Anxiety Flashcards
A patient is diagnosed with agoraphobia. Which of the following would the healthcare identify as a characteristic of this disorder?
A. Avoids being in the presence of clowns
B. Avoids interacting with strangers
C. Refuses to use public restrooms
D. Fears the use of public transportation
Ans: D
rationale:
Agoraphobia is a type of anxiety disorder where the patient fears situations that make the patient feel trapped, helpless, or embarrassed. The patient fears an actual or even an anticipated situation.
Examples of agoraphobic situations include being outside of the home alone or being in a crowd.
Other agoraphobic situations include being in a train or a bus, or other forms of public transportation. Refusing to use a public restroom is a sign of a social phobia. Xenophobia is a fear of strangers, and coulrophobia is a fear of clowns.
A patient diagnosed with obsessive-compulsive disorder (OCD) continually carries a toothbrush, and will brush and floss up to fifty times each day. The healthcare provider understands that the patient’s behavior is an attempt to accomplish which of the following? A. avoid interacting with others B. promote oral health C. relieve anxiety D. experience pleasure
Ans: C
rationale:
The patient diagnosed with OCD often recognizes the repeated actions are excessive and interfere with the patient’s normal routine.
The continual brushing and flossing are a result of persistent thoughts that compel the patient to perform the ritual.
The ritualistic behavior (brushing and flossing the teeth) are compulsions which are performed in an attempt to provide relief from anxiety-provoking obsessions.
When caring for a patient during an acute panic attack, which of the following actions by the healthcare provider is most appropriate?
A. offer patient reassurance and security
B. Explore common phobias related to panic attacks
C. Ask open-ended questions to encourage communication
D. Use distraction techniques the change the patient’s focus
Ans: A
rationale:
The patient is experiencing intense apprehension and fear.
Physical symptoms such as chest pain, palpitations, and trembling are often present.
During the panic attack, the patient’s focus is on the distressing physical symptoms caused by the anxiety. Distraction techniques, open-ended questioning, or exploration of phobias will not be helpful during an acute attack. Because the patient may experience a feeling of impending doom and fears for his or her life, reassurance of safety and security is the best initial intervention for this patient.
A patient diagnosed with general anxiety disorder (GAD) reports ongoing nausea and abdominal bloating. A physical examination fails to confirm a medical illness to explain these symptoms. The healthcare provider suspects these findings are a result of which of the following? A. Dysthymia B. Dissociation C. Somatization D. Derealization
Ans: C
rationale:
The physical symptoms the patient is experiencing are caused by anxiety.
Although the physical symptoms may not be explained by a known medical condition, the symptoms are real to the patient.
Somatization is a means of coping with psychosocial distress by developing physical symptoms (soma = body). Dysthymia is a persistent depressive disorder that may occur together with anxiety and somatization. Derealization is a sense of detachment from reality. Dissociation is impaired awareness of one’s body, self, or environment, and may include derealization.
A patient is receiving care after being diagnosed with generalized anxiety disorder (GAD). Which of these statements made by the patient indicate to the healthcare provider that the patient is beginning to show signs of improvement?
A. “Situations that cause anxiety can always be avoided”
B. “Now that I know that anxiety is caused by a lack of sleep”
C. “As long as I take my medication, I can deal with anxiety”
D. “I can tell when I’m beginning to experience anxiety”
Ans: D
rationale:
GAD is characterized by excessive worrying that may result in problems such as a hyperarousal, muscle tension, difficulty relaxing, and impaired sleep patterns.
Patients diagnosed with GAD often engage in avoidance behaviors.
Recognizing when symptoms of anxiety occur is an initial goal for the patient. Once anxiety is recognized, the patient can employ coping skills to manage the anxiety. Mediations can be helpful in managing GAD, but should be used in conjunction with cognitive-behavioral therapies.
