Chapter 27: Anxiety Disorders: Management of Anxiety and Panic

A nurse is conducting a seminar for a group of individuals at the community center about anxiety. The nurse determines that the seminar was successful based on which group statement? a) "Anxiety cannot be completely eliminated from life." b) "Anxiety and fear are the same." c) "Anxiety is always harmful." d) "Fear is feeling threatened by an unknown entity."

a) "Anxiety cannot be completely eliminated from life."

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? a) "Has something changed at work that is causing you to worry?" b) "Your worries are a feature of your anxiety disorder. Tell yourself that you have nothing to worry about." c) "It sounds to me like you're doing a good job." d) "Why do you think you'll be fired?"

a) "Has something changed at work that is causing you to worry?"

Which question in the assessment of a client with anxiety is most clinically appropriate? a) "How do you feel about everything that is happening in your life right now?" b) "Do you think that you're justified in feeling anxious right now?" c) "What can I give you to make you feel less anxious right now?" d) "Does your anxiety make you feel less valuable and competent as a person?"

a) "How do you feel about everything that is happening in your life right now?"

An anxiolytic agent, lorazepam, has been prescribed for the client. Which statement by the client would indicate to the nurse that client education about this medication has been effective? a) "This medication will relax me, so I can focus on problem solving." b) "My anxiety will be eliminated if I take this medication as prescribed." c) "I will probably always need to take this medication for my anxiety." d) "This medication presents no risk of addiction or dependence."

a) "This medication will relax me, so I can focus on problem solving."

The nurse recognizes that which client is most likely experiencing generalized anxiety disorder (GAD)? a) 40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months b) 70-year-old whose spouse died 1 year ago who has "no desire to leave my house" and reports severe fatigue c) 22-year-old soldier who served in the Middle East who "cannot sleep" and is facing criminal charges for hurting someone in a barroom brawl d) 30-year-old business executive who reports being anxious about attending the meetings and social events that are the executive's job responsibilities

a) 40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months

Panic disorder is treated with cognitive-behavioral techniques, deep breathing, and relaxation, in addition to what? a) Antidepressants b) Antipsychotics c) Central nervous system depressants d) Anticonvulsants

a) Antidepressants

When teaching a client with generalized anxiety disorder, the nurse instructs the client to avoid which of the following? a) Caffeine b) Sodium c) High-fat foods d) Refined sugars

a) Caffeine

When assessing an older adult client who has newly been diagnosed with an anxiety disorder, the mental health nurse's priority is to carry out which task? a) Determine the client's risk for self-harm or harm to others b) Assess for physical conditions that may affect anxiety c) Obtain a thorough history, focusing on the client's physiologic functioning d) Determine the effects that culture has had on the client's anxiety issues

a) Determine the client's risk for self-harm or harm to others

The nurse is conducting an admission assessment of a client who has a history of generalized anxiety disorder. After gauging the client's level of anxiety, what other assessment should the nurse prioritize? a) Determining whether there is potential for the client to harm himself or herself or others b) Obtaining a set of vital signs including apical heart rate and oxygen saturation c) Determining the client's understanding of factors that contribute to his or her anxiety d) Assessing the client's insight into his or her condition and gauging orientation and judgment

a) Determining whether there is potential for the client to harm himself or herself or others

The nurse is educating a client and family about managing panic attacks after discharge from treatment. The nurse includes which in the discharge teaching? Select all that apply. a) Development of a regular exercise program b) Continued development of positive coping skills c) Continued practice of relaxation techniques d) Lessening the amount of daily responsibilities e) Weaning off of medications as necessary

a) Development of a regular exercise program b) Continued development of positive coping skills c) Continued practice of relaxation techniques

