Anxiety Disorders Adaptive Quizzing

Which action would the nurse take first for a client with a generalized anxiety disorder? 1. Encourage the client to exercise on a daily basis. 2. Have the client list the behaviors used to reduce anxiety. 3. Remove as many stimuli from the client's environment as possible. 4. Administer as-needed medications prescribed by the primary health care provider.

Remove as many stimuli from the client's environment as possible.

Which response would the nurse make to a client with a history of obsessive-compulsive behaviors who on the day of the part-time job interview arrives at the mental health center with signs of anxiety? 1. "I know you're anxious, but by forcing yourself to go to the interview you may conquer your fear." 2. "If going to an interview makes you this anxious, you're probably not ready to go back to work." 3. "It must be that you really don't want that job after all. I think you should reconsider going to the interview." 4. "Going for your interview triggered some feelings in you. Perhaps you could call a friend to drive you there."

"Going for your interview triggered some feelings in you. Perhaps you could call a friend to drive you there."

Which piece of assessment data from a client admitted for stress and anxiety requires a nursing intervention? 1. Sleeping until 11:00 AM each day 2. Exercising 160 minutes weekly 3. Drinking 3 cups of coffee each day 4. Getting 9 hours of sleep each night

Sleeping until 11:00 AM each day

Before discharging an anxious client, which information about anxiety would the nurse teach the family? 1. Anxiety is a totally unique feeling and experience. 2. Apprehension is generalized to the total environment. 3. Fears results from conscious actions, thoughts, and wishes. 4. Anxiety is a pattern of emotional and behavioral responses to stress.

Anxiety is a pattern of emotional and behavioral responses to stress. Anxiety is a human response consisting of both physical and emotional changes that everyone experiences when faced with stressful situations. Anxiety is experienced to a greater or lesser degree by every person. Apprehension is usually related to a specific aspect of the environment rather than the total environment. Fears are not intentionally or consciously generated.

Which factor would the nurse assess to best determine the client's present mental status who has generalized anxiety disorder? 1. Memory 2. Behavior 3. Judgment 4. Responsiveness

Behavior Depending upon the level of the client's anxiety, different behaviors will be observed. Thus, the client's current behavior is the best indicator of the client's current mental status because all behavior has meaning.

Which behavior is characteristic of panic during a crisis? 1. Being physically immobile 2. Sobbing for no apparent reason 3. Difficulties with falling asleep 4. Startling to loud noises and touch

Being physically immobile Being unable to physically move is a psychomotor characteristic of extreme panic during a crisis. Sobbing, difficulties with sleep, and startling are associated with lower levels of anxiety.

Which goal would cognitive therapy accomplish for a client who experiences panic attacks? 1. Prevent future panic attacks. 2. Help the client hide the panic attacks. 3. Stop the panic attacks once they begin. 4. Decrease the fear of having panic attacks.

Decrease the fear of having panic attacks.

When a client is expressing severe anxiety by sobbing in the fetal position on the bed, which action would be the nurse's priority? 1. Ensuring a safe therapeutic milieu 2. Monitoring and documenting vital signs 3. Eliminating the cause of the client's anxiety 4. Providing an intense therapy session

Ensuring a safe therapeutic milieu Client safety is the nurse's first priority, and because the client has not experienced any physical injuries and is not at risk, attention should be directed toward psychiatric risk, in this case crisis control. The severely stressed individual is likely to experience increased vital signs but this is not the priority. During a psychological crisis, vital signs do not have to be taken unless physical symptoms develop. Eliminating the cause of the client's anxiety is highly unlikely; not all stress can be eliminated. The client will not be able to concentrate on intense therapy until the crisis has been managed.

Which approach would the nurse take for a client who was involved in a near-fatal automobile collision and arrives at the crisis center with reports of anxiety and flashbacks? 1. Focusing on the present 2. Identifying past stressors 3. Discussing a referral for psychotherapy 4. Exploring the client's history of mental health problems

Focusing on the present

Which question to help reduce anxiety would the nurse ask a client who is pacing the floor and appears extremely anxious? 1. "Are you feeling upset right now?" 2. "Shall we walk together for a while?" 3. "Are you the type to work out?" 4. "Shall we sit and talk about your feelings?"

