Chapter 11 Anxiety w/ Substance Abuse Qs from Test bank

Japanese and Korean culture

, people have a fear of offensive body odor.

4

A cab driver, stuck in traffic, becomes lightheaded, tremulous, diaphoretic, tachycardic, and dyspneic. A work-up in an emergency department reveals no pathology. Which medical diagnosis should the nurse suspect, and what nursing diagnosis should be the nurse's first priority? 1. Generalized anxiety disorder and a nursing diagnosis of fear 2. Mild anxiety disorder and a nursing diagnosis of anxiety 3. Pain disorder and a nursing diagnosis of altered role performance 4. Panic disorder and a nursing diagnosis of anxiety

2

A client admitted for chest pain related to cocaine abuse states, "This is nothing but a little indigestion. What is all the fuss about?" This client is using which defense mechanism? 1. Minimization. 2. Denial. 3. Rationalization. 4. Projection.

2

A client attempted suicide 3 days ago. When the nurse asks about the related events, the client says, "I don't want to think about that now, but maybe we could talk about it later." Which defense mechanism has the client used? 1 Repression 2 Suppression 3 Rationalization 4 Intellectualization

2

A client diagnosed with obsessive-compulsive disorder is admitted to a psychiatric unit. The client has an elaborate routine for toileting activities. Which would be an appropriate initial client outcome during the first week of hospitalization? 1. The client will refrain from ritualistic behaviors during daylight hours. 2. The client will wake early enough to complete rituals prior to breakfast. 3. The client will participate in three unit activities by day three. 4. The client will substitute a productive activity for rituals by day one.

3

A client diagnosed with obsessive-compulsive disorder takes several hours to maintain hygiene. What appropriate method does the nurse apply to help the client in maintaining hygiene? 1 The nurse gives a wide variety of clothing options to the client. 2 The nurse gives continuous directions to the client. 3 The nurse discusses with the client his or her feelings about self-care. 4 The nurse dresses the client.

2

A client diagnosed with panic disorder begins a new prescription for lorazepam. The nurse should provide instructions to discontinue which of this client's usual routine activities? 1 Sewing 2 Mowing the lawn 3 Playing video games 4 Preparing dinner for the family

1

A client diagnosed with panic disorder states, "When an attack happens, I feel like I am going to die." Which is the most appropriate nursing response? 1. "I know it's frightening, but try to remind yourself that this will only last a short time." 2. "Death from a panic attack happens so infrequently that there is no need to worry." 3. "Most people who experience panic attacks have feelings of impending doom." 4. "Tell me why you think you are going to die every time you have a panic attack."

4

A client diagnosed with substance dependence states to the nurse, "My wife causes me to abuse methamphetamines. She uses and expects me to." This client is using which defense mechanism? 1. Rationalization. 2. Denial. 3. Minimization. 4. Projection.

3

A client frantically reports to the nurse, "You have got to help me! Something terrible is happening. I can't think. My heart is pounding, and my head is throbbing." At what level should the nurse assess the client's anxiety? 1 Mild 2 Moderate 3 Severe 4 Panic

3

A client is experiencing a severe panic attack. Which nursing intervention would meet this client's physiological need? 1. Teach deep breathing relaxation exercises. 2. Place the client in a Trendelenburg position. 3. Have the client breathe into a paper bag. 4. Administer the ordered prn buspirone (BuSpar).

4

A client is newly diagnosed with obsessive-compulsive disorder and spends 45 minutes folding clothes and rearranging them in drawers. Which nursing intervention would best address this client's problem? 1. Distract the client with other activities whenever ritual behaviors begin. 2. Report the behavior to the psychiatrist to obtain an order for medication dosage increase. 3. Lock the room to discourage ritualistic behavior. 4. Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors.

