Anxiety Related Disorders Flashcards
Which of the following statements regarding the individual responses to trauma and stressors is a positive outcome?
A) Many individuals are unable to cope with the event, manage their stress and emotions, or resume the daily activities of their lives.
B) Some individuals may develop enhanced coping as a result of dealing with the stressor.
C) These events are only significant in individuals who have risk for or actual mental health problems or issues.
D) Large numbers or groups of people may be affected by a traumatic event.
B) Some individuals may develop enhanced coping as a result of dealing with the stressor
Rationale: People may experience events in their lives that are extraordinary in intensity or severity, well beyond the stress of daily life. These traumatic events or stressors would be expected to disrupt the life of anyone who experienced them, not just individuals at risk for mental health problems or issues. These events and stressors may affect individuals or large numbers and groups of people. While all persons experiencing events such as these manifest anxiety, insomnia, difficulty coping, grief, or any variety of responses, most work through the experience and return to their usual level of coping and equilibrium perhaps even enhanced coping as a result of dealing with the event.
What is the major difference between posttraumatic stress disorder (PTSD) and acute stress disorder?
A) In acute stress disorder, the client is likely to develop exacerbation of symptoms.
B) In PTSD, the recovery rate is 80% within 3 months.
C) The severity and duration of the trauma are the most important variables in acute stress disorder.
D) In PTSD, the symptoms occur 3 months or more after the trauma.
D) In PTSD, the symptoms occur 3 months or more after the trauma
Rationale: In acute stress disorder, the symptoms occur 2 days to 4 weeks after a traumatic event and are resolved within 3 months of the event. In PTSD, the symptoms occur 3 months or more after the trauma. In PTSD, the client is likely to develop exacerbation of symptoms. The severity and duration of the trauma and the proximity of the person to the event are the most important factors affecting the likelihood of developing PTSD. In PTSD, complete recovery occurs within 3 months for about 50% of people.
Which of the following statements about posttraumatic stress disorder is accurate?
A) Estimates are that the disorder is very rare.
B) Estimates are that up to 60% of people at risk develop PTSD.
C) Only 20% of victims of rape develop PTSD.
D) PTSD symptoms usually begin at the time of the trauma
B) Estimates are that up to 60% of people at risk develop PTSD
Rationale: Estimates are that up to 60% of people at risk develop PTSD
Which of the following might the nurse recognize as longer-term responses to trauma and stress? Select all that apply.
A) Acute stress disorder
B) Posttraumatic stress disorder
C) Adjustment disorder
D) Reactive attachment disorder
E) Dissociative disorder
B) Posttraumatic stress disorder
C) Adjustment disorder
D) Reactive attachment disorder
E) Dissociative disorder
Rationale: Acute stress disorder usually occurs from 2 days to 4 weeks after a trauma. Posttraumatic stress disorder usually begins 3 months after the trauma. All of the rest of these are longer-term responses to trauma and stress.
Which of the following would the nurse know are the major elements of posttraumatic stress disorder (PTSD)? Select all that apply.
A) Trying to avoid any places or people or situations that may trigger memories of
the trauma
B) Reexperiencing the trauma through dreams or recurrent and intrusive thoughts
C) Becoming increasingly more isolated
D) Emotional numbing such as feeling detached from others
E) Being on guard, irritable, or experiencing hyperarousal
B) Reexperiencing the trauma through dreams or recurrent and intrusive thoughts
D) Emotional numbing such as feeling detached from others
E) Being on guard, irritable, or experiencing hyperarousal
Rationale: The three major elements of PTSD are reexperiencing the trauma through dreams or recurrent and intrusive thoughts, showing emotional numbing such as feeling detached from others, and being on guard, irritable, or experiencing hyperarousal. The client may also experience a numbing of general responsiveness and may try to avoid any places or people or situations that may trigger memories of the trauma, but these are not the major elements of PTSD.
Which of the following are events that a person may experience, witness, or be confronted by that may trigger posttraumatic stress disorder (PTSD)? Select all that apply.
