Prep U's - Chapter 18 - Anxiety and Panic Disorders: Nursing Care of Persons with Anxiety and Panic

The client has an order for an anxiolytic agent, lorazepam (Ativan). Which of the following statements by the client would indicate 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."

Answer: A Rationale: Anxiolytics are designed for short-term use to relieve anxiety. These drugs are designed to relieve anxiety so that the person can deal more effectively with whatever crisis or situation is causing stress. Benzodiazepines have a tendency to cause dependence. Clients need to know that antianxiety agents are aimed at relieving symptoms such as anxiety but do not treat the underlying problems that cause the anxiety.

An adult client diagnosed with panic disorder is being counseled in the clinic. The nurse teaches the client that when they are experiencing severe anxiety or panic, instead of thinking, "I am going to die," the client learns to think, "This is anxiety, and it will go away." Which technique is the nurse utilizing with the client? A. positive reframing. B. de-catastrophizing. C. assertiveness training. D. dialectical behavioral therapy.

Answer: A Rationale: Cognitive-behavioral therapy (CBT) is used successfully to treat anxiety disorders. Positive reframing means turning negative messages into positive messages. The therapist teaches the client to create positive messages for use during panic episodes. For example, instead of thinking, "My heart is pounding. I think I'm going to die," the client thinks, "I can stand this. This is just anxiety. It will go away." De-catastrophizing involves the therapist's use of questions to appraise the situation more realistically. The therapist may ask, "What is the worst thing that could happen? Is that likely? Could you survive that? Is that as bad as you imagine?" The client uses thought-stopping and distraction techniques to jolt themselves from focusing on negative thoughts. Assertiveness training helps the person take more control over life situations. These techniques help the person negotiate interpersonal situations and foster self-assurance. They involve using "I" statements to identify feelings and to communicate concerns or needs to others. Examples include "I feel angry when you turn your back while I'm talking." Dialectical behavioral therapy (DBT) is not the therapy of choice for anxiety disorders. The client in the scenario is learning to use positive reframing.

A client diagnosed with panic disorder has been receiving medication therapy, which is being discontinued. A nurse would be alert for possible withdrawal symptoms if the client was receiving what? A. Lorazepam B. Duloxetine C. Fluvoxamine D. Escitalopram

Answer: A Rationale: Discontinuation of benzodiazepines, such as lorazepam, places the client at risk for withdrawal symptoms. Withdrawal is not associated with duloxetine, a serotonin-norepinephrine reuptake inhibitor, or escitalopram or fluvoxamine, selective serotonin reuptake inhibitors.

The nurse is caring for a client who is prescribed alprazolam for acute anxiety. Which will the nurse include when educating the client about the medication? A. Avoid alcoholic beverages while taking the medication. B. Avoid foods high in tyramine. C. Report any drowsiness experienced. D. Adjust dose and frequency based on anxiety level.

Answer: A Rationale: Drinking alcohol or taking other anxiolytics along with the prescribed benzodiazepine should be avoided because depressant effects of both drugs will be potentiated. Consuming a tyramine-free diet is necessary only with monoamine oxidase inhibitors. Drowsiness is an expected effect of this medication and needs to be reported only if it is excessive. Clients should be taught not to deviate from the prescribed dose and schedule for administration.

Anxiety has both healthy and harmful aspects depending on its degree and duration as well as on how well the person copes with it. Which level of anxiety helps the client focus attention to learn, problem solve, think, act, feel, and protect himself or herself? A. Mild B. Moderate C. Panic D. Severe

Answer: A Rationale: In mild anxiety, sensory stimulation increases and helps the person focus attention to learn, solve problems, and think. Moderate anxiety causes the person to have difficulty concentrating independently but can be redirected to the topic. Severe anxiety causes the person to have a reduced perceptual field, and he or she cannot complete tasks. Panic anxiety reduces the perceptual field to focus on the self, and the client cannot process any environmental stimuli.

Nursing interventions for physical stress related illness should include what? A. Establishing daily routines of meals and sleeping. B. Fostering use of a social support system. C. Attending group therapy. D. Assessing the need for increased dose of benzodiazepines.

Answer: A Rationale: Individuals experiencing or at risk for untoward stress responses may benefit from a number of biologic interventions. The importance of (re-)establishing regular routines for activities of daily living (e.g., eating, sleeping, self-care, and leisure time) cannot be overstated. As well as ensuring adequate nutrition, sleep and rest, and hygiene, a routine may help to structure an individual's time and give them a sense of personal control or mastery.

The nurse is creating an education plan for a client with diabetes mellitus to address the dietary modifications to manage the disease. Which characteristic identified by the nurse indicates that the client is prepared for the education? A. The client has a heightened focus. B. The client has a rapid rate of speech. C. The client is focused only on the immediate task. D. The client demonstrates a narrowed perceptual field.

Answer: A Rationale: Mild anxiety is associated with increased learning ability. It involves a sensation that something is different and warrants special attention. Sensory stimulation increases and helps the person focus attention to learn, solve problems, think, act, feel, and protect themself. Mild anxiety often motivates people to make changes or to engage in goal-directed activity. Focusing only on immediate task, a faster rate of speech, and a narrowed perceptual field are associated with moderate levels of anxiety, which would be a deficit for learning ability.

