NUR210CH12

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TomWruble
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199481
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NUR210CH12
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2013-03-11 10:11:20
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nur210e1 Anxiety Disorders
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Anxiety and Anxiety Disorders
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  1. Mild Anxiety
    • The person experiencing mild anxiety sees, hears, and grasps more information.
    • Problem solving becomes more effective.
    • Physical symptoms may include slight discomfort, restlessness, irritability and mild tension-relieving behaviors, e.g. nail biting, finger/toe tapping or fidgeting.
  2. Moderate Anxiety
    • Perceptual field narrows and some details are excluded from observation.
    • The person sees, hears, and grasps less information and may demonstrate selective inattention, in which only certain things in the environment are seen or heard unless they are pointed out.
    • The ability to think clearly is hampered, but learning and problem solving can still take place, although not at an optimal level. Physical symptoms include tension, pounding heart, increased pulse and respiratory rate, perspiration, and mild somatic symptoms (gastric discomfort, headache, urinary urgency).
    • Voice tremors and shaking may be noticed. Mild or moderate anxiety levels can be constructive, because anxiety may be a signal that something in the person's life needs attention or is dangerous.
  3. Severe Anxiety
    • The perceptual field of a person experiencing severe anxiety is greatly reduced.
    • A person with severe anxiety may focus on one particular detail or many scattered details and have difficulty noticing what is going on in the environment, even when it is pointed out by another.
    • Learning and problem solving are not
    • possible at this level, and the person may be dazed and confused. Behavior is automatic and aimed at reducing or relieving anxiety. Somatic symptoms (headache, nausea, dizziness, insomnia) often increase; trembling and a pounding heart are common, and the person may experience hyperventilation and a sense of impending doom or dread.
  4. May have heightened perceptual field
    Mild
  5. Has narrow perceptual field; less of what is going on
    Moderate
  6. Has greatly reduced perceptual field
    Severe
  7. Unable to focus on the environment
    Panic
  8. Is alert and can see, hear, and grasp what is happening in the environment
    Mild
  9. Can attend to more if pointed out by another (selective inattention)
    Moderate
  10. → Focuses on details or one specific detail.
    → Attention scattered.
    Severe
  11. Experiences the utmost state of terror and emotional paralysis; feels he or she "ceases to exist"
    Panic
  12. Can identify things that are disturbing and are producing anxiety
    Mild
  13. Completely absorbed with self
    Severe
  14. May have hallucinations or delusions that take the place of reality
    Panic
  15. May not be able to attend to events in environment even when pointed out by others
    Severe
  16. The environment is blocked out. It is as if these events are not occurring.
    Severe to Panic
  17. Able to work effectively toward a goal and examine alternatives.
    Mild
  18. → Able to solve problems but not at optimal ability.
    → Benefits from guidance of others.
    Moderate
  19. → Unable to see connections between events or details.
    → Has distorted perceptions.
    Severe
  20. → May be mute or have extreme psychomotor agitation leading to exhaustion.
    → Shows disorganized or irrational reasoning.
    Panic
  21. → Slight discomfort
    → Attention-seeking behaviors
    → Restlessness
    → Irritability or impatience
    → Mild tension-relieving behavior (foot or finger tapping, lip chewing, fidgeting)
    Mild
  22. → Voice tremors
    → Change in voice pitch
    → Difficulty concentrating
    → Shakiness
    → Repetitive questioning
    → Somatic complaints, (urinary frequency and urgency, headache, backache, insomnia)
    → Increased respiration rate
    → Increased pulse rate
    → Increased muscle tension
    → More extreme tension-relieving behavior (pacing, banging of hands on table)
    Moderate
  23. → Feelings of dread
    → Ineffective functioning
    → Confusion
    → Purposeless activity
    → Sense of impending doom
    → More intense somatic complaints (dizziness, nausea, headache, sleeplessness)
    → Hyperventilation
    → Tachycardia
    → Withdrawal
    → Loud and rapid speech
    → Threats and demands
    Severe
  24. → Experience of terror
    → Immobility or severe hyperactivity or flight
    → Dilated pupils
    → Unintelligible communication or inability to speak
    → Severe shakiness
    → Sleeplessness
    → Severe withdrawal
    → Hallucinations or delusions; likely out of touch with reality
    Panic
  25. Anxiety Defense Mechanism XXX
    is used to make up for
    perceived deficiencies and cover up shortcomings related to these deficiencies to protect the conscious mind from recognizing them.
    Compensation

    A - A shorter-than-average man becomes assertively verbal and excels in business.

