ch. 11

Which statement describes the major distinction between fear and anxiety?

Fear is a response to a specific danger; anxiety is a response to an unknown source. Fear and anxiety are both experienced to some degree in healthy individuals and may contribute to constructive action. Both fear and anxiety have psychological and physiological components.

Which symptom is commonly associated with panic attacks?

Fear of impending doom. Panic attacks are associated with an extreme fear of impending doom. Fever, apathy, and obsessions are not typically associated with panic attacks.

Which level of anxiety is exhibited when the nurse observes a patient wide-eyed, repeating nonsensical statements, running from chair to chair, and not following staff direction or verbal efforts to calm the patient?

Panic. Panic-level anxiety results in markedly disorganized, disturbed behavior, including confusion, shouting, and hallucinating. Individuals may be unable to follow directions and may need external limits to ensure safety. Mild, moderate, and severe levels of anxiety typically do not include such extreme behavior.

Which phrase describes a likely potential problem for a patient diagnosed with severe obsessive-compulsive disorder?

Sleep disturbance. Patients who must engage in compulsive rituals for anxiety relief rarely are afforded relief for any prolonged period. The high anxiety level and need to perform the ritual may interfere with sleep. Excessive socialization, command hallucinations, and altered states of consciousness are not typically associated with obsessive-compulsive disorder.

Which instruction would the nurse provide to a patient diagnosed with anxiety and prescribed buspirone?

"It will take 3 or more weeks for you to feel the full benefit." Buspirone is an alternative antianxiety medication that does not cause dependence, but 3 or more weeks are required for it to reach full effect. It should be taken with food. The drug may be used for long-term treatment and should be taken regularly. Aged cheese products should be avoided when taking monoamine oxidase inhibitors (MAOIs).

Which phrase is the definition of obsession?

A recurrent, persistent thought or impulse Obsessions are thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind. An intense irrational fear of an object or situation is a phobia. A recurrent behavior is a compulsion. Immediately taking an action is not related to obsession. Test-Taking Tip: Sometimes the reading of a question in the middle or toward the end of an exam may trigger your mind with the answer or provide an important clue to an earlier question.

Which statement is true regarding the comorbidity of anxiety disorders?

A second anxiety disorder may co-occur with the first. In many instances, when one anxiety disorder is present, a second one co-occurs. Health care providers and researchers have clearly shown that anxiety disorders frequently co-occur with other psychiatric problems. Major depression often co-occurs and produces a greater impairment with poorer response to treatment. Substance abuse also frequently co-occurs and has a negative impact on treatment.

Which brain structure is involved in a fear of riding in elevators and the resulting behavior of always takes the stairs?

Amygdala. The amygdala plays a role in anxiety disorders. It alerts the brain to the presence of danger and brings about fear or anxiety to preserve the system. Memories with emotional significance are stored in the amygdala and are implicated in phobic responses. The thalamus relays sensory information to other brain centers. The hypothalamus is involved in regulation of the autonomic nervous system. The pituitary gland secretes regulatory hormones. Test-Taking Tip: Identifying content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options.

Which scenario presents the most accurate example of altruism?

An individual who received a liver transplant volunteers at a local organ procurement agency. Altruism is a healthy defense mechanism in which emotional conflicts and stressors are addressed by meeting the needs of others. With altruism, the person receives gratification either vicariously or from the response of others. Volunteering at a local organ procurement agency after receiving an organ transplant would meet the needs of others. Attending a support group, playing tennis, and volunteering at an animal shelter to address one's own fears are all examples of meeting the individual's needs, but they are not necessarily altruistic.

Which theory is evident when a patient tells the nurse "My mother and I are afraid of the dark, so we both always carry a flashlight?

Behavioral theory. According to behavioral theory, the patient shows a learned response to specific environmental stimuli. The patient has observed his or her mother's fear of darkness and also developed a fear of darkness. According to cognitive theory, the patient has poor perception of situations and tends to develop a panic attack by thinking about the situation. According to interpersonal theory, the patient develops emotional distress transmitted from the parents or caregivers. According to psychodynamic theory, anxiety disorder is developed in a person during childhood as a result of unconscious conflicts in his or her surroundings.

Which action would the nurse document in the health record as passive-aggressive behavior by a patient who is using immature defense mechanisms? Select all that apply. One, some, or all responses may be correct.

Being hostile after agreeing to follow unit rules. Avoiding completing tasks when asked by the boss at work. The patient is displaying passive-aggressive behavior when he or she agrees to follow the rules and then becomes hostile toward the nurse. Another example of passive-aggressive behavior is not completing assigned tasks when deadlines are placed at work by the boss. Rationalization is justifying bad behavior as a result of the behavior of others, such as having an affair because a spouse is also cheating. The nurse should document that the patient is splitting if the patient yells at the nurse after providing a compliment. The patient is using projection when blaming family members for losing a job.