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? a) Epinephrine b) Endorphins c) Dopamine d) Testosterone

a) Epinephrine

Nursing interventions for physical stress related illness should include what? a) Establishing daily routines of meals and sleeping b) Attending group therapy c) Fostering use of a social support system d) Assessing the need for increased dose of benzodiazepines

a) Establishing daily routines of meals and sleeping

While conducting a class on anxiety and stress reduction, a nurse describes the symptoms of anxiety (including panic), informing the class that the physical symptoms of a panic attack can mimic what? a) Heart attack b) Appendicitis c) Stroke d) Gastrointestinal flu

a) Heart attack

A nurse is preparing a plan of care for a client with anxiety. Which elements would the nurse likely include? Select all that apply. a) Involving family for support, if appropriate b) Providing supportive feedback c) Using restraint when panic develops d) Using appropriate coping skills e) Identifying treatment modalities

a) Involving family for support, if appropriate b) Providing supportive feedback d) Using appropriate coping skills e) Identifying treatment modalities

The nurse is teaching a class to a group of individuals diagnosed with anxiety disorders. When describing the underlying cause of these disorders, which information would the nurse most likely include? a) Neurotransmitter involvement b) Distorted thinking patterns c) A heritable predisposition unrelated to brain abnormalities d) Inactivation of stress hormones

a) Neurotransmitter involvement

A nurse is reading an article about anxiety and the behaviors of individuals when different degrees of anxiety are experienced. The nurse demonstrates understanding of the article , identifying which degree of anxiety as being evidenced by a client's cognitive process being focused only on the person's defense? a) Panic b) Mild c) Moderate d) Severe

a) Panic

A nurse is providing care to a client with social anxiety disorder. Based on the nurse's understanding of pharmacotherapy, which medication would the nurse anticipate being used as part of the treatment plan? a) Selective serotonin reuptake inhibitors (SSRIs) b) Benzodiazepines c) Beta-blockers d) Tricyclic antidepressants (TCAs)

a) Selective serotonin reuptake inhibitors (SSRIs)

Which medication classification has most commonly been used to treat social phobia? a) Selective serotonin reuptake inhibitors (SSRIs) b) Monoamine oxidase inhibitors (MAOIs) c) Tricyclic antidepressants (TCAs) d) Nonbenzodiazepines

a) Selective serotonin reuptake inhibitors (SSRIs)

A nurse is seeing a client prior to discharge after being admitted to hospital for suicidal ideation. As the nurse begins the discharge process, the client closes the eyes and begins rapid, shallow breathing. The client also begins to shake and perspire profusely. Which actions should the nurse take? Select all that apply. a) Take the client to a quiet space. b) Talk to the client in a comforting manner. c) Ask the client to spend some time alone. d) Assess the client for suicidal ideation. e) Reassure the client of being safe.

a) Take the client to a quiet space. b) Talk to the client in a comforting manner. e) Reassure the client of being safe.

A client reports experiencing increased stress at work. The client has been managing the stress by drinking 2 or 3 glasses of wine per evening. Despite the nurse recommending that drinking alcohol is not an effective way to manage the stress, the client feels it will be difficult to stop drinking. Which statement explains why this will be difficult for the client? a) The client has insufficient adaptive coping mechanisms. b) The client is probably physically dependent on alcohol. c) Drinking alcohol is more socially acceptable than taking medications. d) A few glasses of wine each night is not necessarily a problem.

a) The client has insufficient adaptive coping mechanisms.

Which of the following is inconsistent with panic-level anxiety? a) This level of anxiety can be sustained indefinitely. b) The nurse needs to maintain a nonstimulating environment. c) The nurse should remain with the client until the panic recedes. d) The goal is to lower the client's anxiety to mild or moderate before proceeding with anything else.

a) This level of anxiety can be sustained indefinitely.

Why must nurses understand why anxiety occurs and how anxiety behaviors work? Select all that apply. a) To help nurses to function at a high level b) To help the nurse to mask his or her own feelings of anxiety c) To help understand the role anxiety plays in performing nursing responsibilities d) To provide better care for the client e) So the nurse can identify that his or her own needs are more important than the clients

a) To help nurses to function at a high level c) To help understand the role anxiety plays in performing nursing responsibilities d) To provide better care for the client

