Deck 12: Anxiety and Related Disorders

Question 1

A nurse wants to teach alternative coping strategies to a patient experiencing severe anxiety. Which action should the nurse perform first?

A) Verify the patient's learning style.
B) Lower the patient's current anxiety.
C) Create outcomes and a teaching plan.
D) Assess how the patient uses defence mechanisms.

Answer 1

Lower the patient's current anxiety.

Question 2

A patient in the emergency department shows disorganized behaviour and incoherence after a friend suggested a homosexual encounter. In which room should the nurse place the patient?

A) An interview room furnished with a desk and two chairs
B) A small, empty storage room with no windows or furniture
C) A room with an examining table, instrument cabinets, desk, and chair
D) The nurse's office, furnished with chairs, files, magazines, and bookcases

Answer 2

An interview room furnished with a desk and two chairs

Question 3

A patient preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is most appropriate?

A) Reassure the patient that all nurses are skilled in providing postoperative care.
B) Present the information again in a calm manner using simple language.
C) Tell the patient that staff is prepared to promote recovery.
D) Encourage the patient to express feelings to family.

Answer 3

Present the information again in a calm manner using simple language.

Question 4

A patient undergoing diagnostic tests says, "Nothing is wrong with me except a stubborn chest cold." The spouse reports the patient smokes, coughs daily, lost 15 pounds, and is easily fatigued. Which defence mechanism is the patient using?

A) Displacement
B) Regression
C) Projection
D) Denial

Question 5

A patient fearfully runs from chair to chair, crying, "They're coming! They're coming!" The patient does not follow the staff's directions or respond to verbal interventions. Which nursing diagnosis has the highest priority?

A) Fear
B) Risk for injury
C) Self-care deficit
D) Disturbed thought processes

Question 6

A person speaking about a rival for a significant other's affection says in an emotional, syrupy voice, "What a lovely person. That's someone I simply adore." The individual is demonstrating which of the following?

A) Reaction formation
B) Repression
C) Projection
D) Denial

Question 7

A patient fearfully runs from chair to chair, crying, "They're coming! They're coming!" The patient does not follow the staff's directions or respond to verbal interventions. The initial nursing intervention of highest priority is to do which of the following?

A) Provide for the patient's safety
B) Encourage clarification of feelings
C) Respect the patient's personal space
D) Offer an outlet for the patient's energy

Question 8

A patient experiencing moderate anxiety says, "I feel undone." An appropriate response for the nurse would be which of the following?

A) "What would you like me to do to help you?"
B) "Why do you suppose you are feeling anxious?"
C) "I'm not sure I understand. Give me an example."
D) "You must get your feelings under control before we can continue."

Question 9

A patient checks and rechecks electrical cords related to an obsessive thought that the house may burn down. The nurse and patient explore the likelihood of an actual fire. The patient states this event is not likely. This counselling demonstrates principles of which of the following?

A) Flooding
B) Desensitization
C) Relaxation technique
D) Cognitive restructuring

Question 10

A patient is experiencing moderate anxiety. The nurse encourages the patient to talk about feelings and concerns. What is the rationale for this intervention?

A) Offering hope allays and defuses the patient's anxiety.
B) Concerns stated aloud become less overwhelming and help problem solving begin.
C) Anxiety is reduced by focusing on and validating what is occurring in the environment.
D) Encouraging patients to explore alternatives increases the sense of control and lessens anxiety.

Question 11

A person has minor physical injuries after an auto accident. The person is unable to focus and says, "I feel like something awful is going to happen." This person has nausea, dizziness, tachycardia, and hyperventilation. What is the person's level of anxiety?

A) Mild
B) Moderate
C) Severe
D) Panic

Question 12

An individual experiences sexual dysfunction and blames it on a partner by calling the person unattractive and unromantic. Which defence mechanism is evident?

A) Rationalization
B) Compensation
C) Introjection
D) Regression

Question 13

A patient with an abdominal mass is scheduled for a biopsy. The patient has difficulty understanding the nurse's comments and asks, "What do you mean? What are they going to do?" Assessment findings include tremulous voice, respirations 28, and pulse 110. What is the patient's level of anxiety?

