Hogan Chapters 5,6,7,8,9

Question 1

a DSM-IV diagnosis for the initial symptom of severe stress; a numbing and emotionally nonresponsive reaction to an extreme trauma

Answer 1

acute stress disorder

Question 2

the fear of being incapacitated by being trapped in an unbearable situation with no escape; leads client to avoid places and situations that create anxiety

Answer 2

agoraphobia

Question 3

a state of apprehension, dread, uneasines, or uncertainty generated by a real or perceived threat whose acutal source is unidentifiable

Answer 3

anxiety

Question 4

a state of mental and/or physical exhaustion

Answer 4

burnout

Question 5

unwanted behavioral pattern or act

Answer 5

compulsion

Question 6

efforts to manage specific demands that are appraised as threatening

Answer 6

coping

Question 7

unconscious psychological response designed to diminish or delay anxiety and protect the person

Answer 7

defense mechanism

Question 8

a reaction to a specific danger

Answer 8

fear

Question 9

an automatic psychological state of high anxiety mediated by the sympathetic nervous system

Answer 9

fight-or-flight reaction

Question 10

an automatic physical reaction to stress mediated by the sympathetic nervous system

Answer 10

general adaptation syndrome

Question 11

unwanted, persistent, intrusive thoughts, impulses, or images related to anxiety

Answer 11

obsession

Question 12

a sudden episode of symptoms such as dizziness, dyspnea, tachycardia, palpitations, and feelings of impending doom and death

Answer 12

panic attack

Question 13

an irrational fear of a specific activity, object, or condition that leads to a compelling desire to avoid the feared stimulus

Answer 13

phobia

Question 14

a state of arousal when there is an imbalance between the demands placed on a person and the person’s ability to deal with them; a normal state that may have a positive or negative reaction

Answer 14

stress

Question 15

an internal or external event or situation that leads to feelings of anxiety

Answer 15

stressor

Question 16

Before a newly admitted anxious client begins treatment with benzodiazepines, it is most importatnt for the nurse to assess which of the following?

a. level of motivation for treatment
b. situational and social support
c. stressors and use of coping mechanisms
d. recent use of alcohol or other depressants

Answer 16

D. recent use of alcohol or other depressants

combined use of benzodiazepines and other CNS depressants can lead to death from respiratory failure

Question 17

A physician has just told a client tht surgery will be required to treat a health problem. After the physician leaves, the client reports feeling angry, tense, and shaky. The nurse notes that the client’s palms are sweaty and the pupils are dilated. The nurse interprets this to mean that the client is experiencing symptoms consistent with which level of the general adaptation syndrome?

a. alarm
b. exhaustion
c. generalized anxiety
d. resistance

Answer 17

A. Alarm is correct. This is also referred to as fight-or-flight response and occurs during the alarm stage of the general adapatation syndrome.

Question 18

The nursing assessment indicates that a client is experiencing a panic attack. The client is unable to understand directions and is preoccupied with thoughts of danger. Which of the following would be the most appropriate nursing diagnosis?

a. ineffective health management
b. impaired thought processes
c. risk for noncompliance
d. impaired communication

Answer 18

B. Impaired thought processes related to understanding directions and/or obsessive thoughts is an appropriate nursing diagnosis for clients with severe or panic level anxiety.

Question 19

The nurse would formulte which goal as most appropriate for a client who has been diagnosed as having generalized anxiety disorder?

a. the client will describe dissociative experiences
b. the client will display the ability to cope with mild anxiety
c. the client will relive the traumatic event
d. the client verbalize a sense of control over ritualistic behaviors

Answer 19

B. Displaying the ability to cope with mild anxiety is correct. Clients with generalized anxiety disorder should be able to demonstrate effective coping with mild anxiety.

Question 20

A client who is receving an anxiolytic medication is reluctant to participate in group therapy. The client states, “The pills I am taking will take care of my stress. I don’t need to talk about my problems”. In response to the client’s statement which of the following should the nurse explain?

a. many anxiolytics are habituating
b. medications relieve symptoms but do not change the source of the anxiety
c. the client will need to attend group therapy only until the medication becomes effective
d. the medications will not work unless the client particpates in group therapy

Answer 20

B. Medications releive symptoms but do not change the source of the anxiety. Anxiolytic medications alleviate or reduce symptoms of anxiety so the client can learn to identify stressors and devleop effective coping mechanisms. Anxiolytics allow the client to benefit from individual or group therapy.