A client experiences panic attacks when confronted with riding in elevators. The nurse is teaching the client ways to relax while incrementally exposing the client to getting on an elevator. Which technique will the nurse employ to assist the client with overcoming the phobia? A. Systematic desensitization B. Combination therapy C. Cognitive restructuring D. Flooding

Answer: A Rationale: One behavioral therapy often used to treat phobias is systematic (serial) desensitization, in which the therapist progressively exposes the client to the threatening object in a safe setting until the client's anxiety decreases. Flooding is a form of rapid desensitization in which a behavioral therapist confronts the client with the phobic object (either a picture or the actual object) until it no longer produces anxiety. Cognitive restructuring involves challenging the client's irrational beliefs. Combination therapy is the use of medications and therapy practice.

Which medication classification has most commonly been used to treat social phobia? A. Selective serotonin reuptake inhibitors (SSRIs) B. Nonbenzodiazepines C. Tricyclic antidepressants (TCAs) D. Monoamine oxidase inhibitors (MAOIs)

Answer: A Rationale: SSRIs are used to treat clients with social anxiety disorder because they significantly reduce social anxiety and phobic avoidance. Benzodiazepines are also used to reduce anxiety caused by phobias.

A nurse is creating a plan of care prior to working with a client learning to cope with anxiety and stress. Which outcome does the nurse include in the plan of care for the client? A. Reactions to stressors will change. B. Situations that cause stress will be avoided. C. Major stressors in the client's life will be limited. D. Anxiety will be avoided at all costs.

Answer: A Rationale: Stress and anxiety in life are unavoidable; managing the effects of stress is a reasonable goal for treatment. It is not possible or desirable to avoid anxiety at all costs as anxiety is a warning that the client is not dealing with stress effectively. Learning to heed this warning and to make needed changes is a healthy way to deal with the stress of daily events. Healthy stress management does not involve "ignoring" stressors. Limiting the presence of stressors does not necessarily increase the client's ability to cope with existing stressors.

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

Answer: A Rationale: The benzodiazepines have a high risk for withdrawal symptoms, and the client needs to be educated as to this fact. The benzodiazepines do not interact with certain food groups like monoamine oxidase inhibitors do. The client does not need to have blood drawn when being treated with benzodiazepines; this would be true if the client were on an atypical antipsychotic such as clozapine. There is no risk for dysrhythmias with the benzodiazepines.

During an interview with a nurse, the client reports an intense fear of spiders, stating, "I can't be near them. I get so upset. I start to sweat and hyperventilate if I see one." The nurse documents this as what finding? Select all that apply. A. arachnophobia B. cynophobia C. ophidiophobia D. algophobia E. entomophobia

Answer: A Rationale: The client is describing arachnophobia, a fear of spiders. Algophobia is a fear of pain, entomophobia is a fear of insects, and cynophobia is a fear of dogs. Ophidiophobia is the fear of snakes.

The nurse is educating a client with generalized anxiety disorder about nutrition as a supporting factor in controlling the disorder. Which client statement indicates that further education is required? A. I should only drink tea or coffee and avoid Cola products. B. limit diet to less fat. C. drink beverages with high amounts of refined sugars. D. refrain from foods and beverages high in sodium.

Answer: A Rationale: The effects of caffeine are similar to some anxiety symptoms, and, therefore, caffeine ingestion will worsen anxiety. High-fat foods will not alter the course of the anxiety symptoms but are potentially harmful in the long term. High amounts of refined sugar can elevate blood glucose levels and cause long-term problems, may increase levels of anxiety, and should be limited. Sodium content in high amounts can cause fluid retention in those clients who are salt sensitive or taking medications to treat the anxiety.

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. Obtain a thorough history, focusing on the client's physiologic functioning. C. Assess for physical conditions that may affect anxiety. D. Determine the effects that culture has had on the client's anxiety issues.

Answer: A Rationale: The first step in the assessment process is to identify the client's level of anxiety and to determine whether a threat of self-harm or harm to others exists. In any situation where the client history is not known, the nursing priority is safety.

A client asks the nurse, "Why do I have to go to counseling? Why can't I just take medications?" Which is the most appropriate response by the nurse? A. "Medications combined with therapy help you change how well you function." B. "You cannot get the full effect of your medications without cognitive therapy as well." C. "As soon as your medications reach therapeutic level, you can omit the therapy." D. "Both therapies are effective. You can eventually choose one or the other."

Answer: A Rationale: Treatment for anxiety disorders usually involves medication and therapy. This combination produces better results than either one alone. These interventions complement one another and are not mutually exclusive. The effectiveness of medications is not wholly dependent on cognitive therapy.

The mental health nurse knows that which medication classification has been found to be effective in reducing or eliminating panic attacks? A. Antidepressants B. Antipsychotics C. Antimanics D. Anticholinergics

Answer: A Rationale: Tricyclic and monoamine oxidase inhibitor antidepressants have been found to be effective in treating clients with panic attacks. Why these drugs help control panic attacks is not clearly understood. Anticholinergic agents, which are smooth-muscle relaxants, relieve physical symptoms of anxiety but do not relieve the anxiety itself. Antipsychotic drugs are inappropriate because clients who experience panic attacks are not psychotic. Mood stabilizers are not indicated because panic attacks are rarely associated with mood changes.