A) Mild
B) Moderate
C) Severe
D) Panic

Question 14

A patient tells a nurse, "I was not able to write my final exam as I had a pounding headache and I was not able to read." This patient is demonstrating which of the following?

A) Denial
B) Projection
C) Compensation
D) Conversion

Question 15

Two staff nurses applied for a charge nurse position. After the promotion was announced, the nurse who was not promoted said, "The nurse manager had a headache the day I was interviewed." Which defence mechanism is evident?

A) Introjection
B) Conversion
C) Projection
D) Splitting

Question 16

A patient experiences a sudden episode of severe anxiety. Of these medications in the patient's medical record, which is most appropriate to give as a prn anxiolytic?

A) Buspirone (Bustab)
B) Lorazepam (Ativan)
C) Phenelzine sulfate (Nardil)
D) Tranylcypromine sulfate (Parnate)

Question 17

A person who feels unattractive repeatedly says, "Although I'm not beautiful, I am smart." This is an example of which of the following?

A) Repression
B) Devaluation
C) Identification
D) Compensation

Question 18

Which is an intermediate indicator of the nursing outcome of anxiety self-control?

A) Maintains adequate sleep
B) Monitors intensity of anxiety
C) Controls anxiety response
D) Uses relaxation techniques to lower anxiety

Question 19

A nurse assesses a patient with a tentative diagnosis of generalized anxiety disorder. Which question would be most appropriate for the nurse to ask?

A) "Have you been a victim of a crime or seen someone badly injured or killed?"
B) "Do you feel especially uncomfortable in social situations involving people?"
C) "Do you repeatedly do certain things over and over again?"
D) "Do you find it difficult to control your worrying?"

Question 20

Two staff nurses applied for promotion to nurse manager. The day of the job interviews, one nurse was told by her boyfriend that he wanted to end the relationship. Although visibly upset, the nurse does not think about what her boyfriend has said and prepares for the interview. Which term best describes the nurse's response?

A) Altruism
B) Suppression
C) Intellectualization
D) Reaction formation

Question 21

A patient with fears of serious heart disease was referred to the mental health centre by a cardiologist. Extensive diagnostic evaluation showed no physical illness. The patient says, "My chest is tight, and my heart misses beats. I'm often absent from work. I don't go out much because I need to rest." Which health problem is most likely?

A) Dysthymic disorder
B) Somatic symptom disorder
C) Antisocial personality disorder
D) Illness anxiety disorder (hypochondriasis)

Question 22

A patient with blindness related to conversion (functional neurological) disorder says, "All the doctors and nurses in the hospital stop by often to check on me. Too bad people outside the hospital don't find me as interesting." Which nursing diagnosis is most relevant?

A) Social isolation
B) Chronic low self-esteem
C) Interrupted family processes
D) Ineffective health maintenance

Question 23

A nurse assessing a patient diagnosed with a somatic symptom disorder is most likely to note which of the following?

A) The patient sees a relationship between symptoms and interpersonal conflicts.
B) The patient has little difficulty communicating emotional needs to others.
C) The patient rarely derives personal benefit from the symptoms.
D) The patient has altered comfort and activity needs.

Question 24

A patient has blindness related to conversion (functional neurological) disorder. Which of the following should the nurse do to help the patient eat?

A) Establish a "buddy system" with other patients who can feed the patient at each meal
B) Expect the patient to feed self after explaining arrangement of the food on the plate
C) Direct the patient to locate items on the tray independently and feed self
D) Address needs of other patients in the dining room, and then feed this patient

Question 25

A nurse assesses an individual who commonly experiences anxiety. Which comment by this person indicates the possibility of obsessive-compulsive disorder?

A) "I check where my car keys are eight times."
B) "My legs often feel weak and spastic."
C) "I'm embarrassed to go out in public."
D) "I keep reliving a car accident."

Question 26

For a patient experiencing panic, which nursing intervention should be implemented first?

