Chapter 24: The Client With an Anxiety Disorder Mohr: Psychiatric Mental Health Nursing, 6th Edition
1. A 25-year-old woman tells the nurse that
... [Show More] she has been worried and tearful lately because of pressures at work. She states, “My boyfriend tells me that it's 'stress' and 'anxiety,' but doesn't everyone have that? What is anxiety anyway?” Which of the following responses gives the best information about the nature of anxiety?
A) “Anxiety is an abnormal response to everyday stress.”
B) “Anxiety is a sense of psychological distress.”
C) “Anxiety is a physiologic response to stress.”
D) “Anxiety is a normal response to everyday stress.”
Ans: B Chapter: 24
Client Needs: C-1 Cognitive level: Application
Concepts & Processes: Communication Difficulty: Moderate
Objective: 01
Feedback: Anxiety can be described as a sense of psychological distress. Feeling anxious, frightened, uneasy, or worried are normal responses to threatening or dangerous events.
Page: 2
2. A nurse is giving a presentation on mental health promotion to college students. One student asks the nurse to explain the difference between normal anxiety and an anxiety disorder. Which of the following responses is best?
A) “People with anxiety disorders experience a fight-or-flight response when threatened.”
B) “People with anxiety disorders generally find that the anxiety interferes with daily activities.”
C) “Normal anxiety does not result in feelings of dread or restlessness.”
D) “Normal anxiety occurs in response to everyday stressors.”
Ans: B Chapter: 24
Client Needs: C-1 Cognitive level: Application
Concepts & Processes: Communication Difficulty: Moderate
Objective: 02
Feedback: Pathologic anxiety is suspected if a person feels anxious when no real threat exists,
when a threat has passed long ago but continues to impair the person's functioning, or when a person substitutes adaptive coping mechanisms with maladaptive ones.
Page: 6
3. The cause(s) of anxiety disorders is/are
A) a heritable predisposition for a lowered threshold.
B) alterations in brain structure.
C) distorted thinking patterns and learned responses.
D) neurobiologic and psychodynamic.
Ans: D Chapter: 24
Client Needs: C-2 Cognitive level: Knowledge
Concepts & Processes: Teaching/learning Difficulty: Moderate
Objective: 04
Feedback: According to current research, anxiety disorders have several possible causes. The etiology of anxiety disorders is believed to be a combination of neurobiologic and psychological factors.
Page: 8, 10
4. Severe levels of anxiety result in
A) a heightened sense of awareness.
B) distorted sensory awareness.
C) mild forgetfulness.
D) impaired ability to concentrate.
Ans: B Chapter: 24
Client Needs: C-1
Cognitive level: Comprehension Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 05
Feedback: In severe anxiety, perception becomes increasingly distorted, sensory input diminishes, and processing of sensory stimuli becomes scattered and disorganized.
Page: 4
5. Generalized anxiety disorder (GAD) is characterized by
A) excessive worry or anxiety lasting more than 6 months.
B) flashbacks and feelings of unreality.
C) fear of going outdoors.
D) behavioral changes in response to panic attacks.
Ans: A Chapter: 24
Client Needs: B-2 Cognitive level: Knowledge
Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 05
Feedback: GAD is usually characterized by chronic and excessive worry and anxiety more days than not, occurring for at least 6 months and involving many aspects of the person's life (APA, 2000).
Page: 11
6. Flashbacks and feelings of unreality are associated with
A) post-traumatic stress disorder (PTSD).
B) panic disorder.
C) agoraphobia.
D) obsessive-compulsive disorder (OCD).
Ans: A Chapter: 24
Client Needs: B-2 Cognitive level: Knowledge
Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 06
Feedback: Symptoms of PTSD include generalized anxiety, dissociation, intrusive thoughts or images of the trauma, flashbacks, nightmares, and other sleep disturbances. Additionally, the person feels a need to avoid situations or stimuli that elicit recollections of the trauma.
Page: 16
7. A 30-year-old woman who has been unemployed secondary to her anxiety disorder states that she would like to have a job where she is alone and no one needs to evaluate her work. The nurse
interprets these comments as an indicator of
A) agoraphobia.
B) social phobia.
C) obsessive-compulsive disorder.
D) panic disorder.
Ans: B Chapter: 24
Client Needs: B-2 Cognitive level: Application
Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 05
Feedback: Social phobia represents a persistent, irrational fear of and compelling desire to avoid situations in which the person may be exposed to unfamiliar people or to the scrutiny of others. Additionally, the person harbors the fear of behaving in a way that may prove humiliating or embarrassing. The person will experience marked anticipatory anxiety if confronted with such a situation and will attempt to avoid it.
Page: 12
8. Clients taking benzodiazepines need education about
A) avoiding cheeses and smoked meats.
B) interactions with monoamine oxidase inhibitors (MAOIs).
C) avoiding spending too much time in the sun.
D) potentiation of alcohol effects.
Ans: D Chapter: 24
Client Needs: D-2 Cognitive level: Application
Concepts & Processes: Teaching/learning Difficulty: Moderate
Objective: 07
Feedback: Benzodiazepines have long been the drugs of choice for treatment of anxiety disorders. They can induce a physical dependence, and can induce severe withdrawal symptoms and intense rebound anxiety when discontinued abruptly. They potentiate the effects of alcohol and other sedative hypnotics, are commonly abused, and have several significant side effects.
The most common adverse effects are sedation, ataxia, loss of coordination, slurred speech, memory impairment, paradoxical agitation, and dizziness. They also cause psychomotor impairment.
Page: 22-23
9. A client with generalized anxiety disorder states that he is worried about his job. He never feels like he has control over his responsibilities, even though he puts in extra hours. He adds that he is afraid he will be fired. Which response by the nurse is most therapeutic?
