Practice Questions Care of the patient with Anxiety Disorders

The nurse is caring for a patient on day 1 post surgical procedure. The patient becomes visibly anxious and short of breath, and states, "I feel so anxious! Something is wrong!" What action should the nurse take initially in response to the patient's actions? A. Reassure the patient that what they are feeling is normal anxiety and do deep breathing exercises with her. B. Use the call light to inquire whether the patient has been prescribed prn anxiety medication C. Call for staff help and assess the client's vital signs D. Reassure the patient that you will stay until the anxiety subsides

C. Call for staff help and assess the client's vital signs.

You are caring for Yolanda, a 67 year old patient who has been receiving hemodialysis for 3 months. Yolanda reports that she feels angry whenever it is time for her dialysis treatment. You attribute this to: A. Organic changes in Yolanda's brain B. A flaw in Yolanda's personality C. A normal response to grief and loss D. Denial of the reality of a poor prognosis

C. A normal response to grief and loss

A class of medications commonly prescribed for somatic disorders is a. Mood stabilizers B. Anitdepressants C. Anxiolytics D. Antipsychotics

C. Anxiolytics

What would be an appropriate expected outcome of the treatment plan for a client diagnosed with a conversion disorder that interferes with the ability to walk effective? A. Client will walk unassisted within 1 week B. Client will return to a pre-illness level of functioning within 2 weeks C. Client will be able to state two new effective coping skills within 2 weeks D. Client will assume full self-care within 3 weeks

C. Client will be able to state two new effective coping skills within 2 weeks

Which mental health disorder is an example of a somatoform disorder? A. Depersonalization B. Dissociative fugue C. Conversion disorder D. Dissociative identity disorder

C. Conversion disorder

"Which item of data should be routinely gathered during assessment of a client with a somatoform disorder? A. Potential for violence B. Level of confusion C. Dependence on medication D. Personal identity disturbance

C. Dependence on medication

A Gulf War veteran is entering treatment for post-traumatic stress disorder. What assessment is of importance to this particular client? A. Ascertain how long ago the trauma occurred. B. Find out if the client uses acting-out behavior. C. Determine the use of chemical substances for anxiety relief. D. Establish whether the client has chronic hypertension related to high anxiety.

C. Determine the use of chemical substances for anxiety relief.

Diane, a 63-year old mother of three, was brought to the community psychiatric clinic. Diane and her son had a bitter fight over fianances. Ever since Diane has been complaining of "a severe pain in my neck." She has seen several doctors who cannot find a physical basis for the pain. The nurse knows that: A. Showing concern for Diane's pain will increase her obsessional thinking B. Diane's symptoms are manipulative and under conscious control C. Diane believes there is a physical cause for the pain and will resist a psychological explanation D. Diane is trying to make her son feel bad about the argument

C. Diane believes there is a physical cause for the pain and will resist a psychological explanation

Panic attacks in Latin American individuals often involve demonstration of which behavior? A. Repetitive involuntary actions B. Blushing C. Fear of dying D. Offensive verbalizations

C. Fear of dying

Which disorder is characterized by the client's misinterpretation of physical sensations or feelings? A. Somatic disorder B. Factitious disorder C. Illness anxiety disorder D. Conversion disorder

C. Illness anxiety disorder

Which nursing diagnosis should be investigated for clients with somatoform disorders? A. Deficient fluid volume B. Self-care deficit C. Ineffective coping D. Delayed growth and development

C. Ineffective coping

The record mentions states that the client habitually relies on rationalization. The nurse might expect the client to present with what behavior? A. Makes jokes to relieve tension B. Misses appointments C. Justifies illogical ideas and feelings D. Behaves in ways that are the opposite of his or her feelings

C. Justifies illogical ideas and feelings.

A woman suddenly finds she cannot see but seems unconcerned about her symptom and tells her husband, "Don't worry, dear. Things will all work out." Her attitude is an exmaple of what process? A. Regression B. Depersonalization C. la belle indifference D. Dissociative amnesia