A client states, "I will just die if I don't get this job." The nurse then asks the client, "What will be the worst that will happen if you don't get the job?" Why does the nurse ask this question? a) To help the client appraise their situation more realistically b) To assist the client to make alternative plans for the future c) To assess whether the client has health problems compounded by stress d) To clarify the client's meaning

a) To help the client appraise their situation more realistically

After teaching a group of mental health nursing students about the care of a client experiencing a panic attack, the instructor determines that additional education is required when the students identify which as an appropriate intervention? a) Touching the client in an attempt to comfort the client b) Providing the client with a safe, quiet, and private place c) Approaching the client in a calm, confident manner d) Encouraging the client to verbalize feelings and concerns

a) Touching the client in an attempt to comfort the client

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? a) "Every time you feel anxious, try to focus on how much easier your life would be if you didn't experience anxiety so often." b) "Anxiety is a feeling that is experienced by everyone at some point and it can never be completely removed from one's life." c) "With the development of more life skills and a demonstration of continued success in life, your anxiety will shrink and eventually disappear." d) "If you address the causes of your anxiety head-on, you will find that you can recover from it without medications or therapy."

b) "Anxiety is a feeling that is experienced by everyone at some point and it can never be completely removed from one's life."

A 25-year-old pregnant mother of two children under age 6 is very protective and will not allow her children to play outdoors for fear of tick bites. She is worn out from cleaning the house from top to bottom every day. She asks the nurse how she can stop worrying so much. What is the most appropriate response for the nurse? a) "Have you considered spraying your children with an insect repellent?" b) "Tell me your concerns about the children playing in your backyard." c) "Why do you worry about the children getting tick bites?" d) "Have you sprayed your backyard for ticks or other pests?"

b) "Tell me your concerns about the children playing in your backyard."

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? a) 2 months b) 6 months c) 12 months d) 4 months

b) 6 months

The mental health nurse knows that which medication classification has been found to be effective in reducing or eliminating panic attacks? a) Antipsychotics b) Antidepressants c) Antimanics d) Anticholinergics

b) Antidepressants

A client receiving benzodiazepine therapy as treatment for panic disorder comes to the emergency department for evaluation. The nurse suspects the client is experiencing benzodiazepine withdrawal based on which of the following findings? Select all that apply. a) Sour taste b) Apprehension c) Agitation d) Hypersomnia e) Irritability

b) Apprehension c) Agitation e) Irritability

All of the following pharmacological agents are useful in treating anxiety disorders except which ones? a) Selective serotonin reuptake inhibitors (SSRIs) b) Calcium channel blockers c) Tricyclic antidepressants d) Benzodiazepines

b) Calcium channel blockers

A nurse is assessing a client and determines that the client is experiencing severe anxiety based on which finding? a) Goal directed behavior b) Distorted sensory awareness c) A heightened sense of awareness d) Eagerness for more information

b) Distorted sensory awareness

A nurse is assessing the vital signs of a client in the cardiac clinic. The nurse observes the client's blood pressure and heart rate are higher than what is normally expected for this client. The client tells the nurse, "I'm always so nervous when I come to the clinic." The nurse interprets the client's statement and vital signs as reflecting which situation? a) Severe anxiety b) Fight-or-flight response c) Exhaustion d) Defense mechanism

b) Fight-or-flight response

Concomitant use of antidepressants with monoamine oxidase inhibitors (MAOIs) can cause which life-threatening drug interaction? a) Risk of seizures b) Hypertensive crisis c) Sedation d) Hypotensive crisis

b) Hypertensive crisis

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? a) Vasodilation of peripheral blood vessels b) Increased blood pressure c) Pupil constriction d) Decrease in blood glucose levels

b) Increased blood pressure

After teaching a client about possible side effects of benzodiazepines, the nurse determines that additional teaching is needed when the client identifies which of the following as a possible side effect of the drug? a) Sedation b) Metallic taste c) Visual disturbances d) Dizziness

b) Metallic taste

During which type of anxiety does a person's perceptual field actually increase? a) Severe b) Mild c) Moderate d) Panic

b) Mild

Relaxation techniques help clients with anxiety disorders because they can promote what? a) Increase in sympathetic stimulation b) Reduction of autonomic arousal c) Increase in the metabolic rate d) Release of cortisol

b) Reduction of autonomic arousal

A client says to the nurse, "I just can't talk in front of the group. I'm trembling and I feel like I'm going to pass out." The nurse assesses the client's anxiety to be at which level? a) Panic b) Severe c) Moderate d) Mild

b) Severe

A group of nursing students are reviewing signs and symptoms of anxiety. The students demonstrate a need for additional review when they identify what? a) Motor excitement b) Tearfulness c) Palpitations d) Extreme restlessness

b) Tearfulness

A psychaitric-mental health nurse is preparing a presentation for a group of colleagues on anxiety disorders. As part of the presentation the nurse plans to discuss the concept of interoceptive conditioning. Which information would the nurse most likely include in this discussion? a) The person experiences a phobic avoidance of the event. b) There is an association between physical symptoms and a panic attack. c) A person links an adverse event with a previous neutral event. d) A recent loss is the initiating event that leads to a panic attack.