Question 21

A client states, “I am always late for everything because I can’t leave my room without checking every drawer and door to make sure they are locked. If I don’t do that, I get so worried that I have to go back. I can’t seem to stop my behavior.” The nurse should take which action at this time?

a. allow the client adequate time to carry out the ritual
b. explore childhood experiences that may have led to the behavior
c. encourage the client to remain in the room until the urge to recheck has decreased
d. remind the client that the staff will not allow others to enter the room

Answer 21

A. Allowing the client time to carry out the ritual. Ritualistic behaviors are related to heightened anxiety. The compulsive behaviors increase in intensity and/or frequency as the anxiety level escalates. The nurse should allow the client to complete the ritual in a reasonable and timely manner. Interupting or stopping the ritual will increase the client’s anxiety causing the client’s need to engage in the ritual to increase,

Question 22

The client is experiencing a panic attack. Which of the following actions by the nurse would be appropriate? Select all that apply

a. speak loudly and firmly
b. restrict the client’s physical activity
c. use short simple sentences
d. remain calm and serene
e. teach cognitive restructuring skills

Answer 22

C. D. Using short, simple sentences and remaining calm is correct. At panic level anxiety, the individual will not be able to process complex ideas. Using short simple sentences will provide the best way to communicate information, directions, and support. Additionally, the nurse’s highest priority is to reduce the client’s anxiety to amore tolerable level. Speaking calmly and projecting an image of competence may have a calming effect on the client.

Question 23

A client has obsessive compulsive disorder. Which of the following statements made by the client to the nurse would be the best indicator of improvement?

a. I have more control over my thoughts and behaviors
b. I know that my thoughts and behaviors are not normal
c. I only do my ritual to reward myself when I have been good
d. My friends don’t know about my disorder

Answer 23

A. Loss of control is a major concern for clients who have OCD. Goals related to control of unwanted thoughts and behaviors are appropriate for these clients.

Question 24

The client is taking triazolam to reduce anxiety related symptoms. Which statment indicates that the nurse should provide more teaching to the client? Select all that apply

a. the doctor wants me to take this drug at bedtime because it will help me sleep better.
b. I should stop taking this medication abruptly
c. I might not be able to drive while I am taking this medication
d. I will probably have to take this medication for the rest of my life
e. I don’t need to go to therapy since the medication is working.

Answer 24

B. D. E. Hypnotic and anxiolytic agents should be taken for as short a period of time as possible. Physical dependence on these drugs can develop in a very short period of time. Drugs should not be abruptly stopped; they need to be tapered off. Therapy is a healthy option to take to work through the anxiety.

Question 25

A client with generalized anxiety disorder states, “ I now know the best thing for me to do is just to try to forget my worries.” How should the nurse evaluate this statement?

a. the client is developing insight
b. the client’s coping skills are improving
c. the client needs to be encouraged to verbalize feelings
d. the nurse client relationship should be terminated

Answer 25

C. The client needs encouragement to verbalize feelings. Supression of feelings require energy and will lead to increased anxiety. Clients need to talk about their feelings.

Question 26

a somatoform disorder characterized by preoccupation and/or fear due to an imagined or real defect in appearance

Answer 26

body dysmorphic disorder

Question 27

a somatoform disorder in which motor, sensory, or visceral funciton is impaired and indifferent whereby psychological factors versus biological factors are determined to be the etiology

Answer 27

conversion disorder

Question 28

a somatoform disorder whereby bodily functions and/or bodily symptoms are misinterpreted as severe or life threatening; the obsession causes intense fear and worry

Answer 28

hypochondriasis

Question 29

misinterpratation of external events as having a direct reference to oneself

Answer 29

ideas of reference

Question 30

an indifferent and unconcerned attitude toward physical symptoms; person with this seek secondary gain

Answer 30

la belle indifference

Question 31

symptoms that are based upon pathiophysiological, structural, and/or functional changes as supported by objective data such as a history and physical, laboratory, and/or diagnostic findings

Answer 31

organic basis

Question 32

a somatoform disorder characterized by pain as the primary focus of the individual’s need; psychological vs. physiological factors are determined to be integral to the onset, severity, and exacerbations of the pain

Answer 32

pain disorder

Question 33

symbolic resolution of unconscious conflict that decreases anxiety and wards off the psychogical conflict from conscious awareness

Answer 33

primary gain

Question 34

motor and sensory symptoms that have no objective, laboratory, or diagnostic data to suport an organic basis

Answer 34

pseudoneurological

Question 35

advantage person gains from being ill; the gain may be in the form of sympathy, empathy, disability benefits, and/or attention

Answer 35

secondary gain

Question 36

a somatoform disorder characterized by numerous complaints in multiple body symptoms that include pain, sexual, gastrointestinal, and neurological symptoms; onset is prior to age 30 and lasts for years

Answer 36

somatization disorder

Question 37

a psychiatric disorder whereby there is no organic basis for physical symptoms that are the primary individual’s complaints

Answer 37

somtaoform disorder