Which category of medication used to treat anxiety has a potential for addiction?

Benzodiazepines. Benzodiazepines are commonly prescribed for anxiety because they have a quick onset of action; however, because of the potential for addiction, these medications ideally should be used only for short periods and are not recommended for patients with a known substance abuse history. Tricyclics, selective serotonin reuptake inhibitors, and selective serotonin norepinephrine reuptake inhibitors do not create addiction.

Which medication is used to treat anxiety disorders? Select all that apply. One, some, or all responses may be correct.

Clonidine Paroxetine Alprazolam Venlafaxine Propranolol Clonidine is a nonadrenergic drug used to treat anxiety disorders and panic attacks. Paroxetine is a selective serotonin reuptake inhibitor (SSRI) used to treat generalized anxiety disorder (GAD). Alprazolam is used short-term to manage panic disorders and agoraphobia. Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) used for anxiety, depression, and nerve pain. Propranolol is a nonadrenergic beta blocker that is used for short-term relief of social and performance anxiety.

Which intervention would the nurse apply to help a patient maintain hygiene if the patient is diagnosed with obsessive-compulsive disorder and takes several hours to perform self-care?

Discussing with the patient his or her feelings about self-care. Patients diagnosed with obsessive-compulsive disorder spend several hours maintaining hygiene. The nurse should talk with the patient regarding self-care and encourage the patient to express his or her feelings and thoughts about self-care to help reduce the compulsive behavior. Limiting the choice of clothing would help the patient select clothes quickly. The nurse should give simple directions to the patient to enhance self-hygiene. The nurse should not dress the patient but can assist the patient in dressing. The nurse should encourage the patient to perform the task independently.

Which defense mechanism is being used by a patient after an argument in which the patient blamed the spouse for a new diagnosis of heart failure? Select all that apply. One, some, or all responses may be correct.

Displacement The patient is displacing anger regarding his or her diagnosis onto the spouse. Repression occurs when a person forgets something that is tied to a bad experience. Somatization occurs when suppressed anxiety causes physical illness. Rationalization is the justification of illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations for the behavior. A patient who has hatred toward something and then does the opposite is an example of reaction formation.

Which defense mechanism would the nurse recognize that a patient is using who reports increased anxiety in uncomfortable situations and cracking jokes when under a lot of stress?

Humor. The patient is using humor when cracking jokes in stressful situations. Undoing would be giving a gift to someone after having an argument. Sublimation would be substituting an acceptable activity for one that is not. Suppression would be denying feelings that are present.

Which level of anxiety is experienced when selective inattention is first noted?

Moderate. Selective inattention is noted in patients with moderate anxiety. The individual's perceptual field is reduced, and he or she is not able to see the entire picture of events. Selective inattention is not a feature of mild, severe, or panic-level anxiety.

For which reason would someone feel mildly tense but eager to begin a job interview?

Normal anxiety Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions. Denial involves ignoring unpleasant realities. Compensation involves adopting opposite behaviors or emotions to deal with unpleasant ones. Selective inattention involves narrowing one's perceptual field.

Which cause would be the likely reason for changing study habits to earn better grades after initially failing a test?

Normal anxiety. Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions. Altruism involves addressing stressors by meeting the needs of others. Idealization involves attributing exaggerated positive qualities to others. Acting-out behavior is a destructive coping style of lashing out at others.

Which anxiety disorder involves the inability to leave one's home because of severe anxiety?

Panic attacks with agoraphobia. Panic disorder with agoraphobia is characterized by recurrent panic attacks combined with agoraphobia. Agoraphobia involves intense, excessive anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available if a panic attack occurred. Symptoms of obsessive-compulsive disorder include intrusive thoughts and/or ritualistic behaviors. Posttraumatic stress disorder occurs after an individual experiences or witnesses severe trauma. Generalized anxiety disorder is a chronic disorder marked by excessive and constant worrying.

Which statement is true regarding obsessive-compulsive disorder (OCD)?

Patients diagnosed with OCD should be assessed regularly for risk for suicide. People suffering from OCD may become desperate and attempt suicide. Risk for suicide should be assessed regularly in these patients. OCD can begin in childhood, with symptoms present as early as 3 years of age, but symptoms would not be expected in infancy. People with OCD rarely need hospitalization unless they are suicidal or have compulsions that cause injury. Compulsions are ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety. Obsessions are thoughts, impulses, or images that persist, recur, and cannot be dismissed from the mind.

Which phrase describes an example of response prevention specified in a plan of care for a patient who uses elaborate washing rituals?