"Shall we walk together for a while?"

During the initial assessment phase, which parameter would the nurse focus on for a client with panic disorder and agoraphobia? 1. Easing the client's anxiety so further interviewing may be done 2. Learning about the client's home life to facilitate the planning of future care 3. Suggesting that the client rest for a while before taking the health history 4. Helping the client identify the source of anxiety so the source may be avoided

1. Easing the client's anxiety so further interviewing may be done

Which conscious, healthy, coping behaviors would the nurse recommend a client use to reduce anxiety? Select all that apply. One, some, or all responses may be correct. 1. Eating 2. Sublimation 3. Exercise 4. Suppression 5. Rationalization 6. Talking to friends

3. Exercise 4. Suppression 6. Talking to friends

Which behavior typifies generalized anxiety disorder? 1. Inability to stop washing hands because hospital is dirty 2. Detachment while telling nurse about a traumatic event 3. Anxiety over interpersonal relationships, finances, and health 4. High level of anxiety when riding the hospital elevator

Anxiety over interpersonal relationships, finances, and health

A client with the diagnosis of panic disorder refuses to take the prescribed alprazolam because of fears of addiction. Which action would the nurse perform first? 1. Give verbal and written information about alprazolam. 2. Assess the client's beliefs and knowledge of alprazolam. 3. Ask the health care provider to change the medication. 4. Ask the health care provider to explain addiction risks.

Assess the client's beliefs and knowledge of alprazolam. Before deciding how to ease the client's fears of addiction, the nurse must explore the full extent of the client's knowledge and beliefs about taking this medication. Information may or may not be helpful; the client's beliefs must be addressed. The nurse may eventually ask the health care provider to consider changing the medication or to speak with the client about safety and risk.

Which approach would the nurse use when managing the care of a client diagnosed with generalized anxiety disorder (GAD)? 1. Creating an anxiety-free environment for the client 2. Assisting the client with the development of healthy, adaptive coping mechanisms 3. Avoiding triggers that produce anxiety in the client 4. Providing reinforcement that the client's anxiety issues can be eliminated

Assisting the client with the development of healthy, adaptive coping mechanisms The nurse would assist the client with the development of healthy, adaptive coping mechanisms. GAD is characterized by the maladaptive use of worrying as a coping mechanism. The ultimate goal is for the nurse to help the client replace the ineffective worrying with effective, healthy coping mechanisms. It is not possible or even desirable to create an anxiety-free environment; the goal is to help the client learn to deal with anxiety in a healthy manner. Although identifying triggers is an appropriate outcome, avoiding the triggers is usually not possible. It is not appropriate to falsely reassure the client that anxiety issues can be eliminated; all individuals experience anxiety and must appropriately learn to cope with those anxieties.

Which short-term nursing objective would be essential for a client with agoraphobia who is admitted to the psychiatric unit of a local hospital? 1. Feeling safe in the unit 2. Increasing self-esteem 3. Going out unaccompanied 4. Being comfortable in groups

Feeling safe in the unit

Which descriptions would the nurse expect to hear from a client describing experiences of panic? Select all that apply. One, some, or all responses may be correct. 1. Severe withdrawal 2. Hallucinations or delusions 3. A decreased need for sleep 4. Being more talkative than usual or feeling pressure to keep talking 5. Flight of ideas or the subjective experience that thoughts are racing 6. Feeling unreal (depersonalization) or that the world is unreal (derealization)

1. Severe withdrawal 2. Hallucinations or delusions 6. Feeling unreal (depersonalization) or that the world is unreal (derealization) Panic can cause severe withdrawal, hallucinations or delusions, and a sense of feeling unreal or feeling that the world is unreal (depersonalization and derealization). A decreased need for sleep, being more talkative than usual or feeling pressure to keep talking, and flight of ideas can occur with bipolar I disorder and do not commonly occur with panic.

