EAQ - Ch15: Anxiety & OCD

In a teaching session, the nurse uses strategies that would induce a slight degree of anxiety in the patients attending the session. What is the nurse's intention for this action? a. The patients would be more focused during the session. b. The patients would be more expressive during the session. c. The patients would be more comfortable during the session. d. The patients would be more willing to participate in the session.

a. Mild anxiety causes patients to see, listen, and grasp more information. This helps the patients to focus more on whatever is taught during the teaching session. Mild anxiety is unlikely to improve the patient's expression, comfort level, or willingness to participate. The nurse should involve the patient in discussion so that the patient expresses his or her feelings and should modify the environment of teaching to make the patient comfortable. p. 271

A 3-year-old child is admitted for an extensive stay in an acute care hospital. The parents will be able to visit only on weekends. The nurse bases emotional care of the child on the understanding that a. Children are emotionally resilient at this age b. The nursing staff can act as effective substitutes for the child's parents c. The child is at risk for physical illnesses resulting from the separation d. Providing appropriate stimulating activities will minimize the child's stress-related risks

c. Children who have been separated from their mothers, especially if placed in an impersonal environment, show a decline in physical health. Resiliency will not be sufficient to overcome the effects of separation from parents. The nursing staff may attempt to be substitutes for the parents, but at this age, the child will be aware of the separation and experience the negative effects. Stimulation will address cognitive and development needs but not emotional ones. p. 273

A new patient is diagnosed with generalized anxiety disorder. It is most important for the nurse to assess this patient for which additional problem? a. Conduct disorder b. Alcohol use disorder c. Major depressive disorder d. Obsessive-compulsive disorder

c. Clinicians and researchers have shown clearly that anxiety disorders frequently co-occur with other psychiatric problems. Several studies suggest that other psychiatric disorders coexist about 90% of the time in people with generalized anxiety or panic disorder. Anxiety disorders are comorbid with major depression at a rate of 60%; in this type of comorbidity, anxiety symptoms tend to happen before depressive symptoms. While conduct disorder, alcohol use disorder, and obsessive-compulsive disorder are possibilities, the most likely comorbid problem is depression. p 282

What information will the nurse include in medication education for a patient prescribed an antianxiety medication for obsessive-compulsive behavior? SATA a. Caffeine beverages should be avoided. b. Antacid use can affect medication absorption. c. Benzodiazepines have a quick onset of action. d. Medication should be taken on an empty stomach. e. The medication is recommended for long-term use.

a. b. c. Benzodiazepines are used most commonly for treatment of anxiety disorders because they have a quick onset of action; however, because of the potential for dependence, these medications ideally should be used for short periods only until other medications or treatments reduce symptoms. Beverages containing caffeine should be avoided because they decrease the desired effects of the drug. Antacids may delay absorption. Medications should be taken with or shortly after meals to reduce gastrointestinal discomfort. p. 288

What question would assist a nurse in determining whether a patient diagnosed with obsessive-compulsive disorder has achieved treatment outcomes? SATA a. Can the patient meet his or her own self-care needs effectively? b. Is the patient able to maintain satisfying interpersonal relationships? c. Does the patient understand that anxiety is the cause of the ritual behavior? d. Has the patient learned to use newly acquired methods to manage anxiety? e. Have the patient's cognitive abilities improved since beginning treatment?

a. b. c. d. In general, evaluation of outcomes for patients with anxiety and obsessive-compulsive disorders deals with questions such as: Can the patient maintain satisfying interpersonal relations? Does the patient adequately perform self-care activities? Is the patient able to use newly learned behaviors to manage anxiety? Does the patient recognize symptoms as anxiety-related? Cognitive abilities are not related directly to obsessive-compulsive disorders. p. 291

Which therapeutic intervention can the nurse implement personally to help a patient diagnosed with a mild anxiety disorder regain control? a. Flooding b. Modeling c. Thought stopping d. Systematic desensitization

b. Modeling calm behavior in the face of anxiety or unafraid behavior in the presence of a feared stimulus are interventions that can be used independently. Flooding, thought stopping, and systematic desensitization require agreement of the treatment team. p. 285

An important question to ask during the assessment of a patient diagnosed with anxiety disorder is a. "How often do you hear voices?" b. "Have you ever considered suicide?" c. "How long has your memory been bad?" d. "Do your thoughts always seem jumbled?"

