Anxiety Disorder

Question 1

What is true regarding anxiety?
a. No anxiety is optimal.
b. A small amount of anxiety can be beneficial.
c. A moderate amount of anxiety is necessary to be successful.
d. A severe amount of anxiety can lead to personal breakthroughs.

Answer 1

b

A small amount of anxiety can be beneficial to promote ambition and achievement of tasks. it unreasonable to expect no anxiety at all, and a moderate or severe amount should be mitigated whenever possible.

Question 2

What is the most important intervention when working with a client who is experiencing anxiety?
a. provide a safe environment.
b. record them having an anxiety attack.
c. tell them to calm down.
d. administer a benzodiazepine.

Answer 2

a.

It is most important to provide a safe environment for the patient and maintain their privacy. it is inappropriate to record them. telling them to calm down minimizes their experience and is not therapeutic. a benzodiazepine may be indicated but it is not the priority intervention.

Question 3

When should anxiety intervention techniques be taught?
a. in high school.
b. during the anxiety even.
c. when the patient is calm.
d. only during therapy sessions.

Answer 3

c.

It is important to teach anxiety intervention techniques when the patient is calm so they can practice the tools during an event. they will be unable to take in new information while anxiety is acute.

Question 4

Which are nursing interventions that can assist a client experiencing anxiety? Select all that apply.
a. deep breathing.
b. guided imagery
c. punching a wall
d. cognitive restructuring techniques
e. quitting their job.

Answer 4

a, b, d

Some nursing interventions to help a patient experiencing anxiety include deep breathing, guided imagery, and cognitive restructuring techniques. punching a wall is unsafe and quitting one’s job may not be possible or necessary.

Question 5

What score on the Hamilton Rating Scale for Anxiety indicates moderate severity?
a. Less than 10
b. 11-17
c. 18-24
d. 25-30

Answer 5

c

a score less than 17 indicates mild severity, 18 to 24 indicates moderate severity, and 25 to 30 indicates moderate to severe severity.

Question 6

When discussing various types of anxiolytic medications with a client, the nurse recognizes that which medication has the lowest potential for misuse?

a. Alprazolam
b. Diazepam
c. Buspirone
d. Lorazepam

Answer 6

c

Buspirone is a nonbenzodiazepine medication that does not have misuse potential. Benzodiazepines such as alprazolam, lorazepam, and diazepam have misuse potential and may become addictive.

Question 7

Nursing interventions for physical stress related illness should include what?

a. Assessing the need for increased dose of benzodiazepines
b. Attending group therapy
c. Establishing daily routines of meals and sleeping
d. Fostering use of a social support system

Answer 7

c

Individuals experiencing or at risk for untoward stress responses may benefit from a number of biologic interventions. The importance of (re-)establishing regular routines for activities of daily living (e.g., eating, sleeping, self-care, and leisure time) cannot be overstated. As well as ensuring adequate nutrition, sleep and rest, and hygiene, a routine may help to structure an individual’s time and give them a sense of personal control or mastery.

Question 8

A nurse is preparing a plan of care for a client with anxiety. Which elements would the nurse likely include? Select all that apply.

a. Using appropriate coping skills
b. Identifying treatment modalities
c. Involving family for support, if appropriate
d. Providing supportive feedback
e. Using restraint when panic develops

Answer 8

a, b, c, d

Appropriate measures to include in the plan of care for a client with anxiety include: introducing appropriate coping skills, identifying alternate treatment modalities, involving family and support persons when appropriate, and providing feedback that is supportive to the client. Restraint is always a last resort.

Question 9

An adolescent client reveals that they are about to take a math test from their tutor. Nursing assessment reveals mild anxiety. The nurse explains that this level of anxiety does what?

a. Will interfere with their cognitive abilities
b. Is conducive to concentration and problem solving
c. May be transferred to their tutor and result in test anxiety
d. Is pathologic and warrants postponing the test

Answer 9

b

Mild anxiety is often helpful to individuals and can assist in maintaining concentration and problem-solving abilities. Moderate to severe anxiety can begin to inhibit an individual’s coping because these levels create physiologic responses (such as tachycardia and sweating) and psychological responses (such as loss of concentration and inability to focus) that may prevent the person from functioning adequately, interfere with cognitive abilities, and become pathologic if not treated adequately.