A) Being a survivor of a tsunami that resulted in thousands of deaths
B) Being stranded at the office during a typical winter storm that was anticipated
C) Being a marine in a combat situation where the entire platoon was wiped out
except for one person
D) Being hidden in a closet and hearing the entire family murdered by someone who broke into the home
E) Watching televised segments of the moment when the plane hit the second tower on 9/11
A) Being a survivor of a tsunami that resulted in thousands of deaths
C) Being a marine in a combat situation where the entire platoon was wiped out except for one person
D) Being hidden in a closet and hearing the entire family murdered by someone who broke into the home
E) Watching televised segments of the moment when the plane hit the second tower on 9/11
Rationale: Examples of events that may cause PTSD include someone experiencing, witnessing, or being confronted by a traumatic event such as a natural disaster, combat, or an assault. The person with PTSD was exposed to an event that posed actual or threatened death or serious injury and responded with intense fear, helplessness, or terror. Being a survivor of a tsunami that resulted in thousands of deaths, being a marine in a combat situation where the entire platoon was wiped out except for one person, and being hidden in a closet and hearing the entire family murdered by someone who broke into the house would be situations where the person was exposed to an event that posed actual or threatened death or serious injury and responded with intense fear, helplessness, or terror.
Three years after the death of her father in an ICU, the infection prevention nurse was visiting an ICU in a different hospital to complete a chart review. At one point, the nurse looked at a bed where the patient who had the same diagnosis as her father had and saw her father’s facial features on the patient and had a sense of panic. In a few moments, the nurse realized that the patient in the bed was not her father. Which of these manifestations of PTSD was this nurse experiencing?
A) A flashback
B) Emotional numbing
C) Hyperarousal
D) A dream
A) A flashback
Rationale: This nurse was experiencing a flashback where similar circumstances triggered a sensation that the stressful experience were happening again.
A client is seeking counseling due to difficulty coping with being a victim of a violent attack 16 months ago. The initial medical diagnosis is to rule out posttraumatic stress disorder (PTSD). Which would the nurse assess for when determining the major elements of PTSD? Select all that apply.
A) Reexperiencing the trauma through dreams or recurrent and intrusive thoughts
B) Showing emotional numbing such as feeling detached from others
C) Being on guard, irritable, or experiencing hyperarousal
D) Feeling mildly anxious
E) Occurs 2 weeks after the trauma
A) Reexperiencing the trauma through dreams or recurrent and intrusive thoughts
B) Showing emotional numbing such as feeling detached from others
C) Being on guard, irritable, or experiencing hyperarousal
Rationale: The three major elements of PTSD are reexperiencing the trauma through dreams or recurrent and intrusive thoughts, showing emotional numbing such as feeling detached from others, and being on guard, irritable, or experiencing hyperarousal. Feeling mildly anxious is not a major element of PTSD as the person is likely to feel very anxious. Occurring 2 weeks after the trauma would likely be acute stress disorder as PTSD symptoms occur 3 months or more after the trauma
A man is discovered wandering the street, looking confused and stepping out into traffic. When emergency responders approach the man, he cannot recall his name or where he lives. The responders transport the man to the mental health crisis unit for further evaluation. Which of the following are the man most likely suffering from? Select all that apply.
A) Depersonalization disorder
B) Dissociative identity disorder
C) Repressed memories
D) Dissociative amnesia
E) False memory syndrome
A) Depersonalization disorder
B) Dissociative identity disorder
D) Dissociative amnesia
Rationale: With dissociative amnesia, the client cannot remember important personal information. With dissociative personality disorder, the client displays two or more distinct identities or personality states that recurrently take control of his or her behavior. With depersonalization disorder, the client has persistent or recurring feeling of being detached from his or her mental processes or body (depersonalization) or sensation of being in a dream-like state where the environment seems foggy or unreal (derealization). The client is not psychotic or out of touch with reality. Repressed memories are when a person is unable to consciously recall memories of childhood abuse. False memory syndrome can occur during psychotherapy when the client is encouraged to imagine false memories of childhood sexual abuse.
The police find a woman wandering around a parking lot, singing very loudly. They bring her to the hospital; she has no knowledge of what she has been doing for the past 12 hours and is dressed in unfamiliar clothing. This is an example of:
A. Dissociation
B. Manipulation
C. Psychosis
D. Regression
A. Dissociation
Rationale: The client experienced a temporary alteration in conscious awareness. This situation is not an example of manipulation. The woman is not experiencing psychosis. Regression occurs when there is a retreat to an earlier stage of development and comfort.