C. La belle indifference

The plan of care for a client who has elaborate washing rituals specifies that response prevention is to be used. Which scenario is an example of response prevention? A. Having the client repeatedly touch "dirty" objects B. Not allowing the client to seek reassurance from staff C. Not allowing the client to wash hands after touching a "dirty" object D. Telling the client that he or she must relax whenever tension mounts

C. Not allowing the client to wash hands after touching a "dirty" object

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 which ego dense mechanism? A. Projection B. Rationalization C. Reaction formation D. Undoing

C. Reaction formation

A client frantically reports to the nurse that "You have got to help me! Something terrible is happening. I can't think. My heart is pounding, and my head is throbbing." The nurse should assess the client's level of anxiety as A. Mild B. Moderate C. Severe D. Panic

C. Severe

When prescribed lorazepam (Ativan) 1 mg po qid for 1 week for generalize anxiety disorder, the nurse should A. Question the physician's order because the dose is excessive. B. Explain the long-term nature of benzodiazepine therapy. C. Teach the client to limit caffeine intake. D. tell the client to expect mild insomnia.

C. Teach the client to limit caffeine intake

It is most important for the nurse to employ which holistic strategy when managing clients diagnosed with a somatization disorder? A. Utilizing many different therapeutic strategies or modalities for enhanced coping B. Involving every member of the family as well as the patient in treatment C. Incorporating spirituality and religion into treatment D. Considering all dimensions of the patient, including biological, psychological, and sociocultural

D. Considering all dimensions of the patient, including biological, psychological, and sociocultural

The nurse providing teaching to a preoperative patient just before surgery. The patient is becoming more and more anxious and begins to report dizziness and heart pounding. The patient also appears confused and is trembling noticeable. Considering the scenario, what decision should the nurse make? A. To reinforce the preoperative teaching by restating it slowly. B. Having the patient read the teaching materials instead of providing verbal instruction C. Have a family member read the preoperative materials to the patient D. Do not attempt any further teaching at this time

D. Do not attempt any further teaching at this time

Which medication is FDA approved for treatment of anxiety in children? A. Sertraline B. Fluoxetine C. Clomipramine D. Duloxetine

D. Duloxetine

What is the major distinction between fear and anxiety? A. Fear is a universal experience; anxiety is neurotic B. Fear enables constructive action; anxiety is dysfunctional C. Fear is a psychological experience; anxiety is a physiological experience. D. Fear is a response to a specific danger; anxiety is a response to an unknown danger.

D. Fear is a response to a specific danger; anxiety is a response to an unknown danger

A symptom commonly associated with panic attacks? A. Obsessions B. Apathy C. Fever D. Fear of impending doom

D. Fear of impending doom

What precipitating emotional factor has been associated with anincreased incidence of cancers? Select all that apply. A. Anxiety B. Job-related stress C. Acute grief D. Feelings of hopelessness and despair from depression E. Prolonged, intense stress

D. Feelings of hopelessness and despair from depression E. Prolonged, intense stress

Living comfortable and materialistic lives in Western societies seems to have altered the original hierarchy proposed by Maslow in that: A. Once lower level needs are satisfied, no further growth feels necessary B. Self-actualization is easier to achieve with financial stability C. Esteem is more highly valued than safety D. Focusing on materialism reduced interests in love, belonging, and family

D. Focusing on materialism reduced interests in love, belonging, and family

Delusionary thinking is a characteristic of which form of anxiety? A. Chronic anxiety B. Acute anxiety C. Severe Anxiety D. Panic level anxiety

D. Panic level anxiety

A client experiencing a panic attack keeps repeating, "I'm dying, I can't breathe.". What action by the nurse should be most therapeutic initially? A. Encouraging the client to take slow, deep breaths B. Verbalizing mild disapproval of the anxious behavior C. Asking the client what he means when he says "I am dying." D. Offering an explanation about why the symptoms are occurring.