b) There is an association between physical symptoms and a panic attack.

A client is prescribed a serotonin-norepinephrine reuptake inhibitor. The nurse would identify that which of the following is most commonly prescribed? a) Paroxetine b) Venlafaxine c) Fluoxetine d) Duloxetine

b) Venlafaxine

A nurse detects that a client is experiencing panic-level anxiety. Which intervention should be immediately implemented? a) gather a show of force in preparation for physical control b) provide calm, brief, directive communication c) teach relaxation techniques d) administer anxiolytic medication

b) provide calm, brief, directive communication

A client is currently experiencing panic. Which action would be most appropriate for the nurse to do? a) Employ the use of negative self-talk b) Urge the client to engage in vigorous exercise c) Allow the client to pace d) Ask the client repeated questions about feelings

c) Allow the client to pace

Panic disorder is treated with cognitive-behavioral techniques and deep breathing and relaxation, in addition to which of the following? a) Anticonvulsants b) CNS depressants c) Antianxiety medications d) Antipsychotics

c) Antianxiety medications

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? a) Crisis b) Defense mechanism c) Coping mechanism d) Caregiver burden

c) Coping mechanism

The nurse documents that the client is in a state of panic anxiety when she is observed doing which of the following? a) Reporting that she "can't sleep a wink" if she is not in her own bed b) Wringing her hands and asking staff when they think she will have another heart attack c) Crying hysterically and complaining of a shortness of breath prior to a cardiac procedure d) The client refuses to have her blood pressure taken in her left arm because she is sure something bad will happen

c) Crying hysterically and complaining of a shortness of breath prior to a cardiac procedure

In teaching a client who has been prescribed a benzodiazepine for panic disorder, the nurse must be certain to do what? a) Instruct the client to come in every other week to get blood drawn and monitor for agranulocytosis. b) Instruct the client that if the client has palpitations, the client should contact the client's physician immediately because of the risk for dysrhythmias with this medication. c) Educate the client that this medication has a high risk for withdrawal symptoms, and the client should not discontinue without a doctor's supervision. d) Educate the client that this medication will interact with certain food groups.

c) Educate the client that this medication has a high risk for withdrawal symptoms, and the client should not discontinue without a doctor's supervision.

The nurse plans to teach a client about dietary modifications to manage diabetes. Teaching would be most effective if the client displayed which characteristic? a) Narrowed perceptual field b) Faster rate of speech c) Heightened focus d) Focused only on immediate task

c) Heightened focus

The nurse is teaching a client with an anxiety disorder ways to manage anxiety. The nurse suggests which schedule for practicing relaxation techniques? a) Expect to practice the techniques when meeting with a therapist. b) Reserve these techniques for episodes of panic. c) Practice the techniques when relatively calm. d) Use the techniques as needed when experiencing severe anxiety.

c) Practice the techniques when relatively calm.

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? a) Encouraging the client to verbalize feelings and concerns b) Approaching the client in a calm, confident manner c) Providing the client with a comforting touch d) Providing the client with a safe, quiet, and private place

c) Providing the client with a comforting touch

When developing a plan of care for a client diagnosed with panic disorder, which nursing diagnosis would be considered the priority? a) Powerlessness b) Anxiety c) Risk for Self-Directed Violence d) Social Isolation

c) Risk for Self-Directed Violence

A client experiences panic attacks when confronted with riding in elevators. The therapist is teaching the client ways to relax while incrementally exposing the client to getting on an elevator. This technique is called what? a) Combination therapy b) Cognitive restructuring c) Systematic desensitization d) Flooding