Question 10

A client comes to the emergency department because they think they are having a 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 a nurse to ask?

a “Are you feeling much better now that you are lying down?”
b. “What did you experience just before and during the attack?”
c. “Do you think you will be able to drive home?”
d. “What do you think caused you to feel this way?”

Answer 10

b

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 they feel better provides no information for the nurse and lying down may or may not be effective. Asking the client if they think they 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 11

A client comes in for a therapy session and begins to have a panic attack. The therapist asks the client to sit in the chair and then gently asks the client to imagine the client in a very safe and calm place. This technique, often useful in anxiety disorders, is called what?

a. Decatastrophizing
b. Guided imagery
c. Desensitization
d. Progressive relaxation

Answer 11

b

Guided imagery involves imagining a safe, enjoyable place to relax. In desensitization, the therapist progressively exposes the client to the threatening object in a safe setting until the client’s anxiety decreases. Decatastrophizing involves the therapist’s use of questions to more realistically appraise the situation. In progressive relaxation, the client progressively tightens, holds, and then relaxes muscle groups while letting tension flow from the body through rhythmic breathing.

Question 12

A nurse is caring for an adult client diagnosed with an anxiety disorder. Which intervention(s) would be appropriate for the nurse to implement for the client? Select all that apply.
a. Leave the client alone during a panic attack.
b. Help the client focus on deep breathing.
c. Teach the client to use relaxation techniques.
d. Provide a safe environment.
e. Engage the client to explore how to decrease stressors.

Answer 12

b, c, d, e

Appropriate nursing actions for the nurse caring for a client diagnosed with an anxiety disorder include providing a safe environment, ensuring the client’s privacy during a panic attack, remaining with the client during a panic attack, helping the client focus on deep breathing, talking to the client in a calm and reassuring voice, teaching the client to use relaxation techniques, helping the client to use cognitive restructuring techniques, and engaging the client to explore how to decrease stressors and anxiety-provoking situations. Therefore, all actions provided are appropriate except leaving the client alone during a panic attack, which is contraindicated.

Question 13

Which question in the assessment of a client with anxiety is most clinically appropriate?

a. “What can I give you to make you feel less anxious right now?”
b. “Does your anxiety make you feel less valuable and competent as a person?”
c. “Do you think that you’re justified in feeling anxious right now?”
d. “How do you feel about everything that is happening in your life right now?”

Answer 13

c

An open-ended question that prompts the client to describe their current feelings is a useful assessment technique. Offering medications or other solutions, asking if the client feels justified in their feelings, and questioning the client’s self-worth are not normally appropriate, or effective, assessment techniques.

Question 14

The nurse reviews progressive muscle relaxation with a client who experiences panic attacks. Which client action(s) indicate to the nurse that teaching was effective? Select all that apply.

a. lays down on the floor
b. removes eyeglasses and shoes
c. plans 20–30 minutes for the activity
d. plays soft music while engaged in the activity
e. focuses on a muscle group for 5–10 seconds

Answer 14

a, b, c, e

Progressive muscle relaxation are helpful methods to learn to differentiate muscle tension from muscle relaxation. When performing the activity, the client should be in a comfortable position such as lying on the floor. Restrictive items such as eyeglasses and shoes should be removed. The activity should take 20–30 minutes of uninterrupted time. Each muscle group should be focused on for 5–10 seconds. Music should not be played when engaging in the activity.

Question 15

The nurse explains the purpose of a daily goals sheet to a client experiencing moderate anxiety. Which action would the nurse implement in consideration of the client’s level of anxiety?

a. Use short, simple terms to explain the purpose of the activity.
b. Repeat the explanation of the activity three times.
c. Postpone the activity until the client is calm.
d. Provide a detailed explanation of the activity.

Answer 15

a

With moderate anxiety, the client’s attention can wander, and they may have some difficulty concentrating over time. Speaking in short, simple, and easy-to-understand sentences is effective; the nurse must stop to ensure that the client is still taking in the information correctly. Repeating the explanation or providing detailed explanations is likely to be less effective because it will likely increase their anxiety. Postponing the activity does not allow the nurse or the client to utilize coping strategies to complete tasks and it may be unreasonable to expect the client to be calm.

