1.4 Anxiety EAQ
A client who suspects that she is 6 weeks pregnant appears mildly anxious as she is waiting for her first obstetric appointment. What symptom of mild anxiety does the nurse expect this client to experience? Dizziness Breathlessness Abdominal cramps Increased alertness
Increased alertness Rationale Increased alertness is an expected common behavior that occurs in new or different situations when a person is mildly anxious. Dizziness, breathlessness, and abdominal cramps are all common signs of moderate to severe anxiety.
Which drug is contraindicated in clients with eating and seizure disorders? Bupropion Trazodone Amitriptyline Lithium citrate
Bupropion Rationale Bupropion is contraindicated in clients with eating and seizure disorders. Trazodone is contraindicated in clients with a known allergic reaction to this drug. Amitriptyline is contraindicated in clients who are pregnant and have known allergic reactions to this drug. Lithium citrate is contraindicated in clients with renal or cardiovascular disease.
How should a nurse intervene when a confused and anxious client voids on the floor in the sitting room of the mental health unit? Make the client mop the floor. Restrict the client's fluids for the rest of the day. Toilet the client more frequently with supervision. Withhold the client's privileges each time the client voids on the floor.
Toilet the client more frequently with supervision. Rationale The client is voiding on the floor not to express hostility but because of confusion. Taking the client to the toilet frequently reduces the risk of voiding in inappropriate places. Making the client mop the floor is a form of punishment for something the client cannot control. Restricting the client's fluids for the rest of the day is not realistic; it will have no effect on the problem and may lead to physiologic problems. If the client were doing this to express hostility, withholding privileges might be effective, but not when the client is unable to control the behavior.
A nurse is caring for a client with an obsessive-compulsive personality disorder that involves rituals. What should the nurse conclude about the ritual? It has a purpose but is useless. It is performed after long urging. It appears to be performed willingly. It seems illogical but is needed by the person.
It seems illogical but is needed by the person. Rationale The client's exact adherence to the compulsive ritual relieves anxiety, at least temporarily. Furthermore, it meets a need and is necessary to the client. The compulsive act is purposeless repetition and useful only in that it temporarily eases the client's anxiety. Urging has no effect getting the the client to start or stop the ritualistic behavior. The person cannot stop the activity; it is not under his voluntary control.
A client who was hospitalized with severe anxiety is ready to be discharged. What priority outcome has been met? Follows rules of the milieu Maintains anxiety at a manageable level Verbalizes positive aspects about the self Recognizes that hallucinations can be controlled
Maintains anxiety at a manageable level Rationale Maintenance of anxiety at a manageable level results from teaching the client to recognize situations that provoke anxiety and how to institute measures to control its development. Following the rules of the milieu and verbalizing positive aspects about the self are not priorities; the client has probably had little difficulty in these areas. No evidence was presented to indicate that the client is hallucinating.
A nurse is caring for a client with a somatoform disorder. What should the nurse anticipate that this client will do? Write down conversations to facilitate the recall of information. Monopolize conversations about the anxiety being experienced. Redirect the conversation with the nurse to physical symptoms. Start a conversation asking the nurse to recommend palliative care.
Rationale Redirect the conversation with the nurse to physical symptoms. Clients with somatoform disorders are preoccupied with the symptoms that are being experienced and usually do not want to talk about their emotions or relate them to their current situation. Clients with somatoform disorders do not seek opportunities to discuss their feelings. Memory problems are not associated with somatoform disorders. These clients want and seek treatment, not palliative care.
What childhood problem has legal as well as emotional aspects and cannot be ignored? School phobia Fear of animals Fear of monsters Sleep disturbances
School phobia Rationale School phobia is a disorder that cannot legally be ignored for long because children must attend school. It requires intervention to alleviate the separation anxiety and promote the child's increasing independence. Fear of animals and monsters and sleep disturbances all require parents to comfort the child, to reorient the child to reality, and to help the child regain self-control. Legally there are no requirements mandating treatment for these common childhood problems.
