15 (Anxiety & OCD)

Question 1

You are providing teaching to Lana, a preoperative patient just before surgery. She is becoming more and more anxious as you talk. She begins to complain of dizziness and heart pounding, and she is trembling. She seems confused. Your best response is to:

a. ) reinforce the preoperative teaching by restating it slowly.
b. ) have Lana read the teaching materials instead of verbal instruction.
c. ) have a family member read the preoperative materials to Lana.
d. ) not attempt any teaching at this time.

Answer 1

d.) not attempt any teaching at this time.

Patients experiencing severe anxiety, as the symptoms suggest, are unable to learn or solve problems.

The other options would not be effective because you are still attempting to teach someone who has a severe level of anxiety.

Question 2

Lana is out of surgery and on the medical-surgical unit for recovery. You visit her the day after her surgical procedure. While you are in the room, Lana becomes visibly anxious and short of breath, and she states, “I feel so anxious! Something is wrong!” Your best action is to:

a. ) reassure Lana that she is experiencing normal anxiety and do deep breathing exercises with her.
b. ) use the call light to inquire whether Lana has any prn anxiety medication.
c. ) call for help and assess Lana’s vital signs.
d. ) tell Lana you will stay with her until the anxiety subsides.

Answer 2

c.) call for help and assess Lana’s vital signs.

In anxiety caused by a medical condition, the individual’s symptoms of anxiety are a direct physiological result of a medical condition, such as hyperthyroidism, pulmonary embolism, or cardiac dysrhythmias.

In this case Lana is postoperative and could be experiencing a pulmonary embolism, as evidenced by the shortness of breath and anxiety. She needs immediate evaluation for any serious medical condition.

The other options would all be appropriate after it has been determined that no serious medical condition is causing the anxiety.

Question 3

Stella brings her mother, Dorothy, to the mental health outpatient clinic. Dorothy has a history of anxiety. Stella and Dorothy both give information for the assessment interview. Stella states, “My mother lives with me since my dad died 6 months ago. For the past couple of months, every time I need to leave the house for work or anything else, Mom becomes extremely anxious and cries that something terrible is going to happen to me. She seems OK except for these times, but it’s affecting my ability to go to work.” You suspect:

a. ) panic disorder.
b. ) adult separation anxiety disorder.
c. ) agoraphobia.
d. ) social anxiety disorder.

Answer 3

b.) adult separation anxiety disorder.

People with separation anxiety disorder exhibit developmentally inappropriate levels of concern over being away from a significant other. There may also be fear that something horrible will happen to the other person.

Adult separation anxiety disorder may begin in childhood or adulthood.

The scenario doesn’t describe panic disorder.

Agoraphobia is characterized by intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available.

Social anxiety disorder, also called social phobia, is characterized by severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others.

Question 4

Which medication is FDA approved for treatment of anxiety in children?

a. ) Lorazepam (benzodiazepine)
b. ) Fluoxetine (selective serotonin reuptake inhibitor)
c. ) Clomipramine (tricyclic antidepressant)
d. ) None of the above

Answer 4

d.) None of the above

There are no medications with FDA approval for children with anxiety disorders;

however, medications approved for other age groups are often prescribed. None of the other options are FDA approved to treat anxiety in children.

Question 5

Jerry is a 72-year-old patient with Parkinson’s disease and anxiety. He is living by himself and has had several falls lately. His provider orders lorazepam, 1 mg PO bid, for anxiety. You question this order because:

a. ) Jerry may become addicted faster than younger patients.
b. ) Jerry is at risk for falls.
c. ) Jerry has a history of nonadherence with medications.
d. ) Jerry should be treated with cognitive therapies rather than medication because of his advanced age.

Answer 5

b.) Jerry is at risk for falls.

An important nursing intervention is to monitor for side effects of the benzodiazepines, including sedation, ataxia, and decreased cognitive function. In a patient who has a history of falls, lorazepam would be contraindicated because it may cause sedation and ataxia leading to more falls.

There is no evidence to suggest that elderly patients become addicted faster than younger patients.

A history of nonadherence would not lead to you to question this drug order.

Medication and other therapies are used congruently with all age levels.

Question 6

The major distinction between fear and anxiety is that fear

a. ) is a universal experience; anxiety is neurotic.
b. ) enables constructive action; anxiety is dysfunctional.
c. ) is a psychological experience; anxiety is a physiological experience.
d. ) is a response to a specific danger; anxiety is a response to an unknown danger.

