Chapter 14: Anxiety

Anxiety and fear both refer to the same feeling or being afraid or threatened by an external stimulus. True False

False

A client with Anxiety and sleeplessness should avoid caffeine. True False

True

Clients with anxiety often need to be taught relaxation techniques, such as listening to music, medication etc. to attend work, school and meet their goals. True False

True

In anxiety due to medical conditions, the individual's symptoms of anxiety are a direct physiological medical condition, such as hyperthyroidism, pulmonary embolism, or cardiac dysrhythmias. True False

True

Mild anxiety can be productive and does not require direct intervention. True False

True

A nurse has been told that a client's anxiety is at the panic level. The nurse would assess the client for manifestations at this level of anxiety. a. Dizziness, palpitations, and nausea b. Feelings of "butterflies" in the stomach c. Feelings of fatigue and inability to remain awake d. Obsessive thoughts and compulsive behavior

a. Dizziness, palpitations, and nausea

When an anxious client depersonalizes they often need to be asked "what is happening." True False

True

An individual experiencing panic attacks can also experience depersonalization, which is the sense of being disconnected from one-self. True False

True Rationale: keyword is panic

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

a. Antidepressants 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.

When explaining the difference between anxiety and fear, the mental health nurse shares that (Select all that apply.) a. Anxiety involves experiencing subjective, uncomfortable feelings resulting from unknown causes b. Fear results in objective, physical responses caused by real danger c. Anxiety is likely to result from an attempt to overcome stress d. Depression is a risk factor for developing anxiety e. Obsessive-compulsive behavior is often the result of abandonment

a. Anxiety involves experiencing subjective, uncomfortable feelings resulting from unknown causes b. Fear results in objective, physical responses caused by real danger c. Anxiety is likely to result from an attempt to overcome stress Rationale: When explaining the difference between anxiety and fear, the mental health nurse shares that anxiety involves experiencing subjective, uncomfortable feelings resulting from unknown causes.

A client diagnosed with anxiety disorder has been prescribed benzodiazepine drugs. The nurse is explaining the possible side effects of the medications. Which side effects of the drug explained by the nurse is correct? Select all that apply. a. Clouded sensorium b. Dry mouth c. Blurred vision d. Constipation e. Vomiting

a. Clouded sensorium b. Dry mouth c. Blurred vision d. Constipation Rationale: Dry mouth, blurred vision, clouded sensorium and constipation are known side effects of benzodiazepines. Vomiting is not known to occur with benzodiazepines. These side effects are associated with non benzodiazepine drugs that are used to treat anxiety like Buspirone (BuSpar).

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

a. Continued development of positive coping skills b. Maintaining prescribed medications d. Continued practice of relaxation techniques e. Development of a regular exercise program Rationale: Client/family education for panic disorder includes reviewing breathing control and relaxation techniques, discussing positive coping strategies, encouraging regular exercise, emphasizing the importance of maintaining prescribed medication regimen and regular follow-up, describing time management techniques such as creating "to do" lists with realistic estimated deadlines for each activity, crossing off completed items for a sense of accomplishment, saying "no," and stressing the importance of maintaining contact with community and participating in supportive organizations. Medication should be adhered to as prescribed. Increasing the amount of daily responsibilities at this time may increase anxiety. cannot be avoided,

Which of the following statements about the use of defense mechanisms in persons with anxiety disorders is accurate? Select all that apply. a. Defense mechanisms are a human's attempt to reduce anxiety. b. Persons are usually aware when they are using defense mechanisms. c. Defense mechanisms can be harmful when overused. d. Defense mechanisms are cognitive distortions. e. Defense mechanisms can control the awareness of anxiety. f. The use of defense mechanisms should be avoided.

a. Defense mechanisms are a human's attempt to reduce anxiety. c. Defense mechanisms can be harmful when overused. d. Defense mechanisms are cognitive distortions. e. Defense mechanisms can control the awareness of anxiety. 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.

A nurse is assessing a client with anxiety. Which signs and symptoms would the nurse attribute to sympathetic nervous stimulation? Select all that apply. a. Heart racing b. Bradycardia c. Hypertension d. Fainting f. Pressure to urinate

a. Heart racing c. Hypertension Rartionale: Pressure to urinate, fainting, and bradycardia are related to parasympathetic nervous stimulation.

