Deck 12: Anxiety and Anxiety Disorders

Question 1

A patient tells the nurse,"My new friend is the most perfect person one could imagine! I can't find a single flaw.He is kind,considerate,handsome-and he puts me before anyone or anything else." The nurse should hypothesize that this patient may be demonstrating:

A) denial.
B) projection.
C) splitting.
D) compensation.

Answer 1

splitting.

Question 2

A patient complains of tension,indigestion,and difficult concentrating;his resting pulse is 110/minute.An appropriate nursing response would be:

A) "Perhaps time out in the seclusion room would help you focus."
B) "What do you think would we could do to help you feel calmer?"
C) "It might help to talk.Tell me about what has been going on today."
D) "I'll check about getting you a PRN medication for your anxiety."

Answer 2

"It might help to talk.Tell me about what has been going on today."

Question 3

A rather unattractive woman seems to work diligently to be an excellent mother and a bright,exceptional employee,striving to please her husband and her boss,sometimes to the point that she sacrifices her own needs to assure that their needs are met.This is an example of:

A) intellectualization
B) compensation.
C) identification.
D) undoing.

Answer 3

compensation.

Question 4

A patient who is a university student states that before taking an examination he feels a heightened sense of awareness,a sense of restlessness,and a mild degree of apprehension.Which nursing intervention is most therapeutic?

A) Normalize his symptoms as resulting from mild anxiety and calmly discuss how they may actually help his performance.
B) Advise the patient to discuss his experience with a physician or psychologist,as these symptoms suggest a more serious psychiatric disorder.
C) Offer to explore the possibility of obtaining an order for an anxiolytic medication to be used when necessary.
D) Acknowledge the patient's experience and suggest that he consider counseling to bring this anxiety under control.

Question 5

A patient reports that nothing is wrong with him except a chest cold he's had for a couple weeks and "hasn't been able to shake off." His wife is very worried and says he smokes,coughs a lot,has lost 15 pounds,and is easily fatigued.Which of the following statements best describes this situation?

A) The patient is using suppression to cope adaptively.
B) The patient is using suppression to cope maladaptively.
C) The patient is using denial to cope adaptively.
D) The patient is using denial to cope maladaptively.

Question 6

A patient who is a university student states that before taking an examination he feels a heightened sense of awareness and a sense of restlessness.The nurse should assess the patient's situation as:

A) possible hypoglycemia.
B) possible hyperthyroidism.
C) mild depression.
D) mild anxiety.

Question 7

An anxious patient who receives anxiolytic medication every 6 hours PRN is in the corridor pacing.He grabs the arms of anyone who comes along and asks "When can I have medication?" His voice is high pitched and shaky.His respiratory rate is rapid.His assigned nurse should intervene by:

A) checking when his medication is due and informing him.
B) sending him to his room to lie down for half an hour.
C) joking with him to reduce tension and provide distraction.
D) suggesting that he watch television or play board games.

Question 8

A patient,just laid off from his job of 15 years,is pacing rapidly in the waiting room.His behavior is disorganized,he is trembling,and he can be heard admonishing himself that he should have worked harder.He told the triage nurse that he would like to get some medication to calm him down so he can "think straight." Which of the following would constitute a therapeutic rationale for the use of antianxiety medication as his initial treatment?

A) The patient believes it would be beneficial to him.
B) It would calm the patient and allow his discharge.
C) It would not be as addictive as antidepressant drugs.
D) It would better enable him to participate in treatment.

Question 9

While working with an anxious patient,the nurse begins to feel tense and jittery and notices that she is having difficulty concentrating on what the patient is telling her.How can this be explained? The nurse is experiencing:

A) introjected anxiety.
B) secondary anxiety.
C) contagious anxiety.
D) maturational anxiety.

Question 10

A secretary is asked by her boss to take on additional work.She initially agrees but feels resentful.A day later when the boss asks for the completed work,the secretary explains that she has been working on another priority job and hasn't been able to complete it.When asked several hours later,she states someone else was using the files,so she hasn't been able to do the necessary research before typing the report.The secretary's behavior demonstrates:

A) intellectualization.
B) projection.
C) rationalization.
D) sublimation.

Question 11

The nurse plans to encourage an anxious patient to talk about his feelings and concerns.The rationale for this intervention is that:

A) talking serves as constructive distraction and reduces the patient's anxiety.
B) stating concerns aloud becomes less overwhelming and promotes problem solving.
C) focusing on and validating what is occurring in the environment reduces anxiety.
D) exploring feelings reduces one's sense of powerlessness and lessens anxiety.