A. Encouraging the client to take slow, deep breaths

Which patient has an increased risk for the development of anxiety and will require frequent assessment by the nurse? Select all that apply. A. Exacerbation of asthma signs and symptoms B. History of peanut and strawberry allergies C. History of chronic obstructive pulmonary disease D. Current treatment for unstable angina pectoris E. History of a traumatic brain injury

A. Exacerbation of asthma signs and symptoms C. History of chronic obstructive pulmonary disease D. Current treatment for unstable angina pectoris E. History of traumatic brain injury

A physician describes a client as "malingering." The nurse knows this means that the client is demonstrating which behavior? A. Falsely claiming to have symptoms. B. Experiencing symptoms that cannot be explained medically. C. Experiencing symptoms that have a physiological basis. D. Seeking medication to ease pain of psychological origin.

A. Falsely claiming to have symptoms

Inability to leave one's home because of avoidance of severe anxiety suggests the existence of which anxiety disorder? A. Panic attacks with agoraphobia B. Obsessive-compulsive disorder C. Posttraumatic stress response D. Generalized anxiety disorder

A. Panic attacks with agoraphobia

The care plan of a patient diagnosed with a somatic disorder includes the nursing diagnosis ineffective coping. Which patient behavior demonstrates a successful outcome for that nursing diagnosis? A. Showers and dresses in clean clothes daily B. Calls a friend to talk when feeling lonely C. Spends more time talking about pain in her abdomen D. Maintains focus and concentration

B. Calls a friend to talk when feeling lonely

What therapeutic intervention should be prescribed for a client diagnosed with a somatoform disorder? A. Steering conversation away from the client's feelings B. Conveying an interest in the client rather than in the symptoms C. Encouraging the client to use benzodiazepines liberally D. Encouraging the client to rely on the nurse to meet the client's needs

B. Conveying an interest in the client rather than in the symptoms

A man continues to speak of his wife as though she were still alive, 3 years after her death. This behavior suggests the use of which ego defense mechanism? A. Altruism B. Denial C. Undoing D. Suppression

B. Denial

What can be said about the comorbidity of anxiety disorders? A. Anxiety disorders generally exist alone. B. Depression may occur prior to onset of anxiety. C. Anxiety disorders virtually never coexist with mood disorders. D. Substance abuse disorders rarely coexist with anxiety disorders

B. Depression may occur prior to onset of anxiety

A client who is demonstrating a moderate level of anxiety tells the nurse, "I am so anxious, and I do not know what to do." Which response should the nurse make initially? A. "What things have you done in the past that helped you feel more comfortable?" B." Let's try to focus on that adorable little granddaughter of yours." C. "Why don't you sit down over there and work on that jigsaw puzzle?" D. "Try not to think about the feelings and sensations you're experiencing."

A. "What things have you done in the past that helped you feel more comfortable?"

A 23 year old is addmitted with reports of abdominal pain, dizziness, and headache. When told that all the results of a physical workup have been negative, the client shares, "Now I am having back pain." Which notation in the client;s medical record may alert the nruse to the possibility of malingering? A. A court date this week for drunk driving B. Was adopted at the age of 5 years C. A history of physical abuse by his stepfather D. A history of oppositional defiant disorders E. Raised primarily in a single parent household

A. A court date this week for drunk driving

The nurse anticipates that the nursing history of a client diagnosed with obsessive compulsive disorder (OCD) will reveal what common assessment data? A. A history of childhood trauma B. A sibling with the disorder C. A history of sexual abuse D. A previous suicide attempt E. An eating disorder

A. A history of childhood trauma B. A sibling with the disorder C. A history of sexual abuse E. An eating disorder

The activity of gamma-aminobutyic acid (GABA) contributes to a slowing of neural activity. Which of the following drugs facilitates the action of GABA? A. Benzodiazepines B. Antihistamines C. Anticonvulsants D. Noradrenergic

A. Benzodiazepines

What is a possible outcome criterion for a client diagnosed with anxiety disorder? A. Client demonstrates effective coping strategies B. Client reports reduced hallucinations C. Client reports feelings of tension and fatigue D. Client demonstrates persistent avoidance behaviors.

