Psychiatric - Chp 14

The nurse observes a client who is becoming increasing upset. He is rapidly pacing, hyperventilating, clenching his jaw, wringing his hands, and trembling. His speech is high pitched and random; he seems preoccupied with his thoughts. He is pounding his fist into his other hand. The nurse identifies his anxiety level as

a) mild
b) moderate
c) severe
d) panic

c) severe
When assessing a client with anxiety, the nurse’s questions should be

a) avoided until the anxiety is gone
b) open ended
c) postponed until the client volunteers information
d) specific and direct

d) specific and direct
The best goal for a client learning a relaxation techniques is that the client will

a) confront the source of anxiety directly
b) experience anxiety without feeling overwhelmed
c) report no episodes of anxiety
d) suppress anxious feelings

b) experience anxiety without feeling overwhelmed
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Which of the four classes of medications used for panic disorder is considered the safest because of low incidence of side effects and lack of physiologic dependence?

a) Benzodiazepines
b) Tricyclics
c) Monoamine oxidase inhibitors
d) Selective serotonin reuptake inhibitors

d) Selective serotonin reuptake inhibitors
Which of the following would be the best intervention for a client having a panic attack?

a) involve the client in a physical activity
b) offer a distraction such a music
c) remain with the client
d) teach the client a relation technique

c) remain with the client
A client with GAD states, “I have learned that the best thing I can do is to forget my worries.” How would the nurse evaluate this statement?

a) the client is developing insight
b) the client’s coping skills have improved
c) the client need encouragement to verbalize feelings
d) the client’s treatment has been successful

c) the client need encouragement to verbalize feelings
A client with anxiety is beginning treatment with lorazepam (Ativan). It is most important for the nurse to assess the client’s

a) motivation for treatment
b) family and social support
c) use of coping mechanisms
d) use of alcohol

d) use of alcohol
Interventions for a client with panic disorder would include

a) encouraging the client to verbalize feelings
b) helping the client to avoid panic-producing situations
c) reminding the client to practice relaxation when anxiety level is low
d) teaching the client reframing techniques.
e) teaching relaxation exercises to the client
f) telling the client to ignore any anxious feelings

a) encouraging the client to verbalize feelings
c) reminding the client to practice relaxation when anxiety level is low
d) teaching the client reframing techniques.
e) teaching relaxation exercises to the client
When working with a client with moderate anxiety, the nurse would expect to see

a) inability to compete tasks
b) failure to respond to redirection
c) increased automatisms or gestures
d) narrowed perceptual field
e) selective attention
f) inability to connect thoughts independently

c) increased automatisms or gestures
d) narrowed perceptual field
e) selective attention
f) inability to connect thoughts independently
When discussing various types of anxiolytic medications with a client, the nurse recognizes that which of the following medications has the lowest potential for abuse?

a) Lorazepam (Ativan)
b) Diazepam (Valium)
c) Alprazolam (Xanax)
d) Buspirone (BuSpar)

d) Buspirone (BuSpar)
In teaching a client who has been prescribed a benzodiazepine for panic disorder, the nurse must be certain to do what?

a) Instruct the client to come in every other week to get blood drawn and monitor for agranulocytosis.
b) Instruct the client that if he has palpitations, he should contact his physician immediately because of the risk for dysrhythmias with this medication.
c) Educate the client that this medication has a high risk for withdrawal symptoms, and he should not discontinue without a doctor’s supervision.
d) Educate the client that this medication will interact with certain food groups.

c) Educate the client that this medication has a high risk for withdrawal symptoms, and he should not discontinue without a doctor’s supervision.
Relaxation techniques help clients with anxiety disorders because they do what?

a) Increase metabolic rate
b) Reduce autonomic arousal
c) Increase sympathetic stimulation
d) Release cortisol

b) Reduce autonomic arousal
Which of the following would be an appropriate intervention of a client experiencing an anxiety attack?

a) Leaving the client alone
b) Turning on stereo music
c) Turning on the lights and opening the windows so that the client does not feel crowded
d) Staying with the client and speaking in short sentences

d) Staying with the client and speaking in short sentences
A 21-year-old woman has been recently diagnosed with agoraphobia. Which of the following situations is most likely to cause the woman anxiety?