b. The presence of anxiety may cause an individual to consider suicide as a means of finding comfort and peace. Suicide assessment is appropriate for any patient with higher levels of anxiety. p. 284

After three weeks of hemoptysis (coughing blood), a person finally seeks treatment. A chest x-ray film is taken and the person waits for the results. When the health care provider explains the report, the person complains, "I can't understand what you're saying. You're talking so fast. All I hear is a loud clicking on my watch." The patient is wet with perspiration. Which level of anxiety is evident? a. Mild b. Panic c. Severe d. Moderate

c. Indicators of severe anxiety include cognitive, narrowed perceptual field, selective attention, distortion of time/events, detachment, physical reactions such as diaphoresis, tense muscles, and decreased hearing. Mild anxiety is demonstrated by normal vital signs, minimal muscle tension, broad perceptual field, and awareness of environmental and internal stimuli. There are also feelings of relative comfort, a relaxed appearance, and automatic performance. Moderate anxiety is demonstrated by slightly elevated vital signs; moderate muscle tension; alert, narrow, or focused attention; and inability to problem solve, learn, and be attentive. There is also a feeling of readiness, energy, ability to learn, and interest in the situation. Panic is characterized by a distinct inability to respond to any stimuli other than those occurring internally and a sense of being out of control, physically and emotionally. p. 272

A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, and "burns" money that could be better spent to feed the poor is demonstrating a. Undoing b. Projection c. Rationalization d. Reaction formation

d. Reaction formation keeps unacceptable feelings or behaviors out of awareness by developing the opposite behavior or emotion. p. 274

A symptom commonly associated with panic attacks is a. Obsessions b. Apathy c. Fever d. Fear of impending doom

d. The feelings of terror present during a panic attack are so severe that normal function is suspended, the perceptual field is limited severely, and misinterpretation of reality may occur. p. 276

Which nursing intervention would be helpful when caring for a patient diagnosed with an anxiety disorder? a. Express mild amusement over symptoms. b. Arrange for patient to spend time away from others. c. Advise patient to minimize exercise to conserve endorphins. d. Reinforce use of positive self-talk to change negative assumptions.

d. This technique is a variant of cognitive restructuring. "I can't do that" is changed to "I can do it if I try." p. 276

What characteristics are associated with moderate anxiety? SATA a. The person engages in selective inattention. b. Learning and problem solving are no longer possible. c. People routinely describe a feeling of "impending doom." d. Gastric discomfort and headaches sometimes are reported. e. The sympathetic nervous system begins to control vital signs.

a, d, e. The person experiencing moderate anxiety sees, hears, and grasps less information and may demonstrate selective inattention, in which only certain things in the environment are seen or heard unless they are pointed out. Sympathetic nervous system symptoms begin to kick in. The individual may experience tension, pounding heart, increased pulse and respiratory rate, perspiration, and mild somatic symptoms (e.g., gastric discomfort, headache, urinary urgency). The ability to think clearly is hampered, but learning and problem solving can still take place, although not at an optimal level. A feeling of impending doom is associated with severe anxiety. pp. 271, 272

A young adult invites eight people to dinner. This person has never given a dinner party and wants to prepare every menu item. On the morning of the party, the young adult multitasks and makes progress preparing each food item. As the time approaches for the guests to arrive, which change indicates an increased anxiety level? a. Muscles become tense. The person must stop cooking to use the bathroom every 10 to 15 minutes. b. Blood pressure and pulse rates increase slightly. The person notices feelings of mild muscle tension. c. Fond memories of family reunions and the good food that was served drift in and out of the person's thoughts. d. The person notices there are cobwebs in the corner of the dining room and removes them before the guests arrive.

a. Normal responses to stress and activation of the sympathetic nervous system include muscle tension and frequency or urgency of urination. Other observable symptoms are fine hand tremors, restlessness, nervousness, inability to concentrate, flushing, and sweating. p. 271

A nurse is caring for a patient with claustrophobia. The primary health care provider instructed the nurse to leave the patient in a closed room for 30 minutes daily. Which behavioral therapy was the nurse instructed to implement? a. Flooding b. Modeling c. Thought-stopping d. Response prevention

a. In flooding, the patient is exposed to the fear stimuli repeatedly. With prolonged exposure to the fear, the patient learns to overcome and survive the fear. In modeling, the staff and nurse act as role models and demonstrate appropriate behavior to the fear stimuli. In response prevention, the nurse doesn't allow the patient to perform the ritual response; it can be used in obsessive-compulsive patients. Thought-stopping is used to interrupt the negative thoughts in the patient. The nurse recommends that patients snap a rubber band on their wrist to cause a distraction from negative thoughts. p. 290

