NSG 211 - Ch 14 Anxiety & Anxiety Disorders (test 1)

b.experience anxiety without feeling overwhelmed.

3.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.

c.The client needs encouragement to verbalize feelings.

6.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.

d.use of alcohol. **When client is on benzos, they must be taught to Avoid other CNS depressants, such as antihistamines and alcohol. (p 225)

7.A client with anxiety is beginning treatment with lorazepam (Ativan). It is most 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.

Coping mechanism

A client responds to bad news regarding test results by crying uncontrollably. What is the term for this response to a stressor? Adaptation Homeostasis Coping mechanism Defense mechanism

compulsion

A client spends hours stacking and unstacking towels. The client is repeatedly checking to make sure that the towels are in order of color. What term is used to identify this behavior? Compulsion Obsession Phobia Derealization

-monoamine oxidase (MAO) inhibitors **Buspirone interacts only with MAO inhibitors, producing a hypertensive reaction. Administration of beta-adrenergic blockers, antineoplastic drugs, or antiparkinsonian drugs wouldn't cause an interaction, so they can be administered simultaneously with buspirone.

A client who is a painter recently fractured a tibia and can't work. The client worries about finances. To treat the client's anxiety, the physician orders buspirone, 5 mg by mouth three times per day. Which drugs interact with buspirone? -beta-adrenergic blockers -antineoplastic drugs -antiparkinsonian drugs -monoamine oxidase (MAO) inhibitors

-diarrhea.

A nurse is assessing a client suffering from stress and anxiety. The most common physiologic response to stress and anxiety is: -sedation. -diarrhea. -vertigo. -urticaria.

A, B, C, D

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

Tearfulness and sadness **signs of depression, not anxiety

All except which are considered clinical symptoms of anxiety? Palpitations Extreme restlessness Motor excitement Tearfulness and sadness

Calcium channel blockers **Calcium channel blockers are not used in treating anxiety disorders.

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

-less central nervous system depression

Buspirone has been prescribed for a client with anxiety. When providing health education, the nurse should describe what benefit of this medication over other anxiolytics? -decreased risk of hepatic injury -less central nervous system depression -rapid onset and short duration -sublingual administration

panic attack

During a __________________, the person has overwhelmingly intense anxiety and displays four or more of the following symptoms: palpitations, sweating, tremors, shortness of breath, sense of suffocation, chest pain, nausea, abdominal distress, dizziness, paresthesias, chills, or hot flashes.

Mild

During which type of anxiety does a person's perceptual field actually increase? Panic Moderate Severe Mild

Interpersonal **Peplau's belief that humans exist in interpersonal and physiologic realms. **Peplau also responsible for research on therapeutic communication and stages of therapeutic relationship (orientation, working, termination)

Hildegard Peplau most closely agreed with which school of theory for explaining anxiety? -Intrapsychic/Psychoanalytic -Interpersonal -Behavioral

-Educate the client that this medication has a high risk for withdrawal symptoms, and the client should not discontinue without a doctor's supervision.

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

panic

Level of Anxiety: May be suicidal May bolt and run or totally immobile and mute Dilated pupils Increased blood pressure and pulse Flight, fight, or freeze -mild -moderate -severe -panic

mild anxiety is associated with INCREASED learning ability

Mild anxiety is associated with (increased OR decreased) learning ability.

at least one month

Panic disorder is diagnosed when the person has recurrent, unexpected panic attacks followed by at least_______month of persistent concern or worry about future attacks or their meaning or a significant behavioral change related to them.

Antidepressants **Panic disorder is treated with cognitive-behavioral techniques, deep breathing and relaxation, and medication such as benzodiazepines, selective serotonin reuptake inhibitors, tricyclics, and anti-hypertensives, such as clonidine and propranolol.

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

severe

Physiologic responses to __________________ anxiety include headache, nausea, vomiting, diarrhea, trembling, rigid stance, vertigo, pale, tachycardia, and chest pain. -mild -moderate -severe -panic

-Reduction of autonomic arousal

Relaxation techniques help clients with anxiety disorders because they can promote what? -Increase in the metabolic rate -Reduction of autonomic arousal -Increase in sympathetic stimulation -Release of cortisol

prevent anxiety.