    M - An individual drinks alcohol when self-esteem is low to temporarily diffuse discomfort.
  26. Anxiety Defense Mechanism XXX
    is the unconscious transformation of anxiety into a physical symptom with no organic cause. Often the symptom functions to gain attention or as an excuse.
    Conversion

    A - A student is unable to take a final examination because of a terrible headache.

    M - A man becomes blind after seeing his wife flirt with other men.
  27. Anxiety Defense Mechanism XXX
    involves escaping unpleasant, anxiety-causing thoughts, feelings, wishes, or needs by ignoring their existence.
    Denial

    A - A man reacts to news of the death of a loved one by saying, "No, I don't believe you. The doctor said he was fine."

    M - A woman whose husband died 3 years earlier still keeps his clothes in the closet and talks about him in the present tense.
  28. Anxiety Defense Mechanism XXX
    is the transference of emotions associated with a particular person, object, or situation to another nonthreatening person, object, or situation.
    Displacement

    A - A patient criticizes a nurse after his family fails to visit.

    M - A child who is unable to acknowledge fear of his father becomes fearful of animals.
  29. Anxiety Defense Mechanism XXX
    is a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment. It may result in a separation between feeling and thought. This can also manifest itself in compartmentalizing uncomfortable or unpleasant aspects of oneself.
    Dissociation

    A - An art student is able to mentally separate herself from the noisy environment as she becomes absorbed in her work.

    M - As the result of an abusive childhood and the need to separate from its realities, a woman finds herself perpetually in a world where she feels disconnected from reality.
  30. Anxiety Defense Mechanism XXX
    is attributing to oneself the characteristics of another person or group. This may be done consciously or unconsciously.
    Identification

    A - An 8-year-old girl dresses up like her teacher and puts together a pretend classroom for her friends.

    M - A young boy thinks a neighborhood pimp with money and drugs is someone to look up to.
  31. Anxiety Defense Mechanism XXX
    is a process in which events are analyzed based on remote, cold facts and without passion, rather than incorporating feeling and emotion into the processing.
    Intellectualization

    A - Despite the fact that a man has lost his farm to a tornado, he analyzes his options and leads his child to safety.

    M - A man responds to the death of his wife by focusing on the details of day care and operating the house-hold, rather than processing the grief with his children.
  32. Anxiety Defense Mechanism XXX
    is the process by which the outside world is incorporated or absorbed into a person's view of the self.
    Introjection

    A - After his wife's death, a man has transient complaints of chest pains and difficulty breathing — the symptoms his wife had before she died.

    M - A young child whose parents were overcritical and belittling grows up thinking that she is no good. She has taken on her parents' evaluation of her as part of her self-image.
  33. Anxiety Defense Mechanism XXX
    refers to the unconscious rejection of emotionally unacceptable features and attributing them to other people, objects, or situations. You can remember this defense through the childhood retort of "What you say is what you are."
    Projection

    A - A man who is unconsciously attracted to other women teases his wife about flirting.

    M - A woman who has repressed an attraction toward other women refuses to socialize. She fears another woman will make homosexual advances toward her.
  34. Anxiety Defense Mechanism XXX
    consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller as well as the listener.
    Rationalization

    A - An employee says, "I didn't get the raise because the boss doesn't like me."

    M - A man who thinks his son was fathered by another man excuses his malicious treatment of the boy by saying, "He is lazy and disobedient," when that is not the case.
  35. Anxiety Defense Mechanism XXX
    is when unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite behavior or emotion.
    Reaction formation

    A - A recovering alcoholic constantly preaches about the evils of drink.