Answer 6

d.) is a response to a specific danger; anxiety is a response to an unknown danger.

Fear is a response to an objective danger; anxiety is a response to a subjective danger.

Question 7

The initial nursing action for a newly admitted anxious client is to

a. ) assess the client’s use of defense mechanisms.
b. ) assess the client’s level of anxiety.
c. ) limit environmental stimuli.
d. ) provide antianxiety medication.

Answer 7

b.) assess the client’s level of anxiety.

The priority nursing action is the assessment of the client’s anxiety level.

Question 8

Selective inattention is first noted when experiencing anxiety that is

a. ) mild.
b. ) moderate.
c. ) severe.
d. ) panic.

Answer 8

b.) moderate.

When moderate anxiety is present, the individual’s perceptual field is reduced and the client is not able to see the entire picture of events.

Question 9

Delusionary thinking is a characteristic of

a. ) chronic anxiety.
b. ) acute anxiety.
c. ) severe anxiety.
d. ) panic level anxiety.

Answer 9

d.) panic level anxiety.

Panic level anxiety is the most extreme level and results in markedly disturbed thinking.

Question 10

Generally, ego defense mechanisms

a. ) often involve some degree of self-deception.
b. ) are rarely used by mentally healthy people.
c. ) seldom make the person more comfortable.
d. ) are usually effective in resolving conflicts.

Answer 10

a.) often involve some degree of self-deception.

Most ego defense mechanisms, with the exception of the mature defenses, alter the individual’s perception of reality to produce varying degrees of self-deception.

Question 11

A 20-year-old was sexually molested at age 10, but he can no longer remember the incident. The ego defense mechanism in use is

a. ) projection.
b. ) repression.
c. ) displacement.
d. ) reaction formation.

Answer 11

b.) repression.

Repression is a defense mechanism that excludes unwanted or unpleasant experiences, emotions, or ideas from conscious awareness.

Question 12

The defense mechanisms that can only be used in healthy ways include

a. ) suppression and humor.
b. ) altruism and sublimation.
c. ) idealization and splitting.
d. ) reaction formation and denial.

Answer 12

b.) altruism and sublimation.

Altruism and sublimation are known as mature defenses. They cannot be used in unhealthy ways.

Altruism results in resolving emotional conflicts by meeting the needs of others, and sublimation substitutes socially acceptable activity for unacceptable impulses.

Question 13

Which behavior would be characteristic of an individual who is displacing anger?

a. ) Lying
b. ) Stealing
c. ) Slapping
d. ) Procrastinating

Answer 13

d.) Procrastinating

A passive-aggressive person deals with emotional conflict by indirectly and unassertively expressing aggression toward others.

Procrastination is an expression of resistance.

Question 14

A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, and “burns” money that could be better spent to feed the poor is demonstrating

a. ) projection.
b. ) rationalization.
c. ) reaction formation.
d. ) undoing.

Answer 14

c.) reaction formation.

Reaction formation keeps unacceptable feelings or behaviors out of awareness by developing the opposite behavior or emotion.

Question 15

A man continues to speak of his wife as though she were still alive, 3 years after her death. This behavior suggests the use of

a. ) altruism.
b. ) denial.
c. ) undoing.
d. ) suppression.

Answer 15

b.) denial.

Denial involves escaping unpleasant reality by ignoring its existence.

Question 16

It can be said that the onset of most anxiety disorders occurs

a. ) before the age of 20 years.
b. ) before the age of 40 years.
c. ) after the age of 40 years.
d. ) scattered throughout the life span.

Answer 16

b.) before the age of 40 years.

Epidemiology reports indicate that the onset of most anxiety disorders occurs before age 40 years.

Question 17

What can be said about the comorbidity of anxiety disorders?

a. ) Anxiety disorders generally exist alone.
b. ) A second anxiety disorder may coexist with the first.
c. ) Anxiety disorders virtually never coexist with mood disorders.
d. ) Substance abuse disorders rarely coexist with anxiety disorders.

Answer 17

b.) A second anxiety disorder may coexist with the first.

In many instances, when one anxiety disorder is present, a second one coexists.

Clinicians and researchers have clearly shown that anxiety disorders frequently co-occur with other psychiatric problems.