The nurse has been waiting until after the administration of a toddler's anesthesia before removing the child's clothing and applying monitoring equipment. Doing these actions after the administration of anesthesia will: minimize blood loss. enhance thermoregulation. provide more accurate baseline vital signs. prevent anxiety.

Increased blood pressure

The nurse is assessing a client and finds two enlarged supraclavicular lymph nodes. The nurse asks the client how long these enlarged nodes have been there. The client states, "I can't remember. A long time I think. Do I have cancer?" The nurse is aware that that body responds to stress. Which is an immediate physiologic response to stress the nurse would expect to see in this client? -Vasodilation of peripheral blood vessels -Increased blood pressure -Decrease in blood glucose levels -Pupil constriction

Benzodiazepines

Which medication classifications used in the treatment of panic disorder can cause physical dependence? Benzodiazepines Selective serotonin reuptake inhibitors (SSRIs) Tricyclic antidepressants (TCAs) Serotonin-norepinephrine reuptake inhibitors (SNRIs)

C) GABA

Which neurotransmitter is believed to be dysfunctional in anxiety disorders? A) Serotonin B) Norepinephrine C) GABA D) Dopamine

Automatisms

______________________, which are automatic, unconscious mannerisms, may be apparent. Examples include tapping fingers, jingling keys, or twisting hair. They are geared toward anxiety relief and increase in frequency and intensity with the client's anxiety level.

compulsion

obsession or compulsion: ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety.

compulsion

obsession or compulsion: recurrent, persistent, intrusive, and unwanted thought, image, or impulse that causes marked anxiety and interference with interpersonal, social, or occupational function.

true.

T/F: Anxiety is a person's response to stress.

true. **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

T/F: Defense mechanisms can help a person to reduce anxiety.

Flooding

_____________ is a form of rapid desensitization in which the behavior therapist confronts the client with the phobic object until it no longer produces anxiety. -flooding -cognitive behavior therapy -systematic (serial) desensitization -cognitive restructuring -exposure therapy

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.

(SATA) Interventions for a client with panic disorder would include 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.

D. specific and direct **Use short, simple, and clear statements. The client's ability to deal with abstractions or complexity is impaired. (p 227)

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

d.SSRIs

4.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

c.Remain with the client. **Remain with the client at all times when levels of anxiety are high (severe or panic). The client's safety is a priority. A highly anxious client should not be left alone; his or her anxiety will escalate. (p. 227)

5.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.

"In case anything goes wrong? What are your thoughts and feelings right now?"

A 40-year-old client is admitted for a surgical biopsy of a suspicious lump in the left breast. The client is tearfully writing a letter to the client's two children and tells the nurse, "I want to leave this for my children in case anything goes wrong today." Which response by the nurse would be most therapeutic? "In case anything goes wrong? What are your thoughts and feelings right now?" "I can understand that you're nervous, but this really is a minor procedure. You'll be back in your room before you know it." "Try to take a few deep breaths and relax. I have some medication that will help." "I'm sure your children know how much you love them. You'll be able to talk to them on the phone in a few hours."

-"What did you experience just before and during the attack?"

A client comes to the emergency department because the client thinks the client is having a heart attack. Further assessment determines that the client is not having a heart attack but is having a panic attack. When beginning to interview the client, which question would be most appropriate for the nurse to ask? -"Are you feeling much better now that you are lying down?" -"What did you experience just before and during the attack?" -"Do you think you will be able to drive home?" -"What do you think caused you to feel this way?"

-Anticipatory anxiety

A client has sought treatment because of the overwhelming anxiety the client experiences regarding the safety of the client's young children. The client admits that the client will not normally let the client's children leave the client's sight for fear that they will be abducted, abused, or injured. The client is unable to function at work as a result of this anxiety. The nurse would recognize that this client experiences which condition? -Signal anxiety -Fear -Derealization -Anticipatory anxiety

-Women experience anxiety disorders more often than do men.

A group of students is reviewing information about anxiety disorders in preparation for a class examination. The students demonstrate understanding of the material when they state what? -Most anxiety disorders tend to be short term with individuals achieving full recovery. -Anxiety disorders are more common among children than among adolescents. -Women experience anxiety disorders more often than do men. -Anxiety disorders rank second to depression in psychiatric illnesses being treated.