    M - A woman who has an unconscious hostility toward her daughter is overprotective and hovers over her to protect her from harm, interfering with her normal growth and development.
  36. Anxiety Defense Mechanism XXX
    is reverting to an earlier, more primitive and childlike pattern of behavior that may or may not have been previously exhibited.
    Regression

    A - A 4-year-old boy with a new baby brother starts sucking his thumb and wanting a bottle.

    M - A man who loses a promotion starts complaining to others, hands in sloppy work, misses appointments, and comes in late for meetings.
  37. Anxiety Defense Mechanism XXX
    is a first-line psychological defense against anxiety. It is the temporary or long-term exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness. This happens at an unconscious level.
    Repression

    A -  A man forgets his wife's birthday after a marital fight.

    M - A woman is unable to enjoy sex after having pushed out of awareness a traumatic sexual incident from childhood.
  38. Anxiety Defense Mechanism XXX
    is the inability to integrate the positive and negative qualities of oneself or others into a cohesive image. Aspects of the self and of others tend to alternate between opposite poles; for example, either good, loving, worthy, and nurturing, or bad, hateful, destructive, rejecting, and worthless.
    Splitting

    A - A toddler views her parents as super-human and wants to be like them.

    M - A 26-year-old woman has difficulty maintaining close relationships. Despite the fact that she can initially find many positive qualities about new acquaintances, eventually she becomes disillusioned when they turn out to be flawed.
  39. Anxiety Defense Mechanism XXX
    is an unconscious process of substituting mature, constructive, and socially acceptable activity for immature, destructive, and unacceptable impulses. Often these impulses are sexual or aggressive.
    Sublimation

    A - A woman who is angry with her boss writes a short story about a heroic woman.

    M - The use of sublimation is always constructive, i.e. "healthy"
  40. Anxiety Defense Mechanism XXX
    is the conscious denial of a disturbing situation or feeling. For example, Jessica has been studying for the state board examination for a week solid. She says, "I won't worry about paying my rent until after my exam tomorrow."
    Suppression

    A - A businessman who is preparing to make an important speech later in the day is told by his wife that morning that she wants a divorce. Although visibly upset, he puts the incident aside until after his speech, when he can give the matter his total concentration.

    M - A woman who feels a lump in her breast shortly before leaving for a 3-week vacation puts the information in the back of her mind until after returning from her vacation.
  41. Anxiety Defense Mechanism XXX
    is most commonly seen in children. It is when a person makes up for an act or communication.
    Undoing

    A - After flirting with her male secretary, a woman brings her husband tickets to a concert he wants to see.

    M - A man with rigid, moralistic beliefs and repressed sexuality is driven to wash his hands to gain composure when around attractive women.
  42. Since learning that he will have a trial pass to a new group home tomorrow, Bill’s usual behavior has changed. He has started to pace rapidly, has become very distracted, and is breathing rapidly. He has trouble focusing on anything other than the group home issue and complains that he suddenly feels very nauseated. Which initial nursing response is most appropriate for Bill’s level of anxiety?

    1. “You seem anxious. Would you like to talk about how you are feeling?”
    2. “If you do not calm down, I will have to give you prn medicine to calm you.”
    3. “Bill, slow down. Listen to me. You are safe. Take a nice, deep breath.”
    4. “We can delay the visit to the group home if that would help you calm down.”
    3. “Bill, slow down. Listen to me. You are safe. Take a nice, deep breath.”

    Rationale: In this situation, the patient is demonstrating a severe level of anxiety as evidenced by his hyperventilation, increased purposeless motor activity, inability to focus to respond to his environment, and intensified somatic complaints. Patients at a severe level of anxiety are usually unable to focus sufficiently to engage in a conversation or process complex information. They respond better to short, direct statements or commands. Although the patient might benefit from sedating medication, as presented here, this intervention is more likely to be perceived as an ultimatum or a threat than a form of assistance and is likely to worsen his anxiety rather than calm him. Delaying the trial pass to the group home might also calm the patient but is not an appropriate first response; given that doing so would delay the patient’s discharge, it would be better to withhold this response until less disruptive calming measures had been tried.
  43. A patient, who seems to be angry when his family again fails to visit as promised, tells the nurse that he is fine and that the visit wasn’t important to him anyway. When the nurse suggests that perhaps he might be disappointed or even a little angry that the family has again let him down, the patient responds that it is his family that is angry, not him, or else they would have visited. What defense mechanism(s) is this patient using to deal with his feelings? Select all that apply.