A) Teach relaxation techniques.
B) Administer an anxiolytic medication.
C) Prepare to implement physical controls.
D) Provide calm, brief, directive communication.

Question 27

When alprazolam (Xanax) is prescribed for a patient who experiences acute anxiety, health teaching should include instructions to do which of the following?

A) Report drowsiness
B) Eat a tyramine-free diet
C) Avoid alcoholic beverages
D) Adjust dose and frequency based on anxiety level

Question 28

A person who has been unable to leave home for more than a week because of severe anxiety says, "I know it does not make sense, but I just can't bring myself to leave my apartment alone." Which nursing intervention is appropriate?

A) Help the person use online video calls to provide interaction with others.
B) Advise the person to accept the situation and use a companion.
C) Ask the person to explain why the fear is so disabling.
D) Teach the person to use positive self-talk techniques.

Question 29

A patient has blindness related to conversion (functional neurological) disorder, but is unconcerned about this problem. Which understanding should guide the nurse's planning for this patient?

A) The patient is suppressing accurate feelings regarding the problem.
B) The patient's anxiety is relieved through the physical symptom.
C) The patient's optic nerve transmission has been impaired.
D) The patient will not disclose genuine fears.

Question 30

A student says, "Before taking a test, I feel very alert and a little restless." Which nursing intervention is most appropriate to assist the student?

A) Explain that the symptoms result from mild anxiety and discuss the helpful aspects.
B) Advise the student to discuss this experience with a health care provider.
C) Encourage the student to begin antioxidant vitamin supplements.
D) Listen attentively, using silence in a therapeutic way.

Question 31

A student says, "Before taking a test, I feel very alert and a little restless." The nurse can correctly assess the student's experience as which of the following?

A) Culturally influenced
B) Displacement
C) Trait anxiety
D) Mild anxiety

Question 32

Which prescription medication would the nurse expect to be prescribed for a patient diagnosed with a somatic symptom disorder?

A) Narcotic analgesics for use as needed for acute pain
B) Antidepressant medications to treat underlying depression
C) Long-term use of benzodiazepines to support coping with anxiety
D) Conventional antipsychotic medications to correct cognitive distortions

Question 33

A cruel and abusive person often uses rationalization to explain the behaviour. Which comment demonstrates use of this defence mechanism?

A) "I don't know why I do mean things."
B) "I have always had poor impulse control."
C) "That person should not have provoked me."
D) "I'm really a coward who is afraid of being hurt."

Question 34

Which assessment data would help the health care team distinguish symptoms of conversion (functional neurological) disorder from symptoms of illness anxiety disorder (hypochondriasis)?

A) Voluntary control of symptoms
B) Patient's style of presentation
C) Results of diagnostic testing
D) The role of secondary gains

Question 35

A patient performs ritualistic handwashing. Which action should the nurse implement to help the patient develop more effective coping?

A) Displacement
B) Reflection
C) Systematic desensitization
D) Reaction formation

Question 36

A patient diagnosed with obsessive-compulsive disorder has this nursing diagnosis: Anxiety related to __________ as evidenced by inability to control compulsive cleaning. Which phrase correctly completes the etiological portion of the diagnosis?

A) Feelings of responsibility for the health of family members
B) Approval-seeking behaviour from friends and family
C) Persistent thoughts about bacteria, germs, and dirt
D) Needs to avoid interactions with others

Question 37

A medical-surgical nurse works with a patient diagnosed with a somatic symptom disorder. Care planning is facilitated by understanding which of the following?

A) The patient will probably readily seek psychiatric counselling.
B) The patient will probably be resistant to accepting psychiatric help.
C) The patient will probably attend psychotherapy sessions without encouragement.
D) The patient will probably be eager to discover the true reasons for physical symptoms.

Question 38

To assist patients diagnosed with somatic symptom disorders, nursing interventions of high priority do which of the following?

A) Explain the pathophysiology of symptoms
B) Help these patients suppress feelings of anger
C) Shift focus from somatic symptoms to feelings
D) Investigate each physical symptom as it is reported

Question 39

A patient experiencing panic suddenly began running and shouting, "I'm going to explode!" Select the nurse's best action.

