Ch. 27 Phobias, Panic Disorders, GAD, Anxiety

67. The nurse is assessing a patient who is diagnosed with obsessive-compulsive disorder. Which of the patient's statements would the nurse correctly identify as a compulsion? 1) "I can't stop washing my hands." 2) "I can't stop thinking that I'm going to get deathly ill." 3) "I need drugs to help me with this anxiety." 4) "These symptoms are interfering with my ability to get my work done."

1) "I can't stop washing my hands." A compulsion is a repetitive, ritualistic act, the purpose of which is to reduce anxiety associated with obsessive thoughts. Compulsive handwashing is an example of this behavior.

61. Gary is admitted to the mental health center for treatment of obsessive-compulsive disorder. He tells the nurse that he has a repetitive fear that he has forgotten to lock the doors to his home. Which symptom of this disorder is Gary describing? 1) An obsession 2) A compulsion 3) Auditory hallucinations 4) Claustrophobia

1) An obsession An obsession is a recurrent, intrusive, stressful thought, and this is what Gary is describing in the scenario.

85. Forrest is seeking treatment for an anxiety disorder after his wife tells him she wants a divorce. He reports to the nurse "I know it sounds crazy but I feel like everybody hates me." According to cognitive theory this statement would be an example of which of the following? 1) Cognitive distortion 2) Sublimation 3) Delusion of grandeur 4) Delusion of persecution

1) Cognitive distortion Forrest's statement is an example of overgeneralizing, which is a cognitive distortion or irrational thought. Cognitive distortions, according to cognitive theory, are counterproductive thinking patterns that lead to maladaptive behaviors and emotions.

76. Which of the following is a primary function of nurse generalists in helping clients with anxiety and related disorders? 1) Facilitate the client's development of insight and self-awareness in relation to his or her illness. 2) Decide which antianxiety agent is most appropriate to treat the symptoms.3) Use behavioral therapies such as systematic desensitization and implosion.4) Conduct psychological tests to support proper diagnosis of the anxiety disorder.

1) Facilitate the client's development of insight and self-awareness in relation to his or her illness. Self-awareness and insight into an individual's stressors and anxiety responses lay the foundation for effective treatment and intervention. The nurse generalist plays a key role in helping clients develop this awareness and insight.

70. A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) spends 1 hour packing and unpacking and folding and refolding personal belongings. What is the most likely reason for this behavior? 1) It relieves anxiety. 2) It fosters organizational skills. 3) It delays meeting unfamiliar people in the dayroom. 4) It makes the client feel good.

1) It relieves anxiety. OCD is characterized by recurrent thoughts or ideas (obsessions) that an individual is unable to put out of his or her mind and actions that an individual is unable to refrain from performing (compulsions). This behavior directs the client away from the underlying anxiety and focuses the client on a repetitive activity, such as packing and unpacking and folding and refolding personal belongings.

68. A client is experiencing a panic attack. He states, "I'm losing control. I feel like I'm going crazy." Which nursing intervention takes priority? 1) Stay with the client and offer support. 2) Distract the client by redirecting him to physical activities. 3) Teach about the etiology and management of panic disorders. 4) Encourage the client to express his feelings.

1) Stay with the client and offer support. During a panic attack, the client is experiencing extreme levels of anxiety. The symptoms experienced may mimic life-threatening physiological symptoms, such as chest pain and feelings of suffocation and/or impending doom. Clients need reassurance that these symptoms are psychologically, not physiologically, based. It is a priority to be present for the client and offer this support.

75. After losing a child in a car accident, a client diagnosed with post-traumatic stress disorder (PTSD) asks the nurse, "Why did I live and my beautiful daughter die?" Which is the client experiencing? 1) Survivor's guilt 2) Anger 3) Denial 4) Suppression

1) Survivor's guilt Survivor's guilt is a common situation that occurs when an individual experiences a traumatic event in which others die and the individual survives.

71. After undergoing a complete diagnostic work-up, a client is diagnosed with post-traumatic stress disorder (PTSD). What must the nurse understand about the symptoms of PTSD before planning care? 1) Symptoms are psychological coping mechanisms. 2) Symptoms result in feelings of invulnerability. 3) Symptoms are a means to manipulate others. 4) Symptoms develop from a nonspecific psychic event.

1) Symptoms are psychological coping mechanisms. Symptoms of PTSD include psychological numbing, flashbacks, nightmares, and explosive anger. These symptoms are coping mechanisms used to deal with anxiety by blocking memories of traumatic events. Resolution of the post-trauma response is largely dependent on the effectiveness of the coping strategies employed.

60. What should the nurse plan to teach a client who is taking alprazolam (Xanax) three times a day? 1) That there is a potential for dependence and tolerance 2) The importance of discontinuing Xanax immediately if addiction is suspected 3) The importance of increasing the amount of caffeine consumption 4) That Xanax is not habit forming

1) That there is a potential for dependence and tolerance Xanax is a benzodiazepine and has addictive properties. It is the responsibility of the nurse to teach the client about dependence, tolerance, and other signs and symptoms of addiction.

27. Which of the following symptom assessments would validate the diagnosis of generalized anxiety disorder? Select all that apply. 1. Excessive worry about items difficult to control. 2. Muscle tension. 3. Hypersomnia. 4. Excessive amounts of energy. 5. Feeling "keyed up" or "on edge."

1. A client diagnosed with generalized anxiety disorder (GAD) would experience excessive worry about items difficult to control. 2. A client diagnosed with GAD would experience muscle tension. 5. A client diagnosed with GAD would experience an increased startle reflex and tension, causing feelings of being "keyed up" or being "on edge."

18. Which of the following would the nurse expect to assess in a client diagnosed with posttraumatic stress disorder? Select all that apply. 1. Dissociative events. 2. Intense fear and helplessness. 3. Excessive attachment and dependence toward others. 4. Full range of affect. 5. Avoidance of activities that are associated with the trauma.

1. A client diagnosed with posttraumatic stress disorder (PTSD) may have dissociative events in which the client feels detached from the situation or feelings. 2. A client diagnosed with PTSD may have intense fear and feelings of helplessness. 5. A client diagnosed with PTSD avoids activities associated with the traumatic event.