A primary health care provider instructed a nurse to give cognitive-behavioral therapy to a patient with social phobia. What intervention is appropriate for the patient during the cognitive-behavior therapy? a. Re-evaluate the patient's situation. b. Support the patient's beliefs. c. Give an opinion on patient's thoughts. d. Calm the patient through isolation from peers.

a. The patients must be given cognitive-behavioral therapy to remove the negative feelings. The nurse should re-evaluate the situation realistically. The nurse should develop a positive insight in the patient by replacing the negative thoughts. The nurse should not support the patient's negative beliefs. It can further disrupt the patient's beliefs. The nurse should not give her own opinion on the patient's thoughts as it may make the patient feel rejected. The nurse should not isolate the patient from peers as it can cause withdrawal and aggression in the patient. The nurse should encourage the patient to mingle with peers. p. 291

As a part of group therapy, a patient with anxiety disorder was asked to deliver a speech to the group. However, the patient was unable to perform the given task and started avoiding the nurse. How should the nurse relieve the anxiety of the patient? SATA a. The nurse leaves the patient alone in a room. b. The nurse talks slowly and calmly with the patient. c. The nurse asks the patient to write a list of his or her strengths. d. The nurse encourages the patient to discuss the reason for fear. e. The nurse gives strict instructions to the patient to complete the given task.

b, c, d The symptoms of generalized anxiety disorder include inability to perform a given task and avoiding interacting with others. The nurse should make the patient feel safe by talking slowly and calmly. The nurse can increase the self-esteem of the patient by giving the task to write and asses the strengths of himself or herself. The nurse encourages the patient to discuss the reason for fear. It helps the nurse to identify possible stressors and to eliminate them from the patient's surroundings. The nurse should avoid giving strict instructions to the patient as it may hinder nurse-patient communication. Brief instructions enable the patient to respond in a healthy manner. The nurse should not leave the patient alone but stay with the patient to convey acceptance. p. 278

What mental health disorder can be a direct physiological result of hyperthyroidism? a. Anxiety b. Panic attacks c. Generalized anxiety disorder d. Obsessive-compulsive disorder

b. Anxiety can be a direct physiological result of hyperthyroidism. Panic attacks are a key feature of panic disorders. Generalized anxiety disorder is excessive worry, which is out of proportion to the true impact of events or situations. It is often comorbid with major depressive disorder and other anxiety disorders. Obsessive-compulsive disorder is characterized by both obsession and compulsions that may occur due to a genetic disposition or trauma. p. 279

When prescribed lorazepam 1 mg orally, four times a day, for one week, for generalized anxiety disorder, the nurse should a. Tell the patient to expect mild insomnia b. Teach the patient to limit caffeine intake c. Explain the long-term nature of benzodiazepine therapy d. Question the health care provider's prescription because the dose is excessive

b. Caffeine is an antagonist of antianxiety medication. p. 288

After reviewing the following information, which intervention best demonstrates the importance of the research findings? a. Coordinate the patient's diagnostic testing to determine neurotrophin BDNF levels. b. Include an age- and ability-appropriate exercise routine in each patient's daily routine. c. Include an orientation to the various exercise equipment available on the unit as part of the admission process. d. Educate the patients to the connection between neurotrophin brain-derived neurotrophic factor (BDNF) and anxiety.

b. Implications for Nursing Practice identified by the study encouraged nurses to promote a prescription of daily exercise. Including an age ability appropriate exercise into a patient's daily routine best implements the conclusion of this research. Although educating the patients to the connection between neurotrophin BDNF and anxiety, coordinating the patient's diagnostic testing to determine neurotrophin BDNF levels, and including an orientation to the various exercise equipment available on the unit as a part of the admission process are appropriate, these interventions do not directly implement exercise into a patient's daily routine. p. 286

What is included in the nursing plan of care for a patient diagnosed with anxiety who is exhibiting severe hyperactivity? a. Place the patient in seclusion. b. Attend to the patient's physical needs. c. Help the patient identify the source of anxiety. d. Communicate using simple, loud, clear statements.