During a panic attack, a patient states, “I feel like I’m going to die!” The patient is hyperventilating, tachycardic, and reports feeling upper extremity numbness and tingling. Based on this patient’s presentation, the healthcare provider would anticipate which additional clinical manifestation of the panic attack? A. Kussmaul respiration B. Respiratory acidosis C. Respiratory alkalosis D. Hypercapnia
Ans: C
rationale:
Carbon dioxide is acidic. when the patient hyperventilates, they are exhaling a large amount of C02 out of their body, causing the to be alkaline.
An arterial blood gas will provide evidence of how the hyperventilation is affecting other body systems.
Hyperventilation causes an increase in the volume of air the patient inhales and exhales.
The patient is exhaling more carbon dioxide than normal, causing hypocapnia and respiratory alkalosis. The paresthesia reported by the patient is an additional clinical sign of alkalosis.
A patient diagnosed with an anxiety disorder is prescribed a benzodiazepine. When teaching the patient about the medication, which of the following information would the healthcare provider include?
A. “It’s important that you discontinue the medication when you feel drowsy”
B. “You should avoid taking aspirin while you are taking this medication”
C. “Call our office right away if you experience any restlessness or agitation”
D. “Decreasing you daily caffeine intake is not necessary when taking this medication”
Ans: C
rationale:
Benzodiazepines increase the effects of GABA.
GABA (gamma-aminobutyric acid) is the major inhibitory neurotransmitter in the central nervous system.
Decreased anxiety and a feeling of drowsiness are expected effects of benzodiazepines. Patients should be advised of a possible paradoxical reaction of restlessness or agitation
A patient diagnosed with agoraphobia is scheduled for a functional magnetic resonance imaging (fMRI) study of the brain. The healthcare provider anticipates that the scan will show increased activity in which of the following areas of this patient’s brain? A. Parietal lobes B. Amygdala C. Medulla D. Cerebellum
Ans: B
rationale:
Nerve fibers link this portion of the brain to the limbic system and frontal cortex.
This part of the brain is a component of the patient’s “fear circuitry.”
Patients diagnosed with anxiety disorders often demonstrate hyperactivity of the amygdala, insula, and limbic system.
After being robbed and beaten by an unknown assailant, a patient is diagnosed with post-traumatic stress disorder (PTSD). When developing a plan of care for the patient, which of these interventions will the healthcare provider plan to implement first?
A. ensure that the patient is taking medication as prescribed
B. Assist the patient in recalling the details of the event
C. Teach the patient coping skills to deal with anxiety
D. Promote the establishment of a trusting relationship
Ans: D
rationale:
PTSD is characterized by intrusive thoughts, nightmares, and flashbacks of past traumatic events, causing severe anxiety.
Typically, the patient will avoid reminders of the trauma, so the patient should be encouraged to talk about the trauma at his or her own pace.
Medication therapy and teaching effective coping skills will be part of the patient’s plan of care, but these will have limited effectiveness until the patient feels safe and has a trusting relationship with the healthcare provider.
Which of the following defense mechanisms may be observed in a patient diagnosed with obsessive-compulsive disorder (OCD)? A. Denial B. Undoing C. regression D. Projection
Ans: B
rationale:
Defense mechanisms are used when there is a threat to the patient’s psychological integrity. The patient diagnosed with OCD will use this defense mechanism to deal with intolerable levels of anxiety.
The patient attempts to substitute the anxiety with a behavior which is maladaptive.
Undoing is a way of symbolically canceling out (negating) an experience that the patient finds intolerable. The compulsive behavior is designed to counteract or undo the patient’s obsession.
The healthcare provider is using implosion therapy for a patient diagnosed with a social phobia. Which of the following interventions would the healthcare provider include in this type of cognitive-behavioral therapy? select all that apply
A. Introduce a more adaptive behavior to substitute for the anxiety
B. Abruptly placing the patient in a social situation that causes anxiety
C. Listening to vivid descriptions of anxiety-provoking social situations
D. Progressive relaxation techniques used to extinguish the anxiety
Ans: B and D
rationale:
During implosion therapy the patient will experience intense anxiety.
The goal of implosion therapy is to desensitize the patient to the phobia.