A nurse is caring for a preschooler who is being prepared for surgery. What does the nurse expect to have the most influence on the child's response to hospitalization? Fear of separation Fear of bodily harm Belief in death's finality Belief in the supernatural
Skin pallor Rationale Fear of mutilation is typical of the preschooler because they have vague views of body boundaries. Toddlers are more likely to fear separation from parents. Preschoolers do not view death as final. Although preschoolers do indulge in magical thinking, they have not yet developed the concept of supernatural beliefs.
A 7-year-old boy who is about to have an intravenous line inserted cries out that he is afraid of IVs. What is the nurse's most therapeutic response? "Tell me what frightens you." "It's just a little prick in the arm." "You're a big boy; this will hardly hurt." "Come on—there's no reason to be afraid."
"Tell me what frightens you." Rationale Allowing the child to talk about what is frightening him provides an opportunity for him to express feelings and fears. It is not therapeutic to belittle the child's fears.
How should a nurse respond to parents who are concerned about separation anxiety in their 15-month-old toddler? "This is an expected developmental reaction." "You may be spending too much time with your child." "It might be helpful to leave your child with someone once in a while." "Toddlers who have separation anxiety may have difficulty when they start school."
"This is an expected developmental reaction." Rationale Understanding that separation anxiety is an expected developmental occurrence will be reassuring to the parents. Commenting that the parents may be spending too much time with their child is a value judgment and does not address this expected stage of development. Giving advice is not therapeutic and does not address the child's separation anxiety. There is no connection between separation anxiety in a 15-month-old child and difficulty starting school.
A client who uses a complex ritual says to the nurse, "I feel so guilty. None of this makes any sense. Everyone must really think I'm crazy." What is the most therapeutic response by the nurse? "Your behavior is bizarre, but it serves a useful purpose." "You're concerned about what other people are thinking about you." "I am sure people understand that you can't help this behavior right now." "Guilt serves no useful purpose. It just helps you stay stuck where you are."
"You're concerned about what other people are thinking about you." Rationale Paraphrasing encourages further ventilation of feelings and concerns by the client. Telling the client that the behavior is bizarre but that it serves a useful purpose is a negative response that may increase the client's fears about being "crazy." Saying "I'm sure people understand that you can't help this behavior right now" provides false reassurance and implies that the client is out of control, which may increase the fears. Telling the client that guilt serves no useful purpose and just helps the client stay stuck denies the client's feelings.
A nurse is planning to teach a client about self-care. What level of anxiety will best enhance the client's learning abilities? Mild Panic Severe Moderate
Mild Rationale Mild anxiety motivates one to action, such as learning or making changes. Higher levels of anxiety tend to blur the individual's perceptions and interfere with functioning. Attention is severely reduced by panic. The perceptual field is greatly reduced with severe anxiety and narrowed with moderate anxiety.
A client with chronic renal failure has been on hemodialysis for 2 years. The client communicates with the nurse in the dialysis unit in an angry, critical manner and is frequently noncompliant with medications and diet. The nurse can best intervene by first considering that the client's behavior is most likely for which reason? An attempt to punish the nursing staff A constructive method of accepting reality A defense against underlying depression and fear An effort to maintain life and to live it as fully as possible
A defense against underlying depression and fear Rationale Both hostility and noncompliance are forms of anger that are associated with grieving. The client's behavior is not a conscious attempt to hurt others but a way to relieve and reduce anxiety within the self. The client's behavior is a self-destructive method of coping, which can result in death. The client's behavior is an effort to maintain control over a situation that is really controlling the client; it is an unconscious method of coping, and noncompliance may be a form of denial.