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. Identifying treatment modalities b. Providing supportive feedback c. Using appropriate coping skills d. Involving family for support, if appropriate e. Using restraint when panic develops

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

When a client is experiencing a panic attack while in the recreation room, what interventions are the nurse's first priorities? Select all that apply. a. Provide a safe environment. b. Request a prescription for an antianxiety agent c. Offer the client therapy to calm down d. Ensure the client's privacy. e. Engage the client in recreational activities.

a. Provide a safe environment. d. Ensure the client's privacy. Rationale: During a panic attack, the nurse's first concern is to provide a safe environment and to ensure the client's privacy. If the environment is overstimulating, the client should move to a less stimulating place. 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. An antianxiety agent may be helpful, but it is not the priority. It would likely be stimulating to engage the client in recreational activities.

Which of the following are believed to help individuals mediate, or lessen, the effects of stress. Select all that apply: a. Spirituality b. Wealth c. Higher education level d. Social support e. Culture

a. Spirituality d. Social support

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. Tearfulness b. Motor excitement c. Extreme restlessness d. Palpitations

a. Tearfulness 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.

Interventions for a client with panic disorder would include (select all): a. encouraging the client to verbalize feelings b. helping the client avoid panic-producing situations c. reminding the client to practice relaxation when anxiety level is low d. teaching the client reframing techniques e. teaching relaxation exercises to the client. f. telling the client to ignore any anxious feelings.

a. encouraging the client to verbalize feelings c. reminding the client to practice relaxation when anxiety level is low d. teaching the client reframing techniques e. teaching relaxation exercises to the client.

The nurse is assessing a client who recently experienced their first panic attack while at the grocery store. What question should the nurse ask to identify complications of the disorder? a. "Are you concerned there will be more panic attacks?" b. "Do you have any problems going out alone to public places?" c. "What do you think is the origin of the panic you felt?" d. "Can you describe how you felt physically during the attack?"

b. "Do you have any problems going out alone to public places?" Rationale: To identify complications of the disorder when assessing a client who recently experienced the client's first panic attack while at a grocery store, the psychiatric nurse asks, "Do you have any problems going out alone to public places?"

Which statement, made by a client diagnosed with an anxiety disorder, should trigger the nurse's concern about the client's understanding of the use of defense mechanisms? a. "Defense mechanisms provide a sense of control over the uncontrollable." b. "When I have a problem, I just deny it until it goes away." c. "I'm not sure when I'm actually using a defense mechanism." d. "I'm thankful that I have a way to manage my problems."

b. "When I have a problem, I just deny it until it goes away."

Which level of anxiety helps the client focus the client's attention to learn, problem solve, think, act, feel, and protect himself or herself? a. Moderate b. Mild c. Panic d. Severe

b. Mild

The mental health nurse is gathering a health history on a new client. The client is constantly pacing the floor and is concerned only with stating that the client is about to die. The nurse would classify this level of anxiety as what? a. Mild b. Moderate c. Euphoria d. Severe

b. Moderate Rationale: In moderate anxiety, the client experiences a narrowing of the ability to concentrate. The client paces, has voice tremors, and has an increased rate of speech. During euphoria, the client experiences an exaggerated feeling of well-being that is not directly proportional to a specific circumstance or situation. Mild anxiety causes the client to have an increased alertness to inner feelings or the environment. During severe anxiety, the client is able to focus on only small or scattered details.

A nurse determines that a client who is experiencing anxiety is using relief or primitive survival behaviors. The nurse determines that the client is experiencing which degree of anxiety? a. Mild b. Severe c. Moderate d. Panic

b. Severe Rationale: With mild anxiety, the client is easily able to recognize and name anxiety. With moderate anxiety, the client is usually able to state that he or she is anxious. A client experiencing severe anxiety typically uses relief behaviors. With panic, the client is perplexed and self-absorbed.

Which is a cardiovascular response of the sympathetic nervous system? a. Bradycardia b. Tachycardia c. Hypotension d. Bradypnea

b. Tachycardia

Which would not be included in the plan of care for a client diagnosed with acute anxiety? a. Encouraging the client to verbalize feelings and concerns b. Touching the client in an attempt to comfort the client c. Approaching the client in a calm, confident manner d. Providing the client with a safe, quiet, and private place

b. Touching the client in an attempt to comfort the client

Which nursing assessment is most appropriate for an older client presenting with reports of generalized anxiety? a. assess for dementia b. assess for depression c. assess for panic attacks d. assess for elder abuse

b. assess for depression Rationale: Late-onset generalized anxiety disorder (GAD) is usually associated with depression. Although less common, panic attacks can occur in later life and are often related to depression or a physical illness such as cardiovascular, GI, or chronic pulmonary diseases. While the remaining options are appropriate, they are not associated with the possible comorbid conditions of GAD.

The best goal for a client learning a relaxation technique is that the client will a. confront the source of anxiety directly. b. experience anxiety without feeling overwhelmed. c. report no episodes of anxiety. d. suppress anxious feelings.

b. experience anxiety without feeling overwhelmed.