    1. Rationalization
    2. Introjection
    3. Projection
    4. Regression
    5. Denial
    6. Dissociation
    1, 3, 5

    Rationale:

    Rationalization involves justifying one’s illogical or maladaptive responses by developing acceptable explanations for them; this is evident in the patient’s supporting his claim that he is not upset by stating that the visit was unimportant to him.

    Projection involves taking the unacceptable feelings that are within oneself and projecting them onto others, so that others (in the patient’s view) possess them instead of the patient; this is in evidence here in the patient saying that he is not the angry one but that his family is angry with him instead.

    Denial is escaping anxiety by ignoring or denying its existence; an example of this is the patient’s reporting that he is not angry.

    Introjection involves incorporating within oneself some distressing element from one’s environment (e.g., a person who was raised by excessively critical parents assumes a very critical view of herself in adulthood).

    Regression involves coping by returning to an earlier developmental or functional stage (e.g., a patient who has been criticized by a peer assumes a fetal position and begins to rock back and forth).

    Dissociation involves responding to stress by separating oneself from one’s reality (e.g., during an episode of abuse, a child psychologically detaches herself from the present and enters a fantasy state wherein she feels safe and is able to defend herself from abusers).
  44. John, a construction worker, is on duty when a wall under construction suddenly falls, crushing a number of co-workers. Shaken initially, he seems to be coping well with the tragedy but later begins to experience tremors, nightmares, and periods during which he feels numb or detached from his environment. He finds himself frequently thinking about the tragedy and feeling guilty that he was spared while many others died. Which statement about this situation is most accurate?

    A. John is experiencing post-traumatic stress disorder (PTSD) and requires therapy.
    B. John is experiencing anxiety and grief and should be monitored for PTSD symptoms.
    C. John is experiencing mild anxiety and a normal grief reaction; no intervention is needed.
    D. John has acute stress disorder and should be treated with antianxiety medications.
    B. John is experiencing anxiety and grief and should be monitored for PTSD symptoms.

    Rationale: John is grieving for his lost coworkers and experiencing survivor’s guilt, a common reaction when events cost some their lives while sparing others. He is also evidencing some symptoms associated with anxiety, such as tremor and being sometimes preoccupied with the stressful event. However, he is not experiencing key features of PTSD such as re-experiencing the tragedy, avoidance of focusing on or talking about the event, or emotional numbing. Acute stress disorder is characterized by the presence of at least three dissociative elements in response to a stressor, such as feeling unreal, being less aware of one’s surroundings, or feeling a sense of unreality relative to oneself or one’s environment. In this case, John is experiencing only two such symptoms and has others that are not part of acute stress disorder. As noted, John is experiencing grief and mild-to-moderate anxiety in response to the tragedy he witnessed; however, given the intensity of this tragedy, it is important to monitor John for signs of PTSD, because he is at risk for developing this disorder (which usually manifests within 3 months of the traumatic event). Failure to monitor for PTSD would place John at risk of developing this potentially disabling anxiety disorder, which in some patients can even lead to suicidal behavior. Therefore, although his levels of anxiety and grief are not pathological at this time, because he is at risk for PTSD, he does requirement further intervention in the form of periodic reassessment and support.
    (this multiple choice question has been scrambled)
  45. A variety of medications are used in the treatment of severe anxiety disorders. Which class of medication used to treat anxiety is potentially addictive?

    1. Benzodiazepines
    2. Selective serotonin reuptake inhibitors (SSRIs)
    3. Beta-blockers
    4. Antihistamines
    5. Buspirone
    1. Benzodiazepines

    Rationale: All of the medications listed can be used to treat anxiety disorders, but benzodiazepines are the only type that are potentially addictive.
  46. An older adult in the outpatient internal medicine clinic complains of feeling a sense of dread and fearfulness without apparent cause. It has been growing steadily worse and is to the point where it is interfering with the patient’s sleep and volunteer work. After a brief interview and cursory physical exam, the APRN diagnoses the patient with generalized anxiety disorder and suggests a referral to the mental health clinic. Which response(s) by the clinic nurse would be appropriate? Select all that apply.

