Chapter 14- Anxiety and Anxiety Disorders (Prep U)
The nurse is providing care for a psychiatric-mental health client who has a diagnosis of anxiety. Which statement by the nurse is likely the most therapeutic intervention? "Anxiety is a feeling that is experienced by everyone at some point and it can never be completely removed from one's life." "With the development of more life skills and a demonstration of continued success in life, your anxiety will shrink and eventually disappear." "If you address the causes of your anxiety head-on, you will find that you can recover from it without medications or therapy." "Every time you feel anxious, try to focus on how much easier your life would be if you didn't experience anxiety so often."
"Anxiety is a feeling that is experienced by everyone at some point and it can never be completely removed from one's life." It is therapeutic to foster in clients the understanding that the experience of anxiety is natural and inevitable. It would be inaccurate to promise recovery with increased success in life and self-discipline. Clients with anxiety are likely to be well aware of how much easier their lives would be without recurring anxiety.
A client with generalized anxiety disorder states that the client is worried about the client's job. The client never feels like the client has control over the client's responsibilities, even though the client puts in extra hours. The client adds that the client is afraid the client will be fired. Which response by the nurse is most therapeutic? "Why do you think you'll be fired?" "It sounds to me like you're doing a good job." "Has something changed at work that is causing you to worry?" "Your worries are a feature of your anxiety disorder. Tell yourself that you have nothing to worry about."
"Has something changed at work that is causing you to worry?" The nurse begins an assessment by simply asking the client if he or she is currently feeling anxious or worried or has experienced these feelings recently. The nurse also asks the client about obsessive thinking patterns, worrying, compulsions and repetitive activity, specific phobias, and exposure to traumatic events. Once the nurse has determined that signs and symptoms of anxiety do exist, the nurse assesses the possible underlying causes and inquires about family history, recent life events, current stress level, personal history of anxiety, medical and medication history, history of substance abuse, and other possible causes of the anxiety.
A nurse is giving a presentation on mental health promotion to college students. One student asks the nurse to explain the difference between normal anxiety and an anxiety disorder. Which response is best? "Normal anxiety occurs in response to everyday stressors." "People with anxiety disorders experience a fight-or-flight response when threatened." "People with anxiety disorders generally find that the anxiety interferes with daily activities." "Normal anxiety does not result in feelings of dread or restlessness."
"People with anxiety disorders generally find that the anxiety interferes with daily activities." Pathologic anxiety is suspected if a person feels anxious when no real threat exists, when a threat has passed long ago but continues to impair the person's functioning, or when a person substitutes adaptive coping mechanisms with maladaptive ones.
Which statement by the nurse demonstrates an understanding of the role automatisms have in a panic attack? "I can tell that the more she taps, the less anxiety she is actually feeling." "I discourage her finger tapping since it serves to increase her anxiety level." "She knows that if she taps her fingers she will be able to lessen her anxiety." "The client taps her fingers very rapidly when she is feeling anxious."
"The client taps her fingers very rapidly when she is feeling anxious." Automatisms are automatic, unconscious mannerisms associated with anxiety. Examples include tapping fingers, jingling keys, or twisting hair. Automatisms are geared toward anxiety relief and increase in frequency and intensity with the client's anxiety level. None of the remaining options accurately state the fact that the tapping identifies the level of anxiety a client is experiencing but does not manage or less the emotion.
A client comes to the emergency department because the client thinks the client is having a heart attack. Further assessment determines that the client is not having a heart attack but is having a panic attack. When beginning to interview the client, which question would be most appropriate for the nurse to ask? "What did you experience just before and during the attack?" "Are you feeling much better now that you are lying down?" "What do you think caused you to feel this way?" "Do you think you will be able to drive home?"
"What did you experience just before and during the attack?" After it has been determined that the client does not have other medical problems, the nurse should assess for the characteristic symptoms of panic attack, focusing the questions on what the client was experiencing just before and during the attack. Asking the client if the client feels better provides no information for the nurse, and lying down may or may not be effective. Asking the client if the client thinks the client can drive home is a question that can be asked much later in the interview, after the attack subsides and the client is stable. Asking the client about what caused the attack is inappropriate because numerous stimuli, both external and internal, can provoke an attack. Most clients will not be able to identify a specific cause. The focus of care is on the characteristics of the attack.
