Learning Activity 3

Question 1

The major distinction between fear and anxiety is that fear:
A) is a universal experience; anxiety is neurotic.
B) enables constructive action; anxiety is dysfunctional.
C) is a psychological experience; anxiety is a physiological experience.
D) is a response to a specific danger; anxiety is a response to an unknown danger.

Answer 1

D) is a response to a specific danger; anxiety is a response to an unknown danger.
Fear is a response to an objective danger; anxiety is a response to a subjective danger.

Question 2

The initial nursing action for a newly admitted anxious client is to
A) assess the client’s use of defense mechanisms.
B) assess the client’s level of anxiety.
C) limit environmental stimuli.
D) provide antianxiety medication.

Answer 2

B) assess the client’s level of anxiety.

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

Question 3

Selective inattention is first noted when experiencing anxiety that is:
A)  mild.
B)  moderate.
C)  severe.
D)  panic.

Answer 3

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

Question 4

Delusionary thinking is a characteristic of:
A)  chronic anxiety.
B)  acute anxiety.
C)  severe anxiety.
D)  panic level anxiety.

Answer 4

D) panic level anxiety.

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

Question 5

Generally, ego defense mechanisms:
A) often involve some degree of self-deception.
B) are rarely used by mentally healthy people.
C) seldom make the person more comfortable.
D) are usually effective in resolving conflicts.

Answer 5

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

Question 6

A 20-year-old was sexually molested at age10 but he can no longer remember the incident. The ego defense mechanism in use is
A)  projection.
B)  repression.
C)  displacement.
D)  reaction formation.

Answer 6

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

Question 7

The defense mechanisms that can only be used in healthy ways are
A)  suppression and humor.
B)  altruism and sublimation.
C)  idealization and splitting.
D)  reaction formation and denial.

Answer 7

B) altruism and sublimation.
These defenses are termed mature defenses. They cannot be used in unhealthy ways. Altruism results in resolving emotional conflicts by meeting the needs of others, and sublimation substitutes socially acceptable activity for unacceptable impulses.

Question 8

Which behavior would be characteristic of an individual who is displacing anger?
A)  Lying
B)  Stealing
C)  Slapping
D)  Procrastinating

Answer 8

D) Procrastinating
A passive-aggressive person deals with emotional conflict by indirectly and unassertively expressing aggression toward others. Procrastination is an expression of resistance.

Question 9

A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, "burns" money that could be better spent to feed the poor, and so forth is using
A)  projection.
B)  rationalization.
C)  reaction formation.
D)  undoing.

Answer 9

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

Question 10

A man keeps his wife's clothing in the closet and bureau of his bedroom although she has been dead for 3 years. This behavior suggests the use of
A)  altruism.
B)  denial.
C)  undoing.
D)  suppression.

Answer 10

B) denial.

Denial involves escaping unpleasant reality by ignoring its existence.

Question 11

What can be said about the age of onset of most anxiety disorders? Onset is
A)  before age 20 years.
B)  before age 40 years.
C)  after age 40 years.
D)  scattered throughout the lifespan.

Answer 11

B) before age 40 years.

Epidemiology reports tell us the onset of most anxiety disorders is before age 40 years.

Question 12

What can be said about the comorbidity of anxiety disorders?
A) Anxiety disorders exist alone.
B) A second anxiety disorder may coexist with the first.
C) Anxiety disorders virtually never coexist with mood disorders.
D) Substance abuse disorders rarely coexist with anxiety disorders.

Answer 12

B) A second anxiety disorder may coexist with the first.
In many instances where one anxiety disorder is present, a second one coexists. Clinicians and researchers have clearly shown that anxiety disorders frequently co-occur with other psychiatric problems. Major depression often co-occurs and produces a greater impairment with poorer response to treatment.

Question 13

Studies of clients with posttraumatic stress disorder suggest that the stress response of which of the following is considered abnormal?
A) Brainstem
B) Hypothalamus-pituitary-adrenal system
C) Frontal lobe
D) Limbic system

Answer 13

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

Question 14

An obsession is defined as
A) thinking of an action and immediately taking the action.
B) a recurrent, persistent thought or impulse.
C) an intense irrational fear of an object or situation.
D) a recurrent behavior performed in the same manner.

Answer 14

B) a recurrent, persistent thought or impulse.

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

Question 15

A symptom associated with panic attacks is
A)  obsessions.
B)  apathy.
C)  fever
D)  fear of impending doom.

Answer 15

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

Question 16

Working with a client to help the client view an occurrence in a more positive light is called
A)  flooding.
B)  desensitization.
C)  response prevention.
D)  cognitive restructuring.