Which of the following statements by the nurse would be most appropriate to a colleague who very quietly and numbly tells the nurse that she had arrived at the scene of an automobile pedestrian accident and unsuccessfully performed CPR on a victim 3 days ago? The nurse and her colleague are sitting in the break room and no one else is present.
A) Tell me what you saw.
B) That is horrible!
C) Why did you perform CPR?
D) I know how you feel; the same thing happened to me several years ago and I never recovered.
A) Tell me what you saw.
Rationale: One of the most effective ways of avoiding pathologic responses to trauma is effectively dealing with the trauma soon after it occurs. Describing what the colleague saw may be very helpful to him or her. That is horrible, is a judgment and is not likely to be helpful. Why did you perform CPR, might make the colleague feel defensive. I know how you feel; the same thing happened to me several years ago and I never recovered, is nonsupportive and robs the colleague of any hope that he or she will recover.
Which of the following outcomes would take priority for a client who has survived trauma or abuse? Select all that apply.
A) The client will demonstrate healthy, effective ways of dealing with the stress.
B) The client will be physically safe.
C) The client will establish a social support system in the community.
D) The client will distinguish between ideas of self-harm and taking action on those ideas.
E) The client will express emotions nondestructively.
B) The client will be physically safe.
D) The client will distinguish between ideas of self-harm and taking action on those ideas.
Rationale: It is the highest priority that the client be physically safe. Because persons who have survived trauma or abuse may have thoughts of self-harm, it is also critical that the client will distinguish between ideas of self-harm and taking action on those ideas. The other objectives are not as high a priority as safety and ideas of self-harm.
A fireman survived a fire after escaping a blaze. Several other firefighters were trapped in the burning building and died. After working with this firefighter in counseling, the nurse evaluates which of the following as positive outcomes for this client? Which will the nurse evaluate as positive outcomes for this client? Select all that apply.
A) The client will verbalize feelings of stress related to returning to work.
B) The client will express guilt openly through nondestructive means.
C) The client will identify a social support system within the community.
D) The client will report nightmares and flashbacks of the fire.
A) The client will verbalize feelings of stress related to returning to work.
B) The client will express guilt openly through nondestructive means.
C) The client will identify a social support system within the community.
Rationale: Treatment outcomes for clients who have survived trauma or abuse may include verbalizing feelings, expressing emotions nondestructively, and establishing a social support system in the community. An absence of stress is an unrealistic outcome. Reporting symptoms of PTSD such as nightmares and flashbacks does not indicate positive treatment outcomes.
Which of the following is true about the use of touch with a client with dissociative identity disorder?
A) It is best not to touch the client without his or her permission.
B) Make sure the client knows the touch is friendly and supportive.
C) Touch the client only if you are in his or her direct line of vision.
D) Touching will convey a sense of security to the client.
A) It is best not to touch the client without his or her permission.
Rationale: Clients interpret touch differently, so it is important to assess each client’s comfort with being touched; these clients often have a history of abuse, so permission should be given before touch is used.
Which of the following interventions would be most effective for friends and family members to implement in order to boost the self-esteem of a person who has just experienced trauma or abuse?
A) To identify a list of support people or activities in the community
B) To remind them to calm down when they appear to be experiencing a flashback
C) To encourage them to tell their story repeatedly to everyone they meet
D) To help them to refocus their view of themselves from being victims to being survivors
D) To help them to refocus their view of themselves from being victims to being survivors
Rationale: Often it is useful to view the client as a survivor of trauma or abuse rather than as a victim. For these clients, who believe they are worthless and have no power over the situation, it helps to refocus their view of themselves from being victims to being survivors. Defining themselves as survivors allows them to see themselves as strong enough to survive their ordeal. It is a more empowering image than seeing oneself as a victim. It would be beneficial for the client to identify a list of support people or activities in the community, but this would be to establish social support and not promote their self-esteem. It would not be helpful for anyone to tell the client to calm down when he or she appears to be experiencing a flashback or to encourage him or her to tell his or her story repeatedly.