The client reports that the client feels anxious when interacting socially with others and "never seems to know what to say." Which question indicates the nurse has a sound understanding of interpersonal theory as it relates to anxiety? "Do other members of your family have similar problems?" "What kind of relationship do you have with your parents?" "What have you tried to help manage your feelings and discomfort?" "How long have you experienced these problems?"
"What kind of relationship do you have with your parents?" According to interpersonal theory, caregivers can communicate anxiety to infants or children through inadequate nurturing. Individuals who are exposed to poor parental nurturing may develop poor self-esteem or poor communication skills. The other options, although assessment-oriented questions, do not necessarily relate directly to this client's specific problem.
Which statement, made by a client diagnosed with an anxiety disorder, should trigger the nurse's concern about the client's understanding of the use of defense mechanisms? "I'm thankful that I have a way to manage my problems." "Defense mechanisms provide a sense of control over the uncontrollable." "When I have a problem, I just deny it until it goes away." "I'm not sure when I'm actually using a defense mechanism."
"When I have a problem, I just deny it until it goes away." The dependence on one or two defense mechanisms also can inhibit emotional growth, lead to poor problem-solving skills, and create difficulty with relationships. Denial should not be used to deal with all of one's problems. None of the remaining options present untrue or troubling statements regarding defense mechanisms.
A patient with anxiety disorder has excessive anxiety and worries about multiple life circumstances. For how long would this patient experience these feelings before the anxiety disorder would be considered chronic and generalized? 2 months 6 months 4 months 12 months
6 months For generalized anxiety disorder, the diagnostic criteria listed include unrealistic or excessive anxiety and worry about two or more life circumstances for 6 months or more, during which time these concerns exist for a majority of days.
Which client is most likely to be at risk for drug dependence and difficulties with withdrawal? A client who has recently begun treatment with propranolol for the treatment of social phobia A man whose obsessive-compulsive disorder is being treated long term with paroxetine A woman who has been taking lorazepam for several months after witnessing a traumatic motor vehicle accident A client with generalized anxiety disorder who has responded well since beginning treatment with fluoxetine earlier in the year
A woman who has been taking lorazepam for several months after witnessing a traumatic motor vehicle accident The potential for dependence and difficulties with withdrawal is much higher with benzodiazepines than with beta-blockers or SSRIs.
Which medication classification has been used to treat social phobia? Selective serotonin reuptake inhibitors (SSRIs) Monoamine oxidase inhibitors (MAOIs) Tricyclic antidepressants (TCAs) Nonbenzodiazepines
Selective serotonin reuptake inhibitors (SSRIs) SSRIs are used to treat clients with social phobia because they significantly reduce social anxiety and phobic avoidance. Benzodiazepines are also used to reduce anxiety caused by phobias.
The most important factor in the person's stress response is what? Supportive friends Relaxation techniques Strength of the immune system Adaptive coping strategies
Adaptive coping strategies The most important factor in a person's stress response is the ability of engage in adaptive coping behaviors. This ability can assist a person in developing resilience, or the ability to "bounce back" when faced with stress and stressful situations. The immune system, having a supportive network of friends, and understanding of relaxation techniques are also influencing factors when considering how an individual responds to stress; however, the correct option relates to an internal, sustainable strength that comes from adaptive coping.
A client approaches the nurse on an inpatient psychiatric hospital unit crying, trembling, and feeling nauseous. The client states, "I've tried everything, I still feel so anxious." Which action by the nurse would be most appropriate? Take the client to the dayroom as a distraction. Take the client on a walk around the unit. Administer the prescribed PRN anxiolytic medication. Direct the client to continue deep breathing.
Administer the prescribed PRN anxiolytic medication. The client is experiencing severe anxiety. The client tells the nurse the client has tried other strategies but they have not been effective. Given the client's report of symptoms, it would be appropriate to administer a dose of the prescribed PRN anxiolytic medication. Once the client is experiencing a decrease in the uncomfortable physiologic symptoms associated with the severe anxiety, it will be easier to engage the client in nonpharmacological interventions, such as deep breathing, to manage any residual signs and symptoms of the anxiety.
A client is currently experiencing panic. Which action would be most appropriate for the nurse to do? Ask the client repeated questions about feelings Urge the client to engage in vigorous exercise Employ the use of negative self-talk Allow the client to pace
Allow the client to pace With panic, the nurse should stay with the client. Allow pacing and walk with the client. No content inputs to the client's thinking should be made by the nurse. Asking repeated questions and teaching would be inappropriate because the client is already over-stressed. The client should use positive self-talk. Encouraging vigorous exercise would increase the physiological arousal associated with panic and should be avoided until the client is calm. Exercise should be encouraged for prevention and to promote mental wellness.