Which clinical findings are seen in anxiety disorders? Select all that apply. One, some, or all responses may be correct. 1. Worrying about a variety of issues 2. Acting out with antisocial behavior 3. Converting the anxiety into a physical symptom 4. Displacing the anxiety onto a less threatening object 5. Decreased concentration and impaired problem-solving

1. Worrying about a variety of issues] 3. Converting the anxiety into a physical symptom 4. Displacing the anxiety onto a less threatening object 5. Decreased concentration and impaired problem-solving Excessive anxiety and worry about a number of events, topics, or activities for a 6-month duration are the hallmark of generalized anxiety disorder. Converting anxiety into a physical symptom is an example of a conversion disorder, which eases anxiety. Displacing the anxiety onto a less threatening object, which eases anxiety, is typical of a phobic disorder. Decreased concentration and impaired problem-solving will occur whenever anxiety exceeds the mild level. Acting out with antisocial behavior is more commonly found in individuals with personality disorders rather than anxiety disorders.

Which actions would the nurse take to help a client with obsessive-compulsive disorder discuss how anxiety influences feelings and the ability to function? Select all that apply. One, some, or all responses may be correct. 1. Identify manipulative behaviors. 2. Explore anxiety-provoking situations. 3. Introduce the client to socializing situations. 4. Assist the client in examining coping mechanisms. 5. Assess the quality of interpersonal relationships.

2. Explore anxiety-provoking situations. 4. Assist the client in examining coping mechanisms. The nurse would explore anxiety-provoking situations and assist the client in examining coping mechanisms. Exploration of anxiety-provoking situations is a positive first step in helping the client cope with them. By helping the client review coping mechanisms, the nurse can begin to introduce the concept of flexibility and alternative ways of behaving. Clients with obsessive-compulsive disorder do not tend to be manipulative. Introduction of social opportunities redirects the client's energy away from assessing the anxiety and evaluating how it influences daily functioning. Assessment of relationships is not an appropriate intervention for facilitating a discussion about how anxiety affects the client's feelings and ability to function.

The nurse is developing a care plan for a client with severe generalized anxiety disorder. Which intervention would the nurse include to maintain safety? Select all that apply. One, some, or all responses may be correct. 1. Providing individual counseling 2. Collaborating with all disciplines 3. Instructing on relaxation exercises 4. Delivering calm and consistent care 5. Maintaining a low-stimulation environment

4. Delivering calm and consistent care 5. Maintaining a low-stimulation environment

The nurse teaches a client about ways to manage stress and anxiety. Which statement by the client indicates the need for further instruction? 1. "I should avoid exercise to prevent physical stress on the body." 2. "Journaling can help identify stressors and other things that are causing anxiety." 3. "Trying to find humor in a stressful situation can help make it easier to deal with." 4. "Reframing a negative situation in a positive light can help me change my perception about the situation."

"I should avoid exercise to prevent physical stress on the body."

Which best response would the nurse make to a client with severe anxiety who starts to cry uncontrollably while talking with the nurse? 1. "Talking about your problem is upsetting you." 2. "It's okay to cry; I'll just stay with you for now." 3. "Sometimes it helps to get it out of your system." 4. "You look upset; let's talk about why you're crying."

"It's okay to cry; I'll just stay with you for now." The nurse would say, "It's okay to cry; I'll just stay with you for now." Telling the client that it is all right to cry and offering to stay presents a nonjudgmental attitude that recognizes the client's needs and shows acceptance by the nurse. Although saying, "Talking about your problem is upsetting you" is appropriate, it is not the best response because the nurse is making an observation rather than showing acceptance. Telling the client that it helps to get it out of the system implies that crying will make the client feel better and therefore is false reassurance. Although saying the client looks upset is acceptable, it is not the best because the nurse uses "why," which can put the client on the defensive. Asking the client to describe why is unrealistic; the anxiety level must be lowered before a discussion can begin.