A female client with obsessive-compulsive disorder has become immobilized by her elaborate handwashing and walking rituals. Which feelings does the nurse recall are often the basis of obsessive-compulsive disorder? Anxiety and guilt Anger and hostility Embarrassment and shame Hopelessness and powerlessness
Anxiety and guilt Rationale Ritualistic behavior seen in this disorder is aimed at controlling feelings of anxiety and guilt by maintaining an absolute set pattern of action. Although the person with an obsessive-compulsive disorder may be angry and hostile, the feelings of anger and hostility do not precipitate the rituals. Although the person with an obsessive-compulsive disorder may be embarrassed and ashamed by the ritual or feel hopeless and powerless to the ritual, the basic feelings precipitating the rituals are usually anxiety and guilt.
A client who is to undergo dilation and curettage and conization of the cervix for cancer appears tense and anxious. What is the best approach for the nurse to support the client emotionally? Explaining that these procedures are considered minor surgery Asking whether something is troubling the client and whether she'd like to talk about it Stating that the procedures are routine and asking what the client is really worried about Explaining that everybody is fearful before the surgery even though there is little reason to worry
Asking whether something is troubling the client and whether she'd like to talk about it Rationale Asking whether the client wants to talk about what's troubling her acknowledges that the client is anxious and, by means of indirect questioning, helps facilitate communication. Saying that these procedures are considered minor surgery denies the client's feelings. The client has not indicated that she is upset, and she may be unaware of or unable to verbalize the actual cause of the emotions. Saying that there is little reason to worry is false reassurance and cuts off communication.
A nurse is caring for an anxious, fearful client. Which client response indicates sympathetic nervous system control? Dry skin Skin pallor Constriction of pupils Pulse rate of 60 beats/min
Asking whether something is troubling the client and whether she'd like to talk about it Rationale The sympathetic nervous system constricts the smooth muscle of blood vessels in the skin when a person is under stress, thereby causing skin pallor. The sympathetic system stimulates, rather than inhibits, secretion by the sweat glands. Constriction of pupils is not under sympathetic control; the parasympathetic system constricts the pupils. The parasympathetic system (vagus nerve) slows the pulse, and the sympathetic system increases it.
A client is scheduled for head and neck surgery. Although the healthcare provider has explained the surgery, the client still has moderate to severe anxiety. Which action should the nurse take initially? Attempt to discover what the client is concerned about. Elaborate on what the healthcare provider has already said. Teach the client to use the suction equipment preoperatively. Plan for postoperative communication because a tracheostomy is likely.
Attempt to discover what the client is concerned about. Rationale Various aspects of hospitalization and diagnosis may cause the client to become anxious. The nurse should identify what concerns the client the most. Anxiety interferes with learning, and it is the healthcare provider's responsibility to explain the surgery. Teaching the client to use the suction equipment preoperatively may cause the client unnecessary anxiety. A tracheostomy may not be performed; it depends on the type of surgery.
Which drug is contraindicated in clients with blood dyscrasias? Duloxetine Bupropion Mirtazapine Chlorpromazine
Chlorpromazine Rationale Chlorpromazine is an antipsychotic drug contraindicated in clients with blood dyscrasias. Duloxetine is an antidepressant drug contraindicated in clients with uncontrolled angle-closed glaucoma. Bupropion is an antidepressant drug contraindicated in clients with anorexia nervosa. Mirtazapine is an antidepressant drug contraindicated in clients who have allergic reactions due to drugs and concurrent use of monoamine oxidase inhibitors.
A 68-year-old client who has metastatic carcinoma is told by the practitioner that death will occur within a month or two. Later the nurse enters the client's room and finds the client crying. Before responding, which factor should the nurse consider? Crying relieves depression and helps the client face reality. Crying releases tension and frees psychic energy for coping. Nurses should not interfere with a client's behavior and defenses. Accepting a client's tears maintains and strengthens the nurse-client bond.