The nurse enters the room of a pediatric client whose caregivers were arguing and are now sitting facing away from each other with their arms crossed. Which client indicator(s) of moderate to severe anxiety is the nurse likely to find? Select all that apply. A. flushed skin and rapid breathing. B. asking the nurse how to use the remote. C. displaying rigid muscles and not answering questions. D. following directions to take deep breaths while fidgeting with sheets. E. playing a video game on their cell phone.

Answer: A, C, D Rationale: The pediatric client is likely to be experiencing moderate anxiety related to being present when caregivers were arguing and displaying nonverbal signs of hostility toward each other. The person becomes nervous or agitated but may still be able to follow directions. A person experiencing severe anxiety has trouble thinking and reasoning. Muscles tighten, and vital signs increase. Symptoms of no or mild anxiety include engaging in goal-directed activities such as asking for assistance with a remote or participating in activities such as video games without any signs of distress.

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. Irritability B. Sour taste C. Apprehension D. Agitation E. Hypersomnia

Answer: A, C, D Rationale: Withdrawal symptoms manifest in several ways, including psychological phenomena such as apprehension, irritability, and agitation. Withdrawal from benzodiazepines does not cause a sour taste in the mouth. Insomnia would be more likely than hypersomnia.

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. Providing supportive feedback. B. Using restraint when panic develops. C. Using appropriate coping skills. D. Involving family for support, if appropriate. E. Identifying treatment modalities.

Answer: A, C, D, E Rationale: Appropriate measures to include in the plan of care for a client with anxiety include: introducing appropriate coping skills, identifying alternate treatment modalities, involving family and support persons when appropriate, and providing feedback that is supportive to the client. Restraint is always a last resort.

A nurse is providing care to a client with anxiety. Which information will the nurse obtain to integrate into the plan of care about the use of defense mechanisms in the client? Select all that apply. A. The use of defense mechanisms can control the awareness of anxiety. B. The use of defense mechanisms should be avoided at all costs. C. The client is experiencing cognitive distortions from defense mechanisms. D. The lack of awareness of the client using defense mechanisms. E. The clients use of defense mechanisms to attempt reduction of anxiety. F. The clients overuse of defense mechanisms can be harmful.

Answer: A, C, E, F Rationale: Freud described defense mechanisms as the human's attempt to control awareness of and to reduce anxiety. Defense mechanisms are cognitive distortions that a person uses unconsciously to maintain a sense of being in control of a situation, to lessen discomfort, and to deal with stress. Because defense mechanisms arise from the unconscious, the person is unaware of using them. Some people overuse defense mechanisms, which stops them from learning a variety of appropriate methods to resolve anxiety-producing situations. The dependence on one or two defense mechanisms also can inhibit emotional growth, lead to poor problem-solving skills, and create difficulty with relationships. However, it is unrealistic and unnecessary for a person to exist without the use of any defense mechanisms whatsoever.

The nurse reviews data collected from a client with an eating disorder. Which finding(s) indicates to the nurse that the client is at risk for developing panic disorder? Select all that apply. A. smokes cigarettes 1 ppd x 10 years. B. limits the intake of red meat. C. plays tennis twice a week with friends. D. ingests alcohol several days a week. E. works remotely in customer service.

Answer: A, D Rationale: Panic disorder has a moderately high lifetime prevalence in the general population. The risk is increased in clients who are female, middle aged, of low socioeconomic status, and widowed, separated, or divorced. Smoking tobacco and ingesting alcohol are risk factors for panic disorder. A diet low in red meat, vocation, and activity level are not risk factors for the development of panic disorder.

A nurse is conducting a group session in the behavioral health unit for three clients on the topic of anxiety. The nurse determines that the session was successful based on which statement by the clients? A. "Anxiety is always harmful and not productive in my life." B. "Anxiety cannot be completely eliminated from my life." C. "Fear is feeling threatened by an unknown entity." D. "Anxiety and fear are the same."

Answer: B Rationale: Anxiety is distinguished from fear, which is feeling afraid or threatened by a clearly identifiable external stimulus that represents danger to the person. Anxiety is unavoidable in life and can serve many positive functions, such as motivating the person to take action to solve a problem or to resolve a crisis.

When a client is experiencing panic, which is the priority intervention? A. Physically restrain the client. B. Move the client to a quiet environment. C. Give the client medication immediately. D. Offer the client therapy to calm down.

Answer: B Rationale: Decreasing external stimuli will help lower the client's anxiety level. The client's safety is priority. Anxious behavior can be escalated by external stimuli. In a large area, the client can feel lost and panicked, but a smaller room can enhance a sense of security. Medicating the client would be inappropriate. Restraint should only be used as a last resort. Therapy can be appropriate once the client's anxiety level decreases.