Answer 16

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

Question 17

The primary purpose of performing a physical examination before beginning treatment for any anxiety disorder is
A) legal protection.
B) to establish nursing diagnoses of priority.
C) to provide information about client psychosocial background.
D) to determine if the anxiety is of primary or secondary origin.

Answer 17

D) to determine if the anxiety is of primary or secondary origin.
The symptoms of anxiety can be caused by a number of physical disorders or are said to be caused by an underlying physical disorder. The treatment for secondary anxiety is treatment of the underlying cause.

Question 18

An important question to ask in the assessment of a client with anxiety disorder is
A) “How often do you hear voices?”
B) “Have you ever considered suicide?”
C) “How long has your memory been bad?”
D) “Do your thoughts always seem jumbled?”

Answer 18

B) “Have you ever considered suicide?”
The presence of anxiety may cause an individual to consider suicide as a means of finding comfort and peace. Suicide assessment is appropriate to perform with any client with higher levels of anxiety.

Question 19

A possible outcome criteria for a client with anxiety disorder is
A) Client demonstrates effective coping strategies.
B) Client reports reduced hallucinations.
C) Client reports feelings of tension and fatigue.
D) Client demonstrates persistent avoidance behaviors.

Answer 19

A) Client demonstrates effective coping strategies.

Option 1 is the only desirable outcome listed.

Question 20

K has been getting mediocre grades in school. When she applies for admission at the upper division level, she is rejected on the basis of inadequate grades. Thereafter, K studies harder and receives better grades. K's behavioral change is rooted in
A)  A rude awakening
B)  normal anxiety
C)  trait anxiety
D)  alturism

Answer 20

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

Question 21

D is going to be interviewed for a promotional position. As he enters the interview room he feels as though all his senses are very sharp. He is mildly tense but eager to begin the interview. D can be assessed as showing
A) denial
B)  compensation
C)  normal anxiety
D)  selective inattention

Answer 21

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

Question 22

A client approaches a nurse and blurts "You have got to help me! Something terrible is happening. I am falling apart. I can't think. My heart is pounding and my head is throbbing." The nurse should assess the client's level of anxiety as
A) mild
B)  moderate
C)  severe
D)  Panic

Answer 22

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

Question 23

A client is displaying symptomology reflective of a panic attack. In order to help the client regain control the nurse responds:
A) “you need to calm yourself”
B) “what is that you would like me to do to help you?”
C) “can you tell me what you were feeling just before your attack?”
D) “i will get you some medication to help calm you”

Answer 23

C) “can you tell me what you were feeling just before your attack?”.
A response that helps the client identify the precipitant stressor is most therapeutic.

Question 24

A client is demonstrating a moderate level of anxiety. She tells the nurse “I am so anxious that I could fly! I do not know what to do.” A helpful response for the nurse to make would be
A) “what things have you done in the past that helped you feel more comfortable?”
B) “let’s try to focus on that adorable little granddaughter of yours”
C) “why don’t you sit down over there and work on that jigsaw puzzle”
D) “try not to think about the feelings and sensations you’re experiencing”

Answer 24

A) “what things have you done in the past that helped you feel more comfortable?”
Because the client is not able to think through the problem and arrive at an action that would lower anxiety, the nurse can assist by asking what has worked in the past. Often what has been helpful in the past can be used again.

Question 25

A client is noted to have a high level of non-goal-directed motor activity, running from chair to chair in the solarium. He is wide eyed and seems terror stricken. He repeats "They are coming! They are coming!" He neither follows staff direction nor responds to verbal efforts to calm him. The level of anxiety can be assessed as
A)  mild
B) moderate
C)  severe
D)  panic

Answer 25

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

Question 26

A cultural characteristic that may be observed in a teenage, female Hispanic client in times of stress is to:
A)  suddenly tremble severely
B) exhibit stonic behavior
C)  report both nausea and vomiting
D)  laugh inappropriately

Answer 26

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

Question 27

The nurse anticipates that the nursing history of a client diagnosed with obsessive compulsive disorder (OCD) will reveal:
A) a history of childhood trauma
B) a sibling with the disorder
C) an eating disorder
D) a phobia as well

Answer 27

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

Question 28

A client is diagnosed with generalized anxiety disorder (GAD). The nursing assessment supports this diagnosis when the client reports:
A) that his symptoms started right after he was robbed at gun point
B) being so worried he hasn’t been able to work for the last 12 months
C) that eating in public makes him extremely uncomfortable
D) repeatedly verbalizing his prayers help him feel relaxed

Answer 28

B) being so worried that he hasn’t been able to work for the last 12 months
GAD is characterized by symptomology that lasts 6 months or longer.