The client is aware and alert

A nurse assesses a client and determines that the client is experiencing mild anxiety based on what? The client has focused attention on a small area The client is aware and alert The client is selectively inattentive The client voices feelings of unreality

-Distorted sensory awareness

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

-6 months *p. 237: A person with GAD worries excessively and feels highly anxious at least 50% of the time for 6 months or more

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? -6 months -2 months -4 months -12 months

severe

Level of Anxiety: Perceptual field reduced to one detail or scattered details Cannot complete tasks Cannot solve problems or learn effectively Behavior geared toward anxiety relief and is usually ineffective Doesn't respond to redirection Feels awe, dread, or horror Cries Ritualistic behavior Nausea, vomiting, and diarrhea Trembling Rigid stance Tachycardia Chest pain and headache -mild -moderate -severe -panic

moderate

Level of Anxiety: Perceptual field narrowed to immediate task Selectively attentive Cannot connect thoughts or events independently Increased use of automatisms Diaphoresis Pounding pulse Faster rate of speech GI upset Frequent urination -mild -moderate -severe -panic

Antidepressants **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.

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

moderate

____________________ anxiety is the disturbing feeling that something is definitely wrong; the person becomes nervous or agitated. In ___________________ anxiety, the person can still process information, solve problems, and learn new things with assistance from others. He or she has difficulty concentrating independently but can be redirected to the topic. -mild -moderate -severe -panic

depersonalization.

A nurse is seeing a client who is having severe to panic level anxiety after a physical assault months previously. The client tells the nurse, "When the panic starts I feel like I am watching myself through a window." The nurse can most accurately describe this experience as: depersonalization. derealization. decatastrophizing. demonstrating automatisms.

-"I saw you change clothes several times today. Do you find this tiring?"

A nurse notices that a client with obsessive-compulsive disorder dresses and undresses several times each day. Which comment by the nurse would be most therapeutic? -"I saw you change clothes several times today. Do you find this tiring?" -"It might be helpful if you dress only once per day so you will not be so tired." -"It must really bother you to change your clothes so often. How can I help?" -"I see that you are a perfectionist about the clothes you wear."

panic

Level of Anxiety: Perceptual field reduced to focus on self Cannot process any environmental stimuli Distorted perceptions Loss of rational thought Doesn't recognize potential danger Can't communicate verbally Possible delusions and hallucination -mild -moderate -severe -panic

Buspirone **Buspirone is a nonbenzodiazepine medication that does not have abuse potential. Benzodiazepines such as alprazolam, lorazepam, and diazepam have abuse potential and may become addictive.

When discussing various types of anxiolytic medications with a client, the nurse recognizes that which medication has the lowest potential for abuse? Lorazepam Buspirone Diazepam Alprazolam

6 months

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? 6 months 2 months 12 months 4 months

mild

Level of Anxiety: Wide perceptual field Sharpened senses Increased motivation Effective problem-solving Increased learning ability Irritability Restlessness/Fidgeting -mild -moderate -severe -panic

FALSE. Defense mechanisms are part of the Intrapsychic/Psychoanalytic Theory (Freud).

T/F: Defense mechanisms are part of the Interpersonal Theory for explaining anxiety.

-Panic disorder

The nurse has read in a client's admission record that the client has been taking propranolol for psychiatric, rather than medical, reasons. The nurse should recognize that the client likely has a history of which mental health condition? -Acute stress disorder -Panic disorder -Obsessive-compulsive disorder (OCD) -Nightmares

Interpersonal

___________________ theory proposes that caregivers can communicate anxiety to infants or children through inadequate nurturing, agitation when holding or handling the child, and distorted messages. -Psychoanalytic theory -Interpersonal theory -Behavioral theory

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

(SATA) When working with a client with moderate anxiety, the nurse would expect to see 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.

-decreasing environmental stimulation **This client is at increased risk for injuring self or others. Decreasing environmental stimulation, a measure the nurse may take independently, may reduce the client's hyperactivity.