Question 16

An adult client being admitted to the psychiatric-mental health unit is experiencing severe anxiety. What is the nurse’s priority action for the client?
a. Encourage the client to problem solve.
b. Leave the client alone.
c. Teach relaxation techniques.
d. Decrease the client’s anxiety level.

Answer 16

d

When anxiety becomes severe, the client can no longer pay attention or take in information. The nurse’s goal must be to lower the person’s anxiety level to moderate or mild before proceeding with anything else. The client will not be able to problem solve or learn while experiencing severe anxiety. The nurse should stay with the client, not leave them alone, while experiencing severe anxiety because of the safety risks present. Therefore, the nurse’s priority action is to decrease the client’s anxiety level.

Question 17

The nurse is caring for a client diagnosed with anxiety disorder. The client is demonstrating difficulty concentrating and is preoccupied with feelings of helplessness. When creating the plan of care, which goal would be most appropriate for this client?

a. The client will identify the source of anxiety.
b. The client will avoid stimuli that induces anxiety.
c. The client will display ability to cope with anxiety.
d. The client will show interest in activities.

Answer 17

c.

Coping is a process used by individuals to manage anxiety, and may be effective or ineffective. Anxiety disorders are diagnosed when anxiety no longer functions as a signal of danger, or a motivation for needed change but becomes chronic and permeates major portions of the person’s life, resulting in maladaptive behaviors and emotional disability. Nurses encounter anxious clients and families in a variety of situations. The nurse must first assess the person’s anxiety level because this determines what interventions are likely to be effective. When working with an anxious person, the nurse must remain calm and in control. The goal for the client with anxiety is ultimately to be able to cope with anxiety. During the treatment the client will have to identify the source of anxiety, be able to adapt to stimuli that produces anxiety, and show interest in activities that previously caused anxiety.

Question 18

The nurse can be confident that the client diagnosed with an anxiety disorder will respond well to treatment when which of the following situations or conditions are present?

a. The client states, “I understand my symptoms and what I need to do to help myself, and I’m ready to do it so I’m back to normal.”
b. The client has a family that is truly willing and capable of supporting them during the treatment
c. The client readily agrees to immediately notify the mental health care team if symptoms reoccur after discharge
d. The client has a no history of other psychiatric disorders

Answer 18

a

Clients who respond well to treatment generally self-disclose an understanding of their clinical symptoms, are able to identify causes, and exhibit coping skills to promote behavioral change. This is evident when the client states, “I understand what I need to do, and I’m ready to do it so I’m back to normal.”

Question 19

The most important factor in the person’s stress response is what?

a. Strength of the immune system
b. Supportive friends
c. Relaxation techniques
d. Adaptive coping strategies

Answer 19

d.

The most important factor in a person’s stress response is the ability of engage in adaptive coping behaviors. This ability can assist a person in developing resilience, or the ability to “bounce back” when faced with stress and stressful situations. The immune system, having a supportive network of friends, and understanding of relaxation techniques are also influencing factors when considering how an individual responds to stress; however, the correct option relates to an internal, sustainable strength that comes from adaptive coping.

Question 20

The nurse is providing care for a psychiatric–mental health client who has a diagnosis of anxiety. Which statement by the nurse is likely the most therapeutic intervention?

a. “Anxiety is a feeling that is experienced by everyone at some point and it can never be completely removed from one’s life.”
b. “With the development of more life skills and a demonstration of continued success in life, your anxiety will shrink and eventually disappear.”
c. “Every time you feel anxious, try to focus on how much easier your life would be if you didn’t experience anxiety so often.”
d. “If you address the causes of your anxiety head-on, you will find that you can recover from it without medications or therapy.”

Answer 20

a

It is therapeutic to foster in clients the understanding that the experience of anxiety is natural and inevitable. It would be inaccurate to promise recovery with increased success in life and self-discipline. Clients with anxiety are likely to be well aware of how much easier their lives would be without recurring anxiety.

Question 21

Which medication classification has been found to be effective in reducing or eliminating panic attacks?

a. Antidepressants
b. Anticholinergics
c. Antipsychotics
d. Antimanics

Answer 21

a

Tricyclic and monoamine oxidase inhibitor antidepressants have been found to be effective in treating clients with panic attacks. Why these drugs help control panic attacks is not clearly understood. Anticholinergic agents, which are smooth-muscle relaxants, relieve physical symptoms of anxiety but do not relieve the anxiety itself. Antipsychotic drugs are inappropriate because clients who experience panic attacks are not psychotic. Mood stabilizers are not indicated because panic attacks are rarely associated with mood changes.