Question 12

The nurse wishes to teach an alternative coping strategy to a patient who is currently experiencing severe anxiety.The nurse will first need to:

A) use measures designed to lower the patient's anxiety.
B) determine the mode of learning preferred by the patient.
C) devise outcomes and construct a teaching plan.
D) determine if the patient has an anxiety disorder.

Question 13

A patient accompanied her boyfriend to the emergency department after the two had been in a motorcycle accident.The boyfriend was badly hurt,but the patient had only minor cuts and bruises and was discharged.She mentioned to the nurse that since she was driving,she should have been the one to be injured.Twenty-four hours later,while visiting her boyfriend,the patient reported that she was unable to move from her chair and unable to walk.Diagnostic workup revealed no physical reason for the problem.The anxiety relief behavior the patient is demonstrating is:

A) projection.
B) conversion.
C) sublimation.
D) reframing.

Question 14

A college student who usually gets "straight-A" grades scored a C on a difficult examination.When he received the grade,he began to shake,sweat profusely,and feel sick to his stomach.The best explanation for the student's reaction is that:

A) intense anger associated with the low grade gave rise to acute anxiety.
B) distorted thinking that the low grade would result in failure prompted the response.
C) not receiving the expected grade threatened his self-esteem,causing anxiety.
D) the low grade led to fears of career failure and release of GABA,causing anxiety.

Question 15

A patient who asked for and was refused a pass to leave the unit left the nurse's station and went to his room,where he slammed his closet door several times while looking for a sweater.This behavior is an example of __________ use of __________ .

A) adaptive use of displacement
B) maladaptive use of sublimation
C) adaptive use of repression
D) maladaptive use of reaction formation

Question 16

A patient who asked for and was refused a pass to leave the unit left the nurse's station and went to his room,where he slammed his closet door several times while looking for a sweater.A nurse came into the room and remarked,"You seem pretty angry." The patient replied that he was not the least bit angry.What defense mechanism is the patient demonstrating?

A) Splitting
B) Rationalization
C) Compensation
D) Denial

Question 17

The husband who is sexually inadequate and blames it on his partner,saying that her expectations are unrealistic and that no man could meet them,may be demonstrating:

A) rationalization.
B) regression.
C) compensation.
D) introjection.

Question 18

Two staff nurses were considered for promotion.The promotion was announced by a memo on the unit bulletin board.When the nurse who was not promoted first read the memo and learned that the other nurse had received the promotion,she left the room in tears.This behavior is an example of:

A) conversion.
B) regression.
C) introjection.
D) rationalization.

Question 19

A patient with severe anxiety has been pacing the hall and suddenly begins to run,shouting "I'm going to explode!" over and over.The nurse who has been walking with him should:

A) run after the patient and call out for the patient to stop running.
B) catch up with him and manually hold him to prevent further running.
C) say,"I'm not sure what you mean-tell me more,give me an example."
D) quickly gather more staff and state,"We will help you regain control."

Question 20

A patient is noted to have a high level of non-goal-directed motor activity,running from chair to chair in the solarium.He is wide eyed and seems terror stricken.He cries,"They're coming! They're coming!" He neither follows staff direction nor responds to verbal efforts to calm him.Which nursing response should be the highest priority?

A) Reduce his fearfulness and running
B) Increase environmental stimuli
C) Respect the patient's personal space
D) Encourage clarification of feelings

Question 21

A patient is seeking treatment for her fear of cats;even a picture or a thought of a cat causes her to sweat,tremble,become very apprehensive and uncomfortable,and become sick to her stomach.The nurse has established the nursing diagnosis as Anxiety related to exposure to phobic object (cats).A realistic indicator for the outcome Anxiety self-control would be that within 10 days,the patient will:

A) avoid the feared object whenever possible.
B) face the feared object without supportive assistance.
C) state that the fear of cats is unrealistic and inappropriate.
D) report a decrease in distress when thinking about cats.

Question 22

A patient is scheduled to undergo a biopsy of a mass in his lung tomorrow morning.He seems to have difficulty grasping the procedure as the nurse explains it to him and repeatedly asks questions such as "What do you mean I'm going to have surgery? What are they going to do?" His voice is tremulous.His respirations are 28/minute,and his pulse is 110/minute.Which of the following initial outcome indicators would be most appropriate?

