Chapt. 23: Anxiety Disorders
19. A middle-aged woman has made increasing numbers of changes in her daily routines for the sole purpose of avoiding any possible exposure to spiders. Which of the following conditions involves a persistent, irrational fear attached to an object or a situation that objectively does not pose a significant danger? A) Phobic disorders B) Post-traumatic stress disorder C) Obsessive-compulsive disorder D) Stress disorders
Ans: A Feedback: A phobia is a persistent, irrational fear attached to an object or a situation that objectively does not pose a significant danger. Affected clients experience anticipatory anxiety followed by a compelling desire to avoid the dreaded object or situation, even though they usually recognize that the fear is unreasonable or excessive in proportion to the actual threat.
22. A psychiatric-mental health nurse is completing an assessment of a client who is new to the community mental health drop-in center. How should the nurse best begin an assessment for anxiety in this new client? A) "Have you been having feelings of worry or anxiety lately?" B) "When you face an anxious situation, how do you typically cope?" C) "Is there any history of mental illness in your parents or siblings?" D) "Do you consider yourself to be a peaceful person?"
Ans: A Feedback: Although several formal assessment tools exist, nurses begin assessment by simply asking clients if they are currently feeling anxious or worried or have experienced such feelings recently.
17. A new nursing graduate is experiencing anxiety in the days leading up to the licensing examination. Which of the following types of anxiety has the potential to improve functioning? A) Mild B) Moderate C) Severe D) Pathologic
Ans: A Feedback: Anxiety can be mild, moderate, or severe, affecting cognitive, psychological, and physical function accordingly. Mild anxiety results in improved functioning. however, as anxiety increases, people become less and less able to function.
15. A client states that she copes with her anxiety by cleaning compulsively, a practice that greatly irritates her husband. How should the nurse categorize this behavior? A) Maladaptive, because it is an avoidance response B) Maladaptive, because it bothers her husband C) Adaptive, because she chooses to clean D) Adaptive, because her behavior is not harming anyone
Ans: A Feedback: Clients learn to reduce the anxiety they feel in either functional or dysfunctional ways. Functional responses tend to be voluntary, conscious behaviors that address and acknowledge the stressful situation and help clients to find solutions. Dysfunctional responses tend to be involuntary, inflexible, avoidance-type solutions that impair productivity. The nurse should not ask the client to give up coping mechanisms, even maladaptive ones, without offering other adaptive mechanisms. In other words, it is not appropriate to expect a client to just stop worrying, compulsively checking doors, or otherwise trying to cope with anxiety.
5. The interdisciplinary team is discussing a client's situation in a care conference and weighing the possibility that the client has generalized anxiety disorder (GAD). GAD is primarily characterized by what? A) Excessive worry or anxiety lasting longer than 6 months B) Flashbacks and feelings of unreality C) Fear of going outdoors D) A distinct lack of life skills over the past year
Ans: A Feedback: GAD is usually characterized by chronic and excessive worry and anxiety more days than not, occurring for at least 6 months, and involving many aspects of the person's life (APA, 2000).
14. A nurse therapist is conducting a session with a group of clients in which he is teaching them to utilize relaxation techniques to alleviate anxiety. Relaxation techniques help clients with anxiety disorders because they do what? A) Reduce autonomic arousal B) Increase sympathetic stimulation C) Release cortisol D) Increase metabolic rate
Ans: A Feedback: Regularly inducing the relaxation response reduces the general level of autonomic arousal in anxious clients. It lowers blood pressure, heart rate, metabolic rate, and oxygen demands. This physiological effect may result from effects on the production of cortisol, a hormone the body releases in response to stress. Cortisol is helpful during the fight-or-flight response, but its prolonged presence in chronically anxious or stressed clients can inhibit the immune system and have other deleterious effects on the body.
6. A client has presented to the emergency department distraught over his recent and worsening flashbacks and feelings of unreality. These symptoms are associated with which of the following? A) Post-traumatic stress disorder (PTSD) B) Schizophrenia C) Agoraphobia D) Obsessive-compulsive disorder (OCD)
Ans: A Feedback: Symptoms of PTSD include generalized anxiety, dissociation, intrusive thoughts or images of the trauma, flashbacks, nightmares, and other sleep disturbances. Additionally, the person feels a need to avoid situations or stimuli that elicit recollections of the trauma.
11. A client's psychiatrist has determined that desensitization therapy may benefit his anxiety. What does this treatment consist of? A) A systematic way to replace a panic response with a relaxation response B) A cognitive technique for replacing a worry with a positive statement C) Exposing the client to an anxiety-producing stimulus for 1 to 2 hours (flooding) D) Teaching the client to ignore or become immune to anxiety-producing situations
Ans: A Feedback: Systematic desensitization is a classic conditioning technique by which a client learns to gradually replace a panic response with a relaxation response. It is a behavioral therapy used to treat specific phobias, social phobias, agoraphobia, and post-traumatic stress disorder. The client progressively confronts the object of fear in very small, controlled steps while in a deeply relaxed state.