Question 22

The nurse finds a client pacing the hallway with an anxious expression. Which automatic physical assessment data would the nurse expect to see?
a. dilated pupils
b. facial pallor
c. lower heart rate
d. hyperactive bowel sounds

Answer 22

a

Autonomic nervous system responses to anxiety generate sympathetic nerve stimulation and adrenaline (epinephrine) release, which causes the body to take in more oxygen, dilate the pupils, and increase arterial pressure and heart rate while constricting the peripheral vessels and shunting blood from the gastrointestinal system. This response causes dilated pupils, flushed facial skin, elevated heart rate, and hypoactive bowel sounds.

Question 23

An adult client diagnosed with panic disorder is being counseled in the clinic. The nurse teaches the client that when they are experiencing severe anxiety or panic, instead of thinking, “I am going to die,” the client learns to think, “This is anxiety, and it will go away.” Which technique is the nurse utilizing with the client?
a. dialectical behavioral therapy
b. assertiveness training
c. de-catastrophizing
d. positive reframing

Answer 23

d.

Cognitive-behavioral therapy (CBT) is used successfully to treat anxiety disorders. Positive reframing means turning negative messages into positive messages. The therapist teaches the client to create positive messages for use during panic episodes. For example, instead of thinking, “My heart is pounding. I think I’m going to die,” the client thinks, “I can stand this. This is just anxiety. It will go away.” De-catastrophizing involves the therapist’s use of questions to appraise the situation more realistically. The therapist may ask, “What is the worst thing that could happen? Is that likely? Could you survive that? Is that as bad as you imagine?” The client uses thought-stopping and distraction techniques to jolt themselves from focusing on negative thoughts. Assertiveness training helps the person take more control over life situations. These techniques help the person negotiate interpersonal situations and foster self-assurance. They involve using “I” statements to identify feelings and to communicate concerns or needs to others. Examples include “I feel angry when you turn your back while I’m talking.” Dialectical behavioral therapy (DBT) is not the therapy of choice for anxiety disorders. The client in the scenario is learning to use positive reframing.

Question 24

A nurse is providing a client information about the etiology of generalized anxiety disorder (GAD). The client demonstrates understanding of this information when they identify which item as representing the basis for this disorder?

a. Inaccurate environmental danger assessment
b. Exposure to multiple stressful life events
c. Kindling caused by overstimulation
d. Intense worry and stress about life

Answer 24

d

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 25

The nurse has read in a client’s admission record that the client has been taking propranolol for psychiatric, rather than medical, reasons. The nurse should recognize that the client likely has a history of which mental health condition?

a. Obsessive–compulsive disorder (OCD)
b. Panic disorder
c. Acute stress disorder
d. Nightmares

Answer 25

b

Propranolol is used in the treatment of panic disorder, but it is not a common pharmacological intervention for OCD, acute stress disorder, or nightmares.

Question 26

A client with a specific phobia of spiders is seeing a therapist for the first session of treatment. The therapist hands the client a clear container with a large house spider inside. This activity is repeated continuously until the client’s fear subsides. Which strategy is being used to treat the client’s specific phobia?

a. biofeedback
b. flooding
c. decatastrophizing
d. assertiveness training

Answer 26

b

Flooding is a form of rapid desensitization in which a behavioral therapist confronts the client with the phobic object until it no longer produces anxiety. The goal is to rid the client of the phobia within two sessions. Biofeedback is a slower form of therapy that uses reframing of thought. Decatastrophizing helps the client confront a “worst-case” scenario but is not used in confronting phobias. Assertiveness training would not be used for phobia treatment since it will not be effective.

Question 27

The nurse recognizes that which client is most likely experiencing generalized anxiety disorder (GAD)?

a. 40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months
b. 22-year-old soldier who served in the Middle East who “cannot sleep” and is facing criminal charges for hurting someone in a barroom brawl
c. 70-year-old whose spouse died 1 year ago who has “no desire to leave my house” and reports severe fatigue
d. 30-year-old business executive who reports being anxious about attending the meetings and social events that are the executive’s job responsibilities

Answer 27

a

The nurse recognizes that the client most likely experiencing GAD is a 40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months. GAD is characterized by excessive worry and feelings of anxiety at least 50% of the time for 6 months or more. The client with GAD has three or more of the following symptoms: uneasiness, irritability, muscle tension, fatigue, difficulty thinking, and sleep alterations.