A client is admitted to the acute psychiatric care unit after 2 weeks of increasingly erratic behavior. The client is unkempt, has lost approximately 9 lb (4 kg), has been sleeping poorly, and exhibits hyperactivity. The client loudly denies the need for hospitalization. What priority intervention will the nurse apply? -providing adequate hygiene -asking the client to go eat a meal in the day room -decreasing environmental stimulation -orientating the client to the unit activities

Allow the client to pace

A client is currently experiencing panic. Which action would be most appropriate for the nurse to do? Allow the client to pace Urge the client to engage in vigorous exercise Ask the client repeated questions about feelings Employ the use of negative self-talk

-initially giving the client time to perform rituals and gradually limiting the time

A client is diagnosed with obsessive-compulsive disorder. Which intervention should the nurse include when developing the care plan for this client? -initially setting strict limits on compulsive behavior and gradually decrease limits -initially giving the client time to perform rituals and gradually limiting the time -immediately interrupt when the client performs rituals and discussing the event after client has calmed -instructing the client to notify the nurse when preparing to perform a ritual and praise the client for this effort

Systematic desensitization

A client who experiences panic anxiety around dogs is sitting in a room with a dog and the client's nurse therapist. The nurse therapist is using which behavioral intervention for this type of anxiety? Systematic desensitization Biofeedback Relaxation exercise Implosion therapy

-Inform the client that the assessment can be postponed if the client is finding it overwhelming.

During the admission assessment of a 27-year-old client who has been diagnosed with an anxiety disorder, the nurse observes that the client is becoming increasingly restless and agitated. How should the nurse respond to this development? -Inform the client that the assessment can be postponed if the client is finding it overwhelming. -Increase the speed of the assessment in order to ensure that it is completed sooner and inform the client that the nurse is doing so. -Provide education regarding the level of anxiety that the client may be experiencing. -Explain to the client that the client's current feelings of anxiety have the potential to foster better coping skills in the future.

stress

Stress vs. Anxiety: -the wear and tear that life causes on the body -occurs when a person has difficulty dealing with life situations, problems, and goals -Each person handles it differently

"This medication carries a risk of dependence." **alprazolam = benzo

The nurse has completed teaching a client about alprazolam. Which statement by the client will the nurse document as evidence of successful teaching? "This medication carries a risk of dependence." "I won't become addicted if I take it as prescribed." "I should drive carefully until I know whether this causes dizziness." "I should take it at bedtime to feel calm in the morning."

B) resistance stage

When is the parasympathetic nervous system activated? A) alarm reaction stage B) resistance stage C) exhaustion stage D) fight, flight, or freeze stage

A) alarm reaction stage

When is the sympathetic nervous system activated? A) alarm reaction stage B) resistance stage C) exhaustion stage D) fight, flight, or freeze stage

-A woman who has been taking lorazepam for several months after witnessing a traumatic motor vehicle accident **The potential for dependence and difficulties with withdrawal is much higher with benzodiazepines than with beta-blockers or SSRIs.

Which client is most likely to be at risk for drug dependence and difficulties with withdrawal? -A client with generalized anxiety disorder who has responded well since beginning treatment with fluoxetine earlier in the year -A woman who has been taking lorazepam for several months after witnessing a traumatic motor vehicle accident -A man whose obsessive-compulsive disorder is being treated long term with paroxetine -A client who has recently begun treatment with propranolol for the treatment of social phobia

C **severe anxiety and panic, more primitive survival skills take over, defensive responses ensue, and cognitive skills decrease significantly. A person with severe anxiety has trouble thinking and reasoning. Muscles tighten, and vital signs increase. The person paces; is restless, irritable, and angry; or uses other similar emotional-psychomotor means to release tension. (p. 224)

1.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.

-Based in genetics with clinical symptoms being a result of chromosomal influence

A biologic theory explains anxiety disorders in which way? -Based in genetics with clinical symptoms being a result of chromosomal influence -Rooted in episodes of physical or psychological abuse that occurred at times of developmental growth -Originated from disappointments resulting from an exaggerated sense of self-worth -Caused by substance abuse, particularly narcotics, resulting in damage to the brain's receptors

Deep breathing

A client comes in for a therapy session and begins to have a panic attack. The therapist asks the client to relax in the chair and then gently asks the client to imagine the client in a very safe and calm place. This technique, often useful in anxiety disorders, is called what? Cognitive therapy Deep breathing Desensitization Problem-solving

-Intense worry and stress about work or simple family life **Adults with GAD often worry about matters such as their job, household finances, health of family members, or simple matters (e.g., household chores or being late for appointments). The intensity of the worry fluctuates, and stress tends to intensify the worry and anxiety symptoms.

