Week 4- Anxiety Flashcards
Which mental health disorder can be a direct physiological result of hyperthyroidism?
Anxiety
Panic attacks
Generalized anxiety disorder
Obsessive-compulsive disorder (OCD)
Anxiety
Anxiety can be a direct physiological result of hyperthyroidism. Panic attacks are a key feature of panic disorders. Generalized anxiety disorder is excessive worry, which is out of proportion to the true effect of events or situations. It is often comorbid with major depressive disorder and other anxiety disorders. OCD is characterized by both obsession and compulsions that may occur as a result of a genetic disposition or trauma.
Which action is included in the nursing plan of care for a patient diagnosed with panic-level anxiety who is exhibiting severe hyperactivity?
Place the patient in seclusion.
Attend to the patient’s physical needs.
Help the patient identify the source of anxiety.
Communicate using simple, loud, clear statements.
Attend to the patient’s physical needs.
The nursing care plan for a patient diagnosed with anxiety who is exhibiting severe hyperactivity is to attend to the patient’s physical needs. Severe hyperactivity is characteristic of a panic level of anxiety and attending to physical needs such as elimination, fluids, and nutrition are important. Seclusion should only be initiated after all other interventions have been tried and are unsuccessful. Helping a patient identify the source of anxiety is more effective for a patient experiencing mild to moderate anxiety. When the nurse is communicating with a patient experiencing severe anxiety, a low-pitched voice should be used.
A patient is displaying symptomology reflective of a moderate anxiety. To help the patient regain control, the nurse would respond in which way?
“You need to calm yourself.”
“What is it that you would like me to do to help you?”
“Can you tell me what you were feeling just before your attack?”
“I will get you some medication to help calm you.”
“Can you tell me what you were feeling just before your attack?”
A response that helps the patient identify the precipitant stressor is most therapeutic. It is nontherapeutic to tell a patient “You need to calm yourself.” If the patient is capable of self-calming, the patient already would have done so. Asking, “What is it that you would like me to do to help you?” is focusing the attention on the nurse. Getting medication may not be necessary if the nurse is able to help the patient lower their anxiety level.
A patient approaches the nurse’s station, begins tapping a finger on the desk, and tells the nurse, “I am feeling pretty anxious.” Which nursing action will assist this patient?
Move the patient to a quieter setting.
Escort the patient to an exercise class.
Offer the patient antianxiety medication.
Encourage the patient to attend art therapy.
Escort the patient to an exercise class.
The nurse’s best action is to escort the patient to an exercise class. The patient is displaying a sign of moderate anxiety by tapping their fingers on the desk, and it is ideal to provide this patient outlets for working off excess energy. A patient experiencing severe to panic levels of anxiety should be moved to a quieter setting. Medication is offered to a patient experiencing severe to panic levels of anxiety only after all other interventions have been tried and are unsuccessful. Art therapy will not offer an outlet for expending excess energy the way an exercise class will.
Which outcome is the primary purpose of performing a physical examination before beginning treatment for any anxiety disorder?
Protect the nurse legally.
Establish the nursing diagnoses of priority.
Obtain information about the patient’s psychosocial background.
Determine whether the anxiety is primary or secondary in origin.
Determine whether the anxiety is primary or secondary in origin.
A patient diagnosed with panic disorder is prescribed chlordiazepoxide. Which instruction is the most appropriate suggestion by the nurse?
Follow contraceptive methods.
Stop the medication after 3 months.
Change the medication if there is insomnia.
Coffee and tea are fine to drink and will not interact with the medication.
Follow contraceptive methods.
Chlordiazepoxide belongs to the benzodiazepine class of antianxiety drugs. It causes congenital anomalies in the fetus; therefore the patient should avoid becoming pregnant. As caffeine decreases the efficacy of the benzodiazepines, the nurse should suggest the patient avoid drinking coffee and tea. The nurse should suggest discussing continuing medication with the healthcare provider after 3 to 4 months. Abruptly stopping the medication can cause withdrawal symptoms like dry mouth, tremors, and convulsions.
Psychiatric patients often pull out hair to relieve stress. This condition is called _______________
. Trichorrhexis is a defect in the hair shaft where the hair becomes thin and breaks off easily. Patients who secretly swallow the pulled hair have a condition called trichophagia. The masses of hair present in the stomach are referred to as Rapunzel syndrome.
trichotillomania
Buspirone is prescribed for a patient with anxiety. Which instruction would the nurse provide to this patient?