    1. Complete a neurological history and neurological examination.
    2. Examine the patient’s extremities for edema, and listen to her lungs.
    3. Observe the patient’s respirations, and obtain a pulse oximetry reading.
    4. Review the patient’s current medications, and observe the patient’s gait.
    5. Suggest that a battery of blood tests, including a CBC, be ordered and reviewed.
    6. Ask the APRN to review the nurse’s findings before ordering the referral.
    all

    Rationale: Many medical conditions can cause or mimic anxiety. In an older adult, who would be more likely to have medical illnesses than a younger person (both diagnosed and undiscovered), it is especially important to rule out contributing medical conditions before assuming that symptoms resembling anxiety are of a mental health origin. Since disorders of the respiratory, circulatory, endocrine, metabolic, and neurological systems can all mimic anxiety or cause anxiety symptoms, further assessment of all these body systems is indicated. A professional in the role of patient advocate would use assertive communication techniques to alert the APRN to consider other possible causes for the patient’s presentation before concluding that primary anxiety is behind the patient’s symptoms.
  47. 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.
    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. Text page: 214
    (this multiple choice question has been scrambled)
  48. Selective inattention is first noted when experiencing anxiety that is: 

    A. panic.
    B. severe.
    C. mild.
    D. moderate.
    D. 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. Text page: 213
    (this multiple choice question has been scrambled)
  49. 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.
    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. Text page: 214
    (this multiple choice question has been scrambled)
  50. The defense mechanisms that can only be used in healthy ways are 

    A. idealization and splitting.
    B. suppression and humor.
    C. altruism and sublimation.
    D. reaction formation and denial.
    C. 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.

    Sublimation substitutes socially acceptable activity for unacceptable impulses. Text page: 215
    (this multiple choice question has been scrambled)
  51. Which behavior would be characteristic of an individual who is displacing anger? 

    A. Stealing
    B. Procrastinating
    C. Lying
    D. Slapping
    B. Procrastinating

    A passive-aggressive person deals with emotional conflict by indirectly and unassertively expressing aggression toward others. Procrastination is an expression of resistance. Text page: 215
    (this multiple choice question has been scrambled)
  52. 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. reaction formation.
    B. projection.
    C. rationalization.
    D. undoing.
    A. reaction formation.

    Reaction formation keeps unacceptable feelings or behaviors out of awareness by developing the opposite behavior or emotion. Text page: 216
    (this multiple choice question has been scrambled)
  53. What can be said about the age of onset of most anxiety disorders? Onset is 

    A. scattered throughout the lifespan.
    B. after age 40 years.
    C. before age 20 years.
    D. before age 40 years.
    D. before age 40 years.
    (this multiple choice question has been scrambled)
  54. What can be said about the comorbidity of anxiety disorders? 

    A. A second anxiety disorder may coexist with the first.
    B. Anxiety disorders exist alone.
    C. Substance abuse disorders rarely coexist with anxiety disorders.
    D. Anxiety disorders virtually never coexist with mood disorders.
    A. 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. Text page: 224
    (this multiple choice question has been scrambled)
  55. Studies of clients with posttraumatic stress disorder suggest that the stress response of which of the following is considered abnormal? 

    A. Brainstem
    B. Frontal lobe
    C. Hypothalamus-pituitary-adrenal system
    D. Limbic system
    C. Hypothalamus-pituitary-adrenal system
    (this multiple choice question has been scrambled)
  56. An important question to ask in the assessment of a client with anxiety disorder is 

    A. "Do your thoughts always seem jumbled?"
    B. "Have you ever considered suicide?"
    C. "How often do you hear voices?"
    D. "How long has your memory been bad?"
    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. Text page: 229
    (this multiple choice question has been scrambled)
  57. 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. moderate.
    B. mild.
    C. severe.
    D. panic.
    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. Text page: 213
    (this multiple choice question has been scrambled)
  58. 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. "Can you tell me what you were feeling just before your attack?"
    C. "What is it that you would like me to do to help you?"
    D. "I will get you some medication to help calm you."
    B. "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. Text page: 219
    (this multiple choice question has been scrambled)
  59. A cultural characteristic that may be observed in a teenage, female Hispanic client in times of stress is to: 