A) Vital signs are within normal range for the patient.
B) Patient demonstrates understanding of the procedure.
C) Patient reports acceptance of the cancer diagnosis.
D) Patient identifies two or more coping strategies.

Question 23

A man checks that his doors are locked two or more times each time he leaves home.The door is always found to be locked.Which of the following initial interventions would most likely be useful to this patient?

A) Explaining that his habit is irrational,leads to lateness,and should be discarded.
B) Discussing what the patient was thinking and feeling before checking the door.
C) Requiring the patient to force himself to leave without checking the doors at all.
D) Having him check the doors ten times until he sees the needlessness of checking.

Question 24

A patient with moderate to severe anxiety associated with generalized anxiety disorder can be assessed as successfully lowering her anxiety level to mild when she:

A) implores "What's the matter with me?"
B) stays in her room and rocks or paces.
C) states she is uninterested in eating.
D) concentrates on what the nurse is saying.

Question 25

A patient with chronic obstructive pulmonary disease is hospitalized for respiratory distress and has improved.She becomes very anxious when experiencing shortness of breath.One evening she is found to be restless and disorganized in her behavior and conversation.Which of the following should be considered first in determining the possible causes of these changes?

A) She is becoming more anxious as her respiratory status worsens.
B) The multiple neurocognitive changes may be due to hypoxia.
C) Her anxiety is increasing due to fears of decreasing independence.
D) She is exhibiting early signs of dementia due to chronic hypoxia.

Question 26

A patient with an intense fear of cats reports that after 2 weeks of therapy,she no longer sweats or becomes nauseated when she sees a cat on television but still cannot be in the same room with a cat.The nurse would interpret this change as meaning that the patient:

A) is responding to therapy,and the current treatment can continue.
B) is responding,but slowly,and her treatment plan should be changed.
C) has unrealistic expectations and will always need to avoid cats.
D) is deteriorating and requires medication and more intensive therapy.

Question 27

A patient who has been unable to leave his home for more than a month because of symptoms of severe anxiety tells the nurse,"I know it's probably crazy,but I just can't bring myself to leave my apartment alone.And I can't expect somebody to take me to work every day." The nurse can make the assessment that the patient is:

A) aware that his fear is irrational.
B) misinterpreting or distorting reality.
C) seeking sympathy or attention.
D) experiencing depersonalization.

Question 28

A patient who has been unable to leave his home for more than a month because of symptoms of severe anxiety tells the nurse: "I feel really stupid,a grown man not being able to leave his house." The most therapeutic reply is:

A) "I don't think it's stupid.You're afraid,it happens."
B) "Many individuals share this situation with you."
C) "You feel stupid because you're afraid to leave home?"
D) "I can see how you might feel that way."

Question 29

A nursing student asks to be excused from a required group presentation.He reveals that he is afraid that he will "mess up" and that others will laugh at him.He reports significant dread at the thought of any public presentation,accompanied often by nausea and vomiting when such situations occurred in the past.He reports he was unable to go to prom because he cannot dance well and feared he would be teased or become physically ill.This history suggests the presence of a:

A) social phobia.
B) specific phobia.
C) agoraphobia.
D) generalized anxiety disorder.

Question 30

A patient is hospitalized for acute respiratory distress related to pneumonia and has improved.On admission she had been very anxious because she could not get her breath.On the night shift,she is found to be restless and disorganized in her behavior and conversation.Which of the following nursing interventions should be implemented first?

A) Check her pulse oximetry reading.
B) Administer supplemental oxygen.
C) Reassure her that she is improving.
D) Guide her to use relaxation exercises.

Question 31

A famous general sometimes slowed down his entire army because he felt he must count all the windows in each of the buildings he passed.A patient feels that he must repeat washing his hands three times each time he washes.The nurse recognizes that such behaviors serve the purpose of reducing:

A) sexual conflicts.
B) anxiety.
C) guilt.
D) uncertainty.

Question 32

A soldier serving in the Middle East was in a convoy when an improvised explosive device (IED)killed three fellow soldiers in the vehicle in front of hers.Five weeks later,she began to report intrusive thoughts of missiles screaming toward her and exploding,and loud sounds began to trigger an involuntary re-experiencing of the IED explosion.Three months later,she reported continuing sleep impairment,nightmares,social withdrawal,disrupted relationships,and flashbacks.This soldier's presentation most suggests:

A) acute stress disorder.
B) pathological grief reaction.
C) posttraumatic stress disorder.
D) panic disorder with agoraphobia.

