Deck 13: Disorders of Anxiety, Stress, and Trauma

Question 1

A patient presents to the clinic with an exacerbation of eczema. During the assessment phase, the nurse determines that the 18-year-old was recently diagnosed with panic disorder after being thrown out of her parent's house. The nurse knows that which domain is an important factor in this patient's condition?

A) Cultural
B) Biological
C) Sociological
D) Psychological

Answer 1

Sociological

Question 2

A patient in the clinic is diagnosed with General Adaptation Syndrome (GAS). Which physiological symptoms would indicate that the patient is in the last stage of this syndrome if the patient is unable to find resolution of the stressor?

A) Infection, migraines, stroke
B) Increased cortisol, stroke, high cholesterol levels
C) Hallucinations, fatigue, decreased immune response
D) Decreased albumin, increased adrenaline, decreased blood pressure

Answer 2

Infection, migraines, stroke

Question 3

A 16-year-old patient is brought into the emergency department (ED) after being attacked in an alley. The patient states that she "can't see," but that she is otherwise "okay." The initial assessment reveals no physiological reason for the blindness, but several bruises, cuts, and abrasions are noted. After a thorough assessment, the patient is diagnosed with posttraumatic stress disorder (PTSD). The nurse knows that the patient is employing which defense mechanisms? Select all that apply.

A) Denial
B) Projection
C) Conversion
D) Suppression
E) Displacement

Answer 3

Denial
Conversion
Suppression

Question 4

A patient with a history of an anxiety disorder presents at the community health clinic complaining of headache and dizziness. Which additional symptoms would suggest to the nurse that the patient might be experiencing a recurrence of the anxiety disorder? Select all that apply.

A) Dilated pupils
B) Decreased blood pressure
C) Dry skin
D) Tachycardia
E) Diarrhea

Question 5

When taking care of a patient newly diagnosed with panic attacks, the nurse knows that which sign and/or symptom correlates with Peplau's panic level of anxiety?

A) Delusions and withdrawal into self
B) Restlessness and increased motivation
C) Feelings of dread and hyperventilation
D) Increased heart rate and physical discomfort

Question 6

A nurse manager experiences an increased heart rate, GI discomfort, and perspiration when preparing to give presentations to his staff. He has prepared three presentations, and his charge nurse has given them all. The nurse manager knows he is experiencing which level of anxiety and that which treatment will help?

A) Trait anxiety; Thiamine therapy
B) State anxiety; propranolol (Inderal)
C) Panic anxiety; buspirone (Buspar)
D) Moderate anxiety; alprazalom (Xanax)

Question 7

The nurse who is caring for an Asian patient who is newly diagnosed with an anxiety disorder considers what factors when developing the plan of care? Select all that apply.

A) Adherence to treatment
B) The patient's cultural beliefs
C) The spiritual component of treatment
D) Clarification of stressors and resources
E) Medical history

Question 8

A new nurse has just taken his state board exams and passed, but he has not yet found a job. He also married the month after graduation, and his new wife just announced that she is pregnant. He has recently been experiencing sleep disturbances, difficulty concentrating, and irritability. The nurse at the clinic suspects which disorder?

A) Obsessive-compulsive disorder
B) Generalized anxiety disorder
C) Adjustment disorder
D) Reactive attachment disorder

Question 9

A patient tells the nurse, "Everything makes me anxious now." The nurse suspects the patient is suffering from which condition?

A) Phobia
B) Chronic anxiety
C) Dissociative identity disorder
D) Obsessive-compulsive disorder

Question 10

An ICU nurse diagnosed with acute anxiety is scheduled to take the CCRN exam for the second time in 2 weeks after being unsuccessful the first time. The nurse knows that which medication may be prescribed to help him with his anxiety?

A) Buspirone (Buspar)
B) Citalopram (Celexa)
C) Alprazolam (Xanax)
D) Propranolol (Inderal)

Question 11

The charge nurse is caring for a patient recently diagnosed with an anxiety disorder. The patient has an identical twin. The nurse knows that which condition increases the likelihood that the undiagnosed twin will suffer from the same disorder? Select all that apply.

A) Genetics
B) Environment
C) Shared trauma
D) Psychological influences
E) Developmental influences

Question 12

The nurse caring for a patient recently diagnosed with an anxiety disorder knows that which physiological disturbance is thought to result in pathologic anxiety?

A) Increased pituitary response
B) Increased cortisol production
C) Decreased epinephrine response
D) Increased limbic system response

Question 13

The nurse will expect to observe which responses in behavior in the patient who is experiencing an episode of anxiety? Select all that apply.

A) Irritability
B) Indulgence
C) Withdrawal
D) Perspiration
E) Constricted pupils

Question 14

What physical changes will the nurse likely observe when assessing a patient during an acute panic attack? Select all that apply.