Major depression often co-occurs and produces a greater impairment with poorer response to treatment.

Question 18

Studies of clients diagnosed with posttraumatic stress disorder suggest that the stress response of which of the following is considered abnormal?

a. ) Brainstem
b. ) Hypothalamus-pituitary-adrenal system
c. ) Frontal lobe
d. ) Limbic system

Answer 18

b.) Hypothalamus-pituitary-adrenal system

Studies of clients with posttraumatic stress disorder suggest that the stress response of the hypothalamus-pituitary-adrenal system is abnormal.

Question 19

An obsession is defined as

a. ) thinking of an action and immediately taking the action.
b. ) a recurrent, persistent thought or impulse.
c. ) an intense irrational fear of an object or situation.
d. ) a recurrent behavior performed in the same manner.

Answer 19

b.) a recurrent, persistent thought or impulse.

Obsessions are thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind.

Question 20

A symptom commonly associated with panic attacks is

a. ) obsessions.
b. ) apathy.
c. ) fever.
d. ) fear of impending doom.

Answer 20

d.) fear of impending doom.

The feelings of terror present during a panic attack are so severe that normal function is suspended, the perceptual field is severely limited, and misinterpretation of reality may occur.

Question 21

Working to help the client view an occurrence in a more positive light is called

a. ) flooding.
b. ) desensitization.
c. ) response prevention.
d. ) cognitive restructuring.

Answer 21

d.) cognitive restructuring.

The purpose of cognitive restructuring is to change the individual’s negative view of an event or a situation to a view that remains consistent with the facts but that is more positive.

Question 22

The primary purpose of performing a physical examination before beginning treatment for any anxiety disorder is to

a. ) protect the nurse legally.
b. ) establish the nursing diagnoses of priority.
c. ) obtain information about the client’s psychosocial background.
d. ) determine whether the anxiety is primary or secondary in origin.

Answer 22

d.) determine whether the anxiety is primary or secondary in origin.

The symptoms of anxiety can be caused by a number of physical disorders or are said to be caused by an underlying physical disorder.

he treatment for secondary anxiety is treatment of the underlying cause.

Question 23

An important question to ask during the assessment of a client diagnosed with anxiety disorder is

a. ) “How often do you hear voices?”
b. ) “Have you ever considered suicide?”
c. ) “How long has your memory been bad?”
d. ) “Do your thoughts always seem jumbled?”

Answer 23

b.) “Have you ever considered suicide?”

The presence of anxiety may cause an individual to consider suicide as a means of finding comfort and peace. Suicide assessment is appropriate for any client with higher levels of anxiety.

Question 24

A possible outcome criterion for a client diagnosed with anxiety disorder is

a. ) Client demonstrates effective coping strategies.
b. ) Client reports reduced hallucinations.
c. ) Client reports feelings of tension and fatigue.
d. ) Client demonstrates persistent avoidance behaviors.

Answer 24

a.) Client demonstrates effective coping strategies.

Option A is the only desirable outcome listed.

Question 25

Inability to leave one’s home because of avoidance of severe anxiety suggests the anxiety disorder of

a. ) panic attacks with agoraphobia.
b. ) obsessive-compulsive disorder.
c. ) posttraumatic stress response.
d. ) generalized anxiety disorder.

Answer 25

a.) panic attacks with agoraphobia.

Panic disorder with agoraphobia is characterized by recurrent panic attacks combined with agoraphobia.

Agoraphobia involves intense, excessive anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available if a panic attack occurred.

Question 26

A teenager changes study habits to earn better grades after initially failing a test. This behavioral change is likely a result of

a. ) a rude awakening.
b. ) normal anxiety.
c. ) trait anxiety.
d. ) altruism.

Answer 26

b.) normal anxiety.

Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions.

Question 27

A young adult applying for a position is mildly tense but eager to begin the interview. This can be assessed as showing

a. ) denial.
b. ) compensation.
c. ) normal anxiety.
d. ) selective inattention.

Answer 27

c.) normal anxiety.

Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions.

Question 28

A client frantically reports to the nurse that “You have got to help me! Something terrible is happening. I can’t think. My heart is pounding, and my head is throbbing.” The nurse should assess the client’s level of anxiety as

a. ) mild.
b. ) moderate.
c. ) severe.
d. ) panic.

Answer 28

c.) severe.