Question 33

A patient who has been unable to leave his home for more than a month because of symptoms of severe anxiety tells the nurse,"I know it's probably crazy,but I just can't bring myself to leave my apartment alone." An appropriate nursing intervention for the nurse to include in the initial nursing care plan is:

A) teach the patient to replace negative self-talk with positive.
B) encourage the patient to attend an agoraphobia support group.
C) point out the irrationality of the patient's fears of leaving home.
D) support the use of medication and be patient until they work.

Question 34

A patient who has been pacing rapidly for the past hour cannot immediately be located on the unit.When he is found,he is in his closet,rocking back and forth rapidly and talking rapidly to himself.When staff approach,he only seems to notice them momentarily,then leaves his room and begins running up and down the hallway.Which of the following interventions should be attempted at this point?

A) "I want you to breathe deeply as I do,in slowly,now hold it,now breathe out."
B) "I have some medicine that will calm you;would you like it by pill or in a shot?"
C) In a calm but direct voice say: "Stop running.I will stay with you.Walk with me."
D) Gather a show of force and say: "You need to come with us now to seclusion."

Question 35

When interviewing and planning care for a patient with fear of public speaking,the nurse must be aware that social phobias are often treatable with:

A) neuroleptics.
B) beta-blockers.
C) tricyclic antidepressants.
D) monoamine oxidase inhibitors.

Question 36

The nurse caring for a patient who has been diagnosed as having generalized anxiety disorder tells a preceptor,"I find myself feeling uncomfortable and anxious around the patient.When he starts trembling and perspiring and pacing,I find myself with cold,clammy hands,and my pulse races.I start worrying whether I will be able to help him stay in control." In such an interaction,the patient will most likely experience:

A) claustrophobia.
B) acute stress disorder.
C) increased anxiety.
D) impaired self-esteem.

Question 37

When a patient asks what causes his panic attacks,the nurse should reply that research gives evidence to support the theory that panic disorders have their etiology in:

A) unresolved conflicts.
B) traumatic events.
C) genetic-biological factors.
D) developmental fixations.

Question 38

A patient tells the nurse that she wants her physician to prescribe diazepam (Valium)for anxiety reduction.The physician has prescribed buspirone (BuSpar).The nurse's reply should be based on the knowledge that buspirone:

A) can be administered as a PRN medication.
B) does not increase the risk of blood dyscrasias.
C) is not habituating or likely to be abused.
D) is faster acting than benzodiazepine drugs.

Question 39

For the patient whose nursing diagnosis is Powerlessness related to an inability to control compulsive cleaning,the nurse must understand that the patient uses the cleaning to:

A) enhance her self-esteem.
B) reduce spread of illnesses.
C) exert control over her anxiety.
D) distract herself from her anxiety.

Question 40

A patient who is a recovering alcoholic has been diagnosed as having panic attacks.The psychiatrist mentions plans to treat the patient with daily doses of medication.Of the medications listed below,for which drug should the nurse plan patient teaching?

A) Paroxetine (Paxil)
B) Alprazolam (Xanax)
C) Chlorpromazine (Thorazine)
D) Propranolol (Inderal)

Question 41

An insurance agent who is sitting in his office after returning from a cardiovascular examination in which he was pronounced "in good health" suddenly experiences a feeling of terror.His heart pounds,he feels as though he cannot breathe,and he cannot focus on what is being said to him.Several earlier episodes (for which he was seen in the emergency room,without any findings of cardiovascular disease)and the fear of their repetition had prompted the visit to the doctor for a more thorough evaluation.This experience should be assessed as a possible:

A) panic attack.
B) myocardial infarction.
C) dissociative reaction.
D) acute stress disorder.

Question 42

A patient with obsessive-compulsive disorder spends 2 hours each morning checking and rechecking her home before leaving for work then comes home on the lunch hour and spends more than an hour rechecking faucets,stove burners,appliances,window and door locks,and so forth.The checking continues after work and during the evening.The patient spends so much time in ritualistic behavior that grooming is poor and social activities are nonexistent.Which indicators for measuring progress would be appropriate for this patient? Select all that apply.

A) Denies the presence of anxiety or distress
B) Participates in a social activity 30 minutes per day
C) Checks no more than once when leaving home
D) Calls to a neighbor to check the home in her absence
E) Achieves adequate grooming and hygiene daily

Question 43

The nurse is assisting a patient with obsessive thoughts.The advanced practice nurse suggests using thought-stopping techniques.Which of the following is an example of such a technique?