A client has sought treatment because of the overwhelming anxiety the client experiences regarding the safety of the client's young children. The client admits that the client will not normally let the client's children leave the client's sight for fear that they will be abducted, abused, or injured. The client is unable to function at work as a result of this anxiety. The nurse would recognize that this client experiences which condition? Derealization Fear Signal anxiety Anticipatory anxiety
Anticipatory anxiety Anticipatory anxiety exists in the context of phobia. People with phobias develop anticipatory anxiety even when thinking about possibly encountering the dreaded phobic situation (i.e., danger to the client's children). The anticipatory anxiety in this case is so severe that the client is unable to function in certain situations leading to hardship. Signal anxiety refers to the natural anxiety mechanism that communicates danger or motivation for needed change. Fear refers to feeling afraid or threatened by a clearly identifiable external stimulus that presents a danger to a person. Derealization refers to a stage in the experience of anxiety when a person senses that things are not real.
Panic disorder is treated with cognitive-behavioral techniques, deep breathing, and relaxation, in addition to what? Central nervous system depressants Antidepressants Antipsychotics Anticonvulsants
Antidepressants Panic disorder is treated with cognitive-behavioral techniques, deep breathing and relaxation, and medication such as benzodiazepines, selective serotonin reuptake inhibitors, tricyclics, and antihypertensives, such as clonidine and propranolol.
Which medication classification has been found to be effective in reducing or eliminating panic attacks? Antipsychotics Antimanics Antidepressants Anticholinergics
Antidepressants Tricyclic and monoamine oxidase inhibitor antidepressants have been found to be effective in treating clients with panic attacks. Why these drugs help control panic attacks is not clearly understood. Anticholinergic agents, which are smooth-muscle relaxants, relieve physical symptoms of anxiety but do not relieve the anxiety itself. Antipsychotic drugs are inappropriate because clients who experience panic attacks are not psychotic. Mood stabilizers are not indicated because panic attacks are rarely associated with mood changes.
When explaining the difference between anxiety and fear, the mental health nurse shares what? Select all that apply. Fear results in objective, physical responses caused by real danger Obsessive-compulsive behavior is often the result of abandonment Anxiety involves experiencing subjective, uncomfortable feelings resulting from unknown causes People who experience anxiety tend to use maladaptive coping mechanisms Anxiety is likely to result from an attempt to overcome stress
Anxiety involves experiencing subjective, uncomfortable feelings resulting from unknown causes Fear results in objective, physical responses caused by real danger Anxiety is likely to result from an attempt to overcome stress When explaining the difference between anxiety and fear, the mental health nurse shares that anxiety involves experiencing subjective, uncomfortable feelings resulting from unknown causes. At some point in time, all people experience anxiety, as this is a normal human response to a threat or stress. It is inaccurate to say that people who experience anxiety tend to use maladaptive coping mechanisms. Obsessive compulsive disorder is a complex anxiety disorder that not only has its roots in abandonment, but there are multiple factors contributing to why this anxiety disorder may be present in individuals.
A biologic theory explains anxiety disorders in which way? Caused by substance abuse, particularly narcotics, resulting in damage to the brain's receptors Rooted in episodes of physical or psychological abuse that occurred at times of developmental growth Based in genetics with clinical symptoms being a result of chromosomal influence Originated from disappointments resulting from an exaggerated sense of self-worth
Based in genetics with clinical symptoms being a result of chromosomal influence Research has provided solid evidence that anxiety disorders have a basis in genetics, with clinical symptoms a result of chromosomal influence.
When discussing various types of anxiolytic medications with a client, the nurse recognizes that which medication has the lowest potential for abuse? Alprazolam Lorazepam Buspirone Diazepam
Buspirone Buspirone is a nonbenzodiazepine medication that does not have abuse potential. Benzodiazepines such as alprazolam, lorazepam, and diazepam have abuse potential and may become addictive.
All of the following pharmacological agents are useful in treating anxiety disorders except which ones? Tricyclic antidepressants Selective serotonin reuptake inhibitors (SSRIs) Benzodiazepines Calcium channel blockers
Calcium channel blockers Tricyclic antidepressants and SSRIs are known to be useful in reducing anxiety and are sometimes useful in treating the anxiety disorders. Benzodiazepines are an excellent choice for the treatment of symptoms of anxiety; however, they are extremely addictive and should only be given in the case of true anxiety disorders. Calcium channel blockers are not used in treating anxiety disorders.