Crying releases tension and frees psychic energy for coping. Rationale Crying is an expression of an emotion that, if not expressed, increases anxiety and tension; the increased anxiety and tension use additional psychic energy and hinder coping. Crying does not relieve depression, nor does it help a client face reality. It is not universally true that nurses should not interfere with a client's behavior and defenses. In most instances the client's defenses should not be taken away until they can be replaced by more healthy defenses. The nurse must interfere with behavior and defenses that may place the client in danger, but the client's current behavior poses no threat to the client. It is not always true that accepting a client's crying maintains and strengthens the nurse-client bond. Many clients are embarrassed by what they consider a "show of weakness" and have difficulty relating to the individual who witnessed it. The nurse must do more than just accept the crying to strengthen the nurse-client relationship.
A nurse has been assigned to care for a client with the diagnosis of obsessive-compulsive disorder (OCD). Before providing care for this client, what should the nurse remember about clients with OCD? Are unaware that the ritual serves no purpose Can alter the ritual depending on the situation Should be prevented from performing the ritual Do not want to repeat the ritual but feel compelled to do so
Do not want to repeat the ritual but feel compelled to do so Rationale The repeated thought or act defends the client against even higher, more severe levels of anxiety. Clients usually do recognize that the ritual serves little or no purpose. Rituals are usually followed rigidly; setting limits on or altering a ritual increases anxiety. Preventing the client from performing the ritual may precipitate a panic level of anxiety.
The parents of an 11-year-old child with a terminal illness appear overwhelmed and anxious. What is the best response by the nurse? Explaining the diagnosis in a variety of ways Encouraging the parents to express their feelings Recommending that the parents talk with other parents Offering assurance that surgery will probably correct the problem
Encouraging the parents to express their feelings Rationale The parents need to express and work through their feelings before they can move forward with other coping strategies. Explanation of the diagnosis is not focused on the needs of the parents at this time. Participation in a support group may eventually be suggested; however, this is not the priority at this time. Assuring the parents that surgery will correct the problem is false reassurance; there is no guarantee that the surgery will be successful.
During a home visit to a client, the nurse identifies tremors of the client's hands. When discussing this assessment, the client reports being nervous, having difficulty sleeping, and feeling as if the collars of shirts are getting tight. Of the additional assessment findings, which one should the nurse report to the practitioner? Increased appetite Recent weight loss Feelings of warmth Fluttering in the chest
Fluttering in the chest Rationale Many of these problems are associated with hyperthyroidism; palpitations may indicate cardiovascular changes requiring prompt intervention. The increased metabolism associated with hyperthyroidism can lead to heart failure. Although an increased appetite becomes a compensatory mechanism for the increased metabolism associated with hyperthyroidism, it is not life threatening. Although unexplained weight loss can result from catabolism associated with hyperthyroidism, it is not life threatening. Although a feeling of warmth caused by the increased metabolism associated with hyperthyroidism is uncomfortable, it is not life threatening.
Besides providing reassurance, what should nursing interventions for a client who is hyperventilating be focused on? Administering oxygen Using an incentive spirometer Having the client breathe into a paper bag Administering an IV containing bicarbonate ions
Having the client breathe into a paper bag Rationale Reassurance decreases anxiety and slows respirations; the bag is used so that exhaled carbon dioxide can be rebreathed to resolve respiratory alkalosis and return the client to an acid-base balance. Administering oxygen is not necessary because there is no evidence of hypoxia. Using an incentive spirometer is used to prevent atelectasis. The client is already alkalotic; bicarbonate ions will increase the problem.
A 4-year-old child is being prepared for a myringotomy in the ambulatory care unit. What is most important for the nurse to do when the child is called to the operating room? Removing the child's undergarments Placing the child's toys on the bedside table Allowing the child to climb onto the stretcher Having the parents accompany the child to the operating suite
Having the parents accompany the child to the operating suite Rationale Current practice encourages parents to stay with the child as long as possible; this helps reduce stress related to a frightening experience. Removing undergarments is usually not necessary for a myringotomy procedure. Toys, especially a favorite one, should accompany the child until sedation is induced. The child is too young to climb onto a stretcher.