A) Ask, "I'm not sure what you mean. Give me an example."
B) Capture the patient in a basket-hold to increase feelings of control.
C) Tell the patient, "Stop running and take a deep breath. I will help you."
D) Assemble several staff members and say, "We will take you to seclusion to help you regain control."

Question 40

The nurse assesses a patient who complains of loneliness and episodes of anxiety. Which statement by the patient is mostly likely if this patient also has agoraphobia?

A) "I'm sure I will get over not wanting to leave home soon. It takes time."
B) "Being afraid to go out seems ridiculous, but I can't go out the door."
C) "My family says they like it now that I stay home most of the time."
D) "When I have a good incentive to go out, I can do it."

Question 41

A nurse assesses a patient diagnosed with conversion (functional neurological) disorder. Which comment is most likely from this patient?

A) "Since my father died, I've been short of breath and had sharp pains that go down my left arm, but I think it's just indigestion."
B) "I have daily problems with nausea, vomiting, and diarrhea. My skin is very dry, and I think I'm getting seriously dehydrated."
C) "Sexual intercourse is painful. I pretend I'm asleep so I can avoid it. I think it's starting to cause problems with my marriage."
D) "I choke very easily and have trouble swallowing when I eat. I think I might have cancer of the esophagus."

Question 42

What is an essential difference between somatic symptom disorders and factitious disorders?

A) Somatic symptom disorders are under voluntary control, whereas factitious disorders are unconscious and automatic.
B) Factitious disorders are precipitated by psychological factors, whereas somatic symptom disorders are related to stress.
C) Factitious disorders are individually determined and related to childhood sexual abuse, whereas somatic symptom disorders are culture bound.
D) Factitious disorders are under voluntary control, whereas somatic symptom disorders involve expression of psychological stress through somatization.

Question 43

Which presentations suggest the possibility of a factitious disorder, self-directed type?

A) History of multiple hospitalizations without findings of physical illness
B) History of multiple medical procedures or exploratory surgeries
C) Going from one doctor to another seeking the desired response
D) Claims of illness to obtain financial benefit or other incentive
E) Difficulty describing symptoms

Question 44

Which assessment question could a nurse ask to help identify secondary gains associated with a somatic symptom disorder?

A) "What are you unable to do now but were previously able to do?"
B) "How many doctors have you seen in the last year?"
C) "Who do you talk to when you're upset?"
D) "Did you experience abuse as a child?"

Question 45

A patient says, "I know I have a brain tumor despite the results of the MRI. The radiologist is wrong. People who have brain tumors vomit, and yesterday I vomited all day." Which response by the nurse fosters cognitive reframing?

A) "You do not have a brain tumor. The more you talk about it, the more it reinforces your belief."
B) "Let's see if there are any other possible explanations for your vomiting."
C) "You seem so worried. Let's talk about how you're feeling."
D) "We need to talk about something else."

Question 46

A nurse assesses a patient suspected of having somatic symptom disorder. Which assessment findings regarding this patient support the suspected diagnosis?

A) Female
B) Reports frequent syncope
C) Rates pain as "1" on a scale of "10"
D) First diagnosed with psoriasis at age 12
E) Reports insomnia often results from back pain

Question 47

Which assessment questions would be most appropriate for the nurse to ask a patient with possible obsessive-compulsive disorder?

A) "Are there certain social situations that cause you to feel especially uncomfortable?"
B) "Are there others in your family who must do things in a certain way to feel comfortable?"
C) "Have you been a victim of a crime or seen someone badly injured or killed?"
D) "Is it difficult to keep certain thoughts out of your awareness?"
E) "Do you do certain things over and over again?"

Question 48

A patient diagnosed with a somatic symptom disorder says, "My pain is from an undiagnosed injury. I can't take care of myself. I need pain medicine six or seven times a day. I feel like a baby because my family has to help me so much." It is important for the nurse to assess which of the following?