31. A client leaving home for the first time in a year arrives on the psychiatric in-patient unit wearing a surgical mask and white gloves. The client states, "The germs in here are going to kill me." Which nursing diagnosis addresses this client's problem? 1. Social isolation R/T fear of germs AEB continually refusing to leave the home. 2. Fear of germs R/T obsessive-compulsive disorder. 3. Ineffective coping AEB dysfunctional isolation R/T unrealistic fear of germs. 4. Anxiety R/T the inability to leave home, resulting in dysfunctional fear of germs.

1. According to the North American Nursing Diagnosis Association (NANDA), the nursing diagnosis format must contain three essential components: (1) identification of the health problem, (2) presentation of the etiology (or cause) of the problem, and (3) description of a cluster of signs and symptoms known as "defining characteristics." The correct answer, 1, contains all three components in the correct order: health problem/NANDA stem (social isolation); etiology/cause, or R/T (fear of germs); and signs and symptoms, or AEB (refusing to leave home for the past year). Because this client has been unable to leave home for a year as a result of fear of germs, the client's behaviors meet the defining characteristics of social isolation.

54. A client rates anxiety at 8 out of 10 on a scale of 1 to 10, is restless, and has narrowed perceptions. Which of the following medications would appropriately be prescribed to address these symptoms? Select all that apply. 1. Chlordiazepoxide (Librium). 2. Clonazepam (Klonopin). 3. Lithium carbonate (Lithium). 4. Clozapine (Clozaril). 5. Oxazepam (Serax).

1. Chlordiazepoxide (Librium) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. 2. Clonazepam (Klonopin) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. 5. Oxazepam (Serax) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety.

25. Anxiety is a symptom that can result from which of the following physiological conditions? Select all that apply. 1. Chronic obstructive pulmonary disease. 2. Hyperthyroidism. 3. Hypertension. 4. Diverticulosis. 5. Hypoglycemia.

1. Chronic obstructive pulmonary disease causes shortness of breath. Air deprivation causes anxiety, sometimes to the point of panic. 2. Hyperthyroidism (Graves' disease) involves excess stimulation of the sympathetic nervous system and excessive levels of thyroxine. Anxiety is one of several symptoms brought on by these increases. 5. Marked irritability and anxiety are some of the many symptoms associated with hypoglycemia.

43. A client on an in-patient psychiatric unit is experiencing a flashback. Which intervention takes priority? 1. Maintain and reassure the client of his or her safety and security. 2. Encourage the client to express feelings. 3. Decrease extraneous external stimuli. 4. Use a nonjudgmental and matter-of-fact approach.

1. During a flashback, the client is experiencing severe-to-panic levels of anxiety; the priority nursing intervention is to maintain and reassure the client of his or her safety and security. The client's anxiety needs to decrease before other interventions are attempted.

42. A client experiencing sleepwalking is newly admitted to an in-patient psychiatric unit. Which nursing intervention would take priority? 1. Equip the bed with an alarm that is activated when the bed is exited. 2. Discourage strenuous exercise within 1 hour of bedtime. 3. Limit caffeine-containing substances within 4 hours of bedtime. 4. Encourage activities that prepare one for sleep, such as soft music.

1. Equipping the bed with an alarm that activates when the bed is exited is a priority nursing intervention. During a sleepwalking episode, the client is at increased risk for injury, and interventions must address safety.

37. A newly admitted client diagnosed with social phobia has a nursing diagnosis of social isolation R/T fear of ridicule. Which outcome is appropriate for this client? 1. The client will participate in two daily group activities by day 4. 2. The client will use relaxation techniques to decrease anxiety. 3. The client will verbalize one positive attribute about self by discharge. 4. The client will request buspirone (BuSpar) prn to attend group by day 2.

1. Expecting the client to participate in a set number of group activities by day 4 directly relates to the stated nursing diagnosis of social isolation and is a measurable outcome that includes a time frame.

41. A 10 year-old client diagnosed with nightmare disorder is admitted to an in-patient psychiatric unit. Which of the following interventions would be appropriate for this client's problem? Select all that apply. 1. Involving the family in therapy to decrease stress within the family. 2. Using phototherapy to assist the client in adapting to changes in sleep. 3. Administering medications such as tricyclic antidepressants or low-dose benzodiazepines or both. 4. Giving central nervous system stimulants, such as amphetamines. 5. Using relaxation therapy, such as meditation and deep breathing techniques, to assist the client in falling asleep.

1. Family stress can occur as the result of repeated client nightmares. This stress within the family may exacerbate the client's problem and hamper any effective treatment. Involving the family in therapy to relieve obvious stress would be an appropriate intervention to assist in the treatment of clients diagnosed with a nightmare disorder. 3. Administering medications such as tricyclic antidepressants or low-dose benzodiazepines or both is an appropriate intervention for clients diagnosed with a parasomnia disorder, such as a nightmare disorder. 5. Relaxation therapy, such as meditation and deep breathing techniques, would be appropriate for clients diagnosed with a nightmare disorder to help them fall back to sleep after the nightmare occurs.

9. Which nursing diagnosis reflects the intrapersonal theory of the etiology of obsessive-compulsive disorder? 1. Ineffective coping R/T punitive superego. 2. Ineffective coping R/T active avoidance. 3. Ineffective coping R/T alteration in serotonin. 4. Ineffective coping R/T classic conditioning.

1. Ineffective coping R/T punitive superego reflects an intrapersonal theory of the etiology of obsessive-compulsive disorder (OCD). The punitive superego is a concept contained in Freud's psychosocial theory of personality development.

35. A hospitalized client diagnosed with posttraumatic stress disorder has a nursing diagnosis of ineffective coping R/T history of rape AEB abusing alcohol. Which is the expected short-term outcome for this client problem? 1. The client will recognize triggers that precipitate alcohol abuse by day 2. 2. The client will attend follow-up weekly therapy sessions after discharge. 3. The client will refrain from self-blame regarding the rape by day 2. 4. The client will be free from injury to self throughout the shift.

1. It is a realistic expectation for a client who copes with previous trauma by abusing alcohol to recognize the triggers that precipitate this behavior. This outcome should be developed early in treatment.

15. A client has been diagnosed with insomnia. Which of the following data would the nurse expect to assess? Select all that apply. 1. Daytime irritability. 2. Problems with attention and concentration. 3. Inappropriate use of substances. 4. Nightmares. 5. Sleepwalking.

1. Lack of sleep results in daytime irritability. 2. Lack of sleep results in problems with attention and concentration. 3. Individuals diagnosed with insomnia may inappropriately use substances, including hypnotics for sleep and stimulants to counteract fatigue.

