of anxiety and to prevent contamination of the wound before a new dressing can be applied. The other choices could be done after replacing the dressing on the wound.
The nurse is teaching a client with an anxiety disorder ways to manage anxiety. The nurse suggests which of the following schedules for practicing stress management techniques? A) Practice the techniques each morning and night as part of a daily routine. B) Use the techniques as needed when experiencing severe anxiety. C) Practice the techniques when relatively calm. D) Expect to practice the techniques when meeting with a therapist.
Ans: C Feedback: The nurse can teach the client relaxation techniques to use when he or she is experiencing stress or anxiety, including deep breathing, guided imagery and progressive relaxation, and cognitive restructuring techniques. For any of these techniques, it is important for the client to learn and to practice them when he or she is relatively calm.
The nurse is providing education to a group of persons from several community agencies about hoarding by elder persons. Which of the following is important for the nurse to emphasize? A) Treatment will likely start to be effective in the short term. B) If the person had help to clean up his or her environment, the hoarding would be cured. C) It is not beneficial to tell the client that his or her thoughts and rituals interfere with his or her life or that his or her ritual actions really have no lasting effect on anxiety. D) One agency should be able to address all of the client's needs.
Ans: C Treatment for hoarding in older adults may need to continue over a long period of time to reach successful outcomes. Most persons who are hoarders will not seek assistance to clean up their environment because they feel ashamed. If the environment were to be cleaned up and no other intervention employed, the person would continue to hoard. It is not beneficial to tell the clients that their thoughts and rituals interfere with their life or that their ritual actions really have no lasting effect on anxiety-they already know that. Multiple community agencies may be needed to deal with hoarding in the older adult
Which of the following treatment modalities is most effective for OCD? A) Behavioral techniques B) Medication C) Behavioral techniques and medication D) Ignoring it
Ans: C F Behavioral techniques and medication are the most effective treatment modalities for OCD. This would be more effective than either behavioral techniques or medication alone. It is not appropriate to ignore OCD as it will only get worse until the client is unable to engage in activities of daily living.
An anxiolytic agent, lorazepam (Ativan), has been prescribed for the client. Which of the following statements by the client would indicate to the nurse that client education about this medication has been effective? A) "My anxiety will be eliminated if I take this medication as prescribed." B) "This medication presents no risk of addiction or dependence." C) "I will probably always need to take this medication for my anxiety." D) "This medication will relax me, so I can focus on problem solving."
Ans: D Feedback: Anxiolytics are designed for short-term use to relieve anxiety. These drugs are designed to relieve anxiety so that the person can deal more effectively with whatever crisis or situation is causing stress. Benzodiazepines have a tendency to cause dependence. Clients need to know that antianxiety agents are aimed at relieving symptoms such as anxiety but do not treat the underlying problems that cause the anxiety.
Which one of the following can be a positive outcome of using defense mechanisms? A) Defense mechanisms can inhibit emotional growth. B) Defense mechanisms can lead to poor problem-solving skills. C) Defense mechanisms can create difficulty with relationships. D) Defense mechanisms can help a person to reduce anxiety.
Ans: D Feedback: Defense mechanisms can help a person to reduce anxiety. This is the only positive outcome of using defense mechanisms. The dependence on defense mechanisms can inhibit emotional growth, lead to poor problem-solving skills, and create difficulty with relationships. These are all negative outcomes of using defense mechanisms.
The nurse plans to teach a client about dietary modifications to manage diabetes. Teaching would be most effective if the client displayed which one of the following characteristics? A) Focusing only on immediate task B) Faster rate of speech C) Narrowed perceptual field D) Heightened focus
Ans: D Feedback: Mild anxiety is associated with increased learning ability. It involves a sensation that something is different and warrants special attention. Sensory stimulation increases and helps the person focus attention to learn, solve problems, think, act, feel, and protect himself or herself. Mild anxiety often motivates people to make changes or to engage in goal-directed activity. Focusing only on immediate task, a faster rate of speech, and a narrowed perceptual field are associated with moderate levels of anxiety.
The nurse enters the client's room and finds the client anxiously pacing the floor. The client begins shouting at the nurse, "Get out of my room!" The best intervention by the nurse would be to A) approach the client and ask, "What's wrong?" B) call for help and say, "Calm down." C) turn and walk away from the room without saying anything. D) stand at the doorway and say, "You seem upset."