    A. Laugh inappropriately
    B. Report both nausea and vomiting
    C. suddenly tremble severely
    D. Exhibit stoic behavior
    C. 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. Text page: 227
    (this multiple choice question has been scrambled)
  60. The nurse anticipates that the nursing history of a client diagnosed with obsessive compulsive disorder (OCD) will reveal: 

    A. a phobia as well
    B. a sibling with the disorder
    C. an eating disorder
    D. a history of childhood trauma
    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. Text page: 225
    (this multiple choice question has been scrambled)
  61. A client is diagnosed with generalized anxiety disorder (GAD). The nursing assessment supports this diagnosis when the client reports: 

    A. repeatedly verbalizing his prayers helps him feel relaxed
    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. 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

    GAD is characterized by symptomology that lasts 6 months or longer. Text page: 220
    (this multiple choice question has been scrambled)
  62. Panic attacks in Latin American individuals often involve 

    A. fear of dying.
    B. offensive verbalizations.
    C. repetitive involuntary actions.
    D. blushing.
    A. 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. Text page: 226
    (this multiple choice question has been scrambled)
  63. 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. Not allowing the client to wash hands after touching a "dirty" object
    B. Telling the client that he or she must relax whenever tension mounts
    C. Not allowing client to seek reassurance from staff
    D. Having client repeatedly touch "dirty" objects
    A. 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.Text page: 238
    (this multiple choice question has been scrambled)
  64. A client is experiencing a panic attack. The nurse can be most therapeutic by 

    A. verbalizing mild disapproval of the anxious behavior.
    B. offering an explanation about the role of the sympathetic nervous system in symptom formation.
    C. telling the client to take slow, deep breaths.
    D. asking the client what he means when he says "I am dying."
    C. 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. Text page: 238
    (this multiple choice question has been scrambled)
  65. The nurse caring for a client with a panic attack might anticipate that the psychiatrist would order a stat dose of 

    A. anticholinergic medication.
    B. standard antipsychotic medication.
    C. a short-acting benzodiazepine medication.
    D. tricyclic antidepressant medication.
    C. a short-acting benzodiazepine

    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. Text page: 236
    (this multiple choice question has been scrambled)
  66. A Gulf War veteran is entering treatment for posttraumatic stress disorder. An important facet of assessment is to 

    A. determine use of chemical substances for anxiety relief.
    B. find out if the client uses acting out behavior.
    C. establish whether the client has chronic hypertension related to high anxiety.
    D. ascertain how long ago the trauma occurred.
    A. 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. Text page: 223
    (this multiple choice question has been scrambled)
  67. 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. tell the client to expect mild insomnia.
    C. teach the client to limit caffeine intake.
    D. explain the long-term nature of benzodiazepine therapy.
    C. teach the client to limit caffeine intake.

    Caffeine is an antagonist of antianxiety medication. Text page: 237
    (this multiple choice question has been scrambled)
  68. A potential problem that should be investigated for a client with severe obsessive-compulsive disorder is 

    A. altered state of consciousness.
    B. command hallucinations.
    C. sleep disturbance.
    D. excessive socialization.
    C. 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. Text page: 220
    (this multiple choice question has been scrambled)
  69. A manic client announces to everyone in the day room that a stripper is coming to perform this evening. When a nurse firmly states that this is inappropriate and will not happen, the client becomes verbally abusive and threatens physical violence to the nurse. Based on the analysis of this situation, the nurse determines that the appropriate action would be to:

    A: Orient the client to time, person and place
    B: Tell the client that the behavior is inappropriate.
    C: Escort the manic client to her room, with assistance
    D: Tell the client that smoking privileges are revoked for 24 hours
    C: Escort the manic client to her room, with assistance