During which type of anxiety does a person's perceptual field actually increase? A. Panic B. Mild C. Severe D. Moderate

Answer: B Rationale: During mild anxiety, a person's perceptual field widens slightly, and the person is able to observe more than before and to see relationships. During moderate anxiety, the perceptual field narrows slightly. The person does not notice what goes on peripheral to the immediate focus but can do so if attention is directed there by another observer. The perceptual field is greatly reduced in severe anxiety. During panic anxiety, the perceptual field is reduced to a detail, which is usually "blown up."

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. Approaching the client in a calm, confident manner. B. Touching the client in an attempt to comfort the client. C. Providing the client with a safe, quiet, and private place. D. Encouraging the client to verbalize feelings and concerns.

Answer: B Rationale: For the client experiencing a panic attack, the nurse must establish rapport and trust with the anxious client before using therapeutic touch. Touching an anxious client may actually increase anxiety. Trust can be established by approaching the client in a calm and confident manner; providing a place that is quiet, safe, and private; and encouraging the client to verbalize feelings and concerns.

A nurse is assessing a client and determines that the client is experiencing severe anxiety based on which finding? A. Eagerness for more information. B. Distorted sensory awareness. C. A heightened sense of awareness. D. Goal directed behavior.

Answer: B Rationale: In severe anxiety, perception becomes increasingly distorted, sensory input diminishes, and processing of sensory stimuli becomes scattered and disorganized.

A nurse is assessing a client and determines that the client is experiencing severe anxiety based on which finding? A. Eagerness for more information. B. Distorted sensory awareness. C. Goal directed behavior. D. A heightened sense of awareness.

Answer: B Rationale: In severe anxiety, perception becomes increasingly distorted, sensory input diminishes, and processing of sensory stimuli becomes scattered and disorganized.

Which condition involves a persistent, irrational fear attached to an object or situation that objectively does not pose a significant danger? A. Posttraumatic stress disorder B. Specific phobia C. Obsessive-compulsive disorder D. Generalized anxiety disorder.

Answer: B Rationale: Specific phobia is a disorder marked by persistent fear of clearly discernible, circumscribed objects or situations, which often leads to avoidance behaviors. Posttraumatic stress disorder can occur following exposure to an actual or threatened traumatic event such as death, serious injury, or sexual violence. In obsessive-compulsive disorder, affected clients have both obsessions and compulsions and believe that they have no control over them, which results in devastating consequences for the individuals. Generally speaking, clients with generalized anxiety disorder feel frustrated, disgusted with life, demoralized, and hopeless. They may state that they cannot remember a time that they did not feel anxious. They experience a sense of ill-being and uneasiness and a fear of imminent disaster.

The nurse observes a client that is attending their first group therapy session, exhibiting anxious behaviors. Which is the priority action for the nurse to take to promote comfort when attending the session? A. Have the client perform relaxation techniques after they go into the session. B. Remain calm when approaching and encouraging the client to attend. C. Have the client make a choice about whether they want to attend or come later. D. Inform the client that behaviors won't change without the group therapy.

Answer: B Rationale: The client will feel more secure if you are calm and if the client feels you are in control of the situation. The client may not make sound decisions or may be unable to make decisions or solve problems. The client's anxiety will not be alleviated when telling them they won't get better without therapy. The relaxation techniques should be utilized prior to entering the group session since the client will be more anxious with the anticipation of the group session.

When a parent observes the parent's young child heading toward a busy road the parent becomes stressed, feeling the parent's heart pounding, breathing heavily, and hands becoming wet with perspiration. Which physiological system is activated with the parent's "fight or flight" reaction to this danger? A. Motherly response system. B. Sympathetic nervous system. C. Parasympathetic nervous system. D. Central nervous system.

Answer: B Rationale: The sympathetic nervous system activates the fight or flight response quickly as a survival response that results in an increased heart and respiratory rate, moist hands and feet, and dilated pupils. The parasympathetic system is most active in nonstressful events. The motherly instinct is not a proven physiological system.

The mental health nurse knows that which medication classification has been found to be effective in reducing or eliminating panic attacks? A. Anticholinergics B. Antidepressants C. Antipsychotics D. Antimanics

Answer: B Rationale: Tricyclic and monoamine oxidase inhibitor antidepressants have been found to be effective in treating clients with panic attacks. Why these drugs help control panic attacks is not clearly understood. Anticholinergic agents, which are smooth-muscle relaxants, relieve physical symptoms of anxiety but do not relieve the anxiety itself. Antipsychotic drugs are inappropriate because clients who experience panic attacks are not psychotic. Mood stabilizers are not indicated because panic attacks are rarely associated with mood changes.

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. Anticholinergics D. Antimanics

Answer: B Rationale: Tricyclic and monoamine oxidase inhibitor antidepressants have been found to be effective in treating clients with panic attacks. Why these drugs help control panic attacks is not clearly understood. Anticholinergic agents, which are smooth-muscle relaxants, relieve physical symptoms of anxiety but do not relieve the anxiety itself. Antipsychotic drugs are inappropriate because clients who experience panic attacks are not psychotic. Mood stabilizers are not indicated because panic attacks are rarely associated with mood changes.