A client spends hours stacking and unstacking towels. The client is repeatedly checking to make sure that the towels are in order of color. What term is used to identify this behavior? Obsession Phobia Compulsion Derealization
Compulsion Compulsions are ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety. A phobia is an illogical, intense, persistent fear of a specific object or a social situation that causes extreme distress and interferes with normal functioning. An obsession is a recurrent, persistent, intrusive, and unwanted thought, image, or impulse that causes marked anxiety and interference with interpersonal, social, or occupational function. Derealization is sensing that things are not real.
Clients taking benzodiazepines need education about what? Interactions with monoamine oxidase inhibitors (MAOIs) Avoiding cheeses and smoked meats Avoiding spending too much time in the sun Concomitant use of alcohol
Concomitant use of alcohol Benzodiazepines have long been the drugs of choice for treatment of anxiety disorders. They can induce a physical dependence and can induce severe withdrawal symptoms and intense rebound anxiety when discontinued abruptly. They potentiate the effects of alcohol and other sedative hypnotics, are commonly abused, and have several significant side effects. The most common adverse effects are sedation, ataxia, loss of coordination, slurred speech, memory impairment, paradoxical agitation, and dizziness. They also cause psychomotor impairment.
A young parent tells the nurse, "I can't stop smoking. That is what I do to make myself feel better." What is the term used to describe this behavior? Crisis Defense mechanism Coping mechanism Caregiver burden
Coping mechanism Mild anxiety is often managed without conscious thought by coping mechanisms, which are behaviors used to decrease stress and anxiety. There are many typical behaviors used as coping mechanisms, including smoking.
A client comes in for a therapy session and begins to have a panic attack. The therapist asks the client to relax in the chair and then gently asks the client to imagine the client in a very safe and calm place. This technique, often useful in anxiety disorders, is called what? Deep breathing Cognitive therapy Problem-solving Desensitization
Deep breathing Helping the client focus on deep breathing can decrease the hyperarousal involved in panic attacks. It is also an opportunity for the therapist to teach the client self-help and adaptive coping mechanisms for panic attacks.
When assessing an elderly client who has newly been diagnosed with an anxiety disorder, the mental health nurse's priority is to carry out which task? Obtain a thorough history, focusing on the client's physiologic functioning Determine the client's risk for self-harm or harm to others Determine the effects that culture has had on the client's anxiety issues Assess for physical conditions that may affect anxiety
Determine the client's risk for self-harm or harm to others The first step in the assessment process is to identify the client's level of anxiety and to determine whether a threat of self-harm or harm to others exists. In any situation where the client history is not known, the nursing priority is safety.
A nurse is assessing a client and determines that the client is experiencing severe anxiety based on which finding? Eagerness for more information A heightened sense of awareness Distorted sensory awareness Goal directed behavior
Distorted sensory awareness In severe anxiety, perception becomes increasingly distorted, sensory input diminishes, and processing of sensory stimuli becomes scattered and disorganized.
A client states that the client has just had an argument with the client's spouse over the phone. What can the nurse expect that the client's sympathetic nervous system has stimulated the client's adrenal gland to release? Testosterone Endorphins Epinephrine Dopamine
Epinephrine In the sympathetic-adrenal-medullary response to stress, the sympathetic nervous system stimulates the adrenal gland to release epinephrine and norepinephrine. Corticotropin-releasing factor, adrenocorticotropic hormone (ACTH), and glucocorticoids are released in the hypothalamic-pituitary response to stress.
Nursing interventions for physical stress related illness should include what? Attending group therapy Fostering use of a social support system Assessing the need for increased dose of benzodiazepines Establishing daily routines of meals and sleeping
Establishing daily routines of meals and sleeping Individuals experiencing or at risk for untoward stress responses may benefit from a number of biologic interventions. The importance of (re-)establishing regular routines for activities of daily living (e.g., eating, sleeping, self-care, and leisure time) cannot be overstated. As well as ensuring adequate nutrition, sleep and rest, and hygiene, a routine may help to structure an individual's time and give them a sense of personal control or mastery.