    The client is at risk for injury to self and others and should be escorted out of the dayroom. Option D may increase the agitation that already exists in this client. Orientation will not halt the behavior. Telling the client that the behavior is inappropriate already has been attempted by the nurse.
  70. A client is admitted to a medical nursing unit with a diagnosis of acute blindness. Many tests are performed and there seems to be no organic reason why this client cannot see. The client became blind after witnessing a hit and run car accident, when a family of three was killed. A nurse suspects that the client may be experiencing a:

    A: Psychosis
    B: Repression
    C: Conversion disorder
    D: Dissociative disorder
    C: Conversion disorder

    conversion disorder is the alteration or loss of a physical function that cannot be explained by any known pathophysiological mechanism. A conversion disorder is thought to be an expression of a psychological need or conflict. In this situation, the client witnessed an accident that was so psychologically painful that the client became blind.

    A dissociated disorder is a disturbance or alteration in the normally integrative function of identity, memory or consciousness.

    Psychosis is a state in which a person's mental capacity to recognize reality, communicate, and relate to others is impaired interfering with the person's ability to deal with life's demands.

    Repression is a coping mechanism in which unacceptable feelings are kept out of awareness.
  71. A client's medication sheet contains a prescription for sertraline (***Zoloft***). To ensure safe administration of the medication, a nurse would administer the dose:

    A. Evenly spaced around the clock
    B. At the same time each evening
    C. On an empty stomach
    D. As needed when the client complains of depression
    B. At the same time each evening

    Sertraline (***Zoloft***) is classified as an anti-depressant. Sertraline generally is administered once every 24 hours. It may be administered in the morning or evening, but evening administration may be preferable because drowsiness is a side effect. The medication may be administered without food or with food if gastrointestinal distress occurs. Sertraline is not prescribed for use as needed.
    (this multiple choice question has been scrambled)
  72. A  client taking the MAOI phenelzine (Nardil) tells the nurse that he routinely takes all of the medications listed below. Which medication would cause the nurse to express concern and therefore initiate further teaching?

    A. Diphenhydramine (Benadryl)
    B. Isosorbide dinitrate (Isordil)
    C. Acetaminophen (Tylenol)
    D. Furosemide (Lasix)
    A. Diphenhydramine (Benadryl)

    Over-the-counter medications used for allergies and cold symptoms are contraindicated because they will increase the sympathomimetic effects of MAOIs, possibly causing a hypertensive crisis. None of the remaining medications will increase the sympathomimetic response and, therefore, are not contraindicated.
    (this multiple choice question has been scrambled)
  73. ***Zoloft*** treats?
    Agoraphobia

    It is a SSRI, generic Sertraline
  74. ***Luvox*** treats
    OCD

    It is SSRI, generic Fluvoxamine
  75. Panic Disorder is
    an anxiety disorder

    • Requires:
    • A. Recurrent panic attacks
    • B. At least one attack followed by 1 or more months of:
    • 1 - Concern about additional attacks
    • 2 - Worry about consequences, e.g. heart attack
    • 3 - Significant change in behavior

    With or without Agoraphobia
  76. Simple Agoraphobia ...
    i.e. without a history of PD (Panic Disorder) occurs rarely, and if it does then early in Pt's history.

    Over time, agoraphobia with PA usually develops.
  77. ***Inderal*** treats
    Social phobias (fear of being seen, embarrassed or criticized)

    It is β-blocker, generic Propranolol
  78. Astraphobia
    lightning storms
  79. Glossophobia
    talking
  80. Mysophobia
    germs or dirt
  81. Nyctophobia
    night
  82. Xenophobia
    strangers
  83. An assessment question for a Pt with a phobia
    Do you use any prescriptions, drugs or alcohol to decrease your anxiety associated with the fear?
  84. OCD Compulsions are ritualistic behaviors an individual feels driven to perform for the purpose of...
    reducing anxiety

    The reason for the anxiety is that the obsessions driving the compulsions seem senseless to the individual and this creates anxiety.
  85. GAD is characterized by excessive worry lasting longer then AAA and displays many of these BBB symptoms. The individual's anxiety is CCC to the impact of the event or situation about which the person is worried.
    A) 6 months

    • B) Restlessness
    • Fatigue
    • Poor concentration
    • Irritability
    • Tension
    • Sleep disturbance