Implosion therapy (also called “flooding”) is a technique whereby the patient is exposed to the situation that produces anxiety. The exposure is not gradual. The patient may be exposed to an imaginary situation or an actual (in-vivo) situation.
Which of these clinical manifestations would the healthcare provider anticipate observing in a patient experiencing an acute panic attack? select all that apply A. decreased thyroid B. dilated pupils C. bronchoconstriction D. elevated BP E. Hypoglycemia
Ans: B and D
rationale:
An acute panic attack involves both psychological and physical responses, and is characterized by an abrupt surge of intense fear and a sense of impending doom.
The sympathetic nervous system is responsible for some aspects of the patient’s clinical presentation.
Sympathetic nervous system activation results in fight-or-flight responses such as increased blood sugar (through increased glucocorticoid release from adrenal glands), bronchodilation, increased blood pressure, pupillary dilation, and increased thyroid hormone release.
The healthcare provider is teaching a class on obsessive-compulsive disorder (OCD). Which of the following will be included in the teaching? select all that apply
A. repeating words silently is an example of an obsession
B. The patient often hears a voice that often directs the behavior
C. The obsessions are intrusive and unwanted
D. hair pulling and skin picking are common features
E. The behavior is sometimes related to substance abuse
Ans: C and D
rationale:
OCD is characterized by intrusive thoughts or urges and by repetitive mental or behavioral acts.
If the patient’s behaviors are related to substance abuse, the patient is not diagnosed with OCD.
Patients diagnosed with OCD do not experience hallucinations.
Hair pulling and skin picking are different disorders and not characteristic of OCD.
OCD is characterized by intrusive thoughts or urges (obsessions) that compel the patient to perform repetitive mental or behavioral acts (compulsions). The obsessions and compulsions are typically time-consuming and often impair social, occupational, or other important areas of functioning.
The healthcare provider is planning care for a patient diagnosed with a social phobia. Which of the following should the healthcare provider include in the plan of care for this patient? select all that apply
A. ignore the development of fight or flight symptoms
B. examine validity of thought processes
C. avoid social situations that cause excessive anxiety
D. rehearse relaxation techniques for use in social situations
E. recognize self-defeating thoughts
Ans: B,D,E
rationale:
Social phobia is characterized by anxiety and excessive fear of scrutiny or embarrassment in social situations.
The patient will not engage in social situations in order to avoid experiencing distressing feelings of anxiety.
The patient should learn how to recognize (not ignore) physiological responses and thought processes that undermine their ability to function socially.
Patients should learn to use techniques that will assist them in social situations, such as relaxation and “thought-stopping” which is a technique that helps the patient control intrusive and self-defeating thoughts.
A patient is involved in a motor vehicle accident in which a friend was killed. The patient reports difficulty concentrating and admits to being irritable and angry most of the time. Which of the following additional findings support a diagnosis of post-traumatic stress disorder (PTSD)? select all that apply
A. Excessive attachment to friends or loved ones
B. flashbacks or nighmares
C. tendencies to sleep 12-14 hours per day
D. reluctant to drive motor vehicle
E. sings of sympathetic hyperactivity
F. self-medication with drugs or alcohol
Ans: B,D,E,F
rationale:
PTSD is caused by psychological trauma which affects the patient’s cognitive, physiological, emotional, and behavioral functions.
The traumatic event is repeatedly re-experienced by the patient, which causes extreme anxiety and a physiological reaction.
The patient will avoid situations that remind them of the traumatic event.
DREAMS is a handy mnemonic to help you remember some of the common clinical manifestations of PTSD: Detachment - refers to feeling detached from others or unresponsive emotionally; Re-experiencing the event - the patient often experiences intrusive recollections, flashbacks, or nightmares about the event; Emotional effects - the event causes the patient to experience significant emotional distress; Avoidance - the patient will tend to avoid situations or even close friends that remind them of the event; Medication - the patient may self-medicate with alcohol or other drugs in an attempt to deal with the psychological trauma; Sympathetic hyperactivity - refers to a hypervigilant or hyper-aroused state, irritability, and difficulty falling or staying asleep