20. A client was involved in a motor vehicle accident 1 week ago, in which she struck and killed a pedestrian. She has been having trouble remembering the event and feels as if she is walking around in a dreamlike state. From what condition is the client suffering? A) Post-traumatic stress disorder B) Acute stress disorder C) Dissociative stress disorder D) Amnesic stress disorder
Ans: B Feedback: Acute stress disorder (ASD) occurs within the first month of exposure to extreme trauma: combat, rape, physical assault, near-death experience, or witnessing a murder. Symptoms begin during or shortly after the event. The symptom of dissociation is a state of detachment in which people experience the world as dreamlike and unreal. Poor memory of specific events surrounding the trauma also may accompany the dissociative state. When symptoms of ASD continue for longer than 1 month and are accompanied by functional impairment or stress, the diagnosis changes to acute post-traumatic stress disorder (PTSD).
1. A first-time mother admits to be overwhelmed by feelings of dread and worry since the birth of her son. The nurse has discussed the phenomenon of anxiety with the woman but she is uncertain about the precise definition of anxiety. Which of the following explanations by the nurse gives the best description of anxiety? A) "Anxiety is an abnormal response to everyday stress." B) "Anxiety is a sense of psychological distress." C) "Anxiety is a physiological response to stress." D) "Anxiety is a normal response to life events."
Ans: B Feedback: Anxiety can be described as a sense of psychological distress. Feeling anxious, frightened, uneasy, or worried is a normal response to threatening or dangerous events.
23. As part of a life skills workshop for individuals with mental health disorders, a nurse is teaching stress management skills to participants. Which of the following suggestions about lifestyle changes is most appropriate? A) "Try to conserve energy by limiting yourself to mild levels of exercise." B) "If possible, try to cut out caffeine and nicotine from your lifestyle." C) "Try to eliminate all situations and relationships that cause you stress." D) "Remind yourself that it's possible to cope with stress but not to actually reduce stress."
Ans: B Feedback: Elimination of nicotine and caffeine is advised for individuals who are struggling to manage stress. It is unrealistic to eliminate all sources of stress, though it is possible to reduce stress levels. Vigorous exercise is beneficial in stress management.
4. A nurse is teaching a new nursing graduate about the differentiations between the various levels of anxiety. The nurse should state that severe levels of anxiety result in what? A) A heightened sense of awareness B) Distorted sensory awareness C) Mild forgetfulness D) Impaired ability to concentrate
Ans: B Feedback: In severe anxiety, perception becomes increasingly distorted, sensory input diminishes, and processing of sensory stimuli becomes scattered and disorganized.
2. A nurse therapist is conducting a group session in which a participant asks the nurse to explain the difference between normal anxiety and an anxiety disorder. Which of the following responses is best? A) "People with anxiety disorders experience a fight-or-flight response when threatened." B) "People with anxiety disorders generally find that the anxiety interferes with daily activities." C) "Normal anxiety does not result in feelings of worry or restlessness." D) "Normal anxiety prompts a person to create solutions to problems, but anxiety disorders result in dread."
Ans: B Feedback: 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. Normal anxiety does not always prompt the creation of solutions.
7. A 30-year-old woman who has been unemployed secondary to her anxiety disorder states that she would like to have a job where she is alone and no one needs to evaluate her work. The nurse interprets these comments as an indicator of which of the following? A) Agoraphobia B) Social phobia C) Obsessive-compulsive disorder D) Panic disorder
Ans: B Feedback: Social phobia represents a persistent, irrational fear of and compelling desire to avoid situations in which the person may be exposed to unfamiliar people or to the scrutiny of others. Additionally, the person harbors the fear of behaving in a way that may prove humiliating or embarrassing. The person will experience marked anticipatory anxiety if confronted with such a situation and will attempt to avoid it.
21. A psychiatric-mental health is explaining the profound effects of anxiety disorders on individuals, on communities and on populations. Which of the following statements about the incidence and prevalence of anxiety disorders is most accurate? A) Only schizophrenia affects more adult Americans than anxiety disorders. B) Among adults over age 65, anxiety disorders are the most common psychiatric diagnosis. C) Anxiety disorders are the most common psychiatric disorder at all ages. D) Anxiety disorders were rare in past decades but their incidence and prevalence are rapidly increasing.
Ans: C Feedback: Anxiety disorders affect approximately 40 million Americans 18 years or older in any given year. They are the most common psychiatric disorders for adults and children. Anxiety disorders are not noted to have been rare in the past.