a) Gaining five pounds and being unable to exercise vigorously
b) Going to a crowded, outdoor market on her own
c) Having a blood sample drawn and experiencing mild pain
d) Having her work performance closely scrutinized by a supervisor

b) Going to a crowded, outdoor market on her own
Jonathan comes in for a therapy session and is having a mild panic attack. The therapist asks him to relax in his chair and then gently asks him to imagine himself in a very safe and calm place. This technique, often useful in anxiety disorders, is called:

a) desensitization.
b) cognitive therapy.
c) visualization.
d) problem-solving.

c) visualization.
A nurse assesses a client and determines that the client is experiencing mild anxiety based on which of the following?

a) Selectively inattentive
b) Aware and alert
c) Focused attention on a small area
d) Feelings of unreality

b) Aware and alert
Eight months ago, a client was in a hotel fire and was the last person to be rescued from the roof. She watched her husband burn to death from the helicopter. She continues to have nightmares and is fearful that she will die in a fire. An appropriate nursing diagnosis for the client is what?

a) Ego disintegration related to severe anxiety
b) Unrealistic fear of fire related to conversion reaction
c) Sleep pattern disturbance related to recurrent nightmares
d) Anxiety related to illusions

c) Sleep pattern disturbance related to recurrent nightmares
Which of the following questions in the assessment of a client with anxiety is most clinically appropriate?

a) “Do you think that you’re justified in feeling anxious right now?”
b) “Does your anxiety make you feel less valuable and competent as a person?”
c) “How do you feel about everything that is happening in your life right now?”
d) “What can I give you to make you feel less anxious right now?”

c) “How do you feel about everything that is happening in your life right now?”
Which of the following is the primary concern for a client with panic-level anxiety?

a) Emotional needs
b) Physiologic needs
c) Safety
d) Social support

c) Safety
Which of the following should be included in a teaching plan for a client prescribed a benzodiazepine?

a) Maintain a fluid restriction
b) Consume caffeine in moderation
c) Stop taking drug if sedation develops
d) Rise slowly from a lying or sitting position

d) Rise slowly from a lying or sitting position
Panic disorder is treated with cognitive-behavioral techniques, deep breathing, and relaxation, in addition to which of the following?

a) CNS depressants
b) Antipsychotics
c) Antianxiety medications
d) Anticonvulsants

c) Antianxiety medications
Which term describes feelings of being disconnected from oneself as seen in a panic attack?

a) Depersonalization
b) Automatisms
c) Agoraphobia
d) Derealization

a) Depersonalization
An adolescent client reveals that she is about to take a math test from her tutor. Nursing assessment reveals mild anxiety. The nurse explains that this level of anxiety does what?

a) Will interfere with her cognitive abilities
b) Is pathologic and warrants postponing the test
c) May be transferred to her tutor and result in test anxiety
d) Is conducive to concentration and problem solving

d) Is conducive to concentration and problem solving
A client who experiences paralyzing anxiety at the sight of a dog is supported in the act of sitting in a room with the animal. This is an example of the alternative behavioral technique called …

a) Implosion therapy
b) Systematic desensitization
c) Relaxation exercise
d) Biofeedback

b) Systematic desensitization
Anxiety disorder is considered chronic and generalized when excessive anxiety and worry about two or more life circumstances exist for at least …

a) 4 months
b) 2 months
c) 12 months
d) 6 months

d) 6 months
A nurse is caring for a client who has panic attack. The nurse takes the client in a small isolated room. How would this intervention benefit the client? Choose the best answer.

a) The client would be able to understand what the nurse is saying.
b) The client would return to rational thought.
c) The client would have an enhanced sense of security.
d) The client would be able to demonstrate relaxation techniques.

c) The client would have an enhanced sense of security.
Clients taking benzodiazepines need education about which of the following?

a) Avoiding spending too much time in the sun
b) Avoiding cheeses and smoked meats
c) Potentiation of alcohol effects
d) Interactions with monoamine oxidase inhibitors (MAOIs)

c) Potentiation of alcohol effects
Which of the following would not be included in the plan of care for a client diagnosed with acute anxiety?