Which assessment question is most likely to allow the nurse to differentiate between anxiety disorder due to a general medical condition and psychological factors affecting a medical condition? Reviewing the client's previous medication administration record and the client's current list of medications Asking the client to provide a detailed explanation of his or her medical problem to determine if the presentation is typical of the problem Questioning the client about the clinician who first diagnosed the medical problem Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first
Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first Considering the relationship of anxiety with the onset, exacerbation, or remission of the general medical condition can help determine whether a medical condition contributes to anxiety or vice versa. The client's medication list, the identity of the clinician who diagnosed the disease, and the client's symptoms are all aspects of the assessment process, but these are less likely to establish the primary cause.
During which type of anxiety does a person's perceptual field actually increase? Panic Moderate Mild Severe
Mild During mild anxiety, a person's perceptual field widens slightly, and the person is able to observe more than before and to see relationships. During moderate anxiety, the perceptual field narrows slightly. The person does not notice what goes on peripheral to the immediate focus but can do so if attention is directed there by another observer. The perceptual field is greatly reduced in severe anxiety. During panic anxiety, the perceptual field is reduced to a detail, which is usually "blown up."
The nurse is assessing a client and finds two enlarged supraclavicular lymph nodes. The nurse asks the client how long these enlarged nodes have been there. The client states, "I can't remember. A long time I think. Do I have cancer?" The nurse is aware that that body responds to stress. Which is an immediate physiologic response to stress the nurse would expect to see in this client? Vasodilation of peripheral blood vessels Pupil constriction Decrease in blood glucose levels Increased blood pressure
Increased blood pressure An initial response to stress, as seen by the fight-or-flight response, is an increase in the client's heart rate and blood pressure. Vasoconstriction leads to the increase in blood pressure. Blood glucose levels increase, supplying more readily available energy, and pupils dilate.
A group of students is reviewing information about the etiology of generalized anxiety disorder (GAD). The students demonstrate understanding of this information when they identify which as representing the bases for this disorder? Kindling caused by overstimulation Exposure to multiple stressful life events Inaccurate environmental danger assessment Intense worry and stress about work or simple family life
Intense worry and stress about work or simple family life Adults with GAD often worry about matters such as their job, household finances, health of family members, or simple matters (e.g., household chores or being late for appointments). The intensity of the worry fluctuates, and stress tends to intensify the worry and anxiety symptoms. Cognitive behavioral theory regarding the etiology of GAD proposes that the disorder results from inaccurate assessment of perceived environmental dangers. Although there are no specific sociocultural theories related to the development of GAD, a high-stress lifestyle and multiple stressful life events may be contributors. Kindling results from overstimulation or repeated stimulation of nerve cells by environmental stressors.
Which should be included in a teaching plan for a client prescribed a benzodiazepine? Maintain a fluid restriction Rise slowly from a lying or sitting position Consume caffeine in moderation Stop taking drug if sedation develops
Rise slowly from a lying or sitting position Clients taking a benzodiazepine should rise slowly from a lying or sitting position. The client should drink adequate fluids, avoid caffeine, and not stop taking the drug abruptly.
The mental health nurse is gathering a health history on a new client. The client is constantly pacing the floor and is concerned only with stating that the client is about to die. The nurse would classify this level of anxiety as what? Euphoria Severe Mild Moderate
Moderate In moderate anxiety, the client experiences a narrowing of the ability to concentrate. The client paces, has voice tremors, and has an increased rate of speech. During euphoria, the client experiences an exaggerated feeling of well-being that is not directly proportional to a specific circumstance or situation. Mild anxiety causes the client to have an increased alertness to inner feelings or the environment. During severe anxiety, the client is able to focus on only small or scattered details.
The nurse can document correctly that a client diagnosed with an anxiety disorder is experiencing moderate anxiety when the nurse observes the client doing what? Reporting, "I just can't relax; I've got things to do." Telling another client that "there is nothing they can do for me; I just know it's really bad." Demonstrating difficulty actually verbalizing anxious feelings Pacing and repeatedly asking staff what time the "doctor will be here."
Pacing and repeatedly asking staff what time the "doctor will be here." The nurse documents that a client diagnosed with an anxiety disorder is experiencing moderate anxiety when the nurse observes the client pacing and repeatedly asking staff members when the doctor will arrive. Moderate anxiety is characterized by wandering attention. The client may require repeated redirection, such as in this scenario.
The nurse has read in a client's admission record that the client has been taking propranolol for psychiatric, rather than medical, reasons. The nurse should recognize that the client likely has a history of which mental health condition? Obsessive-compulsive disorder (OCD) Panic disorder Acute stress disorder Nightmares
Panic disorder Propranolol is used in the treatment of panic disorder, but it is not a common pharmacological intervention for OCD, acute stress disorder, or nightmares.