A group of students is reviewing information about the etiology of generalized anxiety disorder (GAD). The students demonstrate understanding of this information when they identify which as representing the bases for this disorder? -Inaccurate environmental danger assessment -Exposure to multiple stressful life events -Kindling caused by overstimulation -Intense worry and stress about work or simple family life

-"Clients with body dysmorphic disorder are encouraged to face their fears by focusing on their appearance."

A new nurse asks the charge nurse why the client with body dysmorphic disorder is always looking at their nose in the mirror. Which of the following would be an appropriate response? -"Clients with body dysmorphic disorder are encouraged to face their fears by focusing on their appearance." -"Clients with body dysmorphic disorder use repetitive compulsions to reduce their anxiety." -"Clients with body dysmorphic disorder are preoccupied with perceived defects in their appearance." -"Clients with body dysmorphic disorder focus on their appearance to have a feeling of control."

-Stay with the client, reminding client the panic attack will only last a brief period

A nurse is admitting a client who is experiencing a panic attack. Physiologic causes have been ruled out. The assessment reveals the client has difficulty breathing, chest pain, and palpitations. The client is pale, with the mouth wide open and eyebrows raised. What should the nurse do first? -Instruct client to place feet flat on the floor and lean back to open airway -Place the crash cart in the exam room for the client to see -Stay with the client, reminding client the panic attack will only last a brief period -Administer an IM anxiolytic as soon as client is ready

-The client would have an enhanced sense of security. **A client with panic-level anxiety should be taken to a small, isolated room. This is to reduce any external stimuli that could escalate anxiety. Taking the client to a small room would make the client feel more protected and secured. A client experiencing a panic attack may lose rational thought; however, this intervention would not directly improve thought processes. The client would not be able to demonstrate relaxation techniques in a panic laden state. This intervention would not enhance the client's ability to understand what the nurse is saying. (p 234)

A nurse is caring for a client who has panic attack. The nurse takes the client in a small, isolated room. How would this intervention benefit the client? Choose the best answer. -The client would return to rational thought. -The client would have an enhanced sense of security. -The client would be able to demonstrate relaxation techniques. -The client would be able to understand what the nurse is saying.

-"People with anxiety disorders generally find that the anxiety interferes with daily activities."

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? -"People with anxiety disorders experience a fight-or-flight response when threatened." -"People with anxiety disorders generally find that the anxiety interferes with daily activities." -"Normal anxiety does not result in feelings of dread or restlessness." -"Normal anxiety occurs in response to everyday stressors."

-interpersonal

A nurse is seeing a client who is experiencing symptoms of moderate anxiety. She tells the nurse she and her parents disagree over her sexual orientation. Which theory would best explain the course of the client's anxiety? -interpersonal -behavioral -genetic -neurochemical

-There is evidence of a substantial familial predisposition to panic disorder **There appears to be a substantial familial predisposition to panic disorder with an estimated heritability of 48%.

A nurse is talking with a client who has experienced panic attacks. The client asks the nurse, "What causes these attacks?" Which information would the nurse most likely integrate into the response about the etiology of panic disorders? -There is evidence of a substantial familial predisposition to panic disorder -Neurologic abnormalities are a rare occurrence with panic disorder -The link between panic disorders and neurotransmitters is lacking -There is a strong evidence supporting a psychodynamic influence

-by setting aside times during which the client can focus on the behavior **The nurse should set aside times during which the client is free to focus on the compulsive behavior or obsessive thoughts. The nurse should urge the client to reduce the frequency of the compulsive behavior gradually, not rapidly. The nurse shouldn't call attention to the behavior or try to prevent it. Trying to prevent the behavior may frighten and hurt the client. The nurse should encourage the client to verbalize anxieties to help distract attention from the compulsive behavior.