A) Mood
B) Cognitive style
C) Secondary gains
D) Identity and memory

Question 49

A child was placed in a foster home after being removed from abusive parents. The child is apprehensive and overreacts to environmental stimuli. The foster parents ask the nurse how to help the child. Which interventions should the nurse suggest?

A) Use a calm manner and low voice.
B) Maintain simplicity in the environment.
C) Avoid repetition in what is said to the child.
D) Minimize opportunities for exercise and play.
E) Explain and reinforce reality to avoid distortions.

Question 50

A patient who experienced a myocardial infarction was transferred from critical care to a step-down unit. The patient then used the call bell every 15 minutes for minor requests and complaints. Staff nurses reported feeling inadequate and unable to satisfy the patient's needs. When the nurse manager intervenes directly with this patient, which comment would be most therapeutic?

A) "I'm wondering if you're feeling anxious about your illness and being left alone."
B) "The staff are concerned that you are not satisfied with the care you are receiving."
C) "Let's talk about why you use your call bell so frequently. It is a problem."
D) "You frustrate the staff by calling them so often. Why are you doing that?"

Question 51

A patient diagnosed with a somatic symptom disorder has been in treatment for 4 weeks. The patient says, "Although I'm still having pain, I notice it less and am able to perform more activities." The nurse should evaluate the treatment plan as which of the following?

A) Marginally successful
B) Minimally successful
C) Partially successful
D) Totally achieved

Question 52

To plan effective care for patients diagnosed with somatic symptom disorders, the nurse should understand that patients have difficulty giving up the symptoms because of which of the following?

A) The symptoms are generally chronic.
B) The symptoms have a physiological basis.
C) The symptoms can be voluntarily controlled.
D) The symptoms provide relief from health anxiety.

Question 53

A patient with a somatic symptom disorder has the nursing diagnosis Interrupted family processes related to patient's disabling symptoms as evidenced by spouse and children assuming roles and tasks that previously belonged to the patient. An appropriate outcome is that the patient will do which of the following?

A) Assume roles and functions of other family members
B) Demonstrate performance of former roles and tasks
C) Focus energy on problems occurring in the family
D) Rely on family members to meet personal needs

Question 54

Which treatment modality should a nurse recommend to help a patient diagnosed with a somatic symptom disorder to cope more effectively?

A) Flooding
B) Response prevention
C) Relaxation techniques
D) Systematic desensitization

Question 55

The nurse assesses an adult who is socially withdrawn and hoards. Which nursing diagnoses most likely apply to this individual?

A) Ineffective home maintenance
B) Situational low self-esteem
C) Chronic low self-esteem
D) Disturbed body image
E) Risk for injury

Question 56

A patient reports fears of having cervical cancer and says to the nurse, "I've had Pap smears by six different doctors. The results were normal, but I'm sure that's because of errors in the laboratory." Which disorder would the nurse suspect?

A) Conversion (functional neurological) disorder
B) Illness anxiety disorder (hypochondriasis)
C) Somatic symptom disorder
D) Factitious disorder

Question 57

A nurse plans health teaching for a patient with generalized anxiety disorder who begins a new prescription for lorazepam (Ativan). What information should be included?

A) Caution in use of machinery
B) Foods allowed on a tyramine-free diet
C) The importance of caffeine restriction
D) Avoidance of alcohol and other sedatives
E) The need to take the medication on an empty stomach

Question 58

A nurse's neighbour says, "I saw a news story about a man without any known illness who died suddenly after his ex-wife committed suicide. Was that a coincidence, or can emotional shock be fatal?" The nurse should respond by noting that some serious medical conditions may be complicated by emotional stress, including which of the following?

A) Cancer
B) Hip fractures
C) Hypertension
D) Immune disorders
E) Cardiovascular disease

Question 59

A patient diagnosed with a factitious disorder says, "Why has God chosen me to be sick all the time and unable to provide for my family? The burden on my family is worse than the pain I bear." Which nursing diagnoses apply to this patient?

A) Spiritual distress
B) Decisional conflict
C) Adult failure to thrive
D) Impaired social interaction
E) Ineffective role performance