“Take this medication on an empty stomach.”
“Take this medication only when you feel anxious.”
“It will take 2 to 4 weeks for you to feel the full benefit.”
“Avoid aged cheese products while you are taking this medication.”
“It will take 2 to 4 weeks for you to feel the full benefit.”
Buspirone is an alternative antianxiety medication that does not cause dependence, but 2 to 4 weeks are required for it to reach full effect. It should be taken with food. The drug may be used for long-term treatment and should be taken regularly. Aged cheese products should be avoided when taking monoamine oxidase inhibitors (MAOIs).
A patient is fearful of riding in elevators and always takes the stairs. Which brain structure is involved in this fear and behavior?
Thalamus
Amygdala
Hypothalamus
Pituitary gland
Amygdala
Which therapeutic intervention can the nurse implement within the scope of nursing practice guidelines to help a patient diagnosed with a mild anxiety disorder regain control?
Flooding
Modeling
Thought stopping
Systematic desensitization
Modeling
Modeling calm behavior in the face of anxiety or unafraid behavior in the presence of a feared stimulus are interventions that can be used independently, within the scope of practice guidelines. Flooding, thought stopping, and systematic desensitization require agreement of the treatment team. Healthcare providers such as psychiatrists or psychiatric nurse practitioners would be providing those interventions.
Which statement demonstrates an expression of anxiety rather than fear?
“I can’t stand spiders.”
“You’d never get me on a roller coaster.”
“I dislike knowing when I’m older, I won’t have enough money.”
“I can’t imagine why anyone would want to parachute out of an airplane.”
“I dislike knowing when I’m older, I won’t have enough money.”
Anxiety is an emotion without a specific object that is provoked by the unknown or by new experiences. Being worried about future finances is a common expression of anxiety. An intense dislike for spiders, roller coasters, and parachuting are fears because they are focused.
Which defense mechanism has an adaptive use?
Splitting
Undoing
Projection
Conversion
Undoing is a defense mechanism with an adaptive use. Splitting and conversion do not have adaptive uses and are almost always pathological. Projection is a defense mechanism that is considered immature and does not have an adaptive use.
A patient diagnosed with panic disorder begins a new prescription for lorazepam. Which daily activity would the nurse instruct the patient to discontinue?
Knitting
Mowing the lawn
Playing video games
Preparing dinner for the family
Mowing the lawn
Lorazepam is a benzodiazepine commonly prescribed for short-term management of anxiety. These medications may make it unsafe to handle mechanical equipment, such as a lawn mower. It would be safe for the patient to knit, play video games, and prepare meals.
Which serotonin norepinephrine reuptake inhibitor (SNRI) is used to treat generalized anxiety disorder?
Fluoxetine
Oxazepam
Venlafaxine
Escitalopram
Venlafaxine
Which scale would the nurse use during a clinical interview to measure phobias present in children?
Yale-Brown obsessive-compulsive scale
Hoarding scale self-report
Fear questionnaire
Panic disorder severity scale
Fear questionnaire
A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, and “burns” money that could be better spent to feed the poor is demonstrating which defense mechanism?
Undoing
Projection
Rationalization
Reaction formation
Reaction formation
Reaction formation keeps unacceptable feelings or behaviors out of awareness by developing the opposite behavior or emotion. Undoing involves a person making up for an act that they regret. Projection refers to the unconscious rejection of emotionally unacceptable features and attributing them to others. Rationalization consists of justifying illogical or unreasonable ideas by developing acceptable explanations that satisfy the teller and the listener.
If the health record mentions that the patient habitually relies on rationalization, the nurse might expect the patient to exhibit which behavior?
Miss appointments.
Make jokes to relieve tension.
Justify illogical ideas and feelings.
Behave in ways that are the opposite of their feelings.
Justify illogical ideas and feelings.
Which category of medication used to treat anxiety has a potential for dependence?
Tricyclics
Benzodiazepines
Selective serotonin reuptake inhibitors
Selective serotonin norepinephrine reuptake inhibitors
Benzodiazepines
Which symptom is commonly associated with panic attacks?
Obsessions
Apathy
Fever
Fear of impending doom
Fear of impending doom
Which assessment finding can the nurse expect in a patient experiencing a panic level of anxiety?