a) Encouraging the client to verbalize feelings and concerns
b) Approaching the client in a calm, confident manner
c) Touching the client in an attempt to comfort him
d) Providing the client with a safe, quiet, and private place

c) Touching the client in an attempt to comfort him
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) “Normal anxiety occurs in response to everyday stressors.”
b) “Normal anxiety does not result in feelings of dread or restlessness.”
c) “People with anxiety disorders experience a fight-or-flight response when threatened.”
d) “People with anxiety disorders generally find that the anxiety interferes with daily activities.”

d) “People with anxiety disorders generally find that the anxiety interferes with daily activities.”
Which of the following conditions involves a persistent, irrational fear attached to an object or situation that objectively does not pose a significant danger?

a) Obsessive-compulsive disorder
b) Stress disorders
c) Post-traumatic stress disorder
d) Phobic disorders

d) Phobic disorders
What does desensitization refer to?

a) A cognitive technique for replacing a worry with a positive statement
b) A systematic way to replace a panic response with a relaxation response
c) Teaching the client to ignore or become immune to anxiety-producing situations
d) Exposing the client to an anxiety-producing stimulus for 1 to 2 hours (flooding)

b) A systematic way to replace a panic response with a relaxation response
Severe levels of anxiety result in what?

a) Impaired ability to concentrate
b) Mild forgetfulness
c) Distorted sensory awareness
d) A heightened sense of awareness

c) Distorted sensory awareness
A client diagnosed with anxiety disorder has been prescribed benzodiazepine drugs. The nurse is explaining the possible side effects of the medications. Which side effects of the drug explained by the nurse is correct? Select all that apply.

a) Blurred vision
b) Constipation
c) Vomiting
d) Agitation
e) Dry mouth

a) Blurred vision
b) Constipation
e) Dry mouth
The nurse is assessing a client who recently experienced her first panic attack while at the grocery store. To identify complications of the disorder, the nurse should ask:

a) “Are you concerned there will be more panic attacks?”
b) “Can you describe how you felt physically during the attack?”
c) “Do you have any problems going out alone to public places?”
d) “What do you think is the origin of the panic you felt?”

c) “Do you have any problems going out alone to public places?”
The nurse recognizes that the client most likely experiencing generalized anxiety disorder (GAD) is a …

a) 70-year-old whose spouse died 1 year ago who has “no desire to leave my house” and reports severe fatigue
b) 22-year-old soldier who served in the Middle East who “cannot sleep” and is facing criminal charges for hurting someone in a barroom brawl.
c) 40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months
d) 30-year-old business executive who reports being anxious about attending the meetings and social events that are his job responsibilities

c) 40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months
Generalized anxiety disorder (GAD) is characterized by what?

a) Excessive worry or anxiety lasting more than 6 months
b) Fear of going outdoors
c) Behavioral changes in response to panic attacks
d) Flashbacks and feelings of unreality

a) Excessive worry or anxiety lasting more than 6 months
The nurse is conducting an admission assessment of a client who has a history of generalized anxiety disorder. After gauging the client’s level of anxiety, what other assessment should the nurse prioritize?

a) Determining whether there is potential for the client to harm himself or herself or others
b) Obtaining a set of vital signs including apical heart rate and oxygen saturation
c) Assessing the client’s insight into his or her condition and gauging orientation and judgment
d) Determining the client’s understanding of factors that contribute to his or her anxiety

a) Determining whether there is potential for the client to harm himself or herself or others
Which of the following is a cardiovascular response of the sympathetic nervous system?

a) Hypotension
b) Bradycardia
c) Bradypnea
d) Tachycardia

d) Tachycardia
Nearly which percentage of adults is affected by anxiety disorders?

a) 25%
b) 55%
c) 40%
d) 10%

a) 25%
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) “Why do you think you’ll be fired?”
b) “Your worries are a feature of your anxiety disorder. Tell yourself that you have nothing to worry about.”
c) “It sounds to me like you’re doing a good job.”
d) “Has something changed at work that is causing you to worry?”

