Chapter 15 Anxiety and Obsessive-compulsive disorders

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

C. Altruism and sublimation rational: Altruism and sublimation are known as mature defenses. They cannot be used in unhealthy ways. Altruism results in resolving emotional conflicts by meeting the needs of others, and sublimation substitutes socially acceptable activity for unacceptable impulses. This statement is not true of the other options.

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

C. Fear is a response to a specific danger; anxiety is a response to an unknown danger. rational: Fear is a response to an objective danger; anxiety is a response to a subjective danger. This information helps identify the correct option.

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

C. Fear of impending doom rational: The feelings of terror present during a panic attack are so severe that normal function is suspended, the perceptual field is severely limited, and misinterpretation of reality may occur. None of the other symptoms are associated with a panic attack.

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

C. Justifies illogical ideas and feelings. rational: Rationalization involves justifying illogical or unreasonable ideas or feelings by developing logical explanations that satisfy the teller and the listener. None of the other options present with this behavior.

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

D. Determine the use of chemical substances for anxiety relief. rational: Substance abuse often coexists with post-traumatic stress disorder. It is often the client's way of self-medicating to gain relief of symptoms.

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

D. Moderate rational: When moderate anxiety is present, the individual's perceptual field is reduced and the client is not able to see the entire picture of events. This is not an initial characteristic of any of the other levels of anxiety.

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

D. Not allowing the client to wash hands after touching a "dirty" object. rational: Response prevention is a technique by which the client is prevented from engaging in the compulsive ritual. A form of behavior therapy, response prevention is never undertaken without physician approval. None of the other options reflect accurate information regarding this form of therapy.

A client frantically reports to the nurse that "You have got to help me! Something terrible is happening. I can't think. My heart is pounding, and my head is throbbing." The nurse should assess the client at what level of anxiety? A. mild. B. panic. C. moderate. D. severe.

D. Severe. rational: Severe anxiety is characterized by feelings of falling apart and impending doom, impaired cognition, and severe somatic symptoms such as headache and pounding heart. Mild and moderate levels of anxiety do not demonstrate these feels while panic is even more intense than the scenario implies.

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

A. Panic attacks with agoraphobia Rational: A panic disorder with agoraphobia is characterized by recurrent panic attacks combined with agoraphobia. Agoraphobia involves intense, excessive anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available if a panic attack occurred. None of the other options are associated with this form of anxiety.

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

B. Being unable to work for the last 12 months. rational: GAD is characterized by symptomatology that lasts 6 months or longer. None of the other descriptions would support the diagnosis.

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

B. Cognitive restructuring rational: The purpose of cognitive restructuring is to change the individual's negative view of an event or a situation to a view that remains consistent with the facts but that is more positive. This is not necessarily true of any of the other options.

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

A. An eating disorder. rational: Sexual and physical abuse in childhood or trauma increases the risk of this disorder. Genetics are strongly associated with this disorder. First-degree relatives have twice the risk. OCD tends to occur along with anxiety disorders 76% of the time. Other comorbid conditions include major depressive disorder, bipolar disorder, and eating disorders. Suicide while a concern is not among the most common issues for the client diagnosed with OCD. C. A history of sexual abuse rational: Sexual and physical abuse in childhood or trauma increases the risk of this disorder. Genetics are strongly associated with this disorder. First-degree relatives have twice the risk. OCD tends to occur along with anxiety disorders 76% of the time. Other comorbid conditions include major depressive disorder, bipolar disorder, and eating disorders. Suicide while a concern is not among the most common issues for the client diagnosed with OCD. D. A history of childhood trauma rational: Sexual and physical abuse in childhood or trauma increases the risk of this disorder. Genetics are strongly associated with this disorder. First-degree relatives have twice the risk. OCD tends to occur along with anxiety disorders 76% of the time. Other comorbid conditions include major depressive disorder, bipolar disorder, and eating disorders. Suicide while a concern is not among the most common issues for the client diagnosed with OCD. E. A sibling with the disorder Rational: Sexual and physical abuse in childhood or trauma increases the risk of this disorder. Genetics are strongly associated with this disorder. First-degree relatives have twice the risk. OCD tends to occur along with anxiety disorders 76% of the time. Other comorbid conditions include major depressive disorder, bipolar disorder, and eating disorders. Suicide while a concern is not among the most common issues for the client diagnosed with OCD.

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

A. denial rational: Denial involves escaping unpleasant reality by ignoring its existence. This is not the outcome of any of the other options.

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

B. Encouraging the client to take slow, deep breaths rational: Slow diaphragmatic breathing can induce relaxation and reduce symptoms of anxiety. Often the nurse has to tell the client to "breathe with me" and keep the client focused on the task. The slower breathing also reduces the threat of hypercapnia with its attendant symptoms. The client needs help to regain composure and stabilize vital signs; the only option that addresses these issues is the correct option.

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

B. Panic level anxiety Rational: Panic level anxiety is the most extreme level and results in markedly disturbed thinking greater than in any of the other options.

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

B. Repression rational: Repression is a defense mechanism that excludes unwanted or unpleasant experiences, emotions, or ideas from conscious awareness. This is not the outcome of any of the other options.

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

B. They often involve some degree of self-deception rational: Most ego defense mechanisms, with the exception of the mature defenses, alter the individual's perception of reality to produce varying degrees of self-deception. This information helps eliminate the other options as the correct statement.

A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, and "burns" money that could be better spent to feed the poor is demonstrating which ego defense mechanism? A. Projection B. Reaction formation C. Rationalization D. Undoing

B. reaction formation rational: Reaction formation keeps unacceptable feelings or behaviors out of awareness by developing the opposite behavior or emotion. This behavior is not associated with any of the other options.

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

C. a short-acting benzodiazepine medication. rational: A short-acting benzodiazepine is the only type of medication listed that would lessen the client's symptoms of anxiety within a few minutes. Anticholinergics do not lower anxiety; tricyclic antidepressants have very little antianxiety effect and have a slow onset of action; and a standard antipsychotic medication will lower anxiety but has a slower onset of action and the potential for more side effects.

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

C. depression may occur prior to onset of anxiety. rational: In many instances, major depression may occur prior to the onset of panic disorder or may occur at the same time. Clinicians and researchers have clearly shown that anxiety disorders frequently co-occur with other psychiatric problems. Major depression often co-occurs and produces a greater impairment with poorer response to treatment.

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

C. suddenly tremble severely rational: Ataque de nervios (attack of the nerves) is a culture-bound syndrome that is seen in undereducated, disadvantaged females of Hispanic ethnicity. None of the other options are associated with this cultural response to stress.

When a client is prescribed lorazepam 1 mg po four times a day (qid) for 1 week for generalized anxiety disorder, the nurse should which intervention as the priority? A. question the physician's order because the dose is excessive. B. explain the long-term nature of benzodiazepine therapy. C. teach the client to limit caffeine intake. D. tell the client to expect mild insomnia.

C. teach the client to limit caffeine intake. rational: Caffeine is an antagonist of antianxiety medication. None of the other options present accurate information regarding lorazepam

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

D. "What things have you done in the past that helped you feel more comfortable?" Rational: Because the client is not able to think through the problem and arrive at an action that would lower anxiety, the nurse can assist by asking what has worked in the past. Often what has been helpful in the past can be used again. While distraction may be helpful in some situations, it is not the initial intervention.

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

D. A recurrent, persistent thought or impulse rational: Obsessions are thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind. None of the remaining statements are accurate when defining the term obsession.

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

D. Client demonstrates effective coping strategies.