c) Systematic desensitization

What part of the brain is thought to be involved in the production of anxiety as a result of the identification of incoming sensory information as threatening? a) Brainstem b) Cerebellum c) Cerebral cortex d) Amygdala

d) Amygdala

Which medication classification has been found to be effective in reducing or eliminating panic attacks? a) Antipsychotics b) Anticholinergics c) Antimanics d) Antidepressants

d) Antidepressants

Which medication classifications used in the treatment of panic disorder can cause physical dependence? a) Serotonin-norepinephrine reuptake inhibitors (SNRIs) b) Tricyclic antidepressants (TCAs) c) Selective serotonin reuptake inhibitors (SSRIs) d) Benzodiazepines

d) Benzodiazepines

A client responds to bad news regarding test results by crying uncontrollably. What is the term for this response to a stressor? a) Defense mechanism b) Homeostasis c) Adaptation d) Coping mechanism

d) Coping mechanism

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? a) Reviewing the client's previous medication administration record and the client's current list of medications b) Questioning the client about the clinician who first diagnosed the medical problem c) Asking the client to provide a detailed explanation of his or her medical problem to determine if the presentation is typical of the problem d) Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first

d) Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first

A psychiatric-mental health nurse is conducting a program for a group of young adults at a community center about anxiety. The nurse determines that the teaching was successful when the group identifies which aspect about anxiety? a) Anxiety primarily makes a person unable to act. b) Anxiety can be avoided in most instances. c) The underlying cause of the anxiety is rarely identifiable. d) Relief behaviors can prevent anxiety from increasing.

d) Relief behaviors can prevent anxiety from increasing.

A client arrives on the psychiatric unit exhibiting restlessness, disorientation, incoherent speech, agitation, purposeless physical activity, and suicidal ideations. Which of the following is the priority nursing diagnosis for this client? a) Ineffective individual coping b) Disturbed identity c) Hopelessness d) Risk for injury

d) Risk for injury

After reviewing various etiologic theories associated with panic disorder, the nurse demonstrates understanding of the psychodynamic theory, identifying which as the underlying cause? a) Heritability b) Conditioning c) Activation of stress hormone d) Separation or loss

d) Separation or loss

The nurse enters the client's room and finds the client anxiously pacing the floor. The client begins shouting at the nurse, "Get out of my room!" The best intervention by the nurse would be to a) Say, "I'm leaving now, but I'll be back." b) Approach the client and ask, "What's wrong?" c) Call for help and say, "Calm down." d) Stand at the doorway and say, "You seem upset."

d) Stand at the doorway and say, "You seem upset."

A nurse assesses a client and determines that the client is experiencing mild anxiety based on what? a) The client voices feelings of unreality b) The client has focused attention on a small area c) The client is selectively inattentive d) The client is aware and alert

d) The client is aware and alert

The nurse can be confident that the client diagnosed with an anxiety disorder will respond well to treatment when which of the following situations or conditions are present? a) The client has a family that is truly willing and capable of supporting him during the treatment b) The client readily agrees to immediately notify the mental health care team if symptoms reoccur after discharge c) The client has a no history of other psychiatric disorders d) The client states, "I understand my symptoms and what I need to do to help myself, and I'm ready to do it so I'm back to normal."

d) The client states, "I understand my symptoms and what I need to do to help myself, and I'm ready to do it so I'm back to normal."

The nursing student understands correctly when identifying which objective is appropriate for all clients with anxiety disorders? a) The client will experience reduced anxiety and accept the fact that underlying conflicts cannot be treated. b) The client will experience reduced anxiety and strive for insight through psychoanalysis. c) The client will experience reduced anxiety and learn to control primitive impulses. d) The client will experience reduced anxiety and develop alternative responses to anxiety-provoking situations.

d) The client will experience reduced anxiety and develop alternative responses to anxiety-provoking situations.

A psychiatric nurse visits a client at home. The client tells the nurse that he or she experiences chest pain, shortness of breath, and sweating whenever leaving home. The client has been unable to go to work for six weeks. The nurse recognizes this problem as which behavior? a) mysophobia b) claustrophobia c) acrophobia d) agoraphobia

d) agoraphobia