A nurse is providing education about trauma and its effects to a community group in a community that has just been hit by a devastating tornado. One of the participants asked about what kind of support a survivor of the tornado will need. Which would be the best response of the nurse?
A) If a person is willing to share his or her feelings about what has happened, he or she is not dealing with their feelings effectively.
B) It is counterproductive for people to share what has happened to them and their feelings about it as there is nothing more to be done.
C) If a person is reluctant to share his or her feelings, he or she may be denying his or her importance and may be at increased risk for future problems such as PTSD.
D) It is best to wait until a survivor’s life has returned to normal before dealing with the trauma.
C) If a person is reluctant to share his or her feelings, he or she may be denying his or her importance and may be at increased risk for future problems such as PTSD.
Rationale: Some people more easily express their feelings and talk about stressful, upsetting, or overwhelming events. They may do so with family, friends, or professionals. Others are more reluctant to open up and disclose their personal feelings. They are more likely to ignore the feelings, deny their importance, or insist ìI’m fine, I’m over it.î By doing that, they increase the risk for future problems such as PTSD. One of the most effective ways of avoiding pathologic responses to trauma is effectively dealing with the trauma soon after it occurs.
Which of the following should be an action of a nurse who is having feelings of judgment regarding a client’s contributory behavior to an automobile accident that resulted in deaths?
A) Discussing the nurse’s personal feelings with a peer or a counselor
B) Acknowledging the judgment regarding the client’s contributory behavior to the client
C) Sharing the client’s horror and encouraging him or her to avoid thinking about it
D) Letting the client know that he or she is now traumatized beyond repair
A) Discussing the nurse’s personal feelings with a peer or a counselor
Rationale: When the traumatized client causes a car accident that injured or killed others, it may be more challenging to provide unconditional support and withhold judgment of the client’s contributory behavior. Remaining nonjudgmental of the client is important, but does not happen automatically. The nurse may need to deal with personal feelings by talking to a peer or counselor. If the nurse is overwhelmed by the violence or death in a situation, the client’s feelings of being victimized to traumatized beyond repair are confirmed. Conveying empathy and validating client’s feelings and experiences in a calm, yet caring professional, manner are more helpful than sharing the client’s horror.
The nurse knows that which of the following are stages in Selye’s general adaptation syndrome? Select all that apply.
A) Alarm reaction stage
B) Resistance stage
C) Coping stage
D) Exhaustion stage
E) Panic stage
A) Alarm reaction stage
B) Resistance stage
D) Exhaustion stage
Rationale: The stages in Selye’s general adaptation syndrome include the alarm reaction stage, the resistance stage, and the exhaustion stage. Selye did not identify either a coping stage or a panic stage.
The nurse knows that which one of the following statements is true about stress and anxiety?
A) All people handle stress in the same way.
B) Stress is a person’s reaction to anxiety.
C) Anxiety occurs when a person has trouble dealing with life situations, problems, and goals.
D) Stress is the wear and tear that life causes on the body.
D) Stress is the wear and tear that life causes on the body.
Rationale: Stress is the wear and tear that life causes on the body. It occurs when a person has difficulty dealing with life situations, problems, and goals. Each person handles stress differently. Anxiety is a vague feeling of dread or apprehension; it is a response to external or internal stimuli that can have behavioral, emotional, cognitive, and physical symptoms. Anxiety is a response to stress.
The nursing student answers the test item correctly when identifying which one of the following statements is true?
A) Anxiety and fear are the same.
B) Anxiety is unavoidable.
C) Anxiety is always harmful.
D) Fear is feeling threatened by an unknown entity.
B) Anxiety is unavoidable.
Rationale: Anxiety is distinguished from fear, which is feeling afraid or threatened by a clearly identifiable external stimulus that represents danger to the person. Anxiety is unavoidable in life and can serve many positive functions such as motivating the person to take action to solve a problem or to resolve a crisis.
The student nurse correctly identifies that which one of the following statements applies to the parasympathetic nervous system?
A) It is activated during the alarm reaction stage.
B) It is activated during the resistance stage.
C) It is activated during the exhaustion stage.
D) It is commonly referred to as the fight, flight, or freeze response.