1

A client is prescribed alprazolam (Xanax) for acute anxiety. What client history should cause a nurse to question this order? 1. History of alcohol use disorder 2. History of personality disorder 3. History of schizophrenia 4. History of hypertension

3

A client living in a beachfront community is seeking help with an extreme fear of bridges, which is interfering with daily functioning. The psychiatric nurse practitioner decides to try systematic desensitization. Which explanation of this treatment should the nurse provide? 1. "Using your imagination, we will attempt to achieve a state of relaxation." 2. "Because anxiety and relaxation are mutually exclusive states, we can attempt to substitute a relaxation response for the anxiety response." 3. "Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety." 4. "In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate."

3

A client who has recently relapsed from alcohol abstinence is seen in the out-patient mental health clinic. The client states, "I don't know what all the fuss is about. Can't I have a few drinks now and then?" Which nursing diagnosis applies to this client? 1. Risk for injury. 2. Risk for violence: self-directed. 3. Ineffective denial. 4. Powerlessness.

1,4,5

A college student has been diagnosed with generalized anxiety disorder. Which of the following symptoms should the campus nurse expect this client to exhibit? (Select all that apply.) 1. Fatigue 2. Anorexia 3. Hyperventilation 4. Insomnia 5. Irritability

3

A college student is unable to take a final exam due to severe test anxiety. Instead of studying, the student relieves stress by attending a movie. Which priority nursing diagnosis should the campus nurse assign for this client? 1. Non-adherence R/T test taking 2. Ineffective role performance R/T helplessness 3. Altered coping R/T anxiety 4. Powerlessness R/T fear

2

A family member is seeking advice about an older parent who seems to worry unnecessarily about everything. The family member states, "Should I seek psychiatric help for my mother?" Which is an appropriate nursing response? 1. "My mother also worries unnecessarily. I think it is part of the aging process." 2. "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning." 3. "From what you have told me, you should get her to a psychiatrist as soon as possible." 4. "Anxiety is a complex phenomenon and is effectively treated only with psychotropic medications."

1,3,4,5

A nurse has been caring for a client diagnosed with generalized anxiety disorder. Which of the following nursing interventions would address this client's symptoms? (Select all that apply.) 1. Encourage the client to recognize the signs of escalating anxiety. 2. Encourage the client to avoid any situation that causes stress. 3. Encourage the client to employ newly learned relaxation techniques. 4. Encourage the client to cognitively reframe thoughts about situations that generate anxiety. 5. Encourage the client to avoid caffeinated products.

2,3

A nurse is discussing treatment options with a client whose life has been negatively impacted by claustrophobia. Which of the following commonly used behavioral therapies for phobias should the nurse explain to the client? (Select all that apply.) 1. Benzodiazepine therapy 2. Systematic desensitization 3. Imploding (flooding) 4. Assertiveness training 5. Aversion therapy

2,3,4

A nurse is working on a project to find the epidemiology of panic disorder in the Latin American community. Which signs should the nurse expect to observe in a client from this community experiencing a panic attack? Select all that apply. 1 The client fears offensive body odor. 2 The client has sensations of choking. 3 The client feels numbness or tingling. 4 The client has sensations of smothering. 5 The client attributes the attack to magic or witchcraft.

1,2

A nurse observes a client's parents at an intensive care unit. The nurse determines that the client's parents have moderate anxiety. Which symptoms of anxiety did the nurse assess in the client's parents? Select all that apply. 1 The parents were talking in trembling voices. 2 The parents were having increased rates of respiration. 3 The parents were confused and unable to make any decisions. 4 The parents were effectively making decisions to solve problems. 5 The mother was tapping her foot, and the father was chewing his lip

2

A nursing instructor is teaching about specific phobias. Which student statement indicates to the instructor that teaching has been effective? 1. "These clients recognize their fear as excessive and frequently seek treatment." 2. "These clients have a panic level of fear that is overwhelming and unreasonable." 3. "These clients experience symptoms that mirror a cerebrovascular accident." 4. "These clients experience the symptoms of tachycardia, dysphagia, and diaphoresis."

