Question 1

The nurse is planning a presentation to a group of nursing students on the topic of anxiety disorders. Which detail would the nurse include when describing panic disorder?

Accepted Answer

Clients diagnosed with a panic disorder may believe they are having a heart attack when a panic attack occurs. Panic disorder peaks during the teenage years and does not usually manifest after the age of 30 years. Individuals with panic disorder (with or without agoraphobia) experience recurrent and unexpected panic attacks.

Question 2

A client comes to the emergency department due to symptoms of a potential 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?

Accepted Answer

After it has been determined that the client does not have other medical problems, the nurse should assess for the characteristic symptoms of panic attack, focusing the questions on what the client was experiencing just before and during the attack. Asking the client if the client feels better provides no information for the nurse, and lying down may or may not be effective. Asking the client if the client can drive home is a question that can be asked much later in the interview, after the attack subsides and the client is stable. Asking the client about what caused the attack is inappropriate because numerous stimuli, both external and internal, can provoke an attack. Most clients will not be able to identify a specific cause. The focus of care is on the characteristics of the attack.

Question 3

A client diagnosed with a panic disorder has been prescribed a benzodiazepine medication. Which risk would the nurse emphasize as associated with using this medication?

Accepted Answer

Although benzodiazepines are well tolerated and tremendously useful in treating intensely distressed individuals, they carry the risks of physical dependence and withdrawal symptoms with discontinuation. Dietary restrictions are not necessary with benzodiazepines. Sedation, rather than agitation, occurs with this class of drugs. Fecal impaction is not associated with benzodiazepines.

Question 4

A client is diagnosed with panic disorder and hasn't left the house in more than a month because of fears of another attack. Which nursing diagnosis would be a priority for this client?

Accepted Answer

The priority nursing diagnosis for the client is social isolation related to fear of recurrence of anxiety symptoms. The client's fear has led to staying home. Powerlessness would be reflected in statements addressing feelings related to loss of control. Decisional conflict would be reflected in statements about which way to act. Ineffective family coping would be reflected in statements about the family and their inability to address or deal with the client's condition.

Question 5

A nurse has instructed a client diagnosed with panic disorder about how to use the technique of positive self-talk. The nurse determines that the client has understood the instructions when the client verbalizes which statement to use during an impending panic attack?

Accepted Answer

An example of positive self-talk is when the client says, "This is only anxiety; it will be over shortly." These types of positive statements can give the individual a focal point and reduce fear when panic symptoms begin.

Question 6

A client who has been diagnosed with panic disorder visits the clinic and experiences a panic attack. The client tells the nurse, "I'm so nervous. My hands are shaking, and I'm sweating. I feel as if I'm having a stroke right now." What would be the priority intervention at this time?

Accepted Answer

The first nursing intervention should be to stay with the client while remaining calm. A calm presence will help to relax the client. The nurse should use short sentences to provide clear directions and then assist the client to an environment with minimal stimuli. A client experiencing panic is unable to process information, so telling the client that the attack will soon pass would be ineffective. Educating the client on deep-breathing techniques would be appropriate later, after the panic subsides and the client is amenable to hearing and processing information.

Question 7

A client diagnosed with generalized anxiety disorder (GAD) is at the outpatient psychiatric clinic for a follow-up appointment. The nurse determines that the client's therapy has been effective when the client makes which statement?

Accepted Answer

Evaluation should focus on the individual's ability and skills in using techniques that control anxiety, such as relaxation, positive self-talk, and stress management. Reducing personal and environmental stress (e.g., removing oneself from a mother-in-law's company) can indicate success, as can incorporating practices that foster relaxation into daily routines. Although alcohol is relaxing for this client, it has the potential for dependency, and encouraging its routine use should be avoided. The statement about stress and things being different at home indicate that the client is still experiencing anxiety. Caffeine is a stimulant and should be avoided.

Question 8

The nurse is caring for a client who is being treated in the emergency department for a panic attack. Which nursing intervention would be most appropriate?

Accepted Answer

It is important to stay with the client and remain calm to help relax the client. Trying to mimic the client's symptoms would further add to the client's anxiety level. It is also important to stress that you will stay with the client and that the client is safe. The nurse should use clear, concise directions and short sentences. Medical jargon, such as telling the client this is an acute exacerbation with a positive prognosis, should be avoided.

Question 9

A nurse determines that a client who is experiencing anxiety is demonstrating relief survival behaviors. The nurse determines that the client is experiencing which degree of anxiety based on this presentation?