Question 29

If a client’s record mentions that the client habitually relies on rationalization, the nurse might expect the client to
A) make jokes to relieve tension
B) miss appointments
C) justify illogical ideas and feelings
D) behave in ways that are the opposite of his or her feelings

Answer 29

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

Question 30

Panic attacks in Latin American individuals often involve
A)  repetitive involuntary actions
B)  blushing
 C) fear of dying
D)  offensive verbalization

Answer 30

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

Question 31

The plan of care for a client with obsessive-compulsive disorder who has elaborate washing rituals specifies that response prevention is to be used. Which scenario is an example of response prevention?
A) Having client repeatedly touch “dirty” objects
B) Not allowing client to seek reassurance from staff
C) Not allowing the client to wash hands after touching a “dirty” object
D) Telling the client that he or she must relax whenever tension mounts

Answer 31

C) Not allowing the client to wash hands after touching a “dirty” object
Response prevention is a technique by which the client is prevented from engaging in the compulsive ritual. A form of behavior therapy, response prevention is never undertaken without physician approval.

Question 32

A client is experiencing a panic attack. The nurse can be most therapeutic by
A) telling the client to take slow, deep breaths.
B) verbalizing mild disapproval of the anxious behavior.
C) asking the client what he means when he says “I am dying.”
D) offering an explanation about the role of the sympathetic nervous system in symptom formation.

Answer 32

A) telling the client to take slow, deep breaths.
Slow diaphragmatic breathing can induce relaxation and reduce symptoms of anxiety. Often the nurse has to tell the client to “breathe with me” and keep the client focused on the task. The slower breathing also reduces the threat of hypercapnia with its attendant symptoms.

Question 33

The nurse caring for a client with a panic attack might anticipate that the psychiatrist would order a stat dose of
A) standard antipsychotic medication.
B) tricyclic antidepressant medication.
C) anticholinergic medication.
D) a short-acting benzodiazepine medication.

Answer 33

D) a short-acting benzodiazepine medication.
A short-acting benzodiazepine is the only type of medication listed that would lessen the client’s symptoms of anxiety within a few minutes. Anticholinergics do not lower anxiety; tricyclic antidepressants have very little antianxiety effect and have a slow onset of action; and standard antipsychotic medication will lower anxiety but has a slower onset of action and the potential for more side effects.

Question 34

A Gulf War veteran is entering treatment for posttraumatic stress disorder. An important facet of assessment is to
A) ascertain how long ago the trauma occurred.
B) find out if the client uses acting out behavior.
C) determine use of chemical substances for anxiety relief.
D) establish whether the client has chronic hypertension related to high anxiety.

Answer 34

C) determine use of chemical substances for anxiety relief.
Substance abuse often coexists with posttraumatic stress disorder. It is often the client’s way of self-medicating to gain relief of symptoms.

Question 35

The physician orders lorazepam (Ativan) 1 mg po qid for 1 week for a client with generalized anxiety disorder. The nurse should
A) question the physician’s order because the dose is excessive.
B) explain the long-term nature of benzodiazepine therapy.
C) teach the client to limit caffeine intake.
D) tell the client to expect mild insomnia.

Answer 35

C) teach the client to limit caffeine intake.

Caffeine is an antagonist of antianxiety medication.

Question 36

Which nursing diagnosis would be most useful for clients with anxiety disorders?
A)  Excess fluid volume
B)  Disturbed body image
C)  Ineffective role performance 
D)  Disturbed personal identity

Answer 36

C) Ineffective role performance
Anxiety disorders often interfere with the usual role performance of clients. Consider the client with agoraphobia who cannot go to work, or the client with obsessive-compulsive disorder who devotes time to the ritual rather than to parenting.

Question 37

Which nursing intervention would be helpful when caring for a client with an anxiety disorder?
A) Express mild amusement over symptoms
B) Arrange for client to spend time away from others
C) Advise client to minimize exercise to conserve endorphins
D) Reinforce use of positive self-talk to change negative assumptions

Answer 37

D) Reinforce use of positive self-talk to change negative assumptions
This technique is a variant of cognitive restructuring. “I can’t do that” is changed to “I can do it if I try.”

Question 38

A potential problem that should be investigated for a client with severe obsessive-compulsive disorder is
A)  sleep disturbance.
B)  excessive socialization.
C)  command hallucinations.
D)  altered state of consciousness.

Answer 38

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

Question 39

Which therapeutic intervention can the nurse independently use with a client with anxiety disorder?
A)  Flooding
B)  Modeling 
C)  Thought stopping
D)  Systematic desensitization

Answer 39

B) Modeling
Modeling calm behavior in the face of anxiety or unafraid behavior in the presence of a feared stimulus are interventions that can be independently used. The other options require agreement of the treatment team.