38. When a client experiences a panic attack, which outcome takes priority? 1. The client will remain safe throughout the duration of the panic attack. 2. The client will verbalize an anxiety level less than 2/10. 3. The client will use learned coping mechanisms to decrease anxiety. 4. The client will verbalize the positive effects of exercise by day 2.

1. Remaining safe throughout the duration of the panic attack is the priority outcome for the client.

51. The nurse is using a cognitive intervention to decrease anxiety during a client's panic attack. Which client statement would indicate that the intervention has been successful? 1. "I reminded myself that the panic attack would end soon, and it helped." 2. "I paced the halls until I felt my anxiety was under control." 3. "I felt my anxiety increase, so I took lorazepam (Ativan) to decrease it." 4. "Thank you for staying with me. It helped to know staff was there."

1. This statement is an indication that the cognitive intervention was successful. By remembering that panic attacks are self-limiting, the client is applying the information gained from the nurse's cognitive intervention.

24. A client newly admitted to an in-patient psychiatric unit is diagnosed with obsessivecompulsive disorder. Which behavioral symptom would the nurse expect to assess? 1. The client uses excessive hand washing to relieve anxiety. 2. The client rates anxiety at 8/10. 3. The client uses breathing techniques to decrease anxiety. 4. The client exhibits diaphoresis and tachycardia.

1. Using excessive hand washing to relieve anxiety is a behavioral symptom exhibited by clients diagnosed with obsessive-compulsive disorder (OCD).

29. A client diagnosed with hypersomnia states, "I can't even function anymore; I feel worthless." Which nursing diagnosis would take priority? 1. Risk for suicide R/T expressions of hopelessness. 2. Social isolation R/T sleepiness AEB, "I can't function." 3. Self-care deficit R/T increased need for sleep AEB being unable to take a bath without assistance. 4. Chronic low self-esteem R/T inability to function AEB the statement, "I feel worthless."

1. Verbalizations of worthlessness may indicate that this client is experiencing suicidal ideations. After assessing suicide risk further, the risk for suicide should be prioritized.

46. The nurse on the in-patient psychiatric unit should include which of the following interventions when working with a newly admitted client diagnosed with obsessive-compulsive disorder? Select all that apply. 1. Assess previously used coping mechanisms and their effects on anxiety. 2. Allow time for the client to complete compulsions. 3. With the client's input, set limits on ritualistic behaviors. 4. Present the reality of the impact that the compulsions have on the client's life. 5. Discuss client feelings surrounding the obsessions and compulsions.

1. When a client is newly admitted, it is important for the nurse to assess past coping mechanisms and their effects on anxiety. Assessment is the first step in the nursing process, and this information needs to be gathered to intervene effectively. 2. Allowing time for the client to complete compulsions is important for a client who is newly admitted. If compulsions are limited, anxiety levels increase. If the client had been hospitalized for awhile, then, with the client's input, limits would be set on the compulsive behaviors. 5. It is important for the nurse to allow the client to express his or her feelings about the obsessions and compulsions. This assessment of feelings should begin at admission.

13. Which charting entry documents a subjective assessment of sleep patterns? 1. "Reports satisfaction with the quality of sleep since admission." 2. "Slept 8 hours during night shift." 3. "Rates quality of sleep as 3/10." 4. "Woke up three times during the night."

1. When the client reports satisfaction with the quality of sleep, the client is providing subjective assessment data. Good sleepers self-define themselves as getting enough sleep and feeling rested. These individuals feel refreshed in the morning, have energy for daily activities, fall asleep quickly, and rarely awaken during the night.

3. A client diagnosed with posttraumatic stress disorder is close to discharge. Which client statement would indicate that teaching about the psychosocial cause of posttraumatic stress disorder was effective? 1. "My experience, how I deal with it, and my support system all affect my disease process." 2. "I have learned to avoid stressful situations as a way to decrease my emotional pain." 3. "So, natural opioid release during the trauma caused my body to become 'addicted.'" 4. "Because of the trauma, I have a negative perception of the world and feel hopeless."

1. When the client verbalizes understanding of how the experienced event, individual traits, and available support systems affect his or her diagnosis, the client demonstrates a good understanding of the psychosocial cause of posttraumatic stress disorder (PTSD).

84. An angry client, throwing objects and scratching eyes, is escorted to the seclusion room by security. Which nursing statement best explains to the client why four-point restraints will be applied? 1) "Restraints are the consequences for what you are doing." 2) "Restraints are a means of providing safety for you and others on the unit." 3) "Restraints are the only way to manage anger." 4) "Restraints are necessary because there is not enough staff on duty to provide other interventions."

2) "Restraints are a means of providing safety for you and others on the unit." It is important to provide safeguards in order to protect clients who are out of control. The nurse is educating the client in a nonjudgmental, objective manner.

77. A client developed paralysis of the lower extremities after experiencing a severe psychic trauma. Which nursing intervention would be initially implemented? 1) Encourage the client to talk about feelings. 2) Assess the client for organic causes of paralysis. 3) Provide range of motion (ROM) to the lower extremities. 4) Encourage discussion of future goals.

2) Assess the client for organic causes of paralysis. The initial intervention is to rule out organic factors contributing to the paralysis. Once this has been identified, a plan of care can be effectively established.

80. A client is experiencing gamophobia. Which fear would the nurse expect to assess? 1) Fear of strangers 2) Fear of marriage 3) Fear of numbers 4) Fear of insanity

2) Fear of marriage

82. For the past year, a college student continually and unrealistically worries about academic performance and love-life performance. The student is irritable and suffers from severe insomnia. This behavior is associated with which Axis I diagnosis? 1) Post-traumatic stress disorder (PTSD) 2) Generalized anxiety disorder (GAD) 3) Social phobia disorder 4) Obsessive-compulsive disorder (OCD)

2) Generalized anxiety disorder (GAD) GAD may be diagnosed when excessive, unrealistic worry and anxiety become chronic and last for at least 6 months. The anxiety experienced is generalized rather than specific. The anxiety is not associated with a specific object, as in phobia, or event, as in PTSD.

64. A client is experiencing a panic attack. What physical symptoms would the nurse expect to assess? 1) Intense fear and helplessness 2) Sweating and palpitations 3) Psychomotor agitation 4) A narrowed perceptual field and a decreased attention span

2) Sweating and palpitations Physical symptoms of a panic attack include sweating and palpitations.