b. The nursing care plan for a patient diagnosed with anxiety who is exhibiting severe hyperactivity is to attend to the patient's physical needs. Severe hyperactivity is characteristic of a panic level of anxiety and attending to physical needs such as elimination, fluids, and nutrition are important. Seclusion should be initiated after all other interventions have been tried and are unsuccessful. Helping a patient identify the source of anxiety is more effective for a patient experiencing mild to moderate anxiety. When the nurse is communicating with a patient experiencing severe anxiety, a low-pitched voice should be used. Test-Taking Tip: Read the question carefully before looking at the answers: (1) Determine what the question is really asking, and look for key words; (2) read each answer thoroughly, and see if it completely covers the material the question asks; and (3) narrow the choices by immediately eliminating answers you know are incorrect. p. 286

The defense mechanisms that can be used only in healthy ways include a. Suppression and humor b. Altruism and sublimation c. Idealization and splitting d. Reaction formation and denial

b. Altruism and sublimation are known as mature defenses. They cannot be used in unhealthy ways. Altruism results in resolving emotional conflicts by meeting the needs of others, and sublimation substitutes socially acceptable activity for unacceptable impulses. p. 272

Which category of medication used to treat anxiety has a potential for dependence? a. Tricyclics b. Benzodiazepines c. Selective serotonin reuptake inhibitors d. Selective serotonin norepinephrine reuptake inhibitors

b. Benzodiazepines commonly are prescribed for anxiety because they have a quick onset of action; however, because of the potential for dependence, these medications ideally should be used for short periods. Benzodiazepines are not recommended for patients with a known substance abuse history. Tricyclics, selective serotonin reuptake inhibitors, and selective serotonin norepinephrine reuptake inhibitors do not create dependency. p. 288

The nurse is providing teaching to a preoperative patient just before surgery. The patient is becoming more and more anxious as the information is presented. Soon the patient begins to report dizziness and heart pounding. The nurse observes obvious trembling and that the patient appears confused. What is the nurse's immediate intervention? a. Reinforcing the preoperative teaching by restating it slowly b. Ceasing any further attempt at preoperative teaching at this time c. Having the patient read the teaching materials instead of listening to them d. Having a familiar family member read the preoperative materials to the patient

b. Patients experiencing severe anxiety, as the symptoms suggest, are unable to learn or solve problems. Restating the preoperative teaching slowly, having the patient read the teaching materials instead of listening to them, and having a familiar family member read the preoperative materials to the patient would not be effective because the nurse is still attempting to teach someone who has a severe level of anxiety. p. 272

A patient counts everything; for example, the patient counts the number of steps to the bathroom, rings of the telephone, and cups in the pantry. How should the nurse document this finding? a. Phobia b. Obsession c. Compulsion d. Trichotillomania

c. Compulsions are ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety or prevent an imagined calamity. Performing the compulsive act temporarily reduces anxiety, but because the relief is only temporary, the compulsive act must be repeated again and again. A phobia is a persistent, irrational fear of a specific object, activity, or situation that leads to a desire for avoidance, or actual avoidance, of the object, activity, or situation. Obsessions are thoughts, impulses, or images that persist and recur, so that they cannot be dismissed from the mind even though the individual attempts to do so. Obsessions often seem senseless to the individual who experiences them (ego-dystonic), and their presence causes severe anxiety. Trichotillomania refers to hair pulling disorder. p. 278

A student nurse observes that a patient often looks at her reflection in the mirror. What is the most appropriate diagnosis the student nurse could make from the patient's behavior? a. The patient has panic disorder. b. The patient has hoarding disorder. c. The patient has body dysmorphic disorder. d. The patient has obsessive-compulsive disorder.

c. Dysmorphic disorders are characterized by a preoccupation with an imagined defective body part. Dysmorphic patients often pay excessive attention to body parts that they imagine to be defective. As a result, they may develop obsessive-compulsive behaviors such as often checking the mirrors. In obsessive-compulsive disorder patients perform repeated activities or rituals. In hoarding disorder the patient accumulates and collects all materials for future use. Patients with panic disorder may have an unusual fear of future events. p. 280

