Anxiety mini quiz
Which behavior by the client exhibits denial after a recent diagnosis? 1 Attempts to minimize the illness 2 Lacks an emotional response to the illness 3 Refuses to discuss the condition with the client's spouse 4 Expresses displeasure with the prescribed activity program
1 Attempts to minimize the illness is a classic sign of denial; by reducing the importance or extent of the problem, the individual is able to cope. Not acknowledging that it is really a problem is a form of denial. Lacking an emotional response to the illness indicates repression of affect rather than denial. Failure to communicate is insufficient evidence to diagnose denial; the marital relationship may be strained, or the client may be worried about upsetting the spouse. Expressing displeasure with the activity program usually indicates displacement of anger, not denial.
When a newly admitted client with paranoid ideation talks about people coming through the doors to commit murder, which action would the nurse use? 1 Ignore the client when she or he mentions delusions. 2 Listen attentively to what the client is saying. 3 Explain that no one can get through the door. 4 Ask where the information was obtained.
2 Listening to what the client is saying demonstrates that the nurse believes that what the client has to say is important; it also encourages verbalization of feelings. Ignoring the client increases feelings of worthlessness and persecution. Explanations accomplish little; a paranoid individual cannot be talked out of her or his feelings. Asking where the information came from reinforces the delusional system.
Which response would the nurse make to a depressed client who asks, "Do you think they'll ever let me out of here"? 1 "We should ask your primary health care provider." 2 "Everyone says you're doing fine." 3 "Do you think you're ready to leave?" 4 "How do you feel about leaving here?"
4 The nurse would ask, "How do you feel about leaving here?" The nurse's response asking about the client's feelings about leaving urges the client to reflect on feelings and encourages communication. Saying, "We should ask your primary health care provider," shifts responsibility from the nurse to the primary health care provider; it is an evasive response. Responding, "Everyone says you're doing fine," does not address what the client is asking the nurse; it closes the door to further communication and the nurse cannot speak for others. Asking, "Do you think you're ready to leave?" may elicit a yes or no answer; it does not encourage communication because it is a closed-ended question.
Which statements are true regarding anxiety? (Select all that apply.) Anxiety is a response to stress. Anxiety is uncommon in women. Anxiety can cause elevations in blood pressure and heart rate. Many conditions are exacerbated by stress and anxiety. Patients with anxiety respond well to relaxation techniques. Children are at the highest risk for anxiety.
Adults and the elderly are at the highest risk for anxiety. Anxiety is more common in women.
Which statement by a nursing student about the effects of the fight or flight response indicates a need for further education? Pupils constrict when a patient is anxious. The heart races when a patient experiences anxiety. Peristalsis slows as the patient decides whether to fight back. The patient may complain of dry mouth when anxious.
Arousal of the sympathetic division of the autonomic nervous system leads to the release of adrenalin which causes the heart to speed up and circulate blood faster, the lungs to dilate to increase the oxygen carrying capacity of the blood, the liver to release stored glucose for a quick infusion of energy, the pupils to dilate for improved visual acuity, and the stomach to inhibit peristalsis as a means to conserve energy. Secondary to these organ system changes, there are observable signs of the "fight or flight" response that include tachycardia, disambiguation, bladder relaxation, tremors, blushing, xerostomia, delayed digestion, and hyperacusis.
The nurse is implementing a nonpharmacological intervention for a patient with anxiety. Which intervention is most appropriate? Increasing caffeine intake Decreasing physical activity Limiting noise or music in the room Performing abdominal breathing exercises
Performing abdominal breathing exercises is a nonpharmacological intervention that can help decrease anxiety. Caffeine should be decreased (not increased). Physical activity is encouraged to relieve anxiety so should not be decreased. Music can help reduce anxiety and does not need to be limited.
Which action should the nurse take to monitor the effects of an acute stressor on a hospitalized patient? (Select all that apply.) Assess for bradycardia. Ask about epigastric pain. Observe for increased appetite. Check for elevated blood glucose levels. Monitor for a decrease in respiratory rate.
The physiological changes associated with the acute stress response can cause changes in appetite, increased gastric acid secretion, and elevation of blood glucose levels. Stress causes an increase in respiratory and heart rates.