Preventing the patient from washing hands after touching a dirty object. Response prevention is a technique by which the patient is prevented from engaging in the compulsive ritual. A form of behavior therapy, response prevention is never undertaken without health care provider approval. Not allowing the patient to wash hands after touching a perceived "dirty" object is an example of response prevention. Withholding reassurance, having the patient repeatedly touch dirty objects, and telling the patient to relax are not examples of response prevention.

Which behavior is characteristic of an individual who is displaying passive aggression?

Procrastinating. A passive-aggressive person deals with emotional conflict by indirectly and unassertively expressing aggression toward others. Procrastination is an expression of resistance. Lying, stealing, and slapping are direct aggressions.

Which intervention by the nurse would be relevant for a patient with social phobia who is receiving cognitive behavioral therapy?

Re-evaluating the patient's situation Cognitive behavioral therapy helps patients learn to control negative feelings. The nurse should re-evaluate the situation realistically and develop a positive insight in the patient by replacing the negative thoughts. The nurse should not support the patient's negative beliefs. The nurse should not give his or her own opinion on the patient's thoughts, because doing so may make the patient feel rejected. The nurse should not isolate the patient from peers, because doing so could cause withdrawal and aggression in the patient.

Which behavior indicates adaptive coping when an adult notices the turkey is burned and inedible just before guests arrive for Thanksgiving dinner?

Saying to the guests, "We are having a vegetarian Thanksgiving dinner this year." In this scenario, announcing a vegetarian dinner indicates the adult has adapted to the anxiety-producing situation. Leaving guests unattended and canceling the dinner are dysfunctional responses. Saying the oven malfunctioned demonstrates maladaptive use of displacement.

The nurse would expect the health care provider to prescribe an immediate dose of which type of medication for a patient experiencing a panic attack?

Short-acting benzodiazepine. A short-acting benzodiazepine is the only type of medication listed that would lessen the patient's symptoms of anxiety within a few minutes. Anticholinergics do not lower anxiety. Standard antipsychotic medications will lower anxiety but have a slower onset of action and the potential for more side effects. Tricyclic antidepressants have very little antianxiety effect and have a slow onset of action.

Which symptom indicates a moderate level of anxiety? Select all that apply. One, some, or all responses may be correct.

Talking in trembling voices. Increased rates of respiration. People having moderate anxiety have voice tremors and tend to talk in a trembling voice. They show increased pulse rate and respiratory rate. In severe anxiety, people are usually confused and are unable to make decisions. They cannot make decisions to solve problems at an optimum level. People with mild anxiety exhibit mild tension-relieving behavior such as foot or finger tapping and lip chewing.

Which sign would indicate to the nurse that a patient's anxiety has decreased after helping the patient perform deep breathing exercises for severe anxiety?

The patient demonstrates selective inattention. In the patient with severe anxiety, learning may be impaired because of inattention. The individual can focus on only one particular detail and has difficulty noticing what is going on in the environment, even if another person points it out. A patient with moderate anxiety demonstrates selective inattention, wherein the patient can perceive stimuli in the environment when it is pointed out. Therefore, for a patient with severe anxiety, selective inattention indicates improvement. Being confused is an indicator of severe anxiety. Pacing, running, shouting, and false sensory perceptions would not be seen in a patient with severe anxiety; these are manifestations of panic attack.

Which is the most likely diagnosis the nurse would expect the health care provider to make for a patient who compulsively looks at his or her reflection in the mirror?

The patient has body dysmorphic disorder Body dysmorphic disorder is characterized by a preoccupation with an imagined defective body part. Patients with body dysmorphic disorder often pay excessive attention to body parts that they imagine to be defective. As a result, they may compulsively look at themselves in the mirror. Patients with panic disorder may have an unusual fear of future events. In hoarding disorder, the patient accumulates and collects materials for future use. Obsessive-compulsive disorder is marked by performing repeated activities or rituals.

Which statement describes the nurse's objective when using strategies that will induce a slight degree of anxiety for patients attending a teaching session?

The patients will be more focused during the session. Mild anxiety causes patients to see, listen, and grasp more information. This helps the patients focus more on whatever is taught during the teaching session. Mild anxiety is not likely to improve the patients' expression, comfort level, or willingness to participate.

Which statement about panic attacks is true? Select all that apply. One, some, or all responses may be correct.

They are characterized by a sudden onset of extreme apprehension. The fear is so intense that it interferes with a person's ability to function normally. People with a history of panic attacks develop a deep-seated fear of having an attack.

Which phrase describes the primary purpose of performing a physical examination before beginning treatment for any anxiety disorder?

To determine whether the anxiety is primary or secondary in origin. The symptoms of anxiety can be caused by an underlying physical disorder. The treatment for secondary anxiety is treatment of the underlying cause. The physical examination does not serve to protect the nurse legally. The physical examination may inform the nursing diagnoses, but this is not its primary purpose. Information about the patient's psychosocial background can be obtained by interviewing the patient, not through a physical examination.