21. Which of the following assessment data would support the disorder of acrophobia? 1. A client is fearful of basements because of encountering spiders. 2. A client refuses to go to Europe because of a fear of flying. 3. A client is unable to commit to marriage after a 10-year engagement. 4. A client refuses to leave home during stormy weather.

2. Acrophobia is the fear of heights. An individual experiencing acrophobia may be unable to fly because of this fear.

44. A client diagnosed with panic attacks is being admitted for the fifth time in 1 year because of hopelessness and helplessness. Which precaution would the nurse plan to implement? 1. Elopement precautions. 2. Suicide precautions. 3. Homicide precautions. 4. Fall precautions.

2. Any client who is exhibiting hopelessness or helplessness needs to be monitored closely for suicide intentions.

19. When treating individuals with posttraumatic stress disorder, which variable is included in the recovery environment? 1. Degree of ego strength. 2. Availability of social supports. 3. Severity and duration of the stressor. 4. Amount of control over recurrence.

2. Availability of social supports is part of environmental variables. Others include cohesiveness and protectiveness of family and friends, attitudes of society regarding the experience, and cultural and subcultural influences.

56. In which situation would benzodiazepines be prescribed appropriately? 1. Long-term treatment of posttraumatic stress disorder, convulsive disorder, and alcohol withdrawal. 2. Short-term treatment of generalized anxiety disorder, alcohol withdrawal, and preoperative sedation. 3. Short-term treatment of obsessive-compulsive disorder, skeletal muscle spasms, and essential hypertension. 4. Long-term treatment of panic disorder, alcohol dependence, and bipolar affective disorder: manic episode.

2. Benzodiazepines are prescribed for short-term treatment of generalized anxiety disorder and alcohol withdrawal and can be prescribed during preoperative sedation.

48. A widow is diagnosed with adjustment disorder with depressed mood. Symptoms include chronic migraines, feelings of hopelessness, social isolation, and self-care deficit. Which nursing intervention would be most appropriate? 1. Present the reality of the consequences of impulsive behaviors. 2. Encourage independent completion of activities of daily living. 3. Discuss the effects of behaviors that guarantee immediate gratification. 4. Teach techniques to improve positive body image.

2. Encouraging the independent completion of activities of daily living provides client success experiences that serve to decrease feelings of hopelessness, social isolation, and self-care deficit.

28. A client diagnosed with obsessive-compulsive disorder is newly admitted to an inpatient psychiatric unit. Which cognitive symptom would the nurse expect to assess? 1. Compulsive behaviors that occupy more than 4 hours per day. 2. Excessive worrying about germs and illness. 3. Comorbid abuse of alcohol to decrease anxiety. 4. Excessive sweating and an increase in blood pressure and pulse.

2. Excessive worrying about germs and illness is a cognitive symptom experienced by clients diagnosed with OCD.

10. The nurse is using an intrapersonal approach to assist a client in dealing with survivor's guilt. Which nursing intervention would be appropriate? 1. Encourage the client to attend a survivors group for peer support. 2. Facilitate expression of feelings during one-to-one interactions with the nurse. 3. Ask the client to challenge the irrational beliefs associated with the event. 4. Administer scheduled paroxetine (Paxil) to deal with depressive symptoms.

2. Facilitating expression of feelings during one-to-one interactions with the nurse is an intrapersonal approach to interventions that treat survivor's guilt associated with PTSD.

45. A client diagnosed with obsessive-compulsive disorder has been hospitalized for the past 4 days. Which intervention would be a priority at this time? 1. Notify the client of the expected limitations on compulsive behaviors. 2. Reinforce the use of learned relaxation techniques. 3. Allow the client the time needed to complete the compulsive behaviors. 4. Say "stop" to the client as a thought-stopping technique.

2. It is important for the client to learn techniques to reduce overall levels of anxiety to decrease the need for compulsive behaviors. The teaching of these techniques should begin by day 4.

47. During an intake assessment, a client diagnosed with generalized anxiety disorder rates mood at 3/10, rates anxiety at 8/10, and states, "I'm thinking about suicide." Which nursing intervention takes priority? 1. Teach the client relaxation techniques. 2. Ask the client, "Do you have a plan to commit suicide?" 3. Call the physician to obtain a prn order for an anxiolytic medication. 4. Encourage the client to participate in group activities.

2. It is important for the nurse to ask the client about a potential plan for suicide in order to evaluate the client's intentions and safety risk. This knowledge would direct appropriate and timely nursing interventions. Clients who have developed suicide plans are at higher risk than clients who may have vague suicidal thoughts.

57. A client recently diagnosed with generalized anxiety disorder is prescribed clonazepam (Klonopin), buspirone (BuSpar), and citalopram (Celexa). Which assessment related to the concurrent use of these medications is most important? 1. Monitor for signs and symptoms of worsening depression and suicidal ideation. 2. Monitor for changes in mental status, diaphoresis, tachycardia, and tremor. 3. Monitor for hyperpyresis, dystonia, and muscle rigidity. 4. Monitor for spasms of face, legs, and neck and for bizarre facial movements.

2. It is important for the nurse to monitor for serotonin syndrome, which occurs when a client takes multiple medications that affect serotonin levels. Symptoms include change in mental status, restlessness, myoclonus, hyperreflexia, tachycardia, labile blood pressure, diaphoresis, shivering, and tremor.

53. Which teaching need is important when a client is newly prescribed buspirone (BuSpar) 5 mg tid? 1. Encourage the client to avoid drinking alcohol while taking this medication because of the additive central nervous system depressant effects. 2. Encourage the client to take the medication continuously as prescribed because onset of action is delayed 2 to 3 weeks. 3. Encourage the client to monitor for signs and symptoms of anxiety to determine the need for additional buspirone (BuSpar) prn. 4. Encourage the client to be compliant with monthly lab tests to monitor for medication toxicity.

2. It is important to teach the client that the onset of action for buspirone (BuSpar) is 2 to 3 weeks. Often the nurse may see a benzodiazepine, such as clonazepam, prescribed because of its quick onset of effect, until the buspirone begins working.

23. A client experiencing a panic attack would display which physical symptom? 1. Fear of dying. 2. Sweating and palpitations. 3. Depersonalization. 4. Restlessness and pacing.