All of the following pharmacological agents are useful in treating anxiety disorders except which ones? A. Tricyclic antidepressants B. Calcium channel blockers C. Selective serotonin reuptake inhibitors (SSRIs) D. Benzodiazepines

Answer: B Rationale: Tricyclic antidepressants and SSRIs are known to be useful in reducing anxiety and are sometimes useful in treating the anxiety disorders. Benzodiazepines are an excellent choice for the treatment of symptoms of anxiety; however, they are extremely addictive and should only be given in the case of true anxiety disorders. Calcium channel blockers are not used in treating anxiety disorders.

A client with a panic disorder has been prescribed a benzodiazepine medication. Which risk(s) would a nurse emphasize as being associated with using this medication? Select all that apply. A. fecal impaction. B. physical dependence. C. withdrawal symptoms. D. dietary restrictions. E. agitation.

Answer: B, C Rationale: Although benzodiazepines are well tolerated and tremendously useful in treating intensely distressed individuals, they carry the risks of physical dependence and withdrawal symptoms with discontinuation. Dietary restrictions are not necessary with benzodiazepines. Sedation, rather than agitation, occurs with this class of drugs. Fecal impaction is not associated with benzodiazepines.

A nurse is providing information on the COVID-19 pandemic to a community. Due to COVID-19, the nurse will include which health condition(s) in the teaching, which will likely cause additional fear, anxiety, or panic? Select all that apply. A. recent surgery B. respiratory illnesses C. panic disorder D. history of cardiac stent E. asthma

Answer: B, C, E Rationale: The serious consequences of a respiratory infection by the COVID-19 contributes to anxiety and panic in individuals with asthma and respiratory illnesses. COVID-19 causes additional fear and anxiety in persons with panic disorder. Physical distancing may exacerbate feeling of seclusion and lead to detrimental prolonged health effects. Recent surgery nor history of cardiac stent are contributing factors to increased fear and anxiety. However, respiratory issues and history of panic and anxiety are exacerbated by COVID-19.

The nurse is educating a client that is experiencing mild anxiety. Which statement made by the client indicates that the education is effective? A. "There are no physical symptoms with anxiety." B. "I need to eliminate all of the stress in my life." C. "Some degree of anxiety is beneficial for learning." D. "I need to take medication for my anxiety every day."

Answer: C Rationale: A client experiencing mild anxiety may have a state of heightened awareness and sharpened senses that may allow the client to learn new behaviors and solve existing problems. Rather than take medication for the management of anxiety, coping skills such as cognitive behavioral therapy would assist in lifelong management of anxiety. It is unrealistic to remove all anxiety from life, and the client requires the tools to manage the anxiety. There are many significant physical signs of anxiety with the different stages of anxiety such as tachycardia, tremulousness, and elevated blood pressure.

When traveling alone and away from home, a client experiences trembling and palpitations. These symptoms have impeded the client from leaving her home. The nurse would correctly note that these are symptoms of which type of phobia? A. Compulsion B. Obsession C. Agoraphobia D. OCD

Answer: C Rationale: Agoraphobia occurs when the client travels away from home and experiences anxiety, with symptoms such as palpitations and trembling.

A nurse is working in an outpatient clinic with clients diagnosed with anxiety disorders. The nurse is teaching families of clients about anxiety disorders. One family asks which anxiety disorder is most common among clients. How should the nurse respond? A. agoraphobia B. social anxiety disorder C. panic disorder D. generalized anxiety disorder (GAD)

Answer: C Rationale: Anxiety disorders have many manifestations, but anxiety is the key feature of each. Types of anxiety disorders include agoraphobia, panic disorder, specific phobia, social anxiety disorder, and generalized anxiety disorder. Of all the anxiety disorders, panic disorder is the most common.

Which would be an appropriate intervention of a client experiencing a panic attack? A. Leaving the client alone. B. Turning on stereo music loudly. C. Staying with the client and speaking in short sentences. D. Turning on the lights and opening the windows so that the client does not feel crowded.

Answer: C Rationale: Appropriate nursing interventions for a panic attack include using short sentences, staying with the client, decreasing stimuli, remaining calm, and medicating as needed. Leaving the client alone, turning on a stereo or lights, and opening windows may increase the client's panic level or anxiety.

A client diagnosed with panic disorder is being admitted to the psychiatric-mental health unit for panic attacks. Which client outcome would be appropriate in the immediate phase of care? A. "The client will demonstrate the ability to perform relaxation techniques." B. "The client will reduce own anxiety level without staff assistance." C. "The client will respond to relaxation techniques with staff assistance and demonstrate a decreased anxiety level within 2 to 3 days." D. "The client will be free from panic attacks."

Answer: C Rationale: Client outcomes vary depending on the stage of care that the client is in. The immediate phase focuses on short-term goals and safety and may include being free from injury throughout hospitalization, discussing feelings within 24 to 48 hours, and responding to relaxation techniques with staff assistance and demonstrating a decreased anxiety level within 2 to 3 days. The stabilization phase focuses on educating and empowering the client regarding their health. Outcomes in the stabilization phase may include demonstrating the ability to perform relaxation techniques and reducing own anxiety level without staff assistance. The community phase of care focuses on long-term goals for the client. Outcomes in the community phase include being free from anxiety or panic attacks and managing the anxiety response to stress effectively. The outcomes, "The client will demonstrate the ability to perform relaxation techniques" and "The client will reduce own anxiety level without staff assistance" will be implemented in the stabilization phase. The outcome, "The client will be free from panic attacks", will be in the community phase of care. Therefore, the outcome, "The client will respond to relaxation techniques with staff assistance and demonstrate a decreased anxiety level within 2 to 3 days" would be appropriate in the immediate phase of care.