A nurse notices that a client with obsessive-compulsive disorder washes the hands for long periods each day. How should the nurse respond to this compulsive behavior? -by setting aside times during which the client can focus on the behavior -by urging the client to reduce the frequency of the behavior as rapidly as possible -by calling attention to or trying to prevent the behavior -by discouraging the client from verbalizing his anxieties

-alprazolam, 0.25 mg orally every 8 hours **Alprazolam's antianxiety properties make it the most appropriate medication for this client. It should only be given very short term because of its addictive potential and the client should be weaned off of it

A nurse refers a client with severe anxiety to a psychiatrist for medication evaluation. The physician is most likely to order which psychotropic drug regimen on a short-term basis? -alprazolam, 0.25 mg orally every 8 hours -benztropine, 2 mg orally twice per day -chlorpromazine, 25 mg orally three times per day -buspirone, 15 mg two times per day 200 mg orally twice per day

A. The client manages fear in group situations. C. The client verbalizes feelings that occur in stressful situations. D. The client develops a plan for responding to stressful situations.

A nurse selects a priority nursing diagnosis of Fear related to being embarrassed in the presence of others for a client who exhibits symptoms of social phobia. Which outcomes, if met, would demonstrate improvement in client's symptoms? Select all that apply. A. The client manages fear in group situations. B. The client develops a plan to avoid situations that may cause stress. C. The client verbalizes feelings that occur in stressful situations. D. The client develops a plan for responding to stressful situations. E. The client denies feelings that may contribute to irrational fears. F. The client uses antianxiety medication to deal with underlying fears.

-Providing the client with a comforting touch **Touching an anxious client may actually increase anxiety.

A nursing instructor is describing the care of a client with acute anxiety to a class of nursing students. The instructor determines that more education is necessary when the students identify which intervention as appropriate? -Providing the client with a comforting touch -Providing the client with a safe, quiet, and private place -Encouraging the client to verbalize feelings and concerns -Approaching the client in a calm, confident manner

-to reduce anxiety and potentiate the neuroleptic's sedative action **Lorazepam, when taken with a neuroleptic such as haloperidol, potentiates the neuroleptic's sedating effect and is used to treat severely agitated clients. Lorazepam wouldn't be given to counteract extrapyramidal effects. Both drugs can cause depression, so they aren't used to treat depression. The drugs' depressant effect would decrease concentration, not increase it.

Lorazepam is commonly given along with a neuroleptic agent. What is the purpose of administering the drugs together? -to reduce anxiety and potentiate the neuroleptic's sedative action -to counteract the neuroleptic's extrapyramidal effects -to manage depressed clients -to increase a client's level of awareness and concentration

systematic (serial) desensitization

One behavioral therapy often used to treat phobias is ____________________________, in which the therapist progressively exposes the client to the threatening object in a safe setting until the client's anxiety decreases. Used in treatment of phobias. -flooding -cognitive behavior therapy -systematic (serial) desensitization -cognitive restructuring -exposure therapy

anxiety **anxiety is the response to stress

Stress vs. Anxiety: -vague feeling of dread or apprehension -response to external or internal stimuli that can have behavioral, emotional, cognitive, and physical symptoms

true. **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.

T/F: Anxiety is unavoidable.

false. **Anxiety is distinguished from fear **fear = feeling afraid or threatened by a clearly identifiable external stimulus that represents danger to the person

T/F: Anxiety and fear are the same.

true. *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.

T/F: Defense mechanisms arise from the unconscious, the person is unaware of using them.

-Increased blood pressure *(p.223): pupils dilate, HR & BP increase, constricting the peripheral vessels and shunting blood from the gastrointestinal (GI) and reproductive systems and increasing glycogenolysis to free glucose for fuel for the heart, muscles, and central nervous system

The nurse is assessing a client and finds two enlarged supraclavicular lymph nodes. The nurse asks the client how long these enlarged nodes have been there. The client states, "I can't remember. A long time I think. Do I have cancer?" The nurse is aware that that body responds to stress. Which is an immediate physiologic response to stress the nurse would expect to see in this client? -Vasodilation of peripheral blood vessels -Increased blood pressure -Decrease in blood glucose levels -Pupil constriction

Headache **Tension headache and pain syndromes in an anxious client indicate that the client has not responded to the stress effectively. Tachycardia and dyspnea are the signs related to the flight and fight response to stress, an automatic physiologic response. Pedal edema is not associated with stress.