Severe anxiety is characterized by feelings of falling apart and impending doom, impaired cognition, and severe somatic symptoms such as headache and pounding heart.

Question 29

A client is displaying symptomatology reflective of a panic attack. In order to help the client regain control, the nurse responds,

a. ) “You need to calm yourself.”
b. ) “What is it that you would like me to do to help you?”
c. ) “Can you tell me what you were feeling just before your attack?”
d. ) “I will get you some medication to help calm you.”

Answer 29

c.) “Can you tell me what you were feeling just before your attack?”

A response that helps the client identify the precipitant stressor is most therapeutic.

Question 30

A client who is demonstrating a moderate level of anxiety tells the nurse, “I am so anxious, and I do not know what to do.” A helpful response for the nurse to make would be

a. ) “What things have you done in the past that helped you feel more comfortable?”
b. ) “Let’s try to focus on that adorable little granddaughter of yours.”
c. ) “Why don’t you sit down over there and work on that jigsaw puzzle?”
d. ) “Try not to think about the feelings and sensations you’re experiencing.”

Answer 30

a.) “What things have you done in the past that helped you feel more comfortable?”

Because the client is not able to think through the problem and arrive at an action that would lower anxiety, the nurse can assist by asking what has worked in the past. Often what has been helpful in the past can be used again.

Question 31

A client is running from chair to chair in the solarium. He is wide-eyed and keeps repeating, “They are coming! They are coming!” He neither follows staff direction nor responds to verbal efforts to calm him. The level of anxiety can be assessed as

a. ) mild.
b. ) moderate.
c. ) severe.
d. ) panic.

Answer 31

d.) panic.

Panic-level anxiety results in markedly disorganized, disturbed behavior, including confusion, shouting, and hallucinating. Individuals may be unable to follow directions and may need external limits to ensure safety.

Question 32

A cultural characteristic that may be observed in a teenage, female Hispanic client in times of stress is to

a. ) suddenly tremble severely.
b. ) exhibit stoic behavior.
c. ) report both nausea and vomiting.
d. ) laugh inappropriately.

Answer 32

a.) suddenly tremble severely.

Ataque de nervios (attack of the nerves) is a culture-bound syndrome that is seen in undereducated, disadvantaged females of Hispanic ethnicity.

Question 33

The nurse anticipates that the nursing history of a client diagnosed with obsessive compulsive disorder (OCD) will reveal

a. ) a history of childhood trauma.
b. ) a sibling with the disorder.
c. ) an eating disorder.
d. ) a phobia as well.

Answer 33

b.) a sibling with the disorder.

Research shows that first-degree biological relatives of those with OCD have a higher frequency of the disorder than exists in the general population.

Question 34

A client is diagnosed with generalized anxiety disorder (GAD). The nursing assessment supports this diagnosis when the client reports

a. ) that his symptoms started right after he was robbed at gunpoint.
b. ) being so worried he hasn’t been able to work for the last 12 months.
c. ) that eating in public makes him extremely uncomfortable.
d. ) repeatedly verbalizing his prayers helps him feel relaxed.

Answer 34

b.) being so worried he hasn’t been able to work for the last 12 months.

GAD is characterized by symptomatology that lasts 6 months or longer.

Question 35

If a client’s record mentions that the client habitually relies on rationalization, the nurse might expect the client to

a. ) make jokes to relieve tension.
b. ) miss appointments.
c. ) justify illogical ideas and feelings.
d. ) behave in ways that are the opposite of his or her feelings.

Answer 35

c.) justify illogical ideas and feelings.

Rationalization involves justifying illogical or unreasonable ideas or feelings by developing logical explanations that satisfy the teller and the listener.

Question 36

The plan of care for a client who has elaborate washing rituals specifies that response prevention is to be used. Which scenario is an example of response prevention?

a. ) Having the client repeatedly touch “dirty” objects
b. ) Not allowing the client to seek reassurance from staff
c. ) Not allowing the client to wash hands after touching a “dirty” object
d. ) Telling the client that he or she must relax whenever tension mounts

Answer 36

c.) Not allowing the client to wash hands after touching a “dirty” object

Response prevention is a technique by which the client is prevented from engaging in the compulsive ritual.

A form of behavior therapy, response prevention is never undertaken without physician approval.