A nursing instructor is describing the care of a client with acute anxiety to a class of nursing students. The instructor determines that more education is necessary when the students identify which intervention as appropriate? Approaching the client in a calm, confident manner Encouraging the client to verbalize feelings and concerns Providing the client with a comforting touch Providing the client with a safe, quiet, and private place
Providing the client with a comforting touch It is important to establish rapport and trust with the anxious client before using therapeutic touch. Touching an anxious client may actually increase anxiety. Trust can be established by approaching the client in a calm and confident manner; providing a place that is quiet, safe, and private; and encouraging the client to verbalize feelings and concerns
Relaxation techniques help clients with anxiety disorders because they can promote what? Increase in the metabolic rate Release of cortisol Reduction of autonomic arousal Increase in sympathetic stimulation
Reduction of autonomic arousal Regularly inducing the relaxation response reduces the general level of autonomic arousal in anxious clients. It lowers blood pressure, heart rate, metabolic rate, and oxygen demands. This physiologic effect may result from effects on the production of cortisol, a hormone the body releases in response to stress. Cortisol is helpful during the fight-or-flight response, but its prolonged presence in chronically anxious or stressed clients can inhibit the immune system and have other deleterious effects on the body.
A 30-year-old client who has been unemployed secondary to anxiety disorder states that the client would like to have a job where the client is alone and no one needs to evaluate the client's work. The nurse interprets these comments as an indicator of what? Panic disorder Social phobia Obsessive-compulsive disorder Agoraphobia
Social phobia Social phobia represents a persistent, irrational fear of and compelling desire to avoid situations in which the person may be exposed to unfamiliar people or to the scrutiny of others. Additionally, the person harbors the fear of behaving in a way that may prove humiliating or embarrassing. The person will experience marked anticipatory anxiety if confronted with such a situation and will attempt to avoid it.
Which condition involves a persistent, irrational fear attached to an object or situation that objectively does not pose a significant danger? Specific phobia Posttraumatic stress disorder Obsessive-compulsive disorder Generalized anxiety disorder
Specific phobia Specific phobia is a disorder marked by persistent fear of clearly discernible, circumscribed objects or situations, which often leads to avoidance behaviors. Posttraumatic stress disorder can occur following exposure to an actual or threatened traumatic event such as death, serious injury, or sexual violence. In obsessive-compulsive disorder, affected clients have both obsessions and compulsions and believe that they have no control over them, which results in devastating consequences for the individuals. Generally speaking, clients with generalized anxiety disorder feel frustrated, disgusted with life, demoralized, and hopeless. They may state that they cannot remember a time that they did not feel anxious. They experience a sense of ill-being and uneasiness and a fear of imminent disaster.
When a parent observes the parent's young child heading toward a busy road the parent becomes stressed, feeling the parent's heart pounding, breathing heavily, and hands becoming wet with perspiration. Which physiological system is activated with the parent's "fight or flight" reaction to this danger? Parasympathetic nervous system Motherly response system Sympathetic nervous system Central nervous system
Sympathetic nervous system The sympathetic nervous system activates the fight or flight response quickly as a survival response that results in an increased heart and respiratory rate, moist hands and feet, and dilated pupils. The parasympathetic system is most active in nonstressful events. The motherly instinct is not a proven physiological system.
All except which are considered clinical symptoms of anxiety? Tearfulness and sadness Motor excitement Extreme restlessness Palpitations
Tearfulness and sadness The clinical symptoms of anxiety are numerous. They are generally classified as physiologic, psychological or emotional, behavioral, and intellectual or cognitive responses to stress. The clinical symptoms may vary according to the level of anxiety exhibited by the client. Tearfulness and sadness are symptoms of depression, not of anxiety.
A client reports the client has been experiencing increased stress at work. The client has been managing the stress by drinking 2-3 glasses of wine per evening. Despite the nurse recommending that drinking alcohol is not an effective way to manage the stress, the client reports it is unlikely that the client will be able to stop. Which statement explains why this will be difficult for the client? The client is probably physically dependent on alcohol. Drinking alcohol is more socially acceptable than taking medications. The client has no adaptive coping mechanisms. A few glasses of wine each night is not necessarily a problem.