2. Sweating and palpitations are physical symptoms of a panic attack.

52. A nursing instructor is teaching about the DSM-IV-TR criteria for the diagnosis of adjustment disorder. Which student statement indicates that learning has occurred? 1. "A client with this disorder should exhibit symptoms within 1 year of the participating event." 2. "A client with this disorder should exhibit symptoms within 3 months of the participating event." 3. "A client with this disorder should exhibit symptoms within 6 months of the participating event." 4."A client with this disorder should exhibit symptoms within 9 months of the participating event."

2."According to the DSM-IV-TR diagnostic criteria for adjustment disorders, the development of emotional and/or behavioral symptoms in response to an identifiable stressor should occur within 3 months of the onset of the stressor."

65. A client has made an appointment to see a primary care provider because of increased anxiety. Which medication would likely be prescribed for anxiety? 1) Chlorpromazine (Thorazine) 2) Clozapine (Clozaril) 3) Diazepam (Valium) 4) Methylphenidate (Ritalin)

3) Diazepam (Valium)

69. Which nursing intervention takes priority for a client experiencing moderate anxiety? 1) Explore the etiology of the anxiety. 2) Investigate decompensation behaviors. 3) Focus on anxiety reduction. 4) Accept the level of anxiety.

3) Focus on anxiety reduction. Reducing anxiety to a tolerable level should be the nurse's first priority. After reassuring the client of his or her safety and security, the nurse should convey an accepting attitude to facilitate trust. Once the anxiety level has decreased, the client can then begin exploring the triggers that induce anxiety.

73. A nursing student diagnosed with acute test anxiety is prescribed propranolol (Inderal). What is the rationale for this treatment? 1) Inderal is a mood stabilizer that will decrease situational anxiety. 2) Inderal is an antihypertensive medication. Question this order. 3) Inderal has potent effects on the somatic manifestations of anxiety. 4) Inderal is an anxiolytic used specifically for generalized anxiety.

3) Inderal has potent effects on the somatic manifestations of anxiety. It has potent effects on the somatic manifestations of anxiety, such as palpitations and tremors, but has less dramatic effects on the psychic components of anxiety. It is most effective in the treatment of acute situational anxiety, such as performance anxiety and/or test anxiety.

59. A client experiencing numbness of the extremities, trembling, fear of dying, and dizziness is admitted to the emergency room with a diagnosis of panic disorder. Which nursing intervention takes priority? 1) Discuss functional coping mechanisms. 2) Determine the source of the problem. 3) Quickly administer an anxiolytic medication. 4) Establish a trusting nurse-client relationship.

3) Quickly administer an anxiolytic medication. Anxiolytic medications work quickly to decrease anxiety levels by depressing the central nervous system. Control of the client's physical symptoms of extremity numbness, trembling, and hyperventilation must take priority to maintain physiological and psychosocial integrity.

79. A despondent college student, being treated for a panic disorder, tells the nurse, "I've had it! For no reason, my heart pounds and I can't seem to breathe. It's not worth it." Based on this information, which nursing diagnosis takes priority? 1) Ineffective Airway Clearance 2) Ineffective Coping 3) Risk for Suicide 4) Knowledge Deficit

3) Risk for Suicide Because the client is despondent and makes statements such as "I've had it!" and "It's not worth it," an indication of self-harm must be considered. Although other nursing diagnoses may be valid and appropriate, the safety of the client is always the nurse's first priority.

36. Which client would the charge nurse assign to an agency nurse who is new to a psychiatric setting? 1. A client diagnosed with posttraumatic stress disorder currently experiencing flashbacks. 2. A newly admitted client diagnosed with generalized anxiety disorder beginning benzodiazepines for the first time. 3. A client admitted 4 days ago with the diagnosis of algophobia. 4. A newly admitted client with obsessive-compulsive disorder.

3. A client admitted 4 days ago with a diagnosis of algophobia, fear of pain, would be an appropriate assignment for the agency nurse. Of the clients presented, this client would pose the least challenge to a nurse unfamiliar with psychiatric clients.

39. The nurse has received the evening report. Which client would the nurse need to assess first? 1. A newly admitted client with a history of panic attacks. 2. A client who slept 2 to 3 hours last night because of flashbacks. 3. A client pacing the halls and stating that his anxiety is an 8/10. 4. A client diagnosed with generalized anxiety disorder awaiting discharge.

3. A client pacing the halls and experiencing an increase in anxiety commands immediate assessment. If the nurse does not take action on this assessment, there is a potential for client injury to self or others.

16. What is the most common form of breathing-related sleep disorders? 1. Parasomnia. 2. Hypersomnia. 3. Apnea. 4. Cataplexia.

3. Apnea refers to the cessation of breathing during sleep. To be so classified, the apnea must last for at least 10 seconds and occur 30 or more times during a 7-hour period of sleep. Apnea is classified as a breathing-related sleep disorder.

55. A client diagnosed with generalized anxiety disorder is placed on clonazepam (Klonopin) and buspirone (BuSpar). Which client statement indicates teaching has been effective? 1. The client verbalizes that the clonazepam is to be used for long-term therapy in conjunction with buspirone. 2. The client verbalizes that buspirone can cause sedation and should be taken at night. 3. The client verbalizes that clonazepam is to be used short term until the buspirone takes full effect. 4. The client verbalizes that tolerance could result with the long-term use of buspirone.

3. Clonazepam would be used for shortterm reatment while waiting for the buspirone to take full effect, which can take 4 to 6 weeks.

20. A newly admitted client is diagnosed with posttraumatic stress disorder. Which behavioral symptom would the nurse expect to assess? 1. Recurrent, distressing flashbacks. 2. Intense fear, helplessness, and horror. 3. Diminished participation in significant activities. 4. Detachment or estrangement from others.

3. Diminished participation in significant activities is a behavioral symptom of PTSD.

17. Which would the nurse expect to assess in a client suspected of having sleep terror disorder? 1. The client, on awakening, is able to explain the nightmare in vivid detail. 2. The client is easily awakened after the night terror. 3. The client experiences an abrupt arousal from sleep with a piercing scream or cry. 4. The client, when awakening during the night terror, is alert and oriented.

3. During a sleep terror, the client does experience an abrupt arousal from sleep with a piercing scream or cry.

7. A client diagnosed with social phobia has an outcome that states, "Client will voluntarily participate in group activities by day 3." Which would be an appropriate intrapersonal nursing intervention to assist the client in achieving this outcome? 1. Offer prn lorazepam (Ativan) 1 hour before group begins. 2. Attend group with client to assist in decreasing anxiety. 3. Encourage discussion about fears related to socialization. 4. Role-play scenarios that may occur in group to decrease anxiety.