A nurse conducts a clinical interview with children to assess types of anxiety. Which scale does the nurse use to measure phobias present in the children? a. Yale-Brown obsessive-compulsive scale b. Hoarding scale self-report c. Fear questionnaire d. Panic disorder severity scale

c. Fear questionnaire is used to measure phobias present in the patients. The patients are questioned about the different types of fear which they experience. The rating is given according to the intensity. Yale-Brown obsessive-compulsive scale is used to measure the severity of compulsive behavior. Hoarding scale self-report is used to measure hoarding in a patient. Panic disorder severity scale is used to measure panic symptoms. p. 282

To support best improvement in an anxious individual's sense of control and competence, the nurse: a. Provides lavish amounts of praise when the individual accomplishes assigned tasks. b. Educates the individual regarding the usefulness of stress management techniques. c. Helps the individual identify several stress situations that he or she was successful in managing. d. Has the individual describe how one demonstrates control and competence over stress.

c. Positive self-concepts result from positive experiences, leading to perceived competence and acceptance. Assisting the patient in identifying such situations will aid in building confidence and one's perception of being competent. Being praised for successes is appropriate, but it must be reserved for situations that the individual recognizes as meaningful. Although stress management techniques are important, they are not linked directly to a sense of competence. Describing how one demonstrates control and competence is applicable but it has limited favor in actually assisting the patient in feeling competent. p. 285

After a year of diarrhea, a patient has a colonoscopy. As the health care provider explains the findings, the patient rapidly says, "You're talking too fast. I can't understand you. All I can hear is a buzz from the fluorescent lights." The patient is wet with perspiration. Which level of anxiety is evident? a. Mild b. Panic c. Severe d. Moderate

c. Symptoms of severe anxiety evident in this scenario are confusion, diaphoresis (sweating), withdrawal, rapid speech, and a perceptual field that is reduced greatly and distorted. The perceptual field is heightened in mild anxiety. In moderate anxiety, the ability to think clearly is hampered, but learning and problem solving can still take place. In panic, communication is unintelligible or there is an inability to speak. p. 272, Table 15.1

A possible outcome criterion for a patient diagnosed with anxiety disorder is a. Patient reports reduced hallucinations b. Patient reports feelings of tension and fatigue c. Patient demonstrates effective coping strategies d. Patient demonstrates persistent avoidance behaviors

c. The patient demonstrating effective coping strategies is the only desirable outcome. p. 284

A patient is displaying symptomology reflective of a panic attack. To help the patient regain control, the nurse responds, a. "You need to calm yourself." b. "What is it that you would like me to do to help you?" c. "Can you tell me what you were feeling just before your attack?" d. "I will get you some medication to help calm you."

c. A response that helps the patient identify the precipitant stressor is most therapeutic. p. 276

The nurse anticipates that the nursing history of a patient diagnosed with obsessive compulsive disorder (OCD) will reveal a. A phobia as well b. An eating disorder c. A sibling with the disorder d. A history of childhood trauma

c. Research shows that first-degree biological relatives of those with OCD have a higher frequency of the disorder than exists in the general population. p. 281

A family member of a recovering alcoholic states, "All my mother talks about now is how bad drinking is when she drank for years." What is the nurse's understanding of the statement? a. The recovering alcoholic is demonstrating adaptive sublimation. b. The recovering alcoholic is demonstrating maladaptive displacement. c. The recovering alcoholic is demonstrating adaptive reaction formation. d. The recovering alcoholic is demonstrating maladaptive intellectualization.

c. The nurse understands that the recovering alcoholic is demonstrating adaptive reaction formation, when unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite behavior or emotion. An example is a recovering alcoholic constantly talking about the harm of drinking. Sublimation is an unconscious process of substituting a mature and socially acceptable activity for immature and unacceptable impulses. Displacement is the transference of emotions associated with a particular person, object, or situation to another nonthreatening person, object, or situation. Intellectualization is a process in which events are analyzed based on remote, cold facts and without passion, rather than incorporating feeling and emotion into the processing. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. Remember the distractors. The second choice may look okay, but the fourth choice may be worded in a way that makes it a slightly better choice. If you do not weigh all the choices, you are not maximizing your chances of correctly answering each question. p. 274

A patient is diagnosed with generalized anxiety disorder (GAD). The nursing assessment supports this diagnosis when the patient reports a. Repeatedly verbalizing prayers helps the patient feel relaxed b. That eating in public makes the patient extremely uncomfortable c. That the symptoms started right after the patient was robbed at gunpoint d. Being so worried the patient hasn't been able to work for the last 12 months

d. GAD is characterized by symptomology that lasts six months or longer. p. 277