A. Client demonstrates effective coping strategies

Melanie is a 38-year old female admitted to the hospital to rule out a neurological disorder. The testing was negative, yet she is reluctant to be discharged. Today she has added lower back pain and a stabbing sensation in her abdomen. The nurse suspects a factitious disorder in which Melanie may: A. Consciously be trying to maintain her role of a sick patient B. Not recognize her unmet needs to be cared for C. Protect her child from illness D. Recognize physical symptoms as a coping mechanism

A. Consciously be trying to maintain her role of a sick patient

Providing care to a client diagnosed with a somatization disorder can be frustrating owing to the client's lack of an organic illness. In order to best manage this barrier to care the staff should implement which personal intervention? A. Regularly discuss their feelings about the client during the unit's interprofessional care meetings. B. Attend in-services that focus on the various aspects of somatic disorders C. Rotate care of the client among the entire nursing department staff to minimize the frustration D. Provide a unified approach to the client's behavior so as to manage and lessen the barrier itself.

A. Regularly discuss their feelings about the client during the unit's interprofessional care meetings

A cultural characteristic that may be observed in a teenage, female Hispanic client in times of stress would include what behavior? A. Suddenly tremble severely B. Exhibit stoic behavior C. Report both nausea and vomiting D. Laugh inappropriately

A. Suddenly tremble severely

In a parent teacher conference, the school nurse meets with the parents of a profoundly shy 8-year-old girl. The parents hold hands, speak softly, respond briefly, and have poor eye contact. The nurse recognizes that the child is most likely exposed to parental modeling and: A. The inherited shyness trait B. Lack of affection in the home C. Severe punishment by the parents D. Is afraid to say something foolish

A. The inherited shyness trait

Generally, which statement regarding ego dense mechanisms is true? A. They often involve some degree of self-deception B. They are rarely used by mentally healthy people. C. They seldom make the person more comfortable D. They are usually effective in resolving conflicts.

A. They often involve some degree of self-deception

Which statement(s) made by the nurse demonstrates an understanding of the effective use of relaxation therapy for anxiety management? Select all that apply. A. "Relaxation therapy's main goal is to prevent exhaustion by removing muscle tensions." B. "Muscle relaxation promotes the relaxation response." C. "Show me how you learned to deep breathe in yesterday's therapy session." D. "You've said that going to group makes you nervous so let's start relaxing now." E. "I've given you written descriptions of the various relaxation exercises for you to review."

B. "Muscle relaxation promotes the relaxation response." C. "Show me how you learned to deep breathe in yesterday's therapy session." D. "You've said that going to group makes you nervous so let's start relaxing now." E. "I've given you written descriptions of the various relaxation exercises for you to review."

Ever since participating in a village raid where explosives were used, a military veteran has been unable to walk. After all diagnostic testing were negative for any physical abnormalities, the client was diagnosed with conversion disorder. What is the nurse's best response when asked by the client, "Why can't I walk?" A. "Your legs don't work because your brain is screwed up." B. "Your emotional distress is being expressed as a physical symptom." C. "You are making up your symptoms as a cry for help." D. "You are overly anxious about having a severe illness."

B. "Your emotional distress is being expressed as a physical symptom.

Which client is most likely to initially demonstrate behaviors suggesting a somatic disorder? A. 13-year-old male B. 23-year old female C. 33-year-old male D. 43-year-old female

B. 23-year old female

An obsession is defined as what? A. Thinking of an action and immediately taking the action B. A recurrent, persistent thought or impulse C. An intense irrational fear of an object or situation D. A recurrent behavior performed in the same manner

B. A recurrent, persistent thought or impulse

Conversion disorder is described as an absence of a neurological diagnosis that manifests in neurological symptoms. Channeling of emotions, conflicts, and stressors into physiological symptoms is thought to be the cause in conversion disorder. Which statement is true? A. People with conversion disorder are extremely upset about often dramatic symptoms B. Abnormal patterns of cerebral activation have been found in individuals with conversion disorder C. An organic cause is usually found in most cases of conversion disorder D. Symtpoms can be turned off and on depending on the patient's choice.