3. Encouraging discussion about fears is an intrapersonal nursing intervention.

26. Which assessment data would support a physician's diagnosis of an anxiety disorder in a client? 1. A client experiences severe levels of anxiety in one area of functioning. 2. A client experiences an increased level of anxiety in one area of functioning for a 6-month period. 3. A client experiences increased levels of anxiety that affect functioning in more than one area of life over a 6-month period. 4. A client experiences increased levels of anxiety affecting at least three areas of functioning.

3. For a client to be diagnosed with an anxiety disorder, the client must experience symptoms that interfere in a minimum of two areas, such as social, occupational, or other important functioning. These symptoms must be experienced for durations of 6 months or longer.

32. A client seen in an out-patient clinic for ongoing management of panic attacks states, "I have to make myself come to these appointments. It is hard because I don't know when an attack will occur." Which nursing diagnosis takes priority? 1. Ineffective breathing patterns R/T hyperventilation. 2. Impaired spontaneous ventilation R/T panic levels of anxiety. 3. Social isolation R/T fear of spontaneous panic attacks. 4. Knowledge deficit R/T triggers for panic attacks.

3. Social isolation is seen frequently with individuals diagnosed with panic attacks. The client in the question expresses anticipatory fear of unexpected attacks, which affects the client's ability to interact with others.

34. A client has a nursing diagnosis of disturbed sleep patterns R/T increased anxiety AEB inability to fall asleep. Which short-term outcome is appropriate for this client? 1. The client will use one coping skill before bedtime to assist in falling asleep. 2. The client will sleep 6 to 8 hours a night and report a feeling of being rested. 3. The client will ask for prescribed prn medication to assist with sleep by day 2. 4. The client will verbalize his or her level of anxiety as less than a 3/10.

3. The client's being able to ask for prescribed prn medication to assist with falling asleep by day 2 is a short-term outcome that is specific, has a time frame, and relates to the stated nursing diagnosis.

49. A client diagnosed with posttraumatic stress disorder has a nursing diagnosis of disturbed sleep patterns R/T nightmares. Which evaluation would indicate that the stated nursing diagnosis was resolved? 1. The client expresses feelings about the nightmares during group. 2. The client asks for prn trazodone (Desyrel) before bed to fall asleep. 3. The client states "My nightmares have stopped and I feel rested." 4. The client avoids napping during the day to help enhance sleep.

3. The client's statement, "My nightmares have stopped and I feel rested" is the evaluation data needed to support the fact that the nursing diagnosis of disturbed sleep patterns R/T nighmares has been resolved.

8. Using psychodynamic theory, which intervention would be appropriate for a client diagnosed with panic disorder? 1. Encourage the client to evaluate the power of distorted thinking. 2. Ask the client to include his or her family in scheduled therapy sessions. 3. Discuss the overuse of ego defense mechanisms and their impact on anxiety. 4. Teach the client regarding blood lactate level as it relates to the client's panic attacks.

3. The nurse discussing the overuse of ego defense mechanisms illustrates a psychodynamic approach to address the client's behaviors related to panic disorder.

12. Clients diagnosed with obsessive-compulsive disorder commonly use which mechanism? 1. Suppression. 2. Repression. 3. Undoing. 4. Denial.

3. Undoing is a defense mechanism commonly used by individuals diagnosed with OCD. Undoing is used symbolically to negate or cancel out an intolerable previous action or experience. An individual diagnosed with OCD experiencing intolerable anxiety would use the defense mechanism of undoing to undo this anxiety by substituting obsessions or compulsions or both. Other commonly used defense mechanisms are isolation, displacement, and reaction formation.

72. Jennifer is a 25-year-old woman of average height and weight who reports to the mental health clinic with complaints that she has been unable to go to work for the last 2 weeks because she can't get her "appearance right." She reports that she repetitively checks the mirror and has to redo her make-up every 5 or 10 minutes. Jennifer is most likely experiencing which of these disorders? 1) Social anxiety disorder 2) Panic disorder 3) Eating disorder 4) Body dysmorphic disorder

4) Body dysmorphic disorder Repetitive mirror-checking and excessive grooming R/T perception of flawed appearance that interferes with social, occupational, or other areas of functioning are symptoms of body dysmorphic disorder.

63. A noncompliant client has a nursing diagnosis of "Social Isolation related to anxiety evidenced by remaining in room during group activities." Which short-term outcome is appropriate for this client? 1) The client will attend three group sessions. 2) The client will understand and accept social withdrawal as a personality trait. 3) The client will remain safe throughout the hospital stay. 4) The client will request as needed (prn) anxiety medication prior to attending group sessions.

4) The client will request as needed (prn) anxiety medication prior to attending group sessions. Acknowledging the need for prn medications prior to attending group sessions indicates a positive outcome for the client problem of social isolation.

50. The nurse teaches an anxious client diagnosed with posttraumatic stress disorder a breathing technique. Which client action would indicate that the teaching was successful? 1. The client eliminates anxiety by using the breathing technique. 2. The client performs activities of daily living independently by discharge. 3. The client recognizes signs and symptoms of escalating anxiety. 4. The client maintains a 3/10 anxiety level without medications.

4. A client's ability to maintain an anxiety level of 3/10 without medications indicates that the client is using breathing techniques successfully to reduce anxiety.

22. In which situation would the nurse suspect an Axis I diagnosis of social phobia? 1. A client abuses marijuana daily and avoids social situations because of fear of humiliation. 2. An 8 year-old child isolates from adults because of fear of embarrassment but has good peer relationships in school. 3. A client diagnosed with Parkinson's disease avoids social situations because of embarrassment regarding tremors and drooling. 4. A college student avoids taking classes that include an oral presentation because of fear of being scrutinized by others.

4. A student who avoids classes because of the fear of being scrutinized by others meets the criteria for a diagnosis of social phobia.

14. Which is important when assessing an individual for a sleep disturbance? 1. Limit caffeine intake in the evening hours. 2. Teach the importance of a bedtime routine. 3. Keep the client's door locked during the day to avoid napping. 4. Check the chart to note the client's baseline sleeping habits per night.

4. An important nursing assessment for a client experiencing a sleep disturbance is to note the client's baseline sleep patterns. These data allow the nurse to recognize alterations in normal patterns of sleep and to intervene appropriately.