2

A nursing instructor is teaching about the symptoms of agoraphobia. Which student statement indicates that teaching has been effective? 1. Onset of symptoms most commonly occurs in early adolescence and persists until midlife. 2. Onset of symptoms most commonly occurs in the 20s and 30s and persists for many years. 3. Onset of symptoms most commonly occurs in the 40s and 50s and persists until death. 4. Onset of symptoms most commonly occurs after the age of 60 and persists for at least 6 years.

1,2,5

An attractive female client presents with high anxiety levels because of her belief that her facial features are large and grotesque. Body dysmorphic disorder (BDD) is suspected. Which of the following additional symptoms would support this diagnosis? (Select all that apply.) 1. Mirror checking 2. Excessive grooming 3. History of an eating disorder 4. History of delusional thinking 5. Skin picking

Panic level of anxiety

An individual is not able to process events in the environment and may lose touch with reality. The result- ing behavior may be con usion, shouting, screaming, or withdrawal.

2,3,5

As a part of group therapy, a client diagnosed with an anxiety disorder was asked to present a speech to the group. The client was unable to perform the given task and started avoiding the nurse. How should the nurse relieve the anxiety of the client? Select all that apply. 1 Leave the client alone in a room. 2 Talk slowly and calmly with the client. 3 Ask the client to write a list of his or her strengths. 4 Give strict instructions to the client to complete the given task. 5 Encourage the client to discuss feelings associated with the fear.

4

As the nurse teaches a preoperative client, the client becomes more and more anxious as the information is presented. Soon the client begins to report dizziness and heart pounding. The nurse observes obvious trembling and confusion. Which is the nurse's priority intervention? 1 Reinforce the preoperative teaching by restating it slowly. 2 Have the client read the teaching materials instead of listening to them. 3 Have a familiar family member read the preoperative materials to the client. 4 Cease any further attempt at preoperative teaching at this time and instead encourage deep breathing.

Propranolol

Beta blocker, reduces the physiological symptoms of anxiety

3

During her aunt's wake, a 4-year-old child runs up to the casket before her mother can stop her. An appointment is made with a nurse practitioner when the child starts twisting and pulling out hair. Which nursing diagnosis should the nurse practitioner assign to this child? 1. Complicated grieving 2. Altered family processes 3. Ineffective coping 4. Body image disturbance

Altruism

Emotional conflicts and stressors are addressed by meeting the needs of others

agoraphobia

Excessive anxiety about of fear of being in a place or situation where help may not be available

2

From a biochemical perspective, what factor is implicated in the predisposition to the abuse of substances? 1. Children of alcoholics are four times more likely than other children to be alcoholics. 2. Animal tests show that injections of the morphine-like substance that is produced by alcohol results in addicted test animals. 3. Fixation in the oral stage of psychosocial development can be the cause of substance abuse disorders. 4. Depressive response cycles and antisocial personality disorders are associated with substance abuse disorders.

Altruism, sublimation , humor , suppression

Healthy defense mechanisms

2

Selective inattention is first noted when an individual experiences which level of anxiety? 1 Mild 2 Moderate 3 Severe 4 Panic

4

The nurse is providing education to a client diagnosed with anxiety. Which statement by the client indicates that teaching has been effective? 1. "There is nothing that I can do to that will reduce anxiety." 2. "Medication is available, but only for those who have had anxiety for a year or more." 3. "If I ignore the symptoms of anxiety, it will go away." 4. "Practicing yoga or meditation may help reduce my anxiety."

1

The nurse is working with a 45-year-old client who has abused alcohol since age 20. Related to this client's stage of psychosocial development, what developmental data would the nurse expect to assess? 1. The client may have trouble establishing intimate relationships. 2. The client may have trouble trusting others. 3. The client may review life, have serious regrets, and experience despair. 4. The client may feel a sense of inferiority or inadequacy.