The military veteran is most likely experiencing posttraumatic stress disorder (PTSD), the older adult may be experiencing depression, and the business executive may have social phobia.

Question 28

The nurse is with a client while having a magnetic resonance imaging (MRI) study when the client begins to have a panic attack. Which is the primary concern for this client that the nurse will immediately address?

a. moving off of the MRI table
b. the heart rate of 128 beats per minute
c. experiencing profuse diaphoresis
d. voiding incontinently

Answer 28

a

During panic-level anxiety, the person’s safety is the primary concern. The client cannot perceive potential harm and may have no capacity for rational thought. The client’s prevention of harm and safety needs will be addressed prior to any other issue. Emotional needs, physiologic needs, and social support are important but not the primary concern.

Question 29

Which is considered a tricyclic antidepressant (TCA) used in the treatment of clients with panic disorder?

a. Imipramine
b. Fluoxetine
c. Sertraline
d. Lorazepam

Answer 29

a

The TCAs include imipramine, nortriptyline, and norpramine. Fluoxetine and sertraline are selective serotonin reuptake inhibitors (SSRIs). Lorazepam is a benzodiazepine.

Question 30

When assessing an older adult client who has newly been diagnosed with an anxiety disorder, the mental health nurse’s priority is to carry out which task?

a. Determine the client’s risk for self-harm or harm to others
b. Obtain a thorough history, focusing on the client’s physiologic functioning
c. Assess for physical conditions that may affect anxiety
d. Determine the effects that culture has had on the client’s anxiety issues

Answer 30

a

The first step in the assessment process is to identify the client’s level of anxiety and to determine whether a threat of self-harm or harm to others exists. In any situation where the client history is not known, the nursing priority is safety.

Question 31

If a client is experiencing “moderate” anxiety. Which clinical manifestation(s) will a nurse observe? Select all that apply.

a. They can sustain attention on a particular focus.
b. They verbally state, “For some reason, I am feeling anxious now.”
c. They may have flights of ideas and confusion noted.
d. Because of inadequacy of observed data, they make distorted inferences.
e. They may pace, run, or fight violently if asked to perform a task they do not want to perform.

Answer 31

a. b

With “moderate” anxiety, the client sees, hears, and grasps less than previously. The client can attend to more if directed to do so. They are able to sustain attention on a particular focus, selectively inattentive to contents outside the focal area. Usually able to state, “I am anxious now.” With severe anxiety, inferences drawn may be distorted because of inadequacy of observed data. With panic, the client has feelings of unreality, flights of ideas or confusion, and fear. They often repeat a detail. Many relief behaviors used automatically (without thought). The enormous energy produced by panic must be used and may be mobilized as rage. In this cases, the client may pace, run, or fight violently.

Question 32

Which factor has the least influence on achieving mental health for the client who has anxiety disorder?

a. The client’s parent also suffered from an anxiety disorder.
b. The client was raised in a household with high stress and frequent geographic moves.
c. The client’s parent often related to the client in ways that reflected the parent’s high level of anxiety.
d. The client is often late to school and makes poor grades in most of the client’s subjects.

Answer 32

d

Being late to school and making poor grades are behaviors that indicate that the client is having difficulty; they are not factors influencing the development of the client’s anxiety disorder.

Question 33

The nurse is caring for a client with a panic disorder. For which first-line medication would the nurse prepare teaching for this client?
a. sedatives
b. benzodiazepines
c. selective serotonin reuptake inhibitors (SSRIs)
d. serotonin–norepinephrine reuptake inhibitors (SNRIs)

Answer 33

c.

Selective serotonin reuptake inhibitors (SSRIs) are recommended as the first drug option in the treatment of clients with a panic disorder. They have the best safety profile and side effects will occur early in treatment before the therapeutic effect takes place. Sedatives are not used to treat a panic disorder. Benzodiazepines are useful in treating intensely distressed clients; however, benzodiazepines have the risk for withdrawal symptoms upon discontinuation of use. They are commonly used even though the SSRIs are recommended for first-line treatment of the disorder. Serotonin–norepinephrine reuptake inhibitors (SNRIs) increase levels of both serotonin and norepinephrine by blocking their reuptake presynaptically. This group of medications is not identified as being the first-line treatment for a panic disorder.