Question 37

A client is experiencing a panic attack. The nurse can be most therapeutic by

a. ) telling the client to take slow, deep breaths.
b. ) verbalizing mild disapproval of the anxious behavior.
c. ) asking the client what he means when he says “I am dying.”
d. ) offering an explanation about why the symptoms are occurring

Answer 37

a.) telling the client to take slow, deep breaths.

Slow diaphragmatic breathing can induce relaxation and reduce symptoms of anxiety.

Often the nurse has to tell the client to “breathe with me” and keep the client focused on the task.

The slower breathing also reduces the threat of hypercapnia with its attendant symptoms.

Question 38

The nurse caring for a client experiencing a panic attack anticipates that the psychiatrist would order a stat dose of

a. ) standard antipsychotic medication.
b. ) tricyclic antidepressant medication.
c. ) anticholinergic medication.
d. ) a short-acting benzodiazepine medication.

Answer 38

d.) a short-acting benzodiazepine medication.

A short-acting benzodiazepine is the only type of medication listed that would lessen the client’s symptoms of anxiety within a few minutes.

Anticholinergics do not lower anxiety;

tricyclic antidepressants have very little antianxiety effect and have a slow onset of action;

and a standard antipsychotic medication will lower anxiety but has a slower onset of action and the potential for more side effects.

Question 39

A Gulf War veteran is entering treatment for post-traumatic stress disorder. An important facet of assessment is to

a. ) ascertain how long ago the trauma occurred.
b. ) find out if the client uses acting-out behavior.
c. ) determine use of chemical substances for anxiety relief.
d. ) establish whether the client has chronic hypertension related to high anxiety.

Answer 39

c.) determine use of chemical substances for anxiety relief.

Substance abuse often coexists with post-traumatic stress disorder. It is often the client’s way of self-medicating to gain relief of symptoms.

Question 40

When prescribed lorazepam (Ativan) 1 mg po qid for 1 week for generalized anxiety disorder, the nurse should

a. ) question the physician’s order because the dose is excessive.
b. ) explain the long-term nature of benzodiazepine therapy.
c. ) teach the client to limit caffeine intake.
d. ) tell the client to expect mild insomnia.

Answer 40

c.) teach the client to limit caffeine intake.

Caffeine is an antagonist of antianxiety medication.

Question 41

Which nursing diagnosis would be most useful for clients with anxiety disorders?

a. ) Excess fluid volume
b. ) Disturbed body image
c. ) Ineffective role performance
d. ) Disturbed personal identity

Answer 41

c.) Ineffective role performance

Anxiety disorders often interfere with the usual role performance of clients.

Consider the client with agoraphobia who cannot go to work, or the client with obsessive-compulsive disorder who devotes time to the ritual rather than to parenting.

Question 42

Which nursing intervention would be helpful when caring for a client diagnosed with an anxiety disorder?

a. ) Express mild amusement over symptoms.
b. ) Arrange for client to spend time away from others.
c. ) Advise client to minimize exercise to conserve endorphins.
d. ) Reinforce use of positive self-talk to change negative assumptions.

Answer 42

d.) Reinforce use of positive self-talk to change negative assumptions.

This technique is a variant of cognitive restructuring. “I can’t do that” is changed to “I can do it if I try.”

Question 43

A potential problem for a client diagnosed with severe obsessive-compulsive disorder is

a. ) sleep disturbance.
b. ) excessive socialization.
c. ) command hallucinations.
d. ) altered state of consciousness.

Answer 43

a.) sleep disturbance.

Clients who must engage in compulsive rituals for anxiety relief are rarely afforded relief for any prolonged period. The high anxiety level and need to perform the ritual may interfere with sleep.

Question 44

Which therapeutic intervention can the nurse implement personally to help a client diagnosed with a mild anxiety disorder regain control?

a. ) Flooding
b. ) Modeling
c. ) Thought stopping
d. ) Systematic desensitization

Answer 44

b.) Modeling

Modeling calm behavior in the face of anxiety or unafraid behavior in the presence of a feared stimulus are interventions that can be independently used.

The other options require agreement of the treatment team.

Question 45

Panic attacks in Latin American individuals often involve

a. ) repetitive involuntary actions.
b. ) blushing.
c. ) fear of dying.
d. ) offensive vebalizations.

Answer 45

c.) fear of dying.

Panic attacks in Latin Americans and Northern Europeans often involve sensations of choking, smothering, numbness or tingling, as well as fear of dying.