NCLEX Anxiety Flashcards
A patient who was savagely attacked by a bear has no memory of the event. Which statement best explains the patient’s inability to remember the attack?
a. The woman lost consciousness and was not cognitively aware of what happened during the attack
b. The brain has produced a chemical anemia that will repress the memories of the attack indefinitely.
c. The patient is unconsciously using a defense mechanism to protect against the repeated memory of the attack.
d. It is a temporary suppression of the attack; her memory will return when she is physically and emotionally ready to handle the memories.
ANS: C
Defense mechanisms are used unconsciously to protect us from threats to the physical, mental, and social aspects of ourselves. The memory of the event may or may not come back but this is not generally related to the patient’s ability to handle the memories. Memory may be lost or impaired as a result of brain trauma but not as likely from a chemical alteration.
Which assessment finding exhibited by a patient being assessed for posttraumatic stress disorder (PTSD) would be considered a defining behavior and support such a diagnosis?
a. Can describe the attack in great detail
b. Experiences dramatic swings in affect
c. Describes vivid “flashbacks” of being attacked
d. Is preoccupied with the need to “tell someone about the attack”
ANS: C
One defining behavior that is seen when an individual has PTSD is that the person re-experiences the traumatic event. This takes place by having recurrent and intrusive disturbing recollections of the trauma, including thoughts, images, or perceptions about the incident. The person sometimes experiences recurrent dreams of the incident and acts or feels as though the event was recurring in the present (flashback). Generally the PTSD patient cannot remember all the details of the trauma nor are they particularly interested in re-telling the events of the trauma. The patient generally has a very limited range of affect.
What is the basis for assessing a male patient who is agoraphobic for panic attacks?
a. Men are more likely to experience panic attacks.
b. An overwhelming number of agoraphobic patients also have panic attacks.
c. Patients are often unaware that the symptoms they are experiencing are those of panic.
d. Panic attacks are generally the cause of a patient developing phobias like agoraphobia.
ANS: B
Almost all patients who present with agoraphobia in clinical samples have a current diagnosis or history of panic disorder. Males are not more likely than females to experience panic attacks. Patients are not usually unaware of panic attack symptoms. Panic attacks don’t cause, but are often triggered by, phobias.
Discharge preparation for a patient includes the administration of the Hamilton Anxiety Scale (HAS). When asked by the patient to explain the purpose of the assessment the nurse responds:
a. “It is an assessment tool used to evaluate the symptoms of anxiety.”
b. “The tool is used to help confirm the diagnosis of anxiety disorder.”
c. “This tool helps determine if your symptoms have improved with treatment.”
d. “It helps identify the presence of any other disorder associated with anxiety.”
ANS: C
The HAS is a valid and time-tested tool that gives the most objective measure of the degree to which anxiety has been effectively treated. The HAS does not evaluate for symptoms of anxiety or act as a diagnosis tool for anxiety or another other associated disorder.
A patient is admitted for treatment for persistent, severe anxiety. Which nursing diagnosis would help effectively direct patient care?
a. Disturbed sensory perception related to narrowed perceptual field
b. Risk for injury related to closed perception
c. Hopelessness related to total loss of control
d. Risk for other-directed violence related to combative behavior
ANS: A
A narrowed perceptual field occurs with severe anxiety; therefore this diagnosis should be considered. Data are not present to support the other diagnoses.
The patient was an awkward child who was ridiculed by his father for his inability to catch a ball. As an adult, the patient developed panic attacks at the time his company established after-work team sporting activities. Which data discussed during the nursing interview provides insight to the possible cause of this anxiety disorder when applying the behavioral model?
a. He always avoids sports because “I’m short and not the least bit athletic.”
b. When in fifth grade, the patient caused his team to “lose the big softball game.”
c. The company he works for places tremendous emphasis of successful team work.
d. As a child he wore a leg brace that prevented him from participating in school sports.
ANS: A
In behavioral models that are based on learning theory, the etiology of anxiety symptoms is a generalization from an earlier traumatic experience to a benign setting or object. As a result, he associates embarrassment and shame with sports events and develops panic attacks. The same kinds of cognitive operations that link embarrassment with sporting events link the cognition of the expectation of embarrassment with the idea of a sporting event, and the individual begins to experience panic attacks while merely thinking about being involved. The remaining options are not as likely to bring about the embarrassment and shame that would produce such a response
The nurse is working with the family of a patient with obsessive-compulsive disorder (OCD). Which concept should the nurse incorporate in the teaching plan?
a. The thoughts, images, and impulses are voluntary.
b. The family should pay immediate attention to symptoms.
c. The thoughts, images, and impulses tend to worsen with stress.
d. OCD is a chronic disorder that does not respond to treatment.
ANS: C
Stress is known to increase the intensity of OCD symptoms. Families should be taught this relationship and the need to reduce stress in the patient’s life as much as possible. The symptoms are not under the patient’s voluntary control. It is nontherapeutic to immediately focus on the symptoms, since to do so contributes to secondary gain. OCD responds well to medication and therapy.
Which question would assist the nurse in determining whether the patient has been experiencing anxiety?
a. “Have you had difficulty concentrating lately?”
b. “Have you been feeling sad and especially lonely?”
c. “Do you have a history of failed personal relationships?”
d. “Do you frequently experience difficulty controlling your anger?”