B) It is activated during the resistance stage.
Rationale: In the alarm reaction stage, stress stimulates the body to send messages to the hypothalamus to the glands, which stimulates the sympathetic nervous system. Sympathetic nerve fibers ìcharge upî the vital signs at any hint of danger to prepare the body’s defensesófight, flight, or freeze. The adrenal glands release adrenaline (epinephrine), 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 and reproductive systems and increasing glycogenolysis to release free glucose for the heart, muscles, and central nervous system. When the danger has passed, parasympathetic nerve fibers reverse this process and return the body to normal operating conditions until the next sign of threat reactivates the sympathetic nervous system. During the resistance stage of the generalized anxiety syndrome, if the threat has ended, the parasympathetic nervous system is stimulated and the body responses relax. If the threat persists, the body will eventually enter the exhaustion stage when the body stores are depleted as a result of the continual arousal of the physiologic responses and little reserve capacity.
The nurse plans to teach a client about dietary modifications to manage diabetes. Teaching would be most effective if the client displayed which one of the following characteristics?
A) Focusing only on immediate task
B) Faster rate of speech
C) Narrowed perceptual field
D) Heightened focus
D) Heightened focus
Rationale: Mild anxiety is associated with increased learning ability. It involves a sensation that something is different and warrants special attention. Sensory stimulation increases and helps the person focus attention to learn, solve problems, think, act, feel, and protect himself or herself. Mild anxiety often motivates people to make changes or to engage in goal-directed activity. Focusing only on immediate task, a faster rate of speech, and a narrowed perceptual field are associated with moderate levels of anxiety.
A client says to the nurse, I just can’t talk in front of the group. I feel like I’m going to pass out. The nurse assesses the client’s anxiety to be at which level?
A) Mild
B) Moderate
C) Severe
D) Panic
C) Severe
Rationale: Physiologic responses to severe anxiety include headache, nausea, vomiting, diarrhea, trembling, rigid stance, vertigo, pale, tachycardia, and chest pain.
A student is preparing to give a class presentation. A few minutes before the presentation is to begin, the student seems nervous and distracted. The student is looking at and listening to the peer speaker and occasionally looking at note cards. When the peer speaker asks a question of the group, the student is able to answer correctly. The professor understands that the student is likely experiencing which level of stress?
A) Mild
B) Moderate
C) Severe
D) Panic
B) Moderate
Rationale: Moderate anxiety is the disturbing feeling that something is definitely wrong; the person becomes nervous or agitated. In moderate anxiety, the person can still process information, solve problems, and learn new things with assistance from others. He or she has difficulty concentrating independently but can be redirected to the topic. Mild anxiety is a sensation that something is different and warrants special attention. Sensory stimulation increases and helps the person focus attention to learn, solve problems, think, act, feel, and protect himself or herself. As the person progresses to severe anxiety and panic, more primitive survival skills take over, defensive responses ensue, and cognitive skills decrease significantly. A person with severe anxiety has trouble thinking and reasoning.
A client who suffers from frequent panic attacks describes the attack as feeling disconnected from himself. The nurse notes in the client’s chart that the client reports experiencing
A) hallucinations.
B) depersonalization.
C) derealization.
D) denial.
B) depersonalization
Rationale: During a panic attack, the client may describe feelings of being disconnected from himself or herself (depersonalization) or sensing that things are not real (derealization). Denial is not admitting reality. Hallucinations involve sensing something that is not there.
Which of the following statements about the use of defense mechanisms in persons with anxiety disorders are accurate? Select all that apply.
A) Defense mechanisms are a human’s attempt to reduce anxiety.
B) Persons are usually aware when they are using defense mechanisms.
C) Defense mechanisms can be harmful when overused.
D) Defense mechanisms are cognitive distortions.
E) The use of defense mechanisms should be avoided.
F) Defense mechanisms can control the awareness of anxiety.
A) Defense mechanisms are a human’s attempt to reduce anxiety.
C) Defense mechanisms can be harmful when overused.
D) Defense mechanisms are cognitive distortions.
F) Defense mechanisms can control the awareness of anxiety.