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. Drinking alcohol is more socially acceptable than taking medications. B. A few glasses of wine each night is not necessarily a problem. C. The client has insufficient adaptive coping mechanisms. D. The client is probably physically dependent on alcohol.

Answer: C Rationale: Clients learn to reduce the anxiety they feel in either functional or dysfunctional ways. The nurse first explores with the client what techniques the client has used in the past and helps the client identify and enhance those strategies that are most beneficial. The nurse and client identify maladaptive coping strategies, such as social withdrawal or alcohol use, and replace them with adaptive strategies that suit the client's personal, cultural, and spiritual values. The nurse should not ask the client to give up coping mechanisms, even maladaptive ones, without offering other adaptive mechanisms.

During which type of anxiety does a person's perceptual field actually increase? A. Moderate B. Severe C. Mild D. Panic

Answer: C Rationale: During mild anxiety, a person's perceptual field widens slightly, and the person is able to observe more than before and to see relationships. During moderate anxiety, the perceptual field narrows slightly. The person does not notice what goes on peripheral to the immediate focus but can do so if attention is directed there by another observer. The perceptual field is greatly reduced in severe anxiety. During panic anxiety, the perceptual field is reduced to a detail, which is usually "blown up."

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

Answer: C Rationale: It is therapeutic to foster in clients the understanding that the experience of anxiety is natural and inevitable. It would be inaccurate to promise recovery with increased success in life and self-discipline. Clients with anxiety are likely to be well aware of how much easier their lives would be without recurring anxiety.

An adolescent client reveals that she is about to take a math test from her tutor. Nursing assessment reveals mild anxiety. The nurse explains that this level of anxiety does what? A. Is pathologic and warrants postponing the test. B. Will interfere with her cognitive abilities. C. Is conducive to concentration and problem solving. D. May be transferred to her tutor and result in test anxiety.

Answer: C Rationale: Mild anxiety is often helpful to individuals and can assist in maintaining concentration and problem-solving abilities. Moderate to severe anxiety can begin to inhibit an individual's coping because these levels create physiologic responses (such as tachycardia and sweating) and psychological responses (such as loss of concentration and inability to focus) that may prevent the person from functioning adequately, interfere with cognitive abilities, and become pathologic if not treated adequately.

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. Moderate B. Severe C. Panic D. Mild

Answer: C Rationale: Panic anxiety reduces the perceptual field to focus on the self, and the client cannot process any environmental stimuli. In mild anxiety, sensory stimulation increases and helps the person focus attention to learn, solve problems, and think. Moderate anxiety causes the person to have difficulty concentrating independently but can be redirected to the topic. Severe anxiety causes the person to have a reduced perceptual field, and the client cannot complete tasks.

When developing a plan of care for a client diagnosed with panic disorder, which nursing diagnosis would be considered the priority? A. Social isolation B. Anxiety C. Risk for Self-Directed Violence D. Powerlessness

Answer: C Rationale: People with panic disorder are often depressed and consequently are at high risk for suicide. Adolescents with panic disorder may be at higher risk for suicidal thoughts and attempt suicide more often than other adolescents. Other diagnoses that are appropriate for this client population, although not the priority, include Powerlessness, Social Isolation, and Anxiety.

A client is currently experiencing a panic attack. Which is the most therapeutic response by the nurse? A. "There is nothing here to harm you." B. "Just try to relax." C. "You are safe. Take a deep breath." D. "What are you feeling right now?"

Answer: C Rationale: Saying "You are safe. Take a deep breath" reassures and redirects the client. Telling the client to relax is simplistic and ineffective. The nurse should follow reassurance ("There is nothing here to harm you") with redirection. Asking the client to describe their feelings does not provide reassurance or redirection, and with panic-level anxiety, the client is likely not able to verbalize feelings.

The nurse is caring for a client with a panic disorder. For which first-line medication would the nurse prepare teaching for this client? A. benzodiazepines B. serotonin-norepinephrine reuptake inhibitors (SNRIs) C. selective serotonin reuptake inhibitors (SSRIs) D. sedatives

Answer: C Rationale: Selective serotonin reuptake inhibitors (SSRIs) are recommended as the first drug option in the treatment of clients with a panic disorder. They have the best safety profile and side effects will occur early in treatment before the therapeutic effect takes place. Sedatives are not used to treat a panic disorder. Benzodiazepines are useful in treating intensely distressed clients; however, benzodiazepines have the risk for withdrawal symptoms upon discontinuation of use. They are commonly used even though the SSRIs are recommended for first-line treatment of the disorder. Serotonin-norepinephrine reuptake inhibitors (SNRIs) increase levels of both serotonin and norepinephrine by blocking their reuptake presynaptically. This group of medications is not identified as being the first-line treatment for a panic disorder.