d) “Has something changed at work that is causing you to worry?”
In speaking with a client with moderate anxiety, the client goes off on unrelated tangents. To help the client’s attention from wandering, which is an effective intervention?

a) The nurse should speak in short and simple sentence.
b) The nurse should take the client to a non-stimulating environment.
c) The nurse should remain with the client until the anxiety is reduced.
d) The nurse should speak in a soft and calm voice.

a) The nurse should speak in short and simple sentence.
Which medication classification has been found to be effective in reducing or eliminating panic attacks?

a) Antipsychotics
b) Antidepressants
c) Anticholinergics
d) Antimanics

b) Antidepressants
The nurse is providing care for a psychiatric-mental health client who has a diagnosis of anxiety. Which of the nurse’s following statements is likely the most therapeutic intervention?

a) “Anxiety is a feeling that is experienced by everyone at some point and it can never be completely removed from one’s life.”
b) “Every time you feel anxious, try to focus on how much easier your life would be if you didn’t experience anxiety so often.”
c) “With the development of more life skills and a demonstration of continued success in life, your anxiety will shrink and eventually disappear.”
d) “If you address the causes of your anxiety head-on, you will find that you can recover from it without medications or therapy.”

a) “Anxiety is a feeling that is experienced by everyone at some point and it can never be completely removed from one’s life.”
Research has provided solid evidence that anxiety disorders have

a) Originated from disappointments resulting from an exaggerated sense of self-worth
b) A basis in genetics with clinical symptoms being a result of chromosomal influence
c) Their roots in episodes of physical or psychological abuse that occurred at times of developmental growth
d) Caused by substance abuse, particularly narcotics, resulting in damage to the brain’s receptors

b) A basis in genetics with clinical symptoms being a result of chromosomal influence
All of the following pharmacological agents are useful in treating anxiety disorders except which ones?

a) SSRIs
b) Tricyclic antidepressants
c) Benzodiazepines
d) Calcium channel blockers

d) Calcium channel blockers
The nurse is teaching shoulder exercises to a client recovering from a mastectomy. The nurse might view the client’s mild anxiety during the session positively, because mild anxiety helps:
Select all that apply

a) calm restlessness.
b) engage in goal-directed activity.
c) to feel and think.
d) motivate to make a change.
e) to focus attention to learn.

b) engage in goal-directed activity.
c) to feel and think.
d) motivate to make a change.
e) to focus attention to learn.
A client is prescribed a serotonin-norepinephrine reuptake inhibitor. The nurse would identify that which of the following is most commonly prescribed?

a) Paroxetine
b) Venlafaxine
c) Duloxetine
d) Fluoxetine

b) Venlafaxine
Which medication classification has been used to treat social phobia?

a) Monoamine oxidase inhibitors (MAOIs)
b) Nonbenzodiazepines
c) Selective serotonin reuptake inhibitors (SSRIs)
d) Tricyclic antidepressants (TCAs)

c) Selective serotonin reuptake inhibitors (SSRIs)
The client diagnosed with social phobia that is culturally induced is the

a) 40-year-old unemployed factory worker who is enrolled in college classes
b) 25-year-old farmer who recently moved to the city
c) 30-year-old Japanese immigrant
d) 19-year-old Hispanic who speaks very little English

c) 30-year-old Japanese immigrant
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 which of the following?

a) Panic disorder
b) Agoraphobia
c) Social phobia
d) Obsessive-compulsive disorder

c) Social phobia
Which level of anxiety helps the client focus attention to learn, problem solve, think, act, feel, and protect himself or herself?

a) Mild
b) Severe
c) Moderate
d) Panic

a) Mild
When assessing an elderly Hispanic client who has newly been diagnosed with anxiety, the mental health nurse’s priority is to …

a) Assess for physical conditions that may affect anxiety
b) Determine the client’s risk for self-harm or harm to others
c) Determining the effects that culture has had on the client’s anxiety issues
d) Obtain a thorough history, focusing on the client’s physiologic functioning

b) Determine the client’s risk for self-harm or harm to others
The mental health nurse is gathering a health history on a new client. The client is constantly pacing the floor and stating that he is about to die. The nurse would classify this level of anxiety as which of the following?