33. During an assessment, a client diagnosed with generalized anxiety disorder rates anxiety as 9/10 and states, "I have thought about suicide because nothing ever seems to work out for me." Based on this information, which nursing diagnosis takes priority? 1. Hopelessness R/T anxiety AEB statement: "Nothing ever seems to work out." 2. Ineffective coping R/T rating anxiety as 9/10 AEB thoughts of suicide. 3. Anxiety R/T thoughts about work AEB rates anxiety 9/10. 4. Risk for suicide R/T expressing thoughts of suicide.

4. Because the client is expressing suicidal ideations, the nursing diagnosis of risk for suicide takes priority at this time. Client safety is prioritized over all other client problems.

40. A client was admitted to an in-patient psychiatric unit 4 days ago for the treatment of obsessive-compulsive disorder. Which outcome takes priority for this client at this time? 1. The client will use a thought-stopping technique to eliminate obsessive and/or compulsive behaviors. 2. The client will stop obsessive and/or compulsive behaviors in order to focus on activities of daily living. 3. The client will seek assistance from the staff to decrease obsessive and/or compulsive behaviors. 4. The client will use one relaxation technique to decrease obsessive and/or compulsive behaviors.

4. By day 4, it would be realistic to expect the client to use one relaxation technique to decrease obsessive or compulsive behaviors. This would be the current priority outcome.

1. From a cognitive theory perspective, which is a possible cause of panic disorder? 1. Inability of the ego to intervene when conflict occurs. 2. Abnormal elevations of blood lactate and increased lactate sensitivity. 3. Increased involvement of the neurochemical norepinephrine. 4. Distorted thinking patterns that precede maladaptive behaviors.

4. Distorted thinking patterns that precede maladaptive behaviors relate to the cognitive theory perspective of panic disorder development.

30. A newly admitted client diagnosed with posttraumatic stress disorder is exhibiting recurrent flashbacks, nightmares, sleep deprivation, and isolation from others. Which nursing diagnosis takes priority? 1. Posttrauma syndrome R/T a distressing event AEB flashbacks and nightmares. 2. Social isolation R/T anxiety AEB isolating because of fear of flashbacks. 3. Ineffective coping R/T flashbacks AEB alcohol abuse and dependence. 4. Risk for injury R/T exhaustion because of sustained levels of anxiety.

4. Risk for injury is the priority nursing diagnosis for this client. In the question, the client is exhibiting recurrent flashbacks, nightmares, and sleep deprivation that can cause exhaustion and lead to injury. It is important for the nurse to prioritize the nursing diagnosis that addresses safety.

5. Which statement explains the etiology of obsessive-compulsive disorder (OCD) from a biological theory perspective? 1. Individuals diagnosed with obsessive compulsive disorder (OCD) have weak and underdeveloped egos. 2. Obsessive and compulsive behaviors are a conditioned response to a traumatic event. 3. Regression to the pre-Oedipal anal sadistic phase produces the clinical symptoms of OCD. 4. Abnormalities in various regions of the brain have been implicated in the cause of OCD.

4. The belief that abnormalities in various regions of the brain cause OCD is an explanation of OCD etiology from a biological theory perspective.

11. A client diagnosed with posttraumatic stress disorder states to the nurse, "All those wonderful people died, and yet I was allowed to live." Which is the client experiencing? 1. Denial. 2. Social isolation. 3. Anger. 4. Survivor's guilt.

4. The client in the question is experiencing survivor's guilt. Survivor's guilt is a common situation that occurs when an individual experiences a traumatic event in which others died and the individual survived.

2. An overuse or ineffective use of ego defense mechanisms, which results in a maladaptive response to anxiety, is an example of the ___________________ theory of generalized anxiety disorder development.

An overuse or ineffective use of ego defense mechanisms, which results in a maladaptive response to anxiety, is an example of the PSYCHODYNAMIC theory of generalized anxiety disorder development.

81. A 60-year-old woman presents at the emergency department with complaints of anxiety unlike anything she has experienced before. She is unable to identify a precipitating stressor related to her anxiety. In addition to psychosocial assessment, which of the following assessments should the nurse conduct in order to facilitate accurate diagnosis? Select all that apply. 1) Vital signs 2) History of substance use 3) Blood sugar 4) History of thyroid disorders 5) Marital status

Correct 1: Anxiety can be a symptom of cardiac conditions such as myocardial infarction, congestive heart failure, and mitral valve prolapse and respiratory conditions such as chronic obstructive pulmonary disease and hyperventilation. Vital signs would be one measure of these systems. Correct 2: Anxiety can be a symptom of intoxication and/or withdrawal from many substances, so a thorough history of this aspect is essential. Correct 3: Anxiety is a symptom of hypoglycemia, so assessment of blood sugar is relevant in evaluating potential causes of anxiety. Correct 4: Anxiety can be a symptom in hyperthyroidism or hypothyroidism. Assessment for history of thyroid disorders is one measure to evaluate for these disorders. Blood tests would be relevant and definitive of whether or not this is a cause for the anxiety symptoms. Feedback 5: Marital status is not directly linked to an increase in anxiety disorders, so although this is demographic data routinely collected during assessment, it would not necessarily contribute to identifying the cause of this patient's symptoms.

86. Paula, who complains of "always being stressed out" and appears to be easily distracted, is seeking counseling for stress management. Which of the following nurse actions will be essential when intervening with Paula? Select all that apply. 1) Assessing the nurse's own level of anxiety 2) Using a calm, matter-of-fact approach 3) Assessing Paula's level of anxiety before initiating education 4) Observing how Paula interacts with coworkers in stressful situations 5) Administering antianxiety agents (as prescribed) before the session begins

Correct 1: Anxiety is "contagious" and may be transferred between the client and nurse, so it is essential that the nurses who intervene evaluate and manage their own anxiety. Correct 2: Using a calm, matter-of-fact style of communicating can be an effective approach to reduce escalation of symptoms in the anxious client. Correct 3: Assessing Paula's level of anxiety before attempting to provide education is essential since, if the client's anxiety is high, education will likely be ineffective. Learning occurs best when anxiety is at the mild level. Feedback 4: Being able to observe how Paula responds in real-life stressful situations is not a realistic expectation. However, exploring Paula's perceptions about how she responds in stressful situations would be beneficial. Feedback 5: Administering antianxiety agents should be considered only when assessment deems them necessary and other interventions are ineffective in reducing anxiety.