Ans: D Feedback: Staying with the client while allowing personal space is an important and safe intervention; this therapeutic communication technique is designed to get the client to communicate feelings. It may not be safe for the nurse to approach the client. Help is not needed at this time, and saying, "Calm down," is not effective. Turning and walking away from the client may seem like rejection and may worsen the client's anxiety as well as damage the nurse-client relationship.
The nurse knows that which one of the following statements is true about stress and anxiety? A) All people handle stress in the same way. B) Stress is a person's reaction to anxiety. C) Anxiety occurs when a person has trouble dealing with life situations, problems, and goals. D) Stress is the wear and tear that life causes on the body.
Ans: D Feedback: Stress is the wear and tear that life causes on the body. It occurs when a person has difficulty dealing with life situations, problems, and goals. Each person handles stress differently. Anxiety is a vague feeling of dread or apprehension; it is a response to external or internal stimuli that can have behavioral, emotional, cognitive, and physical symptoms. Anxiety is a response to stress.
A client asks the nurse, "Why do I have to go to counseling? Why can't I just take medications?" The best response by the nurse would be, A) "Both therapies are effective. You can eventually choose one or the other." B) "You cannot get the full effect of your medications without cognitive therapy as well." C) "As soon as your medications reach therapeutic level, you can omit the therapy." D) "Medications combined with therapy help you change how well you function."
Ans: D Feedback: Treatment for anxiety disorders usually involves medication and therapy. This combination produces better results than either one alone.
The nurse is caring for her first client with obsessive/compulsive disorder. During the treatment team meeting, the nurse shares her frustration as to the client's inability to stop washing his hands. The nurse manager offers which one of the following explanations? A) The hand washing represents a way to exert independence from the staff. B) The client is not aware of the excessive hand washing. C) The client does not think anything is abnormal with washing his hands repeatedly. D) The client feels terrible but cannot stop washing his hands to try to get rid of his anxiety
Ans: D It may be difficult for nurses and others to understand why the person cannot simply stop performing the bizarre behaviors interfering with his or her life. Nurses must understand what anxiety behaviors are and how anxiety behaviors work, not just for client care but to help understand the role anxiety plays in performing nursing responsibilities.
Which of the following might the nurse recognize as longer-term responses to trauma and stress? Select all that apply. A) Acute stress disorder B) Posttraumatic stress disorder C) Adjustment disorder D) Reactive attachment disorder E) Dissociative disorder
B) Posttraumatic stress disorder C) Adjustment disorder D) Reactive attachment disorder E) Dissociative disorder Feedback: Acute stress disorder usually occurs from 2 days to 4 weeks after a trauma. Posttraumatic stress disorder usually begins 3 months after the trauma. All of the rest of these are longer-term responses to trauma and stress.
Which of the following would the nurse know are the major elements of posttraumatic stress disorder (PTSD)? Select all that apply. A) Trying to avoid any places or people or situations that may trigger memories of the trauma B) Reexperiencing the trauma through dreams or recurrent and intrusive thoughts C) Becoming increasingly more isolated D) Emotional numbing such as feeling detached from others E) Being on guard, irritable, or experiencing hyperarousal
B) Reexperiencing the trauma through dreams or recurrent and intrusive thoughts D) Emotional numbing such as feeling detached from others E) Being on guard, irritable, or experiencing hyperarousal Feedback: The three major elements of PTSD are reexperiencing the trauma through dreams or recurrent and intrusive thoughts, showing emotional numbing such as feeling detached from others, and being on guard, irritable, or experiencing hyperarousal. The client may also experience a numbing of general responsiveness and may try to avoid any places or people or situations that may trigger memories of the trauma, but these are not the major elements of PTSD.
Which of the following statements regarding the individual responses to trauma and stressors is a positive outcome? A) Many individuals are unable to cope with the event, manage their stress and emotions, or resume the daily activities of their lives. B) Some individuals may develop enhanced coping as a result of dealing with the stressor. C) These events are only significant in individuals who have risk for or actual mental health problems or issues. D) Large numbers or groups of people may be affected by a traumatic event.
B) Some individuals may develop enhanced coping as a result of dealing with the stressor. Feedback: People may experience events in their lives that are extraordinary in intensity or severity, well beyond the stress of daily life. These traumatic events or stressors would be expected to disrupt the life of anyone who experienced them, not just individuals at risk for mental health problems or issues. These events and stressors may affect individuals or large numbers and groups of people. While all persons experiencing events such as these manifest anxiety, insomnia, difficulty coping, grief, or any variety of responses, most work through the experience and return to their usual level of coping and equilibrium—perhaps even enhanced coping as a result of dealing with the event.