ANS: A
Concentration difficulties occur when moderate or greater levels of anxiety are present. Loneliness is more related to mood. A failed personal relationship is more related to poor self-esteem. Inability to control anger is related to poor impulse control.
The nurse working with patients diagnosed with posttraumatic stress disorder (PTSD) is aware of the need to intervene early in order to de-escalate a patient’s increasing anxiety level. Which patient behavior is likely an early indication of escalating anxiety?
a. Talking rapidly
b. Pacing around the unit
c. Staring out the window
d. Refusing to go to therapy
ANS: B
Recognize the patient’s use of relief behaviors (e.g., pacing, wringing of hands) as indicators of anxiety. Talking rapidly is an indicator of manic behavior. Staring is more likely seen in depression. Refusing to attend therapy is seen in aggressive, defiant patients.
The nurse has been working with a patient who experiences anxiety. Which intervention should the nurse implement initially when the patient is observed pacing and wring her hands?
a. Asking how she has managed anxiety effectively in the past
b. Distracting her by offering to help her make a telephone call
c. Asking her what she believes is causing her increased anxiety
d. Teaching her to take deep, relaxing breaths to manage the anxiety
ANS: A
First help the patient to build on the coping methods that the patient used to manage anxiety in the past. Coping methods that were previously successful will generally be effective in subsequent situations. Distraction is not usually successful initially. Assessing for the cause of the anxiety will not, in this situation, be helpful in managing it; often times patients are not aware of the cause. Teaching will not be effective while the patient is experiencing anxiety but should be done when the patient is relaxed and able to focus.
The nurse is working with a patient with an anxiety disorder whose treatment includes cognitive behavioral therapy. Which statement by the patient gives the nurse reason to assume that the patient has an understanding of the basis of this type of therapy?
a. “My abusive childhood has resulted in my overreaction to stress.”
b. “My delusional thoughts of extreme anxiety are what cause my panic attacks.”
c. “My brain chemistry causes me to overreact to common stress by getting so anxious.”
d. “I’ve learned to react to my daily stress by having anxious thoughts and panic attacks.”
ANS: D
The success of this approach centers on the patient’s understanding that the symptoms are a learned response to thoughts or feelings about behaviors that occur in daily life. Cognitive therapy helps patients identify target symptoms and change the cognitions associated with them. This is a psychodynamic model explanation. Anxiety disorders have no relationship to delusions. Brain chemistry is not a usual cause of anxiety but rather can be altered by anxiety.
- Which verbal intervention would the nurse use when helping a patient who is experiencing severe to panic-level anxiety?
a. “I will stay with you to make sure you remain safe.”
b. “First, you must stop pacing and wringing your hands.”
c. “How can I help you get control of yourself and this anxiety?”
d. “Can you tell me what was happening just before you got upset?”
ANS: A
A patient who is experiencing severe to panic-level anxiety requires brief, directive verbal interchanges aimed at increasing feelings of safety and security. It is not likely the patient will be able to stop the physical behaviors. Severely anxious patients are not able to evaluate their situation and give direction to the nurse or are they able to relate antecedent events to increasing anxiety.
The nurse notes that a patient being treated for an anxiety disorder is becoming more anxious sitting in a congested, noisy room waiting to see the therapist. Which intervention will the nurse implement initially to assist the patient in de-escalating his anxiety?
a. Offering to reschedule the patient’s appointment
b. Taking the patient to an unoccupied interview room
c. Notifying the therapist of the need to see the patient stat
d. Requesting oral prn anxiolytic medication for the patient
ANS: B
A congested, noisy environment is not conducive to maintenance of low anxiety. Moving the patient to a less stimulating environment may be all that is needed for the patient to lower his anxiety level. The other options may not be necessary if the nurse intervenes effectively
A patient is ordered medication therapy to manage the symptoms of anxiety disorder. Which statement by the patient indicates an understanding of the typical classification of medication prescribed for this disorder?
a. “Tricyclic antidepressants are particular good for panic attacks.”
b. “I have to give up beer while taking monamine oxidase inhibitors (MAOIs).”
c. “Selective serotonin reuptake inhibitors (SSRIs) help with panic attacks as well.”
d. “Benzodiazepines are usually effective when taken for chronic anxiety like mine.”
ANS: C
SSRIs are the most widely prescribed medication to treat panic disorder. They are effective and have a low side-effect profile. Tricyclic antidepressants are not effective for panic attacks and have more side effects than SSRIs. MAOIs are effective but require knowledge of and compliance with a special diet and are not the first choice in this situation. Benzodiazepines are effective but produce alterations in sensorium and other side effects and are not used for long-term management.
A patient with OCD tells the nurse, “Thinking these thoughts and doing all my rituals is beyond being silly. I have few friends and I know others laugh behind my back. I sometimes think I can control things, but I always find I can’t. I don’t know if I can continue to live this way.” Which assessment question shows the nurse has an understanding of this patient’s priority risk?
a. “Are you feeling hopeless?”
b. “Do you think you are socially isolated?”
c. “Have you been thinking about hurting yourself?”
d. “Do the rituals affect how you feel about yourself?”
ANS: C
Patients with anxiety disorders should always be assessed for the presence of depression and suicidal ideation, the priority risk to safety. This patient has admitted feeling powerless to control the symptoms, in addition to wondering if she can continue to live the way she has been. There is ample reason for asking about suicidal ideation. The remaining options address hopelessness, social isolation, and low self-esteem. While appropriate nursing concerns, they don’t have the priority self-harm has for this patient.