B. Abnormal patterns of cerebral activation have been found in individuals with conversion disorder

A client's daughter states, "My mother lives with me since my dad died 6 months ago. For the past couple of months, every time I need to leave the house for work or anything else, Mom becomes extremely anxious and cries that something terrible is going to happen to me. She seems OK except for these times, but it's affecting my ability to go to work." This information supports that the client may be experiencing which anxiety-related disorder? A. Panic disorder B. Adult separation anxiety disorder C. Agoraphobia D. Social anxiety disorder

B. Adult separation anxiety disorder

What defense mechanisms can only be used in healthy ways? A. Suppression and humor B. Altruism and sublimation C. Reaction formation and denial D. Idealization and splitting

B. Altruism and sublimation

A client is diagnosed with generalize anxiety disorder (GAD). The nursing assessment supports this diagnosis when the client reports which information? A. Symptoms started right after being robbed at gunpoint. B. Being unable to work for the last 12 months C. Eating in public makes the client extremely uncomfortable D. Repeated verablizing prayers results in a relaxed feeling.

B. Being unable to work for the last 12 months

The primary difference between a factitious disorder and other somatic disorders is described in which statement? A. Facitious disorders respond well to confrontation as a primary therapeutic technique B. Factitious disorders have a symptomatology that is actually controlled by the client C. Factitious disorders have their origins in depression and anxiety D. Factitious disorders are always self-directed

B. Factitious disorders have a symptomatology that is actually controlled by the client

Which should the nurse be prepared to educate patients on when they are prescribed a selective serotonin reuptake inhibitor (SSRI) for panic attacks? A. Alprazolam (Xanax) B. Fluoxetine (Prozac) C. Clonazepam (Klonopin) D. Venlafaxine (Effexor)

B. Fluoxetine (Prozac)

Samantha is a new patient to the mental health clinic and is seeking assistance for what she describes as "severe anxiety." In addition to daily self-medicating with alcohol, Samantha describes long-term use of herbal kava. The nurse knows that kava is associated with inhibiting P450 and orders which of the following tests? A. Electrocardiogram B. Liver enzymes C. Glomerular filtration rate D. Complete blood count

B. Liver enzymes

Selective inattention is first noted when experiencing which level of anxiety? A. Mild B. Moderate C. Severe D. Panic

B. Moderate

A 20-year-old was sexually molested at age 10, but he can no longer remember the incident. Which ego defense mechanism is in use? A. Projection B. Repression C. Displacement D. Reaction formation

B. Repression

When discussing somatic disorders from a cultural perspective, whcih statement is true? A. Somatic disorders are rarely observed in males B. Somatic symptoms vary widely from culture to culture C. Underdeveloped countries rarely tolerate somatic disorders D. Secondary gain is seldom a factor in somatic disorders

B. Somatic symptoms vary widely from culture to culture.

A 72-year-old patient diagnosed with Parkinson's disease is demonstrating behaviors associated with anxiety and has had several falls lately and is reluctant to take medications as prescribed. When his provider orders lorazepam, 1 mg PO bid, the nurse questions the prescription based primarily on what fact? A. The client may become addicted faster than younger patients B. The client is at risk for falls C. The client has a history of nonadherence with medications D. The client should be treated with cognitive therapies because of his advanced age

B. The client is at risk for falls

Lucas is a nurse on a medical floor caring for Kelly, a 48-year-old patient with newly diagnosed type 2 diabetes. He realizes that depression is a complicating factor in the patient's adjustment to her new diagnosis. What problem has the most potential to arise? A. Development of agoraphobia B. Treatment non-adherence C. Frequent hypoglycemic reactions D. Sleeping rather than checking blood sugar

B. Treatment non adherence

The nurse is providing care for a patient demonstrating behaviors associated with moderate levels of anxiety. What question should the nurse ask initially when attempting to help the patient deescalate their anxiety? A. "Do you know what will help you manage your anxiety?" B. "Do you need help to manage your anxiety?" C. "Can you identify what was happening when your anxiety began to increase?" D. "Are you feeling anxious right now?"

C. "Can you identify what was happening when your anxiety began to increase?"

Which statement made by a client would support the diagnosis of illness anxiety disorder? A. "I feel confused and disoriented." B. "i feel as though I'm outside my body watching what is happening." C. "I know I have cancer, but the doctors just cannot find it." D. "I woke up one morning, and my left leg was paralyzed from the knee down."