Accepted Answer

A client experiencing severe anxiety typically uses relief behaviors. With mild anxiety, the client is easily able to recognize and name anxiety. With moderate anxiety, the client is usually able to state that he or she is anxious. With panic, the client is perplexed and self-absorbed.

Question 10

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 make which statement?

Accepted Answer

Women experience anxiety disorders more often than men by a 2 to 1 ratio. Anxiety disorders are the most common of the psychiatric illnesses treated by health-care providers. They tend to be chronic and persistent illnesses with full recovery more likely among those who do not have other mental or physical illnesses. Anxiety disorders are the most common condition of adolescents, with one in three having an anxiety disorder.

Question 11

During an interview, a client reports an intense fear of spiders, stating, "I can't be near them. I get so upset. I start to sweat and hyperventilate if I see one." The nurse documents this finding as which of the following?

Accepted Answer

The client is describing arachnophobia, a fear of spiders. Algophobia is a fear of pain, entomophobia is a fear of insects, and cynophobia is a fear of dogs.

Question 12

After teaching a class about the biologic theories associated with panic disorder, the group leader determines a need for additional education when the group identifies which neurotransmitter as being implicated?

Accepted Answer

Biochemical theories suggest involvement of serotonin, norepinephrine, and GABA as playing a role in panic disorder. Dopamine is not associated with this condition.

Question 13

A nurse is preparing an in-service presentation about panic disorders and associated theories related to the cause. When describing the cognitive-behavioral concepts associated with panic disorders, which of the following would the nurse expect to address?

Accepted Answer

Learning theory underlies most cognitive-behavioral explanations of panic disorder with classic conditioning and interoceptive conditioning as the basis. Personal losses and separation reflect psychodynamic theories. Classic conditioning theory suggests that one learns a fear response by linking an adverse or fear-provoking event, such as a car accident, with a previously neutral event, such as crossing a bridge. One becomes conditioned to associate fear with crossing a bridge. Families affected by panic disorder have difficulty with overall communication, reflecting the family response to the disorder.

Question 14

A nurse is developing a plan of care for a client diagnosed with panic disorder that will include pharmacologic therapy. Which would the nurse most likely expect to administer?

Accepted Answer

Although all of the agents can be used to treat panic disorder, SSRIs are recommended as the first drug option for treatment. Benzodiazepines (antianxiety agents) are used only for short periods of time. MAOIs are reserved for clients who do not respond to SSRIs or serotonin-norepinephrine reuptake inhibitors. The use of TCAs is declining.

Question 15

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 a representation of the bases for this disorder?

Accepted Answer

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. Cognitive behavioral theory regarding the etiology of GAD proposes that the disorder results from inaccurate assessment of perceived environmental dangers. Although there are no specific sociocultural theories related to the development of GAD, a high-stress lifestyle and multiple stressful life events may be contributors. Kindling results from overstimulation or repeated stimulation of nerve cells by environmental stressors.

Question 16

A client is diagnosed with generalized anxiety disorder (GAD) and is prescribed medication therapy. Which agent would the nurse expect to administer to the client to obtain the quickest relief from anxiety symptoms?

Accepted Answer

Alprazolam, a benzodiazepine, provides quick relief from anxiety symptoms until the antidepressant effects of other drugs, such as buspirone, venlafaxine, or imipramine, are felt.

Question 17

A client diagnosed with panic disorder who has been prescribed sertraline in conjunction with alprazolam comes to the clinic for a follow-up. The client states, "I stopped taking the alprazolam about 2 days ago. I was feeling really sleepy and tired." Which manifestations would alert the nurse to suspect possible withdrawal? Select all that apply.

Accepted Answer

Symptoms associated with withdrawal of benzodiazepine therapy are more likely to occur after high doses and long-term therapy, but they can also occur after short-term therapy. Withdrawal symptoms manifest in several ways, including psychological (apprehension, irritability, and agitation).

Question 18

A nurse is developing an education plan for a client diagnosed with generalized anxiety disorder (GAD), focusing on nutrition. Which item would the nurse encourage the client to avoid? Select all that apply.

Accepted Answer

People with social anxiety disorder fear that others will scrutinize their behavior and judge them negatively. They often do not speak up in crowds out of fear of embarrassment. They go to great lengths to avoid feared situations. If avoidance is not possible, they suffer through the situation with visible anxiety. People with social anxiety disorder seem to be highly sensitive to disapproval or criticism, tend to evaluate themselves negatively, have poor self-esteem, and have a distorted view of their personal strengths and weaknesses. They may magnify their personal flaws and underrate their talents.

Quiz 27: Anxiety Disorders: Nursing Care of Patients With Anxiety, Phobia, and Panic