Which therapeutic communication technique is demonstrated when the nurse says, "I'm confused about exactly what is upsetting you. Would you go over that again, please?" 1 Clarifying 2 Structuring 3 Confronting 4 Paraphrasing
1 The nurse is asking for clarification to better understand the intended message. Structuring creates order and allows a client to become aware of problems. Confronting is used when there are discrepancies between what a person says and what a person does or between verbal and nonverbal messages. Paraphrasing helps the speaker and listener understand how the information is being interpreted.
Which response would the nurse make to a client who has been acting out for several weeks and says, "I'm really sorry about how I've acted. I'll bet everyone thinks I'm an idiot"? 1 "You're wondering how others will react to you now." 2 "Some clients are concerned that you might lose control again." 3 "Everyone feels foolish sometimes; you didn't deliberately act that way." 4 "Nobody thinks you're a fool; everyone recognized that you were really struggling to keep control."
1 The nurse would reply, "You're wondering how others will react to you now." Observing that the client is worried about the perception of the other clients best clarifies the client's major concern and encourages discussion of feelings. The nurse cannot legitimately speak for other clients; saying what other clients are thinking may increase the client's anxiety about the future. Saying that everyone feels foolish sometimes is an ineffective use of empathy, because it cuts off further communication; it also indicates that the nurse agrees that the client acted foolishly. Saying that everyone realized that the client was struggling is inappropriate, because the nurse cannot legitimately speak for other staff members and clients.
Which situations accurately represent superego in a client, per Freud? Select all that apply. One, some, or all responses may be correct. 1 Controlling the urge to eat candy because he or she knows it will affect blood sugar levels 2 Having a craving for fruit but not stealing it from the next client because that client needs it more 3 Urinating beside the bed instead of waiting for the nurse to assist him or her 4 Experiencing a stomachache but refraining from stealing medications from a friend because it is illegal 5 Feeling the urge to run away from the hospital but refraining from doing so because the security guard is watching
1,2,4 According to Freud, the superego is influenced by outside social forces. It is also known as the conscience. A client who controls the urge to have candies to prevent negative effects on his or her blood sugar level exhibits superego behavior. A client who does not steal fruit despite craving it because the next client needs it more exhibits superego behavior. A client who does not steal medications because this action is wrong also exhibits superego behavior. A client who gives in to a basic impulse by urinating beside the bed instead of waiting for the nurse to assist exhibits id behavior. A client who does not run away from the hospital because he or she may get caught by the security guard exhibits ego behavior.
Which approach is best to use with a client who is angry and agitated? 1 Confront the client about the behavior. 2 Turn on the television to distract the client. 3 Maintain a calm, consistent approach with the client. 4 Explain to the client why the behavior is unacceptable
3 Consistency allows the client to predict the nurse's behavior and a calming approach helps decrease agitation. Confronting the client may escalate anger and agitation. Environmental stimulants should be decreased, not increased. An agitated client cannot attend to logical explanations and perceived criticisms should be avoided.
For which behavior would the nurse incur liability in handling an inpatient psychiatric client who is laughing loudly and making inappropriate comments to other clients and staff? 1 Reporting the client's behavior to the treatment team 2 Checking the client's prescriptions for an as-needed medication to help calm the client 3 Placing the client in seclusion only until the client stops verbally attacking clients and staff 4 Bringing the client to a quiet area and encouraging a discussion of thoughts and behavior
3 It is unlawful for a client to be placed in seclusion simply because he or she is annoying or bothersome to other clients and staff. A nurse who places a client in seclusion for this reason may be held liable. It is appropriate for the nurse to report the behavior that is being observed to the client's treatment team. It is also appropriate to assess the client's record to see whether an as-needed medication might be beneficial in calming the client's behavior. Bringing the client to a quieter area to provide attention and allow ventilation of feelings may be helpful.
Which approach would the nurse use to establish a trusting relationship with a client who is paranoid? 1 Seeking the client out frequently to spend long blocks of time together 2 Sitting in the unit and observing the client's behavior throughout the day 3 Being available on the unit to meet with the client at mutually acceptable times 4 Calling the client into the office to establish a contract for regular therapy sessions
3 The nurse would be available on the unit to meet with the client at mutually acceptable times. The recommended approach for working with paranoid clients is to allow them to set the pace for the relationship and setting mutually acceptable times will decrease the client's paranoia. Seeking the client out to spend long blocks of time together would be overwhelming for a paranoid client. Sitting and watching the client's behavior on the unit will confirm the client's paranoia. Calling the client into the office to establish a contract may be perceived as threatening and add to the client's feelings of paranoia.