Which of the following outcomes would take priority for a client who has survived trauma or abuse? Select all that apply. A) The client will demonstrate healthy, effective ways of dealing with the stress. B) The client will be physically safe. C) The client will establish a social support system in the community. D) The client will distinguish between ideas of self-harm and taking action on those ideas. E) The client will express emotions nondestructively.
B) The client will be physically safe. D) The client will distinguish between ideas of self-harm and taking action on those ideas. Feedback: It is the highest priority that the client be physically safe. Because persons who have survived trauma or abuse may have thoughts of self-harm, it is also critical that the client will distinguish between ideas of self-harm and taking action on those ideas. The other objectives are not as high a priority as safety and ideas of self-harm.
A nurse is providing education about trauma and its effects to a community group in a community that has just been hit by a devastating tornado. One of the participants asked about what kind of support a survivor of the tornado will need. Which would be the best response of the nurse? A) If a person is willing to share his or her feelings about what has happened, he or she is not dealing with their feelings effectively. B) It is counterproductive for people to share what has happened to them and their feelings about it as there is nothing more to be done. C) If a person is reluctant to share his or her feelings, he or she may be denying his or her importance and may be at increased risk for future problems such as PTSD. D) It is best to wait until a survivor's life has returned to normal before dealing with the trauma.
C) If a person is reluctant to share his or her feelings, he or she may be denying his or her importance and may be at increased risk for future problems such as PTSD. Feedback: Some people more easily express their feelings and talk about stressful, upsetting, or overwhelming events. They may do so with family, friends, or professionals. Others are more reluctant to open up and disclose their personal feelings. They are more likely to ignore the feelings, deny their importance, or insist "I'm fine, I'm over it." By doing that, they increase the risk for future problems such as PTSD. One of the most effective ways of avoiding pathologic responses to trauma is effectively dealing with the trauma soon after it occurs.
What is the major difference between posttraumatic stress disorder (PTSD) and acute stress disorder? A) In acute stress disorder, the client is likely to develop exacerbation of symptoms. B) In PTSD, the recovery rate is 80% within 3 months. C) The severity and duration of the trauma are the most important variables in acute stress disorder. D) In PTSD, the symptoms occur 3 months or more after the trauma.
D) In PTSD, the symptoms occur 3 months or more after the trauma. Feedback: In acute stress disorder, the symptoms occur 2 days to 4 weeks after a traumatic event and are resolved within 3 months of the event. In PTSD, the symptoms occur 3 months or more after the trauma. In PTSD, the client is likely to develop exacerbation of symptoms. The severity and duration of the trauma and the proximity of the person to the event are the most important factors affecting the likelihood of developing PTSD. In PTSD, complete recovery occurs within 3 months for about 50% of people.
Which of the following interventions would be most effective for friends and family members to implement in order to boost the self-esteem of a person who has just experienced trauma or abuse? A) To identify a list of support people or activities in the community B) To remind them to calm down when they appear to be experiencing a flashback C) To encourage them to tell their story repeatedly to everyone they meet D) To help them to refocus their view of themselves from being victims to being survivors
D) To help them to refocus their view of themselves from being victims to being survivors Ans: D Feedback: Often it is useful to view the client as a survivor of trauma or abuse rather than as a victim. For these clients, who believe they are worthless and have no power over the situation, it helps to refocus their view of themselves from being victims to being survivors. Defining themselves as survivors allows them to see themselves as strong enough to survive their ordeal. It is a more empowering image than seeing oneself as a victim. It would be beneficial for the client to identify a list of support people or activities in the community, but this would be to establish social support and not promote their self-esteem. It would not be helpful for anyone to tell the client to calm down when he or she appears to be experiencing a flashback or to encourage him or her to tell his or her story repeatedly.
Which of the following statements about posttraumatic stress disorder is accurate? A) Estimates are that the disorder is very rare. B) Estimates are that up to 60% of people at risk develop PTSD. C) Only 20% of victims of rape develop PTSD. D) PTSD symptoms usually begin at the time of the trauma
Feedback: Estimates are that up to 60% of people at risk develop PTSD.
The nursing student answers the test item correctly when identifying which one of the following statements is true? A) Anxiety and fear are the same. B) Anxiety is unavoidable. C) Anxiety is always harmful. D) Fear is feeling threatened by an unknown entity.
ans B Feedback: Anxiety is distinguished from fear, which is feeling afraid or threatened by a clearly identifiable external stimulus that represents danger to the person. Anxiety is unavoidable in life and can serve many positive functions such as motivating the person to take action to solve a problem or to resolve a crisis.