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. Extreme restlessness B. Motor excitement C. Tearfulness D. Palpitations

Answer: C Rationale: The clinical symptoms of anxiety are numerous. They are generally classified as physiologic, psychological or emotional, behavioral, and intellectual or cognitive responses to stress. The clinical symptoms may vary according to the level of anxiety exhibited by the client. Tearfulness and sadness are symptoms of depression, not of anxiety.

The nurse is educating a client with generalized anxiety disorder about nutrition as a supporting factor in controlling the disorder. Which client statement indicates that further education is required? A. "Foods that contain high amounts of refined sugar should be limited." B. "I will limit the number of foods that are higher in fat." C. "I should only drink tea or coffee and avoid cola products." D. "Food and drinks with high sodium content should be avoided."

Answer: C Rationale: The effects of caffeine are similar to some anxiety symptoms, and, therefore, caffeine ingestion will worsen anxiety. High-fat foods will not alter the course of the anxiety symptoms but are potentially harmful in the long term. High amounts of refined sugar can elevate blood glucose levels and cause long-term problems, may increase levels of anxiety, and should be limited. Sodium content in high amounts can cause fluid retention in those clients who are salt sensitive or taking medications to treat the anxiety.

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. Assess for physical conditions that may affect anxiety. B. Obtain a thorough history, focusing on the client's physiologic functioning. C. Determine the client's risk for self-harm or harm to others. D. Determine the effects that culture has had on the client's anxiety issues.

Answer: C Rationale: The first step in the assessment process is to identify the client's level of anxiety and to determine whether a threat of self-harm or harm to others exists. In any situation where the client history is not known, the nursing priority is safety.

A client with a panic disorder is prescribed a selective serotonin reuptake inhibitor (SSRI). For which reason would the nurse expect the client to also be prescribed a long-acting benzodiazepine? A. it will not accumulate in the body. B. it produces less symptoms when discontinued. C. it produces less symptoms when discontinued. D. it will help reduce the dose of the SSRI.

Answer: C Rationale: Treatment of panic disorder may include benzodiazepines concurrently with antidepressants for the first 4 weeks and then tapering to a maintenance dose. This strategy provides rapid symptom relief but avoids the complications of long-term benzodiazepine use. Benzodiazepines with a long-half life accumulate in the body but are removed more slowly and produce less intense symptoms when discontinued. Benzodiazepines are not used to reduce the dose of SSRIs. Benzodiazepines should not be discontinued abruptly. Short-term benzodiazepines with a short half-life do not accumulate in the body.

Which medication classification has been found to be effective in reducing or eliminating panic attacks? A. Anticholinergics B. Antimanics C. Antidepressants D. Antipsychotics

Answer: C Rationale: Tricyclic and monoamine oxidase inhibitor antidepressants have been found to be effective in treating clients with panic attacks. Why these drugs help control panic attacks is not clearly understood. Anticholinergic agents, which are smooth-muscle relaxants, relieve physical symptoms of anxiety but do not relieve the anxiety itself. Antipsychotic drugs are inappropriate because clients who experience panic attacks are not psychotic. Mood stabilizers are not indicated because panic attacks are rarely associated with mood changes.

A nurse is assessing a client and notes that the client is exhibiting affective manifestations of anxiety. Which manifestation would the nurse most likely assess? A. Restlessness B. Palpitations C. Decreased ability to concentrate. D. Irritability

Answer: D Rationale: Affective signs and symptoms to assess for include irritable, worried, tense, or fearful affect; feelings of helplessness or inadequacy; and overly excited, wary, or anguished affect.

A nurse visits a client at home for an assessment after discharge from an inpatient behavioral health unit. The client informs the nurse about experiencing chest pain, shortness of breath, and sweating whenever leaving home unable to go to work. Which is the best response by the nurse? A. "This is likely due to the medication you are taking to control anxiety." B. "You have many issues related to anxiety and need intensive psychotherapy to overcome them all." C. "It's important for you to push yourself outside of your comfort zone and go outside of the home." D. "This sounds like you may have a fear of open spaces when you leave home called agoraphobia."

Answer: D Rationale: Agoraphobia refers to the client's fear of open spaces, which would be faced whenever the client leaves home. The client is likely experiencing this form of phobia. There are cognitive-behavioral therapies that may be effective along with the antianxiety medication for treatment. The client is not usually able to force themselves out of the home alone and will require therapy such as systematic desensitization to achieve outcomes. Telling the client they have many issues related to anxiety and require intensive psychotherapy is demeaning and nontherapeutic.

During which type of anxiety does a person's perceptual field actually increase? A. Moderate B. Panic C. Severe D. Mild

Answer: D Rationale: During mild anxiety, a person's perceptual field widens slightly, and the person is able to observe more than before and to see relationships. During moderate anxiety, the perceptual field narrows slightly. The person does not notice what goes on peripheral to the immediate focus but can do so if attention is directed there by another observer. The perceptual field is greatly reduced in severe anxiety. During panic anxiety, the perceptual field is reduced to a detail, which is usually "blown up."