The nurse is assessing a client with anxiety. What symptom indicates that the the client has adopted a maladaptive behavior in response to stress? -Tachycardia -Dyspnea -Headache -Pedal edema

-The client is nervous and agitated. **A client who is moderately anxious has a disturbing feeling that something is wrong. This causes nervousness and agitation. Increased concentration and attention is seen in clients having mild anxiety. Cognitive skills are impaired in clients who have severe anxiety. Inability to communicate verbally indicates that the client is panicking. (psych p 225)

The nurse is assessing a client with anxiety. Which behavior might indicate that the client has moderate anxiety? -The client is focused in an activity. -The client is nervous and agitated. -The client has impaired cognitive skills. -The client is unable to communicate verbally.

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

A systematic way to replace a panic response with a relaxation response **Systematic desensitization is a classical conditioning technique by which a client learns to replace gradually a panic response with a relaxation response. It is a behavioral therapy used to treat specific phobias, social phobias, agoraphobia, and posttraumatic stress disorder

What does desensitization refer to? A systematic way to replace a panic response with a relaxation response Teaching the client to ignore or become immune to anxiety-producing situations A cognitive technique for replacing a worry with a positive statement Exposing the client to an anxiety-producing stimulus for 1 to 2 hours (flooding)

Sympathetic nervous system

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? Motherly response system Central nervous system Sympathetic nervous system Parasympathetic nervous system

-Determine the effects that culture has had on the client's anxiety issues **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.

When assessing an elderly client who has newly been diagnosed with an anxiety disorder, the mental health nurse's priority is to carry out which task? -Determine the client's risk for self-harm or harm to others -Obtain a thorough history, focusing on the client's physiologic functioning -Assess for physical conditions that may affect anxiety -Determine the effects that culture has had on the client's anxiety issues

-Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first

Which assessment question is most likely to allow the nurse to differentiate between anxiety disorder due to a general medical condition and psychological factors affecting a medical condition? -Questioning the client about the clinician who first diagnosed the medical problem -Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first -Asking the client to provide a detailed explanation of his or her medical problem to determine if the presentation is typical of the problem -Reviewing the client's previous medication administration record and the client's current list of medications

-The client is often late to school and makes poor grades in most of the client's subjects. **Being late to school and making poor grades are behaviors that indicate that the client is having difficulty; they are not factors influencing the development of the client's anxiety disorder.

Which factor has the least influence on achieving mental health for the client who has anxiety disorder? -The client was raised in a household with high stress and frequent geographic moves. -The client's mother also suffered from an anxiety disorder. -The client is often late to school and makes poor grades in most of the client's subjects. -The client's mother often related to the client in ways that reflected the mother's high level of anxiety.

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

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

"How do you feel about everything that is happening in your life right now?"

Which question in the assessment of a client with anxiety is most clinically appropriate? "What can I give you to make you feel less anxious right now?" "Does your anxiety make you feel less valuable and competent as a person?" "Do you think that you're justified in feeling anxious right now?" "How do you feel about everything that is happening in your life right now?"

-Rise slowly from a lying or sitting position *Teaching for benzodiazepines: (p 225) -Avoid other CNS depressants, such as antihistamines and alcohol. -Avoid caffeine. -Take care with potentially hazardous activities, such as driving. -Rise slowly from lying or sitting position. -Use sugar-free beverages or hard candy. -Drink adequate fluids. -Take only as prescribed. -Do not stop taking the drug abruptly.

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

-Touching the client in an attempt to comfort the client **The nurse should evaluate carefully the use of touch because clients with high anxiety may interpret touch by a stranger as a threat and pull away abruptly. Using open-ended questions, encouraging the client to verbalize feelings and concerns, and maintain a nonstimulating environment are correct actions.

Which would not be an initial intervention for the client with acute anxiety? -Touching the client in an attempt to comfort the client -Use of open-ended communication techniques -Encouraging the client to verbalize feelings and concerns -Maintaining a nonstimulating environment

Mild

____________________ anxiety is 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 himself or herself. -mild -moderate -severe -panic