4

The plan of care for a client who uses elaborate washing rituals specifies that response prevention is to be applied. Which scenario is an example of response prevention? 1 Withholding reassurance from staff 2 Having the client repeatedly touch dirty objects 3 Telling the client to relax whenever tension mounts 4 Preventing the client from washing hands after touching a dirty object

1

Using the principles of biological theory, what contributing factor puts a client at risk for alcoholism? 1. The client is a child of an alcoholic parent. 2. The client is fixated in the oral phase. 3. The client is highly self-critical and has unconscious anxiety. 4. The client is unable to relax or defer gratification.

2,3,4

Using the principles of social learing theory, what contributing factor puts a client at risk for alcoholism? Select All. 1. The client's twin sister is an alcoholic. 2. The client was raised in a home where substance use was the norm. 3. The client is from a family that culturally accepts the use of substances. 4. The client experiences pleasure when a substance is used and subsequently driven to repeat the use. 5. Alcohol produces morphine-like substances that are responsible for addiction.

2

What is the most important question to ask during assessment of a client diagnosed with an anxiety disorder? 1 "How often do you hear voices?" 2 "Have you ever considered suicide?" 3 "How long has your memory been poor?" 4 "Do your thoughts always seem jumbled?"

1

What is the most likely potential problem for a client diagnosed with severe obsessive-compulsive disorder? 1 Sleep disturbance 2 Excessive socialization 3 Command hallucinations 4 Altered state of consciousness

4

What is the primary purpose of performing a physical examination before beginning treatment for any anxiety disorder? 1 To protect the nurse legally 2 To establish the nursing diagnoses of priority 3 To obtain information about the client's psychosocial background 4 To determine whether the anxiety is primary or secondary in origin

4

What symptoms should the nurse recognize that differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)? 1. GAD is acute in nature, and panic disorder is chronic. 2. Chest pain is a common GAD symptom, whereas this symptom is absent in panic disorders. 3. Hyperventilation is a common symptom in GAD and rare in panic disorder. 4. Depersonalization is commonly seen in panic disorder and absent in GAD.

4

What type of anxiety may be associated with delusional thinking? 1 Acute anxiety 2 Severe anxiety 3 Chronic anxiety 4 Panic level anxiety

3

When a client is prescribed lorazepam 1 mg orally four times a day for 1 week for generalized anxiety disorder, what should the nurse do? 1 Question the health care provider's prescription regarding the high dose. 2 Explain the long-term nature of benzodiazepine therapy to the client. 3 Teach the client to limit caffeine intake. 4 Tell the client to expect mild insomnia

4

Which behavior would be characteristic of an individual who is displaying passive aggression? 1 Lying 2 Stealing 3 Slapping 4 Procrastinating

2

Which individual would have the lowest potential for alcohol dependency? 1. A 32-year-old male Finn. 2. A 20-year-old Asian woman. 3. A 60-year-old Irishman. 4. An 18-year-old Native American.

4

Which nursing statement focuses on the personality factors that are implicated in the predisposition to the abuse of substances? 1. "Hereditary factors are involved in the development of substance abuse disorders." 2. "Alcohol produces morphine-like substances in the brain that are responsible for alcohol abuse." 3. "A punitive superego is at the root of substance abuse." 4. "A tendency toward addictive behaviors increases as low self-esteem, passivity, and an inability to relax or defer gratification increase."

3

Which nursing statement to a client about social anxiety disorder versus schizoid personality disorder (SPD) is most accurate? 1. "Clients diagnosed with social anxiety disorder can manage anxiety without medications, whereas clients diagnosed with SPD can only manage anxiety with medications." 2. "Clients diagnosed with SPD are distressed by the symptoms experienced in social settings, whereas clients diagnosed with social anxiety disorder are not." 3. "Clients diagnosed with social anxiety disorder avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life." 4. "Clients diagnosed with SPD avoid interactions only in social settings, whereas clients diagnosed with social anxiety disorder tend to avoid interactions in all areas of life."