Question 34

The nurse is caring for a client that is diagnosed with an anxiety disorder. The client reports chest pain and has dilated pupils, a heart rate of 126, and a BP of 168/102 mmHg. Which stage of anxiety does the nurse document the client is experiencing?

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

Answer 34

d

The client with panic level of anxiety has dilated pupils, elevated heart rate and blood pressure, and dilated pupils. The client with a mild level of anxiety is a positive state of heightened awareness and sharpened senses, allowing the person to learn new behaviors and solve problems. A moderate level of anxiety involves a decreased perceptual field (focus on immediate task only); the person can learn new behavior or solve problems only with assistance. Another person can redirect the person to the task. Severe anxiety involves feelings of dread or terror. The person cannot be redirected to a task; they focus only on scattered details and has physiologic symptoms of tachycardia, diaphoresis, and chest pain. A person with severe anxiety may go to an emergency department, believing they are having a heart attack.

Question 35

Which nursing assessment is most appropriate for an older client presenting with reports of generalized anxiety?

a. assess for depression
b. assess for panic attacks
c. assess for elder abuse
d. assess for dementia

Answer 35

a

Late-onset generalized anxiety disorder (GAD) is usually associated with depression. Although less common, panic attacks can occur in later life and are often related to depression or a physical illness such as cardiovascular, GI, or chronic pulmonary diseases. While the remaining options are appropriate, they are not associated with the possible comorbid conditions of GAD.

Question 36

A client diagnosed with anxiety disorder has been prescribed benzodiazepine drugs. The nurse is explaining the possible side effects of the medications. Which side effects of the drug explained by the nurse is correct? Select all that apply.

a. Agitation
b. Dry mouth
c. Blurred vision
d. Constipation
e. Vomiting

Answer 36

b. c. d

Dry mouth, blurred vision, and constipation are known side effects of benzodiazepines. Agitation and vomiting are not known to occur with benzodiazepines. These side effects are associated with nonbenzodiazepine drugs that are used to treat anxiety like buspirone.

Question 37

The parent of an adolescent is hesitant to have the child treated for anxiety. Which potential issue(s) would the nurse explain the client is at risk for developing if the anxiety is not treated? Select all that apply.

a. homelessness
b. suicide ideation
c. early parenthood
d. drug dependence
e. educational underachievement

Answer 37

b, c, d, e
Anxiety disorders are among the most common conditions of children and adolescents. If left untreated, symptoms persist and gradually worsen and sometimes lead to suicide ideation, early parenthood, drug dependence, and educational underachievement. Untreated anxiety is not identified as a potential precursor to homelessness.

Question 38

In speaking with a client with moderate anxiety, the client becomes tangential discussing unrelated topics. To help the client’s attention from wandering, which is an effective intervention?

a. The nurse should speak in short and simple sentences.
b. The nurse should remain with the client until the anxiety is reduced.
c. The nurse should speak in a soft and calm voice.
d. The nurse should take the client to a nonstimulating environment.

Answer 38

a

Speaking in short, simple, and easy-to-understand sentences has been shown to be effective with clients with moderate anxiety whose attention wanders. Not leaving the client alone unless the anxiety is reduced and speaking in a soft voice are interventions used with a client with severe anxiety. If the client has panic-level anxiety, the nurse should give primary attention to the safety of the client and move the client to a nonstimulating environment.

Question 39

A client is diagnosed with panic disorder. When considering the neurochemical theory of the disorder, which would the nurse expect to administer as the drug of choice initially?

a. Selective serotonin reuptake inhibitors
b. Benzodiazepines
c. Antihypertensives
d. Tricyclic antidepressants

Answer 39

a

Serotonin, the indolamine neurotransmitter usually implicated in psychosis and mood disorders. Although antihypertensives and benzodiazepines may be used, the selective serotonin reuptake inhibitors are recommended as the first drug option in the treatment of clients with panic disorder. They have the best safety profile, and if side effects occur, they tend to be present early in treatment before the therapeutic effect takes place. Tricyclic antidepressants are not typically used to treat panic disorder.