A) “It sounds to me like you're doing a good job.”
B) “Your worries are a feature of your anxiety disorder. Tell yourself that you have nothing to worry about.”
C) “Has something changed at work that is causing you to worry?”
D) “Why do you think you'll be fired?”
Ans: C Chapter: 24
Client Needs: C-2 Cognitive level: Application
Concepts & Processes: Communication Difficulty: Moderate
Objective: 07
Feedback: The nurse begins an assessment by simply asking the client if he or she is currently feeling anxious or worried or has experienced these feelings recently. The nurse also asks the client about obsessive thinking patterns, worrying, compulsions and repetitive activity, specific phobias, and exposure to traumatic events. Once the nurse has determined that signs and symptoms of anxiety do exist, he or she assesses the possible underlying causes and inquires about family history, recent life events, current stress level, personal history of anxiety, medical and medication history, history of substance abuse, and other possible causes of the anxiety.
Page: 25-27
10. A nurse is creating a plan of care for a 30-year-old single woman with a history of post- traumatic stress disorder. The client cannot drive by the park where she was assaulted. The nurse suggests that the client visualize successfully driving by the park. This intervention is an example of
A) cognitive reframing.
B) positive coping statements.
C) covert rehearsal.
D) cognitive restructuring.
Ans: C Chapter: 24
Client Needs: C-2
Cognitive level: Comprehension Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 08
Feedback: In covert rehearsal the client is helped to imagine him self or herself successfully confronting an anxiety-provoking situation.
Page: 20
11. Desensitization refers to
A) a systematic way to replace a panic response with a relaxation response.
B) a cognitive technique for replacing a worry with a positive statement.
C) exposing the client to an anxiety-producing stimulus for 1 to 2 hours (flooding).
D) teaching the client to ignore or become immune to anxiety-producing situations.
Ans: A Chapter: 24
Client Needs: C-2 Cognitive level: Knowledge
Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 07
Feedback: Systematic desensitization is a classical conditioning technique by which a client learns to gradually replace a panic response with a relaxation response. It is a behavioral therapy used to treat specific phobias, social phobias, agoraphobia, and post-traumatic stress disorder.
The client progressively confronts the object of fear in very small, controlled steps while in a deeply relaxed state.
Page: 20
12. Which of the following is a common affective sign or symptom of anxiety?
A) Palpitations
B) Restlessness
C) Decreased ability to concentrate
D) Irritability
Ans: D Chapter: 24
Client Needs: C-1
Cognitive level: Comprehension Concepts & Processes: Nursing process Difficulty: Moderate
Objective: 08
Feedback: Affective signs and symptoms to assess for include irritable, worried, tense, or fearful affect; feelings of helplessness or inadequacy; and overly excited, wary, or anguished affect.
Page: 26
13. A client relates that she has been under increased stress at work and that the only way she knows to manage her anxiety is by drinking a few glasses of wine each evening. The nurse suggests she stop drinking because of the negative effects of alcohol consumption. Which of the following statements explains why this will be difficult for the client?
A) She is probably physically dependent on alcohol.
B) Drinking alcohol is more socially acceptable than is taking medications.
C) She has no coping mechanism with which to replace drinking alcohol.
D) A few glasses of wine each night is not necessarily a problem.
Ans: C Chapter: 24
Client Needs: C-1 Cognitive level: Analysis
Concepts & Processes: Self-care Difficulty: Difficult
Objective: 08
Feedback: Clients learn to reduce the anxiety they feel in either functional or dysfunctional ways. The nurse first explores with the client what techniques the client has used in the past and helps the client identify and enhance those strategies that are most beneficial. The nurse and client identify maladaptive coping strategies such as social withdrawal or alcohol use and replace them with adaptive strategies that suit the client's personal, cultural, and spiritual values. The nurse should not ask the client to give up coping mechanisms, even maladaptive ones, without offering other adaptive mechanisms.
Page: 31
14. Relaxation techniques help clients with anxiety disorders because they
A) reduce autonomic arousal.
B) increase sympathetic stimulation.
C) release cortisol.
D) increase metabolic rate.
Ans: A Chapter: 24
Client Needs: C-1 Cognitive level: Knowledge
Concepts & Processes: Self-care Difficulty: Moderate
Objective: 08
Feedback: Regularly inducing the relaxation response reduces the general level of autonomic
arousal in anxious clients. It lowers blood pressure, heart rate, metabolic rate, and oxygen demands. This physiologic effect may result from effects on the production of cortisol, a hormone the body releases in response to stress. Cortisol is helpful during the fight-or-flight response, but its prolonged presence in chronically anxious or stressed clients can inhibit the immune system and have other deleterious effects on the body.
Page: 31-32
15. A client states that she copes with anxiety by cleaning compulsively, which irritates her husband. The nurse considers this
A) maladaptive, because it is an avoidance response.
B) maladaptive, because it bothers her husband.
C) adaptive, because she chooses to clean.
D) adaptive, because her behavior isn't harming anyone.
Ans: A Chapter: 24
Client Needs: C-2 Cognitive level: Analysis
Concepts & Processes: Teaching/learning Difficulty: Difficult
Objective: 08
Feedback: Clients learn to reduce the anxiety they feel in either functional or dysfunctional ways. Functional responses tend to be voluntary, conscious behaviors that address and acknowledge the stressful situation and help clients to find solutions. Dysfunctional responses tend to be involuntary, inflexible, avoidance-type solutions that impair productivity. The nurse should not ask the client to give up coping mechanisms, even maladaptive ones, without offering other adaptive mechanisms. In other words, it is not appropriate to expect a client to just stop worrying, compulsively checking doors, or otherwise trying to cope with anxiety.
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