A nurse is preparing to care for a client who engages in ritualistic behavior. What is the most appropriate intervention to include in the plan of care? Redirecting the client's energy into activities to help others Teaching the client that the behavior is not serving a realistic purpose Administering antianxiety medications that block out the memory of internal fears Helping the client understand that the behavior is caused by maladaptive coping with increased anxiety
Helping the client understand that the behavior is caused by maladaptive coping with increased anxiety Rationale Helping clients understand that a behavior is being used to control anxiety usually makes them more amenable to psychotherapy. Treatment includes activities to help the client, not others. The client usually understands already that the behavior is not serving a realistic purpose. Administering antianxiety medications that block out the memory of internal fears will only mask symptoms and will not get at the root of what is bothering the client.
A college student is brought to the mental health clinic by parents with a diagnosis of borderline personality disorder. Which factors in the client's history support this diagnosis? Select all that apply. Impulsiveness Lability of mood Ritualistic behavior Psychomotor retardation Self-destructive behavior
Impulsiveness, Lability of mood, Self-destructive behavior Rationale Clients with borderline personality disorder often lead complex, chaotic lives because of their inability to control or limit impulses. Extremes of emotions, ranging from apathy and boredom to anger, may be displayed within short periods. Impulsive self-destructive acts such as reckless driving, spending money, and engaging in unsafe sex often result in negative consequences. Ritualistic behavior is associated with obsessive-compulsive disorders. Psychomotor retardation is associated with mood disorders such as depression.
A client with a personality disorder is playing cards with another person in the lounge. When the other person cheats at cards, the client responds by aggressively scattering the cards around the room. What does the nurse conclude about the client's personality? Poor reality testing A violent personality An antisocial personality Inadequate impulse control
Inadequate impulse control Rationale The client is angry and reacts impulsively; the action is unplanned and is not under the client's control. No data are provided to suggest that the client is out of contact with reality; the client is reacting to a real situation with anger. There is no identifiable cluster of behaviors to suggest that the client has a violent personality. There is no pattern of behavior to suggest an antisocial personality, which may or may not involve impulse control.
A client with rheumatoid arthritis asks the nurse why it is necessary to inject hydrocortisone into the knee joint. What reason should the nurse include in a response to this question? Lubricate the joint Reduce inflammation Provide physiotherapy Prevent ankylosis of the joint
Reduce inflammation Rationale Steroids have an antiinflammatory effect that can reduce arthritic pannus formation. Lubricating the joint does not provide lubrication. Injection of a drug into a joint is not physiotherapy. Ankylosis refers to fusion of joints. It is only indirectly influenced by steroids, which exert their major effect on the inflammatory process.
A client who was recently admitted to the psychiatric unit with the diagnosis of an obsessive-compulsive disorder engages in a handwashing ritual. When the nurse interrupts the ritual, the client becomes angry and acts out. What is the most probable cause for this behavior? The client is feeling overwhelmed in this situation. The client resents the nurse's authoritarian manner. The client's personality is clashing with the nurse's. The client's response reflects an aggressive personality.
The client is feeling overwhelmed in this situation. Rationale The ritual reduces anxiety; when not permitted to complete the ritual, a client with an obsessive-compulsive disorder will experience increased anxiety, frustration, and anger and may act out. The client is experiencing anxiety not related to a personality clash, the nurse's manner, or an aggressive personality.
A nurse is caring for a client with an antisocial personality disorder. What consistent approach should the nurse use with this client? Warm and firm without being punitive Indifferent and detached but nonjudgmental Conditionally acquiescent to client demands Clearly communicative of personal disapproval
Warm and firm without being punitive Rationale The client needs positive relationships with other adults, but clear, consistent limits must be presented to minimize attempts at manipulation. Acting indifferent and detached but nonjudgmental is not a therapeutic approach. Being indifferent and detached gives the impression that the nurse does not care. Being conditionally acquiescent to client demands is not a therapeutic approach because clear, consistent limits are necessary to prevent manipulation. Being clearly communicative of personal disapproval is a judgmental attitude that should be avoided.