Which response would best reflect that the anxious client's cognitive abilities have been affected by the anxiety when asked, "What brought you to the emergency department tonight"? 1. "It's obvious why I came to the emergency department." 2. "The ambulance brought me to the emergency department." 3. "Why do you want to know why I came to the emergency department?" 4. "What do you mean by 'What brought you to the emergency department'?"

"The ambulance brought me to the emergency department." Saying, "The ambulance brought me to the emergency department," would alert the nurse the client's cognitive abilities are affected. Cognitive impairment is a common response to acute anxiety. Such impairment is often observed as an inability to appropriately interpret abstract questions. The response is generally very concrete, as seen in the client's response to the nurse's question, "The ambulance brought me to the emergency department." The statement, "It's obvious why I came to the emergency department," demonstrates agitation rather than cognitive impairment. "Why do you want to know why I came to the emergency department?" is a response that demonstrates paranoia or defensiveness rather than cognitive impairment. The question, "What do you mean by 'What brought you to the emergency department'?" demonstrates a fairly high degree of cognitive processing, because the client is asking for clarification.

Which response would the nurse make to a client with panic disorder who had a panic attack on the previous day and says, "That was a terrible feeling I had yesterday. I'm so afraid to talk about it"? 1. "Okay; we don't have to talk about it." 2. "Why don't you want to talk about it?" 3. "What were you doing yesterday when you first noticed the feeling?" 4. "I understand, but don't be concerned; that feeling probably won't come back."

"What were you doing yesterday when you first noticed the feeling?" The response, "What were you doing yesterday when you first noticed the feeling?" helps the client focus on a situation that has precipitated anxious feelings. Saying, "Okay; we don't have to talk about it," avoids an opportunity for the nurse to help the client explore feelings. The client may not be able to answer the question, "Why don't you want to talk about it?" The focus should be on feelings and the use of "why" should be avoided. The response, "I understand, but don't be concerned; that feeling probably won't come back," is false reassurance; the nurse cannot guarantee that the feelings will not come back. Unfortunately, these feelings usually reappear with panic attacks.

Which initial question by the nurse would be most therapeutic to alleviate the anxiety of the client who is pacing the floor and appears extremely anxious? 1. "What's made you so upset?" 2. "Where would you like to walk with me?" 3. "Shall we sit down to talk about your feelings?" 4. "How would you like to go to the gym to work out?"

"Where would you like to walk with me?"

Which statement would the nurse make to a client with generalized anxiety disorder who asks, "What can I do to keep myself from overreacting to stress?" 1. "Try to recognize the problem." 2. "Improve your time-management skills." 3. "Ignore situations that affect you deeply." 4. "Work on identifying and developing coping strategies."

"Work on identifying and developing coping strategies."

Which response would the nurse make to a client who has just experienced a panic attack? 1. "I would have been upset, too." 2. "You are concerned that this might happen again." 3. "Episodes like this will always come to an end." 4. "Your family must have thought that you were having a heart attack."

"You are concerned that this might happen again." The nurse would say, "You are concerned that this might happen again." Recurrence of attacks is a common concern. Stating that the nurse would have been upset too redirects the focus to the nurse, which is not therapeutic. Although episodes like this do end, it is too early to say this because communication about feelings is cut off. Saying that the family must have thought you were having a heart attack places the focus on what the family believes, and the focus should be on the client.

Which behavior is most commonly used by an individual with a phobic disorder? 1. Rumination 2. Desensitization 3. Avoidance 4. Confrontation

Avoidance The person transfers anxieties to activities or objects, usually inanimate objects, which are then avoided to decrease anxiety. Rumination (continuously rethinking about an issue) is more common in depression. Desensitization is a therapy that is used to treat phobias by systematically exposing the individual to the phobic object using a series of small steps. People with phobias fear confrontation with the phobic object and are less likely to attempt this without the help of a therapist.

When planning nursing care for a client with severe agoraphobia, which action would the nurse take first? 1. Determine the client's degree of impairment. 2. Support the client's self-esteem through verbal interactions. 3. Expose the client gradually to anxiety-provoking situations. 4. Teach the client biofeedback techniques for reducing anxiety.