62. When caring for a client who is experiencing a panic attack, which of the following nursing actions should be implemented? Select all that apply. 1) Leave the client alone to maintain privacy. 2) Reduce stimuli in the immediate environment. 3) Instruct the client regarding unit rules and regulations. 4) Administer antianxiety medication as ordered. 5) Communicate with simple words and brief messages.

Feedback 1: A nurse should stay with a client who is experiencing a panic attack in order to provide a feeling of security and to ensure personal safety. Correct 2: Keeping immediate surroundings as free as possible of stimuli (dim lighting, few people, simple décor) helps the client return to a calmer state. Feedback 3: In an intensely anxious situation, a client is unable to comprehend anything but the most elemental communication. Any instructions given at this time may well increase, not decrease, anxiety. Correct 4: Administering antianxiety medication, as ordered, provides the client relief from the immobilizing effects of anxiety. Correct 5: When communicating with a client experiencing a panic attack, the nurse needs to use simple words and brief messages, spoken calmly and clearly. Any communication that is loud and demanding would only escalate anxiety.

83. The nurse, Robert, is conducting a relaxation group for patients at the mental health center who have been identified as struggling with anxiety disorders. He intends to implement a quality improvement initiative by using an anxiety screening tool to evaluate whether patients report less anxiety at the completion of the program. Which of these would be accepted, reliable tools for that purpose? Select all that apply. 1) Cosmopolitan's "How anxious are you?" quiz. 2) Zung's Self-Rated Anxiety Scale 3) Hamilton Anxiety Rating Scale 4) Beck Anxiety Inventory 5) Folstein's Mini-Mental Status Exam

Feedback 1: Although many magazines and other general public sources offer quizzes that claim to be evaluative of many different conditions, scientific evaluation for the purpose of quality assurance and improvement requires the use of tools that have established reliability and validity. Correct 2: Zung's Self-rated Anxiety Scale is recognized as a reliable tool for evaluation of anxiety symptoms. Correct 3: The Hamilton Anxiety Rating Scale (HAM-A) is recognized as a reliable tool for evaluation of anxiety symptoms. Correct 4: The Beck Anxiety Inventory is recognized as a reliable tool for evaluation of anxiety symptoms. Feedback 5: Folstein's Mini-Mental Status Exam is recognized as a reliable tool to evaluate cognitive function rather than symptoms of anxiety.

78. Which of the following are realistic outcomes that can be used to evaluate care of a client with an anxiety disorder? Select all that apply. ) The client successfully removes all stressors that precipitate anxiety. 2) The client recognizes symptoms of escalating anxiety. 3) The client can maintain anxiety at a manageable level. 4) The client demonstrates adaptive coping strategies for dealing with anxiety. 5) The client commits to staying on benzodiazepines indefinitely.

Feedback 1: It is not realistic to expect that anyone would be able to remove all stressors from their life that precipitate anxiety. A more realistic outcome is that the client will have developed adaptive coping strategies. Correct 2: Essential to managing anxiety is the client's awareness of escalating anxiety and developing strategies to reduce anxiety before it reaches panic level. Correct 3: Anxiety can be beneficial in alerting one to dangers in the environment so the goal is not to rid one of anxiety altogether but to teach the client how to maintain anxiety at a manageable level. Correct 4: The primary goal of interventions to treat anxiety is that the client will develop adaptive rather than maladaptive methods for managing anxiety. Feedback 5: Antianxiety agents are beneficial in the short term for reducing one's anxiety, and mild anxiety is a prerequisite to any interventions that require learning. However, benzodiazepines have the potential to be addictive, so the goal would not be for a client to stay on these agents indefinitely but to develop coping strategies that would eliminate the need for long-term medication, if possible.

58. A client has an irrational fear of height (acrophobia). According to the diagnostic criteria for specific phobias, which of the following symptoms would the nurse expect to assess? Select all that apply. 1) The client does not recognize that the fear is excessive or unreasonable. 2) Exposure to the phobic stimulus provokes an immediate anxiety response. 3) The client tolerates the presence of a specific feared object or situation. 4) The client exhibits marked and persistent fear that is excessive or unreasonable. 5) The client reports that even anticipation of being exposed to heights provokes an anxiety response.

Feedback 1: The client does recognize that the fear is excessive or unreasonable but is powerless to change. The individual may occasionally endure the phobic stimulus but experiences intense anxiety. Correct 2: Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of situationally bound or situationally predisposed panic attack. Feedback 3: The client avoids, not tolerates, the presence of a specific feared object or situation. Correct 4: The client experiences a marked and persistent fear that is excessive or unreasonable. This fear is triggered by the presence of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). Correct 5: Phobias are fears that are cued by the presence or anticipation of exposure to a specific object or situation. This fear almost invariably triggers an immediate anxiety response.

74. A type of therapy in which a client is directed to imagine or actually participate in real-life situations that he or she finds intensely frightening, and to do this for prolonged periods of time, is called____________.

Implosion therapy, or flooding In implosion therapy the therapist "floods" the client with information concerning situations that trigger anxiety, with the belief that prolonged exposure will result in the client experiencing a reduction in anxiety.

4. Counselors have been sent to a location that has experienced a natural disaster to assist the population in dealing with the devastation. This is an example of __________________ prevention.

Sending counselors to a natural disaster site to assist individuals in dealing with the devastation is an example of PRIMARY prevention. Primary prevention reduces the incidence of mental disorders, such as posttraumatic stress disorder, within the population by helping individuals to cope more effectively with stress early in the grieving process. Primary prevention is extremely important for individuals who experience any traumatic event, such as a rape, war, hurricane, tornado, or school shooting.

6. After being diagnosed with pyrophobia, the client states, "I believe this started at the age of 7 when I was trapped in a house fire." When examining theories of phobia etiology, this situation would be reflective of ____________ theory.

When examining theories of phobia etiology, this situation would be reflective of LEARNING theory. Some learning theorists believe that fears are conditioned responses, and they are learned by imposing rewards for certain behaviors. In the instance of phobias, when the individual avoids the phobic object, he or she escapes fear, which is a powerful reward. This client has learned that avoiding the stimulus of fire eliminates fear.

66. Caroline reports to the nurse that she has an intense fear of riding the bus and being in crowds. The type of phobia she is describing is____________.

agoraphobia