C. "I know I have cancer, but the doctors just cannot find it."

Isabel is a straight-A student, yet she suffers from severe test anxiety and seeks medical attention. The nurse interviews Isabel and develops a plan of care. The nurse recognizes effective teaching about mild anxiety when Isabel states: A. "I would like to try a benzodiazepine for my anxiety." B. "If I study harder, my anxiety level will go down." C. "Mild anxiety is okay because it helps me to focus." D. "I have fear that I will fail at college."

C. "Mild anxiety is okay because it helps me to focus."

A homebound patient diagnosed with agoraphobia has been receiving therapy in the home. The nurse evaluates patient teaching is effective when the patient states: A. "I may never leave the house again." B. "Having groceries delivered is very convenient." C. "My risk for agoraphobia is increased by my family history." D. "I will go out again, someday, just not today."

C. "My risk for agoraphobia is increased by my family history."

Emily asks you what kind of therapy will help her. Based on current knowledge, what form of therapy is most appropriate for a client diagnosed with a conversion disorder? A. "A combination of antianxiety and antidepressant therapy is the most effective therapy." B. "Aversion therapy is often used because in effect you are punishing yourself by not being able to walk." C. Modeling will be used; as you see desired behaviors modeled by the therapist you will be able to also achieve the expected outcome. D. Cognitive-behavioral therapy (CBT) has been shown to consistently provide the best outcome for these types of disorders."

D. "Cognitive-behavioral therapy (CBT) has been shown to consistently provide the best outcome for these types of disorders"

What statement by a client would indicate that goals for treatment for a somatization disorder are being achieved? A. "I feel less anxiety than before." B. "My memory is better than it was a month ago." C. "I take my medications just as the physician prescribed." D. "I don't think about my symptoms all the time as I used to."

D. "I don't think about my symptoms all the time as I used to."

Which patient is at greatest risk for developing a stress-induced myocardial infarction? A. A patient who lost a child in an accidental shooting 24 hours ago B. A woman who has begun experiencing early signs of menopause C. A patient who has spent years trying to sustain a successful business D. A patient who was diagnosed with chronic depression 10 years ago.

D. A patient who was diagnosed with chronic depression 10 years ago

The nurse caring for a client experiencing a panic attack anticipates that the psychiatrist would order a stat dose of which classification of medications? A. Standard antipsychotic medication B. Tricyclic antidepressant medication C. Anticholinergic medication D. A short-acting benzodiazepine medication

D. A short-acting benzodiazepine medication

You are caring for Aaron, a 38-year old patient diagnosed with somatic symptom disorder. When interacting with you, Aaron continues to focus on his severe headache. In planning care for Aaron, which of the following interventions would be appropriate? A. Call for a family meeting with Aaron in attendance to confront Aaron regarding his diagnosis. B. Educate Aaron regarding his diagnosis C. Improve reality testing by telling Aaron that you do not believe that the headaches are real. D. After a limited discussion of physical concerns, shift focus to feelings and effective coping skills.

D. After a limited discussion of physical concerns, shift focus to feelings and effective coping skills

To maximize the therapeutic effect, which lifestyle practice should the nurse discourage for a patient who has been recently prescribed an anti-anxiety medication? A. Eating high protein foods B. Using acetaminophen without first discussing it with a healthcare provider C. Taking medications after eating dinner or while having a bedtime snack D. Buying a large coffee with sugar and extra cream each morning on the way to work

D. Buying a large coffee with sugar and extra cream each morning on the way to work

Studies have shown a correlating betwenn mental disorders and which medical condition? A. Psoriasis B. Asthma C. Chronic renal failure D. Cardiovascular disease

D. Cardiovascular disease

Which statement about somatoform disorders is true? A. An organic basis exists for each group of disorders B. Nurses perceive clients with these disorders as easy to care for. C. No relation exists between these disorders and early childhood loss or trauma D. Clients lack awareness of the relations among symptoms, anxiety, and conflicts

D. Clients lack awareness of the relations among symptoms, anxiety, and conflicts.

Working to help the client view an occurrence in a more positive light is referred to by which term? A. Flooding B. Desensitization C. Response prevention D. Cognitive restructuring

D. Cognitive restructuring