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. Endorphins B. Testosterone C. Dopamine D. Epinephrine

Answer: D Rationale: In the sympathetic-adrenal-medullary response to stress, the sympathetic nervous system stimulates the adrenal gland to release epinephrine and norepinephrine. Corticotropin-releasing factor, adrenocorticotropic hormone (ACTH), and glucocorticoids are released in the hypothalamic-pituitary response to stress.

Nursing interventions for physical stress related illness should include what? A. Fostering use of a social support system. B. Attending group therapy. C. Assessing the need for increased dose of benzodiazepines. D. Establishing daily routines of meals and sleeping.

Answer: D Rationale: Individuals experiencing or at risk for untoward stress responses may benefit from a number of biologic interventions. The importance of (re-)establishing regular routines for activities of daily living (e.g., eating, sleeping, self-care, and leisure time) cannot be overstated. As well as ensuring adequate nutrition, sleep and rest, and hygiene, a routine may help to structure an individual's time and give them a sense of personal control or mastery.

Panic disorder is treated with cognitive-behavioral techniques, deep breathing, and relaxation, in addition to what? A. Anticonvulsants B. Central nervous system depressants C. Antipsychotics D. Antidepressants

Answer: D Rationale: Panic disorder is treated with cognitive-behavioral techniques, deep breathing and relaxation, and medication such as benzodiazepines, selective serotonin reuptake inhibitors, tricyclics, and antihypertensives, such as clonidine and propranolol.

Which of the following is inconsistent with panic-level anxiety? A. The goal is to lower the client's anxiety to mild or moderate before proceeding with anything else. B. The nurse needs to maintain a non-stimulating environment. C. The nurse should remain with the client until the panic recedes. D. This level of anxiety can be sustained indefinitely.

Answer: D Rationale: Panic-level anxiety cannot be sustained indefinitely. The nurse should remain with the client until the panic recedes and should maintain a nonstimulating environment. The goal is to the lower the client's anxiety to mild or moderate before proceeding with anything else.

A nurse is giving a presentation on mental health promotion to college students. One student asks the nurse to explain the difference between normal anxiety and an anxiety disorder. Which response is best? A. "Normal anxiety does not result in feelings of dread or restlessness." B. "Normal anxiety occurs in response to everyday stressors." C. "People with anxiety disorders experience a fight-or-flight response when threatened." D. "People with anxiety disorders generally find that the anxiety interferes with daily activities."

Answer: D Rationale: Pathologic anxiety is suspected if a person feels anxious when no real threat exists, when a threat has passed long ago but continues to impair the person's functioning, or when a person substitutes adaptive coping mechanisms with maladaptive ones.

When developing a plan of care for a client diagnosed with panic disorder, which nursing diagnosis would be considered the priority? A. Social isolation B. Anxiety C. Powerlessness D. Risk for self-directed violence.

Answer: D Rationale: People with panic disorder are often depressed and consequently are at high risk for suicide. Adolescents with panic disorder may be at higher risk for suicidal thoughts and attempt suicide more often than other adolescents. Other diagnoses that are appropriate for this client population, although not the priority, include Powerlessness, Social Isolation, and Anxiety.

The nurse recognizes that which client is most likely experiencing generalized anxiety disorder (GAD)? A. 70-year-old whose spouse died 1 year ago who has "no desire to leave my house" and reports severe fatigue. B. 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. C. 30-year-old business executive who reports being anxious about attending the meetings and social events that are the executive's job responsibilities. D. 40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months.

Answer: D Rationale: The nurse recognizes that the client most likely experiencing GAD is a 40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months. GAD is characterized by excessive worry and feelings of anxiety at least 50% of the time for 6 months or more. The client with GAD has three or more of the following symptoms: uneasiness, irritability, muscle tension, fatigue, difficulty thinking, and sleep alterations. The military veteran is most likely experiencing posttraumatic stress disorder (PTSD), the older adult may be experiencing depression, and the business executive may have social phobia.

Linn is a 42-year-old woman who is in the process of moving houses after her divorce. She reports experiencing bouts of increased anxiety recently. How can the nurse best explain the physiological adaptation that occurs during fight or flight to this client? A. An increased immune response and digestion. B. A decrease in heart rate and blood pressure. C. A decrease in blood clotting ability. D. An increase in blood flow to the muscles.

Answer: D Rationale: The widespread effects of the fight-or-flight response include an increase in heart rate, blood pressure, breathing rate, perspiration, blood flow to the muscles, and blood-clotting ability; a decrease in saliva production, digestion, and immune response; and a release of stored glycogen.

The mental health nurse knows that which medication classification has been found to be effective in reducing or eliminating panic attacks? A. Antipsychotics B. Anticholinergics C. Antimanics D. Antidepressants

Answer: D Rationale: Tricyclic and monoamine oxidase inhibitor antidepressants have been found to be effective in treating clients with panic attacks. Why these drugs help control panic attacks is not clearly understood. Anticholinergic agents, which are smooth-muscle relaxants, relieve physical symptoms of anxiety but do not relieve the anxiety itself. Antipsychotic drugs are inappropriate because clients who experience panic attacks are not psychotic. Mood stabilizers are not indicated because panic attacks are rarely associated with mood changes.