Which explanation would the nurse include about systematic desensitization for a client who has a phobia about dogs? 1 "You'll be immediately exposed to dogs until you no longer feel anxious." 2 "Rewards will be given when you don't become anxious around dogs." 3 "Your contact with dogs will be increased, and we'll teach you relaxation techniques." 4 "We'll be engaging in detailed discussions to help you identify what caused your phobia."
3 The nurse would say, "Your contact with dogs will be increased, and we'll teach you relaxation techniques." Increased contact with the object of the phobia or the situation that causes phobia, accompanied by the use of relaxation techniques, is an accurate description of the behavioral therapy method of systematic desensitization. Immediate exposure to the object or situation that inspires fear until the anxiety is gone is a different behavioral approach called flooding. Giving rewards when the client is no longer made anxious by a fear-inspiring object or situation is a different behavioral approach called operant conditioning. Detailed discussions of the reason for the phobia constitute a type of psychoanalytical therapy rather than a behavioral approach, like systematic desensitization.
Which goal would cognitive therapy accomplish for a client who experiences panic attacks? 1 Prevent future panic attacks. 2 Help the client hide the panic attacks. 3 Stop the panic attacks once they begin. 4 Decrease the fear of having panic attacks
4 The goal of cognitive therapy for panic attacks is to decrease the fear of having panic attacks. It is the fear of having an attack as much as the panic attack itself that is debilitating. Once the client's fear of future attacks is diminished, the number of attacks usually decreases as well. Prevention of future attacks is desirable but not always possible with cognitive therapy. Hiding the attacks is not a goal of cognitive therapy. Assisting the client to cope would be more helpful. It usually is impossible to stop a panic attack once it starts.
Which action would the nurse take to help a disturbed, acting-out child develop a trusting relationship? 1 Inquire about the child's feelings regarding the parents. 2 Implement a half-hour one-on-one interaction every day. 3 Initiate limit-setting and explain the rules to be followed. 4 Offer periodic support while emphasizing safety in play activities
4 The nurse would offer periodic support while emphasizing safety in play activities. Offering periodic support while emphasizing safety in play activities sets a foundation for trust because it allows the child to see that the nurse cares. Inquiring about the child's feelings regarding the parents would be threatening at this stage of the relationship. Implementing a half-hour one-on-one interaction daily is too infrequent for the development of trust. Although initiating limit-setting and explaining the rules to be followed are necessary, limit-setting does not support the development of a trusting relationship as much as providing support and emphasizing safety do.
In a cognitive therapy approach, which nursing interventions are best for a client who states, "I get down on myself when I make a mistake."? Select all that apply. One, some, or all responses may be correct. 1 Teaching the client relaxation exercises to diminish stress 2 Exploring with the client past experiences that have caused distress 3 Providing the client with mastery experiences designed to boost self-esteem 4 Encouraging the client to replace these negative thoughts with positive thoughts 5 Helping the client modify the belief that anything less than perfection is unacceptable
4, 5 Cognitive therapy seeks to find underlying self-defeating beliefs and replace them with more reality-based positive beliefs. It encourages the use of cognitive restructuring (cognitive reframing) through positive self-talk and a rational mindset. Teaching the client relaxation exercises to diminish stress reflects a behavioral approach. Exploring with the client past experiences that have caused distress is a psychoanalytical approach. Providing the client with mastery experiences to boost self-esteem is a behavioral approach.
The nurse is assessing a patient's anxiety related to stress. Which changes reflect the short-term physiological response to stress? (Select all that apply.) Cortisol is released, increasing glycogenesis and reducing fluid loss. Immune system functioning decreases, and the risk of cancer increases. Corticosteroid release increases stamina and impedes digestion. Muscular tension, blood pressure, and triglyceride levels increase. Epinephrine is released, increasing the heart and respiratory rates. Risk of depression, autoimmune disorders, and heart disease increases
Cortisol release and increased glycogenesis and reduced fluid loss; corticosteroid release and increased stamina and slowed digestion; increased muscular tension, blood pressure and triglycerides; and epinephrine release resulting in increased heart and respiratory rates are all short-term physiological responses to stress. Increased risk of immune system dysfunction, cancer, cardiovascular disease, depression, and autoimmune disease are all long-term (chronic) effects of stress.