The client has no adaptive coping mechanisms. Clients learn to reduce the anxiety they feel in either functional or dysfunctional ways. The nurse first explores with the client what techniques the client has used in the past and helps the client identify and enhance those strategies that are most beneficial. The nurse and client identify maladaptive coping strategies, such as social withdrawal or alcohol use, and replace them with adaptive strategies that suit the client's personal, cultural, and spiritual values. The nurse should not ask the client to give up coping mechanisms, even maladaptive ones, without offering other adaptive mechanisms.
The nurse is assessing a client with anxiety. Which behavior might indicate that the client has moderate anxiety? The client is nervous and agitated. The client is unable to communicate verbally. The client is focused in an activity. The client has impaired cognitive skills.
The client is nervous and agitated. A client who is moderately anxious has a disturbing feeling that something is wrong. This causes nervousness and agitation. Increased concentration and attention is seen in clients having mild anxiety. Cognitive skills are impaired in clients who have severe anxiety. Inability to communicate verbally indicates that the client is panicking.
Which factor has the least influence on achieving mental health for the client who has anxiety disorder? The client is often late to school and makes poor grades in most of the client's subjects. The client's mother also suffered from an anxiety disorder. The client was raised in a household with high stress and frequent geographic moves. The client's mother often related to the client in ways that reflected the mother's high level of anxiety.
The client is often late to school and makes poor grades in most of the client's subjects. Being late to school and making poor grades are behaviors that indicate that the client is having difficulty; they are not factors influencing the development of the client's anxiety disorder.
The nurse is caring for a client diagnosed with anxiety disorder. The client is demonstrating difficulty concentrating and is preoccupied with feelings of helplessness. When creating the plan of care, which goal would be most appropriate for this client? The client will avoid stimuli that induces anxiety. The client will identify the source of anxiety. The client will show interest in activities. The client will display ability to cope with anxiety.
The client will display ability to cope with anxiety. Coping is a process used by individuals to manage anxiety, and may be effective or ineffective. Anxiety disorders are diagnosed when anxiety no longer functions as a signal of danger, or a motivation for needed change but becomes chronic and permeates major portions of the person's life, resulting in maladaptive behaviors and emotional disability. Nurses encounter anxious clients and families in a variety of situations. The nurse must first assess the person's anxiety level because this determines what interventions are likely to be effective. When working with an anxious person, the nurse must remain calm and in control. The goal for the client with anxiety is ultimately to be able to cope with anxiety. During the treatment the client will have to identify the source of anxiety, be able to adapt to stimuli that produces anxiety, and show interest in activities that previously caused anxiety.
The nurse at the student health center is seeing a group of nursing students who are interested in reducing their stress level. The nurse identifies guided imagery as an appropriate intervention. What does guided imagery involve? The use of progressive tensing and relaxing of muscles to release tension in each muscle group Using a positive self-image to increase and intensify physical workouts in the gym, which decreases stress The mindful use of a word, phrase, or visual image, which allows oneself to be distracted and temporarily escape from stressful situations The use of music and humor to create a calm and relaxed demeanor, which allows escape from stressful situations
The mindful use of a word, phrase, or visual image, which allows oneself to be distracted and temporarily escape from stressful situations Guided imagery is the mindful use of a word, phrase, or visual image for the purpose of distracting oneself from distressing situations or consciously taking time to relax or reenergize. The use of progressive tensing and relaxing of muscles to release tension in each muscle group is incorrect; it describes progressive muscle relaxation. Using a positive self-image to increase and intensify physical workouts in the gym, which decreases stress is incorrect; it is not an identified technique and is an answer that "sounds good" and creates a distraction for the test taker. The use of music and humor to create a calm and relaxed demeanor, which allows escape from stressful situations is incorrect; relaxing with music is not guided imagery.
Which would not be an initial intervention for the client with acute anxiety? Touching the client in an attempt to comfort the client Use of open-ended communication techniques Maintaining a nonstimulating environment Encouraging the client to verbalize feelings and concerns
Touching the client in an attempt to comfort the client The nurse should evaluate carefully the use of touch because clients with high anxiety may interpret touch by a stranger as a threat and pull away abruptly. Use open-ended questions, encouraging the client to verbalize feelings and concerns, and maintain a nonstimulating environment.