Rationale: Freud described defense mechanisms as the human’s attempt to control awareness of and to reduce anxiety. Defense mechanisms are cognitive distortions that a person uses unconsciously to maintain a sense of being in control of a situation, to lessen discomfort, and to deal with stress. Because defense mechanisms arise from the unconscious, the person is unaware of using them. Some people overuse defense mechanisms, which stops them from learning a variety of appropriate methods to resolve anxiety-producing situations. The dependence on one or two defense mechanisms also can inhibit emotional growth, lead to poor problem-solving skills, and create difficulty with relationships.
Which one of the following can be a positive outcome of using defense mechanisms?
A) Defense mechanisms can inhibit emotional growth.
B) Defense mechanisms can lead to poor problem-solving skills.
C) Defense mechanisms can create difficulty with relationships.
D) Defense mechanisms can help a person to reduce anxiety.
D) Defense mechanisms can help a person to reduce anxiety.
Rationale: Defense mechanisms can help a person to reduce anxiety. This is the only positive outcome of using defense mechanisms. The dependence on defense mechanisms can inhibit emotional growth, lead to poor problem-solving skills, and create difficulty with relationships. These are all negative outcomes of using defense mechanisms.
Which of the following best explains the etiology of anxiety disorders from an interpersonal perspective?
A) Anxiety is learned in childhood through interactions with caregivers.
B) Anxiety is learned throughout life as a response to life experiences.
C) Anxiety stems from an unconscious attempt to control awareness.
D) Anxiety results from conforming to the norms of a cultural group.
A) Anxiety is learned in childhood through interactions with caregivers.
Rationale: Interpersonal theory proposes that caregivers can communicate anxiety to infants or children through inadequate nurturing, agitation when holding or handling the child, and distorted messages. In adults, anxiety arises from the person’s need to conform to the norms and values of his or her cultural group. Psychoanalytic theories describe reducing anxiety through the use of defense mechanisms. Defense mechanisms are cognitive distortions that a person uses unconsciously to maintain a sense of being in control of a situation, to lessen discomfort, and to deal with stress.
Which of the following theories about anxiety is based upon intrapsychic theories?
A) A person’s innate anxiety is the stimulus for behavior.
B) Anxiety is generated from problems in interpersonal relationships.
C) A nurse can help the client to achieve health by attending to interpersonal and
physiologic needs.
D) Anxiety is learned through experiences.
A) A person’s innate anxiety is the stimulus for behavior.
Rationale: Theories of anxiety can be classified as intrapsychic/psychoanalytic theories, interpersonal theories, and behavioral theories. Freud’s intrapsychic theory views a person’s innate anxiety as the stimulus for behavior. Interpersonal theories include Sullivan’s theory that anxiety is generated from problems in interpersonal relationships and Peplau’s belief that humans exist in interpersonal and physiologic realms. Behavioral theorists view anxiety as being learned through experiences.
Which of the following are interpersonal theories regarding the etiologies of major anxiety disorders? Select all that apply.
A) Sigmund Freud’s theory
B) Henry Stack Sullivan’s theory
C) Hildegard Peplau’s theory
D) Pavlov’s theory
B) Henry Stack Sullivan’s theory
C) Hildegard Peplau’s theory
Rationale: Theories of anxiety can be classified as intrapsychic/psychoanalytic theories, interpersonal theories, and behavioral theories. Freud’s intrapsychic theory views a person’s innate anxiety as the stimulus for behavior. Interpersonal theories include Sullivan’s theory that anxiety is generated from problems in interpersonal relationships and Peplau’s belief that humans exist in interpersonal and physiologic realms. Behavioral theorists view anxiety as being learned through experiences.
The student nurse correctly identifies that according to Selye (1956, 1974), which stage of reaction to stress stimulates the body to send messages from the hypothalamus to the glands and organs to prepare for potential defense needs?
A) Resistance
B) Exhaustion
C) Alarm reaction
D) Autonomic
C) Alarm reaction
Rationale: In the alarm reaction stage, stress stimulates the body to send messages from the hypothalamus to the glands and organs to prepare for potential defense needs. In the resistance stage, the digestive system reduces function to shunt blood to areas needed for defense. The exhaustion stage occurs when the person has responded negatively to anxiety and stress. There is no autonomic stage.