Determine the client's degree of impairment. The first step is to determine the client's degree of impairment. Assessment is the first step of the nursing process and must be done before care is planned. Nursing interventions follow assessment and planning; supporting the client's self-esteem through verbal interactions is an intervention. Exposing the client gradually to anxiety-provoking situations or teaching biofeedback techniques may be done once the client's degree of impairment is assessed; assessment is the first step.

The nurse advises a client with anxiety to focus on a positive scene. Which relaxation technique is the nurse using? 1. Meditation 2. Biofeedback 3. Guided imagery 4. Progressive muscle relaxation

Guided imagery

Which method would the nurse use to help a client ease anxiety? 1. Avoiding unpleasant events 2. Prolonging exposure to fearful situations 3. Introducing an element of pleasure into fearful situations 4. Helping the client acquire skills with which to face stressful events

Helping the client acquire skills with which to face stressful events The nurse would help the client acquire skills with which to face stressful events. Learning a variety of coping mechanisms helps reduce anxiety in stressful situations. A person must learn to cope with unpleasant events; they cannot be avoided. Prolonged exposure may increase anxiety to possibly uncontrollable levels. Fearful situations can never be viewed as pleasurable.

Which outcome would indicate a client who was hospitalized with severe anxiety is ready to be discharged? 1. Follows rules of the milieu 2. Maintains anxiety at a manageable level 3. Verbalizes positive aspects about the self 4. Recognizes that hallucinations can be controlled

Maintains anxiety at a manageable level Maintaining anxiety at a manageable level would indicate the client is ready to be discharged. 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 priority outcomes for discharge; the client has probably had little difficulty in these areas. No evidence was presented in the scenario to indicate that the client is hallucinating.

Which comorbid disorder is most commonly associated with generalized anxiety disorder (GAD)? 1. Post-traumatic stress disorder 2. Major depressive disorder 3. Histrionic personality disorder 4. Primary hyperinsomnia

Major depressive disorder The most frequent comorbid condition associated with GAD is depression. GAD is excessive worry over an event or situation (relationships, finance, health). Post-traumatic stress disorder can occur after an extremely traumatic event. Histrionic personality disorder is characterized by excessive emotional displays or attention-seeking behavior. Clients with GAD have sleep disturbance, but insomnia (not hypersomnia) is caused by excessive worrying.

Which level of anxiety enhances the client's learning abilities? 1. Mild 2. Panic 3. Severe 4. Moderate

Mild 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.

Which nursing intervention would be indicated for a client with an anxiety disorder? 1. Encouraging suppression of anger by the client 2. Promoting verbalization of feelings by the client 3. Limiting involvement of the client's family during the acute phase 4. Explaining why the client should accept the psychological factors that are precipitating the anxiety

Promoting verbalization of feelings by the client The nurse would promote verbalization of feelings by the client. Freedom to express feelings serves as a safety valve to reduce anxiety. Suppression of anger or hostility may add to the client's anxiety. Limiting involvement of the client's family during the acute phase may or may not be helpful; the client's family members may provide support. Explaining why the client should accept the psychological factors that are precipitating the anxiety is not therapeutic; accepting current situational stresses may not be possible.

Which behavior by the client would indicate to the nurse that a client has successfully achieved the long-term outcome of using effective coping responses when feelings of anxiety begin? 1. Performs a relaxation exercise 2. Gets involved in some type of quiet activity 3. Avoids the situation that precipitated the anxiety 4. Examines carefully what precipitated the anxiety

Performs a relaxation exercise Relaxation techniques refocus energy and eventually ease physical and emotional stress. Getting involved in some type of quiet activity is not always possible; forced quiet activity may increase stress and anxiety rather than reduce it. Avoiding the situation that precipitated the anxiety would not indicate effective coping; stress can develop from a variety of feelings stimulated by many situations. Although examining what precipitated the anxiety is appropriate after the incident, it is not an effective coping response for when feelings of anxiety begin.