A nurse is preparing a plan of care for a client with anxiety. Which elements would the nurse likely include? Select all that apply. Providing supportive feedback Using appropriate coping skills Identifying treatment modalities Using restraint when panic develops Involving family for support, if appropriate
Using appropriate coping skills Identifying treatment modalities Involving family for support, if appropriate Providing supportive feedback Appropriate measures to include in the plan of care for a client with anxiety include: introducing appropriate coping skills, identifying alternate treatment modalities, involving family and support persons when appropriate, and providing feedback that is supportive to the client. Restraint is always a last resort.
A group of students is reviewing information about anxiety disorders in preparation for a class examination. The students demonstrate understanding of the material when they state what? Women experience anxiety disorders more often than do men. Anxiety disorders rank second to depression in psychiatric illnesses being treated. Anxiety disorders are more common among children than among adolescents. Most anxiety disorders tend to be short term with individuals achieving full recovery.
Women experience anxiety disorders more often than do men. Women experience anxiety disorders more often than do men by a 2-to-1 ratio. Anxiety disorders are the most common of the psychiatric illnesses treated by health care providers. They tend to be chronic and persistent illnesses with full recovery more likely among those who do not have other mental or physical illnesses. Anxiety disorders are the most common condition of adolescents, with one in three having an anxiety disorder.
Which nursing intervention is focused on the primary goal of anxiety management and treatment? educating the client concerning the use of medications to manage anxiety disorders assessing the client's ability to implement stress management techniques effectively helping the client identify ways to eliminate all sources of stress in his or her daily life assessing the client for possible symptoms of panic disorder
assessing the client's ability to implement stress management techniques effectively For people with anxiety disorders, it is important to emphasize that the goal is effective management of stress and anxiety, not the total elimination of anxiety. Learning anxiety management techniques and effective methods for coping with life and its stresses is essential for overall improvement in life quality. Although medication is important to relieve excessive anxiety, it does not solve or eliminate the problem entirely. While assessment is appropriate, it is not directly associated with the management and treatment of the original disorder.
A nurse is seeing a client who is having severe to panic level anxiety after a physical assault months previously. The client tells the nurse, "When the panic starts I feel like I am watching myself through a window." The nurse can most accurately describe this experience as: decatastrophizing. derealization. demonstrating automatisms. depersonalization.
depersonalization. Depersonalization is a feeling that the client may describe as being disconnected from herself, such as watching oneself. This is common when individuals experience panic levels of anxiety. Derealization refers to the sensation that things are not real or surreal during panic levels of anxiety. Decatastrophizing refers to a treatment approach used by therapists in which the client is asked questions in order to urge the client to develop a more realistic appraisal of the situation causing the anxiety. Automatisms are automatic, unconscious mannerisms that are geared toward relief of anxiety and increase in intensity and frequency with a rise in the client's anxiety level.
A nurse is seeing a client who is experiencing symptoms of moderate anxiety. She tells the nurse she and her parents disagree over her sexual orientation. Which theory would best explain the course of the client's anxiety? neurochemical behavioral interpersonal genetic
interpersonal The interpersonal theory views anxiety as being generated from problems in interpersonal relationships. The behavioral theory views anxiety as being learned through experiences, and thus purports that behaviors can be unlearned. The neurochemical theory offers an explanation of anxiety as a dysfunction of the neurotransmitter Gamma-aminobutyric acid (GABA). Because GABA reduces anxiety, researchers believe that a problem with the regulation of these neurotransmitters occurs in anxiety disorder. The genetic theory views anxiety as having an inherited component because first-degree relatives of clients with increased anxiety have higher rates of anxiety.
An adolescent who is seeing the school health nurse states, "I won't be able to hang out with my friends on Friday night because I have two essays due Monday." What level of anxiety is the adolescent experiencing? mild moderate severe panic
mild Mild anxiety is characterized by an increase in sensory stimulation that is helping the adolescent focus attention to achieve a goal. The anxiety is positive because it motivates the adolescent but does not interfere with social, occupational, or emotional functioning. The adolescent is still able to concentrate independently without having to be redirected to the topic. Moderate anxiety is characterized by a disturbing feeling that something is wrong. With moderate anxiety, a person can still process information but may have some trouble with concentration and require redirecting to focus. Severe anxiety is characterized by a significant decrease in a person's cognitive skills. If severe anxiety was being experienced, the adolescent would likely have trouble thinking and reasoning. Panic level of anxiety is characterized by physiological responses to anxiety that take over the ability to reason leading to diminished cognitive skills. It would be nearly impossible for the adolescent to make any decisions about how to organize time to complete homework if panic level of anxiety was being experienced.