    C) out of proportion
  86. Timeframes:
    a) Acute PTSD
    b) Chronic PTSD
    c) Delayed PTSD
    • a) duration less than 3 months
    • b) 3 months or more
    • c) onset of symptoms delayed at least 6 months after stress
  87. PTSD symptoms often begin AAA, but a delay of BBB is not uncommon. It involves CCC via DDD, EEE, or FFF.  It lasts more than GGG.
    • A) within 3 months after the trauma
    • B) months or years
    • C) re-experiencing
    • D) intrusive recollections
    • E) dreams
    • F) flashbacks - dissociative experiences in which the event is relived.
    • G) 1 month
  88. Acute stress disorder occur within AAA of the traumatic event and, by definition BBB.
    • A) 1 month
    • B) is resolve within 2 days to 4 weeks
  89. Psychoactive drugs findings necessary for diagnosis of substance-induced anxiety disorder
    • alcohol
    • cocaine
    • heroin
    • hallucinogens
  90. Respiratory causes of Anxiety
    • Chronic obstructive pulmonary
    • Pulmonary embolism
    • Asthma
    • Hypoxia
    • Pulmonary edema
  91. Assessment Guidelines for Anxiety Disorders
    1. Ensure that a sound physical and neurological examination is performed to help determine whether the anxiety is primary or secondary to another psychiatric disorder, medical condition, or substance use.

    2. Determine current level of anxiety (mild, moderate, severe, or panic).

    3. Assess for potential for self-harm and suicide; people suffering from high levels of intractable anxiety may become desperate and attempt suicide.

    4. Perform a psychosocial assessment. Always ask the person, "What is going on in your life that maybe contributing to your anxiety?" The patient may identify a problem that should be addressed by counseling (stressful marriage, recent loss, stressful job or school situation).

    5. Note: Culture can affect how anxiety is manifested.
  92. SSRIs are first-line treatment for acute stress disorders (antidepressant) and are preferred over TCS (tricyclic antidepressants) because of AAA and BBB.
    • A) more rapid onset
    • B) fewer problematic side effects
  93. SSRIs (less side effects)

    antidepressant
    • Celexa
    • Lexapro
    • Prozac
    • ***Luvox*** (OCD)
    • ---more calming than the above are:
    • Paxil
    • ***Zoloft*** (agoraphobia)
  94. SSNRIs
    (Norepinephrine)

    antidepressant
    • Cymbalta
    • Effexor
  95. TCA Tricyclic’s

    antidepressant
    • Elavil
    • Anafranil
    • Norpramine
    • Adapin, Sinequan
    • Tofranil
    • Aventyl, Pamelor
  96. MAOI Monoamine Oxidase Inhibitors

    antidepressant

    These are reserved for treatment-resistant conditions because of the threat of life-threatening hypertensive crisis if the Pt does not follow dietary restrictions for foods containing tyramine, e.g. aged cheeses, pickled/smoked fish, wine, avocadoes, figs, aged/smoked meat, chocolate. Also contraindicated for Pts with comorbid substance abuse.
    • Nardil
    • Parnate
  97. Benzodiazepines

    antianxiety
    monitor for sedation, ataxia (lack of voluntary coordination of muscle movements), decreased cognitive functioning
    quick onset
    highly addictive so short period use
    not for substance abusers, PG or breast feeding women
    • Xanax
    • Librium
    • Klonopin
    • Valium
    • Ativan
  98. Nonbenzodiazepines

    antianxiety
    BuSpar - has no dependence issues and so can be taken long term, but it does takes 2-4 weeks to reach full effects.
  99. Antihistamines

    Added if first course of treatment is ineffective
    • Atarax
    • Vistaril

    • FDA: none
    • Off-label: GAD
  100. β-Blockers

    Added if first course of treatment is ineffective
    • Tenormin
    • ***Inderal*** (social phobia)
  101. Anticonvulsants

    Added if first course of treatment is ineffective
    • Tegretol
    • Neurotin
    • Depakote
  102. D-cycloserine is...
    • an antibiotic for TB
    • It also helps learning or "unlearning" as in fears (phobias)
    • Also helpful with OCD

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