A) Sweating
B) Trembling
C) Vomiting
D) Impaired cognition
E) Breathing difficulty

Question 15

A staff nurse notices that her co-worker has been checking the mirror constantly and asking several times during their shift if her uniform "looks okay." The co-worker has become increasingly preoccupied with any perceived flaws in her personal appearance. The staff nurse is concerned and suspects which disorder?

A) Obsessive-compulsive disorder
B) Posttraumatic stress disorder
C) Body dysmorphic disorder
D) Reactive attachment disorder

Question 16

When assessing a patient with chronic anxiety, the nurse notes that the patient also suffers from frequent infections. Which is most likely the reason for the patient's frequent infections?

A) Trait anxiety leads to immune system compromise.
B) Trait anxiety is a defense mechanism for psychological illness.
C) Proteins released by immune cells indirectly influence brain activity.
D) Psychological illness occurs due to a lack of interpersonal relationships, resulting in manifestations of physiological illness.

Question 17

A six-year-old has been diagnosed with both reactive attachment and disinhibited social engagement disorders after being found living in the streets. The nurse knows that the patient will exhibit which symptoms? Select all that apply.

A) Wandering from caregivers
B) Engaging in repetitive behaviors
C) Unable to seek comfort when distressed
D) Preoccupation with physical appearance
E) Fearfulness despite the absence of stressors

Question 18

The nurse caring for a 5-year-old diagnosed with posttraumatic stress disorder (PTSD) knows that which coping mechanisms and/or symptoms may manifest during treatment?

A) Crying and pacing
B) Hoarding and migraines
C) Nausea and separation anxiety
D) Repetitive play and temper tantrums

Question 19

The nurse taking care of a patient recently diagnosed with anxiety disorder knows that the patient's symptoms of hyperventilation, insomnia, and nausea are at which level according to Peplau?

A) Severe +3
B) Panic +4
C) Mild +1
D) Moderate +2

Question 20

The nurse is taking care of a patient newly diagnosed with an anxiety disorder. Which process is most important in providing care to patients with anxiety disorders?

A) Review of the health care professional's orders for the patient
B) Acquisition of information from the patient's high school counselor
C) Assessment of the patient's response during the initial phase of treatment
D) Awareness of the nurse's own anxiety and how it may affect the patient's treatment

Question 21

The nurse taking care of a patient with panic disorder understands that which nursing interventions are important at this anxiety level?

A) Speak in a low voice and help patient identify triggers.
B) Encourage the patient to explore alternative coping strategies.
C) Remain calm and assist patient with problem-solving techniques.
D) Administer medications as prescribed and respect the need for personal space without leaving the patient unattended.

Question 22

The nurse taking care of an older adult patient recently diagnosed with anxiety disorder. The patient asks why the primary care provider is reluctant to prescribe an antianxiety medication. The nurse educates that patient about which possible adverse effect of antianxiety medications commonly seen in older adults?

A) Dizziness
B) Decreased libido
C) Gastrointestinal distress
D) Paradoxical reaction

Question 23

The mental health nurse is speaking with primary care providers about treatment options for anxiety disorders, including pharmacologic options. Why are selective serotonin-reuptake inhibitors (SSRIs) the choice class of medications for treating anxiety disorders?

A) They have a short half-life.
B) They are metabolized by the liver.
C) They are adrenergic blocking agents.
D) They have fewer side effects than other anti-anxiety medications.

Question 24

The nurse is preparing to discharge a patient diagnosed with anxiety and depression. During evaluation, the nurse determines that which of the patient's outcomes indicate an improvement?

A) The patient reports a decrease in physical symptoms.
B) The patient is able to verbalize anxiety-causing activities.
C) The patient is able to stay focused for a limited amount of time.
D) The patient is sleeping six hours 5 days/week.

Question 25

What is the priority action by the nurse for a patient having a severe panic attack?

A) Explaining about anxiety
B) Teaching about ways to decrease anxiety
C) Reassuring and protecting until the episode subsides
D) Providing a physical activity to redirect patient focus

Question 26

A nurse flying home is called to the front of the airplane by the flight attendant because a woman in the first row is having a panic attack and stating, "I have got to get off of this plane!" The nurse knows that which treatment is best at this time?

A) Ask the woman to focus on the nurse's voice.
B) Ask the other patrons if someone has any alprazalom (Xanax) available.
C) Administer an emergency epinephrine shot to counteract the panic symptoms.
D) Instruct the woman to breathe in through the nose and blow out through the mouth.

Question 27

What is the most important action for the nurse to take when caring for a patient with obsessive-compulsive disorder (OCD) who is performing a ritual?

A) Don't interrupt the ritual.
B) Teach stress reduction strategies.
C) Interrupt the ritual.
D) Teach patient about the disorder.

Question 28

The nurse is caring for a patient who fears being in social settings. What will the nurse recommend to the client as an intervention strategy aimed at helping this patient face the fear?

A) Meditation
B) Physical exercise
C) Group therapy
D) Eye-movement desensitization