Withdrawal
Depersonalization
Scattered attention
Distorted perceptual field
The nurse can expect to find depersonalization in a patient experiencing a panic level of anxiety. Depersonalization is the sense of feeling unreal. Withdrawal, scattered attention, and a distorted perceptual field are more likely to occur in the patient experiencing severe anxiety.
Before transferring a patient for a scheduled procedure, the patient tells the nurse, “I feel like I am going to die.” Based on the statement the patient made, which level of anxiety is the patient experiencing?
Mild
Panic
Severe
Moderate
Severe
When a patient has been prescribed lorazepam for generalized anxiety disorder, which action would the nurse take?
Tell the patient to expect mild insomnia.
Teach the patient to limit caffeine intake.
Explain the long-term nature of benzodiazepine therapy.
Question the healthcare provider’s prescription because the drug is likely to be ineffective.
Teach the patient to limit caffeine intake.
Caffeine is an antagonist of antianxiety medication; therefore patients should avoid beverages containing caffeine because it will decrease the desired effects of the drug. Quitting lorazepam—a benzodiazepine—after the first month of use may cause insomnia. Benzodiazepine therapy should be used only for short periods of time because it has a potential for dependence. Benzodiazepines have a quick onset of action and are shown to be effective in the treatment of anxiety disorders.
Two staff nurses applied for promotion to nurse manager. The nurse not promoted initially had feelings of loss but then became supportive of the new manager by helping make the transition smooth and encouraging others. Which term best describes the nurse’s response?
Reaction formation
Suppression
Altruism
Intellectualization
Altruism
A person who feels unattractive repeatedly says, “Although I’m not beautiful, I am smart.” This is an example of what defense mechanism?
compensation.
devaluation.
repression.
identification.
compensation.
A client tells a nurse, “My best friend is a perfect person. She is kind, considerate, good-looking, and successful with every task. I could have been like her if I had the opportunities, luck, and money she’s had.” This client is demonstrating
rationalization.
compensation.
denial.
projection.
rationalization.
Rationalization consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller as well as the listener. Denial is an unconscious process that would call for the nurse to ignore the existence of the situation. Projection operates unconsciously and would result in blaming behavior. Compensation would result in the nurse unconsciously attempting to make up for a perceived weakness by emphasizing a strong point.
A client checks and rechecks electrical cords related to an obsessive thought that the house may burn down. The nurse and client explore the likelihood of an actual fire. The client states this event is not likely. This counseling demonstrates what appropriate principle of therapy?
flooding.
desensitization.
relaxation technique.
cognitive restructuring.
cognitive restructuring.
A nurse wants to teach alternative coping strategies to a client experiencing severe anxiety. Which action should the nurse perform first?
Verify the client’s learning style.
Lower the client’s current anxiety.
Assess how the client uses defense mechanisms.
Create outcomes and a teaching plan.
Lower the client’s current anxiety.
A client is experiencing moderate anxiety. The nurse encourages the client to talk about feelings and concerns. What is the rationale for this intervention?
Encouraging clients to explore alternatives increases the sense of control and lessens anxiety.
Anxiety is reduced by focusing on and validating what is occurring in the environment.
Offering hope allays and defuses the client’s anxiety.
Concerns stated aloud become less overwhelming and help problem solving begin.
Concerns stated aloud become less overwhelming and help problem solving begin.
A cruel and abusive person often uses rationalization to explain the behavior. Which comment demonstrates use of this defense mechanism?
“I have always had poor impulse control.”
“I’m really a coward who is afraid of being hurt.”
“I don’t know why I do mean things.”
“That person should not have provoked me.”
“That person should not have provoked me.”
Rationalization consists of justifying one’s unacceptable behavior by developing explanations that satisfy the teller and attempt to satisfy the listener. The abuser is suggesting that the abuse is not his or her fault; it would not have occurred except for the provocation by the other person. The distracters indicate some measure of acceptance of responsibility for the behavior.
A client with an abdominal mass is scheduled for a biopsy. The client has difficulty understanding the nurse’s comments and asks, “What do you mean? What are they going to do?” Assessment findings include tremulous voice, respirations 28, and pulse 110. What is the client’s level of anxiety?
Mild
Severe
Panic
Moderate
Moderate
Moderate anxiety causes the individual to grasp less information and reduces problem-solving ability to a less-than-optimal level. Mild anxiety heightens attention and enhances problem solving. Severe anxiety causes great reduction in the perceptual field. Panic-level anxiety results in disorganized behavior.