13. A client relates that she has been under increased stress at work and that the only way she knows how to manage her anxiety is by drinking two or three glasses of wine each evening. The nurse suggests she stop drinking because of the negative effects of alcohol consumption. Which of the following statements explains why this may be difficult for the client? A) She is probably physically dependent on alcohol. B) Drinking alcohol is more socially acceptable than is taking medications. C) She may have no coping mechanism with which to replace drinking alcohol. D) A few glasses of wine each night is not necessarily a problem.
Ans: C Feedback: 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. The client may or may not have a physical dependence on alcohol.
10. A nurse is creating a plan of care for a 30-year-old single woman with a history of post-traumatic stress disorder. The client cannot drive by the park where she was assaulted. The nurse suggests that the client visualize successfully driving by the park. This intervention is an example of what? A) Cognitive reframing B) Positive coping statements C) Covert rehearsal D) Cognitive restructuring
Ans: C Feedback: In covert rehearsal, the client is helped to imagine himself or herself successfully confronting an anxiety-provoking situation.
9. A client with generalized anxiety disorder states that he is worried about his marriage. He never feels like he has control over his relationship despite "trying so hard to be a good husband." He adds that he is terrified of divorce. Which response by the nurse is most therapeutic? A) "It sounds to me like you're doing a great job in your marriage." B) "Your worries are a feature of your anxiety disorder. Tell yourself that you have nothing to worry about." C) "Has something changed at home that is causing you to worry?" D) "Try your best to focus on the positive features of your marriage."
Ans: C Feedback: The nurse begins an assessment by simply asking the client if he or she is currently feeling anxious or worried or has experienced these feelings recently. The nurse also asks the client about obsessive thinking patterns, worrying, compulsions and repetitive activity, specific phobias, and exposure to traumatic events. Once the nurse has determined that signs and symptoms of anxiety do exist, he or she assesses the possible underlying causes and inquires about family history, recent life events, current stress level, personal history of anxiety, medical and medication history, history of substance abuse, and other possible causes of the anxiety.
3. A psychiatric-mental health is facilitating a family meeting with a client who has an anxiety disorder and the members of his immediate family. His daughter asks, "What could have caused this for him?" The nurse should explain that the causes of anxiety disorders are which of the following? A) A heritable predisposition for a lowered threshold B) Alterations in brain structure C) Distorted thinking patterns as a result of lesions D) Neurobiologic and psychodynamic factors
Ans: D Feedback: According to current research, anxiety disorders have several possible causes. The etiology of anxiety disorders is believed to be a combination of neurobiologic and psychosocial stress.
12. Following a comprehensive assessment, the nurse is documenting the signs and symptoms of a client's anxiety in the medical record. Which of the following is a common affective sign or symptom of anxiety? A) Palpitations B) Diaphoresis (sweating) C) Decreased ability to concentrate D) Irritability
Ans: D Feedback: 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.
8. A client's family physician has prescribed benzodiazepines in response to her repeated complaints of anxiety. The nurse should recognize a need to prioritize which of the following subjects in health education? A) Avoiding cheeses and smoked meats B) Interactions with monoamine oxidase inhibitors (MAOIs) C) Avoiding spending too much time in the sun D) Potentiation of alcohol effects
Ans: D Feedback: Benzodiazepines have long been the drugs of choice for treatment of anxiety disorders. They can induce a physical dependence and can induce severe withdrawal symptoms and intense rebound anxiety when discontinued abruptly. They potentiate the effects of alcohol and other sedative hypnotics, are commonly abused, and have several significant side effects. The most common adverse effects are sedation, ataxia, loss of coordination, slurred speech, memory impairment, paradoxical agitation, and dizziness. They also cause psychomotor impairment.
18. A man is experiencing overwhelming feelings of dread in the days leading up to his performance appraisal at work. What part of the brain is thought to be involved in the production of anxiety as a result of the identification of incoming sensory information as threatening? A) Cerebellum B) Cerebral cortex C) Brainstem D) Amygdala
Ans: D Feedback: The amygdala can identify incoming sensory information as threatening and then instigate feelings of anxiety or fear. Also, researchers theorize that emotional memories stored in the central part of the amygdala play a role in phobic disorders, whereas other parts of the amygdala are involved in other forms of anxiety. The amygdala also coordinates fear, memory, and emotion with heart rate, blood pressure, and other physical responses to stressful events.
16. A pregnant woman's anxiety over her imminent labor is precipitating a fight-or-flight response. Which of the following is a body adaptation that occurs during fight-or-flight? A) Decreased heart rate and blood pressure B) Increased immune response and digestion C) Decreased blood-clotting ability D) Increased blood flow to the muscles
Ans: D Feedback: 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.