To determine the effectiveness of therapy, which behavior would the nurse assess for in a client with generalized anxiety disorder? 1. Participating in activities 2. Learning how to avoid anxiety 3. Taking medications as prescribed 4. Recognizing when anxiety is developing

Recognizing when anxiety is developing Recognition of anxiety or symptoms of increasing anxiety is an indication that the client is improving. Participating in activities does not indicate improvement or recognition of feelings; the client may be doing what others expect. Avoidance of anxiety is not a good indication of improvement; there is no guarantee that anxiety can always be avoided. Taking medications as prescribed does not indicate improvement or recognition of feelings; the client may be doing what others expect.

Which characteristic distinguishes post-traumatic stress disorders from other anxiety disorders? 1. Lack of interest in family and others 2. Reliving the trauma in dreams and flashbacks 3. Avoidance of situations that resemble the stress 4. Blunted affect when discussing the traumatic situation

Reliving the trauma in dreams and flashbacks

Which action would be taken when a nurse's personal feelings of anxiety are increasing while caring for an anxious client? 1. Refocus the conversation to more pleasant topics. 2. Tell the client, "Calm down. You're making me anxious, too." 3. Say, "Another staff member is coming in. I'll leave and come back later." 4. Remain quiet so personal feelings of anxiety do not become apparent to the client.

Say, "Another staff member is coming in. I'll leave and come back later." The nurse would say, "Another staff member is coming in. I'll leave and come back later." The nurse who is anxious would leave the situation after ensuring continuity of care; the client will be aware of the nurse's anxiety, and the nurse's presence will be nonproductive and nontherapeutic. The client will probably sense the nurse's anxiety through nonverbal channels, if not through verbal responses. Refocusing the conversation and asking the client to calm down both meet the nurse's need; the anxious client's needs must be met, not the nurse's. The client will be aware of the nurse's anxiety, which will increase the client's own anxiety if the nurse remains quiet.

A client has been diagnosed with generalized anxiety disorder (GAD). Which behavior would the nurse expect to observe? 1. Making huge efforts to avoid "any kind of bug or spider" 2. Experiencing flashbacks to an event that involved a sexual attack 3. Spending hours each day worrying about something "bad happening" 4. Becoming suddenly tachycardic and diaphoretic for no apparent reason

Spending hours each day worrying about something "bad happening" Using worrying as a coping mechanism is a behavior characteristic of GAD. Avoiding bugs and spiders would indicate a phobia. Flashbacks to traumatic events are characteristic of post-traumatic stress disorder (PTSD). Experiencing an accelerated heart rate and perfuse sweating for no apparent reason is consistent with a panic attack.

Which action would the nurse take first for a client who comes to a mental health center with severe anxiety, evidenced by crying, hand-wringing, and pacing? 1. Stay physically close to the client. 2. Gently ask what is bothering the client. 3. Tell the client to try to relax by sitting quietly. 4. Get the client involved in a nonthreatening activity.

Stay physically close to the client. The nurse would first stay physically close to the client. By staying physically close to the client during the time of severe anxiety, the nurse conveys the message that someone cares enough to be there during this frightening incident and that the client is a person worthy of care. Gently asking what is bothering the client will occur later after the client's anxiety has decreased. Sitting still will increase the tension the client is experiencing. Involving the client in a nonthreatening activity is not an initial nursing intervention; this will come later after the anxiety has abated.

Which action would the nurse take for a client with panic disorder who jumps when spoken to, reports feeling uneasy, and says, "It's as though something bad is going to happen"? 1. Stay with the client to be a calming presence. 2. Encourage the client to communicate with the staff. 3. Allow the client to set the parameters for the interaction. 4. Help the client understand the cause of the feelings described.

Stay with the client to be a calming presence.