A person who has been unable to leave home for more than a week because of severe anxiety says, “I know it does not make sense, but I just can’t bring myself to leave my apartment alone.” Which nursing intervention is appropriate?
Help the person use online video calls to provide interaction with others.
Ask the person to explain why the fear is so disabling.
Advise the person to accept the situation and use a companion.
Teach the person to use positive self-talk techniques.
Teach the person to use positive self-talk techniques.
Positive self-talk, a form of cognitive restructuring, replaces negative thoughts such as “I can’t leave my apartment” with positive thoughts such as “I can control my anxiety.” This technique helps the client gain mastery over the symptoms. The other options reinforce the sick role.
A client experiences a sudden episode of severe anxiety. Of these medications in the client’s medical record, which is most appropriate to give as a prn anxiolytic?
lorazepam
buspirone
amitriptyline
desipramine
Lorazepam is a benzodiazepine used to treat anxiety. It may be given as a prn medication.
Buspirone is long acting and is not useful as a prn drug. Amitriptyline and desipramine are tricyclic antidepressants and considered second- or third-line agents.
A person has minor physical injuries after an auto accident. The person is unable to focus and says, “I feel like something awful is going to happen.” This person has nausea, dizziness, tachycardia, and hyperventilation. What is the person’s level of anxiety?
Panic
Moderate
Severe
Mild
Severe
A person speaking about a rival for a significant other’s affection says in an emotional, syrupy voice, “What a lovely person. That’s someone I simply adore.” The individual is demonstrating which defense mechanism?
reaction formation.
repression.
projection.
denial.
Reaction formation is an unconscious mechanism that keeps unacceptable feelings out of awareness by using the opposite behavior. Instead of expressing hatred for the other person, the individual gives praise.
Denial operates unconsciously to allow an anxiety-producing idea, feeling, or situation to be ignored. Projection involves unconsciously disowning an unacceptable idea, feeling, or behavior by attributing it to another. Repression involves unconsciously placing an idea, feeling, or event out of awareness.
A client in the emergency department shows disorganized behavior and incoherence after a friend suggested a homosexual encounter. In which room should the nurse place the client?
A room with an examining table, instrument cabinets, desk, and chair
A small, empty storage room with no windows or furniture
The nurse’s office, furnished with chairs, files, magazines, and bookcases
An interview room furnished with a desk and two chairs
An interview room furnished with a desk and two chairs
Individuals experiencing severe to panic-level anxiety require a safe environment that is quiet, non-stimulating, structured, and simple. A room with a desk and two chairs provides simplicity, few objects with which the client could cause self-harm, and a small floor space in which the client can move about. A small, empty storage room without windows or furniture would feel like a jail cell. The nurse’s office or a room with an examining table and instrument cabinets may be over-stimulating and unsafe.
Two staff nurses applied for a charge nurse position. After the promotion was announced, the nurse who was not promoted said, “The nurse manager had a headache the day I was interviewed.” Which defense mechanism is evident?
Introjection
Conversion
Projection
Splitting
Projection
When alprazolam [xanax] is prescribed for a client who experiences acute anxiety, health teaching should include which instruction?
adjust dose and frequency based on anxiety level.
eat a tyramine-free diet.
avoid alcoholic beverages.
report drowsiness.
avoid alcoholic beverages.
Drinking alcohol or taking other anxiolytics along with the prescribed benzodiazepine should be avoided because depressant effects of both drugs will be potentiated. Tyramine-free diets are necessary only with monoamine oxidase inhibitors (MAOIs). Drowsiness is an expected effect and needs to be reported only if it is excessive. Clients should be taught not to deviate from the prescribed dose and schedule for administration.
For a client experiencing panic, which nursing intervention should be implemented first?
Administer an anxiolytic medication.
Provide calm, brief, directive communication.
Teach relaxation techniques.
Prepare to implement physical controls.
Provide calm, brief, directive communication.
Calm, brief, directive verbal interaction can help the client gain control of overwhelming feelings and impulses related to anxiety. Clients experiencing panic-level anxiety are unable to focus on reality; thus, learning relaxation techniques is virtually impossible. Administering anxiolytic medication should be considered if providing calm, brief, directive communication is ineffective. Although the client is disorganized, violence may not be imminent, ruling out the intervention of preparing for physical control until other less-restrictive measures are proven ineffective.