A) Have her reward herself with a treat for each 2-hour period completed without an obsessive thought.
B) Teach the patient to snap a rubber band on her wrist whenever an obsessive thought enters her mind.
C) Spend three 20-minute periods per day in meditation or doing deep-breathing exercises.
D) Encourage the patient to spend time with peers and maintain adequate nutrition and rest.

Question 44

The nurse interviewing a patient with suspected posttraumatic stress disorder should be alert to findings indicating the patient: Select all that apply.

A) experiences flashbacks or re-experiences trauma.
B) demonstrates hypervigilance or distrusts.
C) feels detached,estranged,or empty inside.
D) feels driven to repeat ritualistic behaviors.
E) avoids people and places that arouse painful memories.

Question 45

Two forms of therapy that call for the nurse to plan for an initial rise in patient anxiety level are:

A) relaxation training and meditation.
B) flooding and response prevention.
C) anxiolytic therapy and beta-blocker use.
D) modeling and cognitive restructuring.

Question 46

Which assessment question would be highly appropriate to ask a patient with possible generalized anxiety disorder ?

A) "Have you been a victim of a crime or seen someone badly injured or killed?"
B) "How do you feel when others are watching,such as at dances or giving speeches?"
C) "Do you do certain things over and over again,things you feel you must do?"
D) "Do you find yourself worrying so much that it causes problems for you?"

Question 47

A Hispanic woman is recovering from surgery on an inpatient unit when she receives word that her mother has passed away unexpectedly.She begins to shout unintelligibly and then complains of palpitations and a sense of heat in her chest and head.She suddenly begins to tremble and exhibit seizure-like motor behavior.Which of the following would be the most appropriate nursing response?

A) Provide reassurance and emotional support while continuing to assess the patient.
B) Seek an order for supplemental oxygen to treat a suspected pulmonary embolism.
C) Report to the physician that the patient appears to be exhibiting a medication reaction.
D) Encourage the patient to calm down and to try to avoid reacting hysterically to her loss.

Question 48

The care plan for an engineer with agoraphobia includes increasing self-esteem with cognitive restructuring.When the patient tells the nurse,"I'm not smart enough to get that job," the nurse should say:

A) "You must be smart to be in that position."
B) "You should not demean your abilities."
C) "Let's stop and think about what you just said."
D) "Poor self-esteem is behind that comment."

Question 49

When working with a patient with posttraumatic stress disorder who has frequent flashbacks as well as persistent symptoms of arousal,effective nursing interventions would include:

A) encouraging repression of memories associated with the traumatic event.
B) explaining that physical symptoms are related to the psychological state.
C) triggering flashbacks as a way to help the patient learn to cope with them.
D) supporting "numbing" as a temporary way to manage intolerable feelings.

Question 50

A nurse has been counseling a patient with generalized anxiety disorder to increase the patient's anxiety self-control.The patient has identified several stressful situations that cause physical and psychological manifestations of anxiety.Which indicator should the nurse monitor relative to the Nursing Outcomes Classification outcome of anxiety self-control?

A) Plans coping strategies for stressful situations
B) Identifies situations that precipitate hostility
C) Refrains from destroying property
D) Identifies alternatives to aggression

Question 51

A patient who has been pacing actively approaches the nurse and blurts out,"You've got to help me! Something terrible is happening.I'm falling apart.I can't think.I can't get my breath;I feel like I'm dying.What's happening to me?!" Which of the following nursing responses would be appropriate? Select all that apply.

A) "You are having a panic episode;I will stay with you until it passes."
B) "It's almost visiting time.I'll help you get your hair combed."
C) "Watch me;I'll show you how to calm by slowing your breathing."
D) "Let's explore your anxiety.Tell me,what has been going on today?"
E) "I'll get you some orange juice,and we'll walk together for awhile."

Question 52

A nurse is counseling a patient with an anxiety disorder by using cognitive therapy strategies.She gives the patient a homework assignment to keep a diary in which he records the symptoms of anxiety he experiences and the events that transpired just before the onset of symptoms.What is the rationale for this strategy?

A) Keep the patient intellectually occupied to prevent dwelling on physiological phenomena.
B) Link symptoms with precipitating events,which provides a basis for discussion and reframing.
C) Anxiety gives rise to automatic,negative thoughts that must be identified and analyzed.
D) Show the patient that certain events are the likely cause of his anxiety and should be avoided.