2,3,4

Which outcome indicates that the individual is demonstrating a commonly observed but negative coping strategy after a crisis event? 1 Scheduling spiritual counseling sessions three times a week 2 Gaining 10 lb over a 6-week period of time 3 Losing one's driver's license for driving drunk 4 Offering numerous excuses for not socializing 5 Running 5 miles daily

1,2,4,5

Which questions would assist a nurse in determining whether a client diagnosed with obsessive-compulsive disorder has achieved treatment outcomes? Select all that apply. 1 Can the client meet self-care needs effectively? 2 Is the client able to maintain satisfying interpersonal relationships? 3 Have the client's cognitive abilities improved since beginning treatment? 4 Has the client learned to use newly acquired methods to manage anxiety? 5 Does the client understand that anxiety is the cause of the ritualistic behavior?

3

Which statement is true regarding obsessive-compulsive disorder (OCD)? 1 Behaviors suggestive of OCD usually begin in infancy. 2 Hospitalization is often necessary for persons diagnosed with OCD. 3 Clients diagnosed with OCD should be assessed regularly for risk for suicide. 4 Compulsions are repetitive thoughts, whereas obsessions are ritualistic behaviors

2,4,5

Which statements about panic attacks are true? Select all that apply. 1 A stressful situation is generally the trigger for a panic attack. 2 They are characterized by a sudden onset of extreme apprehension. 3 The symptomology of panic attacks is primarily psychological in nature. 4 The fear is so intense that it interferes with a person's ability to function normally. 5 People with a history of panic attacks develop a deep-seated fear of having an attack

4

Which symptom is commonly associated with panic attacks? 1 Fever 2 Apathy 3 Obsessions 4 Fear of impending doom

1

Which symptoms should the nurse recognize that differentiate a client diagnosed with obsessive-compulsive disorder (OCD) from a client diagnosed with obsessive-compulsive personality disorder? 1. Clients diagnosed with OCD experience both obsessions and compulsions, and clients diagnosed with obsessive-compulsive personality disorder do not. 2. Clients diagnosed with obsessive-compulsive personality disorder experience both obsessions and compulsions, and clients diagnosed with OCD do not. 3. Clients diagnosed with obsessive-compulsive personality disorder experience only obsessions, and clients diagnosed with OCD experience only compulsions. 4. Clients diagnosed with OCD experience only obsessions, and clients diagnosed with obsessive-compulsive personality disorder experience only compulsions.

suppression

a conscious, deliberate effort to avoid painful and anxiety-producing memories

Intellectualization

a process in which events are analyzed based on facts and without passion, rather than including feeling and emotion.

phobia

abnormal fear

Caffeine

an antagonist of antianxiety medication

ineffective coping

an inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, or inability to use available resources

repression

an unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness

mild anxiety

causes clients to see, listen, and grasp more information

severe anxiety

characterized by feelings of falling apart and impending doom, impaired cognition, and severe somatic symptoms such as headache and pounding heart

severe anxiety

confused and are unable to make decisions

Rationalization

consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations.

Moderate anxiety

escalates, the patient's perceptual field narrows and some details are excluded from observation

Tricyclic antidepressants

have very little antianxiety effect and have a slow onset of action.

moderate anxiety

have voice tremors and tend to talk in a trembling voice increased pulse rate and respiratory rate

social anxiety disorder

intense fear of social situations, leading to avoidance of such

left off at nursing process assesment for substance

left off at nursing process assesment

mild anxiety

mild tension-relieving behavior such as foot or finger tapping and lip chewing.

1

n a teaching session, the nurse uses strategies that will induce a slight degree of anxiety for the clients attending the session. What is the nurse's intention for this action? 1 The clients will be more focused during the session. 2 The clients will be more expressive during the session. 3 The clients will be more comfortable during the session. 4 The clients will be more willing to participate in the session.

mild anxiety

occurs in the normal experience o everyday living. A personals ability to focus is brought into sharp focus.

negative coping mechanisms

overeating, drinking, smoking, withdrawing, yelling or fighting