Which statement by the nurse demonstrates an understanding of the role automatisms have in a panic attack? a. "I discourage her finger tapping since it serves to increase her anxiety level." b. "She knows that if she taps her fingers she will be able to lessen her anxiety." c. "The client taps her fingers very rapidly when she is feeling anxious." d. "I can tell that the more she taps, the less anxiety she is actually feeling."

c. "The client taps her fingers very rapidly when she is feeling anxious." Rationale: Automatisms are automatic, unconscious mannerisms associated with anxiety. Examples include tapping fingers, jingling keys, or twisting hair. Automatisms are geared toward anxiety relief and increase in frequency and intensity with the client's anxiety level. None of the remaining options accurately state the fact that the tapping identifies the level of anxiety a client is experiencing but does not manage or less the emotion.

Nearly what percentage of adults are affected by anxiety disorders? a. 0.55 b. 0.1 c. 0.25 d. 0.4

c. 0.25

A patient with anxiety disorder has excessive anxiety and worries about multiple life circumstances. For how long would this patient experience these feelings before the anxiety disorder would be considered chronic and generalized? a. 2 months b. 12 months c. 6 months d. 4 months

c. 6 months Rationale: For generalized anxiety disorder, the diagnostic criteria listed include unrealistic or excessive anxiety and worry about two or more life circumstances for 6 months or more, during which time these concerns exist for a majority of days.

Which would be the best intervention for a client having a panic attack? a. Involve the client in a physical activity b. Offer a distraction such as music c. Remain with the client d. Teach the client a relaxation technique.

c. Remain with the client

Which should be included in a teaching plan for a client prescribed a benzodiazepine? a. Stop taking drug if sedation develops b. Maintain a fluid restriction c. Rise slowly from a lying or sitting position d. Consume caffeine in moderation

c. Rise slowly from a lying or sitting position

Which is the primary concern for a client with panic-level anxiety? a. Emotional needs b. Social support c. Safety d. Physiologic needs

c. Safety

A client with GAD states, "I have learned that the best thing I can do is to forget my worries." How would the nurse evaluate this statement? a. The client is developing insight b. The client's coping skills have improved c. The client needs encouragement to verbalize feelings d. The client's treatment has been successful

c. The client needs encouragement to verbalize feelings

Which nursing intervention is focused on the primary goal of anxiety management and treatment? a. helping the client identify ways to eliminate all sources of stress in his or her daily life b. assessing the client for possible symptoms of panic disorder c. assessing the client's ability to implement stress management techniques effectively d. educating the client concerning the use of medications to manage anxiety disorders

c. assessing the client's ability to implement stress management techniques effectively

When working with a client with moderate anxiety, the nurse would expect to see (select all): a. inability to complete tasks b. failure to respond to redirection c. increased automatisms or gestures d. narrowed perceptual field e. selective attention. f. inability to connect thoughts independently.

c. increased automatisms or gestures d. narrowed perceptual field e. selective attention. f. inability to connect thoughts independently.

The nurse observes a client who is becoming increasingly upset. He is rapidly pacing, hyperventilating, clenching his jaw, wringing his hands, and trembling. His speech is high-pitched and random; he seems preoccupied with his thoughts. He is pounding his fist into his other hand. The nurse identifies his anxiety level as a. mild b. moderate c. severe d. panic

c. severe

Which term describes feelings of being disconnected from oneself as seen in a panic attack? a. Agoraphobia b. Automatisms c. Derealization d. Depersonalization

d. Depersonalization

Which of the four classes of medications used for panic disorder is considered the safest because of low incidence of side effects and lack of physiological dependence? a. Benzodiazepines b. Tricyclics c. Monoamine oxidase inhibitors d. SSRIs

d. SSRIs

Which would be an appropriate intervention for a client experiencing an anxiety attack? a. Turning on stereo music b. Leaving the client alone c. Turning on the lights and opening the windows so that the client does not feel crowded d. Staying with the client and speaking in short sentences

d. Staying with the client and speaking in short sentences

When assessing a client with anxiety, the nurse's questions should be: a. avoided until anxiety is gone b. Open-ended c. postponed until the client volunteers the information d. simple and calm

d. simple and calm Rationale: p235

When assessing a client with anxiety, the nurse's questions should be avoided until a. the anxiety is gone. b. open-ended. c. postponed until the client volunteers information. d. specific and direct.

d. specific and direct.

A client with anxiety is beginning treatment with lorazepam (Ativan). It is more important for the nurse to assess the client's a. motivation for treatment b. family and social support c. use of coping mechanisms d. use of alcohol

d. use of alcohol