a) Euphoria
b) Severe
c) Mild
d) Moderate

d) Moderate
When assessing a client with anxiety, the nurse should recognize that anxiety may often be a result of what?

a) Fluid and electrolyte imbalance
b) medications

b) medications
Cheryl was physically assaulted 1 week ago. She has been having trouble remembering the event and feels as if she is walking around in a dreamlike state. From what condition is Cheryl suffering?

a) Dissociative stress disorder
b) Posttraumatic stress disorder
c) Acute stress disorder
d) Amnesic stress disorder

c) Acute stress disorder
After reviewing various etiologic theories associated with panic disorder, the nurse demonstrates understanding of the psychodynamic theory, identifying which of the following as the underlying cause?

a) Separation
b) Conditioning
c) Activation of stress hormone
d) Decreased control over environment

a) Separation
The nurse is assessing a client with anxiety. Which behavior might indicate that the client has moderate anxiety?

a) The client is unable to communicate verbally.
b) The client is focused in an activity.
c) The client is nervous and agitated.
d) The client has impaired cognitive skills.

c) The client is nervous and agitated.
All except which of the following are considered clinical symptoms of anxiety?

a) Palpitations
b) Extreme restlessness
c) Tearfulness and sadness
d) Motor excitement

c) Tearfulness and sadness
Which of the following is a parasympathetic effect of anxiety?

a) Constipation
b) Hyperactive bowel sounds
c) Muscle tension
d) Decreased urine output

b) Hyperactive bowel sounds
When explaining the difference between anxiety and fear, the mental health nurse shares that (Select all that apply.)

a) Anxiety involves experiencing subjective, uncomfortable feelings resulting from unknown causes
b) Depression is a risk factor for developing anxiety
c) Fear results in objective, physical responses caused by real danger
d) Anxiety is likely to result from an attempt to overcome stress
e) Obsessive-compulsive behavior is often the result of abandonment

a) Anxiety involves experiencing subjective, uncomfortable feelings resulting from unknown causes
c) Fear results in objective, physical responses caused by real danger
d) Anxiety is likely to result from an attempt to overcome stress
The nurse has read in a client’s admission record that the client has been taking propranolol (Inderal) for psychiatric, rather than medical, reasons. The nurse should recognize that the client likely has a history of what?

a) Obsessive-compulsive disorder (OCD)
b) Panic disorder
c) Nightmares
d) Acute stress disorder

b) Panic disorder
A 25-year-old woman tells the nurse that 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 a sense of psychological distress.”
b) “Anxiety is a physiologic response to stress.”
c) “Anxiety is an abnormal response to everyday stress.”
d) “Anxiety is a normal response to everyday stress.”

a) “Anxiety is a sense of psychological distress.”
The nurse documents that a client diagnosed with an anxiety disorder is experiencing moderate anxiety when …

a) Heard telling another client that, “There is nothing they can do for me; I just know it’s really bad.”
b) Observed pacing and repeatedly asking staff what time the “doctor will be here.”
c) Reporting, “I just can’t relax; I’ve got thing to do.”
d) Has difficulty actually verbalizing his anxious feelings

b) Observed pacing and repeatedly asking staff what time the “doctor will be here.”
The nurse is assessing a client with anxiety. What symptom indicates that the the client has adopted a maladaptive behavior in response to stress?

a) Headache
b) Tachycardia
c) Pedal edema
d) Dyspnea

a) Headache
The nurse documents that the client is in an anxiety state when she is observed …

a) Wringing her hands and asking staff when they think she will have another heart attack
b) Crying hysterically and complaining of a shortness of breath when told that she has been scheduled for a heart catheterization
c) The client refuses to have her blood pressure taken in her left arm because she is sure something bad will happen
d) Reporting that she “can’t sleep a wink” if she is not in her own bed

b) Crying hysterically and complaining of a shortness of breath when told that she has been scheduled for a heart catheterization
The nurse is assessing a client suffering from stress and anxiety. The most common physiologic response to stress and anxiety is

a) Vertigo
b) Skin rash
c) Diarrhea
d) Sedation

c) Diarrhea

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