Which intervention would the nurse include in a plan of care for a client with an anxiety disorder? 1. Promoting the suppression of anger by the client 2. Supporting the verbalization of feelings by the client 3. Encouraging the client to limit anxiety-related behaviors 4. Restricting the involvement of the client's family during the acute phase

Supporting the verbalization of feelings by the client The nurse would include the intervention to support the verbalization of feelings by the client. Freedom to ventilate feelings serves as a safety valve to reduce anxiety. The suppression of anger may increase the client's anxiety. Encouraging the client to limit anxiety-related behaviors is not therapeutic; it may increase the anxiety that the client is feeling. Restricting the involvement of the client's family during the acute phase may or may not be helpful; the client's family may provide support to the client.

For a client who is increasingly agitated, which immediate nursing intervention is most likely to increase anxiety? 1. Being assertive 2. Responding early 3. Providing choices 4. Teaching relaxation

Teaching relaxation Once the client is agitated, teaching will not be effective. Learning requires attention and participation; failure to learn will increase the client's anxiety. Teaching relaxation techniques can be done once the client calms down. Being assertive (not aggressive) shows the client that the nurse is confident in handling the situation. This may help reduce the client's anxiety. Responding before agitation escalates makes interventions more likely to be successful. Providing choices may help the client feel less threatened and avoids a power struggle.

Which verbalization from a client with a dissociative identity disorder, who is to be discharged after a 2-week hospitalization, would indicate effectiveness of the short-term therapy? 1. The ability to deal openly with feelings 2. That many of the personalities can be ignored 3. The need for long-term outpatient psychotherapy 4. That the personalities serve no protective purpose

The need for long-term outpatient The nurse would expect the client to verbalize the need for long-term outpatient psychotherapy. A dissociative identity disorder is a complex, multifaceted problem that requires long-term therapy to achieve integration of the personalities. Although the ability to deal openly with feelings is important, it is a long-term goal. Each personality has the ability to deal openly with feelings, but the personalities need to be integrated. None of the personalities can be ignored, because their presence must be dealt with before integration can occur. The multiple personalities do serve a protective purpose. If they did not serve a protective purpose, they would be abandoned.

An anxious, panicked client states, "I admitted myself because I think I'm going crazy." Which interpretation would the nurse make about the client's remark? 1. This is a plea for support. 2. The client has insight. 3. This is a symptom of depression. 4. The client is testing the nurse's trust.

This is a plea for support. The client's statement is a plea for support. Anxiety is a threat to the identity of the individual; the client is seeking assurance that the anxiety and panic being experienced will not mean loss of control. This is not evidence of insightfulness but instead is a plea for help in reducing the anxiety. The client is not exhibiting depression but is instead exhibiting anxiety and panic. The client is not testing the nurse's trust; the client is asking for help.

Which action would the nurse take when a client experiences a panic attack? 1. Use short sentences and an authoritative voice. 2. Describe the possible reasons for the client's anxiety. 3. Keep asking questions, because the client is probably not going to volunteer much information. 4. Suggest that the client refrain from crying, because most of the time crying makes matters worse.

Use short sentences and an authoritative voice. The nurse would use short sentences and an authoritative voice. During a panic attack the attention span is shortened, making it difficult to follow long sentences. An authoritative voice lets the client know that the nurse is in control of the situation; the client is unable to set controls because of the anxiety level. Describing to the client the possible reasons for the anxiety may increase the client's anxiety level further. Asking questions may increase the client's anxiety level further; it is hard to focus during a panic attack. Crying is an outlet and would not be discouraged; telling someone not to cry usually worsens the crying and the anxiety.

In which situation is a client likely to experience a phobic reaction? 1. When seeking attention from others 2. When thinking about the feared object 3. When coming into contact with the feared object 4. When being exposed to an unfamiliar environment

When coming into contact with the feared object The anxiety and resulting feelings will be precipitated only when the client is in direct contact with the object or situation. Phobias are severe anxiety reactions, not attention-seeking actions. It is not thinking about the feared object that causes anxiety; it is the possibility of having to come into contact with it. It is the presence of the phobic object or situation that triggers the anxiety, not the unfamiliarity of the environment.