Question 40

The nurse is assessing a client with anxiety. What symptom indicates that the the client has adopted a maladaptive behavior in response to stress?

a. Tachycardia
b. Dyspnea
c. Headache
d. Pedal edema

Answer 40

c

Tension headache and pain syndromes in an anxious client indicate that the client has not responded to the stress effectively. Tachycardia and dyspnea are the signs related to the flight and fight response to stress, an automatic physiologic response. Pedal edema is not associated with stress.

Question 41

A client reports experiencing symptoms of stress including nausea, sweating, irritability, and some difficulty sleeping since getting married and becoming a step-parent. The client has always believed symptoms will go away on their own. The nurse is educating the client about stress management. Which statement by the nurse is most appropriate?

a. “Using stress management techniques will help you challenge the validity of your physical symptoms.”
b. “Using stress management techniques will reduce your anxiety until you feel your legs go numb.”
c, “Using stress management techniques will help you focus on what is causing your anxiety.”
d. “Using stress management techniques will help you calm down and relax.”

Answer 41

d

Stress management techniques are meant to reduce anxiety and promote calmness. The goal of using stress management techniques is not to challenge the validity of physical symptoms; this would promote more rumination on the source of the anxiety. Using stress management techniques should not help the client focus on what is causing the anxiety, but rather to distract the client. The client should not strain muscles to the point of numbness.

Question 42

A client admitted to the psychiatric unit describes to the nurse that during a panic attack “I feel like I am going to die, I hyperventilate, I start sweating, it feels like my heart is going to explode. The health care providers say my heart is just fine. “ What will be the nurse’s priority intervention when the client experiences the next panic attack?

a. Assist client to identify triggers for the panic attacks, and monitor for triggers.
b, Teach the client deep-breathing relaxation techniques, and reinforce the use of these techniques.
c, Administer a short-acting benzodiazepine and monitor breathing.
d. Accompany the client to the room, and remain there to provide support.

Answer 42

d

When a client is having a panic attack, the nurse will stay with the client in a less-stimulating environment, such as the client’s room, and maintain a calm but direct and professional manner. Because the client feels flooded with stimuli during a panic attack, the client will not be able to learn new coping techniques or verbalize triggers. Providing a medication such as a benzodiazepine should not be the first choice during a panic attack.

Question 43

A client describes anxiety attacks that usually occur shortly after work when they are preparing an evening meal. Which question would be most appropriate for the nurse to ask the client first in an effort to learn how they can be helped?

a. “Have you tried walking to ease your anxiety?”
b. “What are you thinking about before you start to prepare supper?”
c. “Do you think taking several slow, deep breaths would help?”
d. “What do you do when you’re anxious to help yourself feel better?”

Answer 43

c

The nurse initially helps the client to identify a cause or event that precedes the symptoms of anxiety. Nursing care of an anxious client, however, must ultimately consider all aspects of the client’s anxiety, including what leads to attacks and what happens during an attack. Only then can the nurse help the client understand their anxiety, what personal needs may be unmet, and how to cope with their problem with more satisfactory behavior than having an anxiety attack.
The nurse must first assess the possibility of a trigger for the client’s anxiety before progressing to assessing the client’s coping strategies or educating them regarding adaptive coping.

Question 44

A client has been prescribed alprazolam. Which food should the nurse instruct the client to avoid?

a. coffee
b. cheese
c. alcohol
d. shellfish

Answer 44

c

Using alcohol or any central nervous system depressant while taking a benzodiazepine, such as alprazolam, is contraindicated because of additive depressant effects. Ingestion of cheese or shellfish is not problematic. Coffee in large amounts works against the desired effects of alprazolam but may be consumed in moderation.

Question 45

A client admitted to the unit is visibly anxious. The nurse documents what assessment finding as an expected finding in a client experiencing mild to moderate anxiety?

a. dyspnea
b. chest pain
c. increased heart rate
d. drop in blood pressure

Answer 45

c

During anxiety, the sympathetic nervous system is activated. This can result in increased heart rate and cardiac contractility, leading to an increase in cardiac output and blood pressure (BP = CO x HR). The client’s respiratory rate may increase, but unless the client is experiencing a panic attack, neither dyspnea nor chest pain should be present. If these present with